Racepinephrine (Racemic epinephrine) is used for croup patients who have stridor at rest and post extubation stridor. It is currently on national shortage and many facilities have a very limited supply of the nebules on hand. In times of shortage, intravenous EPINEPHRINE 1 mg/mL can be utilized as a nebulized solution in place of racepinephrine using the dosing of 0.5 mg/kg to a max of 5 mg. Doses that result in a volume of less than 3 mL should have normal saline added to the nebulizer to make a minimum volume of 3 mL.
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About the Author: Brad Sobolewski, MD, MEd
Brad Sobolewski, MD, MEd is a Professor of Pediatric Emergency Medicine and an Associate Director for the Pediatric Residency Training Program at Cincinnati Children's Hospital Medical Center. He is on Twitter/X @PEMTweets, on Instagram @BradSobolewski, authors the Pediatric Emergency Medicine site PEMBlog and is the host and creator of PEM Currents: The Pediatric Emergency Medicine Podcast. All views are strictly my own and not official medical advice.
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The 1mg/ml solution would be more commonly recognized as the IM solution, with the IV solution of Epinephrine being 1mg/10ml, no?
Yes Patrick – using a smaller volume is preferred for nebulized solution “recipes”