Paediatric Emergency Drug Dose Reference

Paediatric emergency dosing from one weight

In a paediatric resuscitation, almost every drug is weight-based, and doing the maths under pressure is where errors creep in. This reference takes the child’s weight once and instantly produces a full table of doses and draw-up volumes for the common arrest, seizure and rapid-sequence-intubation drugs, following APLS and Resuscitation Council UK guidance.

How it works

Each drug stores a per-kilogram dose, an adult maximum cap, and where relevant a standard ampoule concentration. For a given weight the tool computes:

dose   = per_kg_dose × weight   (capped at the adult maximum)
volume = dose ÷ concentration   (when a standard concentration exists)

For example, cardiac-arrest adrenaline is 10 mcg/kg of 1:10,000 (100 mcg/mL), so an 18 kg child needs 180 mcg, drawn up as 1.8 mL. Adenosine, atropine, amiodarone, lorazepam, midazolam, ketamine, suxamethonium, rocuronium, dextrose, bicarbonate, calcium, salbutamol, hydrocortisone, mannitol and fluid boluses are all handled the same way.

Why weight-based calculation errors happen in emergencies

Paediatric drug dosing is more complex than adult dosing because:

• There is no standard dose — every drug dose changes with the child’s weight
• The same drug comes in different concentrations for different age groups
• Mental arithmetic under stress is unreliable, especially for unfamiliar weight ranges
• An error of a factor of ten (mcg vs. mg, 0.1 mL vs. 1 mL) is easy to make and potentially catastrophic

Pre-calculating everything from a single entered weight removes the arithmetic step entirely and replaces it with a verification step — which is far less error-prone under pressure.

How the volume calculation works

For drugs with a single standard ampoule concentration, volume is:

volume (mL) = dose ÷ concentration

For cardiac-arrest adrenaline at 1:10,000 (which contains 100 mcg per mL): a 15 kg child needs 150 mcg, which is 1.5 mL drawn straight from a 1:10,000 ampoule. The tool shows this in the table so the team member drawing up the drug does not need to calculate it separately.

Where no single standard concentration exists — for drugs that come in multiple strengths or are mixed to a weight-based infusion rate — the volume column shows a dash and the dose alone is shown for the prescriber to specify the preparation.

The adult maximum cap

Several paediatric weight-based calculations produce doses that would exceed the safe adult maximum if the child is large. For example, adenosine at 100 mcg/kg in a 60 kg adolescent would compute to 6 mg, but the adult maximum for a single dose is lower. The calculator applies the cap and marks the row with max so the clinician knows the displayed dose is the ceiling, not the weight-based calculation.

This is particularly important for adolescents and larger children whose weight falls between typical paediatric and adult reference ranges.

Measured vs. estimated weight

The most accurate input is a measured weight in kg. When a measured weight is not available — in a pre-hospital setting or an unconscious child brought in by emergency services — an age-based estimate using a validated formula (such as the APLS formula for UK practice) can be used as a temporary starting point. Weight estimates carry meaningful uncertainty and should be replaced with a measured value at the earliest opportunity.

Notes and safety

Doses are rounded for readability and the max label marks any value that has hit its adult ceiling — important for larger adolescents. Use a measured weight whenever possible; age-based estimates are a fallback, not a substitute.

This tool is a quick reference to reduce calculation load, not a prescribing authority. Always confirm against your local formulary, apply a second checker, and account for patient-specific factors before any drug is given. This reference follows APLS and Resuscitation Council UK guidance — local protocols may differ.