What is the easier and more reliable dose calculation for iv Phenytoin in children at risk of developing convulsive status epilepticus, 18 mg/kg or 20 mg/kg?
Background: With the Convulsive Status Guidelines due for renewal, we wondered if a phenytoin dose of ‘20 mg/kg’ would be easier to calculate correctly and therefore safer than the current ‘18 mg/kg’. An educational exercise in dose calculation was therefore undertaken to assess ease of calculatio...
| Main Authors: | , , , , |
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| Format: | Article |
| Published: |
BioMed Central
2013
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| Online Access: | https://eprints.nottingham.ac.uk/2977/ |
| _version_ | 1848790922391715840 |
|---|---|
| author | Prasad, Manish Shenton, Priya Dietz, Sanne Saroha, Vivek Whitehouse, William P. |
| author_facet | Prasad, Manish Shenton, Priya Dietz, Sanne Saroha, Vivek Whitehouse, William P. |
| author_sort | Prasad, Manish |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background: With the Convulsive Status Guidelines due for renewal, we wondered if a phenytoin dose of ‘20 mg/kg’
would be easier to calculate correctly and therefore safer than the current ‘18 mg/kg’. An educational exercise in dose
calculation was therefore undertaken to assess ease of calculation.
Method: A standard question paper was prepared, comprising five clinical scenarios with children of varying ages and
estimated body weights. Medical students, trainee doctors at registrar and senior house officer level, and consultant
paediatricians were asked to complete the exercise, in private, by one of two medical students (SD, PS). Calculations were done with and without a calculator, for 18 mg/kg and for 20 mg/kg in randomised order. Speed and errors (greater than 10%) were determined. The data analysis was performed using SPSS version 18.
Results: All answered all 20 scenarios, giving a total of 300 answers per doctor/student group, and 300 answers per
type of calculation. When comparing the 2 doses, the numbers of errors more than 10% were significantly less in
20 mg/kg dose (0.33%) as compared to the 18 mg/kg dose (9.3%) (p<0.0001). Speed off calculation was significantly
decreased in 20 mg/kg dose when compared with 18 mg/kg dose, with (p<0.001) or without (p<0.0001) the calculator.
Speed was more than halved and errors were much less frequent by using a calculator, for the 18 mg/kg dose but no
difference with or without the calculator for 20 mg/kg dose.
Conclusion: We recommend that the future guidelines should suggest iv Phenytoin at 20 mg/kg rather than 18 mg/kg.
This will make the calculation easier and reduce the risk of significant errors. |
| first_indexed | 2025-11-14T18:20:19Z |
| format | Article |
| id | nottingham-2977 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T18:20:19Z |
| publishDate | 2013 |
| publisher | BioMed Central |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-29772024-08-15T15:14:13Z https://eprints.nottingham.ac.uk/2977/ What is the easier and more reliable dose calculation for iv Phenytoin in children at risk of developing convulsive status epilepticus, 18 mg/kg or 20 mg/kg? Prasad, Manish Shenton, Priya Dietz, Sanne Saroha, Vivek Whitehouse, William P. Background: With the Convulsive Status Guidelines due for renewal, we wondered if a phenytoin dose of ‘20 mg/kg’ would be easier to calculate correctly and therefore safer than the current ‘18 mg/kg’. An educational exercise in dose calculation was therefore undertaken to assess ease of calculation. Method: A standard question paper was prepared, comprising five clinical scenarios with children of varying ages and estimated body weights. Medical students, trainee doctors at registrar and senior house officer level, and consultant paediatricians were asked to complete the exercise, in private, by one of two medical students (SD, PS). Calculations were done with and without a calculator, for 18 mg/kg and for 20 mg/kg in randomised order. Speed and errors (greater than 10%) were determined. The data analysis was performed using SPSS version 18. Results: All answered all 20 scenarios, giving a total of 300 answers per doctor/student group, and 300 answers per type of calculation. When comparing the 2 doses, the numbers of errors more than 10% were significantly less in 20 mg/kg dose (0.33%) as compared to the 18 mg/kg dose (9.3%) (p<0.0001). Speed off calculation was significantly decreased in 20 mg/kg dose when compared with 18 mg/kg dose, with (p<0.001) or without (p<0.0001) the calculator. Speed was more than halved and errors were much less frequent by using a calculator, for the 18 mg/kg dose but no difference with or without the calculator for 20 mg/kg dose. Conclusion: We recommend that the future guidelines should suggest iv Phenytoin at 20 mg/kg rather than 18 mg/kg. This will make the calculation easier and reduce the risk of significant errors. BioMed Central 2013-04-21 Article PeerReviewed Prasad, Manish, Shenton, Priya, Dietz, Sanne, Saroha, Vivek and Whitehouse, William P. (2013) What is the easier and more reliable dose calculation for iv Phenytoin in children at risk of developing convulsive status epilepticus, 18 mg/kg or 20 mg/kg? BMC Pediatrics, 13 (60). ISSN 1471-2431 http://www.biomedcentral.com/1471-2431/13/60 doi:10.1186/1471-2431-13-60 doi:10.1186/1471-2431-13-60 |
| spellingShingle | Prasad, Manish Shenton, Priya Dietz, Sanne Saroha, Vivek Whitehouse, William P. What is the easier and more reliable dose calculation for iv Phenytoin in children at risk of developing convulsive status epilepticus, 18 mg/kg or 20 mg/kg? |
| title | What is the easier and more reliable dose calculation for iv Phenytoin in children at risk of developing convulsive status epilepticus, 18 mg/kg or 20 mg/kg? |
| title_full | What is the easier and more reliable dose calculation for iv Phenytoin in children at risk of developing convulsive status epilepticus, 18 mg/kg or 20 mg/kg? |
| title_fullStr | What is the easier and more reliable dose calculation for iv Phenytoin in children at risk of developing convulsive status epilepticus, 18 mg/kg or 20 mg/kg? |
| title_full_unstemmed | What is the easier and more reliable dose calculation for iv Phenytoin in children at risk of developing convulsive status epilepticus, 18 mg/kg or 20 mg/kg? |
| title_short | What is the easier and more reliable dose calculation for iv Phenytoin in children at risk of developing convulsive status epilepticus, 18 mg/kg or 20 mg/kg? |
| title_sort | what is the easier and more reliable dose calculation for iv phenytoin in children at risk of developing convulsive status epilepticus, 18 mg/kg or 20 mg/kg? |
| url | https://eprints.nottingham.ac.uk/2977/ https://eprints.nottingham.ac.uk/2977/ https://eprints.nottingham.ac.uk/2977/ |