Metabolic Emergencies

Question 1

Benadryl (diphenhydramine) dosing in anaphylaxis?

Answer 1

1 mg/kg (max 50mg)

PO IV IO IM

Question 2

Epinephrine dosing in anaphylaxis has initial and repeat dosing. What are they?

Answer 2

0.01 mL/kg (max 0.5mL) of 1:1000 IM / SQ

Followed by

0.1 mL/kg 1:10,000 (max 1mg) IV/IO over 2 minutes

Question 3

Dosing routes for methylprednisolone in anaphylaxis, and consequent dosing and max?

Answer 3

PO or IV

1 mg/kg (max 60 mg)

Question 4

The three drugs in anaphylaxis?

Answer 4

Benadryl, Epinephrine, methylprednisolone

Question 5

What two meds are needed in adrenal crisis?

Answer 5

Fludrocortisone (Florinef)

And

Hydrocortisone (Solu-Cortef)

Question 6

What is the route and dose of Florinef in adrenal crisis?

Answer 6

0.05 - 0.1 mg PO

Question 7

What is the initial bolus dose of hydrocortisone in adrenal crisis?

Answer 7

1-2 mg/kg initial bolus (IV IO IM), diluted to 50 mg/mL over 3-5 minutes.

Question 8

How are the follow-up doses of hydrocortisone diluted and delivered in adrenal crisis?

Answer 8

The intermittent doses are diluted to 1 mg/mL, given over 20-30 minutes. (They are still about 1 mg/kg.)

Question 9

What do you give a child 30 days - 2 years of age with hypoglycemia?

Answer 9

D25 2-4 mL/kg

Question 10

What do you give a child > 2 years of age with hypoglycemia?

Answer 10

D50 1-2 mL/kg (CVL preferred)

Question 11

Name the six medications used to treat hyperkalemia.

Answer 11

Albuterol, calcium gluconate, dextrose 25%/insulin regular, furosemide, kayexalate, sodium bicarbonate

Question 12

What is the dose of albuterol to treat hyperkalemia?

Answer 12

Albuterol, nebulized 2.5–5 mg

Question 13

What is the dose of calcium gluconate to treat hyperkalemia?

Answer 13

Calcium gluconate 10%
IV/IO 60–100 mg/kg (max 3 g)
Over 3-5 minutes

Question 14

How much D25/Regular Insulin is used to treat hyperkalemia?

Answer 14

1 g/kg D25 (4mL/kg of D25)

And

0.2 units insulin/g OF DEXTROSE

Question 15

How much Lasix is used to treat hyperkalemia?

Answer 15

1-2 mg/kg IV/IM (40 mg max)

Question 16

What are the different routes Kayexalate can be administered?

Answer 16

PO and PR

Question 17

What is the dosing for Kayexalate to treat hyperkalemia?

Answer 17

PO 1 g/kg (max 15 g) q6 Hrs PRN

and

PR 1 g/kg (max 50g) q 2-6 Hrs PRN

Question 18

What are the three possible side effects if pushing sodium bicarbonate too quickly?

Answer 18

HyperNatremia, decreased CSF pressure, intracranial hemorrhage.

Question 19

What is the dosing for sodium bicarbonate in hyperkalemia?

Answer 19

1 mEq/kg IV/IO over 5-15 minutes

Question 20

Two different percentages of sodium bicarbonate are dosed based on age. What are they?

Answer 20

Sodium bicarbonate

2 yrs: 8.4%

Question 21

What drugs can be used to treat hypocalcemia?

Answer 21

10% calcium chloride 20mg/kg (CVL preferred)

or

10% calcium gluconate 60mg/kg

You need 3x as much calcium gluconate and it requires liver metabolism.

Question 22

How is calcium chloride administered and dosed to treat hypocalcemia?

Answer 22

Calcium chloride 10%

20 mg/kg (max 2g) over 10 minutes

• on monitor
• in its own line, ideally central

Question 23

How is calcium gluconate dosed and administered to treat hypocalcemia?

Answer 23

Calcium gluconate 10%

IV/IO 60-100 mg/kg (max 3g) over 3-5 minutes

Question 24

Seizures can be due to what metabolic problem?

Answer 24

Hyponatremia

Question 25

How do you calculate the Sodium Deficit?

Answer 25

[(desired Na - actual Na) x 0.6] x weight in kg

Question 26

How is 3% NS dosed for treatment of hyponatremia?

Answer 26

HTSN 3%

IV (CVL preferred) 3mL/kg bolus over 15 minutes

Question 27

What is the maximum correction rate for sodium when treating hyponatremia?

Answer 27

Correction should not exceed 0.5mEq/L/hr

or

12mEq/L/24 hrs

Question 28

What do you give a child less than 30 days old to treat hypoglycemia?

Answer 28

D10 5-10 mL/kg