From the Guidelines
In anaphylactic shock, if you only have epinephrine 1:10,000 available, administer 0.5 mL (0.05 mg) intramuscularly in the mid-outer thigh for adults, and 0.01 mg/kg up to a maximum of 0.3 mg (3 mL of 1:10,000) for children, as this is the most effective way to manage the condition with the available resources 1.
Key Considerations
- The dose can be repeated every 5-15 minutes if symptoms persist, as the goal is to rapidly alleviate the life-threatening symptoms of anaphylaxis.
- The intramuscular route is preferred for most cases of anaphylaxis as it provides rapid absorption while maintaining safety.
- After administering epinephrine, position the patient supine with legs elevated, provide supplemental oxygen if available, and arrange urgent transfer to a medical facility.
Additional Management Strategies
- Consider fluid resuscitation with normal saline, as anaphylaxis can lead to significant hypotension and fluid shift.
- Antihistamines, such as diphenhydramine, and glucocorticoids may be considered as adjunctive therapy, but their use should not delay the administration of epinephrine.
- In cases of refractory hypotension, consider the use of vasopressors, such as dopamine or norepinephrine, under close hemodynamic monitoring.
Rationale
The management of anaphylactic shock prioritizes the rapid administration of epinephrine to address the life-threatening symptoms of the condition. The use of epinephrine 1:10,000, although less concentrated than the typical 1:1,000 solution, can still be effective when dosed appropriately. The intramuscular route is preferred due to its rapid absorption and safety profile. Supplemental oxygen, fluid resuscitation, and adjunctive therapies may be considered based on the patient's clinical response and the availability of resources.
From the Research
Management of Anaphylactic Shock
When only epinephrine (adrenaline) 1:10,000 is available, the management of anaphylactic shock involves:
- Administering epinephrine 1:10,000 intramuscularly, as it is the most effective route of administration for anaphylaxis treatment 2, 3
- The recommended adult dose is 0.3-0.5 mg, which can be repeated every 10-15 minutes until there is a response 2, 3
- It is essential to note that epinephrine 1:10,000 is typically used for intravenous administration, but it can be used intramuscularly in emergency situations when epinephrine 1:1,000 is not available 3
Key Considerations
- Early administration of epinephrine is crucial in the treatment of anaphylaxis, as failure to inject epinephrine promptly contributes to anaphylaxis fatalities 2
- The use of epinephrine autoinjectors is recommended for the treatment of anaphylaxis, but in this scenario, epinephrine 1:10,000 is being used 4, 3
- Patients should be monitored for a biphasic reaction, which can occur 4-12 hours after the initial anaphylactic reaction 4, 5
Additional Measures
- Supportive care for the patient's airway, breathing, and circulation should be provided, as well as removal of the trigger and a period of observation for potential biphasic reactions 4, 5
- Adjunct medications, such as histamine H1 and H2 antagonists, corticosteroids, beta2 agonists, and glucagon, can be considered after epinephrine administration, but they are not the primary treatment for anaphylaxis 4, 6