Management of Broken Dosage in a 7-Year-Old, 16 kg Patient
When a medication dose is broken, split, or incorrectly administered in a pediatric patient, immediately verify the actual dose received, assess for signs of toxicity or therapeutic failure, and recalculate the correct weight-based dose using the child's actual body weight of 16 kg before administering any correction. 1
Immediate Assessment Steps
Determine what "broken dosage" means in this specific case:
- If the tablet/capsule was physically broken and only part was given, calculate the fraction of intended dose actually received 2, 3
- If an incorrect dose was calculated or administered, determine the actual mg/kg dose delivered 4
- If a dosing error occurred (10-fold calculation errors are common in pediatrics), identify whether this represents overdosing or underdosing 5
Clinical Evaluation Required
Assess the patient for immediate adverse effects or therapeutic inadequacy:
- Check vital signs including heart rate and blood pressure if the medication has cardiovascular effects 4
- Monitor for signs of toxicity if overdose occurred, or treatment failure if underdosed 6, 3
- Document the exact amount of medication received and timing 5
Dose Recalculation Protocol
Use actual body weight (16 kg) for all medication calculations in this non-obese child: 1
- The American Heart Association recommends using actual body weight for medication dosing in children, as it closely approximates ideal body weight 4, 1
- Calculate the correct mg/kg dose based on 16 kg body weight 2
- Never exceed the recommended adult maximum dose regardless of calculation 4, 1
Common pitfall: Avoid using age-based estimates or parent estimates of weight, which are less accurate than actual measured weight 4
Correction Strategy
If underdosed (partial dose given):
- Administer the remaining portion of the correct dose if within the appropriate dosing interval 4
- Do not double the next scheduled dose to "catch up" unless specifically indicated by the medication's pharmacokinetics 2
- Resume normal dosing schedule thereafter 4
If overdosed (excessive dose given):
- Monitor closely for medication-specific adverse effects 6, 3
- Contact poison control or pediatric pharmacist for guidance on specific antidotes or supportive care if needed 6
- Delay or skip the next dose depending on the degree of overdose and medication half-life 2
Prevention of Future Errors
Implement these safeguards to prevent recurrence: 6, 3, 5
- Document the patient's weight in kilograms on all prescriptions to enable pharmacist verification 1
- Use standardized measurement devices for liquid medications at home 6
- Provide written dosing instructions to caregivers with clear mg and mL amounts 5
- Consider using a dosing calculator or clinical decision support tool to reduce calculation errors 7
Critical consideration: Dosing errors are the most common type of medication errors in pediatrics, with 10-fold calculation errors being particularly frequent and potentially fatal 3, 5. For this 16 kg child, ensure all doses are calculated as mg/kg × 16 kg, and verify the decimal point placement before administration 3, 7.