Pediatric Dosing

Question 1

Is there a standard dose for pediatric medicines?

Answer 1

NO

Question 2

List some reasons as to why there is not a standard dose for pediatric medicines?

Answer 2

Rapid child growth is accompanied with changes in:

• absorption
• elimination
• metabolism
• distribution

Question 3

At what age will children usually have mature and active enzymes as well as an adult level GFR?

Answer 3

2 years old

Question 4

What anatomical items alter the distribution of a pediatric drug?

Answer 4

Fat and water content – changes with childhood

Question 5

What are 2 ways that a pediatric dose can be written?

Answer 5

1. mg/kg/day

2. mg/kg/dose

Question 6

What must a child’s weight in pounds be converted to and how?

Answer 6

Kg
== divide lbs by 2.2
(1 kg = 2.2 lb)

Question 7

The starting dose can be based on what 3 things for a child?

Answer 7

Age
Weight
Body Surface Area

Question 8

If a drug is based off a child’s body surface area, what is likely an attribute of the drug?

Answer 8

TOXIC

Question 9

Explain how to calculate a dose if a child weighs 22 lbs, the dosing range is 90 mg/kg/day and they want to give 2 doses a day.

Answer 9

1. 22 lbs/2.2 = 10 kg
2. 10 kg X 90 mg/kg/day = 900 mg/day
3. 900 mg/2 = 450 mg twice a day

Question 10

What dose is often considered the maximum dose for a child?

Answer 10

Adult dose = Maximum dose

Question 11

Body Surface Area is more accurate with dosing but is only used when? What is an example?

Answer 11

With drugs that have a high risk of toxicity

– chemo drugs

Question 12

What are the parameters for when dosing by weight is accurate?

Answer 12

< 18 yo

< 40 kg

Question 13

If a child weighs more than 40 kg, dosing by weight is not as accurate. What dose should you use?

Answer 13

Adult dose

Question 14

With a child that weighs more than 40 kg, you should use weight based dosing unless it exceeds ____

Answer 14

Adult dose

Question 15

Can mg/kg/dose or /day be abbreviated with /d?

Answer 15

NO

Question 16

What measurement should meds be ordered in?

Answer 16

mg

Question 17

Normally, how much water is needed for every _____ of energy expended?

Answer 17

100 mL of water needed for every 100 kcal/kg of energy expended

Question 18

What classifies insensible water loss?

Answer 18

Water loss that is not perceived like skin and respiratory tract

Question 19

What classified sensible water loss?

Answer 19

Sweat, urine and stool

Question 20

What does the Holliday - Segar Method calculate?

Answer 20

Fluids needed

Question 21

The 4-2-1 rule (holliday-segar method) calculates?

Answer 21

Fluids needed for HOURLY replacement

Question 22

Describe the HOURLY fluid replacement rule (4-2-1)?

Answer 22

1. < 10kg = 4 ml/kg/hr
2. 10 - 20 kg = 40 ml + 2 ml/kg for every kg above 10 kg
3. > 20 kg = 60 ml + 1 ml/kg for every kg above 20 kg

Question 23

Describe the HOURLY fluid replacement rule (4-2-1)?

Answer 23

1. < 10 kg = 4 ml/kg/hr
2. 10 - 20 kg = 40 ml + 2 ml/kg for every kg above 10 kg
3. > 20 kg = 60 ml + 1 ml/kg for every kg above 20 kg

Question 24

If you are concerned about hypoglycemia, what can be added to the fluids?

Answer 24

Dextrose

Question 25

Ex. What is the hourly and daily fluid maintenance replacement amount for a 25 kg child.

Answer 25

60 ml + 1 X 5 = 65 ml/hr

=> Daily = 65 X 24 = 1560 ml/day

Question 26

Ex. What is the hourly fluid maintenance for a 5 kg child?

Answer 26

4ml X 5 kg = 20 ml/hr

Question 27

With Rehydration, what type of fluid should you use?

Answer 27

Isotonic fluid always

Question 28

Rehydration fluids are always isotonic fluid. Maintenance fluids can be either 1/2 or normal saline. What is the benefit of normal saline? (isotonic)

Answer 28

Prevents against hyponatremia

– especially with adding KCl and Dextrose

Question 29

What is normal saline?

Answer 29

0.9% NaCl

Question 30

What are the mEq of Na and Cl in normal saline?

Answer 30

154 mEq per liter

Question 31

If you have 154 mEq of Na or Cl, what type of saline do you have?

Answer 31

Normal saline = 0.9% NaCl

Question 32

In order to determine the degree of dehydration in a child, what is beneficial to have?

Answer 32

Pre-weight and post-weight

Question 33

With dehydration, what fluids are needed?

Answer 33

Replacement fluids for what was lost + MAINTENANCE hourly fluids

Question 34

With replacement fluids with dehydration, what is the rate of replacement over 24 hours?

Answer 34

1/2 replaced in the first 8 hours

1/2 replaced in the next 16 hours

Question 35

Ex. Determine how much fluid is lost if a 20 kg child is 10% dehydrated

Answer 35

20 kg X 0.1 = 2 kg = > 2000 mg(cc) fluids LOST = replacement fluids

Question 36

If a dehydrated child (20 kg) needs 2000 ml of replacement fluids, what else must be added to that?

Answer 36

Maintenance hourly fluids

= 60 ml/hr

Question 37

What bolus of isotonic fluid is given for dehydration?

Answer 37

10-20 cc/kg/bolus

Question 38

4 signs of dehydration in a child?

Answer 38

Abnormal appearance
Dry mucus membranes
No tears
Cap refill > 2 seconds

Question 39

4 signs of dehydration in a child?

Answer 39

Abnormal appearance
Dry mucus membranes
No tears
Cap refill > 2 seconds