Pediatric Dosage

Pediatric DosagePediatric Dosage小兒科藥物劑量小兒科藥物劑量

三軍總醫院小兒部Instructor:R2 王聖儒

Fluid supplementFluid supplement• 0～ 10Kg (4 MD/kg)： 100ml/kg/day

• 10～ 20kg(2 MD/kg)： 1000㏄＋ ( BW－ 10 ) ×50㏄ /day

• ＞ 20kg (1 MD/kg)： 1500㏄＋ ( BW－ 20 ) ×20㏄ /day

•Example 1:

BW=25 kg,Keep IV route with 0.33%G/S ______MD/min

•Ans: (10 ×4) + (10 ×2) + (5 ×1) = 65 MD/min

•Example 2:

BW=30 kg,Keep IV route with 0.33%G/S ______MD/min

______c.c. qd

•Ans: (10 ×4) + (10 ×2) + (10 ×1) = 70 MD/min

(10 ×100) + (10 ×50) + (10 ×20) = 1700 c.c./day

Management of DehydrationManagement of Dehydration

Access fluid deficit:Access fluid deficit:• < 5%(mild): Consolable, Dry tongue, Mild loss

of skin turgor• 5% -10%(moderate): Irritable, Reduced urine

output, Deep set eyes, Tachypnea, Marked loss of skin turgor

• > 10%(severe): Lethargy or Coma, Sunken anterior frontanelle and eyes, Cold extremities, Weak or impalpable pulse, Hypotension


• Rehydration: First 8 hr Later 16 hr Deficit 1/2 1/2 Maintenance 1/3 2/3 • e.g.: 10kg, 10% loss, 3 days ≧ • Deficit : 10% x 10 (kg) x 0.6(deficit% from ECF ) X 1000

= 600 ml• Maintenance: 10 x 100 = 1000 ml First 8 hr later 16 hr Deficit 300ml 300ml Maintenance 333ml 660ml


• ShockShock:

• 20ml/kg N/S or Lactate Ringers

• or 10ml/kg 5% albumin, blood, plasma

• Loading speed: 10ml/kg/hr, ( 2ml/kg/hr in CHF )

Electrolyte supplementElectrolyte supplement

• Na ： 3 ～ 4 mEq/kg/day– 3%NaCl 1ml = 0.5 mEq – 0.9% NaCl 500ml = 77mEq

• K ： 2 ～ 3 mEq/kg/day– 15%KCl 1ml ＝ 2 mEq

• Ca ： 200~1000 mg/kg/day q8h-qd– 10% Ca gluconate(100mg/1ml,1Amp ＝ 10ml)

• NaHCO3 ： 1 mEq/kg ( if PH ＜ 7.2 )– 17 mEq/20cc/amp

Correct Metabolic AcidosisCorrect Metabolic Acidosis

Tachypnea (BE=PCO2 – 1.5 x [HCO3] + 8 2 ) BE HCO3 Mild <10 >17 Observation Moderate 10-20 17-8 Slow correction Severe >20 < 8 Rapid supply IVD 10’, taper the speed if PH > 7 7% NaHCO3 ( 17 mEq/20ml ) supply half in 2-8 hours:

2-4 mEq/kg/doseBE x 0.3 x BW( 15-HCO3 ) x 0.6 x BW

Common DoseCommon Dose一般劑量一般劑量

• ＞ 20kg ：錠劑磨粉– 40Kg ： 1 # po qid

– 30Kg ： 1 # po tid 若可吞 ,不用磨– 20Kg ： 1/2# po qid

– 10Kg ： 1/4# po qid

• ＜ 20kg ：糖漿– 一般咳嗽˙流鼻水糖漿多為一般咳嗽˙流鼻水糖漿多為 BW/4 c.c.BW/4 c.c.– 退燒˙抗生素糖漿多為退燒˙抗生素糖漿多為 BW/2 c.c.BW/2 c.c.– 例外：例外：止瀉藥水˙氣管擴張劑糖漿˙紅黴素類糖漿止瀉藥水˙氣管擴張劑糖漿˙紅黴素類糖漿

