Epinephrine Dosing for Myocardial Infarction in Pediatric Patients

Dosing Considerations

• The American College of Cardiology recommends an initial epinephrine dose of 0.01 mg/kg for cardiac arrest situations in pediatric patients, repeated every 3 to 5 minutes for ongoing arrest, with a maximum of 0.3 mg 1
• For a 25kg child, the recommended initial dose translates to 0.25mg (0.25ml of a 1mg/ml solution) 1
• Higher subsequent dosages (0.1-0.2 mg/kg) might be considered for unresponsive asystole or pulseless electrical activity 1

Administration Route and Monitoring

• The American Heart Association recommends administering epinephrine intravenously for immediate effect in MI situations 2, 1
• Monitoring of heart rate and blood pressure should be done every 5-15 minutes during initial administration, although this is based on a guideline from Praxis Medical Insights, a similar recommendation may be found from other societies 3

Important Precautions

• Epinephrine should not be mixed with sodium bicarbonate or other alkaline solutions in the IV line, as they can inactivate the medication 3

Special Considerations for Pediatric Patients

• Central venous access is preferred for administration of epinephrine in pediatric patients, but if unavailable, peripheral IV can be used temporarily with strict monitoring for extravasation, according to Praxis Medical Insights 3