Pediatric Urology Database

Jeffrey A. Stock

I. INTRAVENOUS FLUID THERAPY

A. Maintenance of Normal Kidney Function

1. Fluid requirements

a. Method to estimate daily maintenance rate of fluid

(1) First 10 kg body weight: 100 mL/kg per day

(2) Second 10 kg body weight: 50 mL/kg per day

(3) Third 10 kg body weight and beyond: 25 mL/kg per day

(4) Example 1: A 3-kg infant requires 300 mL fluid per day

(5) Example 2: A 13-kg child requires 1,150 mL fluid per day (1000 + 150 mL)

(6) Example 3: A 40-kg adolescent requires 2,000 mL fluid per day (1,000 + 500 + 500 mL)

b. Method to estimate hourly maintenance rate of fluid

(1) First 10 kg body weight: 4 mL/kg per hour

(2) Second 10 kg body weight: 2 mL/kg per hour

(3) Third 10 kg body weight and beyond: 1 mL/kg per hour

(4) Example 1: A 3-kg infant requires 12 mL per hour (3 kg × 4 mL/kg/h = 12 mL/h)

(5) Example 2: A 13-kg child requires 46 mL per hour [(10 kg × 4 mL/kg/h) + (3 kg × 2 mL/kg/h) = 46 mL/h]

(6) Example 3: A 40-kg adolescent requires 80 mL per hour: [(10 kg × 4 mL/kg/h) + (10 kg × 2 mL/kg/h) + (20 kg × 1 mL/kg/h) = 80 mL/h)]

2. Electrolyte requirements

a. Na+: 50 mEq/m² per day or 3 to 4 mEq/kg per day

b. K+: 20 mEq/m² per day or 2 mEq/kg per day

3. Appropriate solution: The most appropriate solution for routine fluid therapy in postoperative patients is Lactated Ringers (LR).

4. Losses: Losses (e.g., nasogastric suction) must be replaced accurately. Children are best followed up for dehydration by monitoring urine output. If the urine output is between 1 and 2 mL/kg per hour, the appropriate amount of fluid is probably being given.

II. PEDIATRIC UROLOGY FORMULARY

The information provided is not comprehensive. Please consult a more complete reference before using medications with which you are unfamiliar. (Please note that in the “Supplied As” category, the unit quantity in which a drug is supplied is noted in parentheses after the drug concentration; Table 33-1.)

