Please Help/ Peds Math

drugstorecowgirl214 · Aug 2, 2008

I am trying to figure out safe dose for pediatric patient?
#1. the order reads Clindamycin injection 90mg, Intravenous, every 8 hours for a child that weighs 6.78kg. is this dose safe?
I am trying to figure out the safe dose range? I don't have Lexicomp for safe pediatric dosing for an infant 3months old who weighs 6.78kg.
#2. the order reads 170 mg of Ampicillin/Salbactam, IV , every 6 hours for the same infant that weighs 6.78kg. is this dose safe?
Any suggestions???

Clindamycin: for infants > 1 month = 3.75-10 mg/kg q 6hr or 5-13.3 mg/kg q 8 hr. (300mg/day minimum; up to 7.5 mg/kg q 6 hr for bone infections).

Ampicillin/Sulbactam IV: What I've found, and correct me if I'm wrong, is that this drug is for adults & children greater than or equal to 40kg, or children greater than or equal to 1 year of age.

Off of what I gave you on the clindamycin you should be able to figure out if it's a safe dose or not! Let me know if you can't figure it out and I'll see if I can help you, OR Daytonite is certainly the go to woman!!!

LuvScrubs2, BSN, RN · Aug 2, 2008

I think your right about the second one with regarding he dosage for infant and adults. I am still trying to figure it out .

I do appreciate your help.

LuvScrubs2, BSN, RN · Aug 2, 2008

What exactly is the daily dosage? 100 - 200 mg/kg/day for the second one. I am sooooo lost?

Daytonite, BSN, RN · Aug 2, 2008

when this is all the information you have been given then you have a critical thinking and knowledge application situation. you need a drug reference of some sort to assist you because you need to find a resource that tells you what the safe intravenous parameters are for child doses of these drugs. i am giving you online monographs for clindamycin and ampicillin/sulbactam from drugs.com where you will find the dosing information as well.

the order reads clindamycin injection 90mg, intravenous, every 8 hours for a child that weighs 6.78kg. is this dose safe?

information that i have comes from

2007 intravenous medications

, 23rd edition, by betty l. gahart and adrienne r. nazareno page 326,

"pediatric patients over 1 month of age:

15 to 40 mg/kg of body weight/24 hours in 3 or 4 equally divided doses for

serious

infections.

"

a child under 1 month of age is specifically referred to as a

neonate

in literature, so i would assume the problem is referring to a child over 1 month of age. my

2007 mosby's nursing drug reference

on page 1094 gives the child dose of clindamycin for im/iv as 15-20 mg/kg/day divided q6-8h.

http://www.drugs.com/pro/clindamycin-injection-usp.html

you determine the safe dose ranges using the child's weight and compare them to what the doctor has ordered to see if the doctor has ordered a safe dosage amount. the doctor has ordered 90 mg q8h. determine how much drug this would be in 24 hours:

90mg/8 hours = x mg/24 hours,

cross multiply and solve for

x.

you find that

x

=

270.

so, in 24 hours the doctor has ordered

270 mg

of clindamycin for this child. now, you need to determine if this falls within a safe dose range.

to be conservative, i'll use the information from the

2007 mosby's nursing drug reference

which says 15-20 mg/kg/day is a safe dose range for a child. this child's weight is given as 6.78 kg.

(1)

15.78 kg/1

(child's weight)

x 15 mg/kg

(lowest safe dose per day) =

236.7 mg

(2)

15.78 kg/1

(child's weight)

x 20 mg/kg

(highest safe dose per day) =

315.6 mg

analysis:

the safe dose range of clindamycin for a pediatric patient weighing 15.78 kg is between 236.7 to 315.6 mg in 24 hours. the doctor has ordered 270 mg to be given in 3 divided doses in a 24 hour period.

since 270 mg falls between 236.7 and 315.6 mg it is a safe dose

.

the order reads 170 mg of ampicillin/salbactam, iv , every 6 hours for the same infant that weighs 6.78kg. is this dose safe?

ampicillin with sulbactam is a combination antibiotic. i could only find information about it online. the literature from the company drug monograph (

http://www.drugs.com/pro/ampicillin-and-sulbactam-injection.html

) is that 300 mg per kg of body weight administered via intravenous infusion in equally divided doses every 6 hours is the recommended dose in pediatric patients.

you proceed the same once you know your safe dose parameter.

you determine the safe dose using the child's weight and compare it to what the doctor has ordered to see if the doctor has ordered a safe dosage amount. the doctor has ordered 170 mg q6h. determine how much drug this would be in 24 hours:

170mg/6 hours = x mg/24 hours,

cross multiply and solve for

x.

you find that

x

=

680.

so, in 24 hours the doctor has ordered

680 mg

of ampicillin and sulbactam for this child. now, you need to determine if this is a safe dose.

i'll use the information from the company drug monograph for ampicillin

and

sulbactam which says

up to

300 mg/kg/day is a safe dose for a child. this child's weight is given as 6.78 kg.

