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لحل مشكلة كتابة الروشتات للأطفال PDF
لحل مشكلة كتابة الروشتات للأطفال PDF
Therapeutics
By
Dr. Emad Hammad EI-Daly
M.D Pediatrics and Neuropediatrics
Seventh edition
2015
First published
Seventh edition
:2004
:2015
PREFACE
Pressure for efficiency m care and treatment of
pediatrics make the Updated pediatric therapeutics of
increased importance. It is a simplified book aiming to solve
the problems of pediatric prescriptions. It is a basic learning
for house officers, pediatric residents and it is helpful to other
medical and surgical specialists whom dealing with pediatric
patients, It is a simple reference for doses and uses of drugs
in pediatrics. The last chapter includes the doses of the
commonest drugs used in neonate, infant and childhood
periods.
7th
E-mail: aabolel@,hotmaiLcom.
Subject
Page
Chapter one:
Introduction ................................................................................. I
N onnal values .............................................................................. 6
Chapter six:
Commonly used drugs -~227
ChapterOnk
I - Introduction
It is very difficult to prescribe medicines to children and
(~)
volume of water.
4- In dispersible tablets, you could dissolve into certain amount
of water and give the child the required dose (for example
dispersible tablet 25 mg dissolved in 5 ml of water, then
-l-
its wall is acid resistant and the usual method of opening the
capsule and giving its contents to. the child is wrong as the
active ingredient may be affected and becomes less active by
the gastric acidity. Some capsules contain sustained release
granules which not affected by gastric acidity. In spite of that
.not all _capsules are acid resistant, you should avoid this
method of ingestion of drugs.
The third problem is the calculation of the appropriate doses
-2-
the child; if this was not available you should calcufate his
weight by fixed formula for normal values.
4..J~I ~\ ~\.WW\-
Injection forms:
1- Be sure of the method of injection (IM., I.V. or S.C.)
2- If the ampoule or vial is already in solution, you should
calculate the concentration/ml and according your calculated
dose/kg, you will inject.
3- If the vial is a powder you could dissolve it by any volume of
solvent according to the desired concentration/ ml
4- If the calculated dose/kg is a fraction of ml. you could give
V4, Yz or % ml But if these solid fraction are not coincide with
-3-
your needed dose (for example the patient in need for 4/10
mi.) here you could do one of two methods
(a) By the use of 3 ml syringe, the one ml. is divided by 10
dashes and you could give 4 dashes in this dose (see the
following Figure.)
(b) By the use of insulin syringe (100 unit) which is one mi.
divided into 10 segments (10, 20, 30, 40, 50,. 100) each of them
is 1/10 mi. and so 4 segment will give your desired dose (see the
following figure).
cJ-t 1/10 ;. ~ ~}J J..S ,.~1 ~ ~! t......i.. ,_. 1 us ~ 4-i~
-4-
-5-
Then, duriri.g the first year of life the average body weight
increases as follows:
.-
=wt/kgs
2
= weight in kgs
2
-6-
(7 X 7) - 5
Exa~ple,
child 7 years
44
= - - - - = --=
22kg.
!I
N.D.
Put the tap around the head at the most prominent part of the
occiput and over the glabella (above the eye brows).
At birth
35 cm.
3 months
40cm.
6months
44cm.
1 year
47cm.
2 years
49cm.
4 years
50cm.
(4) Pulse:
-
-8-
Chapter two
i
I- Penicillins
2- Cephalosporins
4- AminogiJalsides 5- Sulpha
3- Macrolides
6-Chloramphenicai
1- Penicillin
It is widely used and still the first choice in many
som~
serious
- ~'- 6P ;;, %
- ~,, .. ;;, Yz
~~
to &:Ai cJW:at
~~2D-10
i_..n~~~
-9-
JW:-1
Preparations:
\
!
Rheumatic fever
Chronic tonsillitis and
Acute post-strept. glomerulonephritis.
Dose:
- < 6 years or< 30 Kg= 600~000 U/Kg/dose
(4.Ibll 1/2)
i ~..J
-<A. 6~1
w
#
~Lw.l 4-2
Lali.l
.)
JS .(Jb.ll ~i
.1.a.J
~ ~jJ Lidocaine
Preparations:
Retarpen.vials
Durapen-S vials
All contain 1.200;000 U.
Lastipen vials
Penicid L.A. Vials.
Penadur L.A. vials.
-11-
JjhA
multiform,
hemolytic
anenua, .
'.)
A- Adrenaline ampules.
B- Solu-cortif vials.
C- Fortecortin ampoules.
D- Sterile syringes.
~I~ ~t... ~ o.wl UiaJl ~~~I~ -7
~ ()s.. ~ 0.>- J.Jl ~~ ~ -8
Preparations:
-
~.
-13-
. :~'lls ~~I oj~! J.id f+S 10 .UJJ Jill ulS lj! :Jli.
.~ 500 = ~ 50
10 = f_,Hll c) ~I ~.,P.JI
(2J AmoxiciUin:
Moxipen
Amoxicid
}
as lbiamox and Biomox
-14-
-Preparations:
-Unasyn
- Sulbin
: as Unasyn.
- Unictam: as Unasyn.
-Ampictam: Vials (1500, 7 50 mg), suspension (250 mg/5 ml)
tablets (375 mg).
(B) Amoxicillin + Clavulanic acid:
-15-
- Augmentin.-
- E-MOXCAV
- Curam
-Magna-biotic
- Hibiotic-N
-Klavox
-Megamox
457mg
suspension
-DeltaClav
-- Curam
Vials:
IS
1- Amoxicillin + flucloxacillin:
Flumox vials (500, 1000 mg)
Flumox suspension 250 mg.
Flumox capsules (250, 500 mg)
Flucamox capsules (250, 500 mg).
.:
-17-
2- Ampicillin + dicloxacillin:
Dipenacid vials 250, 500 mg.
Dipenacid suspension: 250 mg/5 ml
Dipenacid drops: IOO mg/ dropper.
Dipenacidcapsules: 250 mg.
Cloxapen capsules : 250, 500 mg.
3- Ampicillin + cloxacillin:
Ampiclox vials: 500 mg
Ampiclox suspension : 250 mg/5 ml.
Ampiclox capsules: 500 mg.
4- Ampicillin + ftuclloxacillin
Amoflux 250mg suspen
~ ~l:t'/1 .&J ~~ ~ ~~ u:tA ~ ~ e~ JS :4J&~
Lk.
WI (J L...4l ~.
. .!WU J:aiA.a..
II- Cephalosporins
Cephalosporins are structurally related to penicillins but
with wider spectrurq of activity especially
ag~t gram
-ve
-18-
Preparations;
(a)
Cephalexin:
(~,
1 gm).
(b) Cephradine:
-19-
- Biodroxil: suspension ( 250, 500 mg/5 ml) and capsules (500 mg).
- Longcef: suspension ( 250 mg/5 ml).
(d) Cephapirin:
- Cefatrexyl: vials only (Yz, 1 gm).
(e) Cefazolin:
-20-
Cefprozil,
cefuroxime,
cefaclor,
cefoxitin
and
cefinandole.
Preparations:
(a)
Cefprozil:
- Cefzil: suspension (125, 250 mg/5 ml) and
tablets
(250, 500 mg).
(b)
Cefuroxime:
Zinnat: suspension (125.250 mg/5 ml), tablets
(125, 250, 500 mg) and vials (250, 750, 1500 mg).
Cefumax: vials (250, 750 mg).
(c)
Cefaclor:
Serviclor: suspension (125, 250 mg/5 ml), capsules (250,
500 mg),.and tablets (375, 500, 750 mg).
-21-
r-
Preparations:
(a) Cefotaxime:
- Claforan:
Vial~
(b) Cefoperazone:
- Cefobid: vials (Y2, 1 gm).
- Cefazone: vials (Yl, 1 gm).
-22-
- Sulperazone:
vials
(lgm)
it
contains
1000
vials( ~,
Y2, 1 gm).
(d) Cefpodoxime:
- Orelox: suspension (40 mg/ 5 ml) dose 8-10
mg/kg/day divided/12 hours
- Podacef: suspension (1 00 mg/ 5 ml) dose 8-1 0
mg/kg/day divided/12 hours.
(f) Ceftazedime:
-23-
mg
-24-
Preparations:
(a) Cefepime:
- Maxipime: vials (Yz, 1 gm).
- Wincefe :vials (Yz, 1 gm).
(b) Cefpirome:
- Cefrom : vials (1
gm)~
-25-
III- Macrolides
Drugs: Erythromycin, spiramycin, azithromycin,
roxitheromycin, and clarithromycin.
....tJ i.-1""'
Spectrum:
Side effects:
- G.I.T. symptoms as nausea, vomiting and
sometimes diarrhea
- Mild cholestasis
12. hours.
-26-
125 mg susp
6) Erythromycin + sulfa:
(i)
Erythromycin + Sulphisoxazole:
-27-
IV- Aminoglycosides
Spectrum:
- Mainely against gram -ve organisms.
- Antipseudomonal effect.
- Mild antistaph effect.
N.D.:
They~
Preparations:
(1) Gentamicin: Dose 5-7 mglkglday I.M. or LV. divided into 2
doses (every 12 hours).
- Gentamicin}
- Garamycin
ampoules (20,40, 80 mg).
- Rigaminol
- Refobacin ampoules (1 0, 40, 80 mg)
- Cidomycin vials (80, 160 mg).
- Epigent ampoules (20 and 80 mg).
-28-
~,_
- Tobcin
- Tobracin vials (40, 80 mg).
(4) Streptomycin:
Neomycin:
-Neomycin suspension (125 mg/5 ml) tablets (500 mg)
Side effects:
1- Skin rash.
2-
Crystalluria.
Preparations:
- Sutrim
Suspension 40 mg trimethoprim +
- Septrin
200 mg sulphamethoxazole.
- Chemotrim
Tabletes
- Septazole
80 mg trimethoprim +
200 mg sulphamethaxazole
- Lidaprim
VI- Chloramphenicol .
Spectrum:
'
s~ific
-30-
Side effects:
1- Aplastic anemia: inspite it is uncommon, chloramphenical
should be restricted in use to typhoid fever, meningitis
and life threatening anaerobic infection.
2- Grey baby syndrome: a fatal shock-like state occurs in
neonatal period and so, it is contraindicated in neonatal
period.
Dose: 50-100 mglkg/day I.M., LV., oral and rectal given in 3-4
divided doses.
Preparatioas:
- Cidocetine: vials (1 gm), suspension (125 mg/5 ml),
suppositories (125, 250 mg) and capsules (250 mg).
- Thiophenicol: vials (750 mg), tablets (250 mg).
- Miphenicol: Suspension (125 mg/5 ml) suppositories
(125, 250, 500 mg) and Capsules (250 mg).
- Eye and ear drops (miphenicol).
- Chlormaphenicol + streptomycin: (streptophenicol) syrup
( 125 mg/5 ml of each) used for treatment of diarhrea.
-31-
VII- Lincosamides
(a) Lincomycin: similar activity as macrolides. Dose 20-40
mg/kg/ once/day IM or IV.
Preparation Dalacin-C
600 mg ampoules.
B- ANTI-PARASITIC DRUGS
1- Anti-amoebic Drugs
(1) Metronidazole: (tissue and luminal amebicidal)
- Entophar
- I.V. infusion: Flagyl, Elyzol and Flazol (500 mg/100
Every 12 hours
-32-
ml).
'
-Furamide
-Farcomide
- Dimetrol
II Anti-Giardial drugs
1- Tinidazole: > 3 years 50 mglkg ... Oral tablets, once
- Fasigyn. Tablet 500mg
Preparations:
- Alzental
- Vermizole
- Bendax
- Anthelmin
-Verm-1.
Flubendazole
"'~)
Abendazole
3)
Niclosamide:
}
as before.
-34-
Dose:
Preparations:
- Yomesan
- Niclosan
- Praziquentel:
Biltricide
Other groups
VANCOMYCIN
-Vancolon
-
vail 0.5 g
Vancomycin
Dose:
Neonate, IV 10-15 mglkg/dose Q12-18 hr
-35-
LINEZOLID
-Averozolid
100mg/5ml
Dose:
Infant and child :10 mglkg/dose PO Q8 hr. Duration of
therapy: 10-14 days,
MEROPENEM
-
Meronem
0.5, 1 g
Dose:
Neonate: 20 mglkg/dose IV/ 8-12 hr
Infant and children: 40-60 mglkg I _8hr
-36-
C-ANTIPYRETICS
Before prescribing antipyretics remember that:
1- The dehydrated baby as in diarrhea show dehydration fever
and it will be corrected with correction of dehydration.
2- The temperature of the newborn baby may be higher than
normal in hot summer and this needs only correction of the
hot environment and addition of preboild water orally and
bathing.
3- The Egyptian mothers usually exaggerate the complaint of
fever and so, you should measure the body temperature
before the use of antipyretics.
(1) Acetaminophen (paracetamol):
-37-
Dose:
-38-
2- Anti-inflammatory dose:
30 Kg/day every 8 hours.
Preparations:
- Brufen: syrup (100 mg!5 mi), tablets (200, 400, 600 mg).
- Marcofen: syrup (100 mg/5 ml), suppositories (100, 300 mg)
and tablets (400, 500 mg).
- Ibufen: syrup (100 mg/5 ml), tablets (200 mg).
- Ultrafen: suppositories (200 mg).
G~D
deficiency.
3- In newborn and early infancy, it may lead to metabolic
disturbances.
