What is the dose of adrenaline (epinephrine) for anaphylactic shock?

From the Guidelines

For anaphylactic shock, the recommended dose of adrenaline (epinephrine) is 0.01 mg/kg of a 1:1000 solution, up to a maximum of 0.5 mg in adults and 0.3 mg in children, administered intramuscularly in the anterolateral thigh. This dose can be repeated every 5-15 minutes if there is no improvement or if symptoms recur 1. In healthcare settings, intravenous adrenaline may be used for severe cases at a dose of 0.1-0.5 mg (1:10,000 solution) administered slowly. Adrenaline works rapidly to reverse the life-threatening effects of anaphylaxis by constricting blood vessels to increase blood pressure, relaxing smooth muscles in the lungs to improve breathing, reducing swelling, and stimulating the heart. It is crucial to administer adrenaline promptly as it is the first-line treatment for anaphylaxis. After administering adrenaline, the patient should be placed in a position of comfort, typically lying flat with legs elevated unless breathing difficulties make this uncomfortable, and emergency medical services should be called immediately.

Some key points to consider when administering adrenaline for anaphylaxis include:

• The dose of adrenaline should be individualized based on the patient's weight and the severity of the reaction
• The anterolateral thigh is the preferred site for intramuscular injection of adrenaline
• Adrenaline should be administered promptly, as delayed use can be ineffective
• Repeat dosing may be required for persistent or recurrent symptoms
• Antihistamines and corticosteroids should not be considered substitutes for adrenaline, but may be used as adjunctive therapy for cutaneous signs and symptoms associated with anaphylaxis 1.

It's also important to note that the management of anaphylaxis should be guided by the most recent and highest quality evidence, and that the use of adrenaline is the cornerstone of anaphylaxis management 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Anaphylaxis: Adults and Children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 to 0.5 mL) intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary Children 30 kg (66 lbs) or less: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0.3 mL), intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary

The dose of adrenaline for anaphylactic shock is:

• 0.3 to 0.5 mg (0.3 to 0.5 mL) for adults and children 30 kg (66 lbs) or more, administered intramuscularly or subcutaneously into the anterolateral aspect of the thigh every 5 to 10 minutes as necessary.
• 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0.3 mL), for children 30 kg (66 lbs) or less, administered intramuscularly or subcutaneously into the anterolateral aspect of the thigh every 5 to 10 minutes as necessary 2.

From the Research

Adrenaline Dose for Anaphylactic Shock

• The recommended dose of adrenaline (epinephrine) for anaphylactic shock is:
  • 300-600 µg for an adult 3
  • 10 µg/kg for a child 3
  • 0.3-0.5 mg, injected intramuscularly in the anterolateral aspect of the mid-thigh for adults 4
  • 0.01 mg/kg (up to 0.5 mg in adults) intramuscularly (IM) in the anterolateral thigh 5
• The dose and route of administration of epinephrine used in the management of anaphylaxis is different from that used in the management of cardiac arrest 6
• Intravenous (IV) epinephrine administration is recommended in patients refractory to IM epinephrine and IV fluids, or those with cardiovascular collapse 5

Administration Method

• The method of choice for administering adrenaline is by intramuscular injection with an autoinjector 3
• The injection is given in the lateral portion of the thigh and can be repeated every 10-15 minutes until there is a response 3
• Intramuscular epinephrine is the immediate treatment of all patients with anaphylaxis 7