ADRENALINE HYDROCHLORIDE

Adrenaline

Reviewed by NICU and Pharmacy
November 2011
Administration Newborn Drug Protocol Index Newborn Services Home Page

Dose and Administration

IV push

  1. 0.1-0.3 ml/kg 1:10,000 concentration by IV push, or intracardiac.

Intratracheal

  1. 0.3ml/kg 1:10,000 concentration. Repeat dose every 3-5 minutes as necessary.

Continuous infusion               

  1. 100-300 nanograms/kg/minute (0.1-0.3micrograms/kg/minute). Start at 100 nanograms/kg/minute (0.1micrograms/kg/minute) and titrate to desired response to a maximum of 1000 nanograms/kg/minute (1microgram/kg/minute).
  2. Use 1:10,000 concentration (0.1mg/ml) to prepare continuous infusion.
  3. Usual dilution 0.3 mg/kg in 50ml D5W, D10W, NS.

Slow IV push/intracardiac

  1. 0.1-0.3ml/kg/minute, 1:10,000 concentration.

Indications

  1. Acute cardiovascular collapse (bradycardia, asystole).
  2. Can be used as a second or third line inotrope.
  3. Short-term use for cardiac failure resistant to other drug management.

Contraindications and Precautions

  1. Hypersensitivity to sympathomimetics.
  2. Shock.
  3. Caution in infants with cardiovascular disease, hypertension.

Clinical Pharmacology

Adrenaline, a catecholamine, stimulates alpha and beta receptors. It increases heart rate, increases myocardial contractility, automaticity and conduction velocity. Adrenaline also increases systemic vascular resistance (via constriction of arterioles), and increases blood flow to skeletal muscle, brain, liver and myocardium. It decreases renal blood flow by 40%. Pulmonary resistance may increase, although the major effect of adrenaline is to redistribute blood from the systemic to pulmonary circulation and thereby increase pulmonary pressure.

Adrenaline must be given parenterally to reach pharmacologically effective concentrations because it is rapidly metabolised in the gastrointestinal tract and liver. Its vasoconstrictive properties account for the slow rate of absorption from subcutaneous or intramuscular administration sites. The major portion of adrenaline is rapidly metabolised by the same enzyme systems that metabolise endogenous catecholamines.

Possible Adverse Effects

  1. Venous irritation, soft tissue injury at the site of IV infusion.
  2. Cardiac arrhythmias (PVCs and ventricular tachycardia).
  3. Renal vascular ischaemia with decreased urine formation.
  4. Severe hypertension with intracranial haemorrhage.
  5. Pulmonary oedema.
  6. Hyperglycaemia related to the inhibition of insulin secretion and conversion of glycogen reserves.
  7. Hypokalaemia.

Special Considerations

  1. Always use as a 1:10,000 concentration (0.1 mg/ml) for individual doses.
  2. If possible, correct acidosis before administration of adrenaline to enhance the effectiveness of the drug.