Pediatric Medications

Question 1

Pediatric maintenance fluids

Answer 1

use D5NS. Use NS if glucose contraindicated

a. ≤10 kg body weight: 4 x (wt in kg) = mL/hr
b. 11–20kgbodyweight:2x(wtinkg–10)+40=2x(Wtinkg)+20=mL/hr
c. >20kgbodyweight:(wtinkg–20)+60= Wtinkg+40=mL/h

Question 2

Pediatric maintenance fluid for head injury

Answer 2

3/4 calculated volume NS

Question 3

Push dose Epi

Answer 3

0.1 mL/kg (1 mcg/kg) every 3 – 5 min PRN to maintain SBP >70 + (2x age in years). Max 20 mcg per dose.

Question 4

Hypovolemic shock fluid resuscitation

Answer 4

20ml/kg

Question 5

Cardiogenic shock fluid bolus

Answer 5

5 – 10 mL/kg NS bolus. May repeat PRN if no pulmonary edema is present (maximum is 60mL/kg total).

Question 6

Pediatric Norepi dose

Answer 6

0.05-2mcg/kg/min not to exceed 45 mcg/min

Question 7

Septic Shock Fluid

Answer 7

20mL/kg LR bolus. Repeat PRN. More than 100mL/kg may be required.

Question 8

Epi infusion

Answer 8

0.05 – 0.3 mcg/kg/min titrated to a maximum 1 mcg/kg/min.

Question 9

Neurogenic shock fluid

Answer 9

(40-60 mL/kg in pediatric
patients),

Question 10

Phenylephrine

Answer 10

0.25 – 5 mcg/kg/min
Maximum rate 200 mcg/min, although some providers may exceed this rate.

Question 11

Dilaudid

Answer 11

<6 months: 5 mcg/kg
>6 months: 15mcg/kg

Question 12

Fentanyl Push dose

Answer 12

1-2 mcg/kg

Question 13

Fentanyl infusion

Answer 13

0.5 mcg/kg/hr after initial IV bolus
After 5 – 10 minutes, if pain control is inadequate,
bolus 0.5 mcg/kg and increase infusion by 0.5 mcg/kg/hr. Repeat bolus and infusion titration q 5 – 10 min PRN to a max of 3 mcg/kg/hr.

Question 14

Morphine

Answer 14

0.1 – 0.2 mg/kg IV/IM.

Question 15

Ketamine for pain adjunct

Answer 15

0.2 mg/kg slow IV push

Question 16

Ativan for sedation

Answer 16

0.05 – 0.1 mg/kg IV or IM.

Question 17

Versed for sedation

Answer 17

0.05 – 0.1 mg/kg IV or IM.
0.3 mg/kg IN (max dose 10 mg), half of dose in each nostril

Question 18

Versed infusion

Answer 18

50 mcg/kg/hr after initial IV bolus.
If sedation inadequate after 5 – 10 minutes, bolus 50
mcg/kg and increase infusion by 10 mcg/kg/hr. Repeat bolus and increase infusion q 5 – 10 min PRN, not to exceed an infusion rate of 100 mcg/kg/hr.

Question 19

Ketamine for sedation

Answer 19

Loading dose 1 mg/kg slow IV push (if induction dose
not given). Repeat 0.5 mg/kg q 15 minutes.

Question 20

Ketamine infusion

Answer 20

0.5 mg/kg/hr
If sedation inadequate after 10 minutes, bolus 0.5 mg/kg and increase infusion by 0.5 mg/kg/hr. Repeat bolus and increase infusion q 10 minutes PRN to a max rate of 4 mg/kg/hr.

Question 21

Pediatric propofol

Answer 21

Bolus with 0.5 mg/kg (max 20 mg), and increase
drip rate by 10 mcg/kg/min q 5 min, not to exceed 75
mcg/kg/min.

Question 22

Ativan for anxiety

Answer 22

0.02mg/kg IV, not to exceed 1mg. May repeat q 30 – 45 min PRN.

Question 23

Narcan

Answer 23

0.02 mg/kg IV/IM/IN
1. May repeat q3–5min (not to exceed 0.4mg in a single
dose).

Question 24

Zofran

Answer 24

0.1mg/kg IV or IM for pediatric patients >1 month old (max 4 mg/dose)

Question 25

Phenergen

Answer 25

> 2 years old: 0.5 mg/kg (25mg max) deep IM or IV

Question 26

Ativan for nausea

Answer 26

0.05 mg/kg IV or IM.

Question 27

Benadryl for nausea

Answer 27

1mg/kg IV (max 25mg)

Question 28

Duoneb for asthma

Answer 28

0.5 mg ipratropium/2.5 mg albuterol (3mL = 1 unit) via nebulizer q 10min PRN
x 3 doses total.

Question 29

Solu-Medrol

Answer 29

2mg/kg IV (Max 60mg).

Question 30

Mag Sulfate for asthma

Answer 30

50 mg/kg IV over 20 – 30 min once. Maximum dose 2
grams.

Question 31

Racemic epi for croup

Answer 31

0.5 mL of 2.25% solution diluted in 2.5mL NS.
May repeat q20–30min PRN.

Question 32

Fentanyl for pretreatment of RSI

Answer 32

2 – 3 mcg/kg slow IV push over 30-60
seconds.

Question 33

Ketamine induction dose

Answer 33

2mg/kg

Question 34

Versed induction dose

Answer 34

0.1 mg/kg IV.

Question 35

Etomidate

Answer 35

0.3 mg/kg IVP. May repeat x 2.

Question 36

Succinylcholine

Answer 36

1.5 mg/kg IV (maximum of 200mg)
Only for 10 years and older

Question 37

Rocuronium

Answer 37

1mg/kg IV
1.8mg/kg IM

Question 38

Atropine if needing during RSI

Answer 38

0.02 mg/kg IV.

Question 39

Pediatric epi dose Cardiac arrest

Answer 39

Epinephrine dosing should be calculated in mL/kg.
a. IV/IO: Epinephrine (1:10,000) 0.1 mL/kg
b. Per ET Tube: Epinephrine (1:1000) 0.1mL/kg.
c. Mayrepeatq3–5min.

Question 40

Epi infusion ROSC

Answer 40

0.1 – 1.0 mcg/kg/min IV, titrated PRN.
No maximum epinephrine dose listed per ACLS and PALS, but consider adding Norepinephrine if hypotension persists beyond 30 mcg/min in adults and 1 mcg/kg/min in pediatric patients.

Question 41

Versed for sedation ROSC

Answer 41

0.025 mg/kg. If BP stable, repeat q 5 minutes to a max of 0.1 mg/kg q 15 minutes (not to exceed 5 mg/dose)

Question 42

Lasix for pulmonary edema

Answer 42

1 – 2 mg/kg IVP up to 20 mg or amount equal to patient’s usual oral dose, whichever is higher.

Question 43

Benadryl for allergic reactions

Answer 43

1mg/kg max 50

Question 44

Epi for anaphylaxis

Answer 44

0.01 mg/kg (0.01 mL/kg) IM (thigh), (maximum
0.5 mg per dose.) May repeat q 10 minutes PRN x 3.
1:1000 concentration