From the FDA Drug Label
2.2 Hypotension associated with Septic Shock Dilute 10 mL (1 mg) of epinephrine from the syringe in 1,000 mL of 5 percent dextrose solution or 5 percent dextrose and sodium chloride solution to produce a 1 mcg per mL dilution. To mix 1 mg of epinephrine for a drip, you need to dilute 10 mL of epinephrine in 1,000 mL of solution, which is a 1:100 dilution ratio.
- The resulting solution will have a concentration of 1 mcg/mL.
- This is based on the instructions for hypotension associated with septic shock 1.
From the Research
To prepare a 1 mg epinephrine drip, you need to dilute it in 250 mL of solution. This is the standard dilution for an epinephrine infusion in most clinical settings, as seen in various studies 2, 3, 4, 5, 6. The resulting concentration will be 4 mcg/mL (1 mg divided by 250 mL), which allows for precise titration of the medication.
Key Considerations
- Typically, this solution is prepared using either normal saline (0.9% sodium chloride) or 5% dextrose in water (D5W) as the diluent.
- When administering an epinephrine drip, it's essential to use an infusion pump for accurate delivery and to monitor the patient closely for cardiovascular effects such as tachycardia, hypertension, or arrhythmias.
- The standard starting dose is usually 1-4 mcg/minute (0.25-1 mL/hour), which can be titrated based on the patient's hemodynamic response.
- Epinephrine is a potent vasoactive medication used primarily for treating hypotension, anaphylaxis, and cardiac arrest situations when given as a continuous infusion, as supported by recent studies like 6.
Clinical Context
In a code blue situation, the priority is to restore adequate circulation and oxygenation. The use of epinephrine is critical in such scenarios, and its preparation should be done swiftly and accurately. The recommended dilution of 1 mg in 250 mL of solution provides a concentration that can be easily titrated to achieve the desired effect, minimizing the risk of adverse reactions.
Monitoring and Titration
Close monitoring of the patient's vital signs and hemodynamic parameters is crucial when administering an epinephrine drip. This allows for timely adjustments to the infusion rate, ensuring that the patient receives the optimal dose to achieve the desired clinical effect while minimizing potential side effects. Studies such as 2 highlight the importance of careful patient monitoring following epinephrine administration.