4- It may increase bronchospasm in asthmatic patients.
Dose: 10-15 mglkg/dose oral, rectal, I.V. or I.M. to repeat every
4-6 hours.
-39-
Preparations:
- Aspegic: vials (500 mg) I.M. or I.V. It is used in severe cases
- Rivo: Pediatric tablets (75 mg) suppositories (165 mg) and
tablets.(300 mg).
- Aspocid: Tablets (75 mg, 300 mg),
...
- Doloran suppositories.
(4) Metamizole:
In spite of its potent antipyretic and analgesic, it should
not be used as it may lead to:
I- Fatal agranulocytosis.
2- Nephropathy.
'
-Novalgin
(5) Diclofenac:
-It has anti-pyretic effect and a
antiinflammatory effect more than others
potent.
-40-
(8) Nimesnlide:
Dose 5 mg/kg/day
-41-
Chapter Three
1- EMERGENCY
Emergency:
Treatment of emergency and life threatening conditions
in your clinic is very: important to save the patient's life and your
life also,
~~_,
1- Adrenaline
ampules.
2- Solu-Cortife ampoules.
3- Dexamethazone ampoules.
4- Calcium gluconate ampoules .
. 5- Valpam ampoules.
6- Avii ampoules.
7- Dolphen or Voltren 12.5 & 25 mg Suppo.
8- Cannula 24,22
9- Syringes 2.5,5 mL.
10- Airway.
11- Nebulizer.
12- Sphegmomanometer.
13- Nonnal Saline.
14- Gulcometer.
~ ~~ ~'l.J+Oi A.!~J ~.J J,.9')rl ~ ~ JS u,.. J.J+Ai 2 .;:i_,.:i ~
-42-
~~ w-o ..>?-Y!J
w'J6.
.~ y.)i .) J.W..YI ~
~_;..11 ~ ~., ~4 ~~
. ..ill
Case 1:
Child with generalized convulsions, of acute onset due to
epilepsy, febrile, . . .. etc.
(J.._;.:o 10
= ~
.~
~ ~)fo ~.J ~
f"""
1)
w..l.IJ
0.5 ~ ~ 12
~ ~~ ~_y:o: ~..r.JI
~~
..l.l_u
21 ~_;.:. _,t
uc
~~WI ~tbc.l
N.B
I.
u-- JUl.~l ~ ~
Case 2:
Child 8 month-old with convulsions no fever I no past
history of convulsions. With carpo pedal spasm + signs of
rickets': it is a Hypocalcaemic convulsion.
Characterized by:
(1) 5-18 month-old and some times in newborn.
(2) Signs and symptoms of rickets.
(3) No loss of conscious
(4) No fever.
(5) One Generalized fit.
(6) Carpal spasm.
(7) Patient is normal in between attacks
Valium is not usually indicated except m severe
conditions with cyanosis.
.
Rl Calcium gluconate IV 10% slowly.
2 mUKg +monitoring.
~ ~l ~
w:-l:i:!i ~ u.c.J
\
~ \j\
1.)-i:.JI
ylill u~ ~ .~~
-l1..r~\Sll ~u.c.J~.,~~~~r~~~ ~
R/Fenstil
R/Tobrin
syrup/drops
ED.
~i 4 o.lAl
u!J..a 3 ~ ~
Case 4: Croup
A child 3 years old with croup~ It is an acute spasmodic
laryngitiS mostly due to viral or allergic etiology. Common
between midnight and early morning in winter seasons.
May be mild, moderate or severe up t() cyanosis and arrest.
Rl Adrenaline Nebulizer 1 mL+ 2 mL Cold water for 15 min.
~~ ~ lA_jfo ~.J
R1 De:umethezone
ampoule
1M
tt t1 _ ..t.. .- .... LA 30 N.!. t:t.tt
bJS ill.......
-...~ ~ ~ vv u - u-w
..1
u"il ~ l r,,
... t \"
~ r .1}
~E~~~4lb.~+
Rl Phenadone.
Antibiotics.
Syrup
45-
amp. 1 mL.
Case 6:
Newborn with bleeding (Cephalhaematoma, umbilical,
post-cercumcision or per-rectum bleeding etc.)
Rl Haemakion
ampoule
Case 7: Acute GI
7 month old with Gastro-enteritis with severe dehydration.
-46-
~.J
-~~~ ~~~I
D.D.:
o$ ~J~I o~ J1S:i ~ +
~ jlo~l J,:9 ~J~I o~ _;!~ ~ +
* Vasovagal attack.
Case 10:
Child 3 years old with irreduciable inguinal hernia. Acute
onset of tender hard painfull indirect inguinal hernia.
~..;~ ~ \.;..) ~_,b..o ~ 4i.;<h
30- 10
~.lJ ~I
~I "~'i
uo.'"i,.aJl.U....) _,1
~I~
J_,b. ~
ljl
Case 11:
A child 4 years old with recurrent epistaxes
.~WI
!)
.U-!~''1
~
Ui.J~
~
I. ~'il
~ ("'lh'
-'
~WI
.
i.E.
....,j,jYI u
.~
,_ ..b.a...;JI
- - <.r-
uk- ~y.11
/,..'
-48-
2- MISCEL!rANIES:
Case 1: Acute lymphadenitis
3. years-old child with temp. 38.5 and large, single,
tender deep cervical lymph node of 2 days duration. (Common
presentation).
Rl Zinnat
250 mg vial.
~lw 12 JS ~
Or. Klavox
457 mg suspension.
~twt2 JS~~s
R/ Ketofan
suspension.
trb.
~!.>44 ~
. ~\- 48 J$
Suppuration and surgical drainage may be needed.
~~ o~tc.j
Rl Claforan
500 mg vial.
Rl Flagellate fort
R/ Ketofan
suspension.
~lw 12 JS ~
trb.
~lw8 JS~~5
~!>A4~
suspension. .
. ~\- 48 J$
Suppuration and surgical drainage may be needed.
-49-
~~ o~tc.j
~Case
3:
5 years-old child complaining of acute pam m lower
RJ Epicozyme
Re evalute after 48 hours
Case 4:
..
RJ Hibiotic-N or DeltaClave
230 mg suspension,
~l.w 12 JS ~ 5
Rl Betadine, Vaginal douches.
-
t A~
-
U:!-IJA l.rfT"'"
RJ Fusi-zone or Pandermal
~);A
Rl Megafen
cream.
Syrup
~Jjlll ~ ~);A 3 ~
-50-
l.:ia.l.a
Case 5:
5 month-old baby with umbilical hernia 0.5 to 2 em.
RJ No need
for treatment and most of them improved with
I
time.
RJ ~ 3 iJ.4l ~ r)):.. ~.;
. ,- 3 DA J:~Si ~' ~
Case 6:
Mother of a 3 years-old child complaining that her child
breathing has a bad odor ~...fo ~ ~..J
Look for:
Rl foreign body in the nose.
Rl Chronic adenoid or tonsils enlargement.
Rl Chronic suppurative lung disease.
Rl Psychic mother.
Rl Infected tooth or abscess.
Case 7:
A child complaining of severe neck pain; inability to
move freely in all direction of 2 days duration. (mostly a muscle
spasm due to abnormal position during sleep).
RJ Ketofan or Olfen 25 mg tabs.
R!Olfen gel
RJ musle relaxant
-51-
:4...calc.
u4-P.-_,:;
Jjl.J- Y~ ~
J.ilJ4 ~\,~_,:ill ~
u4~'11
W-A .l..:U:! ~ wY w'-~1 _,i Y~4
~~a..-~
.
.
.
~1~_,~1
.Wli wts w~ ~_, J~ r~' .:ro ~t... ~ JilJI .l:ali:J ~ rLA:Jl u-ll y.ll~ 'J_, .;~1 "~l ~ ~ ~ 0 i Jihll r:W . ~\ill ~\!WI ~ ~ ~ ~~
-52-
CaseS:
Child 5 years old with NE oncei evecy 3-4 days.
R / No mcdical1reatment is required and follow up.
Case9:
6 years - old Child with NE every night and some time in day
time.
Rl- Tofraail
25 mg tab.
jf.J. 0~ ~ \...4 c.J~J.J
. ~ ~ t.! U! OF..J.W~i
Rl UripaD
5pp
N.B:
No fixed prescnptlon for NE. but should be
individualized according to severity, age, response and patient
compliance.
Case 10:
8 years old Child with NE every night and frequency in day
time.
Rf Minirin
1 mg tablets
Case 11:
A child 2 years old with Oxyuris infestations , anal itching.
-53-
...l.fo _,
~:!) b.
,l~t....... S..l:..\,
slw.J
~
4.c.p. s~l
41~!1
-~'1 ~~-.
-~'I
~
~WI
4.!\.l:.jll _, _j\.JQ':/1
' ...
u--
u.ai
JS ~~
Case 12:
A child 4 years-old with Ascaris and Oxyuris infestations.
Rl Bendax susp.
r4l ~ s.l.41 ~ t.......
ril4 r""l 0
Case 13:
A child 6 years-old with urinary Bilharzia! infestations.
terminal haematuria, dysuria..
Rl Distocide or Biltracide tablets
Case 14:
A child 11 years-old with intestinal Bilharzia! infestations.
Chronic dysentery,melena,pa/lor,live in Delta area.
R/ Distocide or Biltracide tablets
rl:!l
-54-
~ s.l.J
Chapter four
~
At 4 months
At 6 months
At 12 month
At 18 months
Vaccines
BCG.
Oral polio vaccine
Hepatitis B vaccine
Oral polio vaccine
DPT vaccine
Hepatitis B vaccine
Oral polio vaccine
DPT vaccine
Hepatitis B vaccine
Oral polio vaccine
DPTvaccine
MMR
Poliomyelitis vaccine
DPT
(1) Vitamin A capsules are given in a dose of IOOOI.U. with 9month vaccines and 2000 I. U at 18 months vaccines.
-55-
Optional vaccines.
Vaccines
Haemophilus
influenza
type b vaccine
Influenza
vaccine
Hepatitis A
vaccines
Chickenpox
vaccine
Pneumococca
1 vaccine
Time
Tradename
At 2,4,5,18 months
ACT-lllB
* From 6-12 month 2 doses with 1
Vaxem-Hib
month a part, booster at 18 mo
Hibrix
From 1-5 years, single dose
Single dose
From 6 mo and above,
Influvac, fluarix
2 doses with 2 month apart
then once every year
After 2nd birthday
Havrix 720,
2 injection with 6 months apart
A vaxim
After 151 birth day, single injection
Varilrix vaccine
or 2 injection with 2 month apart
if above 12 years old
After age of2 years, for high-risk
Pneumo23
children e.g. sickle cell dis.,
vaccine
nephrotic syndrome
-56-
II- NUTRITION
- Breast milk is the milestone of nutrition in the first year of
life, and sufficient alone for about 4 months.
_ Sometimes and due to maternal or socio-ecomomic causes
artificial feeding is used to replace or complement breastfeeding.
_ If formula milk is indicated the mother could use humanized
milk available in the markets or modified cows or buffalo
milk.
- Similac
- Bebelac- 1 or EC
- Aptamil-1
- Humilac-1
- Dialac M
- NAN 1
- Infalac.
- Biomil-1
-Hero baby
-NAN
- Aptamil
- Bebelac
- Promil
2
2
2
~ ~ ~l.G ~ 60 ~
~ ~~l.G~60~ J~ 1
-58-
J\.:1-a 2
-NAN premature
- s-26 RTF
~ ~ fi-lA~ 60 ~ J~ 1
BebelacFL }
~~~La~ 60 ~ J~2
Dialac LF
-Gain
-Nido
(c.snA 100 1~
6) ;~
~ 2 .l::ul.i.ll
.< ... n ul..4.1- c.,r'' ..;--
~I
~yull
~I
~~~WI
.fi-~2
"t... ("'-"60
r:.;,J
.fi-~- 2
"t...~O
'->'d....JI . ~\:ill
"t...w~
~w~
o~ t..._,~W\
.fi...~
-59-
("'""
60
~~I
.J
J}JI
~.!>11
o
_iL..o:.'J\ "l.li.ll
~ ~
#
#
_i
~~
.,, ~ ~ ()A t~ .J
i.l:i... .L.
1 :':II
~~~
A
4.!\.lai~~
l.;.
w..~ .ll.l~
o.l.:l.l~ .6...ia.1.J ~
~ ~~ .UL..o:a'1 1
#
#0
rJsii 0"'
.u ~ <.St ~
(JA!>cl ~ .Jt ~~ ~ .. ~
~l.....o'jl .. 1~1 .-l..hc:.i Uiy () /'i l ~ ~ ~t...:... _,t Jt._...j
.~I~I~!Jj_,
. y.lc. , ~..'-! , J~
, 4.\,! ~
Jij.JI ~ ~!Jll ~ ~
~I ~.J ~W..'JI
.U.JU:i
uk
'
~I ~6.~
#
JilJI u.w~
~
i ll. t:L
.
.P.ru-va
.Jl+..'JI .. ~1
-60-
.,__..!I
Jill~~
":'H
..._,;. 26-10
J.J'it ~
,J~.J
~>
~~
.~lW.;D ~c):-:!
ui
~.}Jll ~
~1-
~~
~.J
-~..l.JfA
. ...
