TABLE 3

Autoinjector Usage

Approximate Age, yApproximate Weight, kgNo. of Autoinjectors (Each Type)Atropine Dosage Range, mg/kgPralidoxime Dosage Range, mg/kg
3–713–2510.08–0.1324–46
8–1426–5020.08–0.1324–46
>14>513≤0.11≤35
  • Each Mark-1 kit contains 2 autoinjectors (0.8-inch needle-insertion depth), 1 each of atropine 2 mg (0.7 mL) and pralidoxime 600 mg (2 mL); although not approved for pediatric use, they should be used as initial treatment in circumstances for children with severe, life-threatening nerve agent toxicity for whom intravenous treatment is not possible or available or for whom more precise intramuscular (mg/kg) dosing would be logistically impossible. Suggested dosing guidelines are offered; note potential excess of initial atropine and pralidoxime dosage for age/weight, although within general guidelines for recommended total over the first 60 to 90 minutes of therapy for severe exposures. This table lists usage of the Mark-1 kit only down to age 3 based on adherence to recommended dosages for atropine and pralidoxime. However, if an adult Mark-1 kit is the only available source of atropine and pralidoxime after a nerve agent exposure, it should be used for even the youngest child. In such a situation, one should follow weight-based dosing guidelines.

  • Reprinted with permission from Markenson D, Redlener I. Pediatric Preparedness for Disaster and Terrorism: A National Consensus ConferenceExecutive Summary. New York, NY: Columbia University Mailman School of Public Health, National Center for Disaster Preparedness; 2003.