PEDS pharm & fluid calculations quiz
How much does PRBCs increase pediatric hemoglobin?
*10 mL/kg will increase hemoglobin by 1-2 g/dL* Example: - 15 kg child - 150 mL of PRBC increases Hgb by 1-2
How to determine fluid maintenance rate
*4-2-1 rule* - estimated fluid requirement "EFR" 4 mL/kg 1st 10 kg 2 mL/kg 2nd 10 kg 1 mL/kg >20 kg Estimated fluid deficit "EFD" - EFR x NPO hours = EFD HR should guide fluid management Urine output should be >0.5 mL/kg/hr
Calcium pediatric dosing
*Calcium chloride:* 10 - 20 mg/kg *Calcium gluconate:* 30 mg/kg
4 year old who is 18 kg and a starting HCT of 37% Calculate EBV & ABV
*EBV:* 18 kg x 75 mL = *1,350 mL* *ABL:* [(37 - 35)/36] x 1,350 = *75 mL*
Full-term, 3 month infant who is 6 kg and a starting HCT of 39% Calculate EBV & ABV
*EBV:* 6 kg x 80 mL = *480 mL* *ABL* [(39 - 35)/37] x 480 = *52 mL*
Fentanyl pediatric dosing
*IV:* 1 - 5 mcg/kg *IN:* 1 - 2 mcg/kg (onset 13 mins)
Propofol pediatric dosing
*Induction:* *- Age < 3 years: 3 mg/kg IV* *- Age > 3 years: 2 mg/kg IV* Infusion: 100 - 250 mcg/kg/min Emergence delirium: 1-3 mg/kg Pretreatment for injection pain: - 0.3 mg/kg of lidocaine
Remifentanil pediatric dosing
*Infusion:* 0.1 - 2 mcg/kg/min *Bolus:* 1 - 4 mcg/kg
Vecuronium pediatric dose
*Intubation dose:* 0.05 - 0.2 mg/kg *Maintenance dose:* 0.02 mg/kg
Cisatracurium (Nimbex) pediatric dose
*Intubation dose:* 0.1 - 0.2 mg/kg *Maintenance dose:* 0.02 - 0.05 mg/kg
Rocuronium pediatric dose
*Intubation dose:* 0.3 - 1.2 mg/kg *Maintenance dose:* 0.1 mg/kg
Succinylcholine pediatric dosing
*Intubation:* 1 - 2 mg/kg IV Neonates and infants require twice the dose and older children & adults - Sch gets diluted in large ECF volume - babies are sacks of water *Laryngospasm doses:* - IV: 0.5 - 1 mg/kg - IM: 3 - 4 mg/kg *Pre-treatment with atropine when using Sch on children:* - 0.02 - 0.03 mg/kg - prevents life-threatening bradycardia
Local anesthetic pediatric max doses
*Lidocaine:* - 5 mg/kg - 7 mg/kg with Epi *Bupivacaine:* 3 mg/kg *Ropivacaine:* 3 mg/kg
13 kg child presenting for an ORIF of the elbow scheduled for 2 hours. NPO since 2000 & the current time is 0800 Calculate your intra-op fluids
*Maintenance:* 13 kg = (10 x 4) + (3 x 2) = *46 mL/hr* - 46 mL x 2 hr = *92 mL* *Deficit:* 46 mL x 12 hr = 552 mL - 1st hour = 276 - 2nd hour = 138 - 276 + 138 = *414 mL* (deficit not fully replaced) *Insensible losses:* - 5 mL x 13 kg = 65 mL/hr x 2 hr = *130 mL* 92 + 414 + 130 = *636 mL*
35 kg child presenting for a spinal fusion scheduled for 6 hours. NPO since 0000, the current time is 0700 Calculate your intra-op fluids
*Maintenance:* 35 kg = (10 x 4) + (10 x 2) + 15 = 75 mL/hr - 75 mL x 6 hrs = *450 mL* *Deficit:* 75 mL x 7 hr = *525 mL* - 1st hour = 262.5 - 2nd hour = 131.25 - 3rd hour = 131.25 *Insensible losses:* 10 mL x 35 kg = 350 x 6 hr = *2,100 mL* 450 + 525 + 2100 = *3,075 mL* *Be mindful of insensible losses, if the incision is not open yet, the patient is not losing fluid*
6 kg infant presenting for a laparoscopic nissen scheduled for 3 hours. NPO at 2300 and the current time is 0800 Calculate your intra-op fluids
