What is epinephrine (Epi) 1:1,000,000?

Epinephrine 1:1,000 Concentration

Epinephrine 1:1,000 is a highly diluted concentration of epinephrine (1 mg in 1,000 mL or 0.000001 mg/mL) that is not a standard concentration used in clinical practice. The standard concentrations of epinephrine used in clinical settings are 1:1,000 (1 mg/mL) and 1:10,000 (0.1 mg/mL) 1, 2.

Standard Epinephrine Concentrations

Available Concentrations:

• 1:1,000 = 1 mg/mL (1 mg in 1 mL)
• 1:10,000 = 0.1 mg/mL (1 mg in 10 mL)

Concentration Selection Based on Route:

• Intramuscular/Subcutaneous: 1:1,000 concentration
• Intravenous/Intraosseous: 1:10,000 concentration

Clinical Applications and Dosing

Anaphylaxis Management:

• Intramuscular route (preferred): 0.01 mg/kg of 1:1,000 solution (maximum: 0.3-0.5 mg) 1, 2
• Can be repeated every 5-20 minutes as needed
• Auto-injector options: 0.3 mg for adults/children ≥30 kg, 0.15 mg for children 15-30 kg 2

Cardiopulmonary Resuscitation:

• Newborns: 0.01-0.03 mg/kg of 1:10,000 solution 1
• Older infants/children: 0.01 mg/kg of 1:10,000 solution (maximum: 1 mg), repeated every 3-5 minutes 1

Shock Management:

• IV infusion: 0.1-1.0 μg/kg per minute, titrated to clinical effect 1
• Higher doses up to 5 μg/kg per minute may be necessary in severe cases

Common Errors and Safety Considerations

Potential Errors:

• Concentration confusion: Mistaking 1:1,000 for 1:10,000 can lead to 10-fold dosing errors 3
• Route confusion: Using IV doses for IM administration or vice versa can cause serious adverse effects

Safety Measures:

• Verify correct concentration for intended route
• Use prefilled, appropriately labeled syringes when available
• Implement clear labeling to distinguish between concentrations 3
• Administer IV doses slowly when indicated

Important Cautions

• Epinephrine 1:1,000 is not a standard concentration and would be too dilute for clinical use
• Confusion about epinephrine concentrations has led to iatrogenic overdoses and potentially fatal complications 3
• While there are no absolute contraindications to epinephrine in anaphylaxis, cardiac monitoring is essential when administering IV epinephrine 2
• Delayed administration of epinephrine in anaphylaxis is associated with increased morbidity and mortality 2

Conversion Guide

To convert mg/kg dosage to mL/kg:

• 0.01 mg/kg = 0.1 mL/kg of 1:10,000 solution
• 0.1 mg/kg = 0.1 mL/kg of 1:1,000 solution 1

Understanding standard epinephrine concentrations and their appropriate applications is critical for safe administration in emergency situations.