Paediatric dosages Flashcards
NALOXONE HYDROCHLORIDE
respiratory depression due to acute opiate usage
Adult Dosage
- 0.4mg slowly IVI/IMI (0,1mg/kg)
- Repeat every 5 minutes, up to 2mg
- Should 2mg fail to elicit the desired response, then overdose with agents other than opioids should be considered
MORPHINE SULPHATE
Acute severe pain
Adult Dosage
- Dilute to concentration of 1mg/ml and titrate to effect at 1mg/30 seconds slowly IVI (This approach reduces incidence of nausea, vomiting and other complications)
- Titrate to effect (use minimum effective dosage)
MORPHINE SULPHATE
Continuing ischaemic chest pain (Acute Coronary Syndromes (ACS) that is NOT RELIEVED by Glyceryl Trinitrate
Adult Dosage
• Dilute to concentration of 1mg/ml and titrate to effect at 1mg/30 seconds slowly IVI
(This approach reduces incidence of nausea, vomiting and other complications)
• Titrate to effect (use minimum effective dosage)
MORPHINE SULPHATE
Cardiogenic pulmonary oedema
Adult Dosage
• Dilute to concentration of 1mg/ml and titrate to effect at 1mg/30 seconds slowly IVI
(This approach reduces incidence of nausea, vomiting and other complications)
• Titrate to effect (use minimum effective dosage)
MORPHINE SULPHATE
Concomitant use with benzodiazepines for synergism in induction Adult Dosage
• Dilute to concentration of 1mg/ml and titrate to effect at 1mg/30 seconds slowly IVI
(This approach reduces incidence of nausea, vomiting and other complications)
• Titrate to effect (use minimum effective dosage)
MIDAZOLAM
Sedation
Adult Dosage
1mg/min slowly IVI Titrate to effect : use the minimum effective dosage
MIDAZOLAM
Maintenance infusion
Adult Dosage
0.03mg/kg/hr - 0.1mg/kg/hr when used in combination with narcotic analgesics
MIDAZOLAM
Convulsions
Adult Dosage
0.15mg/kg slowly IVI (maximum 0.3mg/kg) IMI not recommended as first line route – absorption too slow.
ONLY give IMI if no IV access available 0.15mg/kg IMI (maximum 0.3mg/kg)
MIDAZOLAM
Induction
Adult Dosage
1mg / 15 to 30 seconds IVI Titrate to effect : use the minimum effective dosage
METOCLOPRAMIDE MONOHYDROCHLORIDE
Nausea and vomiting due to: - Stimulation of CETZ by medication (e.g. morphine) - Motility disorders of the GIT (e.g. gastro-enteritis)
Adult Dosage
• Adults > 60 kg: 10 mg slowly IVI/ IMI • Adults < 60 kg: 5 mg slowly IVI/ IMI
MAGNESIUM SULPHATE
Cardiac arrest and acute severe asthma unresponsive to conventional therapy
Adult Dosage
• 1 – 2g (2 to 4 ml of a 50% solution) • Dilute 1g/2ml vial to 10ml with sterile water = 10% solution. • Give slowly, not exceeding 1.5ml/min, with continuous careful monitoring.
MAGNESIUM SULPHATE
Convulsion in toxaemia of pregnancy
Adult Bolus Dosage
• 2 – 4g of a 10% solution given very slowly, with careful monitoring not exceeding 1.5ml/min (10% solution is obtained by diluting the 1g/2ml vial to 10 ml with sterile water)
MAGNESIUM SULPHATE
Convulsion in toxaemia of pregnancy
Adult Infusion
• 3g in 200 ml 0.9% sodium chloride solution at a rate not exceeding 3ml/min.
LORAZEPAM
Status epilepticus
Adult Dosage
- 2 – 4 mg slowly IVI (< 2 mg/min)
- If required an additional 4mg IVI may be administered after 10 minutes
- Titrate to effect (use the lowest effective dosage)
- Maximum 8mg / 12 hours
LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)
Stable VT or complex ventricular ectopy with myocardial ischemia or causing haemodynamic compromise
Adult Dosage (loading, repeat and maximum)
• Loading dose : 1mg/kg slowly IVI • Repeat loading dose : 0.5mg/kg every 5 minutes • Maximum dose : 3mg/kg
LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)
Stable VT which was successfully restored into a stable rhythm
Adult Dosage (Maintenance infusion)
1-4mg/min (20 – 50 μg / kg / min)
LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)
Restoration of a stable rhythm with reappearance of arrhythmia during constant infusion
Adult Dosage
0.5mg/kg slow IVI bolus dose, and an increase in the infusion rate in incremental doses (maximal rate = 4mg/min)
LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)
Stable VT or complex ventricular ectopy with myocardial ischemia or causing haemodynamic compromise which was successfully restored into a stable rhythm
When must the administration of boluses be terminated?
