UNRS 314 Pediatric Dosages Based on Body Weight Converting pounds to kilograms is done by dividing body weight by 2.

2 Practice problems: change to kilograms - Chapter 13 Curren 58 3/4 lbs 63 1/2 lbs 98 lbs 6lbs 2 oz 8 lbs 10 oz __________ __________ __________ __________ __________

Remember you need to change ounces to a fraction to do the calculations (16 ounces in a pound) Calculating dosages: Calculating total daily dosage is calculated and then it is divided by the number of doses per day to obtain the actual dose administered at one time. Example: Polymox or Amoxicillin oral suspension Average dosage range is 20 40 mg / kg / day This dosage is to be given in divided doses every 8 hours, or a total of three doses (24 hr divided by 8 hours) The child weighs 18.2 kg To calculate average dosage range: 18.2 x 20 = 364 mg / kg / day 18.2 x 40 = 728 mg / kg / day The recommended dosage for an 18.2 kg child is 360 to 728 mg / kg / day Minimus dose is 360 mg / day or 121 mg per dose Maximum dose is 728 mg / kg / day or 243 mg per dose

Practice problems: If the order is to give 125 mg every 8 hours is this within the recommended range? If the order is to give 375 mg every 8 hours is this within the recommended range? If the order is to give 75 mg every 8 hours is this within the recommended range? If the order is to give 250 mg every 8 hours is this within the recommended range? If the order is to give 125 mg every 4 hours is this an accurate dosing? Clinical Pearl: The younger or more compromised by illness the patient, the more critical a discrepancy is likely to be. A po dosage may be rounded to 250 mg per dose versus an IV calculation would need to be within the range of 121 mg to 243 mg per dose. Practice Problem: The label on the medication Polymox reads: 125 mg per 5 mL To give 125 mg you would administer _____ mL or _____ tsp

To give 375 mg you would administer _____mL or _____ tsp

To give 75 mg you would administer _____ mL or

To give 250 mg you would administer ____ mL or _____ tsp

Practice Problem: Oral Medications Principen (ampicillin suspension) 250 mg per 5 mL Child weighs 20 pounds Usual dosage: 100 mg / kg per day (give q.i.d in equally divided doses) What is the childs body weight in kg t the nearest tenth kg? __________

What is the recommended dosage in mg per day for this child? _________ How many doses will this be divided into? _______________

How many mg will this be per dose? ____________________ How many mL would you need to administer to administer the dose? ________

IV Drug Calculations: Ampicillin is often given IV and is unstable is pre-mixed. It is often provided as a vial of powder to be mixed. Physician order is for IV Ampicillin 125 mg every 6 hours. The pharmacy sends you a vial of powdered ampicillin of 250 mg. Look up how to mix this in your drug book. Hint: you can mix this as an IM or IV dose to be given IV According to your drug manual: What solution would you use to mix the drug? __________ For an IM injection how much solution would you add? __________ For direct IV you would add how much solution_________ For Intermittent infusion how much solution would you dilute the drug in ________ What is the rate of administration? ____________________

Route and Dosage: Ampicillin Respiratory or soft tissue infections: PO (adults and children) > 20 kg: 250 mg q 6 hour PO (children) < 20 kg: 50 mg / kg / day divided q 6 8 hours IM, IV (adults and children) > 40 kg: 250 500 mg q 6 hours IM, IV (children) < 40 kg: 25 50 mg / kg / day in divided dose q 6 8 hours Bacterial Meningitis caused by H. influenzae, Staphylocossus pneumonia or N. Meningitidis or Septicemia IM, IV (adults and children): 150 200 mg / kg / day in divided doses q 3 -4 hours Prevention of Bacterial Endocarditis IM, IV (adults): 2 grams 30 minutes before procedure IM, IV (children) 50 mg / kg 30 minutes before procedure Practice problem: You are working in an outpatient surgical clinic and a 12-year-old child is being admitted for a tonsillectomy. The child has a history of heart surgery as an infant. The physician order is for 1.2 grams Ampicillin IV 30 minutes prior to surgery. The pharmacy sends up a vial of powdered Ampicillin containing 1.5 grams. The child weighs 56 pounds. _______________ kg

