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What is epinephrine?
Epinephrine is a hormone produced in the body by the adrenal glands. It is released at times of acute stress to enhance our capability of "fight or flight". We all know the symptoms�the pounding heart, anxiety, tremor. It increases heart rate, diverts blood to the muscles, constricts blood vessels and opens the airways. When you give yourself a dose of epinephrine, you are giving your body something that it is making already. You are just giving it faster and at a higher dose.
When should I use my epinephrine auto-injector?
If you/your child are potentially anaphylactic, you need to give epinephrine at the first sign of a reaction without waiting to see if it will worsen. When someone who is known to be anaphylactic makes significant contact with their trigger, and they have demonstrated a rapid progression of symptoms in the past, epinephrine can be given even before the onset of symptoms.
How long will one dose be effective for?
Studies suggest that significant absorption is still occurring from a subcutaneous injection site after one hour. The absorption time should be more rapid from an intramuscular site (at least in children). The epinephrine auto-injector delivers its dose directly into muscle. If symptoms are still present or worsening after 10-20 minutes, a second dose should be administered. Most anaphylactic reactions will be controlled by the early injection of one dose of epinephrine. It is recommended, however, that at least two doses be kept on hand at all times or one dose for every 10-20 minutes of travel time to a medical facility.
What are the side effects of epinephrine?
Transient and minor side effects of epinephrine can include palpitation (pounding heartbeat), pallor (paleness), dizziness, weakness, tremor (trembling), headache, throbbing, restlessness, anxiety and fear.
What are the risks of epinephrine?
When used to treat a life-threatening reaction, there are no real contraindications to the use of epinephrine. There are few risks attached to the correct use of this drug, especially in children. Adults who are on medication or have significant health problems need to check with their physician about the potential for adverse effects.
While sulfites are present in the epinephrine solution as a preservative, they are not considered to be of concern for people with sulfite sensitivity.
What happens if I inject epinephrine into the wrong site?
If used correctly, significant injury is unlikely. Directions for use are on the package insert. The lateral (outer) aspect of the thigh is the safest site for intramuscular injection as there is minimal risk of injection into major blood vessels or nerves in this area. Intravascular injection (which could occur on the front of the thigh) could lead to acute cardiovascular compromise. Injection into a major nerve (which could occur on the posterior thigh or buttock) can cause significant damage. Accidental injection into the hand, particularly the digits, can cause serious injury and possibly gangrene. This injury needs to be urgently assessed and treated in an emergency room.
When does my child switch from a Jr. auto-injector to a regular auto-injector?
Dosage should be worked out with your physician, but the current general recommendation is that children begin to use the adult auto-injector when their weight approaches 25 kg (55 lbs.).
Where should I keep my auto-injectors?
Given the rapidity with which symptoms can develop and progress,
epinephrine must be available immediately. For this reason it
is recommended that anaphylactic or potentially anaphylactic
people carry their epinephrine with them at all times.
It makes no sense for the auto-injector to be in the office
while a food allergic child is eating in the lunchroom or an
insect sting allergic child is playing outside.
How many epinephrine auto-injectors
should I carry?
There should be at least two doses of epinephrine available at all times. A second dose could be required 10-20 minutes after the first if the reaction is continuing. This situation could occur if the reaction is very severe, the dose given is inadequate or the injector is faulty. This needs to be discussed with your allergist.
At what age should my child
carry his/her own epinephrine auto-injector?
This will vary from child to child. When they are very little,
pre-school children or their friends could injure themselves
while playing with an epinephrine auto-injector in a fanny pack.
At this stage, a caretaker would always be close at hand and
could carry the child's medication for them. This could also
be the case for children in nursery school and kindergarten.
As children progress through school, however, they move to different
classrooms, the lunchroom, gym, recess, and assembly. The only
reliable/consistent place for epinephrine is with the child.
This does not mean that young children would be expected to
inject themselves. While children can and must learn how to
do this from a very young age, they should still have our help.
The child could become too dizzy, confused or frightened to
deal with the situation. Life-long habits are also easiest to
establish early on. Many older children, who have not carried
their medication, find it difficult to start taking responsibility
for this.
How reliable is epinephrine?
If given correctly at the outset of a reaction, epinephrine is extremely reliable.
Do I have to take any precautions with the epinephrine?
Epinephrine is light sensitive and needs to be stored at a temperature
between 15-30� C. It should not be refrigerated and it can't
be left in a car during a heat wave or a cold snap. You should
check your solution regularly to ensure that there is no brown
discoloration or precipitate. You also need to keep an eye on
the expiry date. The shelf life for the epinephrine auto-injectoris
somewhere from 18-24 months. Make sure that you are getting
the best available date when you are making your purchase. Used
auto-injectors need to be discarded in a needle proof container to
minimize any chance of injury.
I used the epinephrine
auto-injector, but there seemed to be some solution still in
the device. Did I not inject it properly?
It may be worth noting that as each auto-injector and Jr. auto-injector
contains 2 ml of solution there will be 1.7 ml remaining after
injection.
Last date modified on Friday, August 1, 2008
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