Epinephrine (Adrenaline) Infusion Dosage Guidelines
For patients requiring epinephrine infusion, prepare by adding 1 mg (1 mL) of 1:1000 epinephrine to 250 mL of D5W to yield a concentration of 4.0 μg/mL, and infuse at 1-4 μg/min (15-60 drops/min), increasing to a maximum of 10 μg/min as needed based on clinical response.
Preparation Options
Standard Preparation (4.0 μg/mL solution):
- Add 1 mg (1 mL) of 1:1000 epinephrine to 250 mL of D5W
- Infuse at 1-4 μg/min (15-60 drops/min with a microdrop apparatus)
- May increase to maximum of 10 μg/min based on clinical response 1
Alternative Preparation (10 μg/mL solution):
- Add 1 mg (1 mL) of 1:1000 epinephrine to 100 mL of saline (1:100,000 solution)
- Initial rate: 30-100 mL/hr (5-15 μg/min)
- Titrate based on clinical response and side effects 1, 2
Dosing by Patient Population
Adults:
- Initial rate: 1-4 μg/min
- Titrate up to maximum of 10 μg/min 1
- For severe shock: 0.1-1.0 μg/kg/min, may require up to 5 μg/kg/min in refractory cases 1
Pediatric Patients:
- Initial dose: 0.1 μg/kg/min
- Calculate using "rule of 6": 0.6 × body weight (kg) = mg of epinephrine diluted to 100 mL; then 1 mL/hr delivers 0.1 μg/kg/min 1
- Titrate based on clinical response
Clinical Indications
Primary Indications:
- Anaphylaxis not responding to IM epinephrine and volume resuscitation 1, 2
- Profound hypotension despite fluid resuscitation 1
- Continued shock after volume resuscitation 1
Special Considerations:
- Monitoring: Continuous hemodynamic monitoring is essential when administering IV epinephrine 1, 2
- Cardiac Monitoring: ECG monitoring should be performed throughout administration 1
- Blood Pressure: Monitor blood pressure every minute during initial titration 1
Important Precautions
Risk of Arrhythmias: IV epinephrine carries risk of potentially lethal arrhythmias 1
Restricted Use: Should only be administered intravenously during:
Extravasation Management: If extravasation occurs, inject phentolamine (0.1-0.2 mg/kg up to 10 mg diluted in 10 mL normal saline) intradermally at the site 1
Contraindications: While there are no absolute contraindications to epinephrine in anaphylaxis, caution is needed in patients with cardiovascular disease 2
Alternative Routes for Epinephrine Administration
When IV access is unavailable, consider:
IM Injection: Preferred route for initial anaphylaxis management
Endotracheal Administration: Less effective than IV/IM routes
Remember that epinephrine is the cornerstone of anaphylaxis management, and prompt administration via the appropriate route can be life-saving. Delays in administration may be fatal, and IV infusion should be reserved for cases not responding to standard IM epinephrine and fluid resuscitation.