Anaphylaxis and Cardiac Arrest Management with Epinephrine

Introduction to Epinephrine Dosing

The American Heart Association recommends repeat doses of epinephrine every 5 minutes as needed for anaphylaxis, with no maximum number of doses, for adults (0.3 mg) and children (0.15 mg for 15-30 kg, 0.3 mg for >30 kg) 1, 2, 3, 4

For anaphylaxis, the initial intramuscular dose of epinephrine should be repeated every 5 minutes if symptoms fail to resolve or worsen, according to the American College of Cardiology 1, 3, 2
The standard adult dose is 0.3 mg IM, and the pediatric dose is 0.15 mg IM for children 15-30 kg and 0.3 mg IM for children >30 kg, as recommended by the American Academy of Pediatrics 3, 4, 2
6-28% of patients require a second dose of epinephrine, and some need three or more doses, highlighting the importance of continuous monitoring, as noted by the American Heart Association 1, 4, 2

The American Heart Association recommends 1 mg IV/IO of epinephrine every 3-5 minutes during ongoing cardiac arrest, with a concentration of 1:10,000 (0.1 mg/mL) for IV/IO administration 3, 5
The pediatric dose for cardiac arrest is 0.01 mg/kg IV/IO (maximum 1 mg), repeated every 3-5 minutes, as recommended by the American Academy of Pediatrics 5, 6

High-dose epinephrine (0.1 mg/kg) as rescue therapy is associated with worse outcomes in pediatric cardiac arrest, and standard doses should be continued instead, according to the American Heart Association 5
Fatalities are associated with delayed or inadequate epinephrine dosing, not with giving multiple doses, emphasizing the need for prompt and repeated administration, as noted by the American College of Cardiology 2
The short half-life of epinephrine necessitates repeat dosing every 5 minutes as long as symptoms persist or progress, highlighting the importance of continuous monitoring, as recommended by the American Heart Association 2
There is no absolute contraindication to epinephrine in anaphylaxis, even in elderly patients or those with cardiac disease, and the risk of death from untreated anaphylaxis far exceeds the risk of epinephrine-related adverse effects, as stated by the American Academy of Allergy, Asthma, and Immunology 2