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Adrenaline Dose Calculation — RACP Paediatrics MCQ

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HardEmergency PaediatricsAdrenaline Dose CalculationRACP Paediatrics

A 20 kg child with anaphylaxis has persistent hypotension and bronchospasm despite two correctly dosed IM adrenaline injections, oxygen and repeated crystalloid boluses. A senior clinician, infusion pump and continuous monitoring are available. What is the next adrenaline strategy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Start a peripheral adrenaline infusion at 0.1 microgram/kg/min and titrate

Explanation lettering: E = shown as B · D = shown as C · C = shown as D · B = shown as E

D is correct. RCH defines refractory anaphylaxis by ongoing respiratory or cardiovascular features after two appropriate IM adrenaline doses. With expert support and monitoring, a peripheral infusion may start at about 0.1 microgram/kg/min and be titrated. E is a cardiac-arrest bolus and is dangerous in a child with circulation. A uses an excessive interval and delays reliable titration. B can supplement bronchospasm treatment but cannot support the circulation or replace adrenaline. C delays definitive therapy; corticosteroids are not routine acute treatment. The infusion needs a dedicated line, close haemodynamic monitoring and urgent critical-care or retrieval involvement.

Reference: Royal Children’s Hospital Melbourne: Anaphylaxis: https://www.rch.org.au/clinicalguide/guideline_index/anaphylaxis/