Nursing Teaching on Side Effects of Epinephrine

Nurse educated the patient and caregiver on the side-effects of using Epinephrine as follows:

The side-effects of epinephrine vary widely, based on the dose and route of administration.

  1. General allergic reactions and constitutional side-effects: Epinephrine use can result in general allergic reactions, such as, skin rashes, hives, and itching. Some patients can present with symptoms of severe allergic and anaphylactic response with epinephrine, such as, difficulty breathing, swelling of face, lips, throat, and tongue, with consequent difficulty breathing. Seek emergency medical help for such findings, especially with difficulty breathing, for any appropriate measures to be considered. Epinephrine use can result in common general constitutional symptoms such as, nausea and vomiting.
  2. Cardiovascular side-effects: Epinephrine use can result in narrowing of blood vessels, contributing to elevated blood pressure, headache, and dizziness. This can be a serious issue, especially in individuals with history of hypertension. Epinephrine use can increase the cardiac performance and the pumping action of the heart, thus resulting in increased volume of blood pumped out of the heart during contraction of heart chambers. This action of epinephrine can also contribute to acutely elevated blood pressure, thus increasing the risk for development of stroke. Epinephrine use may cause very rapid heart rate and can lead to even arrhythmias. In individuals with history of arrhythmias, use of epinephrine can aggravate underlying cardiac arrhythmias leading to severe debility and death. Individuals can present with episodes of lightheadedness, dizziness, pounding heartbeat, and chest pain, due to arrhythmias secondary to epinephrine use. Epinephrine use can also result in narrowing of coronary arteries, supplying oxygenated blood to the heart, thus compromising the blood supply to the heart muscle. This can result in episodes of chest pain and heart attack.
  3. Renal system side-effects: Epinephrine use can result in narrowing of blood vessels in the renal system, contributing to reduced blood flow to the kidneys, decreased filtration by glomerulus, reduced urine formation and decreased urinary output. Low urine output due to epinephrine can result in increased fluid retention, which can lead to edema, swelling, and rapid weight gain.  Individuals with history of compromised renal function can be at increased risk for deteriorating renal function with epinephrine use.
  4. Central nervous system side-effects: Epinephrine, secondary to changes in blood pressure and heart rate, can induce some dizziness and make one drowsy. Epinephrine use also can increase the nervousness, sweating, and anxiety, resulting in impulsiveness, irritability, aggressive behavior, and even seizures.
  5. Tissue damage and necrosis: Repeated epinephrine administration into the same site can result in closing the blood vessels down locally, around the site of injection, thus shutting off the blood supply in that area. Decreased blood supply can reduce the absorption of epinephrine from the site of injection, thus compromising the therapeutic advantage. As epinephrine administration can compromise blood supply in the surrounding tissues, the site of administration can present with numbness, altered sensation, coldness, and pallor. Secondary to poor oxygenated blood supply, the site of epinephrine administration and surrounding tissues can sometimes present with signs and symptoms of infection, such as, redness, pain and tenderness, and swelling. Reduced local blood supply can also result in local tissue death, necrosis, and development of ulcers in the site of repeated epinephrine administration.