Epinephrine dose in mg vs volume to be given
Epinephrine 1:10,000 means 1g : 10,000ml. That is the same as 1000 mg: 10,000ml. Which is the same as 1mg:10ml. That means in an ACLS code situation if you want to give 1mg of epinephrine, you would actually draw 10ml of epinephrine (1:10,000).
If you instead have epinephrine that is 1:1,000, 1mg:1ml. To give 1mg, you will give 1ml.
“Epinephrine injection 1:1000 (1mg/ml) is not suitable for IV use. If the epinephrine1:10000 (0.1mg/ml) injection is not available, epinephrine injection 1:1000 must be diluted to 1:10000 before IV use.” medicines.org.uk/emc/medicine/22030
Note: Epinephrine 1:10,000 is more concentrated than epinephrine 1:10,000. Also, Epinephrine 1:100,000 is more concentrated than epinephrine 1:200,000
The dose of Epinephrine, Clearly Explained
NB: The ACLS dose of epinephrine is 1mg IV/IO q3-5 min prn. That is the maximum dose of epinephrine that can be safely given. Everything else, the dose of epinephrine must be less than that.
E.g. For anaphylaxis, the auto-injectors come in a dose of 0.15mg for people 15-30kg of weight and 0.3mg SC/IM x 1 for people >30 Kg. May repeat x 1 in either case. That means that in anaphylaxis, after the two doses that are recommended, you would have only given the patient 0.3mg + 0.3mg = 0.6mg. That is less than 1mg which is one dose in the ACLS algorithm. But that is understandable since a cardiac arrest is a much worse situation than anaphylaxis.
In severe asthma exacerbation, the dose is 0.3 – 0.5 mg (1:1000 sol) SC/IM q20min x 3 doses prn.
In mydriasis, the dose is 0.1 ml (1:100,000 to 1:400,000 sol) intracamerally x 1
Understanding Lidocaine 1% or 2 % and Epinephrine dilution
When dealing with ratios, e.g. of epinephrine, 1:10,000 means 1g:10,000ml. However, when dealing with percentages, for example, Lidocaine 1% or Lidocaine 2%, it is 1 gram /100ml.
- A 1% solution literally means there is 1gram per 100mls. For example, 1g of lidocaine per 100mls of solvent (e.g. normal saline).
- This is the same as a 1:100 solution dilution.
(1) Lidocaine – “1%” (can also be known as 1:100 dilution)
(2) Epinephrine – “0.1%” (also commonly known as 1:1000 dilution)
This post explains dilution and epinephrine very well: https://emergencypedia.com/2014/01/07/the-solution-to-dilution/