PALS Pharmacology

SVT/ 1st dose (0.1mg/kg IV/IO rapid push; max 6mg), 2nd dose (0.2mg/kg IV/IO rapid push; max 12mg)

Shock, Trauma, Burns/ 0.5-1g/kg (10-20mL/kg of 5% solution) IV/IO rapid infusion

Asthma, Anaphylaxis (bronchospasm), Hyperkalemia MDI: 4-8 puffs INH q 20 minutes PRN with spacer (or ET tube if intubated) Nebulizer: 2.5mg/dose (weight <20kg) OR 5mg/dose (weight >20kg) INH q 20 minutes PRN Continuous Nebulizer: 0.5mg/kg per hour INH (max 20mg/h)

Ductal-dependent Congenital Heart Disease (all forms) 0.05 to 0.1 ug/kg/min IV/IO infusion initially, then 0.01-0.05 ug/kg/min IV/IO

SVT, VT (with pulses) 5mg/kg IV/IO load over 20-60 min (max 300mg), repeat to daily max 15mg/kg (or 2.2g.) Pulseless Arrest (ie, VF/pulseless VT) 5mg/kg IV/IO bolus (max 300mg), repeat to daily max 15mg/kg (or 2.2g)

Bradycardia (symptomatic) -0.02 mg/kg IV/IO (min dose 0.1mg, max single child dose 0.5mg, max single dose adolescent 1mg) may repeat dose once, max total dose child 1mg, max total dose adolescent 2mg Toxins/Overdose (organophosphate, carbamate) -0.02-0.05 mg/kg (<12 years) OR 0.05 mg/kg (>12 years) IV/IO initially, repeat q 20-30 minutes until atropine effect (dry mouth, tachycardia, mydriasis) is observed or symptoms reverse.

Hypocalcemia, Hyperkalemia, Hypermagnesemia, Calcium Channel Blocker Overdose - 20mg/kg (0.2mL/kg) IV/IO slow push during arrest or is severe hypotension, repeat PRN.

Croup -0.6mg/kg PO/IM/IV (max 16mg)

Hypoglycemia -0.5-1 g/kg IV/IO (D₂₅W 2-4mL/kg; D₁₀W 5-10mL/kg)

Anaphylactic Shock -1-2 mg/ kg IV/IO/IM q 4-6 hours (max 50mg)

Congestive Heart Failure, Cardiogenic Shock -2-20 ug/kg/min IV/IO infusion; titrate to desired effect

Cardiogenic Shock, Distributive Shock 2-20ug/kg/min IV/IO infusion, titrate to desired effect

Pulseless Arrest, Bradycardia (symptomatic)

Pulmonary Edema/Fluid Overload 1mg/kg IV/IM (usual max 20 mg if not chronically on LOOP diuretic)

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