-~
~u~
-~~
~ ,1
,t..._,sn .~ :t...L+&ll ~~
-~ ~ ~~ ~u...l
.~l.Q.;l\ OA.J
l~
J.Jfli J$
-61-
~()A
AI ~I ,_1~1
+ ~I.W:a,;
~I
Jl ~~&-~I
(.)A
~~
~~~
(~~.J~~[~
:JAa
~~
.J.F.JI.J --~411
~Ua~
~ ~J cwn
u.- ~ ~~..wal
~~4~ 1
...;;-:tl
.,~_,,
'i":/1
~ J'+""" ~ ~ y
t.j
~l.i:ilwl
.~1_, ~b_,ll
1.::
til
UW' ~""'
~ .):!ill JfiJI *
wt.-t.....-11_,
-62-
(~~1) ~~
wy_,l:JI *
Chapter Three
1
Respiratory Diseases
(1) Respiratory rate: Assess rate, depth, symmetry and mythm
of respiration.. Respiratozy rate is important for diagnosis of
pneumonia by the presence of fast breath as recommended
Age
NormaiR.R.
1 day - 2 months
Fast breath
_5 0 - 60C/m.
> 50 cycle/minute
> I year
> 40 cycle/minute
30-40C/m.
shortness
of breath.
bronchial breathing,
t TvR
movement,
J.. chest
.!. TVF, --1, air entry on the same side of the lesion
-63-
Upper
respiratory
with
brassy
cough.
The
6- Acute
bronchiolitis:
mo-2
years,
severe
R.D,
-64-
Acute Tonsillitis
\
Case 1:
A child 4 years old (about 16 kg) with acute tonsillitis or
pharyngitis.
s I ......:~~.
~
~Jo'"l
.. '
UM~
Case 2:
A child 3 years old with severe acute follicular tonsilitis
temp. 40c, vomiting.
syrnp
Or Abimol supp
-65-
Case 3:
12 JS ~ 5
tab
Rl Betadine M.wash
Case 4:
A child 3 years old with acute tonsillitis, temp. 40c,
vomiting, anorexia
R I Ketofan
syrup
-66-
Case 5:
\
JS ~ ti:b.l\ ~
I I -
"~ ~ ~..J
4at1. 1~
. ...
r-:
..c
~.JA r - '
Case 1:
A child 15 months old (about 11 kg) with Acute O.M.
syrup
Case 2:
250 mg
~l:l
Rl Cataflam
Rl Afrin
0~ ~Lw.
I ~!>o4 -3 ~'JI ui ~ 2
ear drops
R/Catafly
~~
Case 3:
Rl Maxilase
24 JS
drops
-~t:i 3
Rl Audax
vial
syrup
susp .
~~ ~ ~J;..a3 ~~
-68-
Acute Sinusitis
Mild to moderate fever,headach with mucopurulent nasal
and post-nasal discharge. Mouth breathing is common.
Case 1:
A child 5 years (about 18 kg) with acute sinusitis.
Rl Mucosolvin syrup.
Rl Brufen or ketofan syrup
Case 2:A child 10 years old comes with picture of acute sinusitis.
Rl Flumox
Rl Mrin
500
capsule.
Rl Maxilase
syrup
1~~ -3 Ui'll ~ ~ 2
~~ 3 ~ ~
-69-
Cas~
3:
A child 12 years with acute sinusitis.
.,.~t ~ oJ.Al
~t.... 12JS ~J
R/Maxilase
syrup u~3~~
Nasopharyngitis
The most common infection in children and usually
associated with antibiotic abuse. It is a viral infection mainly.
Mild fever, mucoid nasal discharge, sneezi!Ig, cough, anorexia
with good general condition.
Cases 1:
A child 2 month-old with noisy breathing, sneezing and
mild fever.
Rl Otrivin-baby or Lyse
nasal drops
drops
-70-
Cases 2:
\
syrup
R I Iliadin
Case 3:
Child 10 years old with chronic allergic rhinitis (snoring,
mouth breathing, watery nasal disharge)
Rl Claritine
syrup
I,.Lt......G(~lO)~
R/ Rinosin
nasal drops
Rl Maxillase
syrup
R/ Felixonase
spray
~
.t~-: (".1 I,. l.....w .J ~\...a..4
... :!.) .::i <.J-0
-71-
..j4 l..i.a~
0:1-1
.Uta..a
Acute bronchitis
- Common disease in children and sometimes parallel to
nasopharyngitis.
- Mainly cough ,fever and anorexia.
- Chest: free or rhonchi may be heard and x-ray chest
may be normal or mild hilar congestion.
- Post-tussive vomiting is common, sometimes it is the
main complaint.
- Antibiotic is advised in patients less than 2 years.
- A plenty of oral fluids is important as it acts as mucolytics.
Cases 1:
An infant 18 month-old with acute bronchitis:
Rl Hiconcil or Duracef 250 mg syrup
~~
Rl Ambroxol or Mucosolvin
syrup
R/ Tempra or Brufen
Cases 2:
A child 5 years with acute bronchitis , cough
Rl Sinecod or Paxiladine
~.)4
R! Topl~xil syrup or Pulmonale syrup (when productive
cough).
-72-
ulLa 5
~.J:! ~~ 3 ~ 5
Rl Aironyl or Osipect syrup~ if bronchospasm)
~~3~~
Acute Laryngitis
- It may
be
common A
laryngotracheobroncitis.( croup)
- Common pediatric emergency especially in winter seasons.
- It is mainly viral. It may be
mil~
cyanosis.
- Please, don't examine the throat as it may precipitate reflex
spasm of the larynx.
- First aid measures should be given ~fore referral to hospital.
- D.D:Forign.body,
hypertrophied
adenotonsillitis
and
epiglotitis.
Case1:
A child 3 years old with acute laryngitis (croup)
Rl Humdified oxygen (if possible).
Rl Nebulizer
~ .~Lw.% - 1f4 ~.ul.;~l ~..J
~~
-73-
Rl D~xamethazone or Epidrone
amp.
~l....w
12/ ~ ~ %
syrup.
R/
stain
. ~~ 4 J~ ~..J ~ ,.l.t .;I 2 c)&- ~
Antipyretics.
Case2:
A child 2 years old with upper respiratory tract infection and
croupy cough
Rl Klacid or Biodroxil 250 mg susp
~\...12
Rl Maxillase
Rl Rhinopront
syrup.
syrup.
-74-
/c)l- 5
Pneumonia
- The most common lethal chest disease
evaluation and follow up are very important.
good
2- Cyanosis.
Case 1:
A child 4 years (about 15 kg) with broncho pneumonia )
mild RD,cough .
Rl Claforan or Cefotax
Yzgm vials.
~lJI7-5
R!Mucosol
syrup.
R/Farcolin
syrup
~.J.)ll\ ~ ~ ~~l... 6
. t ... ..<. t<~l -:: ...< .tws., t~t
$
vr- ~ ~
!j
JS c.r.-~ UM.J:il
-75-
...
Gase 2:
~
A child 3 years
--~
Rl Garamycin 40 mg amp.
R/Farcolin
R/Brufen
syrup
syrup
Case 3:
A child 1 years
fever, rhonchi, cough,
with bronchopnetimonia(sever R D ,
bronchospas~ ,unable
R1 I V maintenance fluid.
R1 Nothing per mouth.
Rl Oxygen therapy.
Rl Proper I V antibiotics.
-76-
to suck )
Acute borncbiolitis
'
Case:
A child 10 months with mild to moderate bronchiolitis (wheezy
chest, feeding well) .
~J:!~~
Rl Ambroxal
drops
syrup.
Rl Phenadone or Dexaphen
-~~~ 12/
Rl Fortum
~ 3
250 mg vails
-77-
~refer
to hospital.
Bronchial Asthma
- ~Can be diagnosed at any age but common after 2 years of age.
- It has an allergic aetiology which may be environmental,
dietary or familial.
- Inspite of the dramatic response to steroids try to delay and to
limit its use as can as possible. { Steroids Inhalers is the most
effective anti inflammatory and and less side effects}
- Combinations of bronchiodilators from different groups is
indicated.
- ~2 agonist orally has weak therapeutic effects in children less
than 18 months.
- Prophylactic treatment is very important in chronic cases.
- Education and explanation of the patient and his/her parents
for the nature of the disease and uses of medications are the job
of the doctor.
- The common precipitating factor in children is upper and
lower respiratory infections.
-78-
[1]
Tre~tment
Cases 1:
A child 4 years with acute severe asthma:
Rl Farcolin by nebulizer
~..J ~L..a ~..) 0~ ~ ~ t:1.e ~ ~ 3 + ~ Yz
Rl Ventolin syrup
_. ~);A
31 ~ 5
Rl Epicophylline syrup
.~~L.....61 ~5
Rl Xilone
syrup.
~1:1 3 o~ o~lJ ~ ~
~4i 5 o~
-79-
refer to hospitaL
~);A 3
1~ 5
Cqses 2:
A child 3 years with mild to moderate acute asthma.
nebulizer
R/ Combivent or Farcolin
RJ Epicophylline
R/ Bricanyl or Ventolin
6 JS ~
~~l.w
syrup
syrup
Cases 3:
A child 6 years (about 20 kg) with acute severe
astluna and LRT infection.
bronchial
RJ Farcolin by nebulizer
.~ ~ ~l.w ~.J
JS _;~I
Yz
RJ Solu-cortif vial
RJ Claforan or Cefotax
~li::.l.w 8-6 JS
.l.I.JJ
~lS ~
lgm vials.
~l:JI
-~1
"'
-81-
[2] Prophylaxis
A child 5 years with chronic bronchial asthma.
: c):!
w ~I __,1 .b.)j
~~\ ~
syrup
. ~ 3 oJ.Al ~Lw 12 f~ 3
{ zaditen drops, one drop/kg /12 hour}
Or I Quibron SR or theo- SR tab (300 mg)
.~ oJaJ ~Lw
12
I wa.;! Yz
'-'~~";/\
t.s..
w
I . '''.~ <I...J
~ ~
u ~6,:11
. . .~ ~
. ~
t"l~ ~ ~~ ~
;si
JS o.b.!J ~ wa)
Immunostimulant:
By non specific mechanism
R1 Bronchovaxome caps. Pediat
~ 3 oJ.Al ~ __, ~ JS
t"l:!i 10 ;.141
-82-
ta.~ ,.L.a ~ ~ ~~
l.:.Lt... 12 I
~,.ul\
-83-
eros~
Tuberculosis
It is one of the common endemic diseases in Egypt. It is
abdominal examination.
3- Lymphadenopathy with firm, discrete and non-tender
L.N. but later on may be matted.
Softening of L.N.
-84-
6-ESR
7- Accelerated B.C. G.
8- CBC
Treatment regimens:
(1) Single drug therapy (prophylaxis): I.N.H. is used in
children with contact to infectious cases. It is used for 6-12
months.
(2)
-85-
Cases 1:
A child 2 years old (9 kg) with pulmonary T.B.
Rl Rimactan or Rifadin syrup (100 mg/5 ml).
~..>-' ~ 7.5 - ~ ~ o.l.AIJ .;Ud-11
J..:ai b.~ (~ 5)
~~
Cases 2:
A child 2 years old (9 kg) with anorexi~,mild pallor, ..
recuiTet chest infection not responding well to common
. antibiotics. No defmet diagnosis, ESR raised.
-86-
Then re-evaluate
Cases 3
A child 10 years (20 kg) with miliary T.B. or T.B
meningitis
Rl Streptomycin 1 gm vials
Rl Isocid forte
200 mg tab.
t,SJ.A
-87-
Gastrointerology
Constipation
Constipation refers to a state in which the stools are hard,
infrequent and difficult to pass. Passage of hard stool even
twice/day is considered constipation.
N.B. In chronic constipation you should exclude congenital
megacolon and local lesions as anal fissure and in acute cases
you should ask about persistent vomiting to exclude intestinal
obstruction.
-1
.,P.-~1.all.j
-3
Case 1:
An infant 6 months old with functional (not organic)
constipation.
Rf Glycerin
Ped. Supp.
. ~)\ &i ~ ~.J.)lll ~ ~~ (Jol~
-~' ~ J~ 'l
Cases 2:
An infant 16 months-old with chronic constipation.
JS ~ 10
J:ii.jiO
.l-H-J
A.Jb ~
~L..JI ~~4 ~
Gastroesophageal Reflux
Gastro-esophageal reflux should be considered in case of
persistent regurgitation or vomiting in newborn or infant. Other
causes of neonatal vomiting either medical or surgical should be
excluded especially congenital pyloric stenosis, septicaemia.
N.B. If the infant is overweight or at the upper limit of normal
for his age, the vomiting is mostly caused by overfeeding
Regurgitation range from effortless spitting to forceful
vomiting due to weak cardiac sphincter, usually improved
spontaneously with age.
-89-
Case 1:
Child 6 wks old with persistent vomiting not responding
to antiemetics and doesnt gain weight .
.GER
Case 2:
Two month old well baby with frequent vomiting after
feeding. He is bottle feeder and he gain weight( 4 kg).
\
R/ Primpran
drops
.~L... ~~Wa-tt
t.~
!J"' f.i:"
i.w
ul!!>" 4-3
- lJ:!
&11 c.r
. -.i JW 5
r-
OR Motilium syrup
.~L..w.~~Wa)l~ u!JA3~~2
-90-
,,
...,. C'"
w~_)l
~. ~
..l..le
u """'-' ~
~ ~
;;-l\.W ~
JS
:~\..\~~
~b. I.,, yi 4.,jlJ:. .
. "a-'
~ ~_)\
f'
~-
.(F' 10- 5)
-4..J-l
30
..)~1
Case 3:
Three months old baby with chronic Gastro-esophageal
reflux. He is bottle feeder 4 kg.
