Paed Prescribing

Question 1

MORPHINE SULPHATE

Available as injections containing 10mg/ml, 15mg/ml, 30mg/ml and 60mg/ml.

Other concentrations available upon request.

PLEASE CHECK THE STRENGTH OF THE INJECTION CAREFULLY BEFORE USE.

Answer 1

IV BOLUS

May be diluted to a convenient volume, usually 5ml with sodium chloride. Administer over at least 5 – 10 minutes.

Neonate: 50microgram/kg every 6 hours

1 month – 6 months: 100 microgram/kg/dose every 6 hours. Adjust dose according to response.

6 months – 12 years: 100 microgram/kg/dose every 4 hours. Adjust dose according to response.

12 – 18 years: Initially 5mg every 4 hours. Adjust dose according to response.

IV INFUSION

Neonate: Give IV bolus as loading dose first then continuous IV infusion of 5-20 microgram/kg/hour

1 – 6 months: Give IV bolus as loading dose first then continuous IV infusion of 10-30 microgram/kg/hour

6 months – 18 years: Give IV bolus as loading dose first then continuous IV infusion of 20-30 microg/kg/hr.

In non – ventilated patients the maximum dose is 60mcg/kg/hour. Ventilated patients may need to exceed these doses to achieve adequate sedation and pain management.

*Use of a high risk infusion pump recommended*

Dilute to a convenient volume with compatible diluent.

Suggested method of preparation:

Add 1mg/kg of morphine sulphate to 50ml of compatible diluent: 0.5 – 3ml/hr = 10 – 60 mcg/kg/hr

More concentrated solutions may be used in fluid restricted patients.

Compatible diluent: NaCl 0.9%, glucose 5% and 10%, NaCl/glucose. When diluted stable for 24hr.

Monitor blood pressure, heart and respiratory rate during administration for infusion and for at least 20minutes post administration of bolus doses.

Question 2

INSULIN

(Actrapid human, Soluble insulin)

Cambridge Paed drug monograph

All insulin doses must be measured using an insulin syringe.

Answer 2

NORMAL PAEDIATRIC DOSE

Diabetic ketoacidsosis

0.1unit/kg/hour as a continuous infusion.

Variable Rate IV Insulin Infusion for peri-operative surgical management

Titrate continuous infusion according to blood glucose concentrations to provide a blood sugar between 6-12mmol/L

Prescribe all doses in ‘UNITS’ – never use the terms ‘U’ or ‘IU’ when prescribing insulin

Blood Glucose -> Infusion rate

• 6-8mmol/L -> 0.025unit/kg/hour
• 8-12mmol/L -> 0.05unit/kg/hour
• 12-15mmol/L -> 0.075unit/kg/hour
• >15mmol/L -> 0.1unit/kg/hour

INFUSION

Dilute 50 units of Actrapid insulin to a final volume of 50ml with sodium chloride 0.9% to provide a concentration of 1 unit/ml ->

0.1ml/kg/hour = 0.1unit/kg/hour

Insulin may be adsorbed by plastics, flush giving set with 5ml of infusion fluid containing insulin before attaching to patient.

Diluted solution stable for 24hr.

Monitor blood glucose during infusions at least hourly.

Insulin solutions should be water clear and colourless.

Acute events which may accompany administration:

Hypoglycaemia may occur, blood glucose levels should be monitored. Injection site reactions, urticaria and rash are uncommon.