What is the dose of adrenaline (epinephrine) in emergency situations?

Adrenaline (Epinephrine) Dosing in Emergency Situations

The standard dose of epinephrine in emergency situations is 10 mcg/kg (0.01 mg/kg) for pediatric patients with a maximum single dose of 1 mg, and 1 mg IV/IO every 3-5 minutes for adults during cardiac arrest. 1

Adult Dosing

Cardiac Arrest

• IV/IO: 1 mg every 3-5 minutes during CPR 1
• Maximum dose: No specific maximum number of doses, but no survival benefit observed after 10 doses 2
• If IV/IO access is delayed or cannot be established, endotracheal administration at 2-2.5 mg can be considered 1

Anaphylaxis

• IM/SC: 0.3-0.5 mg (0.3-0.5 mL of 1:1000 solution) 3
• May repeat every 5-20 minutes as necessary 1
• The IM route is preferred for anaphylaxis 1

Pediatric Dosing

Cardiac Arrest

• IV/IO: 0.01 mg/kg (10 mcg/kg) per dose 1
• Maximum single dose: 1 mg 1
• Repeat every 3-5 minutes during resuscitation 1

Specific Age Groups

• Newborn infants: 0.01-0.03 mg/kg of 1:10,000 solution IV/IO 1
• Older infants/children: 0.01 mg/kg of 1:10,000 solution (maximum: 1 mg) 1

Anaphylaxis

• IM/SC: 0.01 mg/kg of 1:1000 solution (maximum: 0.3-0.5 mg) 1
• May repeat every 5-20 minutes as needed 1
• For children ≤30 kg: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg 3
• For children >30 kg: 0.3-0.5 mg (adult dose) 3

Continuous Infusion Dosing

Shock States

• Cardiogenic/distributive shock: IV infusion 0.1-1.0 μg/kg/min, titrated to desired clinical effect 1
• Start at lowest dose and titrate up as needed 1
• Doses as high as 5 μg/kg/min are sometimes necessary 1

Administration Routes and Concentrations

Available Concentrations

• 1:1000 (1 mg/mL) - typically used for IM/SC administration 1
• 1:10,000 (0.1 mg/mL) - typically used for IV/IO administration 1

Route Conversion

• To convert mg/kg to mL/kg: 0.01 mg/kg = 0.1 mL/kg of 1:10,000 solution 1
• 0.1 mg/kg = 0.1 mL/kg of 1:1000 solution 1

Important Considerations

Timing of Administration

• Earlier administration of epinephrine in cardiac arrest is associated with improved outcomes 1, 4
• For non-shockable rhythms, administer as soon as feasible 1
• For shockable rhythms, administer after initial defibrillation attempts have been unsuccessful 1

High-Dose vs. Standard-Dose

• High-dose epinephrine (>10 mcg/kg IV) has not shown increased survival to hospital discharge or improved neurologic outcomes in pediatric cardiac arrest 1
• In adults, doses >1 mg have not demonstrated improvement in survival to hospital discharge or neurologic outcome 1, 5
• High-dose epinephrine may be considered in exceptional circumstances such as β-blocker poisoning 1

Potential Adverse Effects

• May cause tachyarrhythmias, ectopic beats, hypotension, and hypertension 1
• Extravasation can result in severe skin injury; phentolamine (0.1-0.2 mg/kg up to 10 mg) can be injected intradermally at extravasation site 1
• In patients with underlying heart disease, may aggravate angina pectoris or produce ventricular arrhythmias 3
• Patients with hyperthyroidism, Parkinson's disease, diabetes, and pheochromocytoma are at greater risk of adverse reactions 3

Common Pitfalls and Caveats

• Ensure selection of the appropriate concentration for the route of administration and patient age/condition 1
• Do not inject into buttocks, digits, hands, or feet 3
• Monitor for signs of infection at injection sites, as rare cases of serious skin and soft tissue infections have been reported 3
• The effectiveness of epinephrine decreases with prolonged cardiac arrest, with diminishing returns after multiple doses 2, 6
• While epinephrine increases rates of ROSC, the impact on neurological outcomes remains uncertain 4