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Key Acute Care Pediatric Medications


This reference includes a combination of FDA-labeled as well as off-labeled indications. Refer to DailyMed for the labeling status of the individual medications.

See also: Key Acute Care Adult Medications

A

Drug Indications/Dosage
Adenosine SVT
0.1 mg/kg IV/IO rapid push (max 6 mg), 2nd dose 0.2 mg/kg IV/IO rapid push (max 12 mg)
Albumin Shock, Trauma, Burns
0.5 to 1 g/kg (10 to 20 mL/kg of 5% solution) IV/IO rapid infusion
Albuterol Asthma, Anaphylaxis (bronchospasm), Hyperkalemia
  • MDI: 4 to 8 puffs INH q 20 minutes PRN with spacer (OR ET if intubated)
  • Nebulizer: 2.5 mg/dose (wt <20 kg) OR 5 mg/dose (wt >20 kg) INH q 20 minutes PRN
  • Continuous nebulizer: 0.5 mg/kg per hour INH (max 20 mg/h)
Aminophylline Treatment of Phosgene induced pulmonary edema (off label - anecdotal evidence)
Aminophylline 5- 6 milligrams/kilogram IV loading dose over 20 minutes (lean ideal body weight) followed by
  • Neonates: 0.2 mg/kg/hr
  • Infants 6 wk - 1 yr: mg/kg/hr = (0.008) x (age in weeks) + 0.21
  • 1-9 yr: 1-1.2 mg/kg/hr
  • 9-12 yr and young adult smokers: 0.9 mg/kg/hr
  • >12 yr health nonsmokers: 0.7 mg/kg/hr
  • The total daily dose may also be administered IV divided Q4- 6 hr
  • See Harriet Lane Handbook for level monitoring information
  • Maintain a serum level of 10 to 20 micrograms/milliliter (neonates 7.5 micrograms/milliliter).
See Phosgene - Emergency Department/Hospital Management Treatment section for off label dosing recommendations
Amiodarone SVT, VT (with pulses)
5 mg/kg IV/IO load over 20 to 60 min (max 300 mg), repeat to daily max 15 mg/kg (or 2.2 g)

 Pulseless Arrest (ie, VF/pulseless VT)
 5 mg/kg IV/IO bolus (max 300 mg), repeat to daily max 15 mg/kg (or 2.2 g)
Amyl Nitrite Antidote for Cyanide Toxicity
Amyl nitrite perle should be broken onto a gauze pad and heal under the nose, placed under the lip of a facemask, or over the Ambu-valve intake. The patient should inhale for 30 seconds of each minute and a new perle should be utilized every three minutes if sodium nitrite infusions will be delayed. Amyl nitrite is not FDA-approved.

See Hydrogen Cyanide - Prehospital Management and Hydrogen Cyanide - Emergency Department/Hospital Management Treatment section for cyanide specific dosing recommendations
Atropine Sulfate Bradycardia (symptomatic)
  • 0.02 mg/kg IV/IO (min dose 0.1 mg, max single dose child 0.5 mg, max single dose adolescent 1 mg), may repeat dose once, max total dose child 1 mg, max total dose adolescent 2 mg
  • 0.04 to 0.06 mg/kg ET
Toxins/Overdose (eg, organophosphate, carbamate)
 0.02 to 0.05 mg/kg (<12 years) OR 0.05 mg/kg (>12 years) IV/IO initially, repeat q 20 to 30 min until atropine effect (dry mouth, tachycardia, mydriasis) is observed or symptoms reverse

See Nerve Agents - Prehospital Management and Nerve Agents - Emergency Department/Hospital Management Treatment section for nerve agent specific dosing recommendations

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C

Drug Indications/Dosage
Calcium Chloride 10% Hypocalcemia, Hyperkalemia, Hypermagnesemia, Calcium Channel Blocker Overdose
Dosing for non-life-threatening situations, refer to Harriet Lane Handbook, or DailyMed for dosing recommendations

Cardiac Arrest or Severe Hypotension
20 mg/kg (0.2 mL/kg) IV/IO slow push during arrest or if severe hypotension, repeat PRN

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D

Drug Indications/Dosage
Dexamethasone Croup
0.6 mg/kg PO/IM/IV (max 16 mg)
Dextrose (Glucose) Hypoglycemia
0.5 to 1 g/kg IV/IO (D25W 2 to 4 mL/kg; D10W 5 to 10 mL/kg)
Diazepam Prolonged Seizures/Status Epilepticus
Neonate - 0.3-0.75 mg/kg/dose IV Q 15-30 min x 2-3 doses
  • IV -1 month - 0.2-0.5 mg/kg/dose Q 15-30 min, max total dose <5 yr : 5mg, ≥5 yr 10 mg
  • IM - 0.2 -0.5 mg/kg, repeat Q 2-5 minutes x 2, max total dose <5 yr : 5mg, ≥5 yr 10 mg
  • Rectal Gel
    2-5 yr: 0.5 mg/kg/dose
    6-11 yr: 0.3 mg/kg/dose
  • 12yr: 0.2 mg/kg/dose
    May repeat in 4-12 hrs prn

