Epinephrine Pediatric Dose — Cardiovascular Infusion
Epinephrine is an endogenous catecholamine that acts on both alpha- and beta-adrenergic receptors, producing dose-dependent increases in heart rate, myocardial contractility, and systemic vascular resistance. As a continuous infusion, it is used in critically ill pediatric patients with refractory shock, including septic, cardiogenic, and post-arrest distributive shock states. It is a cornerstone agent in pediatric intensive care and advanced resuscitation.
Pediatric Dosing
The standard continuous infusion dose range is 0.05 mcg/kg/min to 1 mcg/kg/min IV or IO, titrated to clinical and hemodynamic response.
- Starting dose: 0.05–0.1 mcg/kg/min; titrate upward as needed
- Usual range: 0.05–1 mcg/kg/min
- Route: IV (central venous access preferred) or IO
Worked example: For a 20 kg child at 0.1 mcg/kg/min: 20 × 0.1 = 2 mcg/min total infusion rate. At the upper range of 1 mcg/kg/min: 20 × 1 = 20 mcg/min. Consult institutional protocol for specific concentration and pump programming guidelines.
Indications and Clinical Context
Continuous epinephrine infusion is indicated in pediatric patients with hemodynamically significant shock unresponsive to adequate fluid resuscitation, particularly when both inotropic support and vasopressor effect are required. Common scenarios include fluid-refractory septic shock, cardiogenic shock with low cardiac output, and post-cardiac arrest hemodynamic instability. Per PALS guidelines, epinephrine is a first-line vasoactive agent when dopamine-resistant or norepinephrine-resistant shock is present, or when augmented inotropy is a therapeutic priority.
At lower doses, beta-adrenergic effects predominate (increased heart rate and contractility); at higher doses, alpha-adrenergic vasoconstriction becomes more prominent, raising systemic vascular resistance and mean arterial pressure.
Administration and Monitoring
Epinephrine infusions should ideally be administered via a dedicated central venous catheter, as peripheral or IO extravasation can cause tissue necrosis. IO access is acceptable as a bridge in emergency settings. Continuous cardiorespiratory monitoring is mandatory, including heart rate, blood pressure (arterial line strongly preferred in the PICU), and pulse oximetry.
- Titration: Adjust in small increments (0.05–0.1 mcg/kg/min) every few minutes based on hemodynamic response
- Adverse effects to monitor: Tachycardia, arrhythmias, hypertension, peripheral vasoconstriction, hyperglycemia, and hypokalemia
- Extravasation risk: If peripheral administration is unavoidable, monitor site closely; phentolamine infiltration is the treatment for extravasation injury
- Max dose: Not explicitly defined in source; consult institutional protocol for upper titration limits
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.