Nebulized Epinephrine for Croup

The administration of nebulized epinephrine to patients with moderate to severe croup often results in rapid improvement of upper airway obstruction. Epinephrine constricts precapillary arterioles in the upper airway mucosa and decreases capillary hydrostatic pressure, leading to fluid resorption and improvement in airway edema. 

Racemic versus L-epinephrine — Racemic epinephrine (not available in India), which is a 1:1 mixture of the D- and L-isomers, was initially thought to produce fewer systemic side effects, such as tachycardia and hypertension. However, a randomized double-blind study comparing racemic epinephrine and L-epinephrine in children with croup found no difference between the two preparations.

Dose of L-epinephrine (adrenaline) is administered as 0.5 mL/kg per dose (maximum of 5 mL) of a 1:1000 dilution. (Available adrenaline is in 1:1000 strength) It is given via nebulizer over 15 minutes.

Nebulized epinephrine treatments may be repeated every 15 to 20 minutes if warranted by the clinical course

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