ED Clinical Pathway for Evaluation/Treatment of Children with Anaphylaxis

Immediate MD orders

Administer as indicated by clinical condition:

Anaphylaxis Medications

Medication Route mg/kg Max Dose
Epinephrine* IM 0.01 0.5 mg
Diphenhydramine IV 1 50 mg
Ranitidine** IV 1 50 mg
Methylprednisolone IV 2 125 mg
Prednisone PO 2 60 mg

*Administer IM in lateral thigh

**Administer over 15 to 20 minutes to prevent arrhythmias
PO Cetirizine may replace Diphenhydramine in stable patients
See Order Set for dosing

Respiratory Medications

Albuterol weight-based dosing

Kg

Unit Dose (0.5%)

MDI puffs

Continuous

< 5kg 1.25 mg (0.25mL) 2 5 mg/hr
5-10 2.5 mg (0.5 mL) 2 10 mg/hr
10-20 3.75 mg (0.75 mL) 4 15 mg/hr
>20 kg 5 mg (1.0 mL) 6-8 20 mg/hr
Racemic Epi (1% solution)
< 5 kg 0.25mL
5-10 kg 0.5mL

Infusions

Medications Dose
Epinephrine 0.01 – 1 mcg/kg/min
Dopamine 5 – 20 mcg/kg/min

For Epinephrine - resistant hypotension:

 

Intubation Medications

See Pedi-calculator