In pediatric organophosphate poisoning, what is the initial atropine dose?

• A. 0.05 mg/kg IV/IO (not to exceed 2 mg)
• B. 0.1 mg/kg IV/IO
• C. 0.01 mg/kg IV/IO
• D. 0.5 mg/kg IV/IO

Answer: (A)

In organophosphate poisoning, atropine is given to counteract the muscarinic effects of excess acetylcholine. For pediatric patients, dosing is weight-based and started with 0.05 mg/kg given IV or IO, with a maximum single dose of 2 mg. Doses are repeated every 5 minutes as needed until signs of atropinization appear (such as drying of secretions and improved ventilation). This 0.05 mg/kg starting dose aligns with common EMS standing orders for children and uses a safe cap to prevent excessive anticholinergic effects. The other options either undervalue or overstate a single dose and do not match the standard pediatric protocol.