Calculate pediatric epinephrine doses for anaphylaxis, cardiac arrest, bradycardia, croup, and asthma. Weight-based dosing with concentration conversions and autoinjector guidance.
The Pediatric Epinephrine Dose Calculator provides weight-based epinephrine dosing for the five major pediatric indications: anaphylaxis, cardiac arrest, symptomatic bradycardia, severe croup, and refractory asthma. Epinephrine (adrenaline) is the single most important drug in pediatric emergency medicine, and getting the dose right is literally a matter of life and death — particularly in small children where 10-fold dosing errors have been a documented cause of iatrogenic death.
The complexity of pediatric epinephrine dosing arises from multiple factors: different indications require different doses (0.01 mg/kg for anaphylaxis/cardiac arrest vs. fixed nebulizer doses for croup), different concentrations are used for different routes (1:1,000 for IM, 1:10,000 for IV), and different maximum doses apply (0.5 mg for anaphylaxis, 1 mg for cardiac arrest). Confusion between 1:1,000 and 1:10,000 concentrations — a 10-fold difference — is one of the most dangerous medication errors in emergency medicine.
This calculator eliminates concentration confusion by calculating the exact volume to draw for the specified concentration and route. It provides autoinjector recommendations (EpiPen vs. EpiPen Jr), tracks cumulative doses, and includes quick-reference tables for all indications. The prominent dose display format is designed for rapid reading in emergency situations.
Epinephrine dosing errors in children — particularly 10-fold errors from concentration confusion — are among the most dangerous medication errors in medicine. This calculator automates the weight-based calculation, converts between concentrations, and provides the exact volume to draw, reducing the cognitive burden in high-stress emergency situations. Keep these notes focused on your operational context. Tie the context to the calculator’s intended domain.
Anaphylaxis (IM): 0.01 mg/kg of 1:1,000 (max 0.5 mg) Cardiac Arrest (IV/IO): 0.01 mg/kg of 1:10,000 (max 1 mg), q3–5 min Bradycardia (IV/IO): 0.01 mg/kg of 1:10,000 (max 1 mg), q3–5 min Croup (nebulized): 0.5 mL racemic 2.25% in 3 mL saline Asthma (SC): 0.01 mg/kg of 1:1,000 (max 0.5 mg), q20 min ×3 Volume (mL) = Dose (mg) ÷ Concentration (mg/mL)
Result: 0.2 mg (200 mcg) IM = 0.2 mL of 1:1,000; or use EpiPen Jr 0.15 mg autoinjector
A 20 kg child in anaphylaxis receives 0.01 mg/kg × 20 kg = 0.2 mg epinephrine intramuscularly in the anterolateral thigh. This equals 0.2 mL drawn from a 1:1,000 vial. An EpiPen Jr (0.15 mg) is a reasonable alternative, delivering a slightly lower dose.
The leading cause of epinephrine dosing errors is confusion between 1:1,000 (1 mg/mL, for IM) and 1:10,000 (0.1 mg/mL, for IV). Giving 1:1,000 concentration intravenously delivers 10 times the intended dose and has caused deaths. Many hospitals have adopted unit-dose labeling (mg/mL instead of ratio notation) and restrict 1:1,000 vials from resuscitation carts to reduce this error. Some newer protocols use only mg/mL terminology to eliminate ratio confusion entirely.
Up to 20% of anaphylaxis episodes have a biphasic pattern, where initial symptoms resolve then recur 1–72 hours later (most commonly 8–10 hours). This is why all patients who receive epinephrine for anaphylaxis should be observed for at least 4–6 hours (some guidelines recommend 24 hours for severe reactions). Patients discharged after anaphylaxis must be prescribed an epinephrine autoinjector and educated on its use.
In pediatric cardiac arrest, epinephrine is given IV/IO at 0.01 mg/kg every 3–5 minutes. Unlike adult ACLS where vasopressin was briefly considered an alternative, pediatric guidelines exclusively recommend epinephrine. The first dose should be given as soon as IV/IO access is obtained. For shockable rhythms (VF/pVT), epinephrine is given after the second shock. For non-shockable rhythms (asystole/PEA), epinephrine is given immediately. High-quality CPR with minimal interruptions remains more important than any drug.
1:1,000 contains 1 mg/mL and is used for IM injection (anaphylaxis) and SC injection. 1:10,000 contains 0.1 mg/mL and is used for IV administration (cardiac arrest, bradycardia). Using 1:1,000 IV instead of 1:10,000 delivers a 10-fold overdose, which can cause fatal hypertension and arrhythmias.
EpiPen Jr (0.15 mg) is recommended for children weighing 7.5–25 kg. EpiPen (0.3 mg) is for patients weighing 25 kg or more. For infants under 7.5 kg, epinephrine must be drawn from a vial using a weight-based dose.
The anterolateral thigh (vastus lateralis muscle) is the preferred IM injection site for all ages. It provides faster and higher peak absorption than deltoid or subcutaneous routes. For autoinjectors, inject through clothing if needed — do not delay.
Yes. Epinephrine overdose causes severe tachycardia, hypertension, ventricular arrhythmias, pulmonary edema, and can be fatal. This is why weight-based dosing and concentration verification are critical. However, in true anaphylaxis or cardiac arrest, the risk of not giving epinephrine far outweighs overdose risk.
For anaphylaxis IM: every 5–15 minutes if symptoms persist. For cardiac arrest IV: every 3–5 minutes during CPR. There is no absolute maximum number of doses in cardiac arrest. For anaphylaxis, if 2–3 IM doses fail, transition to IV epinephrine infusion.
If IV/IO access cannot be obtained, epinephrine can be given via endotracheal tube at 10× the IV dose: 0.1 mg/kg of 1:1,000 concentration. However, this route is unreliable and should only be used as a last resort — IO access is preferred over ET.