PCCU Dosing Handbook 2009 .pdf

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CHILDREN’S HOSPITAL
LONDON HEALTH SCIENCES CENTRE

Dosing Guidelines for
Drugs used in the
Paediatric Critical Care Unit
2009 Edition

Children’s Hospital, London Health Sciences Centre

Resuscitation Drugs for Infants and Older Children
Drug
Adenosine
3 mg/ml
Amiodarone

Dose
0.1 mg/kg (max 6 mg)
nd

2 dose 0.2 mg/kg (max.12 mg
5 mg/kg
max. 300 mg
repeat to daily max. 15 mg/kg or
2.2 g

Route
IV,IO push
followed by NS flush
IV, IO
for SVT, VT with pulse give over
20-30 min
for pulseless arrest give as bolus

0.02 mg/kg
min. dose 0.1 mg
max. single dose:
child 0.5 mg
adolescent 1 mg
max. total dose
child 1 mg
adolescent 2 mg

IV, IO

0.03 mg/kg

ETT

Calcium Chloride 10%

20 mg/kg (0.2 ml/kg)

IV, IO
slow push

Epinephrine

Pulseless Arrest, Bradycardia

Atropine

0.01 mg/kg
0.1 ml/kg of 1:10,000
max. 1 mg- 10 ml

IV, IO

0.1 mg/kg
0.1 ml/kg of 1:1000
max 10 mg-10 ml

ETT

Anaphylaxis
0.01 mg/kg
0.01 ml/kg of 1:1000
max. 0.5 mg/dose

IM

+hypotension
0.01 mg/kg
0.1 ml/kg of 1:10,000
max 1 mg

IV, IO

Lidocaine

1 mg/kg
2-3 mg/kg

IV, IO
ETT

Magnesium sulfate

25-50 mg/kg

Naloxone

total narcotic reversal
0.1 mg/kg
max. 2 mg

IV,IO
Over 10-20 min VT with pulses
Bolus –pulseless VT
IV,IO

Sodium Bicarbonate

1 mmol/kg

IV, IO slow bolus

2

Children’s Hospital, London Health Sciences Centre

DOSING GUIDELINES FOR DRUGS USED IN THE
PAEDIATRIC CRITICAL CARE UNIT

Reprinted with permission

INTENDED FOR USE IN THE PAEDIATRIC CRITICAL CARE UNIT (PCCU),
CHILDREN’S HOSPITAL, LONDON HEALTH SCIENCES CENTRE,
LONDON, ONTARIO.
Intended only to serve as a guide; current literature sources and Paediatric
Pharmacists should be consulted for further information.

NOTE:

When treating patients with liver and/or kidney impairment consult
further references for possible dosage adjustments.

Legend
A

Adult

N

Neonate-doses apply to newborn infants until
post-conceptional age >38 weeks and post-natal
age of >4 weeks

C

Child

I

Infant

ETT

Endotracheally

Inh

Inhalation

IM

Intramuscular

IO

Intraosseus

IV

Intravenous

PNA

Post natal age

po

Oral

pr

Rectal

Renal dose
adjust

sc

Dose requires adjustment in renal insufficiency
consult other references
subcutaneous

3

Children’s Hospital, London Health Sciences Centre

Intended for use in the Paediatric Critical Care Unit (PCCU)
Children’s Hospital, London Health Sciences Centre, London, Ontario.

Compiled from a review of the literature and reviewed by L. Burril, S. Campbell,
M. Edwards RD., Dr. D. Fraser, Dr. A. Kornecki, Dr. D. Matsui, Dr. G. Morrison,
Dr. A. Price, Dr. M.J. Rieder, Dr. M. Salvadori, Dr. R. Singh,
Prepared by:
The Department of Pharmacy Services
Intended only to serve as a guide; current literature sources and Paediatric
Pharmacists should be consulted for further information,
NOTE: when treating patients with liver and/or kidney impairment consult
further references for possible dosage adjustments

Copyright September 1986 Revised: 02/87; 06/87; 06/88; 06/89; 06/90; 06/91;
05/92; 06/93; 08/94; 07/96; 05/99; 08/02; 06/03; 07/08

4

Children’s Hospital, London Health Sciences Centre

Children’s Hospital, London Health Sciences Centre, 2008

Table of Contents SECTION PAGE
Drug List.......................................................................
Adrenal Coticosteriod Comparison Chart.....................
Anticoagulation Nomograms ........................................
Continuous Infusion Guide...........................................
Drug Infusions ..............................................................
Fluid Requirements ......................................................
TPN Recommendations/Formulas ...............................
Enternal Feedings ........................................................
Feeding Protocol ..........................................................
Chest Tube/ETT sizes..................................................
Umbilical Catheters ......................................................
Notes............................................................................