Antipyretics Antipyretics 退燒藥退燒藥• Scanol (500mg/1#) ：

– 10 ～ 15mg/kg/dose q4h ～ q6h (50 mg/kg/day)

• Antiphen (Acetaminophen syrup) ：– BW/2 ㏄ q4h prn if BT 38.5℃ 38.5℃(120mg/kg/dose)

• Macsafe(Ibuprofen syrup) ： NSAIDs– 38.5 : BW/4 cc q6h℃ ； 39.5℃39.5℃ : BW/2 cc q6h

• Diclofen (supp)( 12.5mg ) ：– ＜ 6kg 1/3# supp q6h prn if BT 39.5℃– 6 ～ 10kg 1/2# supp q6h prn if BT 39.5℃– ＞ 10kg 1# supp q6h prn if BT 39.5 ℃

Antitussives and expectorantsAntitussives and expectorants止咳化痰藥止咳化痰藥

• Medicon-A ( 20mg/cap ): Common dose• Medicon syrup (Dextromethorphan)(2.5mg/ml) ：

– BW/4 cc po qid ,1-2mg/kg/day q6-8h

• Mucosolven (Ambroxol liq.)(3mg/ml) ( 化痰 ):– BW/4 cc qid ;<2 y/o:2.5~5 cc bid; 2~5y/o:2.5~5 cc tid

; 5~10y/o 5~10cc tid

• Unitussin (Glyceryl guaiacolate)(20mg/ml)( 化痰>止咳 ):– BW/4 cc qid ; 2~6y/o:2.5~5 cc qid ; 6~12y/o 5~10cc q

id

Antihistamines & DecongestantsAntihistamines & Decongestants 流鼻水流鼻水 ,, 鼻塞鼻塞‚‚抗過敏藥抗過敏藥

• Cyproh syrup (Cyproheptadine 0.4 mg/ml) ： — BW/4 cc po qid

• Cyproh tablet ( 嗜睡 ,增加食慾 ) ： Common dose• Demin (Chlorpheniramine 0.5mg/ml ) ：

— BW/4 cc po qid

• CTM tablet ( 嗜睡 ,使痰更濃 ) ： Common dose• Venalin (Diphenhydramine 30mg/amp): 10-50mg IV

or IM q2-3h, max 400mg/day (1mg/kg/dose)– Urticaria, angioedema or EPS 時可用

Antihistamines & DecongestantsAntihistamines & Decongestants 流鼻水流鼻水 ,, 鼻塞鼻塞‚‚抗過敏藥抗過敏藥

• Clarityne(10mg/tab) ：– ＜ 30kg 1/2# po qd ；＞ 30kg 1# po qd

• Clarityne syrup (Loratadine 1mg/ml 60ml )– ＜ 30kg 5ml po qd ；＞ 30kg 10ml po qd

• Allegra (60mg tab) ： 1# bid ->1# qd

Bronchodilator Bronchodilator 氣管擴張劑氣管擴張劑• Bricanyl (Terbutaline 2ml/5mg ) :

– <20Kg:½ # in N/S 3ml for neubrilization q6h; >20Kg:1 # in N/S 3ml for neubrilization q6h

• Ventolin (Salbutamol neubule 2.5ml/5mg) :– The same with Bricanyl; – Tab(2mg): 0.1 mg/kg/dose up to 2 mg PO tid

• Berotec(Fenoterol HBr) syrup(0.5mg/ml) :– BW/4~BW/5 cc tid ;<1 y/o:2.5 cc bid; 1~6y/o:2.5~5 c

c tid ; 6~14y/o 5cc tid

• Meptin(Procaterol) syrup(mg/ml) :– <6 y/o:BW/4~BW/5 cc q12h; >6y/o:5 cc po q12h