Adult Dosage
administration of bolus doses must be terminated when either: - A maximum of 3mg/kg has been administered, or - The blood pressure drops by >10%, or - Ventricular arrhythmias cease, or - Signs of toxicity develop • In the presence of decreased cardiac output, in patients older than 70 years, and in those with hepatic dysfunction, the dose should be reduced: usual bolus followed by half the normal maintenance infusion.
LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)
Restoration of a stable rhythm with reappearance of arrhythmia during constant infusion
When should the usual bolus be followed by half the normal maintenance infusion?
• In the presence of decreased cardiac output, in patients older than 70 years, and in those with hepatic dysfunction, the dose should be reduced: usual bolus followed by half the normal maintenance infusion.
LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)
Patient with decreased level of consciousness due to ventricular tachycardia with hypotension,pulmonary oedema, congestive cardiac failure or AMI, After first successful cardioversion
Adult dosage (Loading dose, maintenance infusion)
• Loading dose : 1mg/kg slowly IVI followed by Maintenance infusion of 1-4mg/min (20 – 50 μg / kg / min)
LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)
Patient with decreased level of consciousness due to ventricular tachycardia with hypotension,pulmonary oedema, congestive cardiac failure or AMI.
Arrhythmia has reappeared after first successful cardioversion and second immediate cardioversion
Adult Dosage
0.5mg/kg IVI Continue infusion 1-4mg/min (20 – 50 μg / kg / min)
LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)
Ventricular fibrillation (Amiodarone is not available)
Adult Dosage (Initial bolus, repeated dose and maximum total bolus dose)
Bolus dose of 1mg/kg IVI/IO push (or 2mg/kg ET as last resort)
followed by 0.5mg/kg IVI/IO (or 1mg/kg ET) every 5 minutes
Maximum total bolus dose = 3mg/kg IVI
LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)
Ventricular fibrillation (Amiodarone is not available)
After Successful defibrillation
Adult Dosage (Infusion)
Maintenance infusion of 1-4mg/min (20 – 50 μg / kg / min)
IPRATROPIUM BROMIDE
Acute bronchospasm
Adult Dosage UDV
UDV: • Ipratropium bromide 0.5mg + appropriate 2 stimulant + balance of N/S to a total of 5ml solution
• Nebulised over 10 minutes
GLYCERYL TRINITRATE
Acute Coronary Syndrome
Adult Dosage
- One tablet sublingual OR one spray (without inhaling) onto oral mucosa (preferably sublingual)
- Repeat every 5 minutes until pain is relieved, or max dose taken
- Maximum of 3 sprays/ tablets
GLYCERYL TRINITRATE
Acute Pulmonary Oedema
Adult Dosage
- One tablet sublingual OR one spray (without inhaling) onto oral mucosa (preferably sublingual)
- Repeat every 5 minutes until pain is relieved, or max dose taken
- Maximum of 3 sprays/ tablets
GLYCERYL TRINITRATE
- Angina pectoris
- Acute myocardial infarction
- Acute pulmonary oedema
When should administration be terminated?
• Terminate administration if systolic blood pressure (SBP) :
- Decreases by more than 10% in a normotensive patient
- Decreases by more than 30% in a hypertensive patient
- Measures lower than 90 mmHg
GLUCAGON
Symptomatic hypoglycaemia (blood glucose < 3.5mmol/L)
Adequate IV access or IV dextrose is not available or effective.
Adult Dosage
- 1mg IMI / IVI / SC
- IMI is preferred route
GLUCAGON
Severe symptomatic bradycardia from beta blockade overdose not responding to other medications e.g. adrenaline
Adult Dosage
• 3mg IV initially as adjuvant treatment of beta blocker OD,
followed by 3mg/hour infusion
GLUCAGON
Calcium channel blocker OD
Adult Dosage
• 3mg IV initially as adjuvant treatment of calcium channel blocker OD,
followed by 3mg/hour infusion
GLUCAGON
Severe anaphylactic reactions.