*Maintenance:* 6 kg x 4 mL = *24 mL/hr* - 24 mL x 3 hrs = *72 mL* *Deficit:* 24 mL x 9 hrs = *216 mL* - 1st hour: 108 - 2nd hour: 54 - 3rd hour: 54 *Insensible losses:* - 5 mL x 6 kg = 30 mL x 3 hr = *90 mL* 72 + 216 + 90 = *378 mL*
Midazolam (Versed) pediatric dosing
*Oral:* - 0.5 - 1 mg/kg *(max 20 mg)* *Intranasal:* - 0.2 - 0.3 mg/kg (burns, least preferred route) *IV:* - 0.05 - 0.1 mg/kg *(max 2 mg)*
Acetaminophen pediatric dosing
*PO:* 10 - 15 mg/kg q 4-6 hrs (max 4 g/day) *IV:* 10 - 15 mg/kg q 6 hours PR: load with 40 mg/kg followed by 20 mg/kg q 6 hrs (max 5 doses per day) *Tylenol is one of THE most dangerous drugs due to overdose related liver failure*
Dexmedetomidine (Precedex) pediatric dosing
*Premedication:* - IM: 1 - 2 mcg/kg - IN: 1 - 2 mcg/kg (max 100mcg) *- IV: 0.5 mcg/kg* *Sedation:* *- 1 - 2 mcg/kg bolus over 10 minutes* *- infusion: 0.5 - 1.5 mcg/kg/hr* Emergence delirium: 0.3 - 1 mcg/kg IV Shivering: 0.5 mcg/kg IV (works in 5 mins)
Neostigmine pediatric dosing
0.05 - 0.07 mg/kg
Morphine pediatric dosing
0.05 - 0.1 mg/kg IV
Ephedrine pediatric dosing
0.1 - 0.2 mg/kg
Atropine pediatric dose Anticholinergic dosing
10 - 20 mcg/kg
Glycopyrrolate pediatric dosing Anticholinergic dosing
10 mcg/kg
Sugammadex pediatric dosing
2 mg/kg for moderate NM blockade 4 mg/kg for extensive NM blockade 16 mg/kg Rescue dose - failed intubation, can't ventilate
Insensible losses (IL) in children
5 mL/kg/hr = minimal incision 10 mL/kg/hr = moderate incision 15 mL/kg/hr = Large incision
Allowable blood loss (ABL) calculation for peds
ABL = [(starting HCT - lowest accetable HCT)/avg HCT] x EBV
Estimated blood volume children
Children 3 - 6 yrs = 70-75 mL/kg Otherwise, these are the numbers from the notes
What factors are considered when calculating intraop fluid replacement?
EFR (maintenance rate) EFD (deficit) IL (insensible losses) EBL
Lowest acceptable hematocrits
Healthy pediatric patient = *28%* Neonate = *35%* - A neonate is considered <1 month
Hydromorphone pediatric dosing
IV bolus: 0.01 - 0.05 mg/kg
Tramadol pediatric dosing
IV bolus: 2 - 2.5 mg/kg
Ketorolac pediatric dosing
IV or IM: 0.5 mg/kg *(max 30 mg)*
Droperidol pediatric dosing
IV: 0.015 - 0.025 mg/kg
Ondansetron pediatric dosing
IV: 0.05 - 0.1 mg/kg *(max 4 mg)*
Dexamethasone pediatric dosing
IV: 0.1 mg/kg *(max dose 20 mg)* - usually 4 mg is given for anti-emetic 0.5 mg/kg (airway dose)
Metoclopramide pediatric dosing
IV: 0.15 - 0.25 mg/kg
Promethazine pediatric dosing
IV: 0.25 mg/kg (Max 6.25 - 12.5 mg)
Phenylephrine pediatric dosing
IV: 1 - 10 mcg/kg
Epinephrine pediatric dosing
IV: 1 - 10 mcg/kg 1 mcg/kg for HOTN 10 mcg/kg code dose
Amiodarone pediatric dosing
IV: 5 mg/kg bolus - infusion 5-10 mcg/kg/min
Ketamine pediatric dosing
Premedication/sedation: - PO: 6 - 10 mg/kg *- IM: 3 - 7 mg/kg (avg 4 mg/kg)* Dart dose *- IV: 0.5 - 2 mg/kg* *Induction:* IV: 1 - 2 mg/kg Analgesic: - IV bolus: 0.1 mg/kg - infusion: 0.1 - 0.3 mg/kg/hr
Estimated blood volume pediatric
Round about numbers