In pediatric anaphylaxis with no palpable pulse, using epinephrine 0.1 mg/mL, what is the maximum per-dose IV/IO epinephrine?

• A. 0.01 mg/kg
• B. 0.1 mg
• C. 0.5 mg
• D. 0.2 mg

Answer: (B)

When a child with anaphylaxis has no palpable pulse, epinephrine must be given promptly via IV/IO as a rapid bolus to restore perfusion. The dose is 0.01 mg/kg of the 1:10,000 concentration, but there is a safety cap: no more than 0.1 mg per dose. Since 1:10,000 epinephrine is 0.1 mg/mL, a 0.1 mg dose equals 1 mL of solution. Therefore the maximum per-dose IV/IO epinephrine is 0.1 mg.

This keeps dosing high enough to be effective in critical situations but avoids excessive exposure that could cause dangerous hypertension or arrhythmias. The other options either represent a lower weight-based amount that wouldn’t exceed the cap or amounts that are unrealistically high for pediatric resuscitation.