TABLE 33-1 Pediatric Dosages

Drug			Dose			Supplied As
Analgesics
Acetaminophen (Tylenol)			10-15 mg/kg/dose Q4-6 h PO			Tabs: 160, 325, 500, 650 mg Chewable tabs: 80 mg Drops: 80 mg/0.8 mL Elixir: 120, 130, 160, 325 mg/5 mL Caplets: 160, 325, 500 mg Suppositories: 120, 125, 300, 325, 650 mg
Acetaminophen (Ofirmev)			Infants and children <2 y: limited data available: 7.5-15 mg/kg/dose every 6 h; maximum daily dose: 60 mg/kg/day (Wilson-Smith, 2009) Children ≥2 y and adolescents: <50 kg: 15 mg/kg/dose every 6 h or 12.5 mg/kg/dose every 4 h; maximum single dose: 15 mg/kg up to 750 mg; maximum daily dose: 75 mg/kg/day not to exceed 3,750 mg/day ≥50 kg: 1,000 mg every 6 h or 650 mg every 4 h; maximum single dose: 1,000 mg; maximum daily dose: 4,000 mg/day			Injectable
	NOTE:	Contraindicated in patients with glucose-6-phosphate dehydrogenase deficiency. Do not exceed five doses per 24 h. Modify dose in patients with renal impairment.
Acetaminophen and codeine (Tylenol with codeine)			Dose based on codeine component: 0.5-1.0 mg/kg/dose Q4-6 h PO			Elixir: acetaminophen 120 mg and codeine 12 mg/5 mL with alcohol 7% Suspension, oral, alcohol-free: acetaminophen 120 mg and codeine 12 mg/5 mL Tabs: Tylenol No. 1: acetaminophen 300 mg + codeine 7.5 mg Tylenol No. 2: acetaminophen 300 mg + codeine 15 mg Tylenol No. 3: acetaminophen 300 mg + codeine 30 mg Tylenol No. 4: acetaminophen 300 mg + codeine 40 mg
Ibuprofen (Motrin, Advil)			4-10 mg/kg/dose Q6-8 h PO			Suspension: 100 mg/5 mL Tabs: 200, 300, 400, 600, 800 mg
	NOTE:	Use with caution in patients with aspirin hypersensitivity, hepatic/renal insufficiency, or GI disease (bleeding or ulcers). IM, IV: 0.5 mg/kg every 6 h; maximum dose: 30 mg/dose, usual reported duration: 48-72 h; not to exceed 5 days of treatment
Ketorolac (Toradol) NOTE: Use is contraindicated in patients with advanced renal impairment or patients at risk for renal failure due to volume depletion.						Injectable
Morphine sulfate			Neonates: 0.05-0.2 mg/kg/dose IM/IV Q4h Children: 0.1-0.2 mg/kg/dose IM/IV Q2-4 h			Injectable
	NOTE:	May cause respiratory and central nervous system depression. Nalaxone 0.01 mg/kg may be used to reverse effects; repeat every 2-3 min as needed, based on response.
Local anesthetics
Bupivacaine (Marcaine)			Maximum dose: 2.5 mg/kg (plain), 3.0 mg/kg (with epinephrine 1:200,000)			0.25% solution = 2.5 mg/mL
Lidocaine			Maximum dose: 4.5 mg/kg/dose (plain), 7 mg/kg/dose (with epinephrine 1:200,000)			1% solution = 10 mg/mL
Antibiotics
Amikacin (Amikin)			Neonates: 75 mg/kg/dose IV/IM Dosing interval:			Injectable
				Postnatal age
			Gestational age	<7 d	>7 d
			<28 wk	Q24h	Q18h
			28-34 wk	Q18h	Q12h
			>34 wk	Q12h	Q8h
			Children: 15-22.5 mg/kg/24 h ÷ Q8-12 h IV/IM
	NOTE:	Therapeutic levels: 20-30 µg/L (peak); 5-10 µg/L (trough). Infusion rate: infants: 1-2 h; children: 30-60 min. Modify dose in patients with renal impairment.
Amoxicillin (Amoxil)			20-50 mg/kg/24 h ÷ Q8h PO UTI prophylaxis: 25 mg/kg QD			Drops: 50 mg/mL (15, 30 mL) Suspension: 125, 250 mg/5 mL (80, 100, 150, 200 mL) Caps: 250, 500 mg Chewable tabs: 125, 250 mg
	NOTE:	Modify dose in patients with renal impairment.
Amoxicillin-clavulanic acid (Augmentin)			<40 kg: 20-40 mg/kg/24h ÷ Q8h PO >40 kg: 250-500 mg Q8h PO			Tabs: 250, 500 mg Chewable tabs: 125, 250 mg Suspension: 125, 250 mg/5 mL (75, 150 mL)
