Pharmacology · patient case question
What is the maximum dose of epinephrine for a patient with significant cardiac disease?
Patient case: The medically complex patient in the chair
Scenario: Three management questions in patients with cardiovascular and metabolic disease.
Show answer and explanation
Correct answer: C. 0.04 mg
- A. 0.2 mg is the ceiling for a healthy ASA I–II patient, roughly eleven cartridges of 1:100,000.
- B. 0.1 mg is not a recognised ceiling for either group.
- C. Correct. The cardiac-risk ceiling is 0.04 mg — about two cartridges of 1:100,000 epinephrine, since each 1.8 mL cartridge contains roughly 0.018 mg.
- D. 0.5 mg is the dose of epinephrine given intramuscularly for anaphylaxis, not a local anaesthetic limit.
Note: Cardiac-risk patients here means ASA III–IV: recent MI or stroke, unstable angina, uncontrolled arrhythmia, or uncontrolled hypertension.