Rl Motilium syrup
Rl Nutrlion AR milk
(~jill~~
U:l) ~ ~ ,.t. ~ 60 ~ ~ 2
Case 1:
Infant 2 weeks old with oral thrush.
Rl Fungistatin
-91-
L~ ~ ~
. ...i ~ u-....
.m ...n \alai
f'
&
1SJ.-ll ~ ~~ f"llt
..<..
y.-..,
t..b. E~ -
Cases 2:
A child 3 years old with sever oral monilasis not
responding to local treatments.(? immundefficency )
Rl Diflucan (5 mglml) syrup.
3~ fl~
~J
J.JI
~L..... 24
H_e_r.:...p_eti_c_S_t_o_m_a_ti_ti_s_ _ _ ____.~I
L..-_ _ _ _ _
-92-
Case 1:
A child 3 years old with herpetic gingivostomatitis.
RJ Brufen or ketofan syrup .
. ~~L-....6 /~5
RJ B.B.C. Spray
~--'= ~.lJA 4-3 ~L.... ~~ JS~I ~ rill~~
Or Oracure
oral gel
.J.il.!.l ~ JS~I J:! ~J:! ~~ 3 wi...Jll c)&- ~ 1f4
RJ Totavit or Top-vit
syrup.
~J:! ~~ 3
V::W ~
Case 2:
A child 2 year old with severe herpetic gingivostomatitis,
high grade fever anorexia.
RJ Zovirax
Spray
-93-
.Jf
.t.i.it...., u~ ~~ ~lk-l
.~!J o4Jl:JI
f'J&.
-I
J.i!J.wll DA ..;~'/1 -2
.~L.a.;ll ~ ~.J
y.JSll
f'l~l -3
-94-
migraine is present.
7- If no cause is present . . . . Idiopathic abdominal pau is
Case:
A child 5 years old with recurrent idiopathic abdominal pain.
-~,Jjln ~
Rl Viscralgine syrup
Rl Digestin or postine syrup
.JS'il
ul1.. 5
.la.i ~!>" 3 1~ 5
POOR APPETITE
Poor appetite is a very common problem in children
beyond 2 years old. The problem leads to marked psychological
troubles to parents and this conflects on children by punchiment
and agression which leads to more refusal of food, regurgition,
vomiting and abnormal behavior. Sometimes, the parents
exaggerates the problem and measures the amount of food by
their own measures not by the standard measures. Simply, th<t
doctor should weigh the child and detailed history .The assurance
is very important. Vitamins and appetizers is a medical trial.
Case 1:
A child 4 year old with poor appetite, his weight is 13 kg.
Rl Tres-orix
syrup.
-~ i.ul ~J:! ~,.>e ~ ~
Rl Totavit or Top-vit
syrup .
-95-
-~.J:! ~~ 3 ~ ~
Rl Acti- 5
syrup
~.J:! ~.)A ~ ~
Case 2:
A 2 years old child with poor appetite and his weight is 12
~kg.
()4
.J
~ a.,p~l
Case .1:
A child 4 year old with poor appetite, anaemic.
Diarrhea
It is a very conimon problem especially in summer
seasons. It has a wide clinical presentations range from simple
diarrhea to severe dehydration and even death. It has a different
aetiologies but Rotavirus is still the commonest. The following
table shows the most common etiqlogies of diarrhea:
-96-
-97-
-98-
' chest
media, tonsillitis, urinary tract infection or
infection).
10- Don't forget in cases of persistent vomiting (especially if
fever.
12- Detect the degree of dehydration:
- ~
u-o
.Jlt.-1 b.- JS ~ ~ 50
.,gl
WJl1
.f.St.J\
J.p..1l ~ ~ ,W.m
J$.
J.a..
Indications:
1- Failme ofORS by cup and spoon.
2- Repeated vomiting.
3-Severe anorexia.
2- Severe dehydration.
3- Anuria
---------------------------------
30
mllk2
70
mlfk2
1-12 month
First hour
> 12 month
***
- 10 to 20 kg
{2) Medications:
a) Antibiotics:
Antibiotics shouldn't be used routinely in diarrhea as
acute diarrhea in infants and children is commonly viral and selflimiting. Abuse of antibiotics may lead to side . effects, poor
absorption or emerging of resistant strains of organisms and
economically load.
-101-
with
malignancy
and
on
those
steroid
or
immunosuppressive therapy.
2- Parenteral diarrhea.
3- Specific irifections:
(a) Amebiasis: Flagyl, Amrizole or Elyzol syrup or tablet (50
mg/kg/day for 10 days).
(b) Giardiasis: as amebiasis but the dose is 30 mg/kg/day for
5_days.
(c) Shigellosis
mglkg/day
parentral)
and
Salmonellosis:
parentral)
or
Ampicillin
Amoxicillin
sulpham.ethoxazole
(50
50
(1 00
mglk:g/day
mglkg/day +
trimethoprim 10 mg/kg/day.
(d) Cholera: 3 days treatment by tetracycline (50 mg/kg/day).
b) Antipyretics: (see chapter of antipyretics).
Example:
Rl Plasil or Meclopram drops.
.~t... ~ ~Jl Jri ~..H ~~ 43
Rl Primepran, Plasil
injection
102-
& I~
Rl Cortigen B6
ped. Ampoules.
Jihll ~
~J .~ ~ ~ ~ 1f2
Examples:
- Diax, Kapect , Smecta
syrup.
~.J:!
Sme~
u!J..a 4-3 f ~ 5
(3) Feeding:
1- Breast milk should be continued.
. 'JA.....
S- Other foods: as apple and apple juice, gtittVa and guava juice,
Lemon syrup.
-103-
Stool analysis.
Urin analysis.
Elyctrolyte.
Prophylaxis:
Cases 1:
An infant 7 months old with vorrutmg 5 times and
diarrhea 10 times/day, liquid, no mucous or blood and no fever.
-~~~~4-3/ ~5
\
Rl Rehydran or low-hydran
,.J.a Ji
packets
u~t ~ ~ '":~JS
,.c)A) ~ ~- ,.tA
,_ 200 ~ ~
-104-
Cases 2:
An infant 9 months with acute watery diarrhea > 10 times
/day, vomiting> 5 times/day, fever and pulse is very wealr :.1.d
extremities are cold (sings of severe dehydration).
Cases 3:
A child 18 month old with G.E., diarrhea > 12 times
liquid, with repeated vomiting, some dehydration and fever .
Rl Rehydran or Rehydro-zinc.
,J,A Ji u~ ~ ~ ~
,J.o)
~ ~ ,Lo ~ 200 ~ ~
JS ~ (~ ~ ~lS.JS ~~j
~ ~l.w 12
JS ~ 1.5 ~ .j ~ 4.5 ~ ~
uJ ~~..)
Cases 4:
A child 3.5 years with bloody diarrhea, mucous, 10 times
/day with severe tensmus no fever or vomiting.
-lOS-
J.ilJ..JI
JJL- JSI
u..a J~'ll
Cases 5:
A child 18 month with acute diarrhea, > 10 ti:ines liquid
with blood and mucous, mild tensmus, abdominal distension and
fever 39.5C. "suspect shigellosis"
. J..4c.
u~Lr.. 8/~ ~
Rl Brufen syrup
.u~L.r.. 6
f~5
Rl Rehydran or Rehydro-zinc.
Stool analysis and culture are advised
Cases 6:
A child 8 month with diarrhea, mild fever, no
vomiting, good appetite
susp.
u~4 ~~
pachets
Rl Lacteol-forte or Semecta
ul>-a 3
-106-
~ 1.4
"::.JS ~.J ~
~~
Cases 7:
A child 8 years with acute severe repeated
vomiting,mild fever, and epigastric pain, no diarrhea,
a.~. ~:er
amp
12
JS~
JS ,.~1
Cases.B:
A child 14 month with acute GE, fever, vomiting,not
dehydrated.
Rl Cefatriaxone 0.5 gm
Rl Brufen syrup
.u~t.......6/ ~5
f"WJ w~ ~J
-107-
JJlw.a JSI
Chronic Diarrhea
Diarrhea continuing for more than 4 weeks is considered
chronic .and usually leads to iron & vitamins deficiency,
malnutrition and poor health.
3-
Tuberclin test.
4-
Cases 1:
A child 1 years-old with diarrhea for 10 days, after
AGE ,no fever, no vomiting ,good appetite, stool analysis
free.
RJ Zincsulphate
susp.
-108-
R/Frutal
susp.
Cases 2:
A child 2 years-old with chronic diarrhea for 20 days,
no fever, no vomiting, good appetite, stool analysis reveals
giardia.
Rl Flagyllate forte
syrup
R1 Grand vit
susp.
Rl Digestin
susp.
Multivitamens.
w..... Jj!)
Jaundice.
-110-
D- Laboratory investigations:
-Serum ALT & AST and alkaline phosphatase is elevated.
- Elevated total and direct bilirubin.
- Normal CBC and Reticulocytes.
Case 1:
A 3 years- old child with acute viral hepatitis A
Rl Legalon
tab.
Rl A-viton
cap.
srrrP
Rl Neodigestine
Case 2:
A 3 years child with acute viral hepatitis, temp is 38,
deep yellow urine, nausea, vomiting.
~.).! ~!>- 3 1~ 5
syrup.
Or I Silymarin sackets
R/ Motilium
f.J.)ll\ ~ ~ 5
Yz.'i;...J:! u}).a 3
~l.o ~.JS ~ ~ ~
supp 10 mg
.~L.. ~ JS1t ~ l;...J:! u!J.. 3 ~~ (Joll.j;\l
Rl Becovit syrup
~-':! u!J.. 3 f ~ 5
.u.J.~Jll.J ~Jll
Case 3:
A child 4 years old comes with history of sleeping tendancy and
severe anorexia since 2 days .No fever, no vomiting & no
jaundice.......most propably non-icteric hepatitis ...... liver
enzymes are confirmatory.
Rl treatment as before. .
-112-
Malnutrition
It is a chronic complex disorder of infant feeding,
precipitated by severe poverty and ignorance.
The
2nd
--)>
infections and
gastroenteritis
Poor absorption
~wJli
,.u.qtt
,..,
...
113-
e,)j.ji
~ ~li._g ~ 6
u.o u~~ c)
~tJ..>.!ll
.u.a ~ Ojj;.
c}lSll ~I ~ J;.!. ~ ~.li.ll ~ ~ ~~ .1~..9
Kwashiorkor
It is.a clinical syndrome due to deficiency of protein and
sufficient carbohydrates. It occurs at weaning time from 6 mo to
2 years usually associated with new delivery or poverity.It
affects all the body systems including CNS and skin, there is
deficiency of all vitamins, minerals and trace elements.
Gastroenteritis and skin infections are common.
.......
Case 1:
Mild and moderate cases can be managed as
marasmus ( anorexia ,feet edema).
-ll4-
2nd
degree
Case 2:
A child 18 month old with typical picture of kwashiorkor
(Oedema, apathy, severe anorexia diarrhae, fever and skin
lesions)
"Hospital management"
N.B: All feeding, medicines and fluid management should be
given oral first or through hasogastric tube. If failed
parenteral route started (according to severity).
Rl Whole blood transfusion.
_,\ L.3ii ~ f'Jll .)~ ~ 4Jb. ~.J - ~tbll ~ JMaL..J ~ ~ 200 Ji.i
c:W'~ U.O~
12 I ~..J.J ~ Y2
Or Bebi.:.vit drops
Rl A-viton caps.
f'.J4 ~ JS ~
ut...Jn ~ ~ ~
,w'l/.
Jw/ ~ 5
solution
- .
~'Lt
~.!>'~ 3 ~-,
'
Rl Correction of hypocalcemia and hypoglycaelllia.
-115-
Rl Dietetic management .
I Jl:!S... U~l ~I
lsomil.~ ~~~__,l
Jil=.ll
s:.~l
Jil=.ll C~
Marasmus
Marasmus can occur at any age from birth to 3 years. The
full clinical picture and senile face occurs when the infant stop
growing and begins to utilize his own subcutaneous fat then his
muscles. Weighing less than 60% of standard weight. The infant
2nd degree
3rd degree
-116-
Case 1:
A child 1 year-old (6 kg) with 1st degree marasmus
(dietetic) exclusively breast feeding.
Diet:
. ~ ~Ws-t1
-
~ _g\
!.)"'
_,i
(S.ll:.)
I - ~\
~ ~
.
Jihll ~\a.b!
Jb. c)
JJ! _,1
UMAJ.A
u~fo.
($
i _,i
_,i ~ -
(,)oil$
. ~_p.lll
-~,Ji:i boa
.~ ul.vW.J ~ u~\.9
Rl Hydroferrin
~JJ:.~I ~~
drops
syrups
Or Enfa-vit drops
Rl A-viton cap.
Case 2:
9 month old infant with severe marasmus. 3rd degree.
Rl Hospital management as Kwashiorkor.
-117-
RICI(ETS
One of the commonest diseases in infancy and early
childhood due to vitamin D deficiency during maximum bone
growth (6 months-2 years). It is easy to be diagnosed clinically
and confirmed radiologically (Signs of active rickets are flaring,
fraying and cupping of the epiphysis).
The prevention is by vitamin D supplementation in early
months of life as both breast and cow's milk are deficient in
Vit. D.
The daily
requirem~nts
Delayed teething.
Delayed sitting and walking.
Bowing of legs.
Recl.irrent chest infection.
Large sized head.
