Deck 9: Pediatric Critical Care

Question 1

A 5-year-old-child, weight 14 kg, with septic shock. Order: dobutamine 10 mcg/kg/min at 2.1 mL/hr; titrate to keep SBP > 90. Dilute as follows: dobutamine 200 mg in D₅W to make a total volume of 50 mL for a syringe pump. Pediatric dosage: 2 to 20 mcg/kg/min. Drug available: dobutamine 250 mg/20 mL
a. What is the concentration per hour?
b. What is the mL per hour?

Answer 1

a. 14 kg x 10 mcg/kg/min = 140 mcg/min, 140 mcg/min x 60 min/hr = 8400 mcg/hr
b. 200 mg = 200,000 mcg
200,000 mcg: 50 mL = x mcg: 1 mL
50x = 200,000
x = 4000 mcg/mL concentration

Question 2

A 5-year-old child with acute status asthmaticus.Child weighs 21 kg. Order: terbutaline 0.1 mcg/kg/min. Dilute 25 mg terbutaline in 25 mL D₅W to make a total volume of 50 mL. Infuse at 0.25 mL/hr with syringe pump. Pediatric dosage range: 0.02 to 0.25 mcg/kg/min. Drug available: terbutaline 1 mg/mL.
a. Concentration per minute?
b. Concentration per hour?
c. Concentration of solution?
d. Infusion rate?
e. Drug order?

Answer 2

a. 21 kg x 0.1 mcg/kg/min = 2.1 mcg/min
b. 2.1 mcg/min x 60 min/hr = 126 mcg/hr = 0.126 mg/hr
c. 25 mg : 50 mL = x mL
50x = 25
x = 0.5 mg/1 mL
d.
e.
25 mL terbutaline added to 25 mL of D₅W to make total volume of 50 mL.

Question 3

A 7-year-old child with pulmonary embolism.Child weighs 20 kg. Order: heparin 25 units/kg/hr using a premixed bag with a standard concentration of 200 units/mL. Run at 2.5 mL/hr with IV pump. Pediatric dosage range: 15 to 25 units/kg/hr. Drug available: heparin 50,000 units/250 mL.
a. Concentration per hour?
b. Concentration of solution?
c. Infusion rate?
d. Drug order?

Answer 3

a. 20 kg x 25 units/kg/hr = 500 units/hr
b. 50,000 units : 250 mL = x units : 1 mL
250x = 50,000
x = 200 units/hr and
c.
d. Premixed bag of heparin 50,000 units/250 mL.

Question 4

A 1-year-old child with hypotensive septic shock.Child weighs 9 kg. Order: dopamine 5 mcg/kg/min. Dilute 40 mg dopamine in 49.5 mL D₅W to make a total volume of 50 mL. Infuse at 3.4 mL/hr with syringe pump. Pediatric dosage range: 2 to 20 mcg/kg/min. Drug available: dopamine 400 mg/5 mL.
a. Concentration per minute?
b. Concentration per hour?
c. Concentration of solution?
d. Infusion rate, volume per hour?
e. Drug order?

Question 5

A 9-year-old child who is intubated postoperatively.Child weighs 30 kg. Order: fentanyl 0.03 mcg/kg/min. Dilute 2.5 mg fentanyl in 30 mL 0.9% normal saline to make a total volume of 50 mL. Infuse at 1 mL/hr with syringe pump. Pediatric dosage range: 0.01 to 0.05 mcg/kg/min. Drug available: fentanyl 2.5 mg/20 mL.
a. Concentration per minute?
b. Concentration per hour?
c. Concentration of solution?
d. Infusion rate, volume per hour?
e. Drug order?

Question 6

A 9-year-old-child, weight 24 kg, with septic shock. Order: dobutamine 10 mcg/kg/min; titrate to keep MAP >65. Dilute as follows: dobutamine 200 mg in D₅W to make a total volume of 50 mL for a syringe pump. Pediatric dosage: 2 to 20 mcg/kg/min. Drug available: dobutamine 250 mg/20 mL
a. Drug order per hour
b. Drug rate per hour
c. Drug concentration
d. Drug order

Question 7

A 3-year-old child with hypertension related to a tumor.Child weighs 16 kg. Order: sodium nitroprusside 2 mcg/kg/min. Dilute 50 mg nitroprusside in 45 mL D₅W to make a total volume of 50 mL. Infuse at 3 mL/hr with syringe pump. Pediatric dosage range: 200 to 500 mcg/kg/hr. Drug available: sodium nitroprusside 50 mg/5 mL
a. What is the concentration per hour?
b. What is the mL per hour?
c. Drug order

Question 8

A 2-day-old child with patent ductus arteriosus.Child weighs 3.4 kg. Order: alprostadil 0.1 mcg/kg/min. Dilute 0.1 mg of alprostadil in 50 mL D₅W to run at 2 mL/hr with syringe pump. Pediatric dosage range: 0.05 to 0.1 mcg/kg/min. Drug available: alprostadil 500 mcg/mL
a. Concentration per minute
b. Concentration per hour
c. Concentration of solution
d. Is the order safe to give, if so confirm drug order.

Question 9

A 10-year-old child with diabetic ketoacidosis.Child weighs 32 kg. Order: regular insulin 0.001 units/kg/min. Dilute: regular Humulin insulin 50 units in 49.5 mL 0.9% saline, total volume 50 mL using syringe pump at 1 mL per hour. Pediatric dosage: 0.001 units/kg/hr. Drug available: regular insulin 100 units/mL.
a. Concentration per minute
b. Concentration per hour
c. Concentration of solution
d. Is the order safe to give, if so confirm drug order.