Epinephrine Infusion Guidelines for Pediatric Patients

Initial Dosing and Preparation

The American Academy of Pediatrics recommends starting epinephrine infusion at 0.1 mcg/kg/min and titrating up to 1.0 mcg/kg/min based on clinical response, with doses up to 5 mcg/kg/min sometimes necessary in severe cases 1
To prepare the infusion, multiply 0.6 × patient's weight in kg to get the number of milligrams of epinephrine, then add this amount to normal saline to make a total volume of 100 mL 2, 1

The typical therapeutic range for epinephrine infusion is 0.1-1.0 mcg/kg/min, with monitoring of blood pressure, heart rate, and perfusion markers every 5-15 minutes during titration 1
Increase the dose incrementally if there is an inadequate response, with maximum doses up to 5 mcg/kg/min sometimes required in refractory cases 1

Central venous access is strongly preferred to minimize extravasation risk and tissue necrosis, with peripheral IV or intraosseous access used temporarily during initial resuscitation if central access is unavailable 1
Monitor blood pressure, heart rate, capillary refill time, mental status, urine output, and signs of excessive vasoconstriction every 5-15 minutes initially 1

Always visually inspect the epinephrine solution before preparation, discarding it if it is not clear and colorless, or if it contains particulate matter or crystals 3
The solution should be prepared by adding 1 mg (1 mL) of 1:1000 epinephrine to 250 mL of D5W, yielding a concentration of 4.0 mcg/mL 3, 2

For anaphylaxis, epinephrine infusion should start at 1-4 mcg/min and titrate up to a maximum of 10 mcg/min, with concurrent aggressive volume replacement with normal saline 3, 2
There is no absolute contraindication to epinephrine in anaphylaxis, even in patients with cardiac disease 3
If extravasation occurs, immediately infiltrate phentolamine 0.1-0.2 mg/kg (up to 10 mg) diluted in 10 mL of 0.9% sodium chloride intradermally at the site to prevent tissue necrosis 1