What is the recommended dose of adrenaline (epinephrine) for the treatment of anaphylaxis?

Recommended Epinephrine Dosage for Anaphylaxis

For anaphylaxis treatment, administer epinephrine via intramuscular injection in the mid-outer thigh (vastus lateralis) with a dose of 0.3-0.5 mg for adults and children ≥30 kg, and 0.01 mg/kg (maximum 0.3 mg) for children <30 kg. 1

Dosage Guidelines by Age/Weight

Adults and Children ≥30 kg (66 lbs):

• Dose: 0.3-0.5 mg epinephrine
• Concentration: 1:1000 (1 mg/mL)
• Volume: 0.3-0.5 mL
• Route: Intramuscular injection into the anterolateral aspect of the thigh
• Frequency: Every 5-10 minutes as necessary if symptoms persist 1, 2

Children <30 kg (66 lbs):

• Dose: 0.01 mg/kg, up to maximum 0.3 mg
• Concentration: 1:1000 (1 mg/mL)
• Volume: 0.01 mL/kg, up to maximum 0.3 mL
• Route: Intramuscular injection into the anterolateral aspect of the thigh
• Frequency: Every 5-10 minutes as necessary if symptoms persist 1, 2

Specific Weight-Based Recommendations for Children

• For children weighing 10-25 kg (22-55 lbs): 0.15 mg epinephrine autoinjector
• For children weighing ≥25 kg (≥55 lbs): 0.3 mg epinephrine autoinjector 3

Administration Considerations

Route of Administration

• Intramuscular (IM) injection into the lateral thigh (vastus lateralis) is the preferred route for first-line treatment 3, 1
• Avoid injection into buttocks, digits, hands, or feet due to risk of tissue damage 2
• Intravenous administration should only be considered in severe cases by experienced providers in monitored settings due to increased risk of adverse effects 4

Timing

• Administer epinephrine as early as possible once anaphylaxis is recognized 1
• Delayed administration is associated with increased mortality 1
• Never delay epinephrine administration while giving secondary medications 1

Important Clinical Pearls

Patient Positioning

• Position patients with hypotension in a supine position with legs elevated 1
• Avoid standing or walking during acute anaphylaxis as this can worsen hypotension 1

Monitoring and Follow-up

• Monitor patients closely for at least 4-6 hours for potential biphasic reactions 1
• Be prepared to administer additional doses if symptoms persist or worsen 1

Common Pitfalls to Avoid

1. Incorrect route: Subcutaneous administration has delayed onset compared to IM injection 4
2. Incorrect dose: Using cardiac arrest dosing (1:10,000 concentration) instead of anaphylaxis dosing (1:1000 concentration) 5, 6
3. Delayed administration: Waiting for other medications or complete symptom development before giving epinephrine 1
4. Inappropriate contraindications: There are no absolute contraindications for epinephrine use in anaphylaxis, even in patients with cardiovascular disease 1

Remember that epinephrine is the cornerstone of anaphylaxis management, and prompt administration can be life-saving. Failure to inject epinephrine promptly is a significant contributor to anaphylaxis fatalities 4.