ICU Medications
Adrenaline (epinephrine) Amiodarone Atropine Dexamethasone Dobutamine Furosemide Glycopyrrolate Hydrocortisone IVIG (Intravenous polyvalent human immune globulin.) Labetalol Lidocaine (Lignocaine) Magnesium sulphate Salbutamol Drugs given in ICU are often diluted and given as an infusion. It is essential that one considers intravenous fluids to be drugs and as such need to consider compatibility
IVIG (Intravenous polyvalent human immune globulin.)
Drugs given in ICU are often diluted and given as an infusion. It is essential that one considers intravenous fluids to be drugs and as such need to consider compatibility with other medications, role of ambient light, temperature and stability of drugs once diluted, characteristics of diluents and the physical characteristics of the infusion set.
Adrenaline (epinephrine)
| Composition | 1 mg/mL ampule, clear fluid. |
|
Pharmacological action/ Indications |
Vasopressor, inotrope, shock, anaphylaxis, cardiac arrest, upper airway obstruction. |
| Route of admin. |
Continuous IV infusion via a central line; IM, for anaphylaxis; nebulized for upper airway obstruction. |
| Dose | 0.05–1 μg/kg/min, IV, (titrated to effect). 0.01 mg/kg, IV, for cardiac arrest. 0.01 mg/kg (maximum0.5 mg), IM, for anaphylaxis. 2–5 mL (1 mg/mL) for nebulization. |
| Compatible fluids | Normal saline 0.9%, 5% dextrose saline, 5% dextrose water. |
Amiodarone
| Composition | 150 mg/ 3 mL (50 mg/mL), clear pale yellow fluid. |
|
Pharmacological action/ Indications |
Specific tachydysrhythmias (refractory SVTs and VTs). |
| Route of admin. |
IV infusion, preferably via a central line |
| Dose | Emergency (VT/VF): 5 mg/kg, IV, bolus over 3 minutes (maximum 300 mg bolus dose). Other arrhythmias: Initial dose: 5 mg/kg (150 mg + 7 mL of 5% dextrose water = 10 mL, so 15 mg/mL) over 20–60 minutes; maximum 300 mg. Infusion: 10 mg/kg over 24 hours with maximum daily dose of 15 mg/kg over 24 hours. |
| Compatible fluids | 5% dextrose water only. |
| Incompatible fluids/drugs | Normal saline, sodium bicarbonate. |
Atropine
| Composition | 0.5 mg/mL; 1 mg/mL. |
|
Pharmacological action/ Indications |
Cholinergic causes of bradycardias, organophosphate/ carbonate poisoning. |
| Route of admin. |
IV infusion, IV bolus. |
| Dose | Bolus: 0.02 mg/kg Infusions: 1 mg into 9 mL of normal saline giving a concentration of 0.1 mg/mL and the rediluted 1 mL of this solution into 9 mL normal saline giving a concentration of 0.02 mg/mL and give at a rate of 0.012 – 0.1 mg/kg/hour. |
Dexamethasone
| Composition | 4 mg/1 mL vial |
|
Pharmacological action/ Indications |
Allergic and anti-inflammatory conditions. Croup/ Airway oedema. Note: Long acting steroid (half-life up to 54 hours), 30 x more potent than hydrocortisone. |
| Route of admin. |
IV bolus. |
| Dose | 0.6 mg/kg, stat. May be followed by 0.15 mg/kg 6 hourly in airway oedema. |
Dobutamine
| Composition | 250 mg/20 mL ampoule, clear fluid. |
|
Pharmacological action/ Indications |
Inotrope vasodilator (< 7.5 μg/kg/min) Vasopressor (> 10 μg/kg/min) |
| Route of admin. |
Continuous IV infusion via a central line. |
| Dose | 5–20 μg/kg/min titrated to effect. |
| Compatible fluids | Normal saline 0.9%, 5% dextrose water, 5% dextrose saline. |
| Incompatible fluids/drugs | Sodium bicarbonate, furosemide, sodium heparin, hydrocortisone, penicillin, cefazolin. |
Furosemide
| Composition | 10 mg/mL in 2 mL/20 mg ampoules or 5 mL/50 mg ampules. |
