{
  "version": "1.0",
  "last_reviewed": "2026-04-20",
  "sections": {
    "anaphylaxis": {
      "drugs": [
        {
          "name": "Epinephrine IM",
          "dose_mg_per_kg": 0.01,
          "max_mg": 0.5,
          "unit": "mg",
          "route": "IM",
          "notes": "1:1000 (1 mg/mL), lateral thigh. May repeat q5-15 min.",
          "concentration": "1:1000",
          "source": "ASCIA 2021"
        },
        {
          "name": "Normal saline bolus",
          "dose_mg_per_kg": 20,
          "max_mg": null,
          "unit": "mL",
          "route": "IV/IO",
          "notes": "Repeat up to 60 mL/kg for hypotension",
          "source": "ASCIA 2021"
        },
        {
          "name": "Diphenhydramine",
          "dose_mg_per_kg": 1.25,
          "max_mg": 50,
          "unit": "mg",
          "route": "IV/IM/PO",
          "notes": "H1 blocker. NOT first-line — adjunct only",
          "source": "AAP/ACAAI"
        },
        {
          "name": "Ranitidine",
          "dose_mg_per_kg": 1,
          "max_mg": 50,
          "unit": "mg",
          "route": "IV over 5 min",
          "notes": "H2 blocker. Optional adjunct",
          "source": "AAP/ACAAI"
        },
        {
          "name": "Dexamethasone",
          "dose_mg_per_kg": 0.6,
          "max_mg": 16,
          "unit": "mg",
          "route": "IV/IM/PO",
          "notes": "Prevents biphasic reaction (4-6 hrs later)",
          "source": "AAP/ACAAI"
        },
        {
          "name": "Methylprednisolone",
          "dose_mg_per_kg": 2,
          "max_mg": 125,
          "unit": "mg",
          "route": "IV",
          "notes": "Alternative steroid",
          "source": "AAP/ACAAI"
        },
        {
          "name": "Glucagon",
          "dose_mg_per_kg": 0.02,
          "max_mg": 1,
          "unit": "mg",
          "route": "IV/IM",
          "notes": "For patients on beta-blockers not responding to epi",
          "source": "ASCIA 2021"
        }
      ]
    },
    "sedation": {
      "drugs": [
        {
          "name": "Ketamine IV",
          "display": "Ketamine",
          "dose_mg_per_kg_low": 1.5,
          "dose_mg_per_kg_high": 2,
          "max_mg_low": 100,
          "max_mg_high": 150,
          "unit": "mg",
          "route": "IV",
          "onset": "1 min",
          "duration": "15-30 min",
          "notes": "Dissociative. Preserves airway reflexes.",
          "source": "AAP sedation guideline"
        },
        {
          "name": "Ketamine IM",
          "display": "",
          "dose_mg_per_kg_low": 4,
          "dose_mg_per_kg_high": 5,
          "max_mg_low": 300,
          "max_mg_high": 400,
          "unit": "mg",
          "route": "IM",
          "onset": "3-5 min",
          "duration": "30-60 min",
          "notes": "Give atropine 0.01 mg/kg to reduce secretions.",
          "source": "AAP sedation guideline"
        },
        {
          "name": "Midazolam IV",
          "display": "Midazolam",
          "dose_mg_per_kg_low": 0.05,
          "dose_mg_per_kg_high": 0.1,
          "max_mg_low": 2,
          "max_mg_high": 5,
          "unit": "mg",
          "route": "IV",
          "onset": "2-3 min",
          "duration": "30-60 min",
          "notes": "Anxiolysis. Titrate q3-5 min.",
          "source": "AAP sedation guideline"
        },
        {
          "name": "Midazolam IN/PO",
          "display": "",
          "dose_mg_per_kg": 0.5,
          "max_mg": 20,
          "unit": "mg",
          "route": "IN/PO",
          "onset": "10-15 min",
          "duration": "30-60 min",
          "notes": "IN (max 10 mg / naris) or PO (max 20 mg).",
          "source": "AAP sedation guideline"
        },
        {
          "name": "Propofol",
          "display": "Propofol",
          "dose_mg_per_kg": 1,
          "max_mg": 40,
