Dexamethasone Dosing for a 34-Pound Pediatric Patient
For a 34-pound (15.4 kg) pediatric patient, administer dexamethasone 0.6 mg/kg (9.2 mg) as a single oral dose for croup or asthma exacerbations, which is the most common indication in this age group. 1
Weight-Based Calculation
- 34 pounds = 15.4 kg
- Standard dose: 0.6 mg/kg × 15.4 kg = 9.2 mg (single dose)
- Maximum dose: 16 mg (not exceeded in this patient) 1
Indication-Specific Dosing
Croup (Most Common)
- Single dose of 0.6 mg/kg (9.2 mg for this patient), maximum 16 mg 1
- Oral route is preferred when the child can tolerate it, as it is equally effective as intramuscular or intravenous routes and avoids injection pain 1
- Clinical duration of action is 24-72 hours, with onset as early as 30 minutes 1
Asthma Exacerbations
- Single dose of 0.6 mg/kg (9.2 mg for this patient), maximum 16 mg 1, 2
- This single dose is equally effective as a 3-5 day course of prednisolone or prednisone 1
- 82% of pediatric emergency medicine providers use 0.6 mg/kg dosing 3
- Alternative dosing of 0.3 mg/kg has been studied but 0.6 mg/kg is the guideline-recommended dose 1, 4
Bacterial Meningitis
- 0.15 mg/kg (2.3 mg for this patient) every 6 hours for 2-4 days 1
- Must be initiated 10-20 minutes prior to, or at least concomitant with, the first antimicrobial dose 1
- Should not be given if antimicrobial therapy has already been started 1
Adrenal Insufficiency (Emergency)
- Initial dose: 2-3 mg/kg IV/IO (30.8-46.2 mg for this patient), maximum 100 mg 5
- Maintenance: 1-5 mg/kg every 6 hours for infants or 12.5 mg/m² every 6 hours for older children 5
- Consider concomitant fluid bolus of 20 mL/kg of D5NS or D10NS during the first hour 5
Critical Dosing Distinctions
The dose varies dramatically by indication—do not confuse them:
- Croup/asthma: 0.6 mg/kg single dose 1
- Meningitis: 0.15 mg/kg every 6 hours 1
- Adrenal crisis: 2-3 mg/kg initial bolus 5
Common Pitfalls to Avoid
Route Selection
- Oral administration is preferred for croup and asthma when the child can tolerate it 1
- Intramuscular administration is less preferred than IV due to lack of medication titration and pain at the injection site, but is appropriate when IV access is not available 5
Duration Considerations
- For short-term treatment courses (less than 14 days), abrupt discontinuation is generally acceptable 6
- Single-dose therapy improves compliance compared to multi-day prednisone courses 2, 4
High-Dose Cautions
- High-dose dexamethasone (0.5 mg/kg/day) is contraindicated for bronchopulmonary dysplasia in preterm infants due to adverse neurodevelopmental outcomes 7, 1
- This is far above the 0.6 mg/kg single-dose used for croup/asthma 1