What is the typical dose of fluorescein (intravenous fluorescein) for diagnostic purposes?

Fluorescein Dye Dose for Diagnostic Purposes

The standard intravenous dose of fluorescein for diagnostic angiography is 500 mg (5 mL of 10% solution or 2 mL of 25% solution) for adults, administered as a rapid bolus injection. 1

Adult Dosing

• Administer 500 mg of fluorescein sodium intravenously as the standard adult dose, which can be given as either 5 mL of 10% solution or 2 mL of 25% solution 1
• The 25% concentration (2 mL volume) demonstrates superior image quality compared to the 10% concentration in both subjective visualization and objective angiogram assessment 2
• Do not use reduced doses (2 mL of 10% solution = 200 mg), as this produces statistically significant inferior image quality and increased difficulty with photography, making the procedure less diagnostically useful 3

Pediatric Dosing

• Calculate pediatric doses at 7.7 mg/kg body weight (or 35 mg per 10 pounds of body weight) 1
• For infants with retinopathy of prematurity, administer 0.1 mL/kg of 10% fluorescein solution as an intravenous bolus, followed by isotonic saline flush 4

Administration Technique

• Inject as a rapid bolus into an antecubital vein or other suitable peripheral vein, followed immediately by a saline flush 1, 4
• Never mix or dilute fluorescein with other solutions or drugs prior to administration 1
• Use a three-way valve system for administration and flushing with physiological saline 5

Critical Safety Considerations

• Screen for fluorescein hypersensitivity before administration, as this is an absolute contraindication 1
• Be prepared for respiratory reactions and potential severe local tissue damage from extravasation 1
• Have first-line emergency drugs and equipment immediately available during the procedure 5
• The most common adverse reactions include skin discoloration, urine discoloration, nausea, vomiting, and gastrointestinal distress 1
• Both 10% and 25% concentrations show no significant difference in incidence or severity of adverse reactions 2

Common Pitfalls to Avoid

• Avoid using insufficient doses (less than 500 mg in adults), as this compromises diagnostic image quality and makes lesion detection more difficult 3
• Do not attempt to reduce the dose to minimize side effects, as the reduction in adverse events does not justify the significant loss of diagnostic quality 3
• Ensure proper intravenous access and monitor for extravasation, which can cause severe local tissue damage 1