Push Dose Epinephrine Recommendations

Preparation and Administration

The American Academy of Allergy, Asthma, and Immunology recommends diluting 0.1-0.3 mL of 1:1000 epinephrine (1 mg/mL) in 10 mL of normal saline for intravenous administration over several minutes 1, 2
For pediatric patients, the American Academy of Pediatrics recommends weight-based dosing of 0.01 mg/kg or 0.1 mL/kg of 1:10,000 solution, with a maximum dose of 0.3 mg 1, 2, 4

Continuous hemodynamic monitoring is essential when administering intravenous epinephrine, as recommended by the American Heart Association 1, 2, 3
In settings where continuous hemodynamic monitoring is unavailable, the American Heart Association recommends monitoring blood pressure and pulse every minute and using electrocardiographic monitoring if available 1, 2
The American Heart Association also recommends administering epinephrine intravenously with caution due to the risk of potentially lethal arrhythmias 1, 2, 3

The American Academy of Allergy, Asthma, and Immunology recommends transitioning to a continuous epinephrine infusion if repeated push doses are required 1, 2, 3
For continuous infusion, the American Academy of Allergy, Asthma, and Immunology recommends preparing a solution by adding 1 mg (1 mL) of 1:1000 epinephrine to 250 mL of D5W to yield a concentration of 4.0 μg/mL 1, 2
The American Academy of Allergy, Asthma, and Immunology also recommends infusing at a rate of 1-4 μg/min (15-60 drops per minute with a microdrop apparatus), increasing to a maximum of 10.0 μg/min as needed 1, 2

Extravascular administration can result in severe skin injury, and the American Academy of Pediatrics recommends ensuring proper intravenous access 4