Pediatric Emergency Drug Dosing
Weight-based emergency drug dosing for PALS resuscitation, RSI, and dextrose.
Verify against your local protocol and Broselow tape zone. Doses from AHA 2020 PALS and WikEM.
[!WARNING] These doses have not been verified against the 2025 AHA/AAP PALS guideline (PMID 411228852025 AHA/AAP PALS Guideline · 2025 · Circulation2025 AHA/AAP pediatric advanced life support guideline covering prearrest, intra-arrest, and post-cardiac arrest care for infants and children up to 18 years (excluding newborns).View source ↗). The 2025 guideline supersedes 2020. Confirm each dose against the current guideline before clinical application. See Pediatric Resuscitation for the 2025 key changes summary.
PALS Resuscitation Drugs
| Drug | Dose | Max | Notes |
|---|---|---|---|
| Epinephrine (1:10,000) | 0.01 mg/kg IV/IO (0.1 mL/kg) | 1 mg | q3-5 min; first-line for PEA/asystole; also before third shock in VF/pVT |
| Amiodarone | 5 mg/kg IV/IO | 300 mg per dose, 15 mg/kg cumulative | May repeat up to 2 times for shock-refractory VF/pVT |
| Lidocaine | 1 mg/kg IV/IO | 100 mg | Alternative to amiodarone for VF/pVT |
| Adenosine | 0.1 mg/kg IV fast push, then 0.2 mg/kg | 6 mg, then 12 mg | For SVT conversion; give second dose if first fails |
| Calcium gluconate (10%) | 100 mg/kg IV/IO (1 mL/kg) | — | For hyperkalemia, hypocalcemia, calcium channel blocker overdose |
| Calcium chloride (10%) | 20 mg/kg IV/IO (0.2 mL/kg) | — | About 3 times more elemental calcium per mL than gluconate |
| Magnesium sulfate | 25-50 mg/kg IV/IO | 2 g | For torsades de pointes; also severe asthma adjunct |
| Sodium bicarbonate (8.4%) | 1 mEq/kg IV/IO | 50 mEq | For hyperkalemia, prolonged arrest, metabolic acidosis; use 0.5 mEq/mL (4.2%) for infants below 1 yo |
| Atropine | 0.02 mg/kg IV/IO | 0.5 mg per dose, 1 mg total | For bradycardia with vagal excess; minimum dose 0.1 mg to avoid paradoxical bradycardia |
| Naloxone | 0.1 mg/kg IV/IO | 2 mg | For opioid overdose; may repeat; may give IM if no IV |
RSI Medications
| Drug | Dose | Notes |
|---|---|---|
| Ketamine | 1-2 mg/kg IV (3-5 mg/kg IM) | Preferred induction for hypotension/shock; dissociative; maintains HR/BP |
| Etomidate | 0.2-0.3 mg/kg IV | Hemodynamically neutral; brief adrenal suppression; single dose rarely clinically significant |
| Rocuronium | 1-1.2 mg/kg IV | RSI dose; rapid onset ~45-60 sec; duration ~30-40 min; no histamine release; sugammadex reversal available |
| Succinylcholine | 1.5-2 mg/kg IV (4 mg/kg IM) | Onset ~30-45 sec; duration ~4-6 min; avoid in hyperkalemia, malignant hyperthermia, myopathy, burns >24 h, crush injury, denervation |
| Atropine pre-treatment | 0.02 mg/kg IV (minimum 0.1 mg, max 0.5 mg) | Prevents vagal bradycardia during laryngoscopy in infants below 1 yo; also reduces oral secretions |
| Midazolam | 0.1-0.3 mg/kg IV | Less preferred for RSI; slower onset; adjunctive sedation only |
| Fentanyl | 1-2 mcg/kg IV | Blunts laryngoscopy response; chest wall rigidity risk with rapid high-dose push |
Defibrillation and Cardioversion Energy
| Intervention | Initial Dose | Escalation | Max |
|---|---|---|---|
| Defibrillation (VF/pVT, pulseless) | 2 J/kg | Second shock 4 J/kg; subsequent shocks at least 4 J/kg | 10 J/kg or adult max dose |
| Synchronized cardioversion | 0.5-1 J/kg | 2 J/kg if needed | — |
Broselow Tape Color Zones
Length-based weight estimation. Use actual body weight when known. If a child appears overweight, consider one zone up for drug dosing only, not for equipment.
| Color | Weight (kg) |
|---|---|
| Grey | 3-5 |
| Pink | 6-7 |
| Red | 8-9 |
| Purple | 10-11 |
| Yellow | 12-14 |
| White | 15-18 |
| Blue | 19-23 |
| Orange | 24-29 |
| Green | 30-36 |
Dextrose Rule of 50s
See the dedicated Hypoglycemia in Pediatrics page for full context. Dextrose dosing by age:
| Age | Dose | Fluid |
|---|---|---|
| Below 1 yo (Infant) | 5 mL/kg | D10 |
| 1-8 yo (Pediatric) | 2 mL/kg | D25 |
| Above 8 yo (Adult) | 1 mL/kg | D50 |
For neonatal dosing and glucose infusion rate calculations, see NICU and Neonatal references.