Adrenaline 1mg/ml IS Already 1:1000 Concentration
Adrenaline 1mg/ml and 1:1000 are the exact same concentration—no preparation or dilution is needed. 1, 2
Understanding the Concentration Terminology
- 1:1000 means 1 gram in 1000 mL, which equals 1 mg per 1 mL (1mg/ml) 1
- This is the standard concentration supplied commercially for intramuscular and subcutaneous administration 2
- The FDA-approved formulation is supplied as "EPINEPHRINE INJECTION, USP 1mg/mL 1:1000" in vials 2
Critical Safety Considerations
The most important clinical issue is avoiding confusion between the two available concentrations:
- 1:1000 (1 mg/mL) - used for IM/SC routes in anaphylaxis, severe asthma, and croup 1
- 1:10,000 (0.1 mg/mL) - used for IV/IO routes in cardiac arrest 1, 3
Common Fatal Error to Avoid
- Do not confuse 1:1000 (IM) with 1:10,000 (IV) concentrations, as this is a common and potentially fatal error 3
- Always verify the concentration on the vial label before administration 1
- Using 1:1000 intravenously (when 1:10,000 is intended) delivers 10 times the intended dose and can cause fatal arrhythmias 3
Storage and Handling
- Store between 20-25°C (68-77°F) at manufacturer-recommended temperatures 4, 2
- Protect from light and freezing 2
- Inspect visually before use—do not use if colored, cloudy, or contains particulate matter 2
- Do not rely on visual inspection alone to determine potency after heat exposure, as degradation may occur without visible changes 4
- Multi-dose vials must be discarded 30 days after initial use 2
Clinical Applications of 1:1000 Concentration
Anaphylaxis (IM route preferred):
- Adults/children >12 years: 0.5 mL (500 mcg) IM into anterolateral thigh 1, 3
- Children 6-12 years: 0.3 mL (300 mcg) IM 1
- Children <6 years: 0.15 mL (150 mcg) IM 1
- Repeat every 5-20 minutes as needed 1, 3
Severe asthma exacerbation (SC route):
- 0.01 mg/kg (0.01 mL/kg) of 1:1000 solution, maximum 0.3-0.5 mg 1
Croup/laryngotracheobronchitis (nebulized):
- 0.5 mL/kg of 1:1000 solution (maximum 5 mL) by nebulizer 1