Emergency Treatment – Adrenaline

Adrenaline is the most important drug in the treatment of anaphylaxis and there is no absolute contraindication for its administration in treating this condition.

When to administer adrenaline

Adrenaline may be administered in life-threatening anaphylactic reactions, even when the following relative contraindications are present:

• Coronary artery disease
• Uncontrolled hypertension
• Serious ventricular arrhythmias
• The second stage of labour

What affect does it have?

Adrenalines alpha-adrenoceptor actions reverse the peripheral vasodilatation and reduce oedema. It also has a beta-receptor action that causes airway dilation, increases the force of myocardial contraction and suppresses the histamine and leukotriene release.

How much to give?

Adrenaline IM dose Use 1 mg/mL [1:1000] adrenaline

Adult and child* > 12 years: 500 micrograms IM (0.5 mL of 1 mg/ml adrenaline)

6 12 years: 300 micrograms IM (0.3 mL)

6 months 6 years: 150 micrograms IM (0.15 mL)

< 6 months: 100 150 micrograms IM (0.1 to 0.15 mL)

*Give 300 micrograms IM (0.3 mL) in a child who is small or prepubertal

Very important! These are very small volumes. They are NOT to be given intravenously, and are NOT the adrenaline concentrations used in cardiac arrest (which is 1:10,000)

Warning: Rapid intravenous infusions of adrenaline may cause death from cerebrovascular haemorrhage, or cardiac arrhythmias or infarction.

• Repeat the IM adrenaline dose after 5 minutes if there is no improvement in the patients condition.
• Nebulised adrenaline can be a useful adjunct in managing upper airway obstruction due to laryngeal oedema, but it should only be considered after intramuscular (or intravenous) adrenaline has been administeredbut not as a substitute. Recommended doses are 5 mL of 1 mg/mL (1:1 000) adrenaline
• IV adrenaline should only be given by experienced specialists in an appropriate setting.