Adrenaline dose in anaphylactic shock is:

AIIMS Delhi NO- 2019

Pharmacology

Easy

Appeared in: AIIMS Delhi NO- 2019

Explanation

The standard dose of adrenaline for an adult in anaphylactic shock is 0.3 to 0.5 mg of a 1:1000 solution administered intramuscularly (IM).
The option 1:1000 (0.5 ml) corresponds to a 0.5 mg dose, which is the correct concentration and the upper limit of the recommended volume for an adult.
The intramuscular route, preferably in the anterolateral aspect of the thigh, is recommended for rapid absorption in anaphylaxis.
The 1:1000 concentration means 1 mg of adrenaline is present in 1 ml of solution.

Option B: The 1:10,000 concentration is too dilute for intramuscular administration in anaphylaxis and is reserved for intravenous use, primarily during cardiac arrest.
Option C: A volume of 1 ml of 1:1000 solution delivers a 1 mg dose, which is double the maximum recommended dose for anaphylaxis and can lead to severe cardiovascular side effects like tachyarrhythmias and hypertension.
Option D: This option combines both an incorrect concentration (1:10,000) and an insufficient volume for the IM treatment of anaphylaxis. This would deliver only 0.1 mg, which is sub-therapeutic for an adult.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Pharmacology: Adrenaline (Epinephrine) Dosing in Anaphylaxis in acute care settings.
Administering the correct concentration of adrenaline is critical for patient safety. A medication error involving using the 1:1000 solution intravenously instead of the 1:10,000 solution can be fatal.
Nurses must always perform the 'five rights' of medication administration, paying special attention to the drug concentration and intended route before administering adrenaline, especially in high-stress emergency situations.
What if? If the patient were a child weighing 15 kg, the dose would be 0.01 mg/kg, which calculates to 0.15 mg. This would be administered as 0.15 mL of the 1:1000 solution.

How to Approach the Question

First, identify the core of the question: the correct adrenaline dose for anaphylactic shock.
Recall the standard emergency drug protocols. Differentiate between the concentrations used for anaphylaxis (IM) and cardiac arrest (IV).
The standard concentration for IM use in anaphylaxis is 1:1000. This immediately narrows the options to A and C.
Next, recall the standard volume/dose for an adult. The dose is 0.3-0.5 mL (which corresponds to 0.3-0.5 mg).
Compare the remaining options to the standard dose. Option A (0.5 ml) falls within this range, while Option C (1 ml) is an overdose.
Therefore, select the option that matches both the correct concentration and the correct volume range for an adult.

Concept Tested & Keywords

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 pp. 1451-1453, 1452-1454