What is the recommended concentration for epinephrine (adrenaline) infusion?

Recommended Epinephrine Infusion Concentrations

For epinephrine infusions, the recommended concentration is 1 mg in 250 mL of D5W (4 mcg/mL) for adults, or alternatively, 1 mg in 100 mL of saline (10 mcg/mL) for situations requiring higher concentrations. 1, 2

Standard Concentrations for Different Clinical Scenarios

For Hypotension in Septic Shock

• FDA-approved concentration: 1 mg (10 mL) of epinephrine diluted in 1,000 mL of 5% dextrose solution to produce a 1 mcg/mL concentration 2
• Dosing range: 0.05 mcg/kg/min to 2 mcg/kg/min, titrated to achieve desired mean arterial pressure
• Administer into a large vein to avoid extravasation
• The diluted solution can be stored for up to 4 hours at room temperature or 24 hours under refrigeration 2

For Anaphylaxis (IV Infusion)

• Concentration option 1: 1 mg (1 mL) of 1:1000 epinephrine in 250 mL of D5W to yield 4 mcg/mL
  • Infuse at 1-4 mcg/min (15-60 drops/min with microdrop), up to maximum 10 mcg/min
• Concentration option 2: 1 mg (1 mL) in 100 mL of saline (1:100,000 solution = 10 mcg/mL)
  • Initial rate of 30-100 mL/hr (5-15 mcg/min), titrated based on clinical response 1

For Continued Shock After Volume Resuscitation in Pediatrics

• Infusion concentration for pediatrics: 0.1-1.0 mcg/kg/min
• Start at lowest dose and titrate to desired clinical effect
• Doses as high as 5 mcg/kg/min may sometimes be necessary 1

Important Administration Considerations

Administration Route

• Infuse epinephrine into a large vein whenever possible 2
• Avoid using a catheter tie-in technique, as obstruction to blood flow may cause stasis and increased local drug concentration 2
• Avoid veins of the leg in elderly patients or those with occlusive vascular diseases 2

Monitoring During Administration

• Continuous monitoring of vital signs, including blood pressure, heart rate, and oxygen saturation is essential 3
• Monitor for acute severe hypertension and potentially serious cardiac arrhythmias, particularly in patients with underlying heart disease 2
• Watch for signs of extravasation, which can cause severe local tissue necrosis 1, 2

Extravasation Management

• If extravasation occurs, phentolamine (0.1-0.2 mg/kg up to 10 mg diluted in 10 mL of 0.9% sodium chloride) injected intradermally at the extravasation site may help counteract dermal vasoconstriction 1

Cautions and Special Populations

• Use epinephrine with caution in elderly patients and those with underlying cardiac disease, hyperthyroidism, Parkinson's disease, diabetes, and pheochromocytoma 3
• Higher concentrations may be needed when fluid restriction is necessary
• Lower concentrations are preferred for peripheral administration to minimize risk of tissue damage from extravasation

Remember that epinephrine is a potent medication with dose-dependent effects. The concentration should be appropriate for the clinical situation, administration route, and patient characteristics, with careful monitoring throughout administration.