From the Guidelines
The recommended dose of adrenaline (epinephrine) per kg of body weight is 0.01 mg/kg, with a maximum dose of 0.3 mg in prepubertal children and up to 0.5 mg in teenagers. This dose is typically administered intramuscularly, using a 1:10,000 concentration (0.1 mg/mL) 1. The dose may vary depending on the specific clinical scenario, such as anaphylaxis or cardiac arrest. For example, in cases of anaphylaxis, the dose is 0.01 mg/kg, up to 0.3 mg in children, and 0.3 to 0.5 mg in adults, depending on the severity of the reaction 1. It is essential to note that the dose should be adjusted according to the patient's weight and the specific clinical situation.
Some key points to consider when administering adrenaline include:
- The dose should be administered intramuscularly, as this achieves peak epinephrine concentrations promptly and is safer than an intravenous bolus injection 1.
- The dose may need to be repeated every 5-15 minutes as needed, depending on the severity of the reaction and the patient's response to treatment.
- Care should be taken to avoid excessive doses, as this can cause dangerous hypertension, arrhythmias, and myocardial ischemia, especially in elderly patients or those with cardiovascular disease.
- Auto-injectors are available in fixed doses, such as 0.15 mg for children weighing 15-30 kg and 0.3 mg for those over 30 kg, but the dose should be adjusted according to the patient's weight and the specific clinical situation 1.
In terms of specific clinical scenarios, the following doses are recommended:
- For anaphylaxis, the dose is 0.01 mg/kg, up to 0.3 mg in children, and 0.3 to 0.5 mg in adults, depending on the severity of the reaction 1.
- For cardiac arrest, higher doses of 1 mg intravenously may be used in adults.
- For adding adrenaline to local anesthetics, concentrations of 1:200,000 to 1:100,000 are typically used.
Overall, the key is to use the minimum effective dose to achieve the desired clinical effect, while minimizing the risk of adverse effects.
From the FDA Drug Label
Adults and Children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 mL to 0. 5 mL) of undiluted Adrenalin® administered intramuscularly or subcutaneously in the anterolateral aspect of the thigh, up to a maximum of 0.5 mg (0.5 mL) per injection, repeated every 5 to 10 minutes as necessary. Children less than 30 kg (66 lbs): 0.01 mg/kg (0. 01 mL/kg) of undiluted Adrenalin® administered intramuscularly or subcutaneously in the anterolateral aspect of the thigh, up to a maximum of 0.3 mg (0.3 mL) per injection, repeated every 5 to 10 minutes as necessary.
The dose of adrenaline per kg is 0.01 mg/kg for children less than 30 kg (66 lbs) 2.
- For adults and children 30 kg or more, the dose is not specified per kg, but rather as a fixed dose of 0.3 to 0.5 mg.
- The dose for children less than 30 kg is directly calculated based on the child's weight.
From the Research
Adrenaline Dosing
- The recommended dose of adrenaline in anaphylaxis is 0.01-mg/kg, with a maximum dose of 0.3-0.5 mg 3.
- For children, the dose is 10 µg/kg 4.
- The dose of adrenaline can exceed the recommended dose when epinephrine auto-injectors (EAIs) are used in infants, although the clinical significance of this is unclear 3.
- A newly available 0.1 mg EAI has a lower dose and shorter needle, which is better suited to patients weighing 7.5 to 15 kg 3.
Administration Route and Site
- The intramuscular route and lateral thigh site are considered superior for adrenaline administration 3.
- The use of an autoinjector is recommended, and patients should practice its use in advance 4.