! X- rays limps
! . s~ calcium,phospharus
! 1&25 DHC level
-ll8-
Case 1:
Rl Vidr op
drops
OR I Pedical
syrup
Case 2:
A 6 month old child with mild richets.
syrup.
Rl Decal B12 or, Vita cal B12
Or/ Cai-D-B12
ampoule
2 boxes
Case 3:
Child 9 month old with advanced rickets
Rl Devarol-s
ampoules.
3amp.
U:F-;.w.-1
JS ~ ~
-119-
Case 3:
Child 12 month old with advanced rickets
R/One-Alpha drops.
Rl Hi-Cal or Calci-top syrup
120.
NEONATOLOGY
Neonatal period starts immediately after delivery until the
the age of 4 weeks.
~he
do it
1- Poor suckling.
~onsidered
as a normal neonatal
and
degree
symptoms:
1-
Sneezing,
snonng
mild
of nasal
obstruction.
2-
3-
4-
5-
6-
7-
,1,._.!Jjl
9-
-122-
significance
and
disappears
spontaneou!lly
tiny
yellow
papules
representing
blocked
R!fobrin or Chloramphinicol
eye drops
-~t:~i 4 oJ.AJ l.:.aJ:f ~~ 3 ~ ~
u~
stain.
-123-
2- Mucopundent Conjunctivitis
R/ Neo-pol or Neo-Myxidin or Tobrin eye drops
.uu.J,WI
(.).!&JI ~ ~
20 days old baby with colicky crying most of night time -ihspite
of good sucking
Rl Babydrink or Babycalm
sachets.
drops
~w1 ~ ~
41\c_,
,.:.A.b~
lly UJ
wi
'""" 1
-2
J:.li:i ~
.lc.
~ ~ t....;.,)I
.llt.l.J
_,i y::..;u
,.,
- .)
.~I..HJI C!~-'
.~1 ~ .lS ~ ~ Jihll
r-.fJ
\...... ?'Yl
~t.......c.i
~.Jl-1
jl
. _!. -'1
u---
. _!. -'1
L 1 .-:.LJ..~f'Yl "~'
u--u."t-""
__."
.i~ i~ ?+"'
~.l\c.:J ~I
~
"""i
4.lb.J
. I:LII
. U"o"W
j l~~~
-4
-5
-6
,_ '-IL.Jw
. <-.
.
. ~
4- Umbilical Granuloma
Rounded red projection at the base of umbilicus causing
bleeding after the Stump fall down
R1 Silver nitrate 5% or Betadine solution.
l;AJ:! u);.A 3 ~~ ~ ~Ull ~ ~_,. ~
-125-
Case:
A full term newborn 2 days, presented with qm1tifocal
convulsions, change of conscious level with history of difficult
labour and ventonse delivery. His weight is 3.5 kg. ( hypoxic
isch. Incephalopathy or I.C. haemorrhage)
- Oxygen therapy
- I.V. fluids ornasogastric tube feeding.
Suction of secretions.
Rl Valium or Valpam
anip
-126-
Anticonvulsions:
Rl Sominelleta. 40 mg/ml
amp.
.J.il!J 3 ~J.A ~
.lJ.J,J
~lS JJ:,..al
.4&.Lr..12/Jll!J 10 ~J.Q ~ JW
ampoule
-~'-- 8 JS ~~ ~,;.& 3
-127-
Case 1:
A newborn, 20 days-old with poor sucking, poor Moro,
temperature 37C wtih episodes of apnea. His w~ight is 3 kg.
Hospitalize and give him:
Rl Unasyn or Unictam 375 mg
vials .
.UaJI ui4 ~1~1 ~.J ~lw 12/c)l- 1.5 ~..J c)lt 2.5
Rl Fortum 250 mg
vial
.~Lt..
Rl I.V. fluids.
R/Oxygen.
-128-
ui ~
12 JS ~- Yz
Case 2:
A newborn full term, 9 days old with poor sucking,
temperature 38C with episodes of apnea,refuse feeding and
contenouse cry. His weight is 3 kg. Hospitalize and give hin. ,
Rl Claforan or Cefatriaxone or Fortum 250 mg vials .
.~Lw 12/ ,..... 1 ~J ,..... 2ui ~
Rl Unasyn 375 mg vials .
4.:iWI ~4 ?I.W.....I ~J ~Lw 12/~ 2 ~J ~ 2.5 r) ~
Rl Amikain 100 mg/2 ml vial
. ~L.wa 12 JS 1.5J.W J:a~ 4
-~.J:I-"''i ~ u~ ~'i ~l.wll ~~ ul.l~ JS
Rl Dexamethazone or Fortecortin
amp.
Case 3: sepsis
A newborn 5 days old with abdominal distension,
irritability,temperature 37.7 with episodes of crying. His weight
is 3.5 kg.( sepsis)
Rl Cefatriaxone or Fortum 500 mg
vials.
"'g;:!J ~ 3 ~ ~
drops
~!>-4-.3
Rl Cetal
drops
-129-
I ~4 ~ t5
Case 1:
Full term baby delevired 2 hours ago for diabetic mother
(IDDM) (Fatal Hypoglycaemia my be occur during first to 2
days)
100/ml/24 h
u~l....ii-4
JS ~~~ ~ ~ c.JoUl;!
~J..):\Ill .;1 ~'ll <)4 ~ ~~..)
Case 2:
Full term baby delevired for diabetic mother in rural area,
no hospital near_to you.
.,1
.~t... 8-4
%10 Jl
%5~ ~t.,
cJilill ~l...ii.J
At;eU J ~I
8- Jaundice (Hyperbilirubinemia)
A- Physiologic jaundice.
N.B.: Physiological jaundice is diagnosed by exclusion.
It appears in full-term infant after the third day of life and
resolves before 10 days, total serum bilirubin less than 13 mg/dl,
direct fraction less than 20% of the total. Breast-fed infants
exhibit higher peak serum bilirubin values and slower resolution
than do formula-fed infants.
B- Phathological Jaundice
When serum bilirubin concentration increases by more
than 5 mg/dl/day, when the total bilirubin is over 15 mg/dl in a
formula-fed full-term or over 17 mgldl in a breast-fed term
infant, or if cord bilirubin is 5 mg/dl or also should be considered
in clinical jaundice in the first 30 hrs.
f- Haemolysis work-up.
-131-
Treatment:
1- No treatment (follow up).
2- Sominaletta therapy
3- Phototherapy
4- Exchange transfusion.
5:-Two ofthe above
Phototherapy
Exchange transfusion
Exchange
I phot
and Phototherapy
transfusion .
1-2 day
>15
>20
>25
2-3 day
> 18
>25
>30
> 3 day
>20
>25
2::30
Case 1:
Full term healthy newborn 6 days old with physiological
jaundice 10 mg/dl.
Rl Sominaletta syrup
.~~...w 12
~ 9-l...a ,-
1~ 2.s
100 ~ UAP 2
JS u..!.Sl1 o.l~! -
Case 3:
Newborn 4 days old, full term, with jaundice> 15 mg/dl.
Rl Phototherapy.
-132-
Case 4:
Newborn 5 days old, healthy full term with jaundice .. 25
mg/dl.with Rh incompatibility
Rl Phototherapy
Rl Prepare for blood exchange.
Case 5:
Newborn 25 days old healthy, jaundiced 15 mg/dl direct
is 6 mg dl 4.5 kg(? Sepsis)
liver function test near normal
u.i ~
Rl Cholestran Sachets.
Rl Bebevit
drops
9- G.I.T. Problems
Case 1:
'
Cases 2:
Newborn 20 days old, healthy bottle fed, pass semiliquid
motion every 2-5 day.
Case 3:
25 days old newborn with repeated vomiting.
Cases 4:
20 days old newborn, with severe straining to pass hard
stool every day.
R I Glycerin
supp. Pediatr.
. ~ttl~~~.......~-"
.....
. . .:. ...t
~
~...Jolo- U"-.!1'!"
('.:1-J"'"
-134-
-135-
-136-
Case:
Newborn 26 days old with fever 38-41 oc since 3 c:2ys,
crying most of time, clinching hands and hip flexion during
micturation, fully conscious, feeding well.
? Urinary tract infection.
"Urine analysis, culture and CBC"
Rl Cataflam or Abimol or Cetal drops
o ~L: ~~.s~ ~
2 ml
~L:I 5 o~ ~ c) ~t..... 12 /~ 1f2
Or Rifobacin 10 mg amp.
-137-
Miscellaneous Problems
Case 1:
Newborn 2 wks old with multiple skin boils (pyoderma),
temp. 3 7 C with good general condition:
;t..aL...
Case 2:
Newborn 3 wks old with noisy breathing, sneezing, interrupted
breast feeding temp. 37 C
Or Rhinostop drops.
-138-
~ .l:W
Case 3:
Newborn with eczema of the face (Red,rough crusty cheeks)'
R I Micort or hydrocortisone 1%
cream
~JJll' J. ~JA ~_jll ~JA u~J
R I Fenistil
drops
,;
l~l.r...A
.j
b.~ ~4 ~
* Chemot.herapeutics.
* Bromocryptine ( Barlodele ) .
* Cimetidine.
* Immunosuppressants used for:
rheumatoid arthritis
Autoimmune disease.
SLE.
*Smoking
* Tetracycline.
*Aspirin.
* Contraceptive pills .
* Primperan (Metclopramide) .
* Metronidazole (Flagyl).
* Psychotropic drags.
* Sulphasalazine.
-139-
NEPHROLOGY
Nephrotic Syndrome (N.S.)
Nephrotic syndrome has 4 components:
1- Proteinuria (heavy >2 gms/24 hs, mainely albuminurea).
2- Hypoproteinemia (mainly hypo-albuminemia with reversal of
albumin/globulin ratio)
3- Edema (recurrent in the face for few days then becomes
generalized starts in L.L.
thigh
B.
Case 1:
A child 2 years old with recent morning bilateral eye
puffuess and normal blood pressure, and disappeared at
afternoon. No other symptoms. (Think in nephrosis)
R1 Urine analysis for protienurea
-140-
Case 2:
A child 5 years old with clinical nephrosis and normal
blood pressure, massive edema and mild oliguria weight 20 !(g.
"Hospitalization is better"
Rl Augmenten 600 mg vial or tab
Rl Lasix tab or Salex tab (40 mg)
Rl Mucogel or Epicogel
44-J -
susp.
25 mg tab.
Rffotavit
susp.
-141-
..hi....::JI
JSi
0-> _;I:Sjl-
.) ~ ~I J)\!"jl -
.ya.ll!, 4.S~4 c~
~ wlijj~l ~
U2..::...)W
Solupred 20mg
Solu-medrol
IV
tablets.
injections
-142-
Case 3:
_____
------:~.;:;...
_______
~-----
-143-
Routine Investigation:
.Serum creatinine, ASOT, C3,C4 and urine analysis , serum
albumen and abdominal ultrasound
Cases 1:
Child 4 years old with nephritis (APSGN) .Facial edema,
smoky urine and hepertensive 140/100 mmHg.
Rl Crystaline penecillin
vials.
25mg
tablets.
Orlnedral
tab
10mg
-144-
.l~'f)j ~~I
()4
()4
~'fl -
uJ;~,J-~~1
c)c .
Routine investigations:
** Urine analysis and CIS.
Abdominal Ultrasonogaphy.
**
Renal functions.
Cases 1:
Child 4 year/old with upper urinary tract infection
(pyelonephritis): "Fever, Rigors, nausea, vomiting apsf tender
flanks''(urine analysis -+ pyurea & urine culture shows
significant bacteruria).
Rl Garamycin
amp40mg.
-~l.....12/ ~4a
susp
Rl Marcofen 300 mg
supp.
Cases 2:
Child 1 year/old with upper urinary tract infection
(pyelonephritis): "Fever, Rigors, failure to thrive, nausea,
vomiting and diarrhea"
(urine analysis ~ pyurea & urine
culture shows significant bacteruria).
Rl Claforan or Cefotax 0.5 gm vials
Y~ ~ ~ .~1 ~ c.JA ~L..w. 12 ~~ ~
susp
Rl Epimag
eff.
granules.
-~J:! ~JA ,.t.. y.JS ~.J ~ "w ~
Rl Temporal , or Brufen
.W=J! ~ ~\.c.l...a 6-41 c)La 5
Rl ::1: I.V fluid.
'"
Case 3:
Child 5 years old with acute cystitis.
(Penile pinching, urgency, enuresis, dysurea), with fever.
R1 Sutrim or septazol
susp.
oJ.AJ ~L.... 12
1c)La 5
-~\:1 10 o~ ~~.c.~...a 8
1u.1l.a 5
- ~\:1
to
-1 46-
Rl Coliurinal or Epimag
eff granules
.i.:-aJ:! ~.)A ~ L4 ~.:~..P ca.; c)&Rl Marcofen or Ketofan or Temporal syrup.
tg
u~L.w,
6 f '-' '\ 5
Case 4:
Child 4 years old with Recurrent UTI:
is indicated to
Rl Prophylaxis:
Sutrim or septazole
susp .
Rl Urological consultation
is
recommended for
-147-
furthur
Renal colic
Not common in pediatric, but can occur at any age, in the
form of acute abdomen of sudden onset in children or persistant
crying unexplained in infancy, haematuria is common but not
associated with fever.
- In recurrent colic, plain X-ray, abdominal sonar, IVP and urine
analysis is indicated.