	NOTE:	Incidence of diarrhea is higher than with use of amoxicillin alone. Modify dose in patients with renal impairment.
Ampicillin			Neonates: Postnatal age <7 d: <2,000 g: 50 mg/kg/24 h ÷ Q12h IM/IV >2,000 g: 75 mg/kg/24 h ÷ Q8h IM/IV Postnatal age >7 d: <2,000 g: 75 mg/kg/24 h ÷ Q8h IM/IV >2,000 g: 100 mg/kg/24 h ÷ Q6h IM/IV Infants and children: 50-100 mg/kg/24 h ÷ Q6h IM/IV/PO			Drops: 100 mg/mL (20 mL) Suspension: 125, 250 mg/5 mg (80, 100, 150, 200 mL), 500 mg/5 mL (100 mL) Caps: 250, 500 mg Injectable
	NOTE:	Modify dose in patients with renal impairment.
Aztreonam (Azactam)			Neonates: Postnatal age <7 d: <2,000 g: 60 mg/kg/24 h ÷ Q12h IM/IV >2,000 g: 90 mg/kg/24 h ÷ Q8h IM/IV Postnatal age >7 d: <2,000 g: 90 mg/kg/24 h ÷ Q8h IM/IV >2,000 g: 120 mg/kg/24 h ÷ Q6h IM/IV Children >1 mo: 90-120 mg/kg/24 h ÷ Q6-8h IM/IV			Injectable
	NOTE:	Reduce dose in patients with cystic fibrosis. Modify dose in patients with renal impairment.
Cefazolin (Ancef) (1st generation)			Neonates: Postnatal age <7 d: 40 mg/kg/24 h ÷ Q12h Postnatal age >7 d: <2,000 g 40 mg/kg/d ÷ Q12h >2,000 g 60 mg/kg/d ÷ Q8h Infants (>1 mo) and children: 50-100 mg/kg/24 h ÷ Q8h			Injectable
	NOTE:	Modify dose in patients with renal impairment.
Ceftriaxone (Rocephin) (3rd generation)			Infants and children: 50-75 mg/kg/24 h ÷ Q12-24h IM/IV Adults: 1-4 g/24 h ÷ Q12-24h IM/IV			Injectable
Cephalexin (Keflex) (1st generation)			Children: 25-100 mg/kg/24 h ÷ Q6h PO Adults: 250-500 mg Q6h PO			Caps: 250, 500 mg Drops: 100 mg/mL (10 mL) Suspension: 125 mg/5 mL (50, 60, 100, 200 mL), 250 mg/5 mL (5, 100, 200 mL) Tabs: 250, 500, 1,000 mg
	NOTE:	Modify doses in patients with renal impairment.
Ciprofloxacin (Cipro)			20-30 mg/kg/24 h ÷ Q12h IV/PO			Tabs: 250, 500, 750 mg Injection: 200 mg/20 mL
	NOTE:	Not recommended for children <16-18 y. Modify doses in patients with renal impairment. Box warning: Fluoroquinolones have been associated with disabling and potentially irreversible serious adverse reactions that have occurred together, including tendinitis and tendon rupture, peripheral neuropathy, and CNS effects. Discontinue ciprofloxacin immediately and avoid the use of fluoroquinolones in patients who experience any of these serious adverse reactions. Because fluoroquinolones have been associated with serious adverse reactions, reserve ciprofloxacin for use in patients who have no alternative treatment options for the following indications: acute exacerbation of chronic bronchitis, acute sinusitis, and acute uncomplicated cystitis.
Gentamicin			Neonates: 2.5 mg/kg/dose IV/IM Dosing interval:			Injectable
				Postnatal age
			Gestational age	<7 d	>7 d
			<28 wk	Q24h	Q18h
			28-34 wk	Q18h	Q12h
			>34 wk	Q12h	Q8h
			Children: 6-7.5 mg/kg/24 h ÷ Q8h IV/IM
			Adults: 3-5 mg/kg/d ÷ Q8h IV/IM
	NOTE:	Therapeutic levels: 6-10 µg/L (peak); <2 µg/L (trough). Modify dose in patients with renal impairment.
Metronidazole (Flagyl)			Anaerobic infections: 30 mg/kg/d ÷ Q6h IV/PO Clostridium difficile infection: 20 mg/kg/d ÷ Q6h PO			Tabs: 250, 500 mg Injectable
Nitrofurantoin (Furadantin, Macrodantin)			Children >1 mo: 5-7 mg/kg/24 h ÷ Q6h PO Prophylaxis: 1-2 mg/kg/QD			Suspension: 25 mg/5 mL Tabs: 50, 100 mg Caps: 25, 50, 100 mg
