Epinephrine Dosing in Pediatric ACLS for a 3-Year-Old
For a 3-year-old child weighing 34.2 pounds (15.5 kg), the recommended epinephrine dose in ACLS is 0.01 mg/kg or 0.155 mg (1.55 mL of 1:10,000 concentration) via intravenous or intraosseous route. 1
Dosing Calculation and Administration
Primary Dosing
- Weight-based dosing: 0.01 mg/kg = 0.155 mg for this 15.5 kg child
- Administration route:
- IV/IO: 0.1 mL/kg of 1:10,000 concentration (1.55 mL total)
- If no IV/IO access: Endotracheal route at 0.1 mg/kg (0.1 mL/kg of 1:1,000 concentration) 1
Administration Schedule
- Initial dose as above
- Repeat every 3-5 minutes during ongoing resuscitation
- Maximum single dose: 1 mg (10 mL) 1
Evidence-Based Considerations
The American Heart Association guidelines clearly specify the epinephrine dosing in pediatric advanced life support. This recommendation is supported by strong evidence (Class I, Level of Evidence B) 1. The guidelines emphasize that high-dose epinephrine provides no survival benefit and may be harmful, particularly in asphyxial arrests, which are more common in pediatric patients (Class III, LOE B).
For this 3-year-old child:
- The weight of 34.2 pounds (15.5 kg) places them in a category where precise weight-based dosing is preferred over fixed-dose autoinjectors that are typically used for anaphylaxis management 1
- The 0.15 mg autoinjector would provide a near-optimal dose for this weight, but in ACLS, precise IV/IO dosing is preferred 1
Practical Administration Tips
- Prepare epinephrine 1:10,000 solution (0.1 mg/mL)
- Draw up 1.55 mL (0.155 mg) for this 15.5 kg child
- Administer via IV/IO push during CPR
- Flush with 5-10 mL of normal saline after administration
- Continue CPR immediately after administration with minimal interruptions to chest compressions
Common Pitfalls to Avoid
Dosing errors: Confusion between 1:1,000 and 1:10,000 concentrations is common. For IV/IO use in ACLS, always use 1:10,000 concentration.
Excessive dosing: Research shows that high cumulative doses of epinephrine (>15 mg total) are associated with impaired oxygen delivery and consumption post-resuscitation 2.
Delayed administration: Epinephrine should be given as soon as vascular access is established in non-shockable rhythms, or after the first shock in shockable rhythms.
Inadequate CPR quality: Effective chest compressions are essential for epinephrine to circulate and reach target tissues.
Remember that while epinephrine is a cornerstone of pediatric ACLS, high-quality CPR with minimal interruptions remains the foundation of successful resuscitation. The timing and quality of CPR may be more important than the absolute dose of epinephrine in determining outcomes.