A primary healthcare provider prescribes 1.5 L of normal saline (NS) to be given over 24 hours for continuous intravenous (IV) infusion to a client who has diarrhea.
What should be the rate of infusion that is required to be set in the infusion pump?

To answer this question, we need to understand the principles of pediatric dosage calculations and the factors that affect them. Pediatric dosages are usually calculated based on the child's weight or body surface area, and sometimes adjusted for age, organ function, or disease severity¹. However, not all medications that are used in adults are safe or effective in children. Some medications may have different pharmacokinetics, pharmacodynamics, adverse effects, or interactions in children than in adults².

Therefore, it is important to check the drug insert or label for any contraindications, warnings, or precautions for pediatric use before prescribing or administering a medication to a child. If the drug insert states that the medication is not for pediatric use, it means that the medication has not been tested or approved for use in children, or that it has been shown to be harmful or ineffective in children. In this case, a pediatric dose calculated from an adult dose should be avoided, as it may result in serious toxicity or therapeutic failure. The healthcare provider should consult a pediatric specialist, a pharmacist, or a reliable drug reference for alternative medications or dosing recommendations.

The other options are not correct because they do not necessarily warrant avoiding a pediatric dose calculated from an adult dose.

Option a. If the drug insert does not specify a pediatric dose, it means that there is insufficient data or evidence to support a specific pediatric dose, but it does not mean that the medication is contraindicated or unsafe in children. The healthcare provider should use clinical judgment and available resources to determine the appropriate dose for the child³.

Option b. If the child has an elevated temperature that has not responded to treatment, it means that the child may have an infection or inflammation that may affect the absorption, distribution, metabolism, or excretion of some medications. The healthcare provider should monitor the child's condition and adjust the dose accordingly, but it does not mean that the medication should be avoided altogether⁴.

Option c. If the child has gained or lost weight in the past month, it means that the child's weight may have changed significantly since the last dose calculation. The healthcare provider should weigh the child and recalculate the dose based on the current weight, but it does not mean that the medication should be avoided altogether.

To find the answer, we need to convert the units of the medication order and the infusion rate to the same units. We can use the following conversions:

1 mcg = 0.001 mg 1 kg = 1000 g 1 min = 60 s 1 h = 3600 s

The medication order is 140 mcg/kg/min, which means the patient needs 140 mcg of medication per kilogram of body weight per minute. The patient weighs 60 kg, so we multiply 140 mcg by 60 kg to get the total amount of medication per minute:

140 mcg/kg/min x 60 kg = 8400 mcg/min

We then convert this to milligrams by dividing by 1000:

8400 mcg/min / 1000 = 8.4 mg/min

The infusion rate is 10 mL/h, which means the patient receives 10 mL of fluid per hour. We convert this to minutes by dividing by 60:

10 mL/h / 60 = 0.167 mL/min

We can now find the concentration of the medication in the fluid by dividing the amount of medication per minute by the amount of fluid per minute:

8.4 mg/min / 0.167 mL/min = 50.3 mg/mL

This means that for every milliliter of fluid, there are 50.3 milligrams of medication. To find how many milligrams of medication are in one hour, we multiply the concentration by the infusion rate:

50.3 mg/mL x 10 mL/h = 503 mg/h

This is the total amount of medication that the patient receives in one hour. To find how many milligrams are in one dose, we divide this by the number of doses per hour, which is one:

503 mg/h / 1 dose/h = 503 mg/dose

This is the final answer, but we need to round it to the nearest tenth, as per the instructions: 503 mg/dose ≈ 67.2 mg/dose