Bronchodilator Bronchodilator 氣管擴張劑氣管擴張劑

• Xidanef (Ketotifen)100 ml syrup:– 2.5-5ml bid

• Atrovent (Ipratropium UDV 0.5mg/2ml):– 1 vial q6h prn

• Epinephrine(1:1000) ： 0.01ml/kg/dose(Max 0.5ml) q15minSC

XanthinesXanthines 茶鹼類茶鹼類• Aminophylline

• S.E ： nausea, vomiting, insomnia, tachycardia• Loading dose ： 5(2~6)mg/kg/dose iv drip for 20 ～ 30 mi

n;Maintain ： 1mg/ kg/hr• Infants=> 0.2~0.9mg/kg/hr,

1-9y/o=>1~1.2mg/kg/hr;• 9-16y/o=>0.8~1mg/kg/hr;• youngsmoker:0.8~1mg/kg/hr,• nonsmoker:0.5~0.7mg/kg/hr

• Apnea of prematurity ： 4~6mg/kg iv 30 min ,then maintaince : 1.5~3 mg/kg/dose iv q8-12h

XanthinesXanthines 茶鹼類茶鹼類• Ventol:3ml/kg/day qid

• Aminophylline tab. ： 200mg/tab po qid ; dose = iv form

Steriods Steriods 類固醇類固醇• Decadron ： 0.1 mg/kg/dose im q8h.• Rinderon (4mg/ml): 0.1 mg/kg/dose im,iv q8h• Prednisolone(5mg/tab):1~2mg/kg/day po qd~qi

d ; max:4#~8#(20~40) mg/day for 3~5 day.• 40kg 給 Pulmicort (steroid ,200mcg/dose) ：

– 1~2 puff bid for 3 month for prevent asthma( 可有效預防氣喘再發 )

Urticaria Urticaria 蕁麻疹蕁麻疹• Benadryl (Diphenhydramine):1mg/kg IM

• Decardon (Dexamethasone):– 0.1mg/kg/dose IM

• Periactin tab ：普通劑量 po qid.

• Prednisolone(5mg/tab.) :1~2 mg/kg/day

Antidiarrheals, digestives and antiAntidiarrheals, digestives and antiflatulentsflatulents 止瀉、消化、消氣劑止瀉、消化、消氣劑

• Kaopectin ：– ＜ 6 mons ： 3 ㏄ po qid （嚴重再給）– 6 mons ～ 6 Y/O ： 5 ㏄ po qid– ＞ 6 Y/O ： 10 ㏄ po qid.

• Biofermin tab ：普通劑量×2 po qid.

• Simethicone tab ：普通劑量 po qid.

• Bismuth: 普通劑量 po qid.

AntiemeticsAntiemetics 止吐劑止吐劑• Motilium(10 mg/tab) ：普通劑量 po qid.

• Prepulsid ： 0.1~0.2mg/kg/dose po qid

• Novamine or Priperam may cause EPS

• EPS ： Akineton=Biperidine(1#=2mg;5mg/1cc/amp) – Adult ： 2mg per 30 min.max 4 vial(20mg)

Laxatives Laxatives 輕瀉劑輕瀉劑• Glycerine ball enema ： 0.5~1# qd

• MgO tab ：普通劑量 po qid.

• Ducolax (Bisacodyl 5mg tab) ： 6~12 yo 1# po st.

• Cascara (Cascara sagrada) ： 1~2# po qhs

Anticonvulsants Anticonvulsants 抗痙攣劑抗痙攣劑• Valium(Diazepam)(10mg/2 ㏄ /amp):

– <5y/o: 0.2 ～ 0.5mg/kg/dose iv slowly q15min × 3 ( max 5mg)

– >5y/o: the same as above except (max 10 mg)

– adolescents: 5-10 mg/dose; max: 30mg.

