Epinephrine Dosing for Cardiac Arrest and Anaphylaxis
For cardiac arrest and anaphylaxis, epinephrine should be administered at specific doses based on patient age and route of administration, with intravenous routes preferred for cardiac arrest and intramuscular routes preferred for anaphylaxis.
Cardiac Arrest Dosing
Newborns
- IV/IO: 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000 solution) 1
- ET tube: 0.05-0.1 mg/kg (0.5-1 mL/kg of 1:10,000 solution) if IV access not available 1
- Repeat every 3-5 minutes as needed 1
Children
- IV/IO: 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution), maximum single dose 1 mg 2
- ET tube: 0.1 mg/kg (0.1 mL/kg of 1:1,000 solution) if IV/IO access not available 2
- Repeat every 3-5 minutes as needed 2
Adults
Anaphylaxis Dosing
Newborns and Infants (<30 kg)
- IM: 0.01 mg/kg (0.01 mL/kg of 1:1,000 solution), maximum 0.3 mg 4
- Administer into anterolateral thigh 4
- May repeat every 5-10 minutes as necessary 4
Children (≥30 kg) and Adults
- IM: 0.3-0.5 mg (0.3-0.5 mL of 1:1,000 solution) 4
- Administer into anterolateral thigh 4
- May repeat every 5-10 minutes as necessary 4
Route Considerations
IV/IO Administration (Preferred for Cardiac Arrest)
- Provides faster and more reliable drug delivery compared to ET route 1
- Use 1:10,000 concentration (0.1 mg/mL) for cardiac arrest 1, 3
- Higher doses (>0.03 mg/kg) are not recommended due to increased risk of post-resuscitation mortality and cerebral blood flow interference 1
Endotracheal Administration
- Only use if IV/IO access cannot be established 1
- Requires higher doses (5-10 times IV dose) due to lower bioavailability 1
- Less effective than IV administration at equivalent doses 1
Intramuscular Administration (Preferred for Anaphylaxis)
- Administer into anterolateral thigh (not buttocks) 4
- Provides appropriate absorption for anaphylaxis management 4
- Use 1:1,000 concentration (1 mg/mL) for anaphylaxis 4
Critical Considerations and Pitfalls
- Avoid dosing errors: Confusion between cardiac arrest and anaphylaxis dosing can lead to potentially lethal complications 5
- Concentration matters: Use 1:10,000 (0.1 mg/mL) for IV/IO in cardiac arrest and 1:1,000 (1 mg/mL) for IM in anaphylaxis 4, 3
- Avoid high-dose IV epinephrine: Evidence suggests increased risk of mortality with high-dose IV epinephrine (0.1 mg/kg) 1
- ET administration limitations: Blood concentrations are significantly lower following ET administration compared to IV administration 1
- Preparation recommendations: For neonatal resuscitation, prepare 0.02 mg/kg (0.2 mL/kg of 1:10,000) in a 1 mL syringe for IV administration 6
- Continuous monitoring: When administering IV epinephrine, continuous hemodynamic monitoring is essential 7
Push-Dose Epinephrine for Hypotension
- Dilute 0.1-0.3 mL of 1:1,000 epinephrine (1 mg/mL) in 10 mL of normal saline 7
- Administer over several minutes with continuous monitoring 7
- For pediatric patients, use weight-based dosing of 0.01 mg/kg or 0.1 mL/kg of 1:10,000 solution 7
Remember that establishing adequate ventilation is the most important step in correcting bradycardia in newborns, with epinephrine administration considered only after adequate ventilation and chest compressions have failed to increase heart rate above 60 beats per minute 1.