Friday, August 30, 2013

Epinephrine: Its Many Ways to Save Your Life

One of my favorite organic molecules is epinephrine because of its many functions in the human body and its many uses in medicine.  Epinephrine, more commonly known as adrenaline, is formed from the amino acids phenylalanine and tyrosine and is formed in the medulla of the adrenal gland in the human body.  There are several instances in which the body produces its own epinephrine; as a result of the “Fight or Flight” response.  In times in which an individual feels fear or anger, or engages in strenuous activity and the body responds by increasing the production of epinephrine.  When released into the body during times of increased stress, more blood will be directed to the tissues.  
When epinephrine is produced exogenously, the applications are seemingly endless.  Currently, the use of epinephrine is approved in emergency departments in hospitals across the country for cardiac arrest, anaphylaxis, severe asthma attacks, and superficial bleeding.  In the ER, if a patient’s heart stops, after starting CPR one of the ER physician’s next decisions is what drugs to administer.  Epinephrine is often the drug of choice for cardiac arrest and other dysrhythmias because it increases cardiac output.  Epinephrine acts on the α1receptors which increase arterial blood pressures.  
I am sure that we all hope that we never have to worry about cardiac arrest, but a much more common indication for epinephrine that many people encounter on a daily basis is the use of epinephrine in the treatment of acute allergic reactions including anaphylaxis.  We are finding that you can be allergic to almost anything, even water!  Some of the more common allergies that people suffer from are nuts, milk products, penicillin, aspirin, latex, bee stings, and ant bites.  Epinephrine stops the body’s swelling response by initiating vasodilation and decreasing mucosal swelling.  If someone who is allergic to bees is stung on their hand, the hand will swell and the person may break out in a rash (urticaria) and in more severe cases, their airway may begin to constrict.  The most common form of epinephrine in outside of hospitals is the Epi-Pen, an auto-injector that can be administered to the leg.  Once epinephrine has entered the body, the person’s swelling will decrease and their allergic rash may begin to subside.  Though the person will still need to seek medical treatment in order to receive steroids and antihistamines in order to completely relieve the symptoms of the reaction, epinephrine can be the difference between life and death for those who suffer from severe allergies.  
I have encountered one of epinephrine’s other uses on far too many occasions.  As an athlete, outdoor enthusiast, and natural born klutz I have ended up in many Urgent Care clinics to have wounds sutured.  Many times, when a provider needs to suture a wound, when they inject lidocaine or other anesthetic into the wound to numb the area, they also inject epinephrine.  When injected into the tissues instead of directly into the blood, epinephrine is a vasoconstrictor so the anesthetic medications last longer instead of being transported away from the wound.  Another effect is that because it is a vasoconstrictor, the total blood loss is less for the patient. The patient appreciates this fact, and the provider does too-because visualization of the wound is better, so the wound repair may be better-appearing and the total procedure time will be less.

File:Epinephrine structure.svg

IUPAC Name: (R)-4-(1-hydroxy-2-(methylamino)ethyl)benzene-1,2-diol


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