From the Guidelines
For anaphylaxis requiring intravenous adrenaline (epinephrine), the recommended infusion rate is 0.05 to 0.1 mg (0.1 mg/mL, aka 1:10 000) via an IV line, with close hemodynamic monitoring, as stated in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
Key Considerations
- The first-line treatment for anaphylaxis remains intramuscular epinephrine (0.3-0.5 mg of 1:1000 solution), with intravenous administration considered for severe cases unresponsive to initial treatment or in anaphylactic shock.
- When administering epinephrine intravenously, it is crucial to monitor patients closely for potential side effects such as tachycardia and hypertension.
- The IV infusion of epinephrine may be considered as an alternative to IV boluses for the treatment of anaphylaxis in patients not in cardiac arrest, as per the guidelines 1.
Preparation and Administration
- Prepare the infusion by adding 1 mg of epinephrine (1 mL of 1:1000 solution) to 100 mL of normal saline, creating a concentration that can be adjusted based on clinical response.
- Administration should ideally be via a central line, if possible, with continuous cardiac monitoring, frequent blood pressure checks, and pulse oximetry.
Clinical Context
- Anaphylaxis is a severe, life-threatening allergic reaction that requires immediate medical attention.
- The use of epinephrine in anaphylaxis works by stimulating alpha-1 receptors to increase peripheral vascular resistance, beta-1 receptors to increase cardiac output, and beta-2 receptors to cause bronchodilation and decrease inflammatory mediator release.
- Given the potential for rapid development of oropharyngeal or laryngeal edema, immediate referral to a health professional with expertise in advanced airway placement is recommended 1.
From the Research
Adrenaline Infusion Rate for Anaphylaxis
- The recommended initial adult dose of adrenaline (epinephrine) for anaphylaxis is 0.3-0.5 mg, injected intramuscularly in the anterolateral aspect of the mid-thigh 2.
- For patients unresponsive to repeated intramuscular injections, a continuous infusion of epinephrine should be started 3.
- The use of adrenaline autoinjectors is recommended for first-aid treatment of anaphylaxis in the community, with novel formulations being developed to improve safety and ease of use 2, 4.
- Alternative routes of administration, such as intranasal, sublingual, inhaled, and needle-free intramuscular, are being investigated as potential alternatives to intramuscular epinephrine administration 4.
- It is essential to administer epinephrine promptly and through the optimal route to ensure effective treatment of anaphylaxis, with delays in treatment potentially leading to increased morbidity and mortality 3, 5.
Key Considerations
- Epinephrine is the drug of choice for the treatment of anaphylaxis, with no other medication having similar life-saving pharmacologic effects 2.
- Antihistamines and corticosteroids are second-line medications and should never be given in lieu of, or prior to, epinephrine 3.
- Aggressive fluid resuscitation should be used to treat the intravascular volume depletion characteristic of anaphylaxis 3.
- Patient observation and disposition should be individualized, with no well-defined period of observation after resolution of signs and symptoms 3, 6.