Epinephrine Dosage - is this too much?

Daytonite, BSN, RN · Jul 25, 2009

Did you ask the nursing staff why the infusion was set so high?

NurseHotFlash · Jul 26, 2009

No, I should have. As a student with little knowledge of these drugs, I would have had to look it up to know the safe dose, and in this clinical experience there was no time. Now that I am working on the care plan, I see the problem. Do you happen to know how the solution Neo-Synephrine usually comes in? I wrote down 40 mg in 4 ml, but that makes no sense. I am beginning to wish I would have chosen another patient for this care plan! Thanks for your help!

Daytonite, BSN, RN · Jul 26, 2009

1 mg in 500 mL D5W (2 mcg/mL)

1 mg in 250 mL D5W (4 mcg/mL)

2 mg in 500 mL D5W (4 mcg/mL)

allnurses Guide · Jul 27, 2009

I have seen people on 20 mcg/min of epi, but they were not long for this world. You get terrible metabolic acidosis from lactate increases with that kind of dose, not to mention arrhythmias.

NurseKitten, MSN, RN · Jul 27, 2009

A patient in anaphylaxis needs the beta-2 action of bronchodilation, and beta-1 action to increase cardiac output. (Remember, CO = HR x SV)

But at 20 mcg/min of Epi, you're also in the range of hitting the alpha-1 receptors for vasoconstriction. I would imagine the issue behind using Epi in this high of a concentration is you're getting equal and opposing effects with the Beta-2's vasodilating and Alpha-1's vasconstricting. It's really not the most effective use of your pharmacologic weapons.

Where Neo comes in is that it's a pure-alpha agonist. It has the vasoconstriction effects of hitting the alpha-1's without the vasodilatory effects of the beta-2's.

Can it be run that high? Sure. Epi really doesn't have a ceiling dose. SHOULD it be run that high?? There are more efficient and effective drugs to get the desired effects. It is possible to reach a point where the benefits of escalating doses don't outweight the other effects of the drug.

hypocaffeinemia, BSN, RN · Jul 27, 2009

If the patient was on neosynephrine too, are you sure you weren't looking at the NORepinephrine (levophed) drip?

20 mcg/min is a typical dose for norepinephrine.

20 mcg/min of epinephrine is a "we've thrown everything but the kitchen sink and then some" dose.

NurseHotFlash · Jul 28, 2009

Thanks so much! I am sure it was a 250 ml bag, so it must have been 1mg. I can't wait to finish this care plan!!!

NurseHotFlash · Jul 28, 2009

He was very bad off. You are certainly right about the metabolic acidosis. His Ph was 7.00 and HCO3 was 6.6.

celclt · Jul 28, 2009

had he coded? did you get a chance for them to explain his EKG? was he already on beta blocker or calcium channel blocker, epinephrine doses must be higher to overcome the effects of these....there's never enough time in clinical ( feast or famine-its crazy busy or I feel like we hover :) )

meandragonbrett · Jul 30, 2009

Yeah, 20mcg/min is possible. I've run epi in excess of 80mcg/min.

NurseHotFlash · Jul 30, 2009

Dear Celclt, he had coded 3 times. He was on all kinds of drips. Neo, norepi, dopamine, vasopressin, nimbex, propofol, the works. I must be out of my mind to try to do a care plan on him, but I really would like to know how all these work together. Your explanation of the high dose of epi to over come other drugs makes perfect sense. This is the type of thing I really would like to under stand. . . . one day! Thanks for your input.