Case 1:
Child 8 years old with acute agonizing renal calic:
Rl Voltarin or diclophinac amp 75 mg 3 ml
~-i)lll ~ ~
ull.. 1
Rl Buscopan amp.
-148-
CARDIOLOGY
Rheumatic fever
It is an inflammatory disease involving mainly big _,vints,
frequ~mtly
the CNS.
Minor criteria
1- Carditis.
1- Fever.
2- Polyarthritis
2- Arthralgia.
3- Chorea.
3- Elevated
4- Erythema
reactants:
I
acute
phase
marginatum
- Raised ESR.
5- Subcutaneous
nodules.
(c)
(d)
Elevated
streptococcal
antihyaluronidastr,
antideoxy
ribonulease
B or positive streptozyme.
The diagnosis of
rheumatic fever is done by two maj or criteria or one major and two minor
_criteria plus evide~ce of streptococcal infection.
arthritis.
c- Treatment of complications as heart failure.
(2) Prophylaxis against rheumatic recurrences.
-150-
Cases 1:
A child 8 years old with acute rheumatic fever presented
with migratory polyarthritis, fever, Positive CRP and evidence of
streptococcal infection and without carditis.
Rl Crystaline Penicillin
JS ~ ~
Rl Mucogel or Epicogel
c.J4J 2
susp.
-151-
Case 2:
A female child 11 years old presenting with rheumatic chorea.
Yz
Rl Durapen-S or Lastipen LA
u-11
.1}):i _, ~~ ~~ ~.)
Case 3:
A child 10 years old (25 kg) with acute rheumatic fever ap.d
evidence.ef carditis and/or failure heart
* Hospitalization
*Bed rest
vials
Rl Hostacortin or Ultracorten 5 mg
JS ~
tablets
~~~ u...a 6:!'='~t ~~:::WI llA ~~~ IJ.+.! .JS'JI Ja.J ~J:! u}>A 4 <.J4J 2
&:l.t...l 4 oJ.AlJ ~..;~ UJJ:!:i,JJSll~.?. <.J4Wi c) i~ ~J UJl~ ~I
Rl Lanoxin (digoxin).
See Heart failure.
Rl Mucogel or Epicogel
susp.
Cases 4:
A child 8 years old with history of rheumatic fever.
Rl Penadura or Lastipen LA
.J..a.NI ~
-153-
. t . ~~. ~25
Infective endocarditis
Infective endocarditis is common. in congenital or
acquired heart diseased. Prolonged low-grade fever, malaise,
anorexia, auscultation of new or changing mmmurs, hematuria,
Investigations include -elevated ESR and positive Creactive prorein. Repeated blood adames and echocamiography
are the dia,goostic evidences of infiecti1re enrJoamfitis.
Cases 1:
A child 10 years old (25 kg) with !Jlbaunatic heart disease
.fJJIU
-iJ.54.:
J.S ~~\
~ F-~l ~ ~~ ~\ Fo~!
Case 2:
A child with rheumatic heart disease gomg to lower
endoscopy or urinary catheterization.
R/ Ampicillin 50 mglkg + gentamicin 3 mglkg
-155-
-156-
Cases 1:
A child 2 years old (11 kg) with big
heart failure.
\rsn
and severe
Yz
JS ~ Jt ~(~I~) ~ Yz
Rl Potassium syrup.
~J:! uJ;.o 3 f ~ 5
Rl Capoten 25 mg tablets
.i~LwwJ b~ ~J. ~
N.B: In Moderate and mild HF oral forms can used.
Cases 2:
A child 15 month old (9 kg) with big VSD and mild heart failure.
'
R!Lano:xin
pediat.elixir
Rl Potassium syrup.
R!Polyvital
drops
-158-
Cases 3:
A child 5 month old (4 kg) with big VSD , PDA and
heart failure.
----------------------------------------R/Lanoxin
pediat. elixir
--
RJ Potassium syrup.
RJ Captopril or capoten 25 mg tablets
~t....12/ ~ ~ 2.5 ~ .J s:.La ~ 10 ~ (,)62..)ill 'f.ly\~
RlAldacton 25 mg tab
~~ ~4 ~ 1.5 ~ .J s:. l-4 ~ 5 ~ (.)62..)ill yl~
Case 4:
A child 10 years old with compensated congestive
cardiomyopathy
Rl Lanoxin or cardixin tablets
Rl Capoten or captopril tab 25 mg.
Rl L-Carnitin
syrup
-~1!1~3/~3
\
-159-
Case 5:
A child 2 years old (1 0 kg) with toxic myocarditis and
severe heart failure due to scorpion sting y ~ .ll
Hospital (Pediatric ICU) management:
t:La ~ ~ 9+ ~ 1
u.- u'~' Jw ~ 10
.u~t....a8 ~Jw~5
.~l....a24
JS v.. ~5
Rl Potassium supplementation.
add to IV fluid or through NGT or oral.
Rl Captopril Tab.
-160-
v..
Case 6:
A child 7 years old with Fallot tetralogy without complications.
Rl lndera110 mg
tab .
~..9:! ~~ 3 (.)4.)
syrup
~ - 4:ia.l.
U:f-1..>'1~
Rl Sytron
Rl Ospen lOOOmg
tab.
~ya
Rl Epicozyme
(.)A.)%
syrup
Case 7:
A child 7 years old with tetralogy ofFallot has an episode
of cyanotic spells (Hypoxemic). "sudden onset of dyspnea,
alteration of consciousness, irritability and syncope).
Rl Oxygen therapy.
Rl NaHCo1 1-2 mEq/ Kg!IV.
o/oS J.f~ ~~ ~ F-~ ..\.l_u ~..f:!.l~ ~~..A!
-161-
Case 8:
A child 13 years old, obese
hypertension 160/95.
Rl Inderall 0 mg
tab .
~.J:! ~!>A 3 ~.)
Case 9:
A child 4 years old, c/o chronic headach with
hypertension 150/95.
Essential hypertension is not common at this age,so you have to
exclude causes ofhypertension.
1- Exclude Renal causes of hypertension.
-163-
HAEMATOLOGY
Average hematological values (parameters):
HB(gldl)
Age
Hct
(%)
MCV
Reticulo
(FL)
cytes
WBC
(%)
-Cord blood
163
5110
11010
9000-30.000
-I month
14 3
4312
10510
7000-20.000
-3 months
112
355
9510
6000-18000
- 1-6 years
122
345
905
6000-15000
133
405
8510
1.6
4500-13.500
-7-12 years
(-1.-MCV)
hypochromic
(-1.-MCHC)
anemia.
-164-
1st
week of therapy.
Cases 1:
An infant 10 month old, only breast milk feeder with
cow's milk supplementation, have mild pallor, anorexia, some
irritability, no organomegaly.
Rl Hydroferrin
OrSytron
R/Cevilene
drops
syrup.
drops
-165-
Case 2:
A child, 6 years old with iron deficiency anaemia HB 7.5 gm.
Rl Vitaferrol or Ferose
syrup.
. ~ 3tl.4l u~.Jll CJ l:-o.J:! u).)A 3 /~ 5
R/Upsa-C
effer. tablets
Rl Haemojet
Case 3:
A child 6 years old with severe iron deficiency anaemia ,
(HB 5 gm/dl) and heart Failure.
Rl Totavit
chewable tablets.
Rl Epicozyme
susp
-166-
3f~5
Prophylaxis:
Prevention better than cure.
10 mg/once daily elemental iron is sufficient to prevent IP ~~
Glucose-6-P-D deficiency
The most common cause of acute haemolysis in Egypt, it
is an X -linked inheritance ( affect males only and rarely females
due to gene mutation). In between the episodes the patient and
his blood indices are normal.
Clinical manifestations:
Management:
1. Oxygen therapy, maintaining of patent airway and
circulation in severe cases.
2. LV. fluids with Na-bicarbonate to alkalinaise the urine to
prevent the precipitation of hemoglobin in the kidney as
acid' hematin which leads to renal failure (lasex IV).
3. Urgent blood transfusion 20 ml/Kg/transfusion.
Case:
A child 3 years old with rapid onset of jaundice, change
color of urine, pallor, fatigue and history of ingestion of broad
beans yesterday~i J_,i ~i .
Rl Intravenous normal saline (diuresis)
-~ ~
Rl Oxygen mask.
R /Sodium Bicarbonate 8.4 %
,.~ J.i.JJ % 5
. R Lasix
J.A ~ 10 + ~U~_H. ~ 10
amp.
R1 Blood transfusion.
.4\a.ll ~ ~ .J ~t.. ~ ~ 300 Ji.i
"l :; . . .~ u-I - t
t
~ Jl t :Ltt
~.J#.*A ~ J~..J u' """" o.oa v- ~
~~. ~
.~Jll
. .. - O:tj
u--
c) G6PD
:~Lc.~l
-168-
laboratory
diagnosis
shows mild
unconjungated
-169-
Case 1:
Achild 4 years old with B-thalassemia major (Wt. 15 kg).
(hypertransfusion)
(Supertransfusion)
JS .;1
u.l:!
cSJ.A ~
9-l....w
JS
~I ~ ~
OR/ Ketler
Case 2:
A child 3 years ol~ known case of sickle cell anaemia,
presented with pallor, crying, painful swollen hands, temperature
39C.
Urgent treatment:
Rl Intraveaoas fluid for hydration
..:.~Lw 8/ JS ~..Jjl\ c) c:l- ~ uL 500
Rl Oxygen therapy
.J.UJI .-:t 3 ----<1 -~1
- 1J"'" . ~ "'
Rl Sodium bicarbonate
solution
.~1 ~
Rl Unictam 375 mg
s:-.iw J.a..;jll ~ /~ 15
vials.
4wlwa.ll J~l
~ ~L...al 3
JS ~
Yz
orofacial
and bone marrow. The normal platelet count is 150,000 400,000/ mm3
-171-
Cases 1:
A child 3 years old with typical picture of ITP
"Echymosis and petechaie on the lips, skin, mild epistaxis, no
fever or organomegally''. HB 11 gm/dl, WBC 5.2/cc, RBCs,
3.4/cc, platelet: 20,000
e.fl- ....
~t....l
JJC.
oJ"=-l -
eW.;! ~
J$.
-~,.}~1 .
J' ~ ~ -
~Al\
'Jc_-
(.$t ~~
-172-
J.c.
~ Case
2:
Case 3:
A child 3 years old with chronic ITP. (4-6 months)
Rl start another course of prednisolone as before
Or/ Spleenectomy is advised.
Or/ Immunoglobulin therapy.
Hemophilia A
An X-linked deficiency of factor Vlll activity it is
Cases 1:
A child 10 years-old known as hemophilic going to
appendectomy.
Rl Fresh frozen plasma Transfusion 250 ml
~\01... 8
JS
-173-
J.I.JJ (o~_,
500) ul..Jo~..Joi.JS
Case 2:
The same child came with severe haemoarthorosis
~~..... 48
Case 3:
A hemophilic boy 5 years with persistent small wound bleeding
or after tooth extraction.
Rl Fresh frozen plasma .
(~~/r)lo 250) 4Jil1 'Lo.P4 o~_,
Jli
JS ~i
tablets
tablets
-174-
w
-j4 -(,)4.;S- l.9:! cJ:!ol
y..a.J:!
~~
3 (,)4.)
INFECTIOUS DISEASES
Viral Infections
Common criteria for viral infections:
-175-
Varicella (Chickenpox)
Mild fever, malaise and anorexia precede the rash. With
the appearance of the rash fever becomes moderate. The rash
appears typically on the.trunk and to some extent the face. .It is
formed of erythematous macules, vesicles . and pustules, as
various stages may present it is called pleomorphic rash. Itching
Is common.
Case 1:
A preschool child with chickenpox, fever 38.5 %.
R/Claritine or Fenistil
syrup.
Rl Calamyl or Caladryllotion
R/Brufen
syrup.
.u~t.-6 JS~S
.4.:i~!J (>I~
~' ,.\~\
.)h.a-
Case 2:
A child 18 month-old with severe chickenpox eruption,
fever 39.5 %, anorexia.
-176-
Rl Fenistil
syrup.
Rl Calamyl or Caladryllotion
Rl Megafenor Tempera
syrup.
-~.JJlll ~ u~L..w 6
Rl Zovirax
JS ~ 5
syrup.
-~l:'
5 o.l.41 'u~L..w 8 JS ~ 5
CJ:I
~13 . N.:.
Case:
-177-
oc,
Erythema Infectiosum
It is a benign exanthematous (rashes) disease of school
age children. Typically the first sign of illness is the rash, which
IS
raised
red
maculopapular
lesions
on
the
cheek
Case: .
A child 7 years old with temp. 38.5 and red
erythematous macules on the check and good general condition
and no obvious focus for infection.
Rl Brufen 200 mg tab
Or Cetal or Megafen syrup.
Measles
-178-
Case:
A child 4 years old with measles, "severe cough
sneezing, conjunctivites, fever and rashes".
R/ Abimol syrup.
R/ Pedipro or Rhinotus
R/ Prisoline eye drops.
R/ Halorange
R I A-viton
caps.
Lw
4&n.
.lJ:! r-~
~~
-179-
Mumps
Common childhood infection. Tender swelling of one or
more of salivary glands but parotid is the commonest where the
swelling displace the ear upward and outward. Mild systemic
manifestations.
Meningeoencephalitis,
pancreatitis
and
Case:
A school aged child with mumps.
Rl Marcofen or Ketofan
Rl Reparil
syrup.
gel.