|
Pharmacological action/ Indications |
Fluid overload. |
| Route of admin. |
IV infusion, IV bolus (Note: IV boluses are associated with hearing loss). |
| Dose | Bolus 0.5–1.5 mg/kg slowly Infusions: 0.05– 0.2 mg/kg/hour (higher doses to be used only in consultation with specialists). |
| Compatible fluids | Normal saline 0.9%, 5% dextrose saline 5% dextrose water, Ringers lactate. |
Glycopyrrolate
| Composition | 0.2 mg/mL in a 1 mL or 2 mL vial. |
|
Pharmacological action/ Indications |
Organophosphate poisoning in the absence of neurological involvement due to the organophosphate (off-label). |
| Route of admin. |
IV infusion, IV bolus. |
| Dose | 0.01 mg/kg2 mg into 9 mL normal saline resulting in a concentration of 0.02 mg/mL. |
Hydrocortisone
| Composition | 100 mg/2 mL (powder). Add 2 mL WFI or normal saline. |
|
Pharmacological action/ Indications |
Adrenal corticosteroid, Anti- inflammatory agent (glucocorticoid). Refractory septic shock. Adrenal insufficiency. Status |
| Route of admin. |
IV bolus. |
| Dose | 5 mg/kg in acute asthma and anaphylaxis. 50 mg/m2 /day in divided doses for catecholamine refractory septic shock. |
IVIG (Intravenous polyvalent human immune globulin.)
| Composition | 3 g powder in 100 mL normal saline, 6 g powder in 200 mL normal saline and 12 g powder in 400 mL normal saline (packaged with diluent). |
|
Pharmacological action/ Indications |
Autoimmune and inflammatory disorders (GBS, Kawasaki, MIS-C, TTP). |
| Route of admin. |
IV infusion. |
| Dose |
2 g/kg (in total) given over 2–5 days. |
Labetalol
| Composition | 5 mg/mL in 20 mL ampules, clear liquid. |
|
Pharmacological action/ Indications |
Hypertensive emergency. |
| Route of admin. |
IV infusion. |
| Dose |
200 mg (2 amps) in 200 mL normal saline = 1 mg/mL. |
| Compatible fluids | Normal saline 0.9%, 5% dextrose saline. |
| Incompatible fluids/drugs | Bolus: 0.2–1 mg/kg, IV, maximum 40 mg Infusion: 0.25–3 mg/kg/hour. |
Lidocaine (Lignocaine)
| Composition | 10 mg/mL (1%), 20 mg/mL (2%) clear colourless fluid. |
|
Pharmacological action/ Indications |
Specific ventricular dysrhythmias. Alternative to amiodarone in VF/VT refractory cardiac arrest. |
| Route of admin. |
IV bolus or IV infusion. |
| Dose |
Bolus:1 mg/kg, with a maximum of 100 mg/dose. Dilute to 1 mg/mL solution and inject at a rate of 25–50 mg/minute. This can be repeated at 5 to 10 minute intervals with a maximum of 3 mg/kg or 300 mg. |
| Compatible fluids | Normal saline 0.9%, 5% dextrose. water, 5% dextrose saline. |
| Incompatible fluids/drugs | Normal saline, sodium bicarbonate. |
Magnesium sulphate
| Composition | 1 g in 2 mL plastic ampoules (2mmol/ml = 4mmol per 2 ml ampoule) |
|
Pharmacological action/ Indications |
Bronchodilation Hypo magnesaemia, cardiac arrest from Torsades de pointes, digoxin toxicity. Pre-eclampsia, eclampsia. |
| Route of admin. |
Intravenous infusion, intravenous bolus. |
| Dose |
Bolus: 20–40 mg/kg, over 20 minutes. |
Salbutamol
| Composition | 0.5 mg/mL (500 μg/mL) |
|
Pharmacological action/ Indications |
Hyperkalaemia |
| Route of admin. |
IV bolus, IV infusion, |
| Dose |
Bolus: 2–4 μg/kg over 20 min. Infusion: Dilute 500 μg into 49 mL of normal saline giving a concentration of 10 μg/mL. 1–2 μg/kg/min. Higher doses only in consultation with a specialist. |
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 23: Paediatric Intensive Care, 23.10 ICU Medications