How do I prepare 1:10,000 and 1:1000 concentrations of adrenaline (epinephrine) from a 1 milligram in 1 milliliter ampule?

Preparing Adrenaline Dilutions from 1mg/1mL Ampules

To prepare 1:1000 concentration, use the ampule as-is without dilution (1mg in 1mL = 1:1000), and to prepare 1:10,000 concentration, dilute 1mL of the 1mg/1mL ampule with 9mL of normal saline to create a total volume of 10mL.

Understanding the Concentrations

Your starting ampule contains:

• 1 milligram (1mg) of adrenaline in 1 milliliter (1mL)
• This is already a 1:1000 concentration 1

Key Concentration Definitions:

• 1:1000 = 1mg per 1mL = 1000 micrograms per mL 1
• 1:10,000 = 1mg per 10mL = 100 micrograms per mL 1

Preparation Instructions

For 1:1000 Concentration (Intramuscular Use)

• No dilution needed - your ampule is already 1:1000 1
• Draw up the required dose directly from the ampule
• Adult dose for anaphylaxis: 0.5mL (500 micrograms) intramuscularly 1
• Pediatric doses vary by age: 0.15mL for children up to 6 years, 0.3mL for 6-12 years 1

For 1:10,000 Concentration (Intravenous Use)

Step-by-step dilution:

1. Take 1mL from your 1mg/1mL ampule (contains 1mg adrenaline)
2. Add this to 9mL of normal saline (0.9% NaCl)
3. Total volume = 10mL containing 1mg adrenaline
4. Final concentration = 1mg/10mL = 1:10,000 1

Alternative method for smaller volumes:

• Take 0.1mL from the 1mg/1mL ampule (contains 0.1mg = 100 micrograms)
• Add to 0.9mL normal saline
• Total = 1mL at 1:10,000 concentration 1

Clinical Usage Guidelines

Intramuscular Administration (1:1000)

• Primary route for anaphylaxis in most settings 1
• Inject into lateral thigh muscle 2
• Adult dose: 0.5mL (500 micrograms) 1
• Can repeat every 5-15 minutes if needed 2

Intravenous Administration (1:10,000)

• Only for use in acute care settings (operating theatres, intensive care) by experienced personnel 1
• Initial adult dose: 0.5mL of 1:10,000 solution (50 micrograms) 1
• Titrate carefully based on response 1
• Multiple doses may be required for severe hypotension or bronchospasm 1

Critical Safety Warnings

Dosing Errors Prevention

• The most common fatal error is giving 1:1000 concentration intravenously instead of 1:10,000 1
• This represents a 10-fold overdose and can cause severe hypertension, arrhythmias, and cardiac arrest
• Always verify concentration before IV administration 1
• Label all syringes clearly with concentration and route 1

Preparation Precautions

• Use aseptic technique when drawing up and diluting 1
• Check decimal points carefully - errors in dilution calculations are common 1
• Prepare fresh dilutions when possible; do not store diluted solutions long-term 1
• Consider using prefilled syringes when available, as they reduce preparation time by 12-16 seconds and minimize dosing errors 3

Route-Specific Cautions

• Never give 1:1000 concentration intravenously - this is a potentially fatal error 1
• Intramuscular route is safer and preferred for most emergency situations outside of monitored settings 1, 2
• IV administration requires continuous cardiac monitoring and should only be performed by experienced clinicians 1