What would be the appropriate dosage for this child? _______________ How would you mix this medication? _________ mL of sterile water After you mix this medication how much would you draw up to administer the 1.2 grams? _______

Medication administration via Burette: Chapter 21 of Curren Volumetric pumps are used extensively to administer intermittent IV medications to infants and children Calibrated burette has a total capacity of 100 to 120 mL of fluid calibrated in 1 mL increment. Regardless of method of administration the medication infusion is routinely followed by a flush t make sure the mediation has cleared the tubing and the total dosage of medication has been administered Volume of the flush will vary depending on the length of the tubing usually 20 mL If primary line exists the medication my be administered by IV piggy-back If no IV is infusing, a saline or heparin lock (heplock) can be used for intermitted infusion or IV push medications The flush needs to be accounted for during administration of the medication in regards to flow rate or gtts/min and hourly fluid intake.

Example: I do differ a bit from the Curren Math for Meds in that I include the medication fluid and flush fluid in the total to be infused for a specific amount of time. I would expect that all IV fluid medication calculations on the quizzes would include the FLUSH. Example: An antibiotic dosage of 125 mg is in1 mL of solution and is to be further diluted in IV solution of dextrose 5% in normal saline to equal 20 mL. The 20 mL is to be infused over 30 minutes. A flush of 20 mL is to follow. A volumetric pump will be used. 20 mL of the fluid with the medication plus the 20 mL of flush is to be infused over 30 minutes (20 mL of medication + 20 mL of flush) Calculate the gtt / min flow __________________ 40 mL over 30 minutes with drip factor of 60 gtt/min = IV pump to be set at 80 gtts/min or 80 mL / hour to get the total mediation infused over 30 minutes. Steps involved in infusion:

Add medication and amount of fluid to equal 20 mL in the burette and close the clamp. Label the burette with a RED TAG indicating a medication is being infused. Set the IV at rate to infuse both the medication and flush in over 30 minutes. After the medication is infused open up the clamp and add the flush to finish the infusion of the IV medication Move the RED TAG to the IV line to indicate that the medication is now in the line and the flush is infusing After the flush is in remove the RED TAG from the line and re-set the IV fluid rate of gtts / min to the ordered IV rate.

Note: the physician will never tell you to add the FLUSH. A typical order may read: Physician order: Ancef 750 mg IV every 8 hours It is the nurse responsibility to: Calculate mg / mg dosage If the medication comes in a vial or in powder form you will need to draw up or mix the solution to appropriate dose Determine how much IV fluid the medication has to be further diluted in How fast to infuse the mediations: 1 to 5 minutes, 30 minutes, 1 hour Example: Ancef (Cefazolin) is provided at 1.5 grams in powdered form. The childs weight is 35 kg. According the drug manual (Davis Drug Guide): IM, IV (children and infants) > 1 mo 6.25 to 25 mg / kg q 6 hours 8.3 to 33.3 mg / kg q 8 hours Calculate the safe range __________to ____________ every 8 hours Dilute 1 g / 10 mL of sterile water Further dilute to 50 to 100 mL of IV solution Mixing 1.5 grams with 10 mL of sterile water how much medication would you draw up to equal 750 mg _____________________

You will add the Medication to IV solution to equal 50 mL to be infused over 60 minutes (you will need to include the FLUSH in the 60 minutes administration).

How fast will you set you IV at (gtts / min or mL / hour) to get the medication in over 60 minutes__________________

24 hour fluid Calculations (you will need to memorize this) 100 mg for 1st 10 kg of weight 50 mg for 2nd 10 kg of weight 20 mg for each additional kg of weight Calculate 14 hour fluid calculation for: 12 pound child:

6 pound child:

33 pound child:

64 pound child: This is for maintenance IV fluids only. The physician order may be for less or more fluids depending on the infant / child diagnosis or fluid needs. In some cases the order will be for 1 times maintenance or 2/3 maintenance.