Dilute epinephrine is used to reduce bleeding during surgery, either as a topical or injected agent. Toxicity can occur if too much epinephrine is absorbed.


Usually a dilute concentration is used for injection, 0.005% or less.

The concentration used for topical application is often 1 in 100,000.


Risk factors for toxicity with injected epinephrine:

(1) use of too high a concentration

(2) injection directly into an artery

(3) repeated and excessive administration


Risk factors for toxicity with topical epinephrine:

(1) application over a large surface area

(2) application over highly vascular tissue, an open wound or into medullary bone


Topical absorption may be slow, so the appearance of toxic effects may be delayed.


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