else is able to give it. It is important to ensure individuals
at risk and their carers understand that:
.two injection devices should be carried at all times to
treat symptoms until medical assistance is available; if,
after thefirst injection, the individual does not start to
feel better, the second injection should be given 5 to
15 minutes after thefirst;
.an ambulance should be called after every
administration, even if symptoms improve;
.the individual should lie down with their legs raised
(unless they have breathing difficulties, in which case
they should sit up) and should not be left alone.
Adrenaline for administration by intramuscular injection is
available in‘auto-injectors’(e.g.Emerade®,EpiPen®,or
Jext®), pre-assembled syringesfitted with a needle suitable
for very rapid administration (if necessary by a bystander
or a healthcare provider if it is the only preparation
available); injection technique is device specific.
To ensure patients receive the auto-injector device that
they have been trained to use, prescribers should specify
the brand to be dispensed.
lPATIENT AND CARER ADVICEIndividuals at considerable
risk of anaphylaxis need to carry (or have available)
adrenaline at all times and the patient, or their carers,
need to beinstructed in advancewhen and how to inject it.
The MHRA has produced an advice sheet on the use of
adrenaline auto-injectors, which should be provided to
patients and their carers.
Medicines for Children leaflet: Adrenaline auto-injector for
anaphylaxiswww.medicinesforchildren.org.uk/adrenaline-for-
anapylaxis
JEXT®300 MICROGRAMS 1. 1 mL of the solution remains in
the auto-injector device after use.
JEXT®150 MICROGRAMS 1. 25 mL of the solution remains
in the auto-injector device after use.
EMERADE®150 MICROGRAMS 0. 35 mL of the solution
remains in the auto-injector device after use.
EMERADE®500 MICROGRAMSNo solution remains in the
auto-injector device after use.
EMERADE®300 MICROGRAMS 0. 2 mL of the solution
remains in the auto-injector device after use.
EPIPEN®AUTO-INJECTOR 0.3MG 1. 7 mL of the solution
remains in the auto-injector device after use.
EPIPEN®JR AUTO-INJECTOR 0.15MG 1. 7 mL of the solution
remains in the auto-injector device after use.
lEXCEPTIONS TO LEGAL CATEGORYPOM restriction does
not apply to the intramuscular administration of up to
1 mg of adrenaline injection 1 in 1000 ( 1 mg/mL) for the
emergency treatment of anaphylaxis.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: solution for injection
Solution for injection
EXCIPIENTS:May contain Sulfites
▶Adrenaline/epinephrine (Non-proprietary)
Adrenaline 100 microgram per 1 mlAdrenaline (base)
100 micrograms/ 1 ml ( 1 in 10 , 000 ) dilute solution for injection
ampoules| 10 ampouleP£ 69. 40
Adrenaline (base) 1 mg/ 10 ml ( 1 in 10 , 000 ) dilute solution for injection
pre-filled syringes| 1 pre-filled disposable injectionP£ 6. 87 |
1 pre-filled disposable injectionP£ 18. 00 (Hospital only)| 10 pre-
filled disposable injectionP£ 180. 00 (Hospital only)
Adrenaline (as Adrenaline acid tartrate) 100 microgram per
1mlAdrenaline (base) 1 mg/ 10 ml ( 1 in 10 , 000 ) dilute solution for
injection ampoules| 1 ampouleP£ 43. 53 | 10 ampouleP
£ 80. 44
Adrenaline (base) 500 micrograms/ 5 ml ( 1 in 10 , 000 ) dilute solution for
injection ampoules| 10 ampouleP£ 73. 94
Adrenaline 1 mg per 1 mlAdrenaline (base) 10 mg/ 10 ml ( 1 in 1 , 000 )
solution for injection ampoules| 10 ampouleP£ 87. 62Adrenaline (base) for anaphylaxis 1 mg/ 1 ml ( 1 in 1 , 000 ) solution for