• Neuropam(Lorazepan)(2mg/ml/amp) ; 中效 (10-15 hrs) ：– 0.03-0.1mg/kg/dose q15 ～ 20min × 2 dose max: 4mg/

dose

Anticonvulsants Anticonvulsants 抗痙攣劑抗痙攣劑• Dilantin(phenytoin) (250mg/5cc/amp) ：

– Loading 10 ～ 20mg/kg iv with rate ＜ 1mg/kg/min,max50mg/min ,Maintain 5mg/kg/day iv q12h, ( 不可加於Glucose solution)

• Luminal(Phennobarbital) (100mg/cc/amp;32mg/1#)– Loading 20mg/kg iv with rate ＜ 30mg/min ; Maintai

n 5-10mg/kg/day to achieve serum level 40 ug/ml

• Chloral hydrate enema(10% 30ml) ：– Neonates: 25-50 mg/kg/dose, – Children: 25-100mg/kg/dose → 1/2~3/4 BW cc enema

Antibiotics Antibiotics 抗生素抗生素• Penicillin :Bctereimia:2.5-5 ;Meningitis 7.5-10 ;

infection 10-25( 單位：萬 u/kg/dose q4-6h)• Ampicillin : IV 100mg/kg/day, q6h. • Amoxicillin Cap(500mg) : (Ac. tonsillitis, AOM)• Hiconcil Cap(250mg)=> 50 mg/kg/day q8h.• Amoxicillin syrup => BW/2 po q8h. • Augmentin (amoxicillin + clavulanic acid, 375m

g/1#,600mg/vial) : BW/2 po q8h.

Antibiotics Antibiotics 抗生素抗生素 -Cephalospori-Cephalosporinsns 頭芽孢素頭芽孢素

• Cephazolin(Veterin) : IV 100mg/kg/day, q6h.• Keflex(250mg/1#,Cephalexin 1',Ceflexin 500mg/1#):25-50 mg/k

g/day poq6h for G(+).• Keflor (2’ Cefaclor,250 mg/1#,125mg/5cc/60cc/susp) 50 mg/kg/d

ay q8h.; BW/2 q8h.(AOM)• Zinacef (2’ Cefuroxime, 250mg,750mg):• <2y/o:125mg/dose po bid; >2mg:250mg/dose po bid• Zinnat (2’ Cefuroxime, 25mg/ml)• AOM : <2 y/o 5ml q12h ; >2 y/o 10ml q12h• Common infection: 5ml q12h • Rocephin,Syntrix(3’Ceftriaxone 500mg/5cc/vial): 50-100mg/kg/day iv q12h-qd; Meningitis:100mg/kg/day q12h

(max:4g/day)• Prostaphlin (Oxacillin) :

– IV 100mg/kg/day, q6h. (Cellulitis)

Antibiotics Antibiotics 抗生素抗生素 - Macrolide- Macrolidess

• Erythromycin(Mycoplasma,Chlamydia,Legionella)• Erythrocin syrup (40mg/cc) ： BW/4 cc po q6h Ilosone

(250/1#):30-50 mg/kg/day q6h.(20kg 1# qid, 40kg 2# qid)

• Zithromax(Azithromycin,250mg/1#,200mg/5cc/susp)• child :1# qd * 3day (>40kg:2#)• Zithromax syrup ： BW/4 cc po qd * 3 days • Klaricid(Clarithromycin ,250/tab): Adult 1~2# po bid; Child:7.5mg/kg bid

Antibiotics Antibiotics 抗生素抗生素 -UTI-UTI

• Nitrofurantoin(Ninru,100mg/1#) ：– 5 ～ 7mg/kg/day, po qid (UTI),Adult::1#po qid.– Prophylactic dose: 1/3~1/4 therapeutic dose

• Azactam(Aztreonam 1 g/inj):90-120mg/kg/day iv q6-8h for G(--) and Pseudomonas

• Mycostatin( 50 萬 u/1#):for Candida(Oral thrush):– Infant: 2/5# (20 萬 u)/dose q6h– Child: 1# (40-60u)/dose q6h

