IV Bolus Administration Guidelines

General Administration Principles

• Most IV bolus medications should be administered slowly over 1-2 minutes after appropriate dilution to minimize adverse effects, with specific timing varying by medication class and patient factors 1
• Dilute concentrated medications to reduce venous irritation and allow controlled administration, for example, D50W should be diluted to D25W when possible 2
• Calculate dilution volumes based on patient weight and desired final concentration 2

Medication-Specific Administration

• Adenosine: 6 mg rapid IV push over 1-3 seconds, followed immediately by saline flush; second dose of 12 mg after 1-2 minutes if needed 1
• Diltiazem: 15-20 mg (0.25 mg/kg) over 2 minutes, with potential repeat dose of 20-25 mg after 15 minutes 1
• Esmolol: 500 mcg/kg loading dose over 1 minute 1
• Enalaprilat: 1.25 mg over 5 minutes to prevent overshoot hypotension 1
• Hydralazine: 10 mg via slow IV infusion (maximum initial dose 20 mg) 1

Pediatric Dosing Adjustments

• Glucose for hypoglycemia: 200 mg/kg as D10W only (2 mL/kg), with D50W diluted to D25W to reduce venous irritation 2
• Haloperidol for agitation: 0.05-0.15 mg/kg (maximum 5 mg single dose), may repeat hourly 3
• Insulin for hyperkalemia: 0.1 unit/kg with 400 mg/kg glucose (ratio 1:4) 2

Critical Safety Monitoring

• Assess blood pressure approximately 2 hours before each dose - if below target, administer 250-500 mL NS or LR bolus over 30-60 minutes 4
• Maintain oxygen saturation >92% - permanently discontinue medications if supplemental oxygen required at time of next dose 4
• Monitor for QT prolongation and arrhythmias, especially with repeated haloperidol doses >7.5 mg/day 3

Dose Adjustments for Special Populations

• Reduce doses by 50% in elderly patients and those with renal impairment (CrCl <50 mL/min for most medications) 5, 1
• Avoid bolus administration in post-cardiac transplant patients without dose reduction 1

Contraindications to Bolus Administration

• Never administer boluses in patients with drug-specific contraindications: beta-blockers in acute asthma, calcium channel blockers in decompensated heart failure, opioids in respiratory depression without resuscitative equipment 1
• Complete heart block is a relative contraindication for calcium channel blockers 1
• Increased intracranial pressure is a relative contraindication for ketamine 2