{
"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 <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. <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. CONTRAINDICATED <2 yr (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": " (IV preferred)",
"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": " (preferred)",
"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": "Avoid <2 yr, hepatic / mitochondrial disease, pregnancy.",
"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"
}
]
}
}
}