1. Medication Administration for Pediatrics
Kim Martin,RN,MSN
Nursing Instructor
Harrisburg Area Community College
Summer 2012

2. Physiological Attributes
Increased Total body water
Increased Membrane permeability, skin and blood brain barrier
Decreased body fat
Immature kidney and liver function
Immature temperature regulation
Increased absorption of drug, decreased blood levels of water soluble drugs
Increased CNS distribution and neurotoxicity, enhanced topical absorption
Increased absorption of fat soluble drugs
Prolonged excretion of metabolism of certain drugs
Dehydrates easily, increasing concentration of drugs

3. Pharmacokinetics Rates of absorption is lower than adults
Prolonged gastric transit time and variable gastric pH lead to diminished absorption
Frequent feedings may impede drug absorption
Low peripheral perfusion and immature heat regulation can decrease absorption
Immature kidney and liver
The average pH is lower, i.e., acidity is greater,

4. Metabolism Drug metabolizing enzymes if infants are immature
More drugs in the circulatory system may increase drug toxicity

5. Distribution
Low concentration of plasma proteins an diminished protein- binding capacity allow drugs to be more available in the circulation
Greater permeability of the blood brain barrier, allows for rapid access of drugs to the CNS
Total body water is 80% compared to adult 50%
Higher doses of water soluble drugs may be needed to achieve therapeutic effects

6. Excretion
Infant’s kidney’ have higher resistance to blood flow, lower GFR with decreased ability to concentrate urine
Infants may secrete drugs more slowly, increasing risk of drug accumulation

7. Pediatric Fluid Management
Influencing Factors
Increased body surface area
Increased metabolic rate
Body surface; The ratio of surface area to mass is much larger for babies, so they cool down faster than adults. As a result, babies can catch a chill even when adults feel warm.

8. Body Surface 2/3 of insensible fluid loss occurs through the skin
1/3 of insensible fluid loss is through the respiratory system
Children have greater body surface, larger quantities of fluid are lost via this route

9. Fluid Balance Total body Weight (TBW) Intracellular Fluid (ICF)
The water contained within the cells
Extracellular Fluid (ECF)
Fluid outside the cells

10. Fluid Requirements Increased Fever Sweating Vomiting Diarrhea Diabetes
Burns
Decreased
Meningitis
Congestive Heart Failure
Renal Failure

11. Calculating Daily Fluid Maintenance Requirements
1-10kg=100 ml/kg
11-20kg=1000ml+50ml/kg for each kg above 10 kg
21-30kg=1500ml+20ml/kg for each kg above 20 kg
OUTPUT
I ml/kg/hr
10 lb child = 10 divided by 2.2 = 4.5 kg x 100 ml/kg=450 divided by 24= 18.9ml/hr
8lb= 8 divided by 2.2= 3.6 x100ml/kg= 360 ml divided by 24=15 ml/hr
18 kg ( 40 lb ) 1000ml+ 8x 50ml/kg (400ml)= 1400ml divided by 24 = 58.3ml/hr
25kg (48lb) x 20/kg (100ml)=1600 divided by 24= 66.6ml/hr

12. One of the most important roles of the health care provider is accurate measurement of intake and output to assess fluid balance