PEDIATRIC EMERGENCY DRUG DOSES

Estimated weight: 2 x (AGE in yrs + 4)

DRUGS DILUTION DOSE MAX DOSE COMMON SIDE EFFECTS /

CAUTIONS
(Adult ≥ 40kg)

Adenosine (6mg/2ml) Neat. Rapid IV bolus 1st dose: 0.1mg/kg 6mg Atrial fibrillation/flutter,
hypotension, proarrythmic
May repeat after 2min 2nd dose: 0.2mg/kg 12mg
effects (polymorphic
ventricular tachycardia),

seizures, etc.

Adrenaline (1mg/ml, Neat for ETT (1mg = 1ml) 0.1ml/kg (ETT) 2.5mg Cardiac effects (angina
1:1000) pectoris or cardiac
Neat for IM 0.01ml/kg (IM) 0.5mg
arrythmias), pulmonary
Dilute 1ml to final volume 10ml 0.1ml/kg (IV, IO) 1mg oedema, and renal effects
WFI/NS for IV (1mg/10ml) (decreased urine output), etc.
(0.1mg/ml)

Amiodarone (150mg/3ml) Pulseless VT/VF: Neat. Rapid IV push 5mg/kg 300mg Optic neuropathy and/or optic
neuritis, photosensitivity, etc.
VT with Pulse: Dilute 3ml (150mg) to
final volume 25ml D5% (6mg/ml).
Infuse over at least 20 mins

Atropine (0.6mg/ml) Dilute 1ml (0.6mg) to final volume 0.02mg/kg 0.6mg Tachycardia, arrhythmia,
6ml NS (1ml = 100 mcg) mydriasis, fever, dry mouth,
(Max total dose 3mg)
ataxia, etc.

Calcium gluconate 10% Slow IV bolus 0.5ml/kg 20ml GI effects such as

(10ml) constipation, bloating and gas,
etc.
(0.22mmol/ml Ca)
 PEDIATRIC EMERGENCY DRUG DOSES

Dextrose 10% (500ml) 0.5g/kg = 5ml/kg 5ml/kg 250ml Hyperosmolarity, oedema,

venous thrombosis,
Dextrose 50% (20ml) Dilute to 25% with WFI 2ml/kg of D25% 100 ml
tachypnea, fever, etc.

Diazepam-Rectal 5mg/tube Not for less than 2 years old < 10kg 2.5mg 10mg Euphoria, incoordination,
rash, diarrhea, etc.
≥ 10kg 5mg

Diazepam (10mg/2ml) Neat. Rate 1-2mg/min. 0.25mg/kg 10mg Maybe painful via IV
administration and may cause
(Not for infants < 6 months old)
lactic acidosis.

Flumazenil (0.5mg/5ml) Give over 15s. Can repeat dose 5mcg/kg 200mcg May cause seizures and
(titrate to effect) at 1 min interval. become refractory to
benzodiazepines. May cause
Max total dose 1mg or 0.05mg/kg
arrhythmias, tachycardia,
(whichever is lower)
↑BP, and unmask effects of
TCA overdose.

Frusemide (20mg/2ml) 0.5-1mg/kg 40mg Hyperuricemia, hypokalemia,

hypotension, etc.

Hydrocortisone (100mg) Reconstitute 100mg in 2ml WFI 5mg/kg 100mg Adrenal suppression,
(50mg/ml) arthralgia, bladder
dysfunction, cardiomegaly,
Physiological stress dose 1mg/kg
1mg/kg “stress dose” hyperglycemia, etc.

Lignocaine 1% (10mg/ml) 1mg/kg IV (0.1ml/kg 100mg Hypotension, skin irritation,

of 1%) (3mg/kg) nausea & vomiting, confusion,
etc.
2mg/kg ETT (Min vol
1ml, dilute with NS)

Magnesium Sulphate 25-50mg/kg IV 2 grams Circulatory collapse,

(MgSO4) respiratory paralysis,
 PEDIATRIC EMERGENCY DRUG DOSES

(Torsades de pointes) hypothermia, pulmonary

oedema, hypotension, etc.

Midazolam (5mg/ml) Dilute 1ml to final volume 5ml NS 0.1 – 0.3 mg/kg 5mg Respiratory and CVS
(1mg/ml) depression, hallucinations,
confusion. Avoid abrupt
withdrawal. Caution in
hepatic/renal dysfunction.

Naloxone (0.4mg/ml) Respiratory arrest (acute opioid 0.1mg/kg IV, OR 2mg Pulmonary edema, arrhythmia
overdose) may occur. Acute withdrawal
< 20kg: 0.1mg/kg
syndrome may occur if patient
Neat. Titrate to effect.
≥ 20kg: 2mg via given large doses of opioid or
IV/IM/SQ opioid dependent.

