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When ordering emergency epinephrine, why does the NRP express the dose as a mass (mg/kg) and a volume (mL/kg)?

Because this question has not been fully resolved, this program describes the dose using both mass (mg/kg) and volume (mL/kg) expressions. Each method has risks and benefits. If the dose is expressed using the mass method, the team member preparing the dose will need to convert milligrams to milliliters, and there is a risk of making a decimal point error. If the dose is expressed using the volume method, the provider preparing the dose does not have to convert between units, but there is a risk of giving a 10-times overdose if the provider accidently uses the concentrated (1 mg/mL) epinephrine solution. This medication error is preventable by ensuring that the dilute (0.1 mg/mL) solution of epinephrine is the ONLY concentration included in neonatal emergency supplies.

Whichever dosing method is used, the providers should use closed-loop communication, repeat back the intended dose, include the desired units and the baby’s estimated weight when ordering and preparing the dose, confirm the concentration of the epinephrine solution used by showing the box to another team member, and compare the prepared dose with a weight-based chart or table to ensure accuracy. 

(February 2022)

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