Pediatric Urology Database



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.

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Sep 29, 2018 | Posted by in UROLOGY | Comments Off on Pediatric Urology Database

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