Pediatric Dosage Calculations

Pediatric Dosage Calculations

Most drugs in children are dosed according to body weight (mg/kg) or body surface area (BSA) (mg/m2). Care must be taken to properly convert body weight from pounds to kilograms (1 kg= 2.2 lb) before calculating doses based on body weight. Doses are often expressed as mg/kg/day or mg/kg/dose, therefore orders written "mg/kg/d" which is confusing, require further clarification from the prescriber. Chemotherapeutic drugs are commonly dosed according to body surface area which requires an extra verification step (BSA calculation) prior to dosing. Medications are available in multiple concentrations, therefore orders written in "mL" rather than "mg" are not acceptable and require further clarification. Dosing also varies by indication, therefore diagnostic information is helpful when calculating doses. The following examples are typically encountered when dosing medication in children. Example 1. Calculate the dose of amoxicillin suspension in mLs for otitis media for a 1-yr-old child weighing 22 lb. The dose required is 40 mg/kg/day divided BID and the suspension comes in a concentration of 400 mg/5 mL. Step 1. Convert pounds to kg: Step 2. Calculate the dose in mg: 22 lb 1 kg/2.2 lb = 10 kg 10 kg 40 mg/kg/day = 400 mg/day

Step 3. Divide the dose by the frequency: 400 mg/day 2 (BID) = 200 mg/dose BID Step 4. Convert the mg dose to mL: 200 mg/dose 400 mg/5 mL = 2.5 mL BID

Example 2. Calculate the dose of ceftriaxone in mLs for meningitis for a 5-yr-old weighing 18 kg. The dose required is 100 mg/kg/day given IV once daily and the drug comes pre-diluted in a concentration of 40 mg/mL. Step 1. Calculate the dose in mg: 18 kg 100 mg/kg/day = 1800 mg/day

Step 2. Divide the dose by the frequency: 1800 mg/day 1 (daily) = 1800 mg/dose Step 3. Convert the mg dose to mL: 1800 mg/dose 40 mg/mL = 45 mL once daily

Example 3. Calculate the dose of vincristine in mLs for a 4-yr-old with leukemia weighing 37 lb and is 97 cm tall. The dose required in 2 mg/m2 and the drug comes in 1 mg/mL concentration. Step 1. Convert pounds to kg: 37 lb 1 kg/2.2 lb = 16.8 kg

Step 2. Calculate BSA (see Body Surface Area Nomograms): 16.8 kg 97 cm/3600 = 0.67 m2 Step 3. Calculate the dose in mg: Step 4. Calculate the dose in mL: 2 mg/m2 0.67 m2 = 1.34 mg 1.34 mg 1 mg/mL = 1.34 mg

Indication : disturbances of GI motility, nausea & vomiti ng of central & peri pheral origin associated w/ surgery,metabolic diseases, infectious & drug induced diseases, facilitate small bowel intubation & radiological proceduresof GIT Action : sti mul ates motility of upper GI tract, increases lower esophageal sphincter tone, and blocks dopaminereceptors at the chemoreceptor trigger zone Adverse Reactions : extrapyramidal reactions, drowsiness, fatigue & lassitude, anxiety, less frequently, insomnia,headache, dizziness, nausea, galactorrhea, gynecomastia, bowel disturbances. Nursing Measures : Monitor BP carefully during IV administration. Monitor for extrapyramidal reactions, and consult physician if they occur. Monitor diabeti c patients, arrange for alteration in insuli n dose or timing if diabeti c control is compromised byalterations in timing of food absorption. Keep diphenhydramine injection readily available in case extrapyramidal reactions occur (50 mg IM). H a v e ph e n t ol a m in e re a di l y a va il a bl e i n ca s e of h yp e rt e n s i ve cri si s (mo s t l i k e l y t o o c c u r wi t h u n d i a g n o s e d pheochromocytoma). 20) MIDAZOLAM HYDROCHLORIDEBrand name : Dormicum Classification : hypnotics & sedatives Dosage : 5mg/5mL Indication : tab: disturbances of sl eep rhythm, insomnia esp difficulty in falling asleep either initiall y or after p r e m a t u r e a wa k e n i n g , t a b / i n j : s e d a t i o n i n p r e m e d b e f o r e s u r g i c a l o r d i a g n o s t i c p r o c e d u r e s , i n d u c t i o n & maintenance of anesth. Action : may potentiate the effects of GABA, depress the CNS, and suppress the spread of seizure activity Adverse Reactions : rarely cardioresp adverse events, nausea, vomiting, headache, hiccoughs, laryngospasm,dyspnoea, hallucination, oversedation, drowsiness, ataxia, rash, paradoxical reactions, amnesic episodes. Nursing Measures : Do not administer intra-arterially, which may produce arteriospasm or gangrene. Do not use small veins (dorsum of hand or wrist) for IV injection. Administer IM injections deep into muscle. Monitor IV injection site for extravasation.

Arrange to reduce dose of midazolam if patient is also being given opioid analgesics; reduce dosage by at least50% and monitor patient closely. Monitor level of consciousness prior to, during, and for at least 26 hr after administration of midazolam. Carefully monitor P, BP, and respirations carefully during administration. Keep resuscitative facilities readily available; have flumazenil available as antidote if overdose should occur. Keep patients in bed for 3 hr; do not permit ambulatory patients to operate a vehicle following an injection. Arrange to monitor liver and kidney function and CBC at intervals during long-term therapy. Establish safety precautions if CNS changes occur (use side rails, accompany ambulating patient). Provide comfort measures and reassurance for patients receiving diazepam for tetanus. Arrange to taper dosage gradually after long-term therapy. Provide patient with written information regarding recovery and follow-up care. Midazolam is a potent amnesiacand memory may be altered. 21) MORPHINE SULFATEBrand name : Morin

Classification :Analgesics (Opioid) Dosage : Adult 5-20 mg IM/SC 4 hrly. Severe or chronic painChildn 10 mg IM/SC 4 hrly, range: 5-20 mg; 6-12 yr 5-10 mg, 1-5 yr 2.5-5 mg, 1-12 mth 200 mcg/kg, <1 mth 150 mcg/kg 4 hrly. Max: 15 mg. Analgesic effect Ped 100-200 mcg/kg SC 4 hrly, max: 15 mg/dose; or 50-100 mcg/kg slow IV. Pre-op 50-100 mcg/kg IM, max: 10 mg/dose. Indication : R e l i e f o f m o d e r a t e t o s e v e r e painnot responsiv e to non-narcotic analgesics. Premed. Analgesicadjunct in general anesth esp in pain associated w/ cancer, MI & surgery. Alleviatesanxietyassociated w/ severepain. Hypnotic for pain-related sleeplessness. Action : alters perception and emotional response to pain Adverse Reactions : Lightheadedness, dizziness, sedation, nausea, vomiting, constipation & sweating. Nursing Measures : Caution patient not to chew or crush controlled-release preparations. Dilute and administer slowly IV to minimize likelihood of adverse effects. Tell patient to lie down during IV administration.

 Keep opioid antagonist and facilities for assisted or controlled r e s p i r a t i o n r e a d i l y a v a i l a b l e d u r i n g I V administration. Use caution when inj ecti ng SC or IM into chilled areas or in patients with hypotension or in shock; impairedperfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation isrestored. Reassure patients that they are unlikely to become addicted; most patients who receive opioids for medicalreasons do not develop dependence syndromes. 22) NICARDIPINE HYDROCHLORIDEBrand name : Cardepine Classification :Calcium Antagonists Dosage : IV infusion Dilute to 10-20 mg/100 mL (conc of 1.01-0.02%). Initial infusion rate: 5 mg/hr; titrate dose upto 15 mg/hr until desired therapeutic response is achieved (DBP <95 mmHg, SBP <140 mmHg). Maintenancerate: Can be tapered down to 10 mg/hr. IV bolus inj 2-7 mg w/out dilution given over 1-2 min. Indication : Hypertensive emergencies or urgencies, peri-op & post-op HTN, hypertensive states of NPO patients. Action : a Calcium channel blocker that inhibits Calcium ion influx across cardiac and smooth muscle cells, alsodilates coronary arteries and arterioles Adverse Reactions : Peripheral edema, headache, tachycardia, palpitations, localized thro m b o p h l e b i t i s & hypotension. Nursing Measures : Patients with hepatic impairment should receive lower dose. Monitor blood pressure.Allow atleast 3 days between dosage adjustment to achieve steady plasma levels. Advise patient to report immediately if experiencing chest pain 23) NTG PATCHBrand name : Deponit, Minitran, Nitrek, Nitro-Dur, Nitrodisc, Transderm-Nitro Classification :Anti-Anginal Drugs Dosage : Starting dose: 0.2-0.4 mg/hr. Dosing schedule: Daily patch-on period of 12-14 hr & daily patch-off periodof 10-12 hr. Indication : Prevention of angina pectorisdue to coronary artery disease Action : a nitrate that reduces cardiac oxygen demand by decreasing left ventricular end diastolic pressure and toa lesser extent, systemic vascular resistance, also increases blood flow through collateral coronary vessels Adverse Reactions : Headache. Transient episodes of lightheadedness. Infrequently, hypotension. Syncope,crescendo angina, rebound HTN, allergic & anaphylactoid reactions. Rarely severe, application site irritation.

Nursing Measures : Administer transdermal systems to skin si te free of hair and not subject to much movement. Shave areas thathave a lot of hair. Do not apply to distal extremities. Change sites slightly to decrease the chance of local irritationand sensitization. Remove transdermal system before attempting defibrillation or cardioversion. To use transdermal systems, you may need to shave an area for application. Apply to a slightly different area eachday. Use care if changing brands; each system has a different concentration. 24) PARACETAMOLBrand name : Aeknil Classification :Analgesics (Non-Opioid) & Antipyretics Dosage : Adult & childn 10 yr 2-3 mL, 10 yr 1-2 mL. Depending on severi ty of case, dose may be repeated 4hrly. In severe cases, dose may be administered by IV very slowly Indication :Pyrexia of unknown origin.Fever &painassociated w/ common childhood disorders,tonsillitis, upper resp tract infections post-immunization reactions, after tonsill ectomy & other conditions. Prev ention of febrileconvulsion.Headache,cold,sinusitis,muscle pain,arthritis&toothacheAction: produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in CNS, relieves fever Adverse Reactions : Hematological, skin & other allergic reactions Nursing Measures : Use liquid form for children and patients who have difficulty swallowing. In children, dont exceed five doses in 24 hours. Advise patient that drug is only for short term use and to consult the physician if giving to children for longer than 5days or adults for longer than 10 days. Adv ise patient or caregiv er that many over the counter products contai n acetaminophen; be aware of thi s whencalculating total dailydose. Warn patient that high doses or unsupervised long term use can cause liver damage.