INTRAVENOUS INFUSIONS FOR ACUTE SEVERE & LIFE-THREATENING ASTHMA

Drug Dose Dilution to Volume Infusion Dose Range

Aminophylline* Loading dose 5 mg/kg Neat over 20 mins Omit loading dose if on
(max 500mg) Theophylline
Peripheral 500 mg 500 ml 1 ml/ kg/hr = 1 mg/kg/hr 1m – 12 yrs: 1mg/kg/hr
line Infusion 5% Dextrose or 0.9% Saline 0.7 ml/ kg/hr = 0.7mg/kg/hr >12 yrs: 0.7 mg/kg/hr
Central line Neat 25 mg/ml Neat 0.028 (>12 yrs) – 0.04 (1 m– 12 yrs) ml/ kg/hr
Magnesium Loading 40 mg/kg Neat over 20 mins Max dose 2 g
Sulphate 10% dose = 0.4 ml/ kg
Infusion 30 mg/kg/hr Neat 0.3 ml/ kg/hr 30 mg/kg/hr
= 0.3 ml/ kg/hr
Magnesium Loading dose 40 mg/kg Neat over 20 mins Max dose 2 g
Sulphate 20% = 0.2 ml/ kg
Infusion 30 mg/kg/hr Neat 0.15 ml/ kg/hr 30 mg/kg/hr
= 0.15 ml/ kg/hr
Magnesium Loading dose 40 mg/kg Diluted to 5 times volume in over 20 mins Max dose 2 g
Sulphate 50% = 0.08 ml/ kg 5% or 10% Dextrose or 0.9% Saline
Infusion 30 mg/kg/hr Diluted to 5 times volume in 30 mg/kg/hr
= 0.06 ml/ kg/hr 5% or 10% Dextrose or 0.9% Saline
Salbutamol Loading dose 1m – 2yrs: Dilute to 50 microgm/ml in over 5 mins Max dose 250 microgm
5 microgm/kg 5% Dextrose or 0.9% Saline
2 – 18 yrs:
15 microgm/kg
(max 250 mcg)
Peripheral 25 mg 50 ml 0.12 – 0.24 ml/ kg/hr 1 – 2 mcg/kg/min
line infusion 5% Dextrose or 0.9% Saline
Central line Neat Neat 0.06 – 0.12 ml/ kg/hr 1 – 2 mcg/kg/min
infusion 1 mg/ml
Fentanyl <25 kgs 100 mcg/kg 50 ml 5% Dextrose or 0.9% Saline 0.5 – 2 ml/hr 1-4 mcg/kg/hr
(if intubated) ≥ 25 kgs 50 mcg/ml Neat 0.02 – 0.08 ml/ kg/hr 1-4 mcg/kg/hr
Ketamine Infusion 30 mg/kg 50 ml 1 – 4 ml/hr 0.6 – 2.4 mg/kg/hr
(if intubated) 5% Dextrose or 0.9% Saline
Midazolam < 40 kgs 6 mg/kg 50 ml 5% Dextrose or 0.9% Saline 0.5 – 2 ml/hr 1-4 mcg/kg/min
(if intubated) ≥ 40 kgs Neat 1 mg/ml Neat 50 mg in 50 ml 0.06 – 0.18 ml/ kg/hr 1-3 mcg/kg/min
 Aminophylline, Salbutamol, Magnesium & Ketamine infusions are incompatible with each other, & must run separately
 *Omit loading dose of Aminophylline if the patient is already on Theophylline. Check a plasma Theophylline level prior to commencing infusion
 *Aminophylline: Check plasma level 4-6 hours after starting the IV infusion. Aim for plasma concentration of 10 - 20 mg/litre, although 5-15
mg/litre can also be effective
 Magnesium : Aim for serum level of 1.5 - 2.5 mmol/L
Ref: 1. BNFC 2010 2. Frank Shann 14th Ed 2008 3. Guy’s Paediatric Formulary 2005 Dr P D’Silva, PICU Consultant May 2009 V8 Apr 2011