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Commonly prescribed drugs in hospital – paediatrics [advanced]

Please note this information is for educational purposes only and prescriptions should not be based on this. OSCEstop takes no responsibility for use of this information.

NOTE: in paediatrics medication doses must be evenly spaced, so prescribe ‘hourly’ rather than TDS/QDS

Emergencies

You must know these:

  • Cardiac arrest: DC shock 4J/kg biphasic, Adrenaline 1:10,000 IV 0.1ml/kg (10mcg/kg), Amiodarone 5mg/kg IV
  • Anaphylaxis: Adrenaline 1:1000 IM <6 years 150mcg (0.15ml), 6-12 years 300mcg (0.3ml), >12 years 500mcg (0.5ml)
  • Seizure: Lorazepam 0.1mg/kg IV (max 4mg; or, if no IV access, Diazepam 0.5mg/kg PR or Buccal midazolam 0.5mg/kg TOP)
  • Sepsis: Ceftriaxone 80mg/kg IV
  • Stridor: Adrenaline nebuliser 0.5ml/kg 1:1000 NEB (max 5ml)
  • Hypoglycaemia: 10% dextrose 2.5ml/kg IV or Glucagon IM neonate 20mcg/kg, <25kg 500mcg, >25kg 1mg (if no IV access) or 0.3g/kg PO glucose gel or tablets
  • SVT (without adverse signs): Adenosine 100mcg/kg IV (can be followed by repeated doses increasing by 50-100mcg/kg until terminated or maximum single dose 500mcg/kg)
  • VT (without adverse signs): Amiodarone 5mg/kg IV over 30mins (maximum 300mg)
  • Tachycardic arrhythmia (with adverse signs): Synchronised DC shock 1J/kg (can be followed by 2J/kg shocks)
  • Bradycardia (due to increased vagal tone): Atropine 20mcg/kg IV (maximum 600mcg single dose)

Analgesia

  • Paracetamol 20mg/kg PO loading dose then 15mg/kg 8-hourly <1 month or 6-hourly >1 month (max: 30mg/kg/d <1 month, 60mg/kg/d <3 months, 1g/dose >3 months)
  • Morphine 0.2mg/kg PO or 0.1mg/kg IV
  • Intranasal diamorphine 0.1mg/kg TOP

Fluid bolus

  • Normal saline 20mg/kg IV (may given by 50ml syringes in infants)

Nausea/vomiting >2 years old

  • Ondansetron 100mcg/kg IV (maximum 4mg)

Wheeze

  • Salbutamol 10 puffs inhaler INH via spacer (or 2 puffs and increase by 2 puffs every 2mins depending on response – max 10 puffs)
  • Salbutamol 2.5mg NEB PRN 4-6hourly (max 20mg)
  • Ipratropium bromide 250micrograms NEB, PRN 4-6hourly (max 2mg)
  • Prednisolone 1-2mg/kg PO OD (max 40mg)

Electrolyte replacement

Hypokalaemia

  • Mild (>2.5mmol/L): Sando-K tablets (12mmol/tablet) or Kay-Cee-L liquid (1mmol/ml) 0.5-1mmol/kg PO BD x 3/7 (max 72mmol/day)
  • Severe (<2.5mmol/L or symptomatic): Potassium chloride 1mmol/kg over 6-12 hours using ready-made solution of 20mmol potassium chloride in 500ml 0.9% saline or 0.9% saline/5% dextrose IV (max rate 0.2mmol/kg/h without ECG monitoring)    

Hyperkalaemia

1. ECG and cardiac monitoring

2. Calcium gluconate 10% 0.5ml/kg IV (max 20ml) over 5-10 mins – can be used undiluted in emergencies

3. Actrapid insulin 0.1units/kg in 2ml/kg 25% dextrose IV over 30 mins

Hypocalcaemia

  • Calcium gluconate 10% 0.5ml/kg IV (over 30mins, max 10ml) – should be diluted: 1ml 10% calcium gluconate to 4ml normal saline or 5% dextrose

Hypomagnesemia

  • Mild (>0.5mmol/L): Magnesium glycerophosphate 4mmol tablets (can be divided to smaller doses) 0.2mmol/kg PO every 8 hours (max 8mmol/dose) x 3/7
  • Severe (<0.5mmol/L or symptomatic): Magnesium sulphate 10% 0.5-1ml/kg (over 2 hours, max 20ml) – note 10ml of 10% = 1g = 4mmol

Hypophosphataemia

  • Mild (>0.65mmol/L): Phosphate-Sandoz effervescent tablets (16.1mmol/tablet) 2-3mmol/kg PO daily in 2-4 divided doses x 3/7 (max 48mmol/day <5years, 97mmol/day >5years)
  • Severe (<0.65mmol/L): Sodium glycerphosphate neonate 1mmol/kg, <2y 0.7mmol/kg, 2-8y 0.4mmol/kg, >25kg 10mmol (not per kg) IV over 12 hours – diluted to 0.02mmol/ml in normal saline e.g. 10mmol sodium glycerophosphate in 500ml normal saline
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