Epinephrine (1:10,000) Pediatric Dose — Resuscitation
Epinephrine is a catecholamine that acts on both alpha- and beta-adrenergic receptors, producing vasoconstriction, increased cardiac contractility, and restoration of spontaneous circulation. The 1:10,000 concentration (0.1 mg/mL) is the standard formulation used for intravenous and intraosseous administration during pediatric cardiac arrest. It is a first-line vasopressor in pediatric cardiopulmonary resuscitation (CPR) per PALS guidelines.
Pediatric Dosing
- IV/IO: 0.01 mg/kg (equivalent to 0.1 mL/kg of the 1:10,000 solution) per dose — Maximum single dose: 1 mg
- Endotracheal (ET) route: Higher doses are required via ET tube — consult institutional protocol for ET dosing; Maximum ET dose: 2.5 mg
Doses may be repeated every 3–5 minutes during ongoing cardiac arrest as guided by clinical response and resuscitation team direction.
Worked example: For a 20 kg child: 20 kg × 0.01 mg/kg = 0.2 mg IV/IO, which equals 20 kg × 0.1 mL/kg = 2 mL of the 1:10,000 solution. For a 70 kg adolescent, the calculated dose would be 0.7 mg — still below the 1 mg maximum.
Indications and Clinical Context
Epinephrine 1:10,000 is indicated for pediatric cardiac arrest, including pulseless ventricular tachycardia (pVT), ventricular fibrillation (VF), pulseless electrical activity (PEA), and asystole. Per PALS guidelines, epinephrine should be administered as soon as IV/IO access is established in non-shockable rhythms (PEA/asystole) and after the second defibrillation attempt in shockable rhythms (VF/pVT). Its primary mechanism during resuscitation is alpha-mediated peripheral vasoconstriction, which increases coronary and cerebral perfusion pressure during CPR.
The IV/IO route is strongly preferred over the endotracheal route due to more reliable drug delivery and pharmacokinetics. ET administration results in lower plasma concentrations and is reserved for situations where vascular access cannot be established.
Administration and Monitoring
Administer each dose as a rapid IV/IO bolus followed by a 5–10 mL normal saline flush to ensure delivery into the central circulation. Use the 1:10,000 concentration (0.1 mg/mL) for IV/IO dosing; confirm the concentration carefully before administration to avoid tenfold dosing errors with the 1:1,000 formulation. The maximum single IV/IO dose is 1 mg; the maximum ET dose is 2.5 mg.
- Monitor for return of spontaneous circulation (ROSC), post-resuscitation hypertension, and tachyarrhythmias.
- After ROSC, anticipate potential need for vasopressor infusion; bolus epinephrine has a short duration of action.
- Extravasation at peripheral IV sites can cause tissue necrosis — IO or central access is preferred.
- Consult institutional protocol for dosing intervals and adjunct therapies during prolonged resuscitation.
Disclaimer: This article is an educational reference summarizing standard pediatric dosing values. It is not a substitute for clinical judgment. Always verify doses against institutional protocols, the current edition of authoritative references (e.g., Lexicomp, Harriet Lane Handbook, PALS guidelines), the patient’s accurate weight, and any patient-specific factors (renal/hepatic function, allergies, comedications) before administration.