Adrenaline (Epinephrine) Dosing in Emergency Situations

Adult Dosing

The American Heart Association recommends IV/IO administration of 1 mg every 3-5 minutes during CPR for adults with cardiac arrest 4
If IV/IO access is delayed or cannot be established, endotracheal administration at 2-2.5 mg can be considered for adults with cardiac arrest 4
The American Academy of Pediatrics recommends that the IM route is preferred for anaphylaxis, with a dose of 0.3-0.5 mg (0.3-0.5 mL of 1:1000 solution) 1
The dose may be repeated every 5-20 minutes as necessary for anaphylaxis 1

The American Academy of Pediatrics recommends IV/IO administration of 0.01 mg/kg (10 mcg/kg) per dose for pediatric patients with cardiac arrest, with a maximum single dose of 1 mg 2, 3, 5
The dose should be repeated every 3-5 minutes during resuscitation for pediatric patients with cardiac arrest 1, 6
For newborn infants, the recommended dose is 0.01-0.03 mg/kg of 1:10,000 solution IV/IO 1
For older infants and children, the recommended dose is 0.01 mg/kg of 1:10,000 solution (maximum: 1 mg) 1
For anaphylaxis in pediatric patients, the recommended dose is 0.01 mg/kg of 1:1000 solution (maximum: 0.3-0.5 mg) 1

The American Academy of Pediatrics recommends a continuous infusion dose of 0.1-1.0 μg/kg/min for cardiogenic or distributive shock, titrated to desired clinical effect 1
The dose should be started at the lowest dose and titrated up as needed 1
Doses as high as 5 μg/kg/min may be necessary in some cases 1

The American Academy of Pediatrics recommends using a concentration of 1:1000 (1 mg/mL) for IM/SC administration and 1:10,000 (0.1 mg/mL) for IV/IO administration 1
To convert mg/kg to mL/kg, 0.01 mg/kg = 0.1 mL/kg of 1:10,000 solution and 0.1 mg/kg = 0.1 mL/kg of 1:1000 solution 1

The American Heart Association recommends earlier administration of epinephrine in cardiac arrest, as it is associated with improved outcomes 7, 8
For non-shockable rhythms, epinephrine should be administered as soon as feasible 8
For shockable rhythms, epinephrine should be administered after initial defibrillation attempts have been unsuccessful 8, 6
High-dose epinephrine (>10 mcg/kg IV) has not shown increased survival to hospital discharge or improved neurologic outcomes in pediatric cardiac arrest 2, 5
In adults, doses >1 mg have not demonstrated improvement in survival to hospital discharge or neurologic outcome 4
High-dose epinephrine may be considered in exceptional circumstances such as β-blocker poisoning 1
Epinephrine may cause tachyarrhythmias, ectopic beats, hypotension, and hypertension 1
Extravasation can result in severe skin injury, and phentolamine (0.1-0.2 mg/kg up to 10 mg) can be injected intradermally at the extravasation site 1

Ensure selection of the appropriate concentration for the route of administration and patient age/condition 1