What is the maximum dose of adenosine in the second administration for treating SVT?

In the management of supraventricular tachycardia (SVT) in pediatric patients, adenosine is administered as a rapid IV push. The dosing for adenosine is typically given in a series of dosing increments due to its short half-life. The initial dose for an infant or child is usually 0.1 mg/kg (up to a maximum of 6 mg), and if this does not convert the SVT, a second dose may be administered.

For the second administration, the recommended dose is 0.2 mg/kg, which can be as high as 12 mg. This is based on clinical guidelines that support titrating the dose to achieve the desired effect while considering the patient's weight and overall condition. Therefore, the maximum dose for the second administration is correctly noted as 12 mg.

Using this dosing strategy helps ensure effective treatment while minimizing potential side effects. This progression from an initial lower dose to a higher second dose aligns with the pharmacological effects of adenosine and the goal of rapid but safe rhythm control.