	NOTE:	Contraindicated in infants <1 month of age. Modify dose in patients with renal impairment.
Trimethoprim (TMP)-sulfamethoxazole (Septra)			Dose based on TMP component: 8-10 mg/kg/24 h ÷ Q12h PO Prophylaxis: 2 mg/kg/24 h QD			Suspension: 40 mg TMP per 5 mL (20, 100, 150, 200, 480 mL) Tabs: 80 mg TMP (single strength [SS]), 160 mg TMP (double strength [DS])
	NOTE:	May cause kernicterus in newborns. Modify dose in patients with renal impairment.
Tobramycin (Tobrex)			Neonates: 2.5 mg/kg/dose IV/IM Dosing interval:			Injectable
				Postnatal age
			Gestational age	<7 d	>7 d
			<28 wk	Q24h	Q18h
			28-34 wk	Q18h	Q12h
			>34 wk	Q12h	Q8h
			Children: 6-7.5 mg/kg/24 h ÷ Q8h IV/IM Adults: 3-5 mg/kg/24 h ÷ Q8h IV/IM
	NOTE:	Therapeutic levels: 6-10 µg/L (peak); <2 µg/L (trough). Modify dose in patients with renal impairment.
Antifungal drugs
Amphotericin B (Fungizone)			Bladder irrigation: 15-50 mg/d in 1 L sterile water or sorbitol/mannitol irrigation instilled over 24 h Infants and children: Test dose: 0.1 mg/kg/dose IV to a maximum of 1 mg; infuse over 30-60 min. Initial therapeutic dose (if test dose is tolerated): 0.25 mg/kg. The daily dose can then be gradually increased, usually in 0.25 mg/kg increments each subsequent day until the desired dose is reached. Maintenance dose: 0.25-1 mg/kg/d QD, infuse over 2-6 h.			Injectable
	NOTE:	Modify dose in patients with renal impairment.
Fluconazole (Diflucan)			Children (3-13 y): Loading dose: 10 mg/kg IV/PO			Tabs: 50, 100, 200 mg
			Maintenance (begin 24 h after loading dose): 3-6 mg/kg/24 h IV/PO QD			Injectable
	NOTE:	PO and IV doses are equivalent. Modify dose in patients with renal impairment.
Flucytosine (5-FC)			Neonates: 20-40 mg/kg/dose Q6h PO Children and adults: 50-150 mg/kg/d ÷ Q6h PO			Caps: 250, 500 mg
	NOTE:	Modify dose in patients with renal impairment.
Antiemetics
Ondansetron (Zofran)			Children >3 y: 0.15 mg/kg/dose IV Q4h			Injectable
	NOTE:	Decreased effectiveness has been reported when administered for more than 3 doses.
Prochlorperazine (Compazine)			Oral, rectal: 0.4 mg/kg/24 h ÷ Q6-8h PO/PR IM: 0.1-0.15 mg/kg/dose TID			Injectable Tabs: 5, 10, 25 mg Syrup: 5 mg/5 mL (120 mL) Suppository: 2.5, 5, 25 mg
	NOTE:	Safety and efficacy have not been established in children <9 kg or <2 y of age.
Trimethobenzamide (Tigan)			Children: Oral, rectal: 15-20 mg/kg/d ÷ 3-4 doses IM: Not recommended Adults: Oral: 250 mg 3-4 times/24 h IM, rectal: 200 mg 3-4 times/24 h			Injectable Caps: 100, 250 mg Suppository: 100, 200 mg
	NOTE:	Contraindicated in neonates and premature infants.
Anti-enuresis drugs
Desmopressin acetate (DDAVP)			Nocturnal enuresis (>6 y): 20 µg at bedtime intranasally Range 10-40 µg			Spray: 5-mL bottle with spray pump delivering 50 doses of 10 µg
Imipramine (Tofranil)			Nocturnal enuresis (>6 y): Initial: 10-25 mg QHS PO Increment: 10-25 mg/dose at 1-2 wk intervals until maximal dose for age or desired effect achieved			Tabs: 10, 25, 50 mg Caps: 75, 100, 125, 150 mg
