A pharmacist's guide to pediatric dosing

Another amazing update from our emergency department pharmacists:

Some more fun pediatric math facts:

Have you ever wondered why the dosing for pediatric medication is often per every 5 milliliters? It's because one teaspoon, a standard unit of measurement in practically every home, holds 4.92892 milliliters (in other words, five). So in every teaspoon of standard pediatric acetaminophen, there are 160 milligrams. In every teaspoon of standard pediatric ibuprofen, there are 100 milligrams.

And we all know the calculation for standard uncuffed endotracheal tube:

uncuffed endotracheal tube size = 4 + age/4

But take that two, three, and four steps further and you get this:

foley/OGtube/NGtube = uncuffed endotracheal tube x 2

estimated depth of ETT = uncuffed endotracheal tube x 3*

chest tube = uncuffed endotracheal tube x 4

As per our previous pharmacist guide, I made a fun, extremely redundant crossword puzzle to help bring the points home. Enjoy!

Peds dosing crossword

Peds dosing crossword key

* This is the traditional equation to measure endotracheal tube depth, but has been found to underestimate appropriate depth by 50%, so always verify with chest x-ray, end tidal CO2, and auscultation.


Thanks to Chilla, @ChillaPharmD, for sharing her amazing educational resources

Koshy T, Misra S, Chatterjee N, Dharan BS. Accuracy of a Chest x-ray-based method for predicting the depth of insertion of endotracheal tubes in pediatric patients undergoing cardiac surgery. J cardiothoracic and Vascular Anesthesia 2016, 30(4):947-53.

Young TP et al. Finger counting: an alternative method for estimating pediatric weights. Am J of Emergency Medicine 2014 Mar;32(3):243-7

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