6
34
35
36
37
38
39
41
44
46
47
48

5

Children’s Hospital, London Health Sciences Centre

DRUG

AGE/COMMENTS

po/pr q4-6h

5mg/kg/dose
5 mg/kg/dose
5 mg/kg/dose
(↑ by 25 mg/kg/day to
max. 100 mg/kg/day)

po, IV q24h
po, IV q8-12h
po, IV q6h

60-100 mg/kg/day

po div q6h

80-100 mg/kg/day

po div q6h

Maintenance

3-5 mg/kg/day

po q 24h

Antiplatelet

3-5 mg/kg/day
(max. 325 mg/day)

po q24h

Neonatal HSV

60 mg/kg/day

IV div q8h

I, C
HSV encephalitis
1 mo-12 yr
> 12y

60 mg/kg/day
30 mg/kg/day

IV div q8h
IV div q8h

N, I, C

acetazolamide

I, C
Diuretic
Urinary alkalinization
Decrease CSF
production

renal dose adjust
acetylsalicylic acid (ASA)

acyclovir
dose IBW
renal dose adjust

ROUTE
FREQUENCY

10-15 mg/kg/dose
Max. dose N 60
mg/kg/day
max. dose I,C 75
mg/kg/day or 4
gm/day whichever is
less)

acetaminophen

IV-SAP product

DOSE

I, C
JRA, pericarditis,
Rheumatic fever
Kawasaki disease
Acute

N

HSV –
immunocompromised
Treatment

15-30 mg/kg/day
80 mg/kg/day
(max. 1000 mg/day)

IV div q8h
po div 3-5 x /day

600-1000 mg/day
(max. 80 mg/kg/day)

po div 3-5 x /day

IV div q8h
IV div q8h

Immunocompetent

30 mg/kg/day
2
1500 mg/m /day
or
30 mg/kg/day
80 mg/kg/day

Zoster- immunocompetent
≥ 12 years

4000 mg/day

po div 5 x/day

Prophylaxis
Varicella-Zoster
immunocompromised
<1 year
≥ 1 year

CMV prophylaxisimmunocompromised

2

1500 mg/m /day
800-3200 mg/day
(max 80 mg/kg/day)

po div q6h

IV div q8h
po div q6-24h

6

Children’s Hospital, London Health Sciences Centre

DRUG
adenosine

AGE/COMMENTS

ROUTE
FREQUENCY

DOSE

N

0.05 mg/kg
increase by
increments 0.05
mg/kg/dose to max
0.25 mg/kg/dose

IV, IO

I, C

0.1 mg/kg/dose (max.
6mg)
followed by 0.2 mg/kg
(max. 12 mg) in 1-2
min prn

IV, IO

Aldactazide
(hydrochlorothiazide/spironolactone)

I, C

2-4 mg/kg/day

po div q6-12h

allopurinol

C≤ 10

10 mg/kg/day
2
or 200-300 mg/m /day
(max 800 mg/day)

po div q8-12h
po div q6-12h

C>10, A

600-800 mg/day

po div q8-12h

I, C

0.05-1.0 mcg/kg/min

IV

renal dose adjust

alprostadil

may reduce dose to
0.025 mcg/kg/min by
titrating to the patency
of patent ductus
arteriosus
alteplase

Blocked catheter
≤ 10 kg

≥ 10 kg

amiodarone

Leave in lumen 2-4
hours then remove

1mg/ml (amount
required to fill volume
of lumen)
(max. 2 ml)

PALS dose
Pulseless VT/VF
Perfusing tachycardia

PSVT

amlodipine

0.5 mg diluted in NS
to volume required to
fill lumen

5 mg/kg
5 mg/kg
(may repeat to max.
15 mg/kg or 300 mg)

IV,IO rapid
IV over 20-60 min

5mg/kg
followed by 5-10
mcg/kg/min

IV over 60 min

LD:10 mg/kg/day
MD: 5.0 mg/kg/day

po div q12-24h(x 710 days)
po div q24h

0.1 mg/kg/day
0.1-0.3 mg/kg/day

po div q24h
po div q24h

I, C
Initial dose
Maintenance

7

Children’s Hospital, London Health Sciences Centre

DRUG

AGE/COMMENTS

DOSE

ROUTE
FREQUENCY

amoxicillin

N, I

20-30 mg/kg/day

po div q12h

renal dose adjust

I>3 months,C
Acute otitis media

25-50 mg/kg/day
80-90 mg/kg/day

po div q8h
po div q8h

Apslenic prophylaxis
(up to 5 years of age)

20 mg/kg/day

po div q12h

N,I< 3 mo
(4:1 formulation)

30 mg
amoxicillin/kg/day

po div q12h

I>3 mo, C<40kg
(7:1 formulation)

25-45 mg
amoxicillin/kg/day
80-90 mg
amoxicillin/kg/day

po div q12h

amoxicillin clavulanate (Clavulin)
renal dose adjust
limit clavulanate dose 10 mg/kg/day
in children

po div q8-12h

dosing recommendations based
on 4:1 formulation for N, I< 3 mo
7:1 formulation for I>3mo, C
Tablets for C>40kg, A

C>40 kg, A

250-500 mg/dose
(as 500 mg tabs)

po q8h

amphotericin B lipsomal

I, C, A

3 mg/kg/day

IV div q24h

ampicillin

N
PNA < 7 days
<2 kg
meningitis

50 mg/kg/day
100 mg/kg/day

IV div q12h
IV div q12h

>2 kg
meningitis
Group B streptococcus

75 mg/kg/day
150 mg/kg/day
200 mg/kg/day

IV div q8h
IV div q8h
IV div q8h

N
PNA >7 days
<2 kg
meningitis

75 mg/kg/day
150 mg/kg/day

IV div q8h
IV div q8h

> 2 kg
meningitis
Group B streptococcus

100 mg/kg/day
200 mg/kg/day
300 mg/kg/day

IV div q6h
IV div q6h
IV div q6h

I,C
meningitis

100-200 mg/kg/day
200-400 mg/kg/day
(max. 12 g/day)

IV div q6h
IV div q6h

renal dose adjust

8

Children’s Hospital, London Health Sciences Centre

DRUG
atropine

AGE/COMMENTS

ROUTE
FREQUENCY

DOSE
0.02 mg/kg/dose

I, C, A

IV, IO

min dose 0.1 mg
max. single dose:
child 0.5 mg
adolescent 1 mg
max. total dose
child 1 mg
adolescent 2 mg

azithromycin

0.03 mg/kg

ETT

10 mg/kg/day

po div q24h x 5
days

Day 1

10 mg/kg/day
max. 500 mg

po, IV once

Day 2-5

5 mg/kg/day
250 mg

po, IV div q24h

I < 6 mo
Pertussis
C≥ 6 mo

Adolescents ≥ 16 years, A
Day 1
Day 2-5
baclofen

budesonide

max.

500 mg
250 mg

po, IV once
po, IV div q24h

10-15 mg/ day
titrate dose q3days in
increments of 5-15
mg/day
(max. 40 mg/day)

po div q8h

≥ 8 years

titrate as above (max.
60 mg/day)

po div q8h

A

5 mg/dose
may increase by 5
mg/dose q3 days
(max. 80 mg/day)

po q8h

Severe acute asthma
Maintenance

500-1000 mcg/dose
250-500 mcg/dose

Inh q12h
Inh q12h

Severe acute asthma
Maintenance

1000-2000 mcg/dose
500-1000 mcg/dose

Inh q12h
Inh q12h

10 mg caffeine
base/kg
2.5 mg caffeine
base/kg/day

IV, po

po div q6h

C 2-7 years
Initial dose

I,C
A

caffeine

N
Loading dose
Maintenance

calcium carbonate

N

50-150 mg elemental
Ca/kg/day

suspension provides 80 mg
elemental Ca/ml
2mmol elemental Ca/ml

C

45-65 mg elemental
Ca/kg/day

IV, po div q24h

po div q6h

9


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