EM Pediatric Medications

Listed below are the most common medications used in the pediatric emergency department along with doses.

Common Medication	Dose
Acetaminophen	10 - 15 mg/kg/dose PO/PR q4h prn (4g/day or 90 mg/kg/day whichever is less)
Activated Charcoal	1 g/kg up to 60 grams PO/NG
Adenosine	0.1 mg/kg rapid IV/IO (max 6 mg/initial dose) 0.2 mg/kg for 2nd dose (max 12 mg/dose)
Albuterol	0.5% inhalation solution 0.25mL (<10kg) INH 0.5% inhalation solution 0.5 mL (10-30kg) INH 0.5% inhalation solution 1 mL (>30kg) INH
Alprostadil (prostaglandin E1)	0.05 - 0.1 mCg/kg/min IV titrate to response
Amiodarone	VF/VT arrest: 5 mg/kg IV/IO rapid push (max 300 mg/dose) Dysrhythmia (unstable): 5 mg/kg IV/IO (max 300 mg/dose) over 20 - 60 minutes
Amoxicillin	80 mg/kg/day/q8h PO (max 3 g/day)
Amoxicillin/Clavulanic Acid	Augmentin: 20 - 40 mg/kg/day/q8h PO Augmenting ES-600: 90 mg/kg/day/q8-12h PO
Ampicillin	200 - 400 mg/kg/day/q6h IV (max 12 g/day)
Ampicillin/Sulbactam	Unasyn: 200 mg/kg/day/q6h IV (max 8 g/day)
Azithromycin	Otitis Media: 30 mg/kg (max 1500 mg/dose) PO x 1 GABHS Pharyngitis: 12 mg/kg/day/QD x 5 d CAP: 10 mg/kg x1 (max 500mg/dose) then 5 mg/kg (max 250mg/day) IV/PO x 4 days
Bactrim	8 - 20 mg TMP/kg/day/q6 -12h IV/PO
Calcium Chloride	10% (100 mg/mL): must dilute 0.2 mL/kg = 20 mg/kg central IV (max 2000 mg) slowly
Calcium Gluconate	10% (100 mg/mL): 1 mL/kg = 100 mg/kg IV (max 3000 mg/dose), dilute further
Cefazolin	50 - 150 mg/kg/day/q8h IV (max 12 g/day)
Cefepime	150 - 200 mg/kg/day/q8h IV (max 6 g/day)
Cefotaxime	150 - 300 mg/kg/day/q6 - 8h IV (max 12 g/day)
Cefoxitin	80 - 160 mg/kg/day/q6 - 8h IV (max 12 g/day)
Ceftazidime	150 mg/kg/day/q8h IV (max 6 g/day)
Ceftriaxone	50 - 100 mg/kg/day/q12 - 24h IV/IM (max 4 g/day)
Cephalexin	25 - 100 mg/kg/day/QID PO (max 4 g/day)
Cetirizine	2 - 5 year: 2.5 - 5 mg/day/QD - BID >6 year: 5 - 10 mg/day/QD - BID
Ciprofloxacin	20 - 30 mg/kg/day/q12h IV (max 800 mg/day)
Clindamycin	25 - 40 mg/kg/day/q8h IV (max 4.8 g/day) 10 - 30 mg/kg/day/q8h PO (max 1.8 g/day)
Codeine	0.5 - 1 mg/kg/dose PO q3 - 4h prn
Dexamethasone	Croup: 0.6 mg/kg/dose IM/PO x 1 (max 10 mg/dose) Inflammation: 0.5 - 2 mg/kg/day q6 - 8 h IV/PO Asthma: 0.4 mg/kg IV x 1, then 0.1 mg/kg/dose IV q6-12h
Dextrose	0.5 - 1 g/kg IV/IO (D25W 2 - 4 mL/kg, D10W 5 - 10 mL/kg)
Diazepam	Rectal Gel: <5 year - 0.5 mg/kg/dose PR q2h prn 6 - 11 year: 0.3 mg/kg/dose PR q2h prn >11 year: 0.2 mg/kg/dose PR q2h prn
Diazepam	IV: 0.05 - 0.2 mg/kg/dose IV q2 - 4h prn (max 10 mg/dose) PO: 0.1 - 0.8 mg/kg/day/q6-8h PO (max 10 mg/dose)
Diphenhydramine	1 mg/kg/dose IV/PO q6h prn (max 50 mg/dose)
Dobutamine	2.5 - 20 mCg/kg/min IV
Dopamine	2.5 - 20 mCg/kg/min IV
Enoxaparin	DVT/PE: <2 mo = 1.5 mg/kg/dose SC q12h >2 mo = 1 mg/kg/dose SC q12h
Epinephrine	IM: (1:1,000) 0.01 mg/kg/dose IM (0.01 mL/kg/dose) (max 0.5 mL/dose IM)
Erythromycin	IV: 15 - 50 mg/kg/dayq6h IV (max 4 g/day) PO: 30 - 50 mg/kg/day/q6h PO (max 3.2 g/day EES)
Esmolol	500 mCg/kg IV x 1 over 1 min, then 50 mCg/kg/min CI. If no response in 4 minutes, repeat 500 mCg/kg IV x1 over 1 min, then 100 mCg/kg/min (max 200 mCg/kg/min)
