Emergency doses

Cardiac emergencies
■■Asystole or pulseless electrical activity
Adrenaline: 20 μg (micrograms)/kg i.v. – this is equivalent to 1 ml/5 kg using 1:10,000
concentration (100 μg/ml). Double dose if used intratracheally.
■■Hyperkalaemic myocardial toxicity
Calcium: 50–150 mg/kg calcium (boro)gluconate = 0.5–1.5 ml/kg of a 10% solution i.v. over
20–30 min or Soluble insulin: 0.5 IU/kg i.v. followed by 2–3 g of dextrose/unit of insulin (for
urinary tract obstruction but not hypoadrenocorticism). Half the dextrose should be given as a
bolus and the remainder administered i.v. over 4–6h.
■■Other bradyarrhythmias
Atropine: 0.01–0.03 mg/kg i.v. – this is equivalent to 0.3–1 ml/20 kg using 0.6 mg/ml solution.
■■Ventricular tachycardia
Lidocaine:Dogs: 2–8 mg/kg i.v. in 2 mg/kg boluses, followed by a constant rate i.v. infusion of
0.025–0.1 mg/kg/min.Cats: 0.25–2.0 mg/kg i.v. slowly in 0.25–0.5 mg/kg boluses followed by a
constant rate i.v. infusion of 0.01–0.04 mg/kg/min.

Pulmonary emergencies
■■Respiratory arrest
Doxapram: 5–10 mg/kg i.v., repeat according to need; duration of effect is approximately 15–
20 min. Neonates: 1–2 drops under the tongue (oral solution) or 0.1 ml i.v. into the umbilical
vein; this should be used only once.

Metabolic emergencies
■■Anaphylaxis
Adrenaline: 10 μg/kg i.v. – this is equivalent to 1 ml/10 kg using 1:10,000 concentration (100
μg/ml).
■■Hypocalcaemia
Calcium: 50–150 mg/kg calcium (boro)gluconate = 0.5–1.5 ml/kg of a 10% solution i.v. over
20–30 min.
■■Hypoglycaemia
Glucose: 1–5 ml 50% dextrose i.v. slowly over 10 min.

Neurological emergencies
■■Seizure control
Diazepam: 0.5 mg/kg i.v. or rectal – repeat after 3 minutes for up to 3 doses or Midazolam:
0.3 mg/kg i.v. or rectal – repeat after 3 minutes for up to 3 doses.If the seizures have been
controlled, maintain on an i.v. infusion of midazolam at 0.3 mg/kg/h.If seizures not controlled by
above: Propofol: induce with 1–4 mg/kg i.v. and then maintain on 0.1–0.4 mg/kg/min.
■■Raised intracranial pressure (impending herniation)
Mannitol: 0.25 g/kg i.v. infusion of 15–20% solution over 30–60 min. May repeat 1–2 times
after 4–8 hours as long as hydration and electrolytes monitored. (For acute glaucoma see
monograph.)

Anaesthesia emergencies
■■Reversing agents
Naloxone: 0.015–0.04 mg/kg i.v., i.m., s.c., intratracheal (give to effect).
Atipamezole: Five times the previous medetomidine or dexmedetomidine dose i.m.; if that
dose unknown, use 100 μg(micrograms)/kg i.m. or very slow i.v.