Nesiritide (recombinant B-type natriuretic peptide) is often given for symptomatic relief of acute decompensated heart failure in adults. The literature describing the safety or efficacy of nesiritide in children is minimal, and we know of no data that describe the effects of a nesiritide overdose in adults or children. A 3-year-old, 10.9-kg girl was admitted to the pediatric intensive care unit with the diagnosis of dilated cardiomyopathy and acute decompensated heart failure. She received several vasoactive infusions during her admission, including nesiritide. On hospital day 47 (day 45 of nesiritide therapy), the patient received an 18-fold overdose of nesiritide, with no hemodynamic, cardiac, or renal sequelae. She subsequently underwent successful cardiac transplantation. The nesiritide treatment duration was longer for this patient than the 45 days previously reported in a pediatric patient. No hemodynamic instability or cardiac or renal sequelae were associated with the large, inadvertent bolus in our patient. This case report demonstrates the lack of adverse events in a pediatric patient administered nesiritide beyond the recommended dosing parameters. Increased vigilance is always advised when administering drugs not commonly given to pediatric patients.