Extreme central acidosis from Abbott epinephrine.

Area of Science:

• Pharmacology
• Critical Care Medicine
• Biochemistry

Background:

• Systemic acidosis is a critical complication during cardiac arrest.
• Epinephrine is a standard resuscitation medication.
• Variations in pharmaceutical preparations can impact patient outcomes.

Purpose of the Study:

• To investigate the cause of extreme systemic acidosis during cardiac arrest.
• To analyze the acid content of different epinephrine formulations.
• To determine the clinical implications of high-acid epinephrine.

Main Methods:

• In vivo and in vitro analysis of epinephrine products.
• Comparative assessment of acid levels in Abbott, Bristol Laboratories, and Parke-Davis preparations.
• Evaluation of the effects of Abbott epinephrine on acidemia.

Main Results:

• Abbott's 1:10,000 single-dose epinephrine contained significantly higher acid levels (8.2x and 1,850x) compared to Bristol Laboratories and Parke-Davis preparations, respectively.
• Injected Abbott epinephrine induced extreme acidemia.
• This acidemia poses a potentially lethal risk, especially in patients with pre-existing acidosis.

Conclusions:

• High unsuspected acid levels in Abbott epinephrine contribute to severe systemic acidosis during cardiac arrest.
• Pharmaceutical quality control is crucial for critical care medications.
• Clinicians should be aware of potential variations in epinephrine preparations.