How to prepare a 1:10,000 epinephrine (adrenaline) solution?

From the Guidelines

To prepare a 1 in 10,000 epinephrine solution, start with a 1:1,000 epinephrine ampule (1 mg/mL) and dilute it by adding 1 mL of this solution to 9 mL of normal saline (0.9% sodium chloride), as recommended by the most recent guidelines 1. This creates a 1:10,000 solution (0.1 mg/mL), which is commonly used in certain emergency situations requiring lower epinephrine concentrations, such as local infiltration or specific pediatric applications. The importance of accurate dilution and administration of epinephrine is highlighted in various clinical scenarios, including anaphylaxis and cardiopulmonary resuscitation, where the correct concentration and dosage are crucial for effective treatment and minimizing adverse effects 1. Key considerations in preparing and administering epinephrine solutions include:

• Using sterile technique to prevent contamination
• Clearly labeling the final solution with the concentration and preparation time
• Verifying the concentration needed for the specific clinical scenario, as different procedures require different epinephrine concentrations
• Being aware of the potential for systemic effects, especially at higher concentrations, and monitoring patients closely for signs of adverse reactions. The most recent guidelines emphasize the importance of early administration of epinephrine in anaphylaxis and provide recommendations for the dose and route of administration, including the use of intramuscular injection or autoinjector, and the potential for intravenous administration in certain situations 1.

From the FDA Drug Label

2.2 Hypotension associated with Septic Shock Dilute 10 mL (1 mg) of epinephrine from the syringe in 1,000 mL of 5 percent dextrose solution or 5 percent dextrose and sodium chloride solution to produce a 1 mcg per mL dilution. To prepare 1 in 10000 epinephrine, you need to dilute 1 mg of epinephrine in 10,000 mL of a suitable solution, such as 5 percent dextrose solution or 5 percent dextrose and sodium chloride solution.

• The resulting concentration will be 1 mcg per mL (or 1:10,000). 2

From the Research

Preparing 1 in 10000 Epinephrine

To prepare 1 in 10000 epinephrine, the following steps can be considered:

• The concentration of epinephrine is typically expressed as a ratio of epinephrine to solution (e.g., 1 mg of epinephrine per 10 mL of solution) 3, 4.
• However, the provided studies do not directly address the preparation of 1 in 10000 epinephrine.
• Epinephrine is often administered intravenously (IV) or intraosseously (IO) in cardiac arrest situations, with a standard dose of 1 mg in adults 3, 4, 5.
• The preparation of epinephrine solutions may involve diluting a concentrated epinephrine solution with a saline or other solution to achieve the desired concentration.

Administration and Dosage

Key points to consider when administering epinephrine include:

• The standard dose of epinephrine in adults is 1 mg, which can be administered IV or IO 3, 4, 5.
• The timing of epinephrine administration is crucial, with earlier administration associated with improved outcomes in cardiac arrest patients 6, 7.
• The route of administration may also impact outcomes, with IO access potentially offering faster and more reliable access in certain situations 5.

Relevant Studies

The provided studies focus on the use of epinephrine in cardiac arrest situations, including:

• The efficacy and timing of epinephrine administration 4, 6, 7.
• The comparison of IV and IO routes for epinephrine administration 5.
• The standardization of epinephrine dosing and administration in cardiac arrest guidelines 3, 4.