Adrenaline IV, IM, SC, Nebulised
Adrenaline mini-jet, EpiPen, Anapen
Upper airway obstruction
Inotrope / vasopressor
Adrenaline comes in vials containing 1mg in 1ml (1:1000) and vials containing 1mg in 10ml (1:10000). Mini-jets that contain 1mg in 10ml are also available.
The standard dilution for adrenaline by infusion in the ICU is 10mg in 100ml of compatible IV fluid
Compatible with the following IV fluids:
Normal saline, D5W, Glucose and Sodium Chloride, Hartmann’s
Store at room temperature. Protect from light. Do not refrigerate. Solutions that are discoloured pink or brown should not be used.
Although IM use is said to be preferred in anaphylaxis and other emergencies, the IV route is generally more appropriate in the ICU setting. Use 1:1000 solution undiluted for administration by the IM route.
Use 1:1000 solution and (if required) make up to a total of 5ml using normal saline prior to administration
10ml of 1:10000 (i.e 1mg) IV
3-10mg of 1:1000 via ETT can be used if IV access cannot be obtained
NOTE: in cardiac arrest after cardiac surgery, consideration should be given to immediate sternotomy. If adrenaline is administered in this setting, a standard 1mg dosage is inappropriate due to the risk of rebound hypertension leading to fatal haemorrhage. Give bolus doses of 1ml of 1:10000 and uptitrate gently if circulation is not restored.
0.05ml/kg of 1:10000 IV with dose titrated to effect followed by IV infusion if required.
0.01ml/kg of 1:1000 IM (avoid administration in the buttocks)
Post-extubation stridor or other upper airway obtruction:
Use the 1:1000 vials up to max. dose 5ml and administer via a nebuliser (if giving less than 4mg, make up to at least 4ml with 0.9% saline).
10mg in 100ml of D5W or normal saline at up to 20ml/hr titrated to effect
0.1ml/kg of 1:10000 IV
0.1ml/kg of 1:1000 via ETT
0.05ml/kg of 1:10000 IV
0.01ml/kg of 1:1000 IM
Use the 1:1000 vials at a dose of 0.5ml/kg/dose, max. dose 5ml and administer via a nebuliser (make up to at least 4ml with 0.9% saline).
0.3mg/kg in 50ml D5W at 0.5-10ml/hr (0.05-1mcg/kg/min)
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
No dosage adjustment is required in renal failure or renal replacement therapy.
Adrenaline is a sympathomimetic drug. It activates an adrenergic receptive mechanism on effector cells and imitates all actions of the sympathetic nervous system except those on the arteries of the face and sweat glands. Adrenaline acts on both alpha and beta receptors.
There are no absolute contraindications to the use of adrenaline in a life-threatening situation.
Adrenaline by infusion commonly leads to hyperlactataemia and hyperglycaemia.
Adrenaline by infusion may worsen dynamic outflow tract obstruction and paradoxically reduce cardiac output (particularly if used in the setting of hypovolaemia)
Some patients may be at greater risk of developing adverse reactions after adrenaline administration. These include: hyperthyroid individuals, individuals with cardiovascular disease, hypertension, or diabetes, and the elderly.
Adrenaline infusion commonly leads to increased lactate. It may be necessary to measure lactate levels if there are clinical concerns.
Drug/Laboratory Test Interactions
The effects of adrenaline may be potentiated by tricyclic antidepressants and monoamine oxidase inhibitors.
Body as a Whole:
Apprehension, nervousness, anxiety and sweating.
Palpitations, tachycardia, pallor.
Hyperventilation, pulmonary oedema
Nausea and vomiting,
Headache, tremor, dizziness, weakness, cerebrovascular haemorrhage