Via ETT 2 times IV

dose (Min vol 1ml,
dilute with NS)

Propranolol (1mg/ml) Infuse over 20min. Rate < 1mg/min 0.1 mg/kg 3mg Aggravated congestive heart
failure, bradycardia,
hypotension, etc.

Salbultamol inhaler Repeat as clinically indicated 0.3 puffs/kg 10 puffs Tremor, nervousness in
(100mcg/puff) children aged 2-6 years,
nausea, fever, bronchospasm,
vomiting, dizziness, etc.

Sodium bicarbonate 8.4% Neat (1mmol/ml) in CENTRAL vein. 1mmol/kg 1mmol/kg Cerebral hemorrhage,
oedema, hypernatremia,
Dilute (WFI) to 4.2% (0.5mmol/ml)
hypocalcemia, hypokalemia,
PERIPHERAL vein
1mmol/kg 1mmol/kg metabolic alkalosis, etc.

Sodium chloride 0.9% Fluid bolus for volume resuscitation 10-20ml/kg 20ml/kg Not applicable
(500ml)
 PEDIATRIC EMERGENCY DRUG DOSES

Avoid LR if on ketogenic diet

Sodium chloride 3% Infuse over 20-30 min. Preferably 2-4ml/kg 4ml/kg

(500ml) CENTRAL vein; PERIPHERAL in
emergencies

Succinylcholine Dilute 2ml (100mg) to a final volume 1-2mg/kg 2mg/kg Apnea, jaw rigidity,
(100mg/2ml) 10ml NS (10mg/ml) respiratory depression, sinus
tachycardia, bradycardia,
hypotension, cardiac
arrythmias, increased IOP, etc.

Synchronized cardioversion 1st dose 0.5 – 1 J/kg

2nd dose 2J/kg

Defibrillation 1st shock 2J/kg

Subsequent shock 4-10J/kg

 PEDIATRIC EMERGENCY DRUG DOSES

Infant paddles < 1 year or < 10kg

Shockable rhythms (VF/pulseless VT)

 PEDIATRIC EMERGENCY DRUG DOSES

CPR

Legends:

CPR 1-2mins, then assess if rhythm shockable

4J/kg each, Max 10 J/kg

Adrenaline every 3-5mins ie alternate shock, AFTER 2 nd shock

Amiodarone every alternate shock, AFTER 3 rd shock (max 3 doses)

Or Lignocaine 1mg/kg (max 100mg) followed by infusion 20-50mcg/kg/min

Consider other antiarrhythmics there after (lignocaine if not given prior, MgSO4 for torsades)
 PEDIATRIC EMERGENCY DRUG DOSES

Intubation Medications

Premedication DOSE AND DILUTION COMMON SIDE EFFECTS / CAUTIONS

(1 or more as indicated)

Atropine 0.02mg/kg IV (max 1mg) Tachycardia, arrhythmia, mydriasis, fever,

dry mouth, ataxia, etc.
(Consider for < 5yrs or with subsequent doses
succinylcholine)

Fentanyl 1mcg/kg IV (consider 2-5mcg/kg/dose if no shock or Respiratory depression, moderate

other sedative – risk of chest wall rigidity, push slowly) bradycardia, rapid bolus can cause ‘rigid
chest syndrome’. Caution in liver
impairment.

Lignocaine 1mg/kg IV (for ICP concerns) Hypotension, skin irritation, nausea &
vomiting, confusion, etc.

Sedation/ Induction (Choose ONE)

Ketamine 2mg/kg IV (3-7mg/kg IM) (pts. with asthma/septic Dissociative hallucinations. Sialagogue,
shock) requires anticholinergic agent. Causes
transient horizontal nystagmus.

Caution in epilepsy patients (proconvulsant

and anticonvulsant properties).
Contraindicated in hypertensive patients.

Midazolam 0.1mg/kg IV/IM (max 5mg IV or 10mg IM) Respiratory and CVS depression,
hallucinations, confusion. Avoid abrupt
 PEDIATRIC EMERGENCY DRUG DOSES

withdrawal. Caution in liver and renal

dysfunction.

Propofol 2mg/kg IV Significant hypotension in dehydrated

patients; myoclonic movements at low
doses; no analgesic properties.

Muscle Relaxant (Choose ONE)

Succinylcholine 1-2mg/kg IV (onset ~1min, duration ~ 5min) (max Contraindicated in hyperkalemia, family or
150mg) personal hx of malignant hyperthermia,
trauma (causes rhabdomyolysis), burns (safe
in first 24 hours), ↑ICP, ↑intraocular
pressure, significant acidosis.

