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           
Anticonvulsants Antibiotics Antihypertensives Analgesics NSAID
Analgesics Opioids Antiemetics/H2 Blockers Antipuritics Bronchodilators
Cardiac Diuretics Fluids and Electrolytes Laxatives
Miscellaneous Muscle Relaxants PCA PCEA
Reversals Sedative/IV Anesthetics Steroids  
ETT info Single Lung Ventilation LMA-Classic LMA-Flexible
 
ET=endotracheal IC=intracardiac IM=intramuscular
IO=intraosseous IV=intravenous PO=oral
PR=rectal SC=subcutaneous mcg = 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)
0.5-1 3.5-4.0 5    
1-2 4.0-4.5 5    
2-4 4.5-5.0 5    
4-6 5.0-5.5 5    
6-8 5.5-6 5 3.5  
8-10 6.0 cuffed 5 3.5 26
10-12 6.5 cuffed 5 4.5 26-28
12-14 6.5-7.0 cuffed 5 4.5 32
14-16 7.0 cuffed 5 6.0 35
16-18 7.0-8.0 cuffed 5 or 9 7.0 35
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LMA Classic
Mask
Size
Patient Size		 Max Cuff
Vol (air) (ml)		 Largest ETT
ID (mm)
1 Neonates/infants up to 5 kg 4 3.5
1½ Infants 5-10 kg 7 4.0
2 Infants/children 10-20 kg 10 4.5
2½ Children 20-30 kg 14 5.0
3 Children 30-50 kg 20 6.0
4 Adults 50-70 kg 30 6.0
5 Adults 70-100 kg 40 7.0
6 Large adults over 100 kg 50 7.0
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LMA Flexible
Mask
Size
Patient Size		 Max Cuff
Vol (air) (ml)		 Internal
diameter (mm)
2 Infants/children 10-20 kg 10 5.1
2½ Children 20-30 kg 14 6.1
3 Children 30-50 kg 20 7.6
4 Adults 50-70 kg 30 7.6
5 Adults 70-100 kg 40 8.7
6 Large adults over 100 kg 50 8.7