Diluting Adrenaline 1mg/ml to 1:10,000 Concentration
To create a 1:10,000 (0.1 mg/mL) solution from 1mg/mL adrenaline, draw up 1 mL of the 1:1000 solution (1 mg) and add 9 mL of normal saline to create 10 mL total volume. 1
Understanding the Concentration
- A 1mg/mL adrenaline ampule is already a 1:1000 concentration (1 gram per 1000 mL = 1 mg per 1 mL) 1
- The 1:10,000 concentration equals 0.1 mg/mL, which is 10 times more dilute than 1:1000 1
- This dilution is commonly called "dirty epinephrine" when prepared at the bedside for emergency IV bolus administration 1
Step-by-Step Preparation Method
Draw 1 mL of 1:1000 epinephrine (containing 1 mg) into a syringe 1
Add 9 mL of normal saline to the same syringe 1
The final volume is 10 mL containing 1 mg of epinephrine, yielding 0.1 mg/mL (1:10,000) 1
Clinical Applications of 1:10,000 Concentration
- Cardiac arrest: Administer 1 mg (10 mL of 1:10,000) IV push every 3-5 minutes during active resuscitation 1
- Anaphylactic shock with IV access: Use 0.05-0.1 mg (0.5-1.0 mL of 1:10,000) IV push every 2-5 minutes for persistent hypotension or bronchospasm 1
- Pediatric cardiac arrest: Give 0.01 mg/kg IV/IO (0.1 mL/kg of 1:10,000), maximum 1 mg per dose 1
Critical Safety Considerations
Never confuse 1:1000 with 1:10,000 concentration—using 1:1000 intravenously when 1:10,000 is indicated delivers 10 times the intended dose 1
- Flush with at least 5 mL normal saline after each IV dose to ensure drug delivery into central circulation 1
- Do not mix epinephrine with sodium bicarbonate or alkaline solutions in the IV line, as epinephrine is inactivated in alkaline environments 1
- If extravasation occurs, immediately infiltrate 5-10 mg phentolamine diluted in 10-15 mL saline at the site to prevent tissue necrosis 1
Alternative Preparation for Continuous Infusion
For continuous IV infusion (not bolus dosing), an alternative concentration can be prepared by adding 1 mg (1 mL) of 1:1000 epinephrine to 250 mL of D5W to yield 4.0 mcg/mL (1:250,000 solution), infused at 1-4 mcg/min 2
Practical Considerations
- Prefilled syringes of 100 mcg/mL epinephrine (1:10,000) are commercially available in some countries but not universally 1
- Familiarity with this dilution method must be part of emergency training and practiced regularly, not attempted for the first time during an actual emergency 1
- Prefilled syringes are approximately 12-16 seconds faster to administer than preparing from ampoules during cardiac arrest 3