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Racemic EpinephrineAka: Nebulized racemic epinephrine

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  1. Indications
    1. Moderate to Severe Croup
    2. Respiratory Syncytial Virus (Bronchiolitis)
  2. Mechanism
    1. Alpha-adrenergic effect
    2. Mucosal vasoconstriction decreases subglottic edema
    3. Rapid response in croup (within 10 minutes)
      1. Consider Croup Differential Diagnosis if no response
    4. Effect dissipates in 2 hours
  3. Pharmacokinetics
    1. Effects last 90 to 120 minutes
  4. Precautions
    1. Avoid too frequent use due to tachyphylaxis
    2. Observe 2-4 hours after racemic Epinephrine
      1. Patient may go home safely if no worsening in 3 hours
  5. Dose
    1. Nebulizer mix
      1. Racemic Epinephrine (2.25%)
        1. Child under 6 months: 0.25 ml
        2. Child: 0.5 ml
        3. Adolescent: 0.75 ml
      2. Normal Saline 2.0 to 3.5 ml
    2. Frequency of dosing
      1. Nebulized Epinephrine may be repeated in 30 minutes
      2. Monitor Heart Rate closely with repeat dosing
  6. Efficacy: Bronchiolitis
    1. Significantly more effective than Beta-agonist
    2. Reduced hospital admissions significantly
    3. Reduced time spent in emergency room significantly
    4. References
      1. Menon (1995) J Pediatr 126:1004

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