What is the pediatric dosing for an initial adenosine bolus?

• A. 0.1 mg/kg IV bolus (max 6 mg); if no response, 0.2 mg/kg (max 12 mg)
• B. 1 mg/kg IV bolus
• C. 0.01 mg/kg IV bolus
• D. 5 mg/kg IV bolus

Answer: (A)

Pediatric dosing for an initial adenosine bolus uses a weight-based plan with a two-step approach. Start with 0.1 mg/kg IV bolus, up to a maximum of 6 mg. If there’s no response within a few seconds, give a second bolus of 0.2 mg/kg IV, up to a maximum of 12 mg. Adenosine works by a very brief block of AV nodal conduction, so a rapid push followed by a saline flush is needed to reach the heart quickly and interrupt a narrow-complex SVT. Using the two-step dosing limits exposure while preserving the chance to terminate the tachycardia; the second, higher dose is only given if the first dose doesn’t work. Doses outside this range aren’t appropriate: 1 mg/kg is too large for an initial bolus and raises risk, 0.01 mg/kg is likely ineffective, and 5 mg/kg would exceed safe maximum limits.