Paradoxical hypotension is an unrecognized risk of push-dose epinephrine overdose

Readers [1] have looked to recent publications in the Journal for insight on the risks of push-dose pressor (PDP) overdose [2,3]. These publications, especially the observational study of prefilled phenylephrine and ephedrine PDPs by Rotando et al., provide a valuable acknowledgement of the frequent errors and adverse effects (AEs) that occur. Reassuringly, no irreversible harm was described, and AEs were generally exaggerations of the desired hypertensive effects. However, larger overdoses can occur when PDP use is attempted with epinephrine 1  mg syringes than with prefilled PDPs, as 1000 μg phenylephrine may be equipotent to only 100 μg epinephrine [4].
Source: The American Journal of Emergency Medicine - Category: Emergency Medicine Authors: Source Type: research