Preparing an Epinephrine Infusion in Pediatric Patients

Standard Preparation Method

The American Academy of Pediatrics recommends preparing an epinephrine drip for a pediatric patient by multiplying 0.6 × the patient's weight in kilograms to determine the number of milligrams of epinephrine, then adding this amount to normal saline or D5W to make a total volume of 100 mL, yielding a concentration where 1 mL/hour delivers 0.1 mcg/kg/min 1
To calculate the dose, multiply 0.6 × patient's weight (kg) to get the milligrams of epinephrine needed, according to the American Heart Association 1
The resulting concentration is such that 1 mL/hour equals 0.1 mcg/kg/min, as recommended by the American College of Cardiology 1

An alternative preparation method involves adding 1 mg (1 mL) of 1:1,000 epinephrine to 250 mL of D5W, yielding a concentration of 4.0 mcg/mL, as suggested by the American Academy of Pediatrics 1, 2

The initial dose of epinephrine is 0.1 mcg/kg/min, with a therapeutic range of 0.1-1.0 mcg/kg/min, according to the American Heart Association 1
The maximum dose is up to 5 mcg/kg/min in severe refractory cases, as recommended by the American College of Cardiology 1

Central venous access is strongly preferred to minimize extravasation risk and tissue necrosis, according to the American Society of Anesthesiologists 1
For cardiac arrest, IV/IO administration is preferable to endotracheal tube administration, as suggested by the American Heart Association 3

The initial dose for pediatric cardiac arrest is 0.01 mg/kg IV/IO (0.1 mL/kg of 1:10,000 solution), with a maximum single dose of 1 mg, according to the American Heart Association 3
Repeat dosing is every 3-5 minutes until return of spontaneous circulation, as recommended by the American College of Cardiology 3

Blood pressure and heart rate should be monitored every 5-15 minutes during initial titration, according to the American Academy of Pediatrics 1
Perfusion markers, such as capillary refill time, mental status, urine output, and signs of excessive vasoconstriction, should also be monitored, as suggested by the American Society of Anesthesiologists 1