Epinephrine IM for Pediatrics during Anaphylaxis

[Sara Bennett]

I would like ask whether it is safe to administer Epinephrine 1:10000 intramuscular during anaphylaxis in pediatric patients weighing less than 7.5 kg. All references recommends a dose of 0.01 mg = 0.01 ml /kg of epinephrine 1:1000. My concern is that measuring a very small dose during an emergency (e.g. 4 kg baby) can be a risk factor for measurement error.
Using Epinephrine 1:10000 the dose will become 0.01 mg = 0.1 ml/ kg which is more practical during emergency.
Both Epipen and epinephrine 1:10 000 have similar excipients and pH levels (2.2 to 5).

[Alchemist]

My advice is to use a dosing diagram. It’s a standardized table that shows the standard dilution, e.g. 1mg in 10ml (100mcg/ml); and the equivalent volume to a series of weights. You can approximate to the nearest weight. As per your example, a dose for a 4kg baby would be (0.04mg) which is equivalent to (0.4ml) of the diluted solution.
This strategy is suggested as a safety issue against the wrong dose calculation associated with preparation. You can find an example of such tables under (Anaphylactic Shock) topic in uptodate. Such tables are to be placed in the anaphylactic trays.

* Another option is to use the ready to use syringes of (0.15mg and 0.3mg) as per the weight ranges indicated:-

EpiPen Jr: IM, SubQ: Children 15 to 29 kg: 0.15 mg; if anaphylactic symptoms persist, dose may be repeated using an additional EpiPen Jr

EpiPen: IM, SubQ: Children ≥30 kg: 0.3 mg; if anaphylactic symptoms persist, dose may be repeated using an additional EpiPen

Finally, as of May,1 2016, ratio expression of epinephrine, e.g 1:1000, is prohibited by ISMP due to associated latent errors.
It’s advised to use (mg) for expression of doses.

[Author]

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