Patient is unresponsive to adrenaline, and is taking beta blockers Adult Dosage
1 - 2 mg every 5 min IM or slow IV if unresponsive to adrenaline, & especially if on beta blockers
FUROSEMIDE
Acute pulmonary oedema of cardiac, hepatic or renal origin
Adult Dosage
0.5mg - 1mg/kg IVI slowly over 1-2 minutes
FLUMAZENIL
Central nervous system sedative effects and respiratory depression due to benzodiazepines alone
Adult Dosage (Initial, Repeat and maximum)
- Initial bolus : 0.2mg slowly IVI over 15 seconds
- Repeat : 0.1mg at 1 minute intervals
- Max dose : 1mg
DIAZEPAM
Convulsions
Adult dosage (Initial, repeat, maximum)
- Convulsions: 5 mg/min slowly IVI (0.15mg/kg)
- Repeat every 2 - 5 minutes
- Titrate to effect (use the lowest effective dosage)
- Maximum 20mg
- Rectally 10mg (maximum 20mg)
DIAZEPAM
Sedation
Adult dosage
Sedation: 1mg every 30 seconds IV titrated to effect when necessary
DEXTROSE 50%
Symptomatic hypoglycaemia Blood glucose
Adult dosage
• 10g (20ml of a 50% solution) slowly IVI • Repeat every 5 minutes should blood glucose remain
CORTICOSTEROIDS
Severe allergy / anaphylaxis
Adult dosage
Hydrocortisone: 200mg – 500mg IVI slowly 5 mg/kg IVI slowly
CORTICOSTEROIDS
Acute asthma attack
Adult dosage
Hydrocortisone: 200mg – 500mg IVI slowly 5 mg/kg IVI slowly
CLOPIDOGREL
Patient who has true aspirin allergy (who cannot tolerate aspirin) with suspected acute myocardial infarction (acute coronary syndromes)
Adult dosage
Administer 300mg orally, i.e. four of the 75mg tablets stat
CALCIUM CHLORIDE 10%
Hyperkalaemia (indicated by tall peaked t-waves, flattened p-waves, broadened QRS complexes, e.g. renal failure, severe tissue damage – crush syndrome)
Adult dosage
- 10ml of calcium chloride 10% solution, slowly IVI
- If being administered pre-arrest, administer at 1ml/min
CALCIUM CHLORIDE 10%
Calcium channel blocker toxicity (e.g. verapamil)
Adult dosage
- 10ml of calcium chloride 10% solution, slowly IVI
- If being administered pre-arrest, administer at 1ml/min
CALCIUM CHLORIDE 10%
Beta blocker toxicity (e.g. propanolol)
Adult dosage

- 10ml of calcium chloride 10% solution, slowly IVI
- If being administered pre-arrest, administer at 1ml/min
LIGNOCAINE HYDROCHLORIDE (LIDOCAINE) (Systemic)
Complex ventricular ectopy with myocardial ischemia or causing haemodynamic compromise which was successfully restored into a stable rhythm
Adult Dosage (Maintenance infusion)

1-4mg/min (20 – 50 μg / kg / min)
SALBUTAMOL
Acute bronchospasm
Adult dosage (Inhalant solution)
1ml Salbutamol (5mg/ml) + 4ml N/S
• Repeat continuously if necessary
SALBUTAMOL
Acute bronchospasm
Adult dosage (UDV)
• 2.5mg/2.5ml or 5mg/2.5ml UDV + N/S diluted up to 5 ml
SALBUTAMOL
Acute bronchospasm
Adult dosage (IV-ampoule)
- 250 μg/10min Dilute 500μg/1ml ampoule Salbutamol with 19ml N/S = 500μg / 20ml = 25 μg / ml
- Administer 1ml/min over 10min (total of 250μg / 10 min)
SALBUTAMOL
PREMATURE / OBSTRUCTED LABOUR / PROLAPSED CORD
Adult dosage (maintenance infusion)
- Dilute 2mg [4 x 500mcg/ml] into 200ml N/S (10 μg/ml solution)
- Start with 10μg/min. May increase by 10μg/min every 10 min to a max of 45 μg/min
Note: Maternal & foetal heart rates & Inhibition of uterine contractions must be continually monitored during infusions.
