Pediatric Drug Dosages

Suggested Pediatric Drug Dosages

07/05/2005 Zwi Jacob, MD

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The dosages and drugs are intended as general guidelines ONLY. The actual drugs and their doses should be administered only following discussion with the attending.

Resuscitation      Cardioversion         
AnticonvulsantsAntibioticsAntihypertensivesAnalgesics NSAID
Analgesics OpioidsAntiemetics/H2 BlockersAntipuriticsBronchodilators
CardiacDiureticsFluids and ElectrolytesLaxatives
MiscellaneousMuscle RelaxantsPCAPCEA
ReversalsSedative/IV AnestheticsSteroids 
ETT infoSingle Lung VentilationLMA-ClassicLMA-Flexible
ET=endotrachealIC=intracardiacIM=intramuscular
IO=intraosseousIV=intravenousPO=oral
PR=rectalSC=subcutaneousmcg = microgram
Resuscitation
Medication
 
Atropine: 0.01-0.03 mg/kg IM, IV, ET, IC, IO
Bicarbonate: 1-2 mEq/kg (0.3 x kg x BE) IV, IC, IO
Calcium Chloride 10% (27 mg Ca++/ml): 0.1 - 0.3 ml/kg) IV, IC slowly (max 1 g/dose)
Calcium Gluconate 10% (9 mg Ca++/ml): 0.6-1 ml/kg (max 2 g/dose) IV, IC

Dextrose 0.5-1 g/kg IV = 1-2 ml/kg D50 

2-4 ml/kg D25W
5-10 ml/kg D10W
10-20 ml/kg D5NS

Diltiazem (Cardizem): 0.25 mg/kg over 2 min; 

May repeat in 15 min @ 0.35 mg/kg over 2 min
Ephedrine: 0.2-0.3 mg/kg/dose

Epinephrine (1:10,000) 10 mcg/kg = 0.1 ml/kg IV, IC, IO;

[ET = 0.1 mg/kg (0.1 ml/kg of 1:1,000)]
Lidocaine: 1 mg/kg IV, IC, ET, IO
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Cardioversion

Atrial arrhythmias: 0.5-1 joule/kg;

adult dose begins at 20 joules

Ventricular Fibrillation: 2 joules/kg

(unsynchronized) using the largest paddles that fit
Ventricular Tachycardia: 1-2 joules/kg

Adenosine: 0.1 mg/kg (Max 6 mg)

Repeat 0.2 mg/kg (Max 12 mg)
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Anticonvulsants
Diazepam: 0.1-0.3 mg/kg IV, IO (adult dose 10 mg)
Lorazepam: 0.05 mg/kg IV, IO, IM (Max 4 mg)

Phenobarbital: 10-20 mg/kg IV; 

Maintenance 2.5 mg/kg/dose BID

Phenyltoin: 10-20 mg/kg IV over 20 min in NS; 

Maintenance 2.5 mg/kg/dose BID (Max 1 g)
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Antibiotics
Ampicillin: 25 mg/kg/dose q4-6h
Cefazolin: 30 mg/kg/dose IV q6h
Clindamicin: 5-10 mg/kg/dose q6-8h (Max 4g/day)
Gentamicin: 2-2.5 mg/kg/dose q8h (Max dose 80 mg)

Metronidazole (Flagyl): 15 mg/kg/load;

Maintenance: 7.5 mg/kg/dose IV, PO q6h
Vancomycin: 10 mg/kg/dose slowly IV
Unasyn: 75 mg/kg/dose slowly IV over 10-15min

Zosyn:

<6mos: 150-300 mg/kg/day/q6-8h
>6mos: 240-400 mg/kg/day/q6-8h
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Antihypertensives
Captopril: 0.1-5 mg/kg/d PO q8h
Diazoxide: 5 mg/kg/dose rapid IV push (Max 10 mg/kg)

Esmolol: 0.5 mg/kg bolus over 1 min;

Maintenance: 50-300 mcg/kg/min
Hydralazine: 0.1-0.2 mg/kg/dose IM, IV q4-6h
Labetolol: 0.25 mg/kg IV q1-2h

Nifidepine: 0.01-0.02 mg/kg IV or 1-2 mg/kg/d

PO, SL (adult dose 10-30 mg PO)
Phentolamine: 0.1 mg/kg/dose IV
Propranalol: 0.01-0.15 mg/kg IV slowly
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Analgesics
NSAID

Acetaminophen: PO 10-15 mg/kg/dose q4h

PR (1st dose only) 30-40 mg/kg followed by PO dose 6 h later
(max 30mg/kg/d in newborn,
60 mg/kg/d in infants,
90 mg/kg/d in children,
4 gm/d in adults)
Ibuprofen: 10 mg/kg PO q6h
Ketorolac: 0.5 mg/kg IV q6h (with normal Cr & no bleeding diathesis; Max 5 days)
Celecoxib (Celebrex): >12 yrs 100-200 mg q12h
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Analgesics
Opioids