See Nerve Agents - Prehospital Management and Nerve Agents - Emergency Department/Hospital Management Treatment section for nerve agent specific dosing recommendations
Diphenhydramine Anaphylactic Shock
1 to 2 mg/kg IV/IO/IM q 4 to 6 hours (max 50 mg)
Dobutamine Congestive Heart Failure, Cardiogenic Shock
2 to 20 μg/kg per minute IV/IO infusion; titrate to desired effect
Dopamine Cardiogenic Shock, Distributive Shock
2 to 20 μg/kg per minute IV/IO infusion; titrate to desired effect

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E

Drug Indications/Dosage
Epinephrine Pulseless Arrest, Bradycardia (symptomatic)
  • 0.01 mg/kg (0.1 mL/kg) 1:10,000 IV/IO q 3 to 5 minutes (max 1 mg; 1 mL)
  • 0.1 mg/kg (0.1 mL/kg) 1:1000 ET q 3 to 5 minutes

Hypotensive Shock
 0.1 to 1 μg/kg per minute IV/IO infusion (consider higher doses if needed)

Anaphylaxis
  • 0.01 mg/kg (0.01 mL/kg) 1:1000 IM in thigh q 15 minutes PRN (max 0.5 mg) OR
  • Auto-injector 0.3 mg (wt ≥30 kg) IM or Child Jr Auto-injector 0.15 mg (wt 10 to 30 kg) IM
  • 0.01 mg/kg (0.1 mL/kg) 1:10,000 IV/IO q 3 to 5 minutes (max 1 mg) if hypotension
  • 0.1 to 1 μg/kg per minute IV/IO infusion if hypotension despite fluids and IM injection
Asthma
 0.01 mg/kg (0.01 mL/kg) 1:1000 SQ q 15 minutes (max 0.5 mg; 0.5 mL)

Croup
  Racemic epinephrine solution (2.25%)
  • <4 yr: 0.05 mL/kg/dose up to a max of 0.5 mL/dose diluted with normal saline to 3.0.
  • Equal or >4: 0.5 mL/dose diluted with normal saline to 3 mL
  • Adolescent 0.75 mL/dose diluted with normal saline to 3 mL
  • Give via nebulizer over 15 minutes PRN, do not routinely give more frequently then Q1-2 hr

Toxins/Overdose (eg, beta-adrenergic blocker, calcium channel blocker)
  • 0.01 mg/kg (0.1 mL/kg) 1:10,000 IV/IO (max 1mg); if no response consider higher doses up to 0.1 mg/kg (0.1 mL/kg) 1:1000 IV/IO
  • 0.1 to 1 μg/kg per minute IV/IO infusion (consider higher doses)

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F

Drug Indications/Dosage
Furosemide Pulmonary Edema, Fluid Overload
1 mg/kg IV/IM (usual max 20 mg if not chronically on loop diuretic)

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H

Drug Indications/Dosage
Hydrocortisone Adrenal insufficiency
2 mg/kg IV bolus (max 100 mg)
Hydroxocobalamin Antidote for Cyanide Toxicity
A dose of 70 mg/kg (not to exceed 5 grams initially) administered over 30 minutes is recommended. This dose can be given IV push in situations of cyanide induced cardiac arrest.

See Hydrogen Cyanide - Prehospital Management and Hydrogen Cyanide - Emergency Department/Hospital Management Treatment section for cyanide specific dosing recommendations

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I

Drug Indications/Dosage
Inamrinone Myocardial Dysfunction and Increased SVR/PVR
Loading dose: 0.75 to 1 mg/kg IV/IO slow bolus over 5 minutes (may repeat twice to max 3 mg/kg), then 5 to 10 μg/kg per minute IV/IO infusion
Ipratropium Bromide Asthma
250 to 500 µg INH q 20 minutes PRN x 3 doses

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L

Drug Indications/Dosage
Lidocaine VF/Pulseless VT, Wide-Complex Tachycardia (with pulses)
  • 1 mg/kg IV/IO bolus
  • Maintenance: 20 to 50 μg/kg per minute IV/IO infusion (repeat bolus dose if infusion initiated >15 minutes after initial bolus)
  • 2 to 3 mg/kg ET
Lorazepam Prolonged Seizures/Status Epilepticus
0.05-0.1 mg/kg/dose IV over 2-5 minutes, may repeat 0.05 mg/kg X1 in 10 -15 min, max dose 2 mg/dose

