What is the recommended dose of epinephrine (adrenaline) for pediatric patients?

From the Guidelines

The recommended dose of epinephrine for pediatric patients is 0.01 mg/kg, with a maximum single dose of 0.3 mg for children under 30 kg and 0.5 mg for larger children, administered intramuscularly for anaphylaxis, as supported by the study published in Pediatrics in 2007 1.

Key Considerations

• The dose of epinephrine for pediatric patients should be based on their weight, with a dose of 0.01 mg/kg being the recommended starting point.
• Auto-injectors are available in fixed doses of 0.15 mg and 0.30 mg, and the choice of auto-injector should be based on the child's weight, with 0.15 mg being suitable for children weighing 10-25 kg and 0.30 mg being suitable for children weighing over 25 kg 1.
• The study published in Pediatrics in 2007 1 provides guidance on the selection of epinephrine auto-injectors for infants and children, including a table outlining the optimal dose and available auto-injector options for different weight ranges.

Administration and Monitoring

• Epinephrine should be administered intramuscularly in the lateral thigh (vastus lateralis) for first-aid treatment of anaphylaxis.
• Caregivers should be aware of the potential for adverse effects, such as pallor, tremor, anxiety, and palpitations, and avoid unnecessary repeat dosing.
• In cases where an auto-injector containing an appropriate dose is not available, the situation is never truly acceptable, and the physician must determine the risk versus benefit of selecting a fixed dose that is either too low or too high 1.

Special Considerations

• Clinical issues that may add risk to underdosing and indicate a relative benefit for a higher dose may include concurrent asthma, previous anaphylaxis to certain allergens, poor access to emergency services, and/or lack of supervision.
• The implications of the "empty-ventricle syndrome" caused by blood pooling in the legs during anaphylactic shock are not known for children, but caregivers should be advised to keep individuals with severe anaphylaxis in a supine position with legs raised until advanced care can be accessed 1.

From the FDA Drug Label

Adults and Children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 mL to 0. 5 mL) of undiluted Adrenalin® administered intramuscularly or subcutaneously in the anterolateral aspect of the thigh, up to a maximum of 0.5 mg (0.5 mL) per injection, repeated every 5 to 10 minutes as necessary. Children less than 30 kg (66 lbs): 0.01 mg/kg (0. 01 mL/kg) of undiluted Adrenalin® administered intramuscularly or subcutaneously in the anterolateral aspect of the thigh, up to a maximum of 0.3 mg (0.3 mL) per injection, repeated every 5 to 10 minutes as necessary.

The recommended dose of epinephrine for pediatric patients is:

• For children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 mL to 0.5 mL) per injection, repeated every 5 to 10 minutes as necessary.
• For children less than 30 kg (66 lbs): 0.01 mg/kg (0.01 mL/kg), up to a maximum of 0.3 mg (0.3 mL) per injection, repeated every 5 to 10 minutes as necessary 2.

From the Research

Recommended Dose of Epinephrine for Pediatric Patients

• The recommended dose of epinephrine for pediatric patients is 0.01 mg/kg, with a maximum dose of 0.3-0.5 mg 3, 4.
• For infants weighing less than 15 kg, the Canadian Society of Allergy and Immunology recommends prescribing the 0.15 mg epinephrine auto-injector due to the lack of a suitable alternative 3.
• A newly available 0.1 mg epinephrine auto-injector has a lower dose and shorter needle, making it better suited for patients weighing 7.5 to 15 kg 4.
• The American Heart Association recommends an intravenous epinephrine dose of 0.01 to 0.03 mg/kg per dose for pediatric patients, with higher doses not recommended 5.

Administration of Epinephrine in Pediatric Anaphylaxis

• In cases of anaphylaxis, epinephrine should be administered promptly, with 54% of pediatric patients receiving epinephrine prior to EMS arrival 6.
• EMS personnel may not be treating anaphylaxis appropriately with epinephrine, with only 12% of patients not given epinephrine prior to EMS arrival receiving it from EMS 6.
• The use of epinephrine auto-injectors in pediatric patients is crucial, with the device and needle length being important considerations for effective administration 4.