Alfentanil: 30-50 mcg/kg induction;

Supplemental Bolus: 10-15 mcg/kg
Maintenance: 0.5-1.5 mcg/kg/min

Codeine: 0.5-1.0 mg/kg PO q4h

Tylenol #1: acetaminophen 300 mg + codeine 7.5 mg
Tylenol #2: acetaminophen 300 mg + codeine 15 mg
Tylenol #3: acetaminophen 300 mg + codeine 30 mg
Tylenol #4: acetaminophen 300 mg + codeine 60 mg
Fentanyl: 0.5-1 mcg/kg/dose IV q1h prn

Hydrocodone/Oxycodone: 0.05-0.15 mg/kg PO

q4h (usual start dose 0.1 mg/kg)

Hydromorphone: 0.03 mg/kg/dose PO q4h

0.015 mg/kg/dose IV q2-4h prn

Meperidine: 1 mg/kg/dose IV q2h prn

For rigors 0.1 mg/kg/dose IV once

Methadone:

Mild pain: 25 mcg/kg/dose)
Moderate pain: 50 mcg/kg/dose) IV q4h
Severe pain: 75 mcg/kg/dose)
Or 0.1 mg/kg q8-12h (beware of cumulative effects after 48-72 h)

Morphine: 0.05-0.15 mg/kg/dose IV q2-4h prn

0.2-0.3 mg/kg/dose PO q4h
Remifentanil: 0.1-0.5 mcg/kg/min infusion
Sufentanil: 10-25 mcg/kg induction
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Antiemetics/H2 Blockers
Granisetron: 10 mcg/kg/dose IV/PO q12h
Lorazepam: 0.05 mg/kg/dose IV/PO q8h

Metoclopramide (Reglan): 0.1-0.2 mg/kg/dose

IV/PO q6h (caution re: extrapyramidal signs)
(max 0.15 mg/kg/dose)

Omeprazole (Prilosec): 0.6-0.7 mg/kg/dose PO

qday to BID

Ondansetron: 0.15 mg/kg IV/SL/PO q8h slowly

(max 8 mg/dose; 32 mg/day)

Prochlorperazine (Compazine): >2y 0.1

mg/kg/dose IM/PO q8h (caution re: extrapyramidal signs)

Promethazine (Phenergan): >2y 0.5 mg/kg/dose

PO/IV/IM q6h (caution re: extrapyramidal signs)

Ranitidine (Zantac): 1-2 mg/kg/dose BID PO, IV

(Max 150 mg BID)

Trimethobenzamide (Tigan): <14kg = 100mgPR

q8h; >14 kg = 200 mg PR q8h
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Antipuritics
Diphenhydramine: 0.5 mg/kg/dose PO/IV q6h
Hydroxyzine: 0.5 mg/kg/dose PO/IV q6h
Nalbuphine: 0.1 mg/kg/dose q6h IV slowly (max 5 mg/dose)
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Bronchodilators

Albuterol nebulizer (0.5% soln): 0.01 ml/kg/2.5 ml NS

(Max 0.5 ml = 2.5 mg)

Aminophylline: 7 mg/kg slowly over 30 min IV;

Maintenance: 0.5-1.5 mg/kg/h

Epinephrine(1:1,000): 0.01 ml/kg SC(max0.4ml)

Racemic epi: 0.25-0.5 ml/5 ml NS nebulized

Isoproterenol: 0.05 mcg/kg/min increasing by 0.1mcg/kg/min to effect

or tachycardia is too fast

Metaproterenol nebulizer (5% soln): 0.01 ml/kg/2.5 ml NS

(Max dose 0.3 ml = 15 mg)
Terbutaline(1 mg/ml): 0.01 ml/kg SC (max 0.25 ml)
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Cardiac
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cardiac
 
 
 
 
 
 
 
 
 
 
 
 
 
Cardiac

Amiodarone (Cordarone): V Fib: 5 mg/kg IV load over 20 min

then 5 – 15 mcg/kg/min; be prepared with volume & Ca++; (max 15 mg/kg/d)
SVT: 5 mg/kg over 10 min X 5 doses

Amrinone (Inamrinone): 0.75-1.0-mg/kg load over 3 min

then 5-10 mcg/kg/min in normal saline

Aprotinin (Trasylol): 0.1-1.0 ml test dose;

Load: 2 ml/kg over 10-15 min
Maintenance: 1 ml/kg/hr

Digitalis: 20-40 mcg/kg given over 24 h (adult dose 1 mg);

Maintenance 5 – 10 mcg/kg/dose BID
IV dose = 2/3 PO dose

Diltiazem (Cardizem): 0.25 mg/kg over 2 min;