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M

Drug Indications/Dosage
Magnesium Sulfate Asthma (refractory status asthmaticus), Torsades de Pointes, Hypomagnesemia
25 to 50 mg/kg IV/IO bolus (pulseless VT) OR over 10 to 20 minutes (VT with pulses) OR slow infusion over 15 to 30 minutes (status asthmaticus) (max 2 g)
Methylprednisolone Asthma (status asthmaticus), Anaphylactic Shock
  • Load: 2 mg/kg IV/IO/IM (max 80 mg) use acetate salt IM
  • Maintenance: 0.5 mg/kg IV/IO q 6 hours (max 120 mg/d)
Midazolam Prolonged Seizures/Status Epilepticus
0.2 – 0.3 mg/kg IM, IN. Buccal (max 10 mg)

Refractory Status Epilepticus
  • 2 month and child: Load with 0.15 mg/kg IV X 1 followed by a continuous infusion of 1 mcg/kg/min, and titrate dose upward Q5 minutes to effect ( mean dose of 2.3 mcg/kg/min)

See Nerve Agents - Prehospital Management and Nerve Agents - Emergency Department/Hospital Management Treatment section for nerve agent specific dosing recommendations
Milrinone Myocardial Dysfunction and Increased SVR/PVR
Loading dose: 50 to 75 μg/kg IV/IO over 10 to 60 minutes followed by 0.5 to 0.75 μg/kg per minute IV/IO/infusion

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N

Drug Indications/Dosage
Naloxone Narcotic (opiate) Reversal
  • Total reversal required (for narcotic toxicity secondary to overdose): 0.1 mg/kg IV/IO/IM/SQ bolus q 2 minutes PRN (max 2 mg)
  • Total reversal not required (eg, for respiratory depression associated with therapeutic narcotic use): 1 to 5 μg/kg IV/IO/IM/SQ; titrate to desired effect
  • Maintain reversal: 0.002 to 0.16 mg/kg per hour IV/IO infusion
Nitroglycerin Congestive Heart Failure, Cardiogenic Shock
  • 0.25 to 0.5 μg/kg per minute IV/IO infusion, may increase by 0.5 to 1 μg/kg per minute q 3 to 5 minutes PRN to 1 to 5 μg/kg per minute (max 10 μg/kg per minute)
  • Adolescents: 10 to 20 µg/min, increase by 5 to 10 µg/min every 5 to 10 minutes PRN to max 200 µg/min
Norepinephrine Hypotensive (usually distributive) Shock (ie, low SVR and fluid refractory)
0.1 to 2 μg/kg per minute IV/IO infusion; titrate to desired effect

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O

Drug Indications/Dosage
Oxygen Hypoxia, Hypoxemia, Shock, Trauma, Cardiopulmonary Failure, Cardiac Arrest
Administer 100% O2 via high-flow O2 delivery system (if spontaneous ventilations) or ET (if intubated); titrate to desired effect

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P

Drug Indications/Dosage
Pralidoxime Nerve Agent/Organophosphate Antidote
20 mg/kg - 50 mg/kg IM, autoinjector or IV (max dose 2 grams)

See Nerve Agents - Prehospital Management and Nerve Agents - Emergency Department/Hospital Management Treatment section for nerve agent specific dosing recommendations
Procainamide SVT, Atrial Flutter, VT (with pulses)
15 mg/kg IV/IO load over 30 to 60 minutes (do not use routinely with amiodarone)

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S

Drug Indications/Dosage
Sodium Bicarbonate Cardiac Arrest, Metabolic Acidosis (severe), Hyperkalemia
See Harriet Lane Handbook for dosing for specific indications

Routine use of sodium bicarbonate in cardiac arrest is not recommended. When used in special situations, the typical initial dose is 1 mEq/kg, and then the dosage should be guide by the bicarbonate concentration or calculated base deficit from blood gas analysis or laboratory measurement (Neumar et al, 2010).

See Phosgene - Emergency Department/Hospital Management Treatment section for off label dosing recommendations
Sodium Nitrite
As soon as IV access has been achieved in a symptomatic patient DC the perles and initiate IV sodium nitrite (ASAP).
  • The pediatric dose is 0.12 to 0.33 ml/kg.
  • The usual adult dose is 10 ml of a 3% solution (300 mg).

See Hydrogen Cyanide - Prehospital Management and Hydrogen Cyanide - Emergency Department/Hospital Management Treatment section for cyanide specific dosing recommendations
Sodium Nitroprusside Cardiogenic Shock (ie, associated with high SVR), Severe Hypertension
1 to 8 μg/kg per minute (wt < 40 kg) OR 0.1 to 5 μg/kg per minute (wt > 40 kg) IV/IO infusion
Sodium Thiosulfate Antidote for Cyanide Toxicity
IV sodium thiosulfate
  • The pediatric dose is 1.65 mL/kg of a 25% solution.
  • The adult dose is 50 ml of a 25% solution
  • (12.5 grams infused over 10 - 20 minutes).
  • Repeat one-half of the initial dose in 30 minutes if there is an inadequate clinical response or at 2 hours for prophylaxis

See Hydrogen Cyanide - Prehospital Management and Hydrogen Cyanide - Emergency Department/Hospital Management Treatment section for cyanide specific dosing recommendations

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