Development of recommendations for dosing of commonly prescribed medications in critically ill obese children

Abstract

The inadequacy of obesity dosing information for most medications commonly ordered for children admitted to a pediatric intensive care unit led to the development of a decision support tool to aid in formulating dosing recommendations.

A validation study of the PAWPER XL tape: accurate estimation of both total and ideal body weight in children up to 16 years of age

“…The problem of potential overdosing of obese children poses challenges during dose calculations based on TBW for drugs with serious side-effects, such as analgesic, anti-convulsant or anti-arrhythmic drugs. For these drugs, a dosing scalar such as ideal body weight (IBW) is recommended instead of TBW during weight-based dose calculations [9,10]. The use of IBW as a weight-descriptor is usually most applicable in obese children when dosing hydrophilic medications with a small volume of distribution (e.g.…”

Medication Dosage in Overweight and Obese Children

“…9,10,13 Additionally, drug solubility and the need for loading or maintenance dosage should be reviewed because these factors are important for determining appropriate weight/size descriptors (i.e., TBW, ideal body weight, adjusted body weight, body surface area) to calculate the final dose. 10,14,15 In obese children requiring loading doses, for hydrophilic medications, use ideal body weight; for lipophilic medications, use TBW; for partially lipophilic medications, use adjusted body weight. 10,15 Lean body weight should be used for maintenance doses because it is most closely related to lean body mass.…”

“…10,14,15 In obese children requiring loading doses, for hydrophilic medications, use ideal body weight; for lipophilic medications, use TBW; for partially lipophilic medications, use adjusted body weight. 10,15 Lean body weight should be used for maintenance doses because it is most closely related to lean body mass. 9,10,15 Several studies have evaluated equations to estimate lean body mass in children and adolescents; [16][17][18][19] however, more research is needed to support their use.…”

High-tech adjuncts to emergency weight estimation: Point-of-care ultrasound and point-of-care bioelectrical impedance measurements can increase the accuracy of length-based weight estimation in children

“…This is not true for obese children. It is important to safeguard obese children from potentially harmful overdoses with hydrophilic medications such as adrenaline, which would occur if TBW was used as the dose-scalar [14,18]. An estimation of IBW in obese children would therefore be advantageous to allow these drugs to be dosed correctly.…”

“…Recent advances on the appropriate use of weight-descriptors for hydrophilic and lipophilic drugs in obese children has made a rational dosing strategy now realistically possible [14]. This is important, even in emergencies, as there is potential harm from incorrect dosing [3,18,20].…”