Vasopressin Pediatric Dose — Cardiac Arrest Resuscitation
Vasopressin is an endogenous antidiuretic hormone that acts as a potent vasoconstrictor through V1 receptor-mediated smooth muscle contraction, increasing systemic vascular resistance and coronary perfusion pressure. In pediatric resuscitation, it is considered a second-line adjunct in cardiac arrest scenarios that have not responded to standard epinephrine therapy. Its use in children remains limited by sparse pediatric-specific evidence.
Pediatric Dosing
- Indication: Epinephrine-refractory cardiac arrest
- Route: IV or IO bolus
- Dose: 0.5–1 unit/kg IV/IO
- Maximum single dose: 40 units
Not routinely recommended — vasopressin is reserved for cases where standard epinephrine-based PALS resuscitation has failed. Consult institutional protocol before administration.
Worked example: For a 20 kg child: 20 × 0.5 unit/kg = 10 units (low end) or 20 × 1 unit/kg = 20 units (high end). For a 50 kg adolescent: 50 × 1 unit/kg = 50 units, but the dose is capped at 40 units maximum.
Indications and Clinical Context
Vasopressin may be considered in pediatric cardiac arrest that is refractory to repeated doses of epinephrine, typically in the setting of prolonged resuscitation efforts. Standard PALS guidelines identify epinephrine as the primary vasopressor in pediatric cardiac arrest; vasopressin is explicitly not routinely recommended in children and should be viewed as a salvage intervention. Evidence supporting its use in pediatric populations is largely extrapolated from adult data and case series.
This agent may offer a theoretical advantage in prolonged arrest states where catecholamine receptor downregulation has occurred, as its mechanism is catecholamine-independent. However, clinicians should weigh the limited evidence base and defer to institutional protocols and experienced team leadership when considering its use.
Administration and Monitoring
Vasopressin should be administered as an IV or IO bolus. The dose range is 0.5–1 unit/kg, with a hard ceiling of 40 units per dose; consult institutional protocol regarding repeat dosing intervals. Given its potent vasoconstrictive properties, continuous cardiorespiratory monitoring is essential. Key adverse effects include peripheral ischemia, hypertension, and bradycardia upon return of spontaneous circulation (ROSC).
- Preferred routes: IV or IO (peripheral or central)
- Administer as a rapid bolus during active CPR
- Monitor closely for signs of ischemia post-ROSC
- Use with caution in patients with known vascular disease or prior vasopressor sensitivity
- Maximum single dose: 40 units regardless of weight
Disclaimer: This article is an educational reference summarizing standard pediatric dosing values. It is not a substitute for clinical judgment. Always verify doses against institutional protocols, the current edition of authoritative references (e.g., Lexicomp, Harriet Lane Handbook, PALS guidelines), the patient’s accurate weight, and any patient-specific factors (renal/hepatic function, allergies, comedications) before administration.