Dose of adrenaline
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adrenaline epinephrine dose indications anaphylaxis cardiac arrest
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The retrieved result covers anaphylaxis dosing well. Let me supplement with my comprehensive knowledge on all indications.
Adrenaline (Epinephrine) Dosing
1. Anaphylaxis
First-line treatment — no absolute contraindications in anaphylaxis.
| Route | Adults | Children (0.01 mg/kg, max 0.5 mg) |
|---|---|---|
| IM (anterolateral thigh) | 0.3–0.5 mg (1:1,000) | 0.01 mg/kg, max 0.3 mg |
| Auto-injector (EpiPen) | 0.3 mg (adult) | 0.15 mg (<25 kg) |
| IV (refractory/ICU) | 0.1–0.2 mg (1:10,000) slow bolus | Titrated infusion |
IM into the anterolateral thigh achieves faster, higher plasma levels than subcutaneous or deltoid injection. Repeat every 5–15 minutes if needed. (Stinging Insect Hypersensitivity, p. 18)
2. Cardiac Arrest (ALS/ACLS)
| Setting | Dose | Route | Timing |
|---|---|---|---|
| VF/Pulseless VT | 1 mg IV/IO | After 3rd shock | Every 3–5 min |
| PEA / Asystole | 1 mg IV/IO | As soon as access | Every 3–5 min |
| Pediatric | 0.01 mg/kg (max 1 mg) | IV/IO | Every 3–5 min |
Concentration used: 1:10,000 (0.1 mg/mL). Flush with 20 mL saline after each dose.
3. Severe Bronchospasm / Acute Severe Asthma
- IM: 0.3–0.5 mg (1:1,000) — if life-threatening and nebulized treatment failing
- Rarely used now that IV salbutamol and Mg²⁺ are available
4. Croup (Nebulized)
- Nebulized adrenaline: 0.5 mL/kg of 1:1,000, max 5 mL, via nebulizer
- Provides ~2–3 hours of relief; observe for rebound
5. Vasopressor Infusion (Septic Shock / Refractory Hypotension)
- 0.01–1 mcg/kg/min IV infusion, titrated to MAP ≥65 mmHg
- Higher doses (>0.1 mcg/kg/min) carry risk of tachyarrhythmia and lactic acidosis
6. Local Anaesthetic Adjunct
- 1:200,000 (5 mcg/mL) added to local anaesthetic to prolong duration and reduce bleeding
- Avoid in end-artery sites (digits, penis, ear, nose, tip of nose)
7. Upper GI Bleeding (Endoscopic Injection)
- 1:10,000 dilution, injected submucosally in 0.5–2 mL aliquots, total dose varies
Key Pharmacology Reminders
- 1:1,000 = 1 mg/mL (IM use)
- 1:10,000 = 0.1 mg/mL (IV use)
- Onset: 1–2 min (IV), 8–10 min (IM)
- Half-life: ~2–3 min (IV)
Critical: Antihistamines and corticosteroids are not substitutes for epinephrine in anaphylaxis — delay in epinephrine use is associated with fatal outcomes. (Stinging Insect Hypersensitivity, p. 18)
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