Anaphylaxis Treatment and Dispo

19 Sep

•Give IM epinephrine in the mid thigh for mild to moderate cases. Give IV epinephrine for severe cases

IM injection is preferred over SC injection because it provides a more rapid increase in the plasma and tissue concentrations of epi

•IM injection should be of the concentration 1mg/mL, also written as a dilution of 1:1000

IM dose for children is 0.01mg/kg of the 1:1000 dilution. This may be repeated every 5-15 minutes

•An Epipen  (0.3mg) may be used instead. Use an Epipen Jr (0.15mg) for children less than 25kg.

Fluids for anyone who does not respond to IM epi

IV epi for anyone who does not respond to IM epi and fluids.

IV epi is the 0.1mg/mL concentration or 1:10,000 dilution. Dosing for children is 0.1-1microgram/kg/min

•There is no consensus regarding optimal observation period. One suggestion: Patients with moderate anaphylaxis who do not respond promptly to epinephrine, and all patients with severe anaphylaxis, should be admitted to an observation unit or to a hospital.

•For patients with anaphylaxis that resolved promptly and completely with treatment, consider a minimum observation period of a few hours, and if possible a period of 8 to 10 hours.

If patients are sent home after only a few hours, they should be trained to use an epipen and should actually be supplied with one, rather than simply handed a prescription for one.


Submitted by M. Smith.


References: Simons FER, Camargo CA. Anaphylaxis, Rapid Recognition and Treatment., 2012. picture




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