injection pre-filled syringes| 1 pre-filled disposable injectionP
£ 10. 40
Adrenaline (base) 1 mg/ 1 ml ( 1 in 1 , 000 ) solution for injection pre-filled
syringes| 1 pre-filled disposable injectionP£ 10. 40
Adrenaline (as Adrenaline acid tartrate) 1 mg per 1 mlAdrenaline
(base) 5 mg/ 5 ml ( 1 in 1 , 000 ) solution for injection ampoules|
10 ampouleP£ 85. 07
Adrenaline (base) 500 micrograms/ 0. 5 ml ( 1 in 1 , 000 ) solution for
injection ampoules| 10 ampouleP£ 67. 72 DT = £ 67. 72
Adrenaline (base) 1 mg/ 1 ml ( 1 in 1 , 000 ) solution for injection ampoules
| 10 ampouleP£ 6. 01 DT = £ 6. 01
▶Emerade(Bausch & Lomb UK Ltd)
Adrenaline 1 mg per 1 mlEmerade 300 micrograms/ 0. 3 ml ( 1 in
1 , 000 ) solution for injection auto-injectors| 1 pre-filled disposable
injectionP£ 25. 99 DT = £ 26. 45
Adrenaline (as Adrenaline acid tartrate) 1 mg per 1 mlEmerade
150 micrograms/ 0. 15 ml ( 1 in 1 , 000 ) solution for injection auto-
injectors| 1 pre-filled disposable injectionP£ 25. 99 DT = £ 23. 99
Emerade 500 micrograms/ 0. 5 ml ( 1 in 1 , 000 ) solution for injection auto-
injectors| 1 pre-filled disposable injectionP£ 26. 99
▶EpiPen(Meda Pharmaceuticals Ltd)
Adrenaline 500 microgram per 1 mlEpiPen Jr.
150 micrograms/ 0. 3 ml ( 1 in 2 , 000 ) solution for injection auto-injectors
| 1 pre-filled disposable injectionP£ 26. 45 DT = £ 26. 45 | 2 pre-
filled disposable injectionP£ 52. 90 DT = £ 52. 90
Adrenaline 1 mg per 1 mlEpiPen 300 micrograms/ 0. 3 ml ( 1 in 1 , 000 )
solution for injection auto-injectors| 1 pre-filled disposable
injectionP£ 26. 45 DT = £ 26. 45 | 2 pre-filled disposable
injectionP£ 52. 90
▶Jext(ALK-Abello Ltd)
Adrenaline 1 mg per 1 mlJext 300 micrograms/ 0. 3 ml ( 1 in 1 , 000 )
solution for injection auto-injectors| 1 pre-filled disposable
injectionP£ 23. 99 DT = £ 26. 45
Adrenaline (as Adrenaline acid tartrate) 1 mg per 1 mlJext
150 micrograms/ 0. 15 ml ( 1 in 1 , 000 ) solution for injection auto-
injectors| 1 pre-filled disposable injectionP£ 23. 99 DT = £ 23. 998 Oedema
Diuretics
Overview
Diuretics are used for a variety of conditions in children
including pulmonary oedema (caused by conditions such as
respiratory distress syndrome and bronchopulmonary
dysplasia), congestive heart failure, and hypertension.
Hypertension in children is often resistant to therapy and
may require the use of several drugs in combination.
Maintenance offluid and electrolyte balance can be difficult
in children on diuretics, particularly neonates whose renal
function may be immature.
Loop diureticsare used for pulmonary oedema,
congestive heart failure, and in renal disease.
Thiazidesare used less commonly than loop diuretics but
are often used in combination with loop diuretics or
spironolactone p. 126 in the management of pulmonary
oedema and, in lower doses, for hypertension associated
with cardiac disease.
Aminophylline infusion p. 167 has been used with
intravenous furosemide p. 140 to relievefluid overload in
critically ill children.Heart failure
Heart failure is less common in children than in adults; it can
occur as a result of congenital heart disease (e.g. septal
defects), dilated cardiomyopathy, myocarditis, or cardiac
surgery. Drug treatment of heart failure due to left
ventricular systolic dysfunction is covered below; optimal
management of heart failure with preserved left ventricular
function has not been established.
Acute heart failurecan occur after cardiac surgery or as a
complication in severe acute infections with or without138 Oedema BNFC 2018 – 2019
Cardiovascular system2