# Morphine sulfate

Adult formulation-dependent doses and pediatric weight-based analgesia.

Population: Adult & pediatric guidance. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources..
Canonical page: https://www.ocmedic.com/guides/morphine/
Official source: [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Check before giving

- Withhold if systolic BP is below 90 or falls below 90; adult injury/burn orders require BP above 90 before giving analgesia.
- Morphine is stocked in different concentrations. A matching milligram dose can require a very different volume.

## Source documents

- [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=3)
- [I-20 — Pediatric Medication Volume Dose by Weight](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf)
- [SO-C-015 — Chest Pain of Suspected Cardiac Origin or Suspected Angina Equivalent Symptoms](https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-C-15%20updated.pdf)
- [SO-T-005 — General Injury and Trauma - Adult / Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-T-05%20Gen%20Trauma%204-2024_0.pdf)
- [SO-E-005 — Burn (Thermal, Electrical, Chemical) - Adult](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-E-05%20Burn%204-2024_0.pdf)
- [SO-P-015 — General Injury and Trauma - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-P-15%20Peds%20Injury%204-2024_0.pdf)
- [SO-P-095 — Burn (Thermal, Electrical, Chemical) - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-P-95%20Burn%204-2024_0.pdf)

## Use in OCEMS

- Opioid analgesia for appropriate injury/burn pain and IV treatment of suspected cardiac pain after nitroglycerin fails or cannot be given.
- I-15 retains different adult doses for the 4 mg carpuject and 10 mg/mL vial presentations.

## Adult / adolescent

| Indication / route | Dose & limits |
| --- | --- |
| Pain — IV/IM | 4 mg from the 4 mg carpuject, or 5 mg with the 10 mg/mL vial. May repeat once after about 3 minutes for persistent pain. |
| Cardiac pain | Use the IV route under SO-C-015 after 3 nitroglycerin doses fail or nitroglycerin cannot be administered. |
| IO in crush/burn injury | Only if already established for other treatment: 4 mg or 5 mg according to the preparation, with one repeat after 3 minutes as specified in I-15. |

## Pediatric

- SO-P-015 severe injury pain: 0.1 mg/kg IV/IM, maximum 5 mg per dose. May repeat once after 3 minutes; total maximum 10 mg.
- Contact base for children age 2 or younger under SO-P-015. Check the pediatric condition order before using an IO route.

## Pediatric weight table — Severe injury pain

- Source: SO-P-015. Dose rule: 0.1 mg/kg; route: IV/IM.
- 0.1 mg/kg IV/IM, maximum 5 mg per dose. May repeat once after 3 minutes; total maximum 10 mg.
- Base contact is required for age 2 or younger. Match the product concentration and route: the I-20 examples distinguish IV carpuject products from the 10 mg/mL IM preparation.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IV/IM | Volume at 1 mg/mL — IV | Volume at 4 mg/mL — IV | Volume at 10 mg/mL — IM |
| --- | --- | --- | --- | --- |
| 3 kg | 0.3 mg | 0.3 mL | 0.075 mL | 0.03 mL |
| 4 kg | 0.4 mg | 0.4 mL | 0.1 mL | 0.04 mL |
| 5 kg | 0.5 mg | 0.5 mL | 0.125 mL | 0.05 mL |
| 6 kg | 0.6 mg | 0.6 mL | 0.15 mL | 0.06 mL |
| 8 kg | 0.8 mg | 0.8 mL | 0.2 mL | 0.08 mL |
| 10 kg | 1 mg | 1 mL | 0.25 mL | 0.1 mL |
| 12 kg | 1.2 mg | 1.2 mL | 0.3 mL | 0.12 mL |
| 15 kg | 1.5 mg | 1.5 mL | 0.375 mL | 0.15 mL |
| 20 kg | 2 mg | 2 mL | 0.5 mL | 0.2 mL |
| 25 kg | 2.5 mg | 2.5 mL | 0.625 mL | 0.25 mL |
| 30 kg | 3 mg | 3 mL | 0.75 mL | 0.3 mL |
| 35 kg | 3.5 mg | 3.5 mL | 0.875 mL | 0.35 mL |
| 40 kg | 4 mg | 4 mL | 1 mL | 0.4 mL |
| 45 kg | 4.5 mg | 4.5 mL | 1.125 mL | 0.45 mL |
| 50 kg | 5 mg | 5 mL | 1.25 mL | 0.5 mL |
| 60 kg | 5 mg | 5 mL | 1.25 mL | 0.5 mL |

## Preparation & reassessment

- Confirm the concentration on the actual vial/syringe and record total milligrams.
- Reassess pain, respiratory effort, mental status, and blood pressure. Document dose times and response; maintain readiness for airway support.