epinephrine dosage calculations

[icemountain]

Can anyone explain how to accurately and efficiently calculate out dosages for different amounts of epinephrine. I get confused because of the ratios. -Befuddled new CA-1.

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[dfk]

depends on what you're using it for (how you're using it):
typical calculation i usually have for peds is 0.01-0.03 mg/kg (for infusion/bradycardia IVP).
if giving it for low HR (decreasing rapidly), i consider 100-200 mcg IVP.
i forget source, but minimum dose in peds is 200 mcg IVP, regardless of weight. i'll verify and repost.
there are several calulations based on concentration of epi and for what purpose. so, in the end, it really depends on what [C] and for what purpose.
however, if you're wondering how to figure out the ratios, consider this:
1:200,000 equals 5 mcg/ml
1:1,000 equals 1,000 mcg/ml
1:10,000 equals 100 mcg/ml
essentially take the number on the right and see how many times that number goes into 1,000,000 and that's your epi per ml concentration.

 

[Arch Guillotti]

i forget source, but minimum dose in peds is 200 mcg IVP, regardless of weight. i'll verify and repost.

???



I have never heard of a minimum epi dose for peds.

 

[Noyac]

???



I have never heard of a minimum epi dose for peds.

I had a whole rebuttal typed up for that very statement. I deleted it b/c it wasn't worth the argument. But I having 2nd thoughts.

DFK, The OP asked for ratios not dosages. Every one has access to epi dosages. So the bottom part of your post is what he was looking for. But you opened a whole nutha issue. DFK, have you seen what 200 mcg of epi does to a infant? I haven't. But I can tell you it ain't gonna be pretty. You give 200 mcg epi to a 5 kg infant and Kaboom. Minimum dose my arse.
You can post here all you want but, as a nurse you should be careful what it is you are posting.

OK Kaboom may be a strong statement but really 200 mcg minimum.

 

[thegasman]

maybe he is thinking of atropine but that's not the right dose.

 

[Noyac]

maybe he is thinking of atropine but that's not the right dose.

Yes atropine has a minimum dose. But if he is confusing epi with atropine then, well I/we can't help him.

 

[Arch Guillotti]

When I was on peds rotation we would draw up and dilute epi on all the peds cases. Starting with a 1 mg 1:1000 ampule I would make 3 syringes w/varying amounts of epi. One syringe of 100 mc/cc, one with 10 mcg/cc and one for 1 mcg/cc. For pediatric badness the dose was somewhat flexible, depending on the amount of badness. Fortunately I only had to give epi to kids a couple if times, anywhere from 1 mcg/kg to 10 mcg/kg and doses could be repeated depending on clinical situation.

For adults the code dose is 1 mg of the 1:10,000 (the bristojet). That is for pts that CPR is in progress on. You can give less (say .5 mg) if they are rapidly circling the drain. Really, you can give as much as you want. For anyphylaxis many would start out w/as little as 10 mcgs (total) and escalate doses based on response. If a sick ASA IV pt. crumps when the surgeons open the belly you may give several hundred mcgs. You can always give more if need be.

 

[dfk]

I had a whole rebuttal typed up for that very statement. I deleted it b/c it wasn't worth the argument. But I having 2nd thoughts.

DFK, The OP asked for ratios not dosages. Every one has access to epi dosages. So the bottom part of your post is what he was looking for. But you opened a whole nutha issue. DFK, have you seen what 200 mcg of epi does to a infant? I haven't. But I can tell you it ain't gonna be pretty. You give 200 mcg epi to a 5 kg infant and Kaboom. Minimum dose my arse.
You can post here all you want but, as a nurse you should be careful what it is you are posting.

OK Kaboom may be a strong statement but really 200 mcg minimum.

yea yea, i know it sounds absurd. when i heard it, i thought the same thing. i was told this by two peds attendings, so harsh their mellow not mine. like i said, i have to find the source. and yea, i know what 200 mcg of epi can do to an adult, let alone (imagine) an infant.

 

[Noyac]

yea yea, i know it sounds absurd. when i heard it, i thought the same thing. i was told this by two peds attendings, so harsh their mellow not mine. like i said, i have to find the source. and yea, i know what 200 mcg of epi can do to an adult, let alone (imagine) an infant.

Then why are you posting this ****?

 

[Arch Guillotti]

Then why are you posting this ****?

What he said.

 

[dfk]

Then why are you posting this ****?

this made me do it. i swear!

http://www.startribune.com/lifestyl...ArksLckD8EQDUoaEyqyP4O:DW3ckUiD3aPc:_Yyc:aUUJ

 

[Fastrach]

Not to hijack the thread, but what's the most epi you've given at one time and seen the pt come out alive afterward? My personal best was on an OPCABG that arrested and crashed onto pump after things turned south... 1 mg epi nuthin, another 1 mg still nuthin, 5 mg maybe somethin, then another 5 mg epi and the guy finally came around, so 12 mg total for this cat over about 3 minutes, and he made it out to see another day... liquid Jesus, indeed...

 

[fakin' the funk]

For adults the code dose is 1 mg of the 1:10,000 (the bristojet). That is for pts that CPR is in progress on.

Arch, did you mean "1 cc of the 1:10000" (i.e., 100mcg)? Cuz, 1 mg = 1 mg regardless of concentration right?