SALBUTAMOL
PREMATURE/ OBSTRUCTED LABOUR / PROLAPSED CORD
Adult dosage (bolus)
Slow IV 100 – 250 μg IV
Dilute 500μg/1ml ampoule Salbutamol with 19ml N/S = 500μg /20ml = 25 μg / ml
• Administer 1ml/min until: - Total of 250μg/10 min has been given,
i. e. 10ml.
- Mother’s heart rate > 120bpm
- Contractions cease
ATROPINE SULPHATE
REFRACTORY SYMPTOMATIC BRADYCARDIA
Adult dosage (initial bolus, repeat, maximum)
0.5mg IVI push
Repeat : 0.5 – 1mg every 3 to 5 minutes
Maximum : 3mg (0.04mg/kg) = total vagolytic dose
ATROPINE SULPHATE ORGANOPHOSPHATE POISONING
Adult dosage (initial bolus, repeat, maximum)
- Intravenous : 0.5 – 2.5 mg IVI
- Repeat : every 4 minutes until atropinisation occurs(decreasing bronchial secretions is single most reliable factor)
- Titrate to effect
- No absolute maximum dosage
AMIODARONE HYDROCHLORIDE
DEFIBRILLATION REFRACTORY VENTRICULAR FIBRILLATION OR PULSELESS VENTRICULAR TACHYCARDIA
Adult dosage
- Administer 300mg IVI as a rapid bolus
- Perform 2 minutes of CPR and reassess rhythm — deliver shock for VF / Pulseless VT
- If ventricular fibrillation or pulseless ventricular tachycardia does not respond to defibrillation, administration of initial 300mg IVI bolus, and further defibrillation,
then consider the administration of an additional dose of 150 mg in 3 to 5 minutes
AMIODARONE HYDROCHLORIDE
Successful defibrillation with Amiodarone
Adult dosage (infusion)
Slow intravenous infusion of 1mg/minute (360mg IV over 6 hours) may be administered
• Maximum cumulative dose of 2.2g IV/24 hours
AMIODARONE HYDROCHLORIDE
STABLE VENTRICULAR TACHYCARDIA or SUPRAVENTRICULAR TACHYCARDIA
Adult dosage (bolus, follow up infusion)
- 150mg IVI over 10 minutes (15mg/min), followed by:
- Infusion: slow IVI of 1mg/minute (360mg over 6 hours)
- Maximum cumulative dose of 2.2g IV/24 hours
ADRENALINE
Cardiac arrest
Adult dosage
- Intravenous / Intraosseous : 1mg IVI push
- Tracheal : 2mg, diluted to 10ml with water for injection preferred.
NOTE: Tracheal option is the last resort route of administration - IV/IO definitely preferred.
• Repeat : every 3 to 5 minutes
ADRENALINE
Post-cardiac arrest hypotension (BP< 70mmHg)
Adult dosage
2-10μg/min –titrating to effect [add 1ml of 1:1000 to 200mls normal saline = 5μg/ml]
ADRENALINE
Resistant symptomatic bradycardia (SBP<85mmHg)
Adult dosage (infusion)

- 2-10μg/min
- Titrate to effect
ADRENALINE
Anaphylaxis
Adult dosage
Intramuscular:
- Initial : 0.3mg of 1:1000 undiluted (ideally anterolateral thigh)
- Repeat : every 15 - 20 minutes if no clinical improvement
- Titrate to effect
Intravenous (only if life-threatening / unresponsive to IMI):
- Caution – extremely dangerous and must be diluted
- Continuous patient and ECG monitoring is required
- Initial : 0.1mg IVI diluted slowly over 5 minutes (see below)
- Repeat : every 5 minutes if no clinical improvement
- Carefully titrate to effect
ADRENALINE
Life threatening asthma (near fatal asthma)
Adult dosage
Subcutaneously/intramuscularly
• 0.01 mg/kg divided into three doses of 0.3 mg given very 20 minutes,
i.e: • Initial : 0.3 mg or 1:1000 undiluted
- Repeat : after 20 minutes if no clinical improvement, and then again at 40 minutes
- Titrate to effect
ADENOSINE
Stable patients with narrow-complex Paroxysmal Supra-Ventricular Tachycardia, to terminate the reentry SVT.
Adult dosage

- 6 mg rapid IV push (followed immediately by 20 ml N/S IVI push) (Draw up adenosine dose and flush in two separate syringes)
- 12 mg rapid IV push if no response after 2 minutes.
- 12 mg rapid IV push may be considered if no response after 2 minutes