Rocuronium 1mg/kg IV (onset ~1min, duration < 1yr ~ 40min, > 1yr Myopathy, pain over injection site.
~ 30min)
Caution in liver and renal impairment
(effects might be prolonged).

Reversal Agents (Choose ONE)

Naloxone < 20kg: 0.1mg/kg IV/IM/SQ Pulmonary edema, arrhythmia may occur.
Acute withdrawal syndrome may occur if
≥ 20kg: 2mg IV/IM/SQ
patient given large doses of opioid or opioid
Via ETT 2 times IV dose (min vol 1ml-dilute with NS) dependent.

Flumazenil 0.01mg/kg IV (max individual dose 0.2mg, 1 mg total) May cause seizures and become refractory
to benzodiazepines. May cause arrhythmias,
tachycardia, ↑BP, and unmask effects of
TCA overdose. Caution in liver failure.

Airway Medications
 PEDIATRIC EMERGENCY DRUG DOSES

DRUGS DOSE AND DILUTION COMMON SIDE EFFECTS /

CAUTIONS

Salbutamol <1 yr 4 puffs MDI or 2.5 mg nebulized Tremor, nervousness in children

inhalation aged 2-6 years, nausea, fever,
< 6yr
bronchospasm, vomiting, dizziness,
6 puffs MDI or 2.5 mg nebulized
≥ 6yr etc. Insomnia has been reportted in
inhalation
children aged 6-12 years in higher
10 puffs MDI or 5 mg nebulized doses.
inhalation or 20mg/hour continuous
nebulized inhalation

Dexamethasone 0.6mg/kg IV/IM/PO (max 16mg) Bradycardia, cardiac arrest, cardiac

arrythmias, hyperglycemia, acne,
allergic dermatitis, hirsutism, etc.
May elevation in serum liver
enzymes level (usually reversible).

Ipratopium (Atrovent) < 6yr 4 puffs MDI or 0.25 mg nebulized Bronchitis, chronic obstructive
inhalation pulmonary disease, sinusitis,
≥ 6yr
dyspnea, urinary tract infection,
8 puffs MDI or 0.5 mg nebulized
headache, flulike symptoms, dry
inhalation
mouth, dizziness, dyspepsia, etc.

Methylprednisolone 1-2mg/kg IV (max 60mg) Acne, adrenal suppression, delayed

wound healing, oedema, fluid
Prednisolone 1-2mg/kg PO (< 2yr max 20mg; 2-5yrs max retention, hyperglycemia or
30mg) (up to 40mg) glucose intolerance, GI perforation,
increased transaminases, etc.

Adrenaline (for anaphylaxis) 0.01mg/kg IM (1:1000; 0.01ml/kg) (max 0.3mg) Cardiac effects (angina pectoris or
cardiac arrythmias), pulmonary
oedema, and renal effects
 PEDIATRIC EMERGENCY DRUG DOSES

(decreased urine output), etc.

MgSO4 (for asthma) 25-75mg/kg IV (max 2 grams) Circulatory collapse, respiratory

paralysis, hypothermia, pulmonary
oedema, hypotension, etc.

Terbutaline 6-10mcg/kg IV (load over 10min) Nervousness, restlessness,

transient hyperglycemia, transient
0.1-5mcg/kg/min IV infusion
hypokalemia, trembling,
tachycardia, hypertension, etc.

Drug Infusions

DRUGS DOSE AND DILUTION COMMON SIDE EFFECTS /

CAUTIONS

Dobutamine 2-20 mcg/kg/min IV

Dopamine 2-20 mcg/kg/min IV (CENTRAL line preferred)

Adrenaline 0.01-2 mcg/kg/min IV (CENTRAL line preferred)

Noradrenaline 0.01-2 mcg/kg/min IV (CENTRAL line preferred)

Milrinone 0.25-1 mcg/kg/min IV

Insulin (Regular) 0.05-0.1 unit/kg/hour IV

(for neonates start at 0.01 units/kg/hour)

Lignocaine 1mg/kg IV (initial bolus)

20-50 mcg/kg/min IV

Vasopressin 0.5 units/kg (initial bolus) (CENTRAL line preferred)

 PEDIATRIC EMERGENCY DRUG DOSES

Hypotension 10-200 milliunits/kg/h IV

GI Bleed 120-300 milliunits/kg/h IV

DI 0.5-10 milliunits/kg/h IV

Seizures Medications

DRUGS DOSE AND DILUTION COMMON SIDE EFFECTS /

CAUTIONS

Diazepam 0.1-0.2mg/kg IV (Not for infants < 6 months old) Euphoria, incoordination, rash,
diarrhea, etc. Maybe painful via IV
0.2-0.5mg/kg PR (round to 2.5mg increments PR; max 20mg/dose)
administration and may cause lactic
acidosis.

