Pediatric Epinephrine Dose Calculator
Determine correct epinephrine doses for children in emergency situations. This calculator provides weight-based dosing for anaphylaxis, cardiac arrest, and severe asthma by route of administration.
If this is a real emergency, act now. Call emergency services immediately. If the person has a prescribed epinephrine auto-injector (EpiPen, Auvi-Q, or similar), use it right away — do not delay treatment to calculate an exact dose with this tool.
Educational reference tool for caregivers and trained professionals, not medical advice. In a real anaphylaxis, cardiac arrest, or severe asthma emergency, call your local emergency number immediately (911 in the US, 999 in the UK, 112 in the EU) and use a prescribed epinephrine auto-injector right away if one is available — do not wait to calculate an exact dose first.
Epinephrine Dosing for Anaphylaxis
Anaphylaxis is a severe, life-threatening allergic reaction requiring immediate epinephrine administration. Epinephrine works by reversing airway constriction, stabilizing blood pressure, and stopping the allergic cascade. Intramuscular injection into the thigh is the gold standard route because it provides rapid, reliable absorption with peak levels in 8-10 minutes.
The pediatric dose is 0.01 mg/kg up to a maximum of 0.3 mg, using 1:1000 epinephrine (1 mg/mL concentration). A 15kg child receives 0.15mg, which equals 0.15mL. A 35kg child would calculate to 0.35mg but is capped at this 0.3mg maximum: this calculator applies that cap to every age because it only collects weight, and UK Resuscitation Council guidance reserves the higher 500mcg (0.5mg) dose for adolescents over 12. Auto-injectors mirror this plateau: EpiPen Jr delivers 0.15mg for children 15-30kg, while the standard EpiPen delivers 0.3mg for those over 30kg.
Timing is critical—epinephrine should be given at the first sign of serious allergic reaction: difficulty breathing, throat tightness, wheezing, significant swelling, or signs of shock (pale, weak, confused). Antihistamines like diphenhydramine are adjuncts that help with hives and itching but do not treat the life-threatening airway and cardiovascular components. Delaying epinephrine to give antihistamines first is a common and potentially fatal error. Epinephrine is always first-line treatment.
Cardiac Arrest Epinephrine Protocols
In pediatric cardiac arrest, epinephrine helps restore spontaneous circulation by increasing coronary perfusion pressure and improving myocardial contractility. The dosing, concentration, and route differ completely from anaphylaxis treatment, and confusion between protocols can be deadly.
For IV or intraosseous (IO) administration during cardiac arrest, the dose is 0.01 mg/kg using 1:10,000 concentration (0.1 mg/mL), with a maximum single dose of 1mg (same as adult dose). A 20kg child receives 0.2mg, which equals 2mL of 1:10,000 solution. This is given every 3-5 minutes during CPR until return of spontaneous circulation or resuscitation is terminated. The 1:10,000 concentration prevents accidental overdose during rapid administration in a chaotic resuscitation.
When IV/IO access is not available, epinephrine can be given via endotracheal tube (ET) at 0.1 mg/kg using 1:1000 concentration (1 mg/mL), maximum 2.5mg. This is 10 times the IV dose because absorption through the trachea is much less efficient. For a 20kg child, this equals 2mg or 2mL of 1:1000 epinephrine. However, IV/IO access is strongly preferred because ET absorption is unpredictable and may delay effective drug delivery.
Safety and Common Errors
Concentration confusion is the most dangerous error with epinephrine. Using 1:1000 for IV cardiac arrest dosing (instead of 1:10,000) delivers 10 times the intended dose and can cause severe hypertension, arrhythmias, and myocardial ischemia. Conversely, using 1:10,000 for anaphylaxis (instead of 1:1000) delivers only one-tenth the needed dose and may fail to reverse the reaction. Always verify concentration before drawing and administering epinephrine.
Route errors also occur: inadvertent intravenous injection of 1:1000 epinephrine intended for IM use can cause catastrophic outcomes. Auto-injectors are designed for IM use only and should never be used intravenously. Subcutaneous injection, once common for asthma and allergies, is now discouraged because absorption is slower and less reliable than IM administration.
Storage and expiration matter—epinephrine degrades when exposed to light and heat, turning brown or forming precipitates. Discolored or cloudy epinephrine should not be used. Auto-injectors have a shelf life of 12-18 months and must be replaced before expiration. In absolute emergencies, expired epinephrine is better than no epinephrine, but potency may be reduced. Families with children at risk of anaphylaxis should carry two auto-injectors in case a second dose is needed or the first device malfunctions.
Frequently Asked Questions
What is the pediatric dose of epinephrine for anaphylaxis?
The standard dose is 0.01 mg/kg intramuscular (IM) using 1:1000 concentration (1 mg/mL), with a maximum single dose of 0.3 mg (this calculator applies the conservative pediatric cap because it does not collect age; UK Resuscitation Council guidance allows up to 0.5 mg for adolescents over 12). For a 20kg child, this equals 0.2mg or 0.2mL of 1:1000 epinephrine.
Where do you inject epinephrine in children?
The preferred site is the mid-outer thigh (vastus lateralis muscle). This provides faster absorption than subcutaneous injection and can be given through clothing in emergencies. The anterolateral thigh is large and easily accessible even in obese children.
What is the difference between 1:1000 and 1:10,000 epinephrine?
1:1000 contains 1mg per mL and is used for IM injection (anaphylaxis, severe asthma). 1:10,000 contains 0.1mg per mL and is used for IV administration during cardiac arrest. Using the wrong concentration can result in a 10-fold dosing error.
When should you repeat epinephrine in anaphylaxis?
If symptoms do not improve or worsen after 5-15 minutes, repeat the dose. About 20% of anaphylaxis cases require a second dose. Some patients need three or more doses. Continue until symptoms resolve or advanced medical care arrives.
Can you give too much epinephrine in an emergency?
While epinephrine overdose can cause tachycardia, hypertension, tremor, and anxiety, the risk of death from untreated anaphylaxis far exceeds the risk of epinephrine side effects. In true anaphylaxis, there is no absolute contraindication to epinephrine.