About This Calculator

Our Epinephrine Dose Calculator is a clinical support tool for healthcare professionals to rapidly determine appropriate epinephrine doses for various emergency scenarios. It simplifies calculations for anaphylaxis, cardiac arrest, continuous infusions, and other critical conditions in both adult and pediatric patients.

Understanding the Outputs

After entering the required patient and clinical data, the calculator provides the following key outputs:

• Dose (mg): The precise amount of epinephrine to be administered, calculated based on indication and patient weight where applicable.
• Volume to Administer (mL): The volume of the selected epinephrine concentration needed to deliver the correct dose.
• Concentration & Route: The recommended concentration (e.g., 1:1,000 or 1:10,000) and the appropriate route of administration (e.g., IM, IV/IO, Nebulized).
• Infusion Rate (mL/hour): For continuous infusions, the calculator determines the pump rate required to achieve the desired vasopressor effect.
• Preparation Instructions: For scenarios like push-dose pressors, the tool provides clear instructions for dilution.

How to Use the Calculator

Follow these steps for an accurate calculation:

1. Select Clinical Indication: Choose the patient's condition from the dropdown menu (e.g., Anaphylaxis, Cardiac Arrest).
2. Specify Patient Type: Select either 'Adult' or 'Pediatric'. For pediatric patients, you have the option to estimate weight based on age if the actual weight is unknown.
3. Enter Patient Weight: Input the patient's weight and select the unit (kg or lbs).
4. Choose Available Concentration: Select the epinephrine concentration you have on hand (typically 1:1,000 for multi-dose vials or 1:10,000 for pre-filled cardiac syringes).
5. Input Infusion Details (if applicable): For continuous infusions, provide the desired dose rate, total epinephrine in the IV bag, and total fluid volume.

Epinephrine Dosing Overview

Anaphylaxis

The standard treatment is intramuscular (IM) injection of 1:1,000 epinephrine. The typical pediatric dose is 0.01 mg/kg, capped at a maximum single dose (e.g., 0.5 mg). Adult dosing is typically a fixed 0.5 mg IM.

Cardiac Arrest

Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) guidelines recommend 1:10,000 epinephrine for IV/IO administration. The standard adult dose is 1 mg every 3-5 minutes. The pediatric dose is 0.01 mg/kg (max 1 mg) every 3-5 minutes.

Continuous Infusion (Vasopressor)

For post-resuscitation care, shock, or severe hypotension, a continuous epinephrine infusion is used. Dosing is titrated to effect, commonly starting at rates of 0.05 to 0.1 mcg/kg/min.

Symptomatic Bradycardia / Push-Dose

For transient hypotension or bradycardia, a "push-dose pressor" can be prepared by diluting 1:10,000 epinephrine to a final concentration of 10 mcg/mL. Small boluses (e.g., 5-20 mcg) are given slowly.

Switching Routes and Concentrations

Using the correct epinephrine concentration for the intended route is critical to patient safety. 1:1,000 epinephrine (1 mg/mL) is for IM, subcutaneous, or nebulized use. It must be diluted before IV administration. Conversely, 1:10,000 epinephrine (0.1 mg/mL) is standard for IV/IO push in cardiac arrest. Administering the wrong concentration via the wrong route can lead to severe adverse events, including hypertensive crisis or cardiac arrest.

Repeat Dosing Guidelines

Epinephrine is a short-acting medication, and repeat dosing is often necessary. The interval depends on the clinical indication and patient response:

• Anaphylaxis: Repeat the IM dose every 5 to 15 minutes if symptoms persist or recur.
• Cardiac Arrest: Repeat the IV/IO dose every 3 to 5 minutes during resuscitation efforts.
• Push-Dose Pressors: Repeat small boluses every 2 to 5 minutes, titrating to the desired blood pressure.

Key Safety Alerts

• Verify Concentration: Always double-check the vial or syringe to confirm you are using the correct concentration (1:1,000 vs. 1:10,000) for the intended clinical use and route.
• Heed Maximum Doses: The calculator automatically caps pediatric doses at established maximums. Do not exceed these limits without consulting clinical protocols or a specialist.
• Titrate Infusions Carefully: When using a continuous infusion, start at a low rate and titrate based on continuous hemodynamic monitoring.
• Clinical Judgment is Paramount: This tool is an aid, not a replacement for clinical judgment. Always consider the full clinical context and adhere to local institutional protocols.

Frequently Asked Questions (FAQ)

Why is 1:10,000 epinephrine used for IV cardiac arrest instead of 1:1,000?

The 1:1,000 concentration is ten times more concentrated and poses a significant risk of causing severe hypertension and ventricular arrhythmias if given as an IV bolus. The pre-diluted 1:10,000 formulation is the standard of care for IV push during cardiac arrest to mitigate this risk.

What is the maximum single dose of epinephrine for pediatric anaphylaxis?

The generally accepted maximum single dose for a pediatric patient is 0.5 mg, which is equivalent to the standard adult dose. Our calculator automatically caps the weight-based dose at this limit.

How do I prepare push-dose epinephrine for symptomatic bradycardia?

A common method is to take 1 mL of 1:10,000 epinephrine (which contains 100 mcg) and add it to 9 mL of normal saline in a 10 mL syringe. This creates a final concentration of 10 mcg/mL. The calculator provides guidance for this specific scenario.

Can I use the calculator to estimate weight for a child if I don't know it?

Yes. When 'Pediatric' is selected, an option appears to estimate weight from age. This uses a standard formula (e.g., [Age in years x 2] + 8) to provide a quick estimate when a scale is not available.

What is the difference between mcg/kg/min and mcg/min for infusions?

A mcg/kg/min dose is weight-based and is common in pediatrics and for precise titration. A mcg/min dose is not weight-based and is sometimes used in adults for simplicity. The calculator allows you to select either unit for infusion calculations.

Why does the calculator cap the dose for children?

Pediatric dosing is weight-based up to the point where the calculated dose would exceed the standard adult dose. At that point, the dose is capped at the adult maximum to prevent overdosing in larger children.

Is intramuscular or subcutaneous epinephrine preferred for anaphylaxis?

Intramuscular (IM) administration in the anterolateral thigh is preferred because it provides more rapid absorption and higher peak plasma concentrations compared to subcutaneous injection.

Why is patient weight not required for the push-dose bradycardia calculation?

Push-dose epinephrine is administered as small, fixed-dose boluses (e.g., 5-20 mcg) that are titrated directly to a physiological response (i.e., blood pressure), making a precise weight-based calculation unnecessary for this specific emergent use.

References

• Panchal, A. R., et al. (2020). Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 142(16_suppl_2), S366–S468. View Source
• Shaker, M. S., et al. (2020). Anaphylaxis—a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. Journal of Allergy and Clinical Immunology, 146(5), 1082-1123. View Source
• U.S. Food and Drug Administration. (2016). Highlights of Prescribing Information: Epinephrine Injection, USP 1:1000. Drugs@FDA. View Source
• Topjian, A. A., et al. (2020). Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 142(16_suppl_2), S469–S523. View Source