Bacterial Infections:
~~----------------T--et_a_n_u_s___________' __--~1
It is a lethal disease particularly in newborn, but it is
decreased due to compulsory vaccination for most of children
and booster doses for the pregnant women. The main lines of
treatment are supportive and antitoxins. Clinically the baby is
irrttable with spasms of jaw muscles, stiffness of the back, neck
-180-
I
I
1
Cases 1:
A child 7 years old with macerated wounds due to car
accident, "he received all vaccines"
Rl Antibiotics
Rl Care of the wounds
Rl Tetanus toxoid vaccine
Case 2:
Child 10 years old with the same condition "not
vaccinated .
Rl Antibiotics
Rl Tetanus toxoid vaccine
fi~ 45
JS u~.;.l. 4
Case 3:
Newborn 1 week old with typical tetanus neonatoruin
"Hospital care"
-181-
Diphtheria
Also has decreased in incidence due to vaccination program
-182-
Cases:
(Hospitalization in fever hospital and notification )
A child 3 years old with diphtheria complicated by heart
failure (myocarditis).
Rl Procain penicillin
vaiaL
vaial.
tab. 5 mg
Rl Digitalization
(See heart failure)
N.B. Heart failure can occur within 6 weeks
.U~I ~ WF-~i o.l.J J,!")rl ~ y..;-11
.U~I ~I u~l t~
-183-
~JJ.JJ ~l.k.J
Typhoid Fever
Typhoid fever in pediatrics is not typically manifested as
in adults; it has a wide range of presentation.
Clinically: the child complaints of fever, malaise, headache
and crampy abdominal pain with distension, constipation or
diarrhea, high fever and toxaemia, in addition to mild
hepatosplenomegally and symptoms of complications as
intestinal perforation or meningitis.
Blood, urine and stool cultures are diagnostic, while Widal
test is suggestive even if positive.
Infection is by contact to patient or feco-oral and waterborne.
Case 1:
A child 10 years old with typhoid fever (Prolonged
Hyperpyrexia, toxic, tender abdominal distension, severe
anorexia and vomiting).
Rf. Thiophenicol 750 mg
widely used)
R/ Septazol or Septrin
syrup.
.~Lw.12/~~
syrup.
Rl Ketofan or Marcofen
-184-
Case 2:
A child 6 years-old diagnosed as a typhoid fever with
toxemia and pallor
R/IV Fluids
.~~ 12
Rf Cefatriaxone or Claforan 1 gm
JS
~ J~ ~00
vial
.~l.w 12/~ ,jl ~ ~
Rf Epidrone
amp
-185-
-186-
Scarlet fever
Group A streptococcal infection. It may leads to
rheumatic fever. Acute onset of fever, malaise, and headache.
The tongue is coated with white membrane with prominent red
papillae (white strawberry appearance tl.J);ill U,J.l ul.....Jll). After
shedding of the membrane, the tongue gives a red strawberry
appearance. The rash is red, punctate, blanches on pressure with
no rash around the mouth (Circumoral pallor).
Case 1:
A 7 years age child with typical scarlet fever.
Rl Augmentin 457 mg
susp.
Rl Ultrafen or Ketofan
syrup.
~.J:! ~~4 ~5
Case 2:
An infant 7 month-old age child withtypical scarlet fever
(fever 39.5, strawberry tangue, vomiting and skin erythema)
-187-
Case 3:
A 10 years age child with typical scarlet fever.
Rl Penadur 1.200,000 iu
vial
.4-.t....:.. .;~1 ~ .&J .1=1! o~IJ v,.. ~ c.s.lAll J.!~ ~ Ub.
R/Megafen
tablets
Case 4:
An infant 11 month-old age child with typical scarlet
fever (fever 40.5, red strawberry tartgue, vomiting and skin
erythema)
syrup
-188-
NEUROLOGY
Antiepileptic Drugs:
ill Sodium
Valproate:
doses.
Preparations:
Oepakine:
Convulex
- Tegretol
-Tablets 200 mg
"' Epanutin
-189-
. Tablets 15 mg
. Syrup 15 mg/5 ml.
. Ampoules 40 mg/ml
- Sominal
. Ampules 20 mg/ml
. Tablets 60 mg.
&
-190-
Febrile Convulsions
It is an absolute childhood convulsions occurs between 6
months....:... 6 years. Simple febrile convulsion (Generalized, < 15
minutes, with short post-ictal sleep, occurs once/febrile illness
and E.E.G. is normal after 15 days of the fit), the reverse to the
previous characters called complex or atypical febrile. The cause
of fever is essentially extracranial (G.E., O.M., pneumonia,
tonsillitis or U.T.I.).
D.D.
*Febrile convulsions,
* Intracranial infection
* Epilepsy precipitated by infection causing fever.
Case: .
A child 23 months old coming with fever and generalized
convulsions lasting about 5 minutes with no signs suggestive of
intracranial infection and he regains conscious levet shortly after
the fit. He has tonsillitis and -ve family history of epilepsy or
convulsions.
-191-
R/ Tempra syrup.
R/ Dolphin 12.5 mg supp.
Rl E-Mox or Ospexin 250 mg susp .
.R/ Valpam syrup
Or Diazepam supp 5 mg
.~14,;J e,l.i:iJI U!,A! ~ u~LA..a 6 fer.-~ UM~
uiJL4S ~ ~
IJ. ..aHI
-ll
~
ta..!:)J
~ lJ.:j!)I 9- J..ill
.-:~_ ...,.
~
I,..
e.
4JJ U:iJI
J~ ~ ~ ~~~ u~
. (CSF analysis)
~J ~~
J.il.w
.~1
~ JI u
m--11 ~ r.st~ ~~
"'~ "i l...il-'1
~
!J ~~
~ u~l
.
-192-
Epilepsy
As starting antiepileptic therapy is a dangerous decision.
You should be sure that the case is epilepsy (i.e. exclue
syndromes that mimic epilepsy as syncope, breath holding
attacks, shuddring attacks, benign paroxysmal vertigo ... etc).
If the case is sure epileptic, you should ask yourself . . . Is
it first attack ? If yes, you could postpone antiepileptics until
another attack occurs as 70% of the first attacks don't recur, but
if the first attack is associated with +ve family history of
epilepsy, or the patient has a neurological deficit or mental
subnormality you should start antiepileptic drug therapy.
The rule is to start with single drug (monotherapy) and
increase the dose gradually until response is achieved, if no
response on the maximum dose, use another drug and on
control withdraw the first drug gradually.
N. B.: Duration of therapy is minimally 2 years free from fits.
Case 1:
A child 5 years old with recurrent absence attacks (> 10
times per day without loss of body tone) and E.E.G. shows 3HZ
spike and slow waves. His weight is 19 kg.
Rl Depakine syrup.
.~i
1 ~ 3oo ~
If no response add:
Rl Apetryl or Amotril
0.5 mg tab.
Case 2:
A infant 10 months with first attack of generalized tonicclonic convulsions without fever. The growth and development
is normal with normal neurological examination. Serum calcium
is 10.4 mg/dl and E.E.G. is normal. Family history is -ve for
epilepsy.
RI
Case 3:
A male child 3 years old presented with.recurrent attacks
of right hemiconvulSions with short period (few hours) ofTodd's
paralysis of the right side. E.E.G. shows focal epileptic discharge
and C.T. is free. His weight is 14 kg.
-194-
Rl Tegretol syrup
.~i o.1.Al c.::a~L.... 8 JS ~ ~ 2.5
.~i o.1.Al c.::a~L.... 8 JS ~ ~ 3.~ ~
~~c.::a~L....8
JS
~~4.5~
,.'II ~ ~
..>AYI 1~ ~ f'_flll
Case 4:
A female infant 8 months with recurrent generalized tonic
(G.n. convulsions not related to fever. Serum calcium 9.7 mg/dl,
E.E.G. shows generalized epileptogenic activity and there was
+ve family histocy of epilepsy. Her weight is.9 kg.
Rl Epanutin
syrup
.c.::a~L.... 8
1~ 2.s
"':'+.!
Asb
-195-
Status Epilepticus
Status epilepticus is a
- Intial management:
1. Assess oral airway for patency and insert and
oropharyngeal .airway, if available. Excessive oral
secretions are removed by gentle suctioning.
2. Give 100% oxygen better by a face mask. .
mg/2 ml).
2. I.V phenytoin: It .is given in a dose of 15-20 mg!Kg over
10-15 minutes. Close monitoring of the heart is essential
-196-
as
senous
heart
block may
occur.
Commercial
-197-
3rd
Hospital Management
Case:
A male infant 14 month old with fever, irritability,
vomiting and 2 attacks ofG.T.C. convulsions and bulged anterior
fontanelle. CSF examination shows protein 100 mg/dl, sugar 10
mg/dl and over counted polymorphs. His weight is 10.5 kg.
Combination of
1- Epicocillin 500 mg
3- Cidostiile 1 gm
vials
vials.
-198-
U,.,.a.j ($ J.4
Rl Dexamethazone
~- j:.~
($ .lJ...)J
amp
-~l:fl ~~ o.l.J ~~t-...
s JS ($~ ~ 1
Poliomyelitis
It is an acute viral infection of the anterior horn cells of
the spinal cord and the motor nuclei of the brain stem. It was a
common cause of acute flaccid paralysis in childhood but
nowadays, with the Egyptian program for polio-eradication,
guided by the Ministry ofHealth, it is very seldom to see any
cases.
Criteria for diagnosis of paralytic poliomyelitis
1- Acute massive flaccid paralysis.
2- Haphazard in distribution.
3- Purely motor with completely intact sensation
-199-
physiotherapy
orthopedic surgery and
rehabilitation.
Cerebral Palsy
Cerebral palsy is one of the commonest neurological
probiems of infancy and childhood. For managemelit of this
problem, a team work of neuropediatrician, physiotherapist and
orthopedic doctors are required. Cerebral palsy may be spastic,
hypotonic, ataxic, choreoathetoid or mixed type. It may be
hemiplegic, quadriplegic or paraplegic.
-200-
Case 1:
A Child 19 M. with atonic C.P. and left hemi-convalsions, his
weight is 11 kg.
Rl Teqretol
syrup
Rl Depovite B 12 ampoules
Rl Ginsing
syrup
Rl Neurocet
syrup
~~I
Case 2:
A child 5 years old with spastic C.P. He speaks few
words but scissoring and spasticity are marked.
R/Neuroton
ampoules . .
~--':! u-U.
-201-
JS ~ (~ '1.5) tiLJI %
R/ Myolastan 50 g tab.
~L...w ~,)
Yz
Rl Botox or Dysport local injection in adductor group of
muscles.
~~ y~l ~ U~~~ ~ ~~ Y-+IJ ~~~I ol..A
.(Neuropediatrician)
R/ Surgical release of adductor tendons.
Case 3:
A newborn 25 days-old with diffuse hypoxic-'ischemic
encephalopathy (H.I.E) on CT, due to_obstructed laboure.
R/ Neurocet
syrup
R/ Tanakan
syrup
R1 Vitapoly
drops
-202-
ENDOCRINOLOGY
Congenital hypothyroidism
Neonatal screening program in Egypt is the only means
of . early diagnosis. Congenital hypothyroidism should be
diagnosed by neonatal screening within 10 days of birth, it may
be recognized clinically during the first month of life or may be
Case:
Newborn 30days old with Hypothyroidism (T3 & T4 are
low and TSH is High)
R/Eltroxin
so p.g
tab.
ketoacidosis.
Other manifestations
are palyuria,
glucose
level
without hypoglycemia
or
diabetic
3- Exercise
4- Management of hypoglycemia.
-204-
4~
Rapid acting:
Act rapid HM
40 IU/ml
HumulinR
100 IU/ml
Actrapid penfill
100 IU/ml
100 IU/ml
Intermediate acting:
Insulin retard
40 IU/ml.
HumulinN
100 IU/ml
Long acting:
Lantus
100 IU/ml
Comibjnation:
Mixtard 30/70
40 IU/ml
Humulin L 30/70
100 IU/ml
-205-
=
--==
=
.J
rlil'
c.
~
)ooo-4
-206-
-207-
Diet:
The nutritional needs of ?hildren with DM do not differ
from those of healthy children.
50% carbohydrates:
Complex carbohydrate eg.
(~ U,JJ ~lS
.4.5!;!. J.J.
~~. ti~)
- J-c.
-~..)A-~~~-~~-~- ~La~
-4 ~ t~ ~Jll ~~~I .J ~I ~
-208-
1.)..4
~'II ~ ~ 6J~
~~
1.)..4
.;US"il
.~IJ~I
Exercise:
Exercise lowers the blood glucose concentration, depending
on intensity and duration of the physical activity;
Increased energy expenditure should be covered by providing
an extra snak before and during the activity if prolonged.
~ ~
{ iJ":.; c!l.l~
0
Case 1:
A child 5 years old with recent history of polyurea ,polydipsia
and loss of weight ,RBS was 460 mg/dl , ketones in urine ++ and
fully conscious .
R/HumulinR
100 IU/ml
5 "~I !
.~_,!1
.o_r
~ j:...JI ~ ~
l.o.L;$.
~WI ~l..
24
J~ ~..t-J~I ~~ y~ ~
.~250J100
.~)i
R/Humulin L
100 IU/ml
30170
lOOIU/ml
:~
. JIW~I
Jl ~l.-.11 ~~I~ !
