Intramuscular adrenaline is the first treatment for anaphylaxis, and delay is the commonest error. The dose of the 1 mg/mL (1:1,000) solution is 0.01 mg/kg, to a maximum of 0.5 mg in adults, given into the anterolateral thigh, where absorption is faster than in the deltoid.
It can be repeated after about five minutes if there is no improvement. Antihistamines and steroids do not treat airway swelling or shock and should not delay adrenaline. Patients with persistent shock after two doses need an adrenaline infusion and senior help.
- Give 0.01 mg/kg of 1 mg/mL adrenaline intramuscularly, maximum 0.5 mg in adults.
- Inject into the anterolateral thigh rather than the arm.
- Repeat after about five minutes if there is no improvement.
- Do not wait for antihistamines or steroids before giving adrenaline.
Why it matters
Delayed adrenaline, not the wrong second-line drug, is what costs lives in anaphylaxis.
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