What is the recommended dose and administration of epinephrine (adrenaline) in a clinical setting?

From the Guidelines

The recommended dose and administration of epinephrine for anaphylaxis is 0.01 mg/kg (1mg/mL dilution, to a maximum total dose of 0.5 mL) intramuscularly into the lateral thigh muscle, which can be repeated every 5–15 min if needed, as supported by the most recent and highest quality study 1.

Key Considerations

• For adults, the dose is typically 0.3-0.5 mg (0.3-0.5 mL of 1:1000 solution) intramuscularly in the mid-outer thigh.
• For children weighing less than 30 kg, the dose is 0.15 mg.
• The dose can be repeated every 5-15 minutes if anaphylaxis signs or symptoms persist.
• Epinephrine should be administered intramuscularly into the vastus lateralis (antero-lateral thigh) for optimal absorption and effect.

Administration and Monitoring

• When administering epinephrine, monitor vital signs closely, as it can cause tachycardia, hypertension, and arrhythmias.
• Additional emergency management includes placing the patient in a supine position if their presentation is mainly cardiovascular, monitoring vital signs, and administration of oxygen to patients with respiratory distress and those receiving further doses of epinephrine.
• Intravenous fluids should be administered early with the first epinephrine dose to patients with cardiovascular involvement and should be repeated if lack of response.

Special Considerations

• For patients receiving beta-blockers, glucagon 1–5 mg i.v. infusion over 5 min and followed by an infusion (5–15 mg/min) titrated to clinical response may be useful for treating refractory cardiovascular effects.
• Antihistamines and glucocorticoids are not reliable interventions to prevent biphasic anaphylaxis, but may be used as adjunctive therapy for cutaneous signs and symptoms associated with anaphylaxis.
• The use of epinephrine in anaphylaxis is supported by strong evidence, with no absolute contraindications to its use, as stated in 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Epinephrine Injection, USP is administered by intravenous injection and/or in cardiac arrest, by intracardiac injection into the left ventricular chamber or via endotracheal tube directly into the bronchial tree. The adult intravenous dose for hypersensitivity reactions or to relieve bronchospasm usually ranges from 0.1 to 0.25 mg (1 to 2. 5 mL of 1:10,000 solution), injected slowly.

Inject Adrenalin® intramuscularly or subcutaneously into the anterolateral aspect of the thigh, through clothing if necessary. When administering to a child, to minimize the risk of injection related injury, hold the leg firmly in place and limit movement prior to and during an injection. The injection may be repeated every 5 to 10 minutes as necessary

The recommended dose and administration of epinephrine in a clinical setting are as follows:

• Intravenous administration: 0.1 to 0.25 mg (1 to 2.5 mL of 1:10,000 solution) for adults, injected slowly, for hypersensitivity reactions or to relieve bronchospasm 2.
• Intramuscular administration: 0.3 to 0.5 mg (0.3 mL to 0.5 mL) for adults and children 30 kg (66 lbs) or more, repeated every 5 to 10 minutes as necessary 3.
• Pediatric dose: 0.01 mg/kg (0.01 mL/kg) for children less than 30 kg (66 lbs), up to a maximum of 0.3 mg (0.3 mL) per injection, repeated every 5 to 10 minutes as necessary 3.
• Cardiac arrest: 0.5 to 1.0 mg (5 to 10 mL of 1:10,000 solution) may be given intravenously, and the dose can be repeated every 5 minutes 2.

From the Research

Epinephrine Administration

The administration of epinephrine is a critical aspect of treating various medical emergencies, including cardiac arrest and anaphylaxis. The recommended dose and route of administration vary depending on the indication.

Dosing for Anaphylaxis

• For anaphylaxis, epinephrine is given intramuscularly at a low dose 4.
• The use of prefilled intramuscular dose syringes can help avoid confusion and errors in dosing 4.

Dosing for Cardiac Arrest

• For cardiac arrest, a higher dose of epinephrine is required, typically administered intravenously 4, 5.
• The optimal dose of epinephrine during cardiopulmonary resuscitation (CPR) is unknown, but studies suggest that a dose of 1 mg may be insufficient, and higher doses (3-5 mg) may be required every 5 minutes or as a continuous infusion 5.
• Current guidelines recommend administering 1 mg of epinephrine every 3-5 minutes during CPR, but the evidence for this interval is limited 6.

Potential Risks and Complications

• Inadvertent epinephrine overdose can occur due to confusion about proper dosing, leading to potentially lethal complications 4, 7.
• High-dose epinephrine administration can cause severe systolic dysfunction, cardiac complications, and even death 4, 7.
• However, in some cases, high-dose epinephrine may be beneficial, such as in anaphylaxis-associated cardiac arrest with severe vasoplegic state 7.

Best Practices

• Clear packaging and labeling of epinephrine syringes can help avoid errors and unnecessary complications 4.
• Standardization of dosing and administration protocols, as well as closed-loop communication, can reduce the risk of medical errors 7.