Intramuscular adrenaline into the anterolateral thigh is the first-line treatment for anaphylaxis. The adult dose is 0.5 mg (0.5 mL of 1 mg/mL), and for children 0.01 mg/kg up to 0.5 mg. It can be repeated after five minutes if there is no improvement.
Subcutaneous injection absorbs more slowly and less reliably. Intravenous adrenaline belongs to resuscitation settings with monitoring, given as a titrated infusion or small boluses by experienced clinicians, because undiluted intravenous boluses cause dangerous arrhythmias and hypertension.
- Give 0.5 mg intramuscular adrenaline into the anterolateral thigh for adult anaphylaxis.
- Use 0.01 mg/kg, maximum 0.5 mg, in children.
- Repeat after five minutes if there is no improvement.
- Reserve intravenous adrenaline for monitored settings and experienced hands.
Why it matters
Wrong route and delay remain the commonest errors in anaphylaxis.
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