Adrenaline

Adrenaline

[adrenaline minijet $17.13; 1 vial $1.01]

ADMINISTRATION ROUTES:

  • IV, IM, SC, Nebulised

ALTERNATIVE NAMES:

  • Adrenaline mini-jet, Adrenaline (DBL)

ICU INDICATIONS:

  1. cardiac arrest
  2. anaphylaxis
  3. upper airway obstruction
  4. inotrope/vasopressor

PRESENTATION AND ADMINISTRATION:

  • IV:
    Adrenaline comes in ampoules containing 1mg in 1ml (1:1000) and ampoules 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.
  • IM:
    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.
  • Nebulised :
    Use 1:1000 solution and (if required) make up to a total of 5ml using normal saline prior to administration

DOSAGE:

  • Cardiac arrest:
    10ml of 1:10000 (i.e 1mg) IV OR 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 leaking to fatal haemorrhage. Give bolus doses of 1ml of 1:10000 and uptitrate gently if circulation is not restored.
  • Anaphylaxis:
    0.05ml/kg of 1:10000 IV with dose titrated to effect followed by IV infusion if required. OR 0.01ml/kg of 1:1000 IM (avoid administration in the buttocks)
  • Post-extubation stridor or other upper airway obtruction:
    Use the 1:1000 ampoules 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).
  • IV Infusion:
    10mg in 100ml of D5W or normal saline at up to 20ml/hr titrated to effect

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • No dosage adjustment is required in renal failure or renal replacement therapy.

DOSAGE IN PAEDIATRICS:

  • Cardiac arrest:
    0.1ml/kg of 1:10000 IV 0.1ml/kg of 1:1000 via ETT
  • Anaphylaxis:
    0.05ml/kg of 1:10000 IV OR 0.01ml/kg of 1:1000 IM
  • Severe Croup:
    Use the 1:1000 ampoules 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).
  • IV Infusion:
    0.3mg/kg in 50ml D5W at 0.5-10ml/hr (0.05-1mcg/kg/min)

CLINICAL PHARMACOLOGY:

  • 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.

CONTRAINDICATIONS:

  • There are no absolute contraindications to the use of adrenaline in a life-threatening situation.

WARNINGS

  • 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)

PRECAUTIONS

  • General:
    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.
  • Laboratory Tests:
    Adrenaline infusion commonly leads to increased lactate.  It may be necessary to measure lactate levels if there are clinical concerns.
  • Drug/Laboratory Test Interactions:
    None reported

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • The effects of adrenaline may be potentiated by tricyclic antidepressants and monoamine oxidase inhibitors.

ADVERSE REACTIONS

  • Body as a Whole:
    Apprehension, nervousness, anxiety and sweating.
  • Cardiovascular System:
    Palpitations, tachycardia, pallor.
  • Respiratory System:
    Hyperventilation, pulmonary oedema
  • Digestive System:
    Nausea and vomiting,
  • Nervous System:
    Headache, tremor, dizziness, weakness, cerebrovascular haemorrhage

Critical Care Drug Manual

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