| Example of preparation of epinephrine infusion for refractory symptoms of anaphylaxis for pediatric patient of 10 kg body weight for emergency/critical care units |
| Final concentration: Epinephrine 10 mcg/mL |
| Preparation |
- CHECK vial strength.
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- Add 1 milligram epinephrine to 100 mL bag of 0.9% normal saline (NS) or 5% dextrose water (D5W)
- If you have 0.1 mg/mL strength epinephrine (may also be labeled 1:10,000) use 10 mL to deliver 1 mg to bag*
- If you have 1 mg/mL strength epinephrine (may also be labeled 1:1000) use 1 mL to deliver 1 mg to bag*
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| Administration |
- Infuse an initial dose of 0.1 mcg/kg/minute using a programmable infusion pump and titrate, as needed, while continuously monitoring the patient's cardiac rhythm and blood pressure.
- For detail on titrating the infusion based upon response, refer to the UpToDate topic on emergency treatment for anaphylaxis.
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| Pediatric dose for 10 kg child | Administration rate for infusion pump to deliver pediatric dose shown |
| mcg per kg per minute | Multiply by patient weight
(10 kg) | mcg per minute | mL per minute for 10 kg child | Multiply by 60 minutes | mL per hour for 10 kg child |
| 0.05 | 0.5 | 0.05 | 3 |
| 0.1 | 1 | 0.1 | 6 |
| 0.2 | 2 | 0.2 | 12 |
| 0.3 | 3 | 0.3 | 18 |
| 0.4 | 4 | 0.4 | 24 |
| 0.5 | 5 | 0.5 | 30 |
| 0.6 | 6 | 0.6 | 36 |
| 0.7 | 7 | 0.7 | 42 |
| 0.8 | 8 | 0.8 | 48 |
| 0.9 | 9 | 0.9 | 54 |
| 1 | 10 | 1 | 60 |
- The above table is provided as an example. There are other acceptable concentrations.
- Intravenous epinephrine, like all vasopressors, can cause life-threatening hypertension, cardiac ischemia, and ventricular arrhythmias. It should be administered ONLY by clinicians trained and experienced in dose titration of intravenous epinephrine using continuous noninvasive electronic monitoring of heart rate and blood pressure.
- Epinephrine is an ischemia-causing agent and vesicant. Monitor infusion site for extravasation. Central venous catheter administration is preferred when available. Refer to the Lexicomp drug reference for information on managing extravasation including infiltration of phentolamine.
- To reduce the risk of making a medication error, we suggest that centers have available an institutionally approved protocol for epinephrine infusion that includes steps on how to prepare and administer the infusion and standard concentration(s).
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