Pediatric Epinephrine Dose Calculator
Enter the child's weight and select the administration route to get the epinephrine dose in both milligrams and millilitres. The calculator covers all four routes used in paediatric emergencies, applies the correct concentration for each route, and enforces published maximum doses. Switch between a child older than 28 days and a neonate to apply the appropriate dosing ranges. All results should be verified by a licensed clinician before administration.
What is epinephrine and why is weight-based dosing critical?
Epinephrine (adrenaline) is the first-line medication for paediatric cardiac arrest and anaphylaxis. It stimulates alpha- and beta-adrenergic receptors, increasing heart rate, myocardial contractility, and systemic vascular resistance. Because the therapeutic window is narrow and the drug is highly potent, paediatric doses are always calculated on a per-kilogram basis. Even a small error in weight estimation or decimal placement can result in a tenfold overdose or an ineffective underdose. Tools such as the Broselow tape are used at the bedside to estimate weight and guide dosing when the actual weight is unknown.
How this calculator works: formula and concentrations
The core formula is: dose (mg) = weight (kg) x dose rate (mg/kg). The dose rate and concentration depend on the route. Intravenous and intraosseous (IV/IO) routes use 0.01 mg/kg of the 1:10,000 solution (0.1 mg/mL), so 0.1 mL/kg is drawn up. Intramuscular and subcutaneous (IM/SC) routes also use 0.01 mg/kg but with the more concentrated 1:1,000 solution (1 mg/mL), giving only 0.01 mL/kg. The endotracheal (ET) route requires a tenfold higher dose of 0.1 mg/kg using the 1:1,000 solution because bioavailability is lower through lung tissue. Nebulized epinephrine for croup uses 0.5 mg/kg of the 1:1,000 solution, up to 5 mg. The calculator applies each maximum dose automatically and flags when the ceiling is reached.
Neonatal dosing: different ranges and concentrations
Newborns (28 days old or younger) have different pharmacokinetics and narrower therapeutic ranges. Intravenous neonatal dosing is 0.01-0.03 mg/kg of the 1:10,000 solution, and endotracheal dosing is 0.03-0.1 mg/kg of the 1:10,000 solution. Unlike older children, neonates always use the 1:10,000 concentration for all routes to reduce the risk of overdose. Select the "Neonate" age group in the calculator to display both the low-end and high-end values of the neonatal range.
EpiPen auto-injectors: fixed doses and weight thresholds
Auto-injectors deliver a fixed dose rather than a weight-based volume. The EpiPen Jr delivers 0.15 mg and is indicated for children weighing 15-30 kg. The standard EpiPen delivers 0.3 mg and is recommended for patients weighing 30 kg or more. For children below 15 kg, a weight-based syringe dose is typically preferred because the fixed auto-injector doses may represent a significant relative overdose. The insight panel in this calculator notes which auto-injector is weight-appropriate when relevant.
Epinephrine dosing by route - children older than 28 days
| Route | Dose (mg/kg) | Concentration | Volume equivalent | Max dose |
|---|---|---|---|---|
| IV / IO | 0.01 | 1:10,000 (0.1 mg/mL) | 0.1 mL/kg | 1 mg |
| IM / SC | 0.01 | 1:1,000 (1 mg/mL) | 0.01 mL/kg | 0.5 mg |
| Endotracheal (ET) | 0.1 | 1:1,000 (1 mg/mL) | 0.1 mL/kg | 10 mg |
| Nebulizer | 0.5 | 1:1,000 (1 mg/mL) | 0.5 mL/kg | 5 mg |
Standard doses per kg with the recommended concentration and published maximum for each administration route. Source: PALS / AHA 2020 guidelines.
Frequently asked questions
Why does the IV route use a different concentration than IM?
The IV route uses the 1:10,000 solution (0.1 mg/mL) because slower, more dilute delivery reduces the risk of arrhythmia and coronary vasospasm. The IM and SC routes use the more concentrated 1:1,000 solution (1 mg/mL) because the drug is absorbed more slowly through muscle tissue, and a smaller injection volume is more practical. Giving the 1:1,000 concentration intravenously is a serious medication error that can cause ventricular fibrillation.
How often can epinephrine be repeated in cardiac arrest?
Per the American Heart Association Pediatric Advanced Life Support (PALS) 2020 guidelines, epinephrine can be repeated every 3 to 5 minutes during CPR. Each dose is 0.01 mg/kg IV/IO (0.1 mL/kg of 1:10,000), up to a maximum of 1 mg per dose. Timing between doses should be consistent and coordinated with ongoing chest compressions and rhythm checks.
What is the maximum dose of epinephrine for a child?
Maximum doses depend on the route. For IV/IO use in cardiac arrest, the maximum is 1 mg per dose. For IM/SC use in anaphylaxis, the maximum is 0.3-0.5 mg (this calculator uses 0.5 mg as the ceiling). For the endotracheal route, the maximum is 10 mg. For nebulized epinephrine in croup, the maximum is 5 mg. Heavier children will have their weight-based dose automatically capped at the published maximum.
Can I use this calculator for neonates?
Yes. Select "Neonate (28 days or younger)" in the Age group field. The calculator will display the neonatal dose range rather than a single value, because neonatal guidelines provide a low and high bound rather than a single rate. Neonatal IV dosing is 0.01-0.03 mg/kg and ET dosing is 0.03-0.1 mg/kg, both using the 1:10,000 solution. Always involve a neonatologist or paediatric intensivist for dosing decisions in newborns.
What weight should I use if the child has not been weighed?
Use a Broselow paediatric tape or an age-based weight formula as an estimate. Common formulae include: weight (kg) = (age in years + 4) x 2 for children 1-10 years (APLS formula). A Broselow tape correlates length to weight and provides colour-coded dosing ranges, which many emergency departments use as the primary reference during resuscitation. Always use an actual weight when available, as obesity is increasingly common in paediatric populations.
Why is the endotracheal dose ten times higher than the IV dose?
The lungs do not absorb epinephrine as efficiently as the bloodstream. Only a fraction of the drug deposited in the trachea reaches the systemic circulation, so the dose is multiplied by approximately 10 to achieve an equivalent effect. Because of this unpredictable absorption, the endotracheal route is considered a last resort when IV or IO access cannot be established quickly.