Epinephrine is a commonly used medication in the emergency department for the management of anaphylaxis and cardiac arrest. Administering this drug can be confusing as the dosage and concentration are different for each indication.
The “allergy epi” 1:1000 concentration is 10 times more concentrated than the “cardiac epi”. The “allergy epi” is delivered IM while the “cardiac epi” is delivered IV.
This difference leads to an increased risk of error as the incorrect epinephrine dosage, concentration, or route can have disastrous consequences for patients including coronary dissection, infarction, and ventricular arrhythmias (1-3). Here is a little saying to easily remember the dosage and concentration of epinephrine in both anaphylaxis and cardiac arrest…
Anaphylaxis and Epinephrine Dosage
LESS (volume) is MORE (concentrated)
Less (0.5cc) is More (1:1000)
Use ½ ml of 1:1000 epinephrine and deliver it into the muscle (IM). This will deliver a total of 0.5mg of epinephrine IM.
Cardiac Arrest and Epinephrine Dosage
MORE (volume) is LESS (concentrated)
More (10cc) is Less (1: 10,000)
Use 10cc of 1: 10,000 epinephrine and give it intravenously (IV). This will deliver 1mg of epinephrine IV.
- Kanwar M, Irvin CB, Frank JJ, et al. Confusion about epinephrine dosing leading to iatrogenic overdose: a life-threatening problem with a potential solution. Ann Emerg Med. 2010. Apr;55(4):341-4
- Wood JP, Traub SJ, Lipinski C. Safety of epinephrine for anaphylaxis in the emergency setting. World J Emerg Med. 2013;4(4):245-51
- Campbell RL, Bellolio MF, Kuntson BD, et al. Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. J Allergy Clin Immunol Pract. 2015 Jan-Feb;3(1):76-80