Pediatric emergency medicine trisk 4585 4585
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TABLE 132.7
PHARMACEUTICAL STOCKING ESTIMATES FOR ONE
EMERGENCY DEPARTMENT IN A HYPOTHETICAL CHEMICAL
AGENT ATTACK a
Agent/antidote
Pediatric dose
Adult dose
Total
requirement (for
500 patients)
Nerve agents
Atropine
0.02–0.05 mg/kg 2–5 mg
(minimum dose,
0.1 mg)
Pralidoxime
25–50 mg/kg
1–2 g
1 ampule 30 sec
out of every
minute
0.33 mL/kg (for
Hgb 12 g/dL)
1.65 mL/kg
1 amp
10 mL
1,500 ampules
4,575 mL
50 mL
25,000 mL = 500
vials (50 mL
each)
2,138 g
Cyanide
Amyl nitrite
Na nitrite (3%)
Na thiosulfate
(25%)
Hydroxocobalamin 70 mg/kg
5g
6,875 mg = 17,188
amps (1 mL of
0.4 mg/mL);
859 vials (20
mL of 0.4
mg/mL)
1,875 g = 1,875
vials (1 g each)
Note: Cyanide treatment would require either 375 nitrite/thiosulfate-based or 428 hydroxocobalamin-based
cyanide antidote kits.
a Assumptions: 500 patients to one emergency department (as per one hospital’s experience in the Tokyo
sarin attack); one-half of the patients are children with average weight of 10 kg; if nerve-agent attack, severe
exposure necessitating maximal doses of atropine and pralidoxime; five atropine doses over 12 hrs; three
pralidoxime doses over 12 hrs; if cyanide attack, severe exposure necessitating initial full dose of Na
nitrite/Na thiosulfate, or hydroxocobalamin, followed by 50% of initial dose × 1.
Na, sodium; Hgb, hemoglobin.
CONCLUSION