 

[proman]

The code dose for an adult is 1 mg or 10 cc of 1:10,000. The 1:1,000 concentration isn't used in codes. When I was a medic, I used to use a 30cc vial of 1:1,000 and put in a large syringe with final concentration of 1:5,000. We'd call the code before running out.

 

[Noyac]

Not to hijack the thread, but what's the most epi you've given at one time and seen the pt come out alive afterward? My personal best was on an OPCABG that arrested and crashed onto pump after things turned south... 1 mg epi nuthin, another 1 mg still nuthin, 5 mg maybe somethin, then another 5 mg epi and the guy finally came around, so 12 mg total for this cat over about 3 minutes, and he made it out to see another day... liquid Jesus, indeed...

That's a big dose.
I remember giving "high" dose epi to an ICU arrest as a resident. I think the dose was 10mg all told. That guy stuck around for about 24 hrs b/4 his heart finally gave out. So the most I've given and seen work is in the 2-4mg range. Now with vasopressin (I started ACLS b/4 vasopressin) it's even less.

 

[pgg]

yea yea, i know it sounds absurd. when i heard it, i thought the same thing. i was told this by two peds attendings, so harsh their mellow not mine. like i said, i have to find the source. and yea, i know what 200 mcg of epi can do to an adult, let alone (imagine) an infant.

You know, you could just stop posting altogether.

You're giving every intelligent and competent CRNA out there a bad name. Half the CRNAs I know would deliver an epic beatdown to any SRNA who delivered the load you just plopped onto the forum. They wouldn't accept the "I think I heard a doctor say this once" excuse, either.

You're answering questions on a physician anesthesiology forum, not just incorrectly, but astoundingly mind-bogglingly eye-poppingly morbidity-and-mortality-inducingly incorrectly. When corrected, you resort to the age old "I'm just a nurse and not responsible for anything I say or do" defense by blaming two unnamed doctors for your ignorance of the most basic of drug doses. And then you have the gall to cry about someone harshing your mellow when they correct you.

Just ... stop.

 

[dhb]

Not to hijack the thread, but what's the most epi you've given at one time and seen the pt come out alive afterward?

17mg; latex anaphylaxis not me but an attending 2y/a.

 

[Arch Guillotti]

Arch, did you mean "1 cc of the 1:10000" (i.e., 100mcg)? Cuz, 1 mg = 1 mg regardless of concentration right?

1 mg is the full code dose. This is the dose that comes in the bristojets (the tubes that you can pop the tops like Johnny and Roy used to on Emergency!) It is 1 mg in 10 cc's, or 100 mcg/ml. Higher doses hasve been studided in arrest situations but as far as I am aware they don't make much difference. If you give enough epi you can give a grapefruit a pulse.

The 1 mg in 1 cc vials (100 mcg per .1 cc) are ones that are typically used for subcutaneous administration in anaphylaxis.

The whole mcg/cc thing for epi additives to local anesthetics used to confuse me, as did the whole difference between the 1:10,000 amp and the 1:1000 amp and what those ratios actually meant.

Heres an explanation that I think makes things easier:

1 L=1 kg

This would be an equivalent mixture of each if put one kg in one liter. i.e.1:1.

Apparently the ratio always denotes the mass first

therefore, 1:200,000, if interpreted at the level of kg and liter, would be 1 kg in 200000 L

multiply each side by conversion factors to get in into workable number. Knowing that we need to get a much smaller mass, we can start with the kgs.

1kg=1000g; therefore 1:200,000=1000g in 200,000 L
divide each side by 1,000 and you get 1 gm in 200L

1gm=1000mg; therefore 1gm in 200L = 1000mg in 200L

1L=1000mL; therefore 1000mg in 200L= 1000mg in 200,000mL
divide each side by 1000 and you get 1 mg in 200 mL

Then by algebra you get 5 mcg in 1mL and hence our calculation that we need 100 mcg in 20 mL to make 5 mcg in one mL or 1:200,000 epi...

You can also use this conversion to figure out why 1:1000 epi is 1 mg per mL

OR:

The shortcut form is to look at the ratio and divide the first number (almost always 1) by the next 3 numbers (x hundred) and this will give you mg per mL

For example, 1:200,000 you would divide 1 by 200 and you get 0.005 mg per mL or 5 mcg per mL.

1:300,000 would be 1 divided by 300 or 0.0033 (3.3 mcg per mL)

This is probably more than anyone ever wanted to know about this stuff!

 

[icemountain]

thank you Arch G. , your answer is the kind of information I was looking for. Thank you.

 

[Arch Guillotti]

thank you Arch G. , your answer is the kind of information I was looking for. Thank you.

No problem.

 

[cloud9]

this made me do it. i swear!

http://www.startribune.com/lifestyl...ArksLckD8EQDUoaEyqyP4O:DW3ckUiD3aPc:_Yyc:aUUJ

IS this for real?

The Doc's name is Aas.

Dr. Aas wants to do stool transplants?

 

[dfk]

IS this for real?

The Doc's name is Aas.

Dr. Aas wants to do stool transplants?

yea, and according to Dr. Aas: "So what we do is take normal stool from a normal person, make an extract of it, put it in a blender with water, take two tablespoons of that cocktail, and introduce it into the patient's body."

this, apparently, is the gift that keeps on giving.

 

[badgas]

If you give enough epi you can give a grapefruit a pulse.

I couldn't. All I got was strange looks in the cafeteria.