Seattle Children's Hospital and University of Washington, Seattle, Washington.
Ann Allergy Asthma Immunol. 2018 Jul;121(1):53-60. doi: 10.1016/j.anai.2018.05.001. Epub 2018 May 7.
This review was undertaken to review epinephrine dosing, site and route of administration, focusing on special populations (patients weighing less than 15 kg, and obese patients); and to discuss storage and delivery of epinephrine in prehospital and hospital settings.
Review of published literature.
Relevance.
The recommended 0.01-mg/kg (maximum 0.3-0.5 mg) epinephrine dose in anaphylaxis is based on limited pharmacokinetic data in healthy volunteers. No pharmacokinetic or pharmacodynamics studies involving patients in anaphylaxis have been published. When epinephrine auto-injectors (EAIs) are used in infants, the dose increasingly exceeds the recommended dose as weight decreases, although the clinical significance of this is unclear. Limited data indicate that the intramuscular route and lateral thigh site are superior. Ultrasound studies suggest that 0.15 EAI needles may be too long for many patients weighing less than 15 kg, and 0.3 mg EAI needles may be too short for obese patients weighing more than 30 kg. A newly available 0.1 mg EAI has a lower dose and shorter needle better suited to patients weighing 7.5 to 15 kg. In some medical settings, vials and syringes may provide a safe, efficient alternative with substantial cost savings over EAIs.
EAIs should be available in the community with doses and needle depths that meet the needs of all patients. More research on epinephrine pharmacodynamics are needed in children and adults in anaphylaxis, to better delineate what optimal doses should be. Optimizing epinephrine dose and delivery has the potential to improve anaphylaxis outcomes and prevent adverse events.
本综述旨在回顾肾上腺素的给药剂量、给药部位和途径，重点关注特殊人群（体重小于 15kg 的患者和肥胖患者）；并讨论在院前和医院环境中肾上腺素的储存和输送。
已发表文献的综述。
相关性。
在过敏反应中，推荐的 0.01mg/kg（最大 0.3-0.5mg）肾上腺素剂量是基于在健康志愿者中有限的药代动力学数据。尚未发表涉及过敏反应患者的药代动力学或药效学研究。当在婴儿中使用肾上腺素自动注射器（EAI）时，随着体重的减轻，剂量逐渐超过推荐剂量，尽管其临床意义尚不清楚。有限的数据表明，肌肉内途径和外侧大腿部位更优。超声研究表明，对于体重小于 15kg 的许多患者，0.15 EAI 针头可能过长，而对于体重超过 30kg 的肥胖患者，0.3mg EAI 针头可能过短。一种新的 0.1mg EAI 具有较低的剂量和较短的针头，更适合体重在 7.5 至 15kg 的患者。在某些医疗环境中，小瓶和注射器可能是一种安全、有效的替代方法，与 EAI 相比可节省大量成本。
EAI 应在社区中提供，剂量和针头深度应满足所有患者的需求。需要在儿童和成人过敏反应中进行更多关于肾上腺素药效学的研究，以更好地确定最佳剂量。优化肾上腺素剂量和输送有可能改善过敏反应结局并预防不良事件。