          "unit": "mg",
          "route": "IV",
          "onset": "30 sec",
          "duration": "5-10 min",
          "notes": "Short procedures. Causes apnea — manage airway.",
          "source": "AAP sedation guideline"
        },
        {
          "name": "Fentanyl IV",
          "display": "Fentanyl",
          "dose_mg_per_kg": 1,
          "max_mg": 100,
          "unit": "mcg",
          "route": "IV",
          "onset": "2-3 min",
          "duration": "30-60 min",
          "notes": "Analgesic. Often combined with midazolam.",
          "source": "AAP sedation guideline"
        },
        {
          "name": "Fentanyl IN",
          "display": "",
          "dose_mg_per_kg": 2,
          "max_mg": 100,
          "unit": "mcg",
          "route": "IN",
          "onset": "5-10 min",
          "duration": "30-60 min",
          "notes": "Intranasal.",
          "source": "AAP sedation guideline"
        },
        {
          "name": "Nitrous oxide",
          "display": "Nitrous oxide",
          "dose_mg_per_kg": null,
          "max_mg": null,
          "unit": "mix",
          "dose_display": "50:50 or 70:30 mix",
          "route": "Inhaled",
          "onset": "2-5 min",
          "duration": "5 min off",
          "notes": "Self-administered via demand valve. Anxiolysis + mild analgesia.",
          "source": "AAP sedation guideline"
        },
        {
          "name": "Dexmedetomidine IN",
          "display": "Dexmedetomidine",
          "dose_mg_per_kg_low": 2,
          "dose_mg_per_kg_high": 3,
          "max_mg_low": 100,
          "max_mg_high": null,
          "unit": "mcg",
          "route": "IN",
          "onset": "15-30 min",
          "duration": "60-90 min",
          "notes": "Intranasal. No respiratory depression. Good for imaging.",
          "source": "AAP sedation guideline"
        },
        {
          "name": "Naloxone",
          "display": "Naloxone",
          "dose_mg_per_kg": 0.1,
          "max_mg": 2,
          "unit": "mg",
          "route": "IV/IM/IN",
          "reverses": "Opioids (fentanyl, morphine)",
          "notes": "Max 2 mg. Repeat q2-3 min. Duration shorter than opioids — monitor for re-sedation.",
          "source": "AAP sedation guideline"
        },
        {
          "name": "Flumazenil",
          "display": "Flumazenil",
          "dose_mg_per_kg": 0.01,
          "max_mg": 0.2,
          "unit": "mg",
          "route": "IV",
          "reverses": "Benzodiazepines (midazolam)",
          "notes": "Max 0.2 mg single dose. Repeat q1 min to max 1 mg total. Risk of seizures — use cautiously.",
          "source": "AAP sedation guideline"
        }
      ]
    },
    "agitation": {
      "drugs": [
        {
          "name": "Lorazepam PO",
          "display": "Lorazepam",
          "step": 2,
          "dose_mg_per_kg": 0.05,
          "max_mg": 2,
          "unit": "mg",
          "route": "PO",
          "notes": "0.05 mg/kg. May repeat in 30 min.",
          "source": "AAP/ACEP agitation"
        },
        {
          "name": "Midazolam PO",
          "display": "Midazolam",
          "step": 2,
          "dose_mg_per_kg": 0.5,
          "max_mg": 10,
          "unit": "mg",
          "route": "PO",
          "notes": "0.5 mg/kg (max 10 mg)",
          "source": "AAP/ACEP agitation"
        },
        {
          "name": "Midazolam IN",
          "display": "Midazolam",
          "step": 2,
          "dose_mg_per_kg": 0.3,
          "max_mg": 10,
          "unit": "mg",
          "route": "IN (5 mg/mL)",
          "notes": "0.3 mg/kg split between nares (max 10 mg)",
          "source": "AAP/ACEP agitation"
        },
        {
          "name": "Olanzapine (ODT)",
          "display": "Olanzapine (ODT)",
          "step": 2,
          "dose_mg_per_kg": null,
          "max_mg": null,
