What is the concentration of PUSH DOSE EPINEPHRINE used in the protocol for refractory septic shock?

• A. 1:1000
• B. 1:100000
• C. 1:10000
• D. 1:10

Answer: (B)

Push-dose epinephrine in refractory septic shock is given as a very dilute, titratable bolus to quickly raise perfusion while allowing precise control of blood pressure. The concentration used is 1:100,000, which equals about 10 micrograms per milliliter. This is achieved by diluting one part of the standard 1:10,000 epinephrine with nine parts normal saline, producing 10 mL of 1:100,000 solution. Administer small boluses (for example, 0.5 mL to deliver ~5 mcg, then repeat as needed) every few minutes and titrate to the desired MAP and perfusion. This concentration strikes a balance between achieving a rapid vasopressor effect and avoiding large, abrupt changes in blood pressure or excessive vasoconstriction, which is why it’s used in this protocol.