Epinephrine Dosing for a 25kg Patient with Myocardial Infarction
For a 25kg patient experiencing a myocardial infarction, the appropriate epinephrine dose is 0.01 mg/kg (0.25mg) administered intravenously using the 1mg/ml solution, which equals 0.25ml of the solution. 1
Dosing Considerations
- For cardiac arrest situations in pediatric patients, the recommended initial resuscitation dosage is 0.01 mg/kg (0.1 mL/kg of a 1:10,000 solution up to a maximum of 0.3 mg) repeated every 3 to 5 minutes for ongoing arrest 1
- For a 25kg child, this translates to 0.25mg (0.25ml of a 1mg/ml solution) 1
- Higher subsequent dosages (0.1-0.2 mg/kg) might be considered for unresponsive asystole or pulseless electrical activity 1
Administration Route and Monitoring
- Administer epinephrine intravenously for immediate effect in MI situations 1
- Monitor heart rate and blood pressure every 5-15 minutes during initial administration 2
- Watch for potential side effects including hypertension, arrhythmias, and tissue ischemia 2
Important Precautions
- Ensure proper dilution and administration to avoid iatrogenic overdose, which can lead to severe cardiac complications 3
- Use caution when administering epinephrine in MI as excessive doses may contribute to unnecessarily high aortic afterload and promote post-arrest myocardial dysfunction 4
- Avoid mixing epinephrine with sodium bicarbonate or other alkaline solutions in the IV line, as they can inactivate the medication 2
Special Considerations for Pediatric Patients
- Central venous access is preferred for administration of epinephrine, but if unavailable, peripheral IV can be used temporarily with strict monitoring for extravasation 2
- If extravasation occurs, infiltrate 5-10 mg of phentolamine diluted in 10-15 mL of saline into the site as soon as possible to prevent tissue necrosis 2
- For pediatric patients with MI requiring continuous infusion, doses typically range from 0.1-1.0 mcg/kg per minute, starting at the lowest dose and titrating to desired clinical effect 2
Evidence on Epinephrine Dosing
- Recent research suggests that cumulative epinephrine doses above 3 mg during cardiac arrest may be associated with unfavorable neurologic outcomes 4
- Studies have shown that reducing the dose of epinephrine administered during out-of-hospital cardiac arrest was not associated with a change in survival to hospital discharge 5
- While some historical studies have explored higher doses of epinephrine for prolonged cardiac arrest, these approaches have not demonstrated improved neurological outcomes 6