From the Guidelines
Atropine should be administered at a dose of 0.02 mg/kg IV/IO for controlling secretions, with a minimum dose of 0.1 mg and a maximum single dose of 0.5 mg, as recommended by the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
Key Considerations
- The dose of atropine for controlling secretions is weight-based for children, with a recommended dose of 0.02 mg/kg IV/IO 1.
- The minimum dose of atropine is 0.1 mg, and the maximum single dose is 0.5 mg 1.
- Atropine works by blocking muscarinic acetylcholine receptors, which reduces secretion production from salivary, bronchial, and gastrointestinal glands.
- Common side effects of atropine include dry mouth, blurred vision, urinary retention, and confusion, particularly in elderly patients.
- Atropine should be used with caution in patients with glaucoma, prostatic hypertrophy, or certain cardiac conditions.
Alternative Options
- Alternative anticholinergic medications like glycopyrrolate (0.1-0.2 mg IV/SC every 4 hours) may be preferred in some cases as they have fewer central nervous system effects.
- Scopolamine and glycopyrrolate are also options for reducing excessive secretions, particularly in palliative care settings 1.
Clinical Context
- The use of atropine for controlling secretions is particularly relevant in end-of-life care or palliative settings, where excessive secretions can cause significant distress for patients and their families.
- The dose and administration of atropine should be individualized based on the patient's specific needs and medical condition.
From the Research
Atropine Dose for Controlling Secretions
- The dose of atropine for controlling secretions is not explicitly stated in most of the studies, but one study suggests that sublingual atropine 1% ophthalmic drops can be used for the management of terminal respiratory secretions 2.
- Another study evaluated the pharmacokinetics and effects of sublingual and oral atropine on saliva flow, and found that a dose of 0.6 mg and 1.2 mg atropine sulfate sublingual solution was effective in reducing saliva secretion 3.
- The study also found that the area under the atropine plasma concentration-time curve (AUC0-∞) was highest after the 1.2 mg sublingual solution administration, and that the saliva secretion reduction was largest after the 1.2 mg sublingual solution administration [-79% (-93,-64)] 3.
- A study on the reversal of neuromuscular blockade found that atropine doses of 10,20, or 30 microgram/kg were used, but the study did not specifically address the use of atropine for controlling secretions 4.
- Another study discussed the pharmacokinetic implications for the clinical use of atropine, but did not provide specific dosage information for controlling secretions 5.
- A study on anticholinergic medications for managing noisy respirations in adult hospice patients mentioned atropine as one of the medications used, but did not provide specific dosage information 6.