          "unit": "mg",
          "route": "PO / ODT",
          "dose_display_if_under_30kg": "2.5-5 mg",
          "dose_display_if_30kg_or_more": "5-10 mg",
          "notes": "Age ≥6 yr. Avoid IM + benzo combo (risk of resp depression).",
          "source": "AAP/ACEP agitation"
        },
        {
          "name": "Diphenhydramine PO",
          "display": "Diphenhydramine",
          "step": 2,
          "dose_mg_per_kg": 1,
          "max_mg": 50,
          "unit": "mg",
          "route": "PO",
          "notes": "1 mg/kg. Adjunct only; sedating.",
          "source": "AAP/ACEP agitation"
        },
        {
          "name": "Midazolam IV/IM",
          "display": "Midazolam",
          "step": 3,
          "dose_mg_per_kg": 0.1,
          "max_mg": 5,
          "unit": "mg",
          "route": "IV / IM",
          "notes": "0.05-0.1 mg/kg IV, 0.1-0.15 mg/kg IM (max 10 mg)",
          "source": "AAP/ACEP agitation"
        },
        {
          "name": "Lorazepam IV/IM",
          "display": "Lorazepam",
          "step": 3,
          "dose_mg_per_kg": 0.1,
          "max_mg": 4,
          "unit": "mg",
          "route": "IV / IM",
          "notes": "0.05-0.1 mg/kg (max 4 mg). May cause resp depression.",
          "source": "AAP/ACEP agitation"
        },
        {
          "name": "Haloperidol",
          "display": "Haloperidol",
          "step": 3,
          "dose_mg_per_kg": 0.05,
          "max_mg": null,
          "unit": "mg",
          "route": "IM / IV",
          "dose_display_if_under_40kg": "0.025-0.075 mg/kg",
          "dose_display_if_40kg_or_more": "2.5-5 mg",
          "notes": "Avoid &lt;3 yr. Risk: QT, EPS, NMS. ECG if repeated.",
          "source": "AAP/ACEP agitation"
        },
        {
          "name": "Olanzapine IM",
          "display": "Olanzapine",
          "step": 3,
          "dose_mg_per_kg": null,
          "max_mg": null,
          "unit": "mg",
          "route": "IM",
          "dose_display_if_under_40kg": "2.5-5 mg",
          "dose_display_if_40kg_or_more": "5-10 mg",
          "notes": "Avoid benzo co-administration (resp depression, hypotension)",
          "source": "AAP/ACEP agitation"
        },
        {
          "name": "Ketamine IM",
          "display": "Ketamine",
          "step": 3,
          "dose_mg_per_kg": 4,
          "max_mg": 500,
          "unit": "mg",
          "route": "IM",
          "notes": "4-5 mg/kg IM (rescue for severe excited delirium). Monitor airway.",
          "source": "AAP/ACEP agitation"
        },
        {
          "name": "Droperidol",
          "display": "Droperidol",
          "step": 3,
          "dose_mg_per_kg": 0.05,
          "max_mg": null,
          "unit": "mg",
          "route": "IM / IV",
          "dose_display_prefix": "0.03-0.07 mg/kg",
          "notes": "Effective but QT concern — get ECG.",
          "source": "AAP/ACEP agitation"
        }
      ]
    },
    "antiemetics": {
      "drugs": [
        {
          "name": "Ondansetron",
          "dose_mg_per_kg": 0.15,
          "max_mg": 8,
          "unit": "mg",
          "route": "PO / ODT / IV",
          "weight_band_dose": {
            "under_15kg": "2 mg",
            "15_to_30kg": "4 mg",
            "30kg_or_more": "8 mg"
          },
          "notes": "First-line. Max single 8 mg. Repeat q8h. QT prolongation — avoid with other QT drugs. &lt;6 mo: limited data.",
          "source": "AAP gastroenteritis; Lexicomp"
        },
        {
          "name": "Metoclopramide",
          "dose_mg_per_kg": 0.15,
          "max_mg": 10,
          "unit": "mg",
          "route": "IV / IM / PO",
          "notes": "0.1-0.15 mg/kg (max 10 mg). Give with diphenhydramine to prevent EPS / dystonia.",
          "source": "Lexicomp"
        },
        {
          "name": "Dimenhydrinate",
          "dose_mg_per_kg": 1.25,
