What are the emergency drug dosages for a 3-year-old child weighing 13 kg in the Pediatric Intensive Care Unit (PICU)?

Emergency Drug Dosage Chart for 3-Year-Old, 13 kg Child

Critical Resuscitation Medications

Epinephrine (Cardiac Arrest)

• IV/IO dose: 0.13 mg (1.3 mL of 1:10,000 concentration) every 3-5 minutes during cardiac arrest 1
• Maximum single dose: 1 mg 1
• If no IV/IO access: Endotracheal dose 0.13 mg (1.3 mL of 1:1,000 concentration) 1

Atropine (Bradycardia)

• IV/IO dose: 0.26 mg (minimum dose 0.1 mg) 1
• May repeat every 3-5 minutes 1
• Maximum single dose: 0.5 mg in children 1

Amiodarone (Ventricular Arrhythmias)

• IV/IO bolus: 65 mg over 20-60 minutes for ventricular fibrillation/pulseless ventricular tachycardia 1
• May repeat up to 3 total doses for refractory rhythms 1

Lidocaine (Alternative for Ventricular Arrhythmias)

• IV/IO loading dose: 13 mg 1
• Repeat every 5-10 minutes as needed 1
• Maximum total dose: 39 mg (3 mg/kg) 1

Sedation and Procedural Medications

Midazolam

• IV sedation: 0.65-1.3 mg given over 2-3 minutes (initial dose 0.05-0.1 mg/kg for age 6 months to 5 years) 2
• Wait 2-3 minutes between doses to assess effect 2
• Total dose usually does not exceed 6 mg 2
• IM sedation: 1.3-2.0 mg (0.1-0.15 mg/kg) for anxiolysis prior to procedures 2
• For intubation adjunct: 2.6 mg IV (0.2 mg/kg) 1
• Continuous infusion (intubated patients): Loading dose 0.65-2.6 mg IV over 2-3 minutes, then 0.78-1.56 mg/hour (0.06-0.12 mg/kg/hr) 2

Critical Warning: Pediatric patients 6 months to 5 years are particularly vulnerable to airway obstruction and hypoventilation; careful monitoring and respiratory support readiness are essential 2

Ketamine

• IV sedation: 13-26 mg, titrate to effect 1
• IM dissociative sedation: 52-65 mg (4-5 mg/kg, onset within 5 minutes) 1
• May repeat half the initial IM dose if full dissociation not achieved 1
• Atropine or glycopyrrolate may be used to prevent increased salivation 1
• Avoid in patients with increased intracranial pressure 1

Morphine

• IV/IM: 1.3 mg (0.1 mg/kg) for pain 1
• Repeat as necessary for clinical effect 1
• Higher doses may be necessary if patient is opioid-tolerant 1

Lorazepam (Status Epilepticus)

• IV/IM: 0.65-1.3 mg (0.05-0.1 mg/kg, maximum 4 mg per dose) 1
• May repeat every 10-15 minutes if seizures continue 1
• Monitor for respiratory depression 1

Airway and Respiratory Medications

Magnesium Sulfate (Status Asthmaticus)

• IV/IO: 325-650 mg over 15-30 minutes (25-50 mg/kg, maximum 2 g) 1
• Rapid infusion may cause hypotension and bradycardia 1
• Have calcium chloride available to reverse toxicity 1

Methylprednisolone (Asthma/Allergic Reaction)

• IV/IM: 13-26 mg initial dose (1-2 mg/kg) 1
• Must use acetate salt for IM route 1

Metabolic Emergency Medications

Dextrose (Hypoglycemia)

• D10W: 26-130 mL IV/IO (0.5-1.0 g/kg = 5-10 mL/kg of D10W) 1
• D25W: 10-52 mL IV/IO (0.5-1.0 g/kg = 2-4 mL/kg of D25W) 1
• D50W is irritating to veins; dilution to D25W or D10W is preferred in children 1
• Maintenance infusion: D10W at 91 mL/hour (7 mg/kg/min = 100 mL/kg per 24 hours) 1

Hydrocortisone (Adrenal Insufficiency)

• IV/IO: 26-39 mg over 3-5 minutes (2-3 mg/kg, maximum 100 mg) 1
• Strongly consider concomitant fluid bolus of 260 mL D5NS or D10NS during first hour 1

Antiemetic Medications

Ondansetron

• IV/IM/PO: 2.0 mg (0.15 mg/kg per dose, maximum 8 mg for oral) 3
• For oral suspension (6 mg/mL): give approximately 0.33 mL 3
• Caution: Can prolong QT interval; avoid in congenital long QT syndrome 3

Analgesic/Antipyretic Medications

Acetaminophen

• Oral: 130-195 mg every 4-6 hours (10-15 mg/kg per dose) 4
• Maximum daily dose: 780 mg (60 mg/kg/day) 4
• Rectal: 195 mg every 4-6 hours (15 mg/kg per dose), though oral route preferred due to more consistent absorption 4

Ibuprofen

• Oral: 130 mg every 6-8 hours (10 mg/kg per dose) 4, 5
• Maximum daily dose: 390 mg (30 mg/kg/day) 5
• Generally not recommended for infants under 6 months 4

When alternating acetaminophen and ibuprofen: Give acetaminophen every 4-6 hours and ibuprofen every 6-8 hours, staggering timing so medications are given every 3-4 hours if both needed 4

Fluid Resuscitation

Crystalloid Bolus

• Initial bolus: 260 mL of normal saline or lactated Ringer's (20 mL/kg) 1
• May repeat as needed based on clinical response 1

Critical Pitfalls to Avoid

• Weight-based calculations are error-prone in emergencies—pre-calculated doses for this specific weight minimize calculation errors during resuscitation 6, 7
• Midazolam requires slow titration over 2-3 minutes with 2-3 minute observation periods between doses to avoid oversedation and respiratory depression 2
• Never exceed maximum daily acetaminophen dose of 60 mg/kg or give more than 5 doses in 24 hours to prevent hepatotoxicity 4
• D50W should be diluted to D25W or D10W in pediatric patients to avoid vein irritation 1
• Ondansetron should not be used in infants under 6 months due to limited safety data 3
• Always have airway equipment and reversal agents readily available when administering sedatives or opioids 1, 2