What is the dose of Glycopyrrolate for a child weighing 22 kilograms?

Glycopyrrolate Dosing for a 22kg Child

For a 22kg child, the recommended dose of glycopyrrolate injection is 0.004 mg/kg, which equals 0.088 mg per dose. This dose can be administered intravenously or intramuscularly based on the clinical indication 1, 2.

Dosing Based on Clinical Indication

Preanesthetic Medication

• Dose: 0.004 mg/kg IM (0.088 mg for a 22kg child)
• Timing: 30-60 minutes prior to anesthesia induction or when preanesthetic medications are administered
• Maximum: Not to exceed 0.1 mg in a single dose 1

Intraoperative Use

• Dose: 0.004 mg/kg IV (0.088 mg for a 22kg child)
• Maximum: Not to exceed 0.1 mg in a single dose
• Frequency: May be repeated at intervals of 2-3 minutes as needed
• Note: If glycopyrrolate was used as preanesthetic medication, additional intraoperative doses are rarely needed 1, 2

Reversal of Neuromuscular Blockade

• Dose: 0.2 mg for each 1.0 mg of neostigmine or 5.0 mg of pyridostigmine
• Administration: Can be mixed in the same syringe with neostigmine or pyridostigmine and administered simultaneously by IV injection 1

Important Considerations

Weight-Based Dosing Precautions

• For children weighing less than 25kg (like this 22kg child), the standard pediatric dosing of 0.004 mg/kg is appropriate 3
• The total dose should not exceed 0.1 mg in a single administration 1

Administration Routes

• Can be administered intramuscularly or intravenously without dilution
• Compatible with dextrose 5% and 10% in water, saline, dextrose 5% in sodium chloride 0.45%, sodium chloride 0.9%, and Ringer's Injection 1
• Incompatible with Lactated Ringer's solution 1

Monitoring

• Monitor for anticholinergic side effects including dry mouth, constipation, urinary retention, flushing, and tachycardia
• Be particularly vigilant in younger children who may be more sensitive to anticholinergic effects 4

Special Situations

For Chronic Drooling

If glycopyrrolate is being used for chronic drooling in this child:

• Starting dose: 0.02 mg/kg three times daily (0.44 mg TID for a 22kg child)
• Titration: Can be increased in increments of 0.02 mg/kg every 5-7 days
• Maximum dose: 0.1 mg/kg three times daily, not exceeding 3 mg per dose 5
• Note: While FDA approval for drooling is for children 3-16 years, studies have shown efficacy in younger children as well 6

Overdose Management

If overdose occurs:

• For peripheral anticholinergic effects: neostigmine methylsulfate may be given IV in proportionately smaller doses than the adult dose of 0.25 mg
• For CNS symptoms: physostigmine may be used in proportionately smaller doses than the adult dose of 0.5-2 mg 1

Practical Administration Tips

• Visually inspect solution for particulate matter and discoloration before administration
• Do not combine glycopyrrolate with medications that would result in a pH higher than 6.0 1
• Calculate the exact dose carefully based on accurate weight measurement to avoid dosing errors

Remember that glycopyrrolate has a long duration of action, so additional doses for anticholinergic effect are rarely needed if it was used as preanesthetic medication 1, 2.