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Stability of epinephrine in alkalinized solutions
L Bonhomme1, D Benhamou, E Comoy
1Laboratoire de Pharmacie et de Toxicologie, Hôpital Antoine Béclère, Clamart, France.
Annals of Emergency Medicine
|November 1, 1990
Summary
Epinephrine and sodium bicarbonate can be infused together during cardiopulmonary resuscitation (CPR). While alkaline solutions do degrade epinephrine, the reaction is slow and may not significantly impact its biological activity in short-term clinical use.
Area of Science:
- Pharmacology
- Emergency Medicine
- Biochemistry
Background:
- Elevated pH in epinephrine solutions accelerates oxidation, potentially reducing biological activity.
- It is commonly advised against co-infusing epinephrine and sodium bicarbonate via the same IV line during CPR due to this concern.
Purpose of the Study:
- To investigate the validity of the assumption that epinephrine and sodium bicarbonate should not be administered together during CPR.
- To assess the stability of epinephrine when mixed with sodium bicarbonate.
Main Methods:
- Two epinephrine solutions with varying sodium metabisulfite concentrations (0.46% and 0.02%) were studied.
- Epipnephrine solutions were diluted in 8.4% sodium bicarbonate at two dosages (1 mg/1 mL and 10 mg/10 mL).
- Epinephrine concentration was monitored over a two-week period.
Main Results:
- Epinephrine concentration declined slowly over two weeks, reaching zero.
- At 30 minutes post-alkalinization, epinephrine concentrations remained at approximately 70% and 100% of control values.
- The rate of degradation was dependent on the initial sodium metabisulfite concentration.
Conclusions:
- Epinephrine undergoes oxidation in alkaline solutions.
- The oxidation reaction is slow, suggesting it may not be clinically significant for short durations.
- Co-administration of epinephrine and sodium bicarbonate during CPR may be safe for short-term use.