How to Prepare 1:1000 Epinephrine from a 1mg/mL Ampule
A 1mg/mL epinephrine ampule is already a 1:1000 concentration and requires no dilution. 1, 2
Understanding the Concentration
- 1:1000 epinephrine means 1 gram per 1000 mL, which equals 1 mg per 1 mL 1
- Your ampule labeled as "1 mg/mL" is mathematically identical to a 1:1000 solution 2
- No preparation or dilution is needed—the ampule is ready to use as-is 1, 2
Clinical Applications of 1:1000 Epinephrine
The 1:1000 concentration (1 mg/mL) is used for:
- Anaphylaxis (IM/SC): 0.3-0.5 mg (0.3-0.5 mL) for adults, or 0.01 mg/kg (0.01 mL/kg) for children, administered intramuscularly in the anterolateral thigh 1, 2, 3
- Severe asthma exacerbation (SC): 0.01 mg/kg (maximum 0.3-0.5 mg) subcutaneously, repeated every 20 minutes up to 3 doses 1
- Croup/laryngotracheobronchitis (nebulized): 0.5 mL/kg (maximum 5 mL) administered by nebulizer 1
- Endotracheal administration during resuscitation: 0.1 mg/kg (0.1 mL/kg) for older infants/children (maximum 10 mg) 1
Common Pitfall to Avoid
- Do not confuse 1:1000 with 1:10,000 concentration 1
- 1:10,000 epinephrine (0.1 mg/mL) is used for IV/IO administration during cardiac arrest, requiring 0.01 mg/kg (0.1 mL/kg) 1
- Using 1:1000 intravenously when 1:10,000 is indicated would deliver 10 times the intended dose 1
If Dilution Is Actually Needed for Other Concentrations
If you need to create 1:10,000 epinephrine from your 1:1000 ampule:
- Take 1 mL of the 1:1000 solution (1 mg) and add 9 mL of normal saline to create 10 mL of 1:10,000 solution (0.1 mg/mL) 1
If you need to create 1:100,000 epinephrine for ophthalmic surgery:
- Dilute 1 mL of 1:1000 epinephrine in 100 mL of ophthalmic irrigation fluid 2
Administration Route Considerations
- For anaphylaxis, always use the intramuscular route in the anterolateral thigh (vastus lateralis muscle), not deltoid, buttock, or subcutaneous tissue 2, 3
- Do not administer repeated injections at the same site, as vasoconstriction may cause tissue necrosis 2
- Never inject into digits, hands, feet, or buttocks 2