J.:i 2/3
. ~!.!.All J.:i
R1 Multisanostol
1/3
syrup
-~.J:!~~~
-210-
Case 2:
A child 3 years old with IDDM
R/Lantus
R/HumulinR
lOOIU
100 IU/ml
.}.i J
~1~1
-211-
3J \;f1io 5 J
\:.-~ o~J
:"}\.!..o
Hypoglycemia
Decrease blood sugar below the lower.limit of normal. .
It commonly occurs due to
-212-
DERMATOLOGY
General principles:
A- Topical steroids: varymg potency and preparatiom ue
useful for controlling inflammation.
1- The choice of particular steroid is a function of the location
and type of eruption, the age of the patient, and the duration
of treatment.
2- Skin atrophy can occur when strong preparations are used on
the face, groin, axillae, and area of thin skin.
Topical glucocorticoids
Potency
Low potency
Cases
Hydrocortison 1% cream & oint.
Micort cream, Locoid oint
Moderate potency
High potency
Vologcream
Betnovate crean & oint
Betaderm, Dermovate oint and
. creem
-213-
B. Antihistamines:
Systemic antihistamines are useful for control of intense pruritus
and significant sedation.
Types of antihistamines:
(1) Sedating antihistamines:
- Primalan or Fenistil or Tavegyl or Allergy! syrup .
uA uJ.>..a 3 I& 1~
~--------------D_i_a_p_e_r_D_e_r_m_a_t_i_ti_s--------------~'
Most cases of diaper dennatitis are due to irritation from
prolonged exposure to alkaline urine and faces, secondary
inva5ion by Candida albicans contribute after use of systemic
antibiotic or diarrhea
-214-
Case 1:
Infant 2 month old with normal diaper.
Rl Zinc-olive or Al stain
.u~l ~ ~~~ ~
stain
Case 2:
Infant 2 month old with simple diaper dermatitis
Rl Daktarin or Miconaz-H cream
.u~ c)&- ~I.Wl ~ , iJb'iill ~ ~l:!f 5 o~ ~.)'Q
c.;oW.Jo4 ulA~
~ ~ ~ .W U,H~I ~I.W.....I ~~
~J:!ll DA ~~ u);:lil ~
ClA..JI
~\ljll
Case 3:
Infant 6 month old with sever diaper dermatitis and
i"ected skin ulcers
R1 Lotriderm or Miconaz-H cream
. u~l ~ ~tb.ll ~ , iJh.'i.;t1 ~ ~l:!i 5 o~ ~.>4
-215-
c.;oWJ-4 ulAJ
RJ Fusiderm
oint
~Lr..JI ~ JJ~ ~~ ~..,.. ~_,..
RJ Mycostatins
utAJ
oral drops
Urticaria
Erythematous,
blanchable,
circumscribed,
pruritic
Case:
Child 5 years old with severe urticaria after sea food meal.
R, Decadron or Fortecartin
RJ Claritine
R- Vendexin
amp.
syrup
or Phenadon syrup
-~..>A~ ~413 ~~ I.::&}J.e 3 ~ 5
-216-
Atopic Eczema
It is a chronic, relapsing eczematous dermatitis . It is a
Case:
Child 4 years old with chronic relapsing atopy ( eczema).
syrup
If there is infection:
Rl Ceporex 250 mg
susp
-~~\..., ~~l.w
Or/ Zinnat
8JS ~ 5
125 mg syrup
-~L-12/ ~5
-217-
Impetigo Contagiosa
Erosions covered by honey-colored crusts are diagnostic
of impetigo, staphylococci and group A streptococci are
important pathogens in this disease. Face and limbs are common
sites of affection. Pediculosis and insect bite are a predisposing
factors.
Case:
Infant 13 month old with non-bullous impetigo of the
face, no fever.
Rl Betadine or Boric acid 4%.
Lotion
.~);.o3~~
Rl Fusi-Top or Baneocin
oint.
.u);.o 3 ~~ ..IL:I ~.J-4 uiAJ
susp.
-218-
1st
or 2nd generation
Scabies
bedtime with lesions along the wrists, between the fingers, on the
palms and soles, around the umbilicus, in the axillae is the full
clinical picture.
Cases:
Rl Ectomethrin or permetbrin cream or Lotion 5%.
o.l.Al ~fo.J ~4 t)l.1 ~l4.:.. ~
UMbl\5 ~,jll I~
F.l
JS ~ . ~ (Jl.\.1
~t:t 3 ~ ~.J ~~
JS
~ ulAJ
.4ttl.A
Rl Cetrak or Mosedin
syrup
.~~
Rl Velosef or Ospexine susp.
w' ~ ~j4 Jt ~ 1~ 5
.~~t_...
s 1WJ.Jl' ~
-219-
r.J&-
'~-----------------P_e_d_i_cu_I_Q_.s_is----------------~
Pediculosis capitis (Head lice) is highly contagious and
spread through direct contact or through contaminated objects;
hats, cloths ... etc.
Case:
Rl Ectometbrin or- Newcid shampoo 2.5 % lotion or cream.
~..J U-.H~J
.wl .a~
u--hn
i.J)J ~
.44!
-~~~
Or Licid spray or Lotion
Or Benzanil or Lotion Or Pharcobenzyl cream.
-220-
Seborrheic dermatitis
Seborrheic dermatitis may first appear as adherent,
yellowish scaling of the scalp (Cradle Cap) or as sudaen
appearance of erythema in the skin folds of the axillae, groin,
and neck, secondary staphylococal infection may occur.
Case:
Infant 4 month old with cradle cap.
R/Dentinox
shampoo
Or Betadine shampoo.
5 ~I ~.J ~Iolli -.W4 c..iW ~ I!UJ:J (Jo'lhll o.J) ~ ~~ 3 ~J
-~.,HoWl ~.)A ~.J
Or Tonoscalpine Lotion
.~w
~ ~ 'l ~ u~'J1
.Jil:ll ~
.t;~
. .t J.':-<i ~
.. ~.~~~
,~
-221-
~~~
,__ ,.0-JoU...J"
~.~II~ ~ U\.Qi.
:!J ?'
~
~
POISONING
Acute poisoning in children is a common problem it may
be accidental (the commonest and occurs with druges,
insecticides, petroleum products and paints), iatrogenic (as drug
overdose).
General lines of management:
1 -History and urgent evaluation.
Airway control.
-222-
Orgonophoshorus poisoning
Opiats
Isoniazid
Pyridoxine (B6)
B-Blockers
Glucagon
Anticholinergics
Physostigmine
atropine.
Naloxone
~
Disphenhydramine
Case 1:
A child 3 Yz years presented with fever, sweating, nausea
vomiting dehydration, tachycardia and hyperventilation . He is
comatose with history of Rivo one stripe ingestion since about 8
hours.
R/ Maintain respiratory and circulatory support .
Rl Gastric lavage.
R/ I.V. fluids and Na- bicarbonate.
R1 Amri-k amp.
~l.u 12 JS ~ J..H,.ti 1fz
R/potassium chloride 3-5m Eq/kglday, to replace potassium loss~
-223-
Case 2:
A child 2 Yz year presented with coma, convulsions,
tachycardia, wheezing, frothing, miosis and urine incontinence.
History of insecticide poisoning and the odour of the insecticide
is smelled n his clothes.
Rl Maintain respiratory and circulatory support.
Rl Remove the contaminated clothes and clean skin with
soap and water .
Rl Suction of secretion.
Rl I.V. valium.
Rl I.V. atropine (O.lmglkgldose)
J.S ~ ~ 1 ~...iJjl
~I
cJ:-1~
Case 3:
A child 2 years old with severe vomiting and diarrhea
received primpran ampoule IM to stop vomiting after 3 hour
received another ampoule, the child develop extrapyramidal
manifestations
(crying,
oculogyric
crisis,
dystonia).(metclopromide toxicity).
Rl phenergan or allergyl syrup
Or allergyl or avil ampoules
Or akinton2 mg tab
Rl treatment of G.E.
-224-
Case 4:
A Childs 3 years old accidentally swallow oral
hyphyolglycaemic tablets of his father ( unknown amount one
hour ago. The child doing well, playing.
JS -~ ~I ~ ~\.:!
.fo.J J:.l.i!JI ~
cSJlill
10 JSJA JJS~
.1.1...JJ%
Cases:
A child 2 years old ingest pottase
"~m~rgency
"
.,gi ~I
.,gl ~I~
cSJ~
.
~I u,..a ~ cSi ~I ~~l
-225-
~..P -
Case 6:
A child 4 years with kerosene ingestion.
. t.;,_,-.11 ~i
~I ~l.lw...JI
. JjU!, u4J\
(~ ~) ~":1\Sll.
~ ~!, ~I ~~i
~~
~4lJI
'
~t....JI_, ~Ull
. ~YI~JJ
. ~~~~
-226-
Chapter Six
Doses of the commonly used drugs
Drug
Paracetamol
Medical use
Analgesic
&
Pyral,Tempra
antipyretic
Acetazolamide
Hydrocephalus
& Glucoma
Acyclovir
Herpetic
Zovirax,
viroses
Novirus
CMV
&
Dose
- 10 - 15 mglkgldose every 4-6 hours.
Albumin
Plasma volume
expander & in
hypoproteine-
mia
Albuterol
Bronchodilator
Ventolin
(Bragonist)
Nebulizer solution
Allopurinol
Hyperuricemia
-227-
Drug
Amikacin
Medical use
Antibiotic
Dose
15-20 mglkg/24 hours divided into 2-3
doses. LV. or I.M.
sulfate
Aminophylline
Bronchodilator
Amoxicillin
Antibiotic
Antibiotic
as amoxicillin
Antibiotic
clavulanate
Augmentin
Curam
Ampicillin
Antibiotic
As ampicillin.
Ascorbic acid
Vitamin-C
Acyetylsalicylic
Antipyretic and
acid
anti-
inflammatory
Atropine
Antiacetyl-
sulfate
choline
Ampicillinsulbactam
Unasyn
Unictam
Rivo .Aspejic
and
antihistamine
-228-
Drug
AZathioprine
Azithromycin
Medical use
Immunosuppr-
Dose
Loading: 2-5 mglkg/24 LV. or oral.
essant agent
Antibiotic
Zithromax,
for 3 days.
Xithone
Aztreonam
Antibiotic
Azactam
Antifungal
Baclofen
Skeletal
muscle
doses orally.
relaxant
Beelome-
Corticosteroid
thasone
inhalation
Calcitriol
Vitamin
analogue
. Calcium
Calcium
gluconate
the
heart .every
hours
untill
Calf
lung
- 3 mVkgfdose endotracheal.
surfactant
Captopril
Antihyperten-
Capoten
sive
Children:
0.3
-{).5
mglkgfdose
Anticonvulsant
-229-
Drug
Tegretol
Medical use
agent
Dose
mglkg/day and increase gradually 5
mglkg/week according the response.
Carbenicillin
Antibiotic
Carnitine
Dietary
supplement
Children:
50-100
mg/kg/24
hours
Antibiotic
Bacticlor
Cefadro~il
Antibiotic
Curicej.
Durisafe
Cefazolin
Antibiotic
Cefepime
Antibiotic
Maxipime
Cefixime
Ximacef
Cefoperazone
Antibiotic
Cefobid
Cefozon
Cefotaxime
Antibiotic
Claforan
every 12 hours.
Cefotax
Cefprozil
Cefzil
Antibiotic
-230-'
Drug
Cefbzidine i
Medical use
Antibiotic
Fortum
Dose
50-100 mglkgf24 hours I.V. or I.M.
divided into 3 doses.
Neonates: 40-100
Antibiotic
Zinnat
mglkg/24 hours
I.VJorlM
Children: 50-100 mglkg/24 hours.
Antibiotic
Ceponx
O!puine
Ceplmtdiae
Yelase[
orally.
Anbbiotic
Hypnotic
Clllaroqaiae
ami-amebic
300 mgldose).
Malaria bcalment: 10 mglkg/ initial
Clllontbiazide
Diuretic
Clalorpbeair-
Antihistaminic
Children
..} ~ 10 JSl ~ 5
Cblorpromazia
Antipsychotic,
hypnotic
&
antiemetic
-231-
Drug
Cholestyramin
Medical use
Bile
acid
Dose
-240 mglkg/24 hours divided into 3 divided
e resin
chelating
doses.
Cimetidine
HrantagQnist
Tagamet.
Clindamycin
Antibiotic
Clomipramine
Antidepresant
Clonazepam
Antiepileptic
Cloxacillin
Antibiotic
Codeine
Narcotic anal-
tussive
Antitussive:
Anti-gout
For
agent
mediterranean fever:
prophylaxi3
against
familial
-232-
Drug
Corticotropin
Medical use
Adrenal
Dose
50-150 u/kg/24 hours I.M. divided into,
(ACTH)
corticosteroid
2-3 doses.
Cortisone
Anti-
acetate
inflammatory
trimethoprim-
Antibiotic
sulfamethaxozo
combination
le (TMP-sMZ)
Septazol
Sutrim
Cromolyn
Mast
sodium
stabilizer
cell
Intal
Athma:
l-2
puffs or 2
ml
Cyanocoba-
Vitamin B12
lam in
or
twice/week
for
several
months.
Cyclophospba
Antineoplastic
mide
agent
-233- .
Drug
Cyproheptadin
Medical use
Antihistaminic
t
Dose
Children 2-6 years: 2 mg/dose every 8-
-appetizer
12 hours
Tres-orex
Deferoxamine
Desfera/
Chronic
iron
overload:
20;40
mglkg/24 hours S.C. portable infusion
pump over 8-12 hours.
Acute iron overload: "Poisning"
Desmopressin
acetate
Minirin
Vasopressin
analogