CPR PEDIATRIC DRUG DOSAGES
Medications for Neonatal Resuscitation
|
Medication
|
Dose
|
Remarks
|
Epinephrine
|
I.V.: 0.01-0.03 mg/kg
(0.1-0.3 mL/kg, 1:10,000)
|
I.V. is preferred neonatal route. While obtaining I.V. access, may consider higher doses via E.T.: Up to 0.1 mg/kg (1 mL/kg, 1:10,000), but safety and efficacy of this practice has not been evaluated.
|
Naloxone
|
I.V./I.M.: 0.1 mg/kg
|
E.T. route is not recommended (lack of clinical data in neonates). Avoid use in newborns whose mothers are suspected of long-term exposure to opioids. Monitor neonates closely for recurrent apnea or hypoventilation; additional doses of naloxone may be needed.
|
Adapted from American Heart Association Emergency Cardiovascular Care Committee, "2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC), Part 13: Neonatal Resuscitation Guidelines," Circulation , 2005, 112(24 Suppl):IV-192.
|
PALS Medications for Pediatric Resuscitation and Arrhythmias
|
Medication
|
Dose
|
Remarks
|
Adenosine
|
0.1 mg/kg
Maximum dose: 6 mg
Repeat: 0.2 mg/kg
Maximum dose: 12 mg
|
Monitor ECG
Rapid I.V./I.O. bolus
|
Amiodarone
|
I.V./I.O.: 5 mg/kg (maximum 300 mg/dose)
May repeat up to maximum total daily dose of 15 mg/kg (2.2 g/day in adolescents)
|
Monitor ECG and blood pressure
Adjust administration rate to urgency (give more slowly when perfusing rhythm present)
Use caution when administering with other drugs that prolong QT (consider expert consultation)
|
Atropine
|
I.V./I.O.: 0.02 mg/kg
E.T.1: 0.03 mg/kg
Repeat once if needed
Minimum dose: 0.1 mg
Maximum single dose:
Child: 0.5 mg
Adolescent: 1 mg
|
Higher doses may be used with organophosphate poisoning
|
Calcium chloride
(10%)
|
I.V./I.O.: 20 mg/kg (0.2 mL/kg)
|
Slowly
Adult dose: 5-10 mL
|
Epinephrine
|
I.V./I.O.: 0.01 mg/kg
(0.1 mL/kg, 1:10,000)
Maximum dose: 1 mg
E.T.1: 0.1 mg/kg
(0.1 mL/kg, 1:1000)
Maximum dose: 10 mg
|
May repeat every 3-5 minutes
|
Glucose
|
I.V./I.O.: 0.5-1 g/kg
|
D10W: 5-10 mL/kg
D25W: 2-4 mL/kg
D50W: 1-2 mL/kg
|
Lidocaine
|
Bolus I.V./ I.O: 1 mg/kg
Maximum dose: 100 mg
Infusion: 20-50 mcg/kg/min
E.T.1: 2-3 mg/kg
|
|
Magnesium sulfate
|
I.V./I.O.: 25-50 mg/kg over 10-20 minutes; faster in torsade de pointes
Maximum dose: 2 g
|
|
Naloxone
|
<5 y or ≤20 kg:
I.V./I.O./E.T.1: 0.1 mg/kg
≥5 y or > 20 kg:
I.V./I.O./E.T.1: 2 mg
|
Use lower doses to reverse respiratory depression associated with therapeutic opioid use (1-15 mcg/kg)
|
Procainamide
|
I.V./I.O.: 15 mg/kg over 30-60 minutes
Adult dose: I.V. infusion: 20 mg/min up to total maximum dose: 17 mg/kg
|
Monitor ECG and blood pressure
Use caution when administering with other drugs that prolong QT (consider expert consultation)
|
Sodium bicarbonate
|
I.V./I.O.: 1 mEq/kg/dose slowly
|
After adequate ventilation
|
I.V. = intravenous; I.O. = intraosseous; E.T. = endotracheal tube.
|
1Flush with 5 mL of normal saline and follow with 5 ventilations.
|
Adapted from American Heart Association Emergency Cardiovascular Care Committee, "2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC), Part 12: Pediatric Advanced Life Support," Circulation , 2005, 112(24 Suppl):IV-171 and Pediatric Advanced Life Support, Provider Manual , copyright American Heart Association, 2006.
|
PALS Medications to Maintain Cardiac Output and For Postresuscitation Stabilization
|
Medication
|
Dose Range
|
Comment
|
Inamrinone
|
I.V./I.O.: 0.75-1 mg/kg over 5 minutes; may repeat x 2; then 2-20 mcg/kg/min
|
Inodilator
|
Dobutamine
|
I.V./I.O.: 2-20 mcg/kg/min
|
Inotrope; vasodilator
|
Dopamine
|
I.V./I.O.: 2-20 mcg/kg/min
|
Inotrope; chronotrope; renal and splanchnic vasodilator in low doses; pressor in high doses
|
Epinephrine
|
I.V./I.O.: 0.1-1 mcg/kg/min
|
Inotrope; chronotrope; vasodilator in low doses; pressor in higher doses
|
Milrinone
|
I.V./I.O.: 50-75 mcg/kg over 10-60 minutes, then 0.5-0.75 mcg/kg/min
|
Inodilator
|
Norepinephrine
|
0.1-2 mcg/kg/min
|
Inotrope; vasopressor
|
Sodium nitroprusside
|
1-8 mcg/kg/min
|
Vasodilator; prepare only in D5W
|
I.V. = intravenous; I.O. = intraosseous.
|
Alternative formula for calculating an infusion:
|
Infusion rate (mL/h) = [weight (kg) x dose (mcg/kg/min) x 60 (min/h)] / concentration mcg/mL).
|
Adapted from American Heart Association Emergency Cardiovascular Care Committee, "2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC), Circulation , 2005, 112(24 Suppl):IV-180.
|
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