May repeat in 15 min @ 0.35 mg/kg over 2 min
Dopamine, Dobutamine: 2-20 mcg/kg/min

Epinephrine, Isoproterenol, Norepinephrine:

0.05-1 mcg/kg/min

Esmolol: 0.5 mg/kg bolus over 1 min;

Maintenance: 50-300 mcg/kg/min

Lidocaine: 1-2 mg/kg/dose IV (Max. 10 mg)

Maintenance: 20-50 mcg/kg/min (adult dose 1-4 mg/min)

Magnesium sulfate for Torsades de Pointe:

25-50 mg/kg (max. 2gm) over 10-20 min

Milrinone (Primacor): 20-50 mcg/kg load;

Maintenance: 0.3-0.7 mcg/kg/min
Nitroglycerin: 0.5-5 mcg/kg/min
Nitroprusside: 0.5-10 mcg/kg/min
PGE1: 0.05-0.1 mcg/kg/min
Phenylephrine: 0.5-10 mcg/kg/min

Procainamide: 10-20 mg/kg over 45 min load;

Maintenance 20-60 mcg/kg/min (adult 1-4 mg/min)
Propranolol: 0.05-0.15 mg/kg IV slowly (Max 5 mg)

Vasopressin: Bolus 0.4-1 U/kg;

BP maintenance: Mix 1.5 U/kg in 50 ml so 1 ml/hr = 0.0005 U/kg/min. Double q 10 min until response achieved or until 4 U/hr (adult dose) is reached.
GI Bleed: 0.002-0.005 U/kg/min
Verapamil: 0.05-0.2 mg/kg IV over 2 min (Max 5 mg)
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Diuretics
Aldactone: 0.25-0.8 mg/kg/dose PO BID-QID
Chlorthiazide: 10-15 mg/kg/dose PO BID
Furosemide: 0.5-1 mg/kg/dose PO, IM, IV
Mannitol: 0.25-1 g/kg/dose IV
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Fluids and Electrolytes

Maintenance: 4 ml/kg/h for 1st 10 kg + 2 ml/kg/h

for 2nd 10 kg + 1 ml/kg/h for every kg >20 kg
Potassium: 2-3 mEq/kg/d
Calcium: 200-300 mEq/kg/d
Glucose: 8 mg/kg/min

Hyperkalemia: Dextrose 0.5-1 g/kg IV over 15 min

with 0.2-0.3 U Reg Insulin/g Dextrose;
Ca++ = 4-5 mg/kg IV over 5-10 min;
Kayexelate: 1-2 gm/kg PO, PR (with 20% Sorbitol)
NaHCO2 = 1-2 mEq/kg
Shock: 10-20 ml/kg of NS, RL or 5% albumin
PRBC: 10 ml/kg will raise Hg by 1 gm
Platelets: 5-10 ml/kg will raise count 50-100x109/L; for >10 kg patient 1 U/10 kg
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Laxatives

Bisacodyl Suppository (Dulcolax):

<2y 5 mg PR
>2y 10 mg PR

Docusate sodium (Colace):

<3y: 10 mg PO q8h
3 - 6y: 15 mg PO q8h
6 - 12y: 50 mg PO q8h
>12y: 100 mg PO q8h
Senna Syrup (218 mg/5ml): > 3y 5 ml @ bedtime
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Miscellaneous

Dantrolene: 2.4 mg/kg IV load;

If no response, 4.8 mg/kg until symptoms are controlled;
Maintenance: 1.2 mg/kg IV q6h as needed

Heparin: 50-100 U/kg IV bolus then 10-20 U/kg/h;

Cardiopulmonary bypass: 300 U/kg IV
Insulin: 0.02-0.1 U/kg/h

Magnesium sulfate: 25-50 mg/kg (max 2g) over 10-20 min;

Maintenance: 16 mg/kg/h to achieve plasma levels of 0.8-1.2 mmol/L (max 2g)
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Muscle Relaxants
Cisatracurium: 0.1-0.2 mg/kg/dose IV; lasts 15 - 45 min
Metubine: 0.1-0.4 mg/kg/dose IV; lasts 1-2 h
Mivacurium: 0.2-0.3 mg/kg/dose IV; lasts 15-20 min
Pancuronium: 0.1 mg/kg/dose IV; lasts 1-2 h
Rocuronium: 0.4-1.0 mg/kg/dose IV; lasts 20-45 min

Succinylcholine: 1-2 mg/kg IV; 4 mg/kg IM;

consider giving atropine first
Vecuronium: 0.1 mg/kg/dose IV; lasts 30 min
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PCA

Hydromorphone (0.2 mg/ml):

Demand: 0.003 mg/kg/dose q 10 min  
Night basal (optional): 0.003 mg/kg/h
Nursing boluses: 0.006 mg/kg/dose up to 3 times q4h

Morphine (1 mg/ml); if under 10 kg (0.5 mg/ml):

