Paper
The Myth of a Minimum Dose for Atropine
Published Apr 1, 2011 · K. Barrington
Pediatrics
20
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Abstract
Since its first appearance, the Pediatric Advanced Life Support (PALS) course has recommended a minimum dose of atropine of 0.1 mg regardless of the body weight of the child. The most recent update of PALS, after the extensive International Liaison Committee on Resuscitation (ILCOR) process, designed to develop the evidence base of resuscitation recommendations, still contains this same recommendation.1 This recommendation is frequently quoted by pediatric residents fresh from their PALS courses; I have often been informed that a lower dose causes “paradoxical bradycardia.” Indeed, the computerized printouts for resuscitation drugs and doses from our hospital information system are based on the PALS guidelines and give the same recommended dose. Thus, if the computerized printout were to be followed, a 2-kg infant would receive 0.1 instead of 0.04 mg of atropine. If the indication persisted and a second dose were to be given, potentially lethal overdosage could occur. This minimum dose is widely repeated. The 12th edition of The Harriet Lane Handbook 2 states that the preanesthesia dose (30–60 minutes before operation) for a child is “0.01 mg/kg/dose SC/IV/IM, max. dose: 0.4 mg/dose; min. dose: 0.1 mg/dose; may repeat Q4–6 hr” and for “Cardiopulmonary resuscitation (see remarks): Child,” the recommended dose is “0.02 mg/kg/dose IV Q5 min × 2–3 doses PRN; min. dose: 0.1 mg”; the remarks to which the authors refer included: “Doses < 0.1 mg have … Address correspondence to Keith J. Barrington, MB, ChB, Division of Neonatology, Saint Justine University Hospital Center, 3175 Cote St Catherine, Montreal, Quebec, Canada H3T 1C5. E-mail: keith.barrington{at}umontreal.ca
The minimum dose of atropine recommended by PALS is 0.1 mg, regardless of the child's body weight, and this dose may be potentially lethal if overdosing occurs.
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