Which is a precaution when using epinephrine 1:1000?

• A. Hypertension
• B. Tachycardia
• C. Pulmonary edema
• D. Narrow angle glaucoma

Answer: (C)

Epinephrine 1:1000 has powerful effects on both the heart and blood vessels, raising heart rate and contractility while constricting vessels. That combination increases the pressure that the left side of the heart has to pump against. In someone with limited cardiac reserve or existing heart failure, this can raise left atrial and pulmonary venous pressures enough to push fluid into the lungs, causing pulmonary edema. So, pulmonary edema is a meaningful precaution because it reflects a potential serious cardio-pulmonary complication from epinephrine’s hemodynamic impact, especially in susceptible patients or if dosing/route lead to higher systemic exposure.

Hypertension and tachycardia are common, expected effects of epinephrine and are monitored, rather than unusual precautions. Narrow-angle glaucoma is a consideration with some adrenergic agents, but the most immediate and clinically significant precaution in many emergency settings relates to the risk of pulmonary edema when the cardiovascular system is stressed.