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Racemic Epinephrine
Aka: Racemic Epinephrine, Nebulized racemic epinephrine
- Indications
- Moderate to Severe Croup
- Respiratory Syncytial Virus (Bronchiolitis)
- Mechanism
- Alpha-adrenergic effect
- Mucosal Vasoconstriction decreases subglottic edema
- Rapid response in croup (within 10-30 minutes)
- Consider Croup Differential Diagnosis if no response
- Effect dissipates in 2 hours (some effects may persist up to 4 hours)
- Pharmacokinetics
- Effect onset within 10-30 minutes
- Effects last 90 to 120 minutes (with some effects lasting up to 4 hours)
- Precautions
- Avoid too frequent use due to tachyphylaxis
- Observe 2-3 hours after Racemic Epinephrine
- Patient may go home safely if no worsening in 2-3 hours
- Most croup decompensations will occur 1 to 1.5 hours after nebulized Epinephrine
- Typically admit patient if requires repeat Epinephrine nebs
- See Croup protocol which allows discharge after 2 Epinephrine nebs and adequate observation without decompensation
- Dose
- See Croup
- Nebulizer mix
- Normal Saline 2.0 to 3.5 ml
- Racemic Epinephrine (2.25%)
- Dose: 0.05 ml/kg (maximum 0.5 ml in children)
- Child under 6 months: 0.25 ml
- Child: 0.5 ml
- Adolescent: 0.75 ml
- Alternative option
- L-Epinephrine 0.5 ml/kg (maximum 5 ml) of 1:1,000 via nebulizer
- Similar efficacy to Racemic Epinephrine and more widely available
- Frequency of dosing
- Nebulized Epinephrine may be repeated in 30 minutes
- Monitor Heart Rate closely with repeat dosing
- Efficacy: Bronchiolitis
- Significantly more effective than Beta-agonist
- Reduced hospital admissions significantly
- Reduced time spent in emergency room significantly
- References
- Menon (1995) J Pediatr 126:1004-7 [PubMed]