For lidocaine used in pediatric and adult ALS, what is the maximum total dose in terms of mg/kg?

• A. 2 mg/kg
• B. 3 mg/kg
• C. 4 mg/kg
• D. 5 mg/kg

Answer: (B)

The maximum total lidocaine dose in ALS is 3 mg/kg for both adults and children. In practice, you give an IV bolus of 1–1.5 mg/kg, and if the arrhythmia persists you may give a second bolus of 0.5–0.75 mg/kg, but you must not exceed a total of 3 mg/kg. This cap exists to prevent lidocaine toxicity, which can show up as central nervous system symptoms (drowsiness, confusion, seizures) or cardiovascular effects (bradycardia, hypotension). Pediatric dosing uses the same weight-based approach and the same maximum total, ensuring safety across ages in these protocols.