Adrenaline (C9H13NO3)

Definition:

Adrenaline is a natural stimulant made in the adrenal gland of the kidney. Its biological name is epinephrine, from the Greek “nephros” for kidney. Adrenaline is carried in the bloodstream and affects the autonomous nervous system, which controls functions such as the heart rate, dilation of the pupils, and secretion of sweat and saliva.

Adrenaline is a chemical that narrows blood vessels and opens airways in the lungs. These effects can reverse severe low blood pressure, wheezing, severe skin itching, hives, and other symptoms of an allergic reaction.

Purpose:

Frequently used to aid in weaning off bypass due to its potent b1 stimulation

•          Bradycardia [heart blocks] & cardiac arrest

•          Ventricular dysfunction, vasodilatation, bronchoconstriction, anaphylaxis

•          Drug of 1st choice in anaphylactic shock as:

i) Vasopressor; elevates systolic BP due to:

a) Positive inotropic & chronotropic cardiac effect [b1-receptors]

b) Vasoconstriction [a-receptors]

ii) Antihistamine action

iii) Bronchodilator [b2-receptors]

Side Effects:

Common side effects include agitation , increased heart rate, sweating, sleeplessness, fatigue, dizziness, hallucinations, impaired memory, weakness, disorientation, breathlessness, reddening of the skin and face, cold fingers and toes, increase blood sugar levels and raised blood pressure.

Doses:

•     Adrenaline is only for subcutaneous or intramuscular use. It is not an intravenous drug.

•     It’s essential that patients understand how, when and where to give themselves an adrenaline injection.

•     Do not use if the injection is brown or contains a precipitate.

•     The adrenaline is supplied as a single use prefilled syringe. After using the drug, discard the syringe with any remaining solution.

•     It’s pertinent that patients seek medical advice soon after administering an adrenaline injection so that patient is monitored.

•     Adrenaline should be stored in the dark and below 25 degrees; however, it should not be refrigerated.

Intravenous:

USE 1 IN 10,000 AMPOULES ONLY

0.1 – 0.3mL/kg/dose

Intravenous infusion:

USE 1 in 1000 AMPOULE ONLY

To be further diluted (see Preparation section)

Initially 0.1microgram/kg/minute, increasing to a maximum of

1microgram/kg/min

Endotracheal tube:

USE 1 IN 10,000 AMPOULES ONLY

0.1 – 0.3mL/kg/dose

For ease of calculation in an acute resuscitation a dose of 1mL may be given

In a term infant and 0.5mL in a preterm infant. Repeated doses may be required.

Nebulization:

Using Respirator Solution

0.05mL/kg/dose

Using 1 in 1000 ampoule only

0.5mL/kg/dose

Dilute to 2-4mL with saline.

Routes of Administration:

•     Intravenous injection

•     Intravenous infusion

•     Umbilical arterial/venous injection

•     Nebulization

Method of administration

•     1:1000 (1mg/ml) or 1:10,000 (1mg/10ml)

•     May be made up: 10mg/500 ml

•     Continuous infusion e.g. 0.05 1g/Kg/min

Brands:

•     Barrett

•     Dosaco

•     Elite

•     HSC

•     MBL

•     Opth-Pharma

•     Orient

•     PDH

•     Shifa

Toxicity of Adrenaline:

•     Arrhythmias

•     Elevated BP with secondary: cerebral hemorrhage; pulmonary edema

•     Increased myocardial work load

•     Extravasations into subcutaneous tissues may cause local ischemia

•     Vasoconstriction

•     Tachycardia, hypertension, tremor, cold extremities, agitation

•     Severe hypertension, cardiac arrhythmias, pulmonary edema and cerebral hemorrhage.