From the Guidelines
A 1:1000 dose means that a substance is diluted at a ratio of 1 part active ingredient to 1000 parts of solution, which is commonly used to express the concentration of medications, particularly epinephrine, with 1 gram of epinephrine in 1000 milliliters of solution equaling 1 milligram per milliliter (1 mg/mL) 1. This concentration is typically used for intramuscular or subcutaneous administration in anaphylaxis, where the standard adult dose is 0.3-0.5 mg (0.3-0.5 mL of the 1:1000 solution) 1. Some key points to consider when using a 1:1000 dose of epinephrine include:
- The dose should be administered intramuscularly into the anterolateral thigh 1
- The standard adult dose is 0.3-0.5 mg (0.3-0.5 mL of the 1:1000 solution) 1
- The dose may need to be repeated every 5-15 minutes if symptoms persist or worsen 1
- Understanding these concentration ratios is crucial for healthcare providers to administer the correct dose by the appropriate route, as using the wrong concentration could result in a 10-fold dosing error 1 It's also important to note that epinephrine 1:10,000 (0.1 mg/mL) is more dilute and used for intravenous administration in cardiac arrest situations, highlighting the need to carefully select the correct concentration for the specific clinical scenario 1. When working with medications expressed in ratio strengths, always convert to standard units (mg/mL) to ensure accurate dosing, as this can help prevent dosing errors and ensure the best possible outcomes for patients 1.
From the FDA Drug Label
1:1000 VIAL is supplied in the following dosage forms EPINEPHRINE INJECTION, USP 1mg/mL The 1:1000 dose means that there is 1 gram of epinephrine per 1000 mL of solution, which is equivalent to 1 milligram of epinephrine per 1 mL of solution. 2
From the Research
Definition of 1:1000 Dose
The term "1:1000 dose" refers to a concentration of epinephrine, where 1 gram of epinephrine is dissolved in 1000 milliliters of solution.
- This concentration is often used for intramuscular injections to treat anaphylaxis, as studied in 3 and 4.
- The 1:1000 dose is typically administered via an autoinjector, such as an EpiPen, which contains a single dose of 0.3 mg of epinephrine 3, 5.
- In medical settings, the 1:1000 dose may also be administered manually using a syringe, but autoinjectors are generally preferred due to their ease of use and reduced risk of dosing errors 5.
Administration Routes
Epinephrine can be administered through various routes, including:
- Intramuscular (IM) injection, which is the preferred route for treating anaphylaxis 6, 4.
- Sublingual administration, which has been studied as a potential alternative to IM injection 3, 4.
- Continuous intravenous (CIV) infusion, which may be used in severe cases of anaphylaxis where IM injection is not effective 7.
Key Findings
- The intramuscular route is the preferred method for administering epinephrine in cases of anaphylaxis 6, 4.
- Autoinjectors are a convenient and effective way to administer epinephrine, with a lower risk of dosing errors and improved ease of use 3, 5.
- Continuous intravenous infusion of epinephrine may be a safe and effective alternative to IM injection in certain cases, with fewer adverse events and improved symptom resolution 7.