Pediatric Epinephrine Dose (Anaphylaxis)

The Pediatric Epinephrine Dose Calculator provides weight-based dosing for epinephrine (adrenaline) in pediatric emergency situations, primarily anaphylaxis but also including cardiac arrest, severe croup, and shock. Epinephrine is the most critical medication in emergency pediatric medicine and is the first-line treatment for anaphylaxis at any age. Rapid and accurate dosing can be life-saving.

For anaphylaxis, the standard pediatric dose of intramuscular (IM) epinephrine is 0.01 mg/kg of the 1:1,000 (1 mg/mL) concentration, with a maximum dose of 0.5 mg. This should be administered immediately upon recognition of anaphylaxis into the anterolateral thigh (vastus lateralis muscle). The dose may be repeated every 5-15 minutes if symptoms persist or recur. Delays in epinephrine administration are associated with increased fatality rates.

Auto-injector devices provide pre-measured doses: the EpiPen Jr (or equivalent) delivers 0.15 mg and is recommended for children weighing 7.5-25 kg, while the adult EpiPen delivers 0.3 mg and is appropriate for children 25 kg and above. For infants under 7.5 kg, weight-based dosing with a syringe and needle is preferred because 0.15 mg may be excessive. A 0.1 mg auto-injector has been developed for infants in some markets.

In cardiac arrest (pulseless arrest), epinephrine is given intravenously or intraosseously at 0.01 mg/kg of the 1:10,000 (0.1 mg/mL) concentration, with a maximum dose of 1 mg. This is repeated every 3-5 minutes during resuscitation. Note the different concentration: IM uses 1:1,000 and IV uses 1:10,000. Using the wrong concentration is a potentially fatal error that must be avoided through clear labeling and double-checking.

For severe croup (laryngotracheobronchitis) with stridor at rest, nebulized epinephrine (racemic 2.25% solution or L-epinephrine 1:1,000) is used to reduce subglottic edema. The standard nebulized dose is 0.5 mL/kg of 1:1,000 epinephrine (maximum 5 mL), diluted to 3-5 mL with normal saline and administered over 15 minutes. The child should be observed for at least 2-4 hours after nebulization for rebound symptoms.

Epinephrine works through alpha-1 adrenergic effects (vasoconstriction, increased blood pressure, reduced mucosal edema), beta-1 effects (increased heart rate and contractility), and beta-2 effects (bronchodilation, reduced mediator release from mast cells). These combined actions make it uniquely effective for anaphylaxis, which involves hypotension, airway edema, and bronchospasm simultaneously.

This calculator provides route-specific dosing, volume calculations for different concentrations, auto-injector size selection, and repeat dosing intervals. In emergency situations, the most common error is failure to give epinephrine or delayed administration. When in doubt, give epinephrine IM at 0.01 mg/kg. The risk of withholding epinephrine in anaphylaxis far exceeds the risk of giving it.