The Mythical Shot of Adrenaline

Recently, I read a great thriller by a well-known author, who had a wee little error in his medical facts, but one that took me out of the story at a key moment: As the injured and sleep-deprived protagonist desperately seeks to save his daughter from a horrific serial killer (yeah, redundant, but this guy was super-twisted), he asks a doctor to give him a shot of adrenaline. Said doctor complies.

Unfortunately, that scenario sets off the MD BS-detector (and I don’t mean Bachelor of Science).

Epinephrine.svg

Adrenaline

A “shot of adrenaline” does exist, as in the epi-pen prescribed for those with an anaphylactic reaction (lethal allergy) to bee stings or peanuts. The intramuscular injection prevents the most deadly effects, including closure of the airways (bronchospasm) and low blood pressure (vasodilation). However, the injection lasts no more than fifteen minutes, and that only because of gradual release from the muscle. Once in the bloodstream, adrenaline lasts less than a minute.

The rationale is not unreasonable, when we exercise, or are terrified, or are terrified because someone suggested we exercise, we secrete adrenaline. It increases breathing, heart rate and blood flow, and releases sugar into the bloodstream (energy to burn, so to speak). But a shot into a muscle for gradual absorption is not the same as your body dripping it into your blood stream. Not to mention, adrenaline is only one of many hormones of exercise.

And then there’s the down-side–heart attack from constricting the coronary vessels, cardiac arrest from arrhythmia, stroke from extremely elevated blood pressure, etc.

So, while a well-timed injection of adrenaline can save the life of an anaphylaxis or cardiac arrest patient, an unnecessary shot of adrenaline is more likely to be lethal than to give your hero energy to chase the bad guy.

As an aside, the whole “adrenaline vs epinephrine” argument is interesting, though perhaps only to geeky wordophiles. The hormone was identified in an extract from the top of the kidney. In Greek derivation, on (ad) the kidney (renal). Unfortunately, the company that marketed the drug trademarked the name Adrenalin (without the ‘e’) in the US. So, while the rest of the world uses the term adrenaline, in the US we use the Latin version epi (on) nephron (kidney) = “epinephrine.”

Not a big deal, until a US doctor in Europe tries to help in an emergency and skips over a vial of adrenaline in search of epinephrine (or vice versa, of course).

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