From the Guidelines
For anaphylaxis, the recommended intravenous (IV) epinephrine dose is 0.01 mg/kg (0.1 mL/kg of a 1:10,000 solution; maximum dose, 0.3 mg) for children, and an initial rate of 30 to 100 mL/h (5-15 mg/min) for adults, titrated up or down depending on clinical response or epinephrine side effects (toxicity) 1.
Key Considerations
- The IV epinephrine dose should be administered slowly and with caution, as it can cause cardiac arrhythmias 1.
- Continuous cardiac monitoring is essential during IV administration due to the risk of cardiac arrhythmias 1.
- IV epinephrine should only be used when intramuscular administration isn't possible or in cases of severe, life-threatening anaphylaxis with cardiovascular collapse 1.
- The solution can be prepared by adding 1 mg (1 mL) of a 1:1000 dilution of epinephrine to 250 mL of D5W to yield a concentration of 4.0 mg/mL, and infused at a rate of 1 to 4 mg/min (15 to 60 drops per minute with a microdrop apparatus) 1.
Additional Measures
- Other supportive measures, including oxygen, IV fluids, antihistamines, and corticosteroids, should be initiated as appropriate 1.
- Diphenhydramine, 1 to 2 mg/kg or 25 to 50 mg per dose (parenterally), and ranitidine, 50 mg in adults and 12.5 to 50 mg (1 mg/kg) in children, can be considered as second-line therapy to epinephrine 1.
- For bronchospasm resistant to epinephrine, nebulized albuterol, 2.5 to 5 mg in 3 mL of saline, can be administered and repeated as necessary 1.
From the Research
Intravenous Dose of Epinephrine for Anaphylaxis
- The provided studies do not specify a recommended intravenous (IV) dose of epinephrine for the treatment of anaphylaxis 2, 3, 4, 5, 6.
- According to the studies, epinephrine is typically administered intramuscularly in the anterolateral thigh at a dose of 0.3-0.5 mg for adults 2, 3, 4, 6.
- One study mentions that intravenous application of epinephrine can be tried in very severe cases or under conditions of surgical interventions, but does not provide a specific dose 5.
- Another study recommends an initial dose of 0.01 mg/kg of 1:1000 (1 mg/ml) solution to a maximum initial dose of 0.5 mg, but this is for intramuscular administration 4.