In pediatric moderate/severe anaphylaxis, what is the recommended epinephrine dosing and maximum single dose?

• A. Epinephrine 1:1,000 0.01 mg/kg IM; max 0.5 mg; may repeat q5min up to 1.5 mg
• B. Albuterol 2.5 mg in 3 mL SVN, repeat as needed
• C. NS or LR bolus 20 mL/kg; may repeat up to 60 mL/kg
• D. Diphenhydramine 1 mg/kg IM/IV/IO/PO; max 50 mg

Answer: (A)

In pediatric moderate to severe anaphylaxis, epinephrine given promptly by intramuscular injection is the most important and time-sensitive treatment. Use a 1:1,000 (1 mg/mL) epinephrine solution at 0.01 mg/kg per dose, delivered into the mid-anterolateral thigh. Do not exceed a single dose of 0.5 mg. If symptoms persist or recur, repeat the same dose every 5 minutes, with a total maximum of 1.5 mg. This approach directly counteracts airway swelling, bronchospasm, and circulatory collapse associated with anaphylaxis. Other therapies like albuterol for bronchospasm, IV fluids for hypotension, or diphenhydramine as an adjunct can be considered, but they do not replace epinephrine as first-line treatment.