	NOTE:	Maximal dose: 6-12 y: 50 mg/24 h; 12-14 y: 75 mg/24 h or 2 mg/kg/d. Boxed warning: Antidepressants increased the risk compared with placebo of suicidal thinking and behavior (suicidality) in short-term studies in children, adolescents, and young adults with major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of imipramine or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults older than 24 years; there was a reduction in risk with antidepressants compared with placebo in adults 65 years and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the health care provider. Imipramine is not approved for use in pediatric patients except for patients with nocturnal enuresis.
Bladder analgesics
Phenazopyridine (Pyridium)			Children 6-12 y: 12 mg/kg/24 h ÷ TID			Tabs: 100, 200 mg
	NOTE:	Colors urine orange, may also stain contact lenses and clothing.
Histamine₂ blockers
Cimetidine (Tagamet)			Neonates: 5-10 mg/kg/d ÷ Q8-12h PO/IV/IM Infants: 10-20 mg/kg/d ÷ Q6-12h PO/IV/IM Children: 20-30 mg/kg/d ÷ Q6h PO/IV/IM Adults: 300 mg/dose Q6h PO/IV/IM, 400 mg/dose Q12h, or 800 mg/dose QHS			Tabs: 200, 300, 400, 800 mg Syrup: 300 mg/5 mL (237 mL) Injectable
	NOTE:	Modify dose in patients with renal impairment.
Ranitidine (Zantac)			PO: 2-4 mg/kg/24 h ÷ Q12h IV: 1-2 mg/kg/24 h ÷ Q8-8h			Tabs: 150, 300 mg Syrup: 15 mg/mL (7.5% alcohol)
	NOTE:	Modify dose in patients with renal impairment.
Drug therapy for neurogenic bladder dysfunction Anticholinergic
Hyoscyamine (Levsin)			SL tabs: Children 2-12 y: 1/2 to 1 tab Q4h. Do not exceed 6 tabs in 24 h 12 y of age and older: 1-2 tabs Q4h. Do not exceed 12 tabs in 24 h or 0.03 mg/kg BID-0.1 mg/kg QID			SL tabs: 0.125 mg
Oxybutynin (Ditropan)			Children <5 y: age in y = mL per dose BID/TID >5 y: 0.2 mg/kg BID-QID			Tabs: 5 mg Syrup: 5 mg/5 mL (473 mL)
Propantheline (Pro-Banthine)			0.5 mg/kg BID-QID			Tab: 7.5, 15 mg
Sympathomimetic
Pseudoephedrine (Sudafed)			0.4 mg/kg BID-0.9 mg/kg TID			Tabs: 30, 60 mg Liquid: 15 mg/5 mL (120 mL), 30 mg/5 mL (120 mL, 240 mL, 473 mL)
Sympatholytic
Tamsulosin (Flomax) Children >3 y: Initial dose 0.2 mg once daily, increase by 0.2 mg increments based on response (symptoms and urodynamic studies) and tolerability. Maximum reported daily dose 0.8mg/day
						Caps: 0.4 mg
Hormonal treatment of retractile testes
Chorionic gonadotropin (Pregnyl)			50 USP U/kg IM Q5d × 5 doses			Injectable
	NOTE:	Maximal single dose 2,000 USP U. Maximal total dose 10,000 USP U.
Cathartics
Bisacodyl (Dulcolax)			Oral: Children 3-12 y: 5-10 mg or 0.3 mg/kg/d as a single dose Suppository: Children <2 y: 5 mg/d as a single dose Children 2-11 y: 5-10 mg/d as a single dose			Tabs: 5 mg Suppository: 5, 10 mg
Docusate (Colace)			<3 y: 10-40 mg/24 h ÷ QD-QID 3-6 y: 20-60 mg/24 h ÷ QD-QID 6-12 y: 40-120 mg/24 h ÷ QD-QID >12 y: 50-500 mg/24 h ÷ QD-QID			Caps: 50, 100, 240, 250, 300 mg Tabs: 50, 100 mg Syrup: 20 mg/5 mL (240 mL)
Mineral oil Polyethylene glycol (Miralax)			5-11 y: 5-20 mL QD >12 y: 15-45 mL QD 0.2-0.8 g/kg/d, maximum dose 17 g/d			Emulsion: 1.4 g/5 mL (480 mL), 2.5 mL/5 mL (420 mL), 2.75 mL/5 mL (480 mL), 4.75 mL/5 mL (240 mL) Liquid: 500, 1000, 4000 mL
Senna (Senokot)			Oral: Children: 10-20 mg/kg/dose at bedtime Rectal: Children >27 kg: 1/2 suppository at bedtime			Granules: 325 mg/teaspoonful Liquid: 7% (130 mL, 360 mL), 6.5% (75 mg, 150 mL) Syrup: 218 mg/5 mL (60 mL, 240 mL) Tab: 187, 217, 600 mg Suppository rectal: 652 mg
	NOTE:	Maximal dose = 872 mg.
From Stock JA, Packer MG, Kaplan GW. Pediatric urology facts and figures: data useful in the management of pediatric urologic patients. Urol Clin N Am 1995;22:205-219.