Paeds Cases · clinical-pharmacology-and-therapeutics
Weigh it, cap it, check it — weight-based dosing and dose calculation
A bedside structured clinical encounter testing the safe calculation and verification of a paediatric drug dose: obtaining a measured weight and height, choosing between weight-based and body-surface-area dosing, working the Mosteller formula, applying the maximum adult-dose cap, applying the leading-zero and no-trailing-zero writing rules, arranging an independent double check, and running the therapeutic drug monitoring loop for a level-guided antimicrobial, alongside clear communication with the family.
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Setting the scene
Role: You are the paediatric registrar leading the prescribing for a seven-year-old admitted to a regional ward. The nurse preparing the first intravenous dose has paused because the order looks large for the child's size. Your task is to recalculate the dose from the beginning, apply every safety check, and communicate the corrected plan to the team and the family. [2] [3]
References5ShowHide
- [1]El Edelbi R, Lindemalm S, Eksborg S Estimation of body surface area in various childhood ages--validation of the Mosteller formula Acta Paediatrica, 2012.PMID 22211780
- [2]Hirata KM, Kang AH, Ramirez GV, et al. Pediatric Weight Errors and Resultant Medication Dosing Errors in the Emergency Department Pediatric Emergency Care, 2019.PMID 28976456
- [3]Lesar TS Tenfold medication dose prescribing errors Annals of Pharmacotherapy, 2002.PMID 12452740
- [7]McNeil JC, Kaplan SL Vancomycin Therapeutic Drug Monitoring in Children: New Recommendations, Similar Challenges Journal of Pediatric Pharmacology and Therapeutics, 2020.PMID 32839650
- [8]Rybak MJ, Le J, Lodise TP, et al. Therapeutic Monitoring of Vancomycin for Serious Methicillin-resistant Staphylococcus aureus Infections: A Revised Consensus Guideline and Review by the American Society of Health-system Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists Clinical Infectious Diseases, 2020.PMID 32658968