nebulized epinephrine dosing for croup

30 Jan

2011 Cochrane Review:


  • Compared to no medication, inhaled epinephrine improved croup symptoms in children at 30 minutes following treatment
  • This treatment effect disappeared two hours after treatment 
  • However, children’s symptoms did not become worse than prior to treatment



aerosolized epi works at alpha-adrenergic receptors in subglottic mucosa

vasoconstriction -> decreased edema -> less stridor

quick onset: < 10 min



Croup (laryngotracheobronchitis) is a common respiratory illness of childhood

clinical picture is characterized by the abrupt onset of a distinctive barky cough, which may be accompanied by stridor

often preceded by non-specific symptoms such as cough, rhinorrhea and fever. 

most common etiology is a viral infection, predominantly parain-fluenza virus



Studies used:

  • 0.5 ml of 2.25% racemic epinephrine
  • 0.5 mg/kg of 2.25% racemic epinephrine
  • 0.25 ml of 2.25% racemic epinephrine per 5 kg of body weight
  • 5 ml of 1:1000 dilution of L-epinephrine
  • 0.25 ml of 2.25% of racemic epinephrine 

most common dose: 0.5 mL of 2.25% racemic epi



Small ICU study (96 patients) on post-extubation stridor in kids

Nebulized L-epinephrine at doses of 0.5, 2.5 and 5 ml demonstrated a lack of dose response in effect on PES and a modestly clinically significant increase in undesired side effects (heart rate and blood pressure) at higher doses.”



References: Rosen’s Emergency Medicine (2011); cochrane review; small ICU study; picture


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