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Clinic staff rush over a 6-year-old child for management in the ED. The child had received a new IV chemotherapeutic agent and 5 minutes later began to develop wheezing, hives, periorbital and perioral angioedema, and felt weak and dizzy. Heart rate is 165 and blood pressure is 80/40.
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June 5, 2024 at 5:39 pm
C) 0.01 mg/kg of IM 0.1 mg/mL epinephrine
Epinephrine is the first-line drug for anaphylaxis, which is what this child is experiencing. It is generally preferable to give the epinephrine by the IM route even if an IV is already in place because of the potential cardiac adverse effects of pushing IV epinephrine (unless the patient is in cardiac or respiratory arrest or is profoundly hypotensive). The dose is 0.01 mg/kg (or 0.15 mg auto-injector for a child weighing 7.5-25kg, 0.3 mg auto-injector for a child 25 kg or more), and the 1:1000 or 1mg/mL concentration of epinephrine should be used. If epinephrine is given IV, one should use 1:10,000 or 0.1 mg/mL concentration. The thigh muscle is preferred over the deltoid or gluteal muscles for IM epinephrine. The 0.15 mg auto-injector is the ideal dose for a 15 kg child, and the 0.3 mg auto-injector is the ideal dose for a 30 kg child. Experts suggest that at 25 kg the benefits of being closer to the 0.1 mg/kg dose outweigh the risks of receiving a slight overdose, so the child should start using the 0.3 mg auto-injector.