What is the difference between epinephrine (Epi) 1:1000 and epinephrine (Epi) 1:10000?

Difference Between Epinephrine 1:1000 and Epinephrine 1:10000

The main difference between epinephrine 1:1000 and 1:10000 is the concentration: epinephrine 1:1000 contains 1 mg/mL (10 times more concentrated), while epinephrine 1:10000 contains 0.1 mg/mL (10 times more dilute). 1

Concentration Comparison

• Epinephrine 1:1000 = 1 mg/mL (more concentrated) 1
• Epinephrine 1:10000 = 0.1 mg/mL (more dilute) 1

Route-Specific Applications

Epinephrine 1:1000 (1 mg/mL) is typically used for:

• Intramuscular (IM) injection for anaphylaxis (0.01 mg/kg, maximum 0.3-0.5 mg) 1
• Subcutaneous (SC) injection for severe asthma (0.01 mg/kg, maximum 0.3-0.5 mg) 1
• Nebulized treatment for croup/laryngotracheobronchitis (0.5 mL/kg, maximum 5 mL) 1

Epinephrine 1:10000 (0.1 mg/mL) is typically used for:

• Intravenous (IV) administration during cardiac arrest or severe shock 1
• Intraosseous (IO) administration when IV access isn't available 1
• Endotracheal administration in newborns and infants during resuscitation 1

Dosing Conversion

To convert mg/kg dosage to mL/kg: 1

• 0.01 mg/kg = 0.1 mL/kg of 1:10000 solution
• 0.1 mg/kg = 0.1 mL/kg of 1:1000 solution

Clinical Applications by Age Group

Cardiopulmonary Resuscitation:

• Newborn infants: 0.01-0.03 mg/kg of 1:10000 solution 1
• Older infants/children (IV/IO): 0.01 mg/kg of 1:10000 solution (maximum 1 mg), repeated every 3-5 minutes 1
• Older infants/children (endotracheal): 0.1 mg/kg of 1:1000 solution (maximum 10 mg) 1

Anaphylaxis:

• IM/SC: 0.01 mg/kg of 1:1000 solution (maximum 0.3-0.5 mg), repeated every 5-20 minutes 1
• The IM route in the anterolateral thigh is preferred for anaphylaxis 1

Safety Considerations

• Critical safety issue: Using the wrong concentration can lead to potentially fatal overdose 1
• Severe adverse effects are more likely when epinephrine is given in overdose by any route, particularly when 1:1000 solution is incorrectly administered intravenously instead of the appropriate 1:10000 solution 1
• Intravenous epinephrine should only be administered during cardiac arrest or to profoundly hypotensive patients who have failed to respond to volume replacement and several injected doses of epinephrine 1

Pharmacokinetics

• IM administration in the thigh provides more rapid increase in plasma and tissue concentrations of epinephrine compared to subcutaneous injection 1
• Endotracheal administration is less reliable than IV or IO routes, with inconsistent absorption 2, 3
• For endotracheal administration, peripheral bronchial dosing may provide better absorption than central endotracheal dosing 3

Common Pitfalls

• Confusing the two concentrations, especially during emergencies 1
• Using 1:1000 concentration for IV administration (should use 1:10000) 1
• Inadequate dilution when preparing infusions 1
• Delayed administration in anaphylaxis (epinephrine should be given early) 1

Always verify the correct concentration for the intended route of administration and patient condition before administering epinephrine to prevent potentially serious medication errors.