| Example of preparation of epinephrine infusion for refractory symptoms of anaphylaxis (adult patient) for emergency/critical care units |
| Final concentration: Epinephrine 4 mcg/mL |
| Preparation |
- CHECK vial strength.
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- Add 1 milligram of epinephrine to 250 mL bag of 0.9% normal saline (NS) or 5% dextrose water (D5W)
- If you have 0.1 mg/mL strength epinephrine (may also be labeled 1:10,000) use 10 mL to deliver 1 mg to bag*
- If you have 1 mg/mL strength epinephrine (may also be labeled 1:1000) use 1 mL to deliver 1 mg to bag*
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| Administration |
- Start the epinephrine infusion at 0.1 mcg/kg/minute using a programmable infusion pump while continuously monitoring the patient's cardiac rhythm and blood pressure (ie, approximately 6 to 10 mcg/minute in most adults).
- Using a body weight of 80 kg as an example, you can determine the infusion rate to deliver a dose of 0.1 mcg/kg/minute from a 4 mcg/mL bag as follows:
- Multiply 0.1 mcg/kg/minute dose by 80 kg body weight to determine dose in mcg/minute (= 8 mcg/minute).
- Use this table to convert 8 mcg/minute to infusion rate of 2 mL/minute (= 120 mL/hour).
- Every two to three minutes, increase the infusion rate by approximately one-half of the starting rate until the blood pressure and perfusion improve. For more detail, refer to the UpToDate topic on emergency treatment of anaphylaxis.
- In morbidly obese adults, we suggest initiating the infusion using a standard, ie, non-weight-based dose (eg, up to 10 mcg/minute initially) and titrating to effect.
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| Adult infusion dose | Administration rate for infusion pump to deliver adult dose shown |
| mcg per minute | mL per minute | mL per hour |
| 1 | 0.25 | 15 |
| 2 | 0.5 | 30 |
| 3 | 0.75 | 45 |
| 4 | 1 | 60 |
| 5 | 1.25 | 75 |
| 6 | 1.5 | 90 |
| 7 | 1.75 | 105 |
| 8 | 2 | 120 |
| 9 | 2.25 | 135 |
| 10 | 2.5 | 150 |
| 11 | 2.75 | 165 |
| 12 | 3 | 180 |
| 13 | 3.25 | 195 |
| 14 | 3.5 | 210 |
| 15 | 3.75 | 225 |
| 16 | 4 | 240 |
- The above table is provided as an example. There are other acceptable concentrations.
- Intravenous epinephrine, like all vasopressors, can cause life-threatening hypertension, cardiac ischemia, and ventricular arrhythmias. It should be administered ONLY by clinicians trained and experienced in dose titration of intravenous epinephrine using continuous noninvasive electronic monitoring of heart rate and blood pressure.
- Epinephrine is an ischemia-causing agent and vesicant. Monitor infusion site for extravasation. Central venous catheter administration is preferred when available. Refer to the Lexicomp drug reference for information on managing extravasation including infiltration of phentolamine.
- To reduce the risk of making a medication error, we suggest that centers have available an institutionally approved protocol for epinephrine infusion that includes steps on how to prepare and administer the infusion by programmable infusion pump and standard concentration(s).
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