Hydromorphone IV Dosing for an 8-Year-Old Female Weighing 29.3 kg
The recommended intravenous (IV) dose of hydromorphone for this 8-year-old female weighing 29.3 kg is 0.015 mg/kg, which equals approximately 0.4-0.5 mg per dose. This dose can be administered every 2-3 hours as needed for pain control 1.
Dosing Calculation and Rationale
The FDA-approved hydromorphone dosing guidelines recommend:
- For IV administration in opioid-naïve patients: 0.2-1 mg every 2-3 hours as necessary for pain control 1
- For pediatric patients, this translates to approximately 0.015 mg/kg IV
For this 29.3 kg child:
- 29.3 kg × 0.015 mg/kg = 0.44 mg per dose
- Round to 0.4-0.5 mg for practical administration
Administration Considerations
- Administer IV hydromorphone slowly, over at least 2-3 minutes 1
- Start at the lower end of the dosing range for pediatric patients
- Titrate based on the individual patient's response to their initial dose
- Monitor closely for respiratory depression, which can occur at any time during opioid therapy
Special Considerations for Pediatric Patients
- Children may require higher mg/kg doses than adults but should still be started at the lowest effective dose
- Allow sufficient time between doses (2-5 minutes) to assess effect before administering additional medication
- For patients with hepatic or renal impairment, start with one-fourth to one-half the usual dose 1
Monitoring Requirements
- Continuous monitoring of vital signs, particularly respiratory rate and oxygen saturation
- Assess level of sedation frequently
- Have naloxone readily available for reversal of respiratory depression if needed
- Monitor for common side effects: nausea, vomiting, pruritus, and constipation
Potential Adverse Effects
- Respiratory depression is the most serious potential complication
- Other common side effects include sedation, nausea, vomiting, and pruritus
- Hydromorphone may cause less pruritus, sedation, and nausea compared to morphine 2
Potency Considerations
- Hydromorphone is approximately 5 times as potent as morphine orally and 8.5 times as potent as morphine intravenously 2
- This high potency requires careful dosing, especially in pediatric patients
Remember to use the lowest effective dose for the shortest duration necessary to control pain while minimizing adverse effects. Titrate carefully based on the patient's response and pain assessment.