15.78 kg/1

(child's weight)

x 300 mg/kg

(safe dose per day) =

4,734 mg

analysis:

the safe dose of ampicillin and sulbactam for a pediatric patient weighing 15.78 kg is 4,734 mg in 24 hours. the doctor has ordered 680 mg to be given in 4 divided doses in a 24 hour period.

since 680 mg falls short of 4,734 mg it is a safe dose, but one has to wonder if it is an effective dose

.

eljamstudent · Aug 3, 2008

when this is all the information you have been given then you have a critical thinking and knowledge application situation. you need a drug reference of some sort to assist you because you need to find a resource that tells you what the safe intravenous parameters are for child doses of these drugs. i am giving you online monographs for clindamycin and ampicillin/sulbactam from drugs.com where you will find the dosing information as well.
the order reads clindamycin injection 90mg, intravenous, every 8 hours for a child that weighs 6.78kg. is this dose safe?
information that i have comes from
2007 intravenous medications
, 23rd edition, by betty l. gahart and adrienne r. nazareno page 326,
"pediatric patients over 1 month of age:
15 to 40 mg/kg of body weight/24 hours in 3 or 4 equally divided doses for
serious
infections.
"
a child under 1 month of age is specifically referred to as a
neonate
in literature, so i would assume the problem is referring to a child over 1 month of age. my
2007 mosby's nursing drug reference
on page 1094 gives the child dose of clindamycin for im/iv as 15-20 mg/kg/day divided q6-8h.
http://www.drugs.com/pro/clindamycin-injection-usp.html
you determine the safe dose ranges using the child's weight and compare them to what the doctor has ordered to see if the doctor has ordered a safe dosage amount. the doctor has ordered 90 mg q8h. determine how much drug this would be in 24 hours:
90mg/8 hours = x mg/24 hours,
cross multiply and solve for
x.
you find that
x
=
270.
so, in 24 hours the doctor has ordered
270 mg
of clindamycin for this child. now, you need to determine if this falls within a safe dose range.

to be conservative, i'll use the information from the
2007 mosby's nursing drug reference
which says 15-20 mg/kg/day is a safe dose range for a child. this child's weight is given as 6.78 kg.
(1)
15.78 kg/1
(child's weight)
x 15 mg/kg
(lowest safe dose per day) =
236.7 mg

(2)
15.78 kg/1
(child's weight)
x 20 mg/kg
(highest safe dose per day) =
315.6 mg
analysis:
the safe dose range of clindamycin for a pediatric patient weighing 15.78 kg is between 236.7 to 315.6 mg in 24 hours. the doctor has ordered 270 mg to be given in 3 divided doses in a 24 hour period.
since 270 mg falls between 236.7 and 315.6 mg it is a safe dose
.
the order reads 170 mg of ampicillin/salbactam, iv , every 6 hours for the same infant that weighs 6.78kg. is this dose safe?
ampicillin with sulbactam is a combination antibiotic. i could only find information about it online. the literature from the company drug monograph (
http://www.drugs.com/pro/ampicillin-and-sulbactam-injection.html
) is that 300 mg per kg of body weight administered via intravenous infusion in equally divided doses every 6 hours is the recommended dose in pediatric patients.
you proceed the same once you know your safe dose parameter.
you determine the safe dose using the child's weight and compare it to what the doctor has ordered to see if the doctor has ordered a safe dosage amount. the doctor has ordered 170 mg q6h. determine how much drug this would be in 24 hours:
170mg/6 hours = x mg/24 hours,
cross multiply and solve for
x.
you find that
x
=
680.
so, in 24 hours the doctor has ordered
680 mg
of ampicillin and sulbactam for this child. now, you need to determine if this is a safe dose.

i'll use the information from the company drug monograph for ampicillin
and
sulbactam which says
up to
300 mg/kg/day is a safe dose for a child. this child's weight is given as 6.78 kg.
15.78 kg/1
(child's weight)
x 300 mg/kg
(safe dose per day) =
4,734 mg
analysis:
the safe dose of ampicillin and sulbactam for a pediatric patient weighing 15.78 kg is 4,734 mg in 24 hours. the doctor has ordered 680 mg to be given in 4 divided doses in a 24 hour period.
since 680 mg falls short of 4,734 mg it is a safe dose, but one has to wonder if it is an effective dose
.

i haven't started school yet, i start on the 15 of this month, but i have been practicing some dosage calculations. everything made sense to me but the childs weight. it was originally given as 6.78 kg but you show it as 15.78 kg, why the change? am i correct if using the 6.78 weight it would not be a safe dose for the first part of the question?

i may be completely off but since the rest of it made sense to me except the weight i thought i would ask.

thank you

Daytonite, BSN, RN · Aug 3, 2008

I haven't started school yet, I start on the 15 of this month, but I have been practicing some dosage calculations. Everything made sense to me but the childs weight. It was originally given as 6.78 kg but you show it as 15.78 kg, why the change? Am I correct if using the 6.78 weight it would not be a safe dose for the first part of the question?
I may be completely off but since the rest of it made sense to me except the weight I thought I would ask.
Thank you

Thanks for pointing this out. It was a typo on my part. I will correct it. I wonder if the OP used what I originally posted?

