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EpinephrineAka: Adrenaline

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  1. Definition
    1. Natural Catecholamine with Alpha and beta activity
  2. History
    1. Medical case report in 1923 on intracardiac adrenaline
      1. Shown to reverse "Acute heart paralysis"
  3. Pathophysiology
    1. Alpha Adrenergic Agonist Effects
      1. Most important for cardiac arrest
      2. Vasoconstriction
        1. Increases Systemic Vascular Resistance
        2. Increases Systolic and Diastolic Blood Pressure
      3. Increases Vital Organ Perfusion
        1. Increases Myocardial perfusion
        2. Increases Cerebral perfusion
      4. Decreases Non-Vital Organ Perfusion
        1. Decreases splanchnic and intestinal perfusion
        2. Decreases renal perfusion
        3. Decreases skin perfusion
    2. Beta Adrenergic Agonist effects (Under 0.3 ug/kg/min)
      1. Increases myocardial contractility
      2. Increases Heart Rate
      3. Relaxes bronchial smooth muscle (bronchodilation)
    3. Epinephrine has a short half-life: ~2 minutes
  4. Indications
    1. Initial Resuscitation Management (bolus)
      1. Cardiac arrest
        1. Vasopressin may be used instead in some protocols
      2. Symptomatic Bradycardia unresponsive to
        1. Oxygenation
        2. Ventilation
      3. Hypotension not related to volume depletion
    2. Post-Resuscitation Stabilization (Infusion)
      1. Poor systemic perfusion or hypotension despite
        1. Intravascular volume replacement AND
        2. Stable rhythm
      2. Significant Bradycardia
  5. Newborn Dosing (refractory and persistant Bradycardia)
    1. Epinephrine (1:10,000) 0.1 to 0.3 ml/kg by IV or ET
    2. Do not use the 1:1000 concentration in newborns
  6. Pediatric Dosing
    1. Symptomatic Bradycardia (with a pulse)
      1. Dose: 0.01 mg/kg IV/IO (0.1 ml/kg of 1:10,000 Epi)
    2. Pulseless cardiac arrest
      1. Initial regular dose epinephrine
        1. Dose: 0.01 mg/kg IV/IO (0.1 ml/kg of 1:10,000 Epi)
      2. Subsequent High Dose Epinephrine (if no effect above)
        1. Dose: 0.1 mg/kg IV/IO (0.1 ml/kg of 1:1000 Epi)
        2. Maximum dose: 0.2 mg/kg
      3. Repeat dose every 3-5 minutes
    3. Endotracheal Administration
      1. Adults and children: 0.1 mg/kg (0.1 ml/kg of 1:1000)
      2. Newborn: 0.1 mg/kg (1 ml/kg of 1:10,000)
  7. Adult Dosing
    1. Symptomatic Bradycardia
      1. Infusion: 2-10 ug/min (See below)
    2. Pulseless Arrest
      1. Rhythms
        1. Asystole
        2. Pulseless Electrical Activity
        3. Ventricular Fibrillation
      2. Initial
        1. IV: 1 mg (10 ml of 1:10,000 Epi) IV push
        2. Endotracheal: 2.5 ml of 1:1000 Epi in 10 ml NS
      3. Repeat every 3-5 minutes
      4. Consider increasing dose to 3 or 5 mg (0.1 mg/kg)
  8. Pediatric Infusion (Same as Isoproterenol preparation)
    1. Preparation
      1. Draw up "x" mg of Epinephrine
      2. Where "x" = 0.6 x WeightKg
      3. Add enough D5W or NS to Epinephrine for 100 ml total
      4. At this dilution
        1. Infusion rate of 1 ml/h provides 0.1 ug/kg/h
    2. Start Dose: 20 ml/hour until tachycardia
      1. Indicates drug has entered circulation
    3. Titrate Dose
      1. Decrease to desired rate (0.1 - 1.0 ug/kg/min)
      2. Adjust infusion rate every 5 min to desired effect
  9. Adult Infusion for cardiac arrest
    1. Preparation
      1. Draw up 30 mg of Epinephrine (30 ml of 1:1000)
      2. Add Epinephrine to 250 ml Normal Saline or D5W
    2. Start Dose: 100 ml/h
    3. Titrate to desired effect
  10. Adult Infusion for symptomatic Bradycardia
    1. Preparation
      1. Draw up 1 mg Epinephrine (1 ml of 1:1000)
      2. Add Epinephrine to 500 ml Normal Saline or D5W
    2. Start Dose: 1 ug/min
    3. Titrate Dose to desired effect (2-10 ug/min)
  11. Precautions
    1. Carefully check concentration (1:1000 OR 1:10,000)
    2. Observe for side effects after Resuscitation
      1. Supraventricular Tachycardia
      2. Ventricular Tachycardia
      3. Severe Hypertension
    3. Extravasation into tissues
      1. may causes local ischemia or necrosis
    4. Can exacerbate Myocardial Ischemia
    5. Do not mix with alkaline solutions

Epinephrine (C0014563)

Definition (MSH)The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics.
Definition (CSP)active sympathomimetic hormone from the adrenal medulla in most species; it stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels; used in treatment of asthma and cardiac failure and to delay absorption of local anesthetics.
Definition (NCI)A hormone and neurotransmitter. Also called adrenaline.
Definition (PDQ)The synthetic form of the naturally occurring sympathomimetic amine with bronchodilating, intraocular pressure reducing, and vasoconstricting activity. By stimulating alpha adrenergic receptors, this agent causes vasoconstriction, thereby increasing vascular resistance and blood pressure. When administered in the conjunctiva, epinephrine binds to alpha-adrenergic receptors in the iris sphincter muscle, thereby causing vasoconstriction and a decrease in the production of aqueous humor. Through its beta1-receptor stimulating actions, this agent increases the force and rate of myocardial contraction and relaxes bronchial smooth muscle, thereby causing bronchodilatation. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=41857&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=41857&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C473" NCI Thesaurus)
Definition (NCI)The synthetic form of the naturally occurring sympathomimetic amine with bronchodilating, intraocular pressure reducing, and vasoconstricting activity. By stimulating alpha adrenergic receptors, this agent causes vasoconstriction, thereby increasing vascular resistance and blood pressure. When administered in the conjunctiva, epinephrine binds to alpha-adrenergic receptors in the iris sphincter muscle, thereby causing vasoconstriction and a decrease in the production of aqueous humor. Through its beta1-receptor stimulating actions, this agent increases the force and rate of myocardial contraction and relaxes bronchial smooth muscle, thereby causing bronchodilatation.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121) , Neuroreactive Substance or Biogenic Amine (T124) , Hormone (T125)
EnglishAdrenal, adrenalin, Adrenaline, Adrenaline preparation, Adrenaline product, Epi, Epinephrine, Epinephrine preparation, Epinephrine product, therapeutic epinephrine
Spanishadrenalina, epinefrina, preparado con adrenalina, preparado con epinefrina, preparado de adrenalina, preparado de epinefrina
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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