What is the dose of adrenaline (epinephrine) with dilution for emergency situations?

Adrenaline (Epinephrine) Dosing and Dilution for Emergency Situations

For anaphylaxis management, epinephrine should be administered intramuscularly in the anterolateral thigh at a concentration of 1:1000 (1 mg/mL) at a dose of 0.01 mg/kg up to 0.5 mg in adults and 0.3 mg in children. 1

Intramuscular (IM) Administration - First Line

Adult Dosing

• Adults and children ≥30 kg (66 lbs): 0.3-0.5 mg (0.3-0.5 mL of 1:1000 solution) 1, 2
• Inject into anterolateral thigh (vastus lateralis muscle) for faster absorption 3, 1
• May repeat every 5-15 minutes as necessary based on clinical response 1

Pediatric Dosing

• Children <30 kg (66 lbs): 0.01 mg/kg (0.01 mL/kg of 1:1000 solution), up to 0.3 mg 1, 2
• Weight-based recommendations:
  • 25-30 kg (55-66 lbs): 0.3 mg
  • 10-25 kg (22-55 lbs): 0.15 mg
  • <10 kg: 0.01 mg/kg (up to 0.3 mg) 1

Intravenous (IV) Administration - For Severe Cases Only

IV Bolus (Only for profound hypotension or cardiac arrest)

• 0.05-0.1 mg (0.5-1 mL of 1:10,000 solution) 1

IV Infusion Preparation Options

1. Option 1: Add 1 mg (1 mL of 1:1000 epinephrine) to 250 mL of D5W to yield a concentration of 4.0 μg/mL 3

   • Infuse at 1-4 μg/min (15-60 drops/min with microdrop apparatus)
   • Can increase to maximum of 10 μg/min for adults and adolescents 3

2. Option 2: Add 1 mg (1 mL of 1:1000) epinephrine to 1000 mL of normal saline 1

   • Start at 2 μg/min (2 mL/min or 120 mL/hr)
   • May increase up to 10 μg/min (10 mL/min or 600 mL/hr)
   • Titrate according to blood pressure, cardiac rate, and oxygenation 1

3. Alternative for 1:100,000 solution: Add 1 mg (1 mL) in 100 mL saline 3

   • Initial rate of 30-100 mL/hr (5-15 μg/min)
   • Titrate based on clinical response or side effects 3

Pediatric IV Infusion

• Dose: 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution; maximum dose, 0.3 mg) 3
• Alternative "rule of 6" dosing: 0.6 × body weight (kg) = number of milligrams diluted to total 100 mL of saline
  • 1 mL/hr delivers 0.1 μg/kg/min 3

Endotracheal Administration (If IV/IO Access Unavailable)

• Use 2-3 times the standard IV dose diluted in 10 mL of 0.9% saline 3
• Follow with five ventilations to maximize absorption 3

Critical Considerations

1. Route Selection:

   • IM injection into the anterolateral thigh produces higher and more rapid peak plasma levels compared to arm injections 3
   • IV route should be reserved for cardiac arrest or profound hypotension unresponsive to IM epinephrine and fluid resuscitation 1

2. Safety Warnings:

   • No absolute contraindication to epinephrine in anaphylaxis 3, 1
   • Several anaphylaxis fatalities have been attributed to injudicious use of intravenous epinephrine 3
   • Continuous hemodynamic monitoring is essential when administering IV epinephrine 3

3. Common Errors to Avoid:

   • Incorrect injection site (thigh is preferred over arm) 1
   • Delayed administration (associated with increased mortality) 1
   • Overreliance on antihistamines instead of epinephrine as first-line treatment 1

4. Monitoring Requirements:

   • Continuous cardiac monitoring
   • Frequent blood pressure measurements
   • Pulse oximetry 1

By following these guidelines for adrenaline (epinephrine) administration, healthcare providers can effectively manage emergency situations requiring this critical medication while minimizing risks.