Demand: 0.015 mg/kg/dose q 10 min;
Night basal (optional): 0.015 mg/kg/h
Nursing Boluses: 0.03 mg/kg/dose q15min up to 3 times q 4h
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PCEA

Bupivacaine (0.625 or 1.25 mg/ml NS + Fentanyl

2 mcg/ml + Clonidine 0.1 mcg/ml): 0.1-0.4 ml/kg/h;
Do not to exceed:
Neonates        0.2 mg/kg/h of bupivacaine
Older Children 0.4 mg/kg/h of bupivacaine
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Reversals
Atropine: 0.01-0.02 mg/kg IV

Edrophonium: For PAT & myasthenia: 0.2 mg/kg IV;

For muscle relaxants: 1 mg/kg IV with anticholinergic

Flumazenil: Sedation reversal: 0.01 mg/kg IV

Overdose: 0.01 mg/kg then 0.005-0.01 mg/kg/h
(Max 0.2 mg/dose; 0.05 mg/kg or 1 mg)
Glycopyrrolate: 0.005-0.01 mg/kg IV
Narcan: 0.01-0.1 mg/kg/dose IV, ET; lasts 20 Min
Neostigmine: 0.05-0.07 mg/kg IV with anticholinergic
Physostigmine: 0.01 mg/kg slowly IV with anticholinergic (adult dose 2 mg)
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Sedative/IV Anesthetics
Chloral Hydrate: 30-80 mg/kg/dose PO, PR
Clonidine: 0.004 mg/kg PO (Max 0.1 mg)

Diphenhydramine: 0.2-2 mg/kg/dose IV q4-6h;

or 1.25 mg/kg/dose q6h (Max 400 mg/d)
Etomidate: 0.3 mg/kg IV
Haloperidol: 0.4-5 mg/dose

Ketamine: 1-2 mg/kg IV;

3-6 mg/kg PO;
6-10mg/kg PR;
3 mg/kg intranasal

Methohexital: 1-2 mg/kg/dose IV;

30-40 mg/kg PR

Midazolam: 0.05-0.3 mg/kg IV, IM;

Infusion: 0.4 mcg/kg/min
PO: 0.5-0.75 mg/kg
PR: 0.5-1 mg/kg
Intranasal: 0.2 mg/kg
Pentobarbital: 2 mg/kg IM, IV, PO

Propofol: 2-3 mg/kg IV;

Maintenance: 50-300 mcg/kg/min

Thiopental: 3-7 mg/kg IV

PR: 20-40 mg/kg
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Steroids
Dexamethasone: 0.3-1 mg/kg/dose IV

Hydrocortisone (Solu-Cortef): 0.2-1 mg/kg/dose q6h (anti-inflammatory);

Status asthmaticus: load 4-8 mg/kg then 2-4 mg/kg/dose q4-6h

Methylprednisolone (Solu-Medrol): 0.04-0.2 mg/kg q6h (anti-inflammatory);

Status asthmaticus: load 2 mg/kg then 0.5-1 mg/kg/dose q4-6h
Spinal Shock: 30 mg/kg IV over 1 h then 5.4 mg/kg/h x 23 h
Liver Transplantation: 20 mg/kg
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ETT Information
Endotracheal tube size = 4 + Age/4
Endotracheal depth > 1 yr = 12 + Age/2 or 10 + Age

Blade Size:

Newborn = #0 Miller
1-18 mos = #1 Miller
18 mos – 8 yrs = #2 Mac/Miller
>8 yrs = #3 Mac/Miller
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Single Lung Ventilation
Age (yrs)ETT (ID in mm)BB (Fr)Univent®DLT (Fr)
0.5-13.5-4.05  
1-24.0-4.55  
2-44.5-5.05  
4-65.0-5.55  
6-85.5-653.5 
8-106.0 cuffed53.526
10-126.5 cuffed54.526-28
12-146.5-7.0 cuffed54.532
14-167.0 cuffed56.035
16-187.0-8.0 cuffed5 or 97.035
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LMA Classic
Mask
Size
Patient Size		Max Cuff
Vol (air) (ml)		Largest ETT
ID (mm)
1Neonates/infants up to 5 kg43.5
1½Infants 5-10 kg74.0
2Infants/children 10-20 kg104.5
2½Children 20-30 kg145.0
3Children 30-50 kg206.0
4Adults 50-70 kg306.0
5Adults 70-100 kg407.0
6Large adults over 100 kg507.0
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LMA Flexible
Mask
Size
Patient Size		Max Cuff
Vol (air) (ml)		Internal
diameter (mm)
2Infants/children 10-20 kg105.1
2½Children 20-30 kg146.1
3Children 30-50 kg207.6
4Adults 50-70 kg307.6
5Adults 70-100 kg408.7
6Large adults over 100 kg508.7