minimum atropine

[turnupthevapor]

---

Members don't see this ad.

Throughout my training several attendings have told me to never give less than 100 mcg atropine to little babies. Question though...does this apply to babies that resemble chipmunks (ie 790 gramers)? I would think 20 mcg/kg (so like 40 mcgs for those little guys

what do you experts think?

thanks👍

 

[rsgillmd]

Throughout my training several attendings have told me to never give less than 100 mcg atropine to little babies. Question though...does this apply to babies that resemble chipmunks (ie 790 gramers)? I would think 20 mcg/kg (so like 40 mcgs for those little guys

what do you experts think?

thanks👍

Not an expert, but did a fair number of peds during residency. I've had two peds fellowship trained people tell me the same thing -- dose is 20 mcg/kg, with a minimum dose of 0.1 mg. However, the smallest kid that I gave this dose of atropine to was 1.5 kg (I think).

However, I know in adults ACLS says minimum dose is 0.5 mg. Our atropine comes as 0.4 mg/ml. I've given that dose (0.4 mg) a handful of times during residency to adults, and never seen a paradoxical bradycardia. So you may be able to get away with less in kids, but I'm not definite. I generally don't worry about tachycardia in kids -- I was always taught to think of them as giant vagus nerves. When I worked EMS I was taught to think of them as being bowling balls on sticks (big head relative to body). Those two generalizations have gotten me far.

 

[pgg]

One brand's package insert explicitly recommends 0.1 mg for pediatric patients up to 3 kg, another says there's no standard minimum dose for kids under 5 kg while acknowledging that underdosing atropine can cause bradycardia. 0.1 mg as a minimum dose was the consensus amongst the peds staff I've worked under.

That said, I'm not sure I've ever given atropine to a kid under 5 kg. In my small peds experience, when a neonate "needs" atropine, usually what he really needs is epinephrine.

Bottom line though, I'd start with 20 mcg/kg with a minimum of 0.1 mg regardless of size.

 

[2ndyear]

I agree with minimum 0.1. Without diluting the atropine it would be hard to give much less. I've only given it IM with sux, and you probably don't even need it then, but it's always there.