Fentanyl	1 - 2 mCg/kg/dose IV q1h prn (usual adult 100 mCg/dose)
Fluconazole	3 - 12 mg/kg/day/QD IV/PO (max 800 mg/day)
Fosphenytoin	20 mg PE/kg IV load (run at 3 mg PE/kg/min, max 150 mg PE/min), then 5 - 8 mg PE/kg/day/q12h IV/IM
Furosemide	1 mg/kg/dose IV/PO q6h
Glucagon	< 20kg: 0.5 mg IM/SC/IV > 20 kg: 1 mg IM/SC/IV
Haloperidol	0.025 - 0.075 mg/kg/dose (max 10 mg/dose) IV q6h
Heparin	75 units/kg IV x 1, then continuous infusion as follows: <1 yo = 28 units/kg/hr IV >1 yo = 20 units/kg/hr IV
Hydralazine	0.1 - 0.5 mg/kg/dose IV q4 - 6h (adult 20 mg/dose)
Ibuprofen	10 mg/kg/dose PO q6h prn
Insulin (Regular)	0.1 units/kg IV/SC x 1, CI 0.1 units/kg/hr IV
Ipratropium (Atrovent)	<10 kg: 0.25 mg INH q4 - 6h >10 kg: 0.5 mg INH q4 - 6h
Kayexalate	PO: 1 g/kg/dose (max 15 g/dose) PO q6h PR: 1 g/kg/dose (max 50 g/dose) PR q2- 6h
Ketorolac (Toradol)	8 - 12.5 kg = 4 mg IV q6h x 24 - 72h 12.5 - 25 kg = 7.5 mg IV q6h x 24 - 72h >25 - 50 kg = 15 mg IV q6h x 24 - 72h >50 kg = 30 mg IV q6h x 24 - 72h
Labetalol	0.25 - 1 mg/kg/dose IV q 4-6h (max 20 mg/dose) Continuous Infusion = 0.25 - 1 mg/kg/hr
Lorazepam (Ativan)	0.05 - 0.1 mg/kg/dose IV/PO q4 - 8h prn (max 4 mg/dose) Continuous Infusion = 0.05 - 0.1 mg/kg/hr IV
Magnesium Sulfate	Asthma: 40 mg/kg IV slow over 20 min (max 2g/dose)
Mannitol	0.5 - 1 g/kg/dose IV over 20 min for increased ICP/cerebral edema, then 0.25 - 1 g/kg/dose IV q4 - 6h
Methylprednisolone	Asthma: 2 mg/kg x 1, then 1 mg/kg/dose IV q12h SCI: 30 mg/kg load IV x 1 over 15 min then 45 minutes later start 5.4 mg/kg/hour Conversion: methylprednisolone 5 mg = dexamthasone 1mg
Metoclopramide	0.1 - 0.2 mg/kg/dose IV/PO q6h prn (max 10 mg/dose)
Metronidazole	30 mg/kg/day/q6h IV/PO (max 4 g/day)
Midazolam (Versed)	IV/IM: 0.05 - 0.1 mg/kg/dose IV/IM q1 - 2h prn CI: 0.05 - 0.1 mg/kg/hr IV
Milrinone	50 mCg/kg IV x 1, then 0.25 - 1 mCg/kg/min IV
Morphine	<6 months: 0.05 mg/kg/dose IV q2-4h prn >6 months: 0.05 - 0.1 mg/kg/dose IV q2h prn
N-acetylcysteine	PO: 140 mg/kg PO x 1 then 70 mg/kg PO q4h x 17 doses IV: 140 mg/kg IV over 45 min then 70 mg/kg IV q4h x 12 doses
Nifedipine	0.25 - 0.5 mg/kg/dose/q6h PO (Max 10 mg/dose)
Nitroglycerin	0.5 - 5 mCg/kg/min IV
Nitroprusside	0.5 - 10 mCg/kg/min IV
Norepinephrine	0.05 - 1 mCg/kg/min IV
Octreotide	1 - 2 mCg/kg/hr IV (max 50 mCg/hr)
Omeprazole	1 mg/kg/QD PO
Penicillin G (aqueous)	100K - 400K units/kg/day/q4 - 6h IV (max 24 mill units/day)
Penicillin G Benzathine	50K units/kg IM x 1 (max 1.2 million units/dose)
Penicillin VK	25 - 50 mg/kg/day/q6 - 8h PO (max 2 g/day)
Phenobarbital	20 mg/kg IV load, then 5 mg/kg/day/q12 - 24h IV/PO
Phenylephrine	0.1 - 0.5 mCg/kg/min IV
Phytonadione (Vitamin K₁)	1 - 5 mg/dose SC/IV q24h x 3 days
Piperacillin/Tazobactam	Zosyn - 300 mg/kg/day/q6h IV (max 18 g/day)
Prednisone	Asthma: 2 mg/kg PO x 1 (max 80 mg/dose), then 2 mg/kg/day/q12h PO
Racemic Epinephrine	2.25%: 0.25 mL (<5 kg), 0.5 mL (>5 kg) INH q1h prn
Terbutaline	10 mCg/kg IV/SC x 1
Vancomycin	40 - 60 mg/kg/day/q6-8h IV

Procedural Sedation	Dose
Fentanyl	1 - 2 mcg/kg/dose IV x 1 (max 100 mCg/dose) Repeat does 1 mCg/kg/dose (max 50 mCg/dose) q3 min
Ketamine	1 - 2 mg/kg/dose IV x 1 (max 100 mg/dose) Repeat dose 0.5 mg/kg/dose IV (max 50 mg/dose) q2-5min Max 5 mg/kg or 500 mg
Midazolam	IV: 0.05 - 0.1 mg/kg/dose IV x 1 (max 2 mg/dose) Repeat q3 min at 0.05 mg/kg (total max 0.3 mg/kg or 10mg, whichever is less)
Pentobarbital	1 - 2 mg/kg/dose (max 100 mg/dose) IV q 5 min Total Max 6 mg/kg or 300 mg, whichever is less

Reversal Agents	Dose
Naloxone	Opioids: 0.1 mg/kg/dose IV/IM (max 2 mg/dose)
Flumazenil	Benzodiazepines: 0.01 mg/kg/dose IV (max 0.2 mg/dose)

Sexual Assault	Dose
Ceftriaxone	125 mg IM x 1
Azithromycin	1 gm PO x 1
Plan B	1.5 mg (2 tabs) PO x 1

PALS	Medication	Dose
Bradycardia	Epinephrine	IV: (1:10,000): 0.1 mL/kg (0.01 mg/kg) IV/IO q3min Consider high-dose (1:1,000) 0.1 mL/kg (0.1mg/kg) ET: (1:1,000): 0.1 mL/kg (0.1 mg/kg) ET q 3min
	Atropine	0.02 mg/kg/dose IV/IO (min 0.1 mg/dose, max 1 mg/dose); repeat x 1 prn ET dose 2 - 10 x IV dose
VF/Pulseless VT	Epinephrine	(see above)
	Lidocaine	1 mg/kg IV/IO x 1, infusion 20 - 50 mCg/kg/min IV/IO
	Amiodarone	VF/VT arrest: 5 mg/kg IV/IO (max 300 mg/dose) Dysrhythmia (unstable): 5 mg/kg IV/IO over 20 - 60 min
PEA/Asystole	Epinephrine	(see above)
PSVT	Adenosine	0.1 mg/kg rapid IV/IO (max 6 mg/initial dose) If not effective repeat 0.2 mg/kg IV/IO (max 12 mg/dose)

RSI	Medication	Dose
Premedication	Atropine	(<7 years): 0.02 mg/kg/dose IV (min 0.1 mg/dose, max 1 mg/dose); repeat x 1 prn
	Lidocaine	1 mg/kg IV x1
Sedatives	Etomidate	0.3 mg/kg/dose IV
	Ketamine	IV: 0.5 - 2 mg/kg/dose IV IM: 3 - 7 mg/kg/dose IM
	Lorazepam	0.1 mg/kg/dose IV (max 4 mg/dose)
	Midazolam	0.1 mg/kg/dose IV (max 2 mg/dose)
	Thiopental	4 - 6 mg/kg/dose IV
Paralytics	Rocuronium	0.6 - 1.2 mg/kg/dose IV
	Succinylcholine	IV: 1 - 2 mg/kg/dose IV IM: 3 - 4 mg/kg/dose IM (max 150 mg/dose) (Premed with atropine < 7 y)

Blood Products	Dose
Albumin (5%)	10 mL/kg = 0.5 g/kg
Cryoprecipitate	1 unit/10kg
Factor VIII	15 - 50 units/kg
FFP	10 - 15 mL/kg
Packed Red Cells	10 mL/kg will raise Hct approx 10%
Platelets	1 unit/10kg