What is the recommended dose of adrenaline (epinephrine) for an adult and pediatric patient?

Recommended Adrenaline (Epinephrine) Dosage for Adults and Pediatric Patients

For anaphylaxis, adults and children ≥30 kg should receive 0.3-0.5 mg (0.3-0.5 mL of 1:1000 solution) intramuscularly into the anterolateral thigh, while children <30 kg should receive 0.01 mg/kg (0.01 mL/kg of 1:1000 solution) up to a maximum of 0.3 mg. 1

Adult Dosing

Anaphylaxis

• Intramuscular (IM) injection: 0.3-0.5 mg (0.3-0.5 mL of 1:1000 solution [1 mg/mL]) into the anterolateral thigh 1
• Repeat every 5-10 minutes as necessary based on clinical response 1
• Do not administer repeated injections at the same site due to risk of tissue necrosis from vasoconstriction 1

Cardiac Arrest

• Intravenous (IV) or intraosseous (IO): 1 mg (10 mL of 1:10,000 solution [0.1 mg/mL]) every 3-5 minutes 2
• For refractory cases, an epinephrine infusion can be prepared by adding 1 mg (1 mL) of 1:1000 solution to 250 mL of D5W to yield 4.0 μg/mL 3
• Infuse at 1-4 μg/min (15-60 drops/min with microdrop apparatus), increasing to maximum of 10.0 μg/min if needed 3

Pediatric Dosing

Anaphylaxis

• Children <30 kg: 0.01 mg/kg (0.01 mL/kg of 1:1000 solution) IM or subcutaneously into anterolateral thigh, maximum 0.3 mg per dose 1
• Children ≥30 kg: Same as adult dosing (0.3-0.5 mg) 1
• Repeat every 5-10 minutes as necessary 1

Cardiac Arrest

• IV/IO: 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution), maximum single dose 1 mg 3
• For continuous infusion, the "rule of 6" can be used: 0.6 × body weight (kg) = mg diluted to 100 mL of saline; then 1 mL/h delivers 0.1 μg/kg/min 4

Route of Administration Considerations

• IM injection is preferred over subcutaneous for anaphylaxis as it provides more rapid increase in plasma and tissue concentrations 3, 5
• The anterolateral thigh (vastus lateralis muscle) is the recommended site for IM injection 3, 5
• Ensure needle length is adequate to reach the muscle beneath subcutaneous tissue 3
• IV administration (1:10,000 solution) should be reserved for cardiac arrest or severe shock unresponsive to IM epinephrine and fluid resuscitation 3, 5

Important Cautions

• Verify the correct concentration before administration - 1:1000 (1 mg/mL) for IM use and 1:10,000 (0.1 mg/mL) for IV use 5
• Using the wrong concentration can lead to potentially fatal overdose, particularly when 1:1000 solution is incorrectly administered intravenously 5
• For pediatric patients, hold the leg firmly in place during injection to minimize risk of injury 1
• Monitor patients clinically for severity of allergic reaction and potential cardiac effects 1

Alternative Preparations for Continuous Infusion

• For cases requiring continuous infusion, an alternative 1:100,000 solution (1 mg in 100 mL saline) can be prepared and administered at 30-100 mL/h (5-15 μg/min) 3
• When using an infusion pump, titrate dose based on clinical response and monitor for side effects 3

Remember that prompt administration of epinephrine is critical in anaphylaxis and cardiac arrest, with appropriate dose adjustments based on patient weight and clinical response 6.