Daytonite, BSN, RN · Aug 3, 2008

corrected calculations

the order reads clindamycin injection 90mg, intravenous, every 8 hours for a child that weighs 6.78kg. is this dose safe?

information that i have comes from

2007 intravenous medications

, 23rd edition, by betty l. gahart and adrienne r. nazareno page 326,

"pediatric patients over 1 month of age:

15 to 40 mg/kg of body weight/24 hours in 3 or 4 equally divided doses for

serious

infections.

"

a child under 1 month of age is specifically referred to as a

neonate

in literature, so i would assume the problem is referring to a child over 1 month of age. my

2007 mosby's nursing drug reference

on page 1094 gives the child dose of clindamycin for im/iv as 15-20 mg/kg/day divided q6-8h.http://www.drugs.com/pro/clindamycin-injection-usp.html

you determine the safe dose ranges using the child's weight and compare them to what the doctor has ordered to see if the doctor has ordered a safe dosage amount. the doctor has ordered 90 mg q8h. determine how much drug this would be in 24 hours:

90mg/8 hours = x mg/24 hours,

cross multiply and solve for

x.

you find that

x

=

270.

so, in 24 hours the doctor has ordered

270 mg

of clindamycin for this child. now, you need to determine if this falls within a safe dose range.

to be conservative, i'll use the information from the

2007 mosby's nursing drug reference

which says 15-20 mg/kg/day is a safe dose range for a child. this child's weight is given as 6.78 kg.

(1)

6.78 kg/1

(child's weight)

x 15 mg/kg

(lowest safe dose per day) =

101.7 mg

(2)

6.78 kg/1

(child's weight)

x 20 mg/kg

(highest safe dose per day) =

135.6 mg

analysis:

the safe dose range of clindamycin for a pediatric patient weighing 6.78 kg is between 101.7 to 135.7 mg in 24 hours. the doctor has ordered 270 mg to be given in 3 divided doses in a 24 hour period.

since 270 mg is above 101.7 and 135.6 mg it is

not

a safe dose

.however, if you use the highest safe dose suggested by gahart and nazareno which is 40 mg/kg of body weight/24 hours you get

6.78 kg/1

(child's weight)

x 40 mg/kg

(highest safe dose per day) =

270.2 mg

which would make the doctor's dose a safe one.

the order reads 170 mg of ampicillin/salbactam, iv , every 6 hours for the same infant that weighs 6.78kg. is this dose safe?

ampicillin with sulbactam is a combination antibiotic. i could only find information about it online. the literature from the company drug monograph (

http://www.drugs.com/pro/ampicillin-...injection.html

) is that 300 mg per kg of body weight administered via intravenous infusion in equally divided doses every 6 hours is the recommended dose in pediatric patients.

you proceed the same once you know your safe dose parameter.

you determine the safe dose using the child's weight and compare it to what the doctor has ordered to see if the doctor has ordered a safe dosage amount. the doctor has ordered 170 mg q6h. determine how much drug this would be in 24 hours:

170mg/6 hours = x mg/24 hours,

cross multiply and solve for

x.

you find that

x

=

680.

so, in 24 hours the doctor has ordered

680 mg

of ampicillin and sulbactam for this child. now, you need to determine if this is a safe dose.

i'll use the information from the company drug monograph for ampicillin

and

sulbactam which says

up to

300 mg/kg/day is a safe dose for a child. this child's weight is given as 6.78 kg.

6.78 kg/1

(child's weight)

x 300 mg/kg

(safe dose per day) =

2,034 mg

analysis:

the safe dose of ampicillin and sulbactam for a pediatric patient weighing 6.78 kg is 2,034 mg in 24 hours. the doctor has ordered 680 mg to be given in 4 divided doses in a 24 hour period.

since 680 mg falls short of 2,034 mg it is a safe dose, but one has to wonder if it is an effective dose

.

LuvScrubs2, BSN, RN · Aug 5, 2008

THanks everyone, I just looked at the calculations this morning......

Daytonite, BSN, RN · Aug 5, 2008

THanks everyone, I just looked at the calculations this morning......

Hmmm. I just corrected another mistake I found that I made in the corrected version I posted. Hope you re-worked and checked the math yourself to be on the safe side.