Dear friends,

As I am sure you are aware, we have encountered a national shortage in the supply of Epinephrine 1:10,000. The anticipated date for beginning to supply again is approximately the end of June or early July 2010. Please assess your inventories of Epinephrine carefully.

Please use this note as authorization to use the following alternative method to administer 1:10,000 Epinephrine according to the BioTel Guidelines. In the absence of available stocks of Epinephrine 1:10,000, then this letter authorizes you to carry Epinephrine 1:1,000 as a substitute for Epinephrine 1:10,000, to be diluted according to the following method to produce Epinephrine 1:10,000.

Should the need arise in a situation where Epinephrine 1:10,000 is required for administration but no stock is available, it is satisfactory to dilute Epinephrine 1:1,000 to the appropriate concentration using one of the following two methods:

1. One dilution technique is to draw up the entire contents of a 1 cc ampule of Epinephrine 1:1,000 into a 10 cc syringe. After that, 9 cc of normal saline for injection are pulled into the syringe. Gentle mixing in the syringe should be done. This mixture is Epinephrine 1:10,000, and it may be administered according to the BioTel Guidelines. Careful attention to sterile technique should be maintained.

2. Another alternative dilution technique is to use a saline flush syringe for dilution. The provider may use a 10 cc syringe of saline flush to achieve the same dilution purpose above. The provider would eject 1 cc of saline from the 10 cc saline flush syringe, leaving 9 cc of saline remaining. The entire contents of an ampule of Epinephrine 1:1,000 (1 cc total) should then be pulled into the saline flush syringe, followed by mixing gently.

I understand also that D50 is back-ordered as well, so please assess your current stocks. Please report in if you have problems.

Thank you for your attention to this matter, and please do not hesitate to contact me if you have any questions or comments.


Ray Fowler, MD, FACEP
Chief of BioTel Operations
Professor of Emergency Medicine
Co-Chief in the Section on EMS, Disaster Medicine, and Homeland Security
UT Southwestern Medical Center


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