What is the rate of a bolus (Bolus, intravenous push)?

From the Guidelines

The rate of a bolus for medications such as adenosine, esmolol, metoprolol tartrate, propranolol, and diltiazem can vary significantly, but is often administered rapidly over 1-2 minutes, as seen in the administration of adenosine, which is given as a 6-mg rapid IV bolus over 1–2 seconds, followed by a rapid saline flush 1. The specific rate of administration depends on the medication, patient condition, and clinical context. For example, esmolol is administered as a 500-mcg/kg IV bolus over 1 min, while metoprolol tartrate is given as a 2.5–5.0-mg IV bolus over 2 min 1. It's crucial to consider the potential adverse effects of rapid bolus administration, such as hypotension, worsening heart failure, bronchospasm, and bradycardia, and to adjust the rate accordingly based on the patient's cardiovascular status, age, and underlying conditions 1. Key factors to consider when determining the rate of a bolus include:

• The specific medication being administered
• The patient's weight, age, and underlying medical conditions
• The clinical context, such as the presence of heart failure or reactive airway disease
• The potential adverse effects of the medication and the risk of too-rapid administration. In general, the goal is to achieve a rapid therapeutic effect while minimizing the risk of adverse reactions, and the rate of administration should be tailored to the individual patient's needs, as supported by the guidelines for the management of adult patients with supraventricular tachycardia 1.

From the FDA Drug Label

To provide hemodynamic support in septic shock associated hypotension in adult patients, the suggested dosing infusion rate of intravenously administered epinephrine is 0.05 mcg/kg/min to 2 mcg/kg/min, and is titrated to achieve a desired mean arterial pressure (MAP). The rate of a bolus is not specified in the provided drug labels. Bolus administration is not mentioned in the context of the provided information, which focuses on infusion rates for hypotension associated with septic shock.

• The information provided discusses infusion rates, not bolus administration.
• There is no direct information about the rate of a bolus in the provided drug labels 2 2.

From the Research

Definition of a Bolus

• A bolus is a single, large dose of a drug or substance administered intravenously or intramuscularly 3.
• In the context of anaphylaxis, a bolus of epinephrine is often administered to rapidly alleviate symptoms [(3,4,5)].

Rate of a Bolus

• The rate of a bolus can vary depending on the specific drug, patient, and medical condition being treated 6.
• In the case of epinephrine administration for anaphylaxis, the rate of the bolus is typically rapid, with the goal of quickly achieving therapeutic levels of the drug [(3,5)].
• However, the exact rate of a bolus is not explicitly defined in the provided studies, and may depend on various factors such as the patient's weight, medical history, and the specific protocol being followed [(3,4,5)].

Administration of a Bolus

• A bolus can be administered through various routes, including intravenously (IV) or intramuscularly (IM) [(3,6)].
• In the context of anaphylaxis, IM administration of epinephrine is often preferred due to its faster onset of action and lower risk of adverse cardiovascular events compared to IV administration [(3,4,5)].
• The administration of a bolus should be done with caution and under medical supervision, as it can be associated with adverse effects such as overdose or cardiovascular complications [(3,6)].