Name | Dosage | Indication | Contraindication | Comments |
---|---|---|---|---|
Fluid resuscitation | Lactated Ringers or normal saline: 20 mL/kg boluses for <5 min, for total of 80 mL/kg in the first 20 minutes; in patients with cardiac insufficiency, dose 5–10 mL/kg bolus | Hemodynamic instability | Congestive heart failure | Obtain 2 large-bore IV lines. Place a Foley catheter to monitor urine output. If poor response, use crystalloid solutions; consider colloid solutions, such as albumin or plasma, and place intraosseous access immediately. |
Proton pump inhibitors | Omeprazole: 1 mg/kg/24 hr by mouth in 1 or 2 divided doses or IV once daily; reported effective range: 0.2–3.5 mg/kg/24 hours | Duodenal or gastric ulcer; stress gastritis Prophylaxis is an off-label indication | Drug hypersensitivity | Children 1–6 years old may require higher doses because of enhanced drug clearance. PPIs have a longer duration of action than H2 receptor antagonists. Limited safety and efficacy information in children. Duration of therapy is unknown. |
H2 receptor antagonist | Ranitidine: Oral: 2–4 mg/kg BID IV or IM: 2–4 mg/kg/day divided and administered every 6–8 hours Maximum dose: 50 mg every 6–8 hours | Duodenal or gastric ulcer; stress gastritis Prophylaxis is an off-label indication | No absolute contraindications | Duration of therapy is unknown. |
Vasoactive drug | Octreotide: 1 μg/kg IV bolus, followed by infusion 1to 2 μg/kg/hour | Variceal bleeding is an off-label indication | No absolute contraindications | No randomized controlled trials on use in children |
β-Blockers | Propranolol: Oral: 0.5–2 mg/kg/day in 2–4 divided doses, with the goal of reducing heart rate to 75% of baseline | Portal hypertension and esophageal varices are an off-label indications | Asthma, atrioventricular block, bradycardia, cardiogenic shock, sick sinus syndrome | A meta-analysis found that combining endoscopic therapy and β-blockers reduced overall rebleeding more than endoscopic therapy alone or β-blocker use alone in patients with cirrhosis and bleeding esophageal varices. |
BID, twice a day; H2, histamine 2; IM, intramuscular; IV, intravenous; PPI, proton pump inhibitor.