What intramuscular dose of Kenalog (triamcinolone acetonide) should be given for a severely swollen uvula in an adult, and what is the weight‑based dosing for children?

Intramuscular Kenalog Dosing for Severe Uvular Edema

For a severely swollen uvula in adults, administer 40–60 mg of triamcinolone acetonide (Kenalog) intramuscularly as a single dose. 1

Adult Dosing

• Standard IM dose: 40–60 mg as a single injection for acute inflammatory conditions requiring systemic corticosteroid effect 1
• This dose provides sustained anti-inflammatory action over several days to weeks due to the depot formulation's unique pharmacokinetic properties 2
• The 40 mg dose has been validated in multiple acute inflammatory conditions including asthma exacerbations and acute crystal-induced arthritis 3, 1
• For severe presentations, the upper range (60 mg) is appropriate and supported by rheumatology guidelines for acute inflammatory episodes 1

Pediatric Dosing

• Children: 2–3 mg/kg intramuscularly (maximum 100 mg) 1
• Weight-based dosing is critical in pediatric patients to avoid excessive systemic exposure while maintaining therapeutic efficacy 1
• The maximum single dose should not exceed 100 mg regardless of weight 1

Clinical Rationale

The intramuscular route is particularly advantageous for uvular edema because:

• Single-dose compliance: Eliminates concerns about adherence to multi-day oral prednisone regimens, which is especially valuable when airway compromise requires reliable treatment 3
• Sustained depot effect: The acetonide ester formulation has low aqueous solubility, resulting in slow absorption from the injection site and prolonged anti-inflammatory action lasting 1–4 weeks 2
• Equivalent efficacy: A single 40 mg IM dose produces relapse rates comparable to 5 days of oral prednisone 40 mg daily (9.0% vs 14.5%, difference not statistically significant) 3

Critical Safety Considerations

Contraindications to verify before administration: 1

• Active systemic infection (relative contraindication—weigh airway risk vs infection risk)
• Known hypersensitivity to triamcinolone or formulation components
• Live vaccine administration within recent weeks

Use with heightened caution in: 1

• Diabetes mellitus (expect transient hyperglycemia for 1–2 weeks)
• Heart failure or uncontrolled hypertension
• Active peptic ulcer disease

Common Pitfalls to Avoid

• Do not use intralesional injection for uvular edema: The 5–10 mg/mL concentrations used for dermatologic lesions are inappropriate for this indication; systemic IM dosing is required 1, 4
• Do not underdose: The 20–40 mg range used for large joint injections may be insufficient for severe systemic inflammatory conditions like uvular edema 1
• Monitor for airway compromise: Corticosteroids require hours to achieve peak effect; if airway patency is threatened, secure the airway first and administer epinephrine if angioedema is suspected 1
• Counsel about delayed onset: Patients should understand that maximal benefit occurs over 24–48 hours, not immediately 3

Administration Technique

• Inject deep intramuscularly (deltoid or gluteal muscle preferred) 3
• Use a 21–23 gauge needle to accommodate the suspension 3
• Shake the vial thoroughly before drawing up the dose to ensure uniform suspension 3