          "max_mg": 50,
          "unit": "mg",
          "route": "PO / IV / IM / PR",
          "notes": "1.25 mg/kg (max 50 mg) q6h. ≥2 yr.",
          "source": "Lexicomp"
        },
        {
          "name": "Diphenhydramine",
          "dose_mg_per_kg": 1,
          "max_mg": 50,
          "unit": "mg",
          "route": "PO / IV / IM",
          "notes": "1 mg/kg (max 50 mg) q6h. Adjunct, sedating.",
          "source": "Lexicomp"
        },
        {
          "name": "Promethazine",
          "dose_mg_per_kg": 0.25,
          "max_mg": 25,
          "unit": "mg",
          "route": "PO / IV / IM",
          "notes": "0.25-1 mg/kg. <strong>CONTRAINDICATED &lt;2 yr</strong> (resp depression). Tissue injury if IV extrav.",
          "source": "Lexicomp"
        },
        {
          "name": "Dexamethasone",
          "dose_mg_per_kg": 0.15,
          "max_mg": 10,
          "unit": "mg",
          "route": "IV / PO",
          "notes": "Adjunct, esp. chemo-induced. 0.15 mg/kg (max 10 mg).",
          "source": "Lexicomp"
        },
        {
          "name": "Scopolamine patch",
          "dose_mg_per_kg": null,
          "max_mg": null,
          "unit": "mg",
          "dose_display": "1.5 mg patch",
          "route": "Transdermal",
          "notes": "≥12 yr. Motion sickness. Apply 4h before exposure.",
          "source": "Lexicomp"
        }
      ]
    },
    "seizure": {
      "drugs": [
        {
          "name": "Lorazepam",
          "phase": "1st benzo",
          "dose_mg_per_kg": 0.1,
          "max_mg": 4,
          "unit": "mg",
          "route": "IV / IO",
          "label_suffix": " <span style=\"color:#065f46;font-weight:600;\">(IV preferred)</span>",
          "notes": "Slow push over 1-2 min.",
          "source": "AES 2016; ESETT 2019"
        },
        {
          "name": "Midazolam",
          "phase": "1st benzo",
          "dose_mg_per_kg": 0.2,
          "max_mg": 10,
          "unit": "mg",
          "route": "IM / IN / buccal",
          "notes": "Use 5 mg/mL concentrate for IN; split between nares.",
          "source": "AES 2016; ESETT 2019"
        },
        {
          "name": "Diazepam",
          "phase": "1st benzo",
          "dose_mg_per_kg": 0.5,
          "max_mg": 20,
          "unit": "mg",
          "route": "PR",
          "notes": "Only if no IV/IM/IN access.",
          "source": "AES 2016"
        },
        {
          "name": "Levetiracetam",
          "phase": "2nd-line",
          "dose_mg_per_kg": 60,
          "max_mg": 4500,
          "unit": "mg",
          "route": "IV over 5-15 min",
          "label_suffix": " <span style=\"color:#065f46;font-weight:600;\">(preferred)</span>",
          "notes": "Best tolerability. No ECG monitoring needed.",
          "source": "ESETT 2019"
        },
        {
          "name": "Fosphenytoin",
          "phase": "2nd-line",
          "dose_mg_per_kg": 20,
          "max_mg": 1500,
          "unit": "mg PE",
          "route": "IV over 10 min",
          "notes": "Max rate 3 mg PE/kg/min. Monitor ECG, BP. Avoid if cardiac dysrhythmia.",
          "source": "ESETT 2019"
        },
        {
          "name": "Valproic acid",
          "phase": "2nd-line",
          "dose_mg_per_kg": 40,
          "max_mg": 3000,
          "unit": "mg",
          "route": "IV over 10 min",
          "notes": "<strong>Avoid &lt;2 yr, hepatic / mitochondrial disease, pregnancy.</strong>",
          "source": "ESETT 2019"
        },
        {
          "name": "Phenobarbital",
          "phase": "2nd-line",
          "dose_mg_per_kg": 20,
          "max_mg": 1000,
          "unit": "mg",
          "route": "IV over 20 min",
          "notes": "Last-choice 2nd line. High risk of resp depression + hypotension.",
          "source": "AES 2016"
        }
      ]
    }
  }
}
