Epinephrine Dosing for Adults in Emergency Situations
For emergency situations requiring 1mg/ml epinephrine in adults, the recommended dose is 0.3-0.5 mg (0.3-0.5 ml) administered intramuscularly into the anterolateral aspect of the thigh every 5-10 minutes as necessary. 1
Anaphylaxis Management
Intramuscular Administration (Preferred Initial Route)
- Dose: 0.2-0.5 mg (0.2-0.5 ml of 1:1000 concentration) 2
- Site: Anterolateral aspect of the thigh (vastus lateralis) 2
- Frequency: Can be repeated every 5-15 minutes as needed 2
- Rationale: Intramuscular injection into the thigh provides rapid peak plasma epinephrine concentrations and is the preferred initial route due to ease of administration, effectiveness, and safety 2, 3
Intravenous Administration (When IV Access is Available)
- Dose: 0.05-0.1 mg (5-10% of the cardiac arrest dose) 2
- Concentration: Use 0.1 mg/ml (1:10,000) solution 2
- Caution: IV route carries higher risk of adverse effects compared to IM administration 3
Continuous Infusion (For Persistent Anaphylaxis)
- Preparation: Add 1 mg (1 ml) of 1:1000 epinephrine to 100 ml of saline to create a 1:100,000 solution 2
- Initial rate: 30-100 ml/hr (5-15 μg/min) 2
- Titration: Adjust based on clinical response and side effects 2
- Duration: Can be discontinued 30 minutes after resolution of all signs and symptoms 2
Cardiac Arrest Management
Standard Dosing
- Dose: 1 mg IV/IO every 3-5 minutes during cardiac arrest 2
- Concentration: 1:10,000 (0.1 mg/ml) 2
- Evidence: Standard-dose epinephrine (1 mg) improves return of spontaneous circulation compared to placebo 2
Important Considerations and Pitfalls
- Route selection matters: Subcutaneous injection may delay onset of action, while IV administration increases risk of adverse effects 3
- Monitoring: Close hemodynamic monitoring is essential in patients receiving epinephrine, especially those with anaphylactic shock 2
- Common errors: Studies show that only 16.8% of junior doctors administer epinephrine correctly in anaphylaxis scenarios, highlighting the importance of clear dosing guidelines 4
- Adverse effects: Watch for anxiety, restlessness, tremor, palpitations, headache, and in higher doses, arrhythmias and cerebral hemorrhage 1
- Contraindications: Use with caution in patients with heart disease, hyperthyroidism, Parkinson's disease, diabetes, and pheochromocytoma 1
Special Considerations
- Extravasation: If extravasation occurs with IV administration, infiltrate the site with phentolamine to prevent tissue necrosis 5
- Drug interactions: Epinephrine effects may be potentiated by tricyclic antidepressants, MAO inhibitors, and certain antihistamines 1
- Storage: Epinephrine should be protected from light and stored at room temperature to maintain potency 1