Midazolam 0.2mg/kg intranasal (max 10mg, administer intranasal preparation Respiratory and CVS depression,
only, ½ to each nostril) hallucinations, confusion.

0.2mg/kg IM (max 10mg) Avoid abrupt withdrawal.

Caution in hepatic/renal
dysfunction.

Phenobarbitone 15-20mg/kg IV (max rate: if <60kg 30mg/min,

if ≥60kg 50mg/min)

Phenytoin 15-20mg/kg IV (<1mg/kg/min in NS)

Hypertonic saline 3% 2ml/kg IV (max 20ml/min)

(for hyponatremic seizures)

Analgesics
 PEDIATRIC EMERGENCY DRUG DOSES

DRUGS DOSE AND DILUTION COMMON SIDE EFFECTS /

CAUTIONS

Fentanyl 1-2mcg/kg IV (max 100mcg)

Ketorolac 0.5mg/kg IV/IM (max 30mg)

Morphine 0.05-0.1mg/kg IV (max 4mg)

Oxycodone 0.05-0.15mg/kg PO (max 10mg)

Sedatives:

DRUGS DOSE AND DILUTION COMMON SIDE EFFECTS / CAUTIONS

Midazolam 0.05-0.1 mg/kg IV (max 5mg)

0.2mg/kg nasal (max 10mg)

0.5mg/kg PO (max 15mg)

Other Medications

DRUGS DOSE AND DILUTION COMMON SIDE EFFECTS /

COMMENTS

Charcoal 1g/kg PO/NG

Diphenhydramine 1mg/kg IV/IM/PO

Frusemide 1-2mg/kg IV/IM (max 80mg)

Hydralazine 0.1-0.2mg/kg IV (max 20mg)

 PEDIATRIC EMERGENCY DRUG DOSES

Hydrocortisone

Adrenal crisis 2mg/kg IV bolus (max 100mg)

Stress dose 1mg/kg IV/IM (max 50mg)

Hypertonic Saline 3% 2ml/kg IV (rate ≤ 20ml/min) - for increased ICP

Insulin (Regular) < 5yrs:

DKA 0.05 units/kg/h IV

Insulin (Regular) ≥ 5yrs:

DKA 0.1 units/kg/h IV

Hyperkalemia 0.2 units/kg IV

(Administer with Dextrose 1g/kg)

Mannitol 0.5-1 g/kg IV

Methylprednisolone

Status asthmaticus 2mg/kg IV (max 60mg)

Spinal cord injury 30mg/kg IV over 15mins then 5.4mg/kg/hour for 23-48 hours

References:

1. British National Formulary (BNF) for Children (2020 – 2021)

2. Frank Shann 2021, Drug Doses 18th edition

3. Lexicomp/UpToDate

4. GINA 2021 Main Report - Global Initiative for Asthma

 PEDIATRIC EMERGENCY DRUG DOSES

Normal BP Estimates

70 + (2x age in years) ~5th percentile sBP

90 + (2x age in years) ~50th percentile sBP

2/3 sBP ~ dBP

Lowest acceptable mean BP in neonates (5 th percentile) ~ gestational age in weeks

Resuscitation Equipment

Age Approx Wt Laryngoscope Uncuffed ETT Cuffed ETT ETT Suction NG/OGT (Fr) CVL(Fr) Chest Tube
(kg) size Tube (4+age Tube (3.5+age Catheter (Fr) (Fr)
in yrs/4) in yrs/4)
(~4xETT size)

Premature <3 0.0 2.5-3 NA 5 5 UVC 3.5-5 8

Full term 4 0-1 3.5 3.0 6-8 6 UVC 5 10-12

6mo 8 1 4.0 3.5 8 8 3-4 10-14

1year 10 1 4.0 3.5 8 8-10 3-4 16-20

2years 12 1-1.5 4.5 4.0 8 10 4 16-20

5years 20 2 5.0 4.5 10 12-14 4 24-32

10years 30 2-3 6.5 6.0 12 14-18 4-5 28-32

12years 40 3 7.0 6.5 14 18 5+ 32-40

16years 60 3 8.0 7.5 14 18 5+ 32-40

 PEDIATRIC EMERGENCY DRUG DOSES

Prepared by: Verified by: Endorsed by:

Dr Lee Siew Wah Adilah Mohd Fazli Dr Ang Ee Lee

Pediatric Intensivist Pharmacist Head of Pediatric Dept, HTAR

*ALL INFORMATION PROVIDED IS ONLY FOR INTERNAL USE OF PEDIATRIC DEPARTMENT, HTAR.