• Baktar(TMP-80 + SMX-400):6-12 mg/kg/day po q12h (Contraindication < 2 months,G6PD deficiency)

Cardiologic diseaseCardiologic disease

• PGE1 （ PDA ） :IV 0.05-0.1μg/kg/min• Supraventricular tachycardia

– Adenosine:0.1mg/kg rapid IV push give double or triple the dose in 2-3 min (6mg max)

• Digoxin(not for WPW):loading 30-40μg/kg– Give 1/2 dose, then 1/4 dose q6-8h for 2 more doses

• Verapamil(Isoptin 5mg/2ml/amp, 1# 80mg):– >1y/o; 0.075-0.15 mg/kg,slow IV, repeat twice q15m

其他特殊用藥其他特殊用藥• Aspirin(500mg/13):

Analgesic:10-15 mg/kg/dose po q6-8h Anti-rheumatic:65-100mg /kg/day po q6-8h Kawasaki disease: 100mg/kg/day po q6h

• Indocin: Dose : No.1 No.2 No.3 <48h-- 0.2 0.1 0.1 (mg/kg 2-7days -- 0.2 0.1 0.2 q12-24h ) >7 days -- 0.2 0.1 0.25

其他特殊用藥其他特殊用藥• Lasix(40mg/1#,20mg/2cc/inj):1-2mg/kg/dose q6-12h• Mannitol(60mg/20%/300cc):0.5-1.0g/kg/dose iv for 30

min • Insulin:• DKA:0.05-0.1u/kg/hr iv drip ,• maintain ： 0.5-1u/kg/day/SC• Glucose intolerance in prematurity: 0.01-0.1u/kg/hr.• Difflam® Anti-Inflammatory Spray （得伏寧消炎噴液劑） • ¨ 成份：每 mL 含 Benzydamine Hydrochloride 15 mg • ¨ 作用： Benzydamine 為一抗炎止痛劑，可舒解口腔及咽喉疼痛。 • ¨ 用法：直接噴 5-10 次於疼痛和發炎部位，再輕輕吞下，視需要，可每 1.5-3

小時重覆一次。

CPR CPR 用藥用藥• E-T tube size ：

– Newborn ： 2.5 ～ 4 Fr ; ＞ 2 Y/O = 4 ＋ (age / 4) Fr– Depth:lip-tip length (about ＝ 3 * E-T tube size)– Depth: 1/ 2/ 3/ 4 kg ＝ > 7 / 8 / 9/ 10 cm

• Epinephrine ( 1 ： 1000 ) ： ( 1mg ＝ 1ml )– 0.01 ml/kg/dose iv; or 0.1 ml/kg/dose via ET tube

• Dopamine ： ( 6×BW ) kg in N/S final V ＝ 100ml 1MD/min ＝ 1ug/kg/min

• N.E.(Levophed):1mg/ml; 0.05-0.1ug/kg/min drip.• Nitroprusside(Nipride): 0.5-1.0 ug/kg/min drip.

CPR CPR 用藥用藥• Atropine ： 0.02mg/kg (1ml ＝ 0.1mg ) q5m, total max d

ose: child=1mg, adolescent: 2mg;minimal dose=0.1mg

• NaHCO3 ： 1 meq/kg ( if PH ＜ 7.2 )

• Lidocaine(10mg/ml): 1mg/kg loading, 20-50ung/kg/min, (60xBW)mg of lidocaine dilute with N/S to 100ml, then 1

MD/min10ug/kg/min

• Adenosine: for PSVT– Neonates and child: 0.05mg/kg iv push, increase bolus doses by 0.

05mg/kg q2min, max dose:0.25mg/kg or 12mg

– Adult: 6mg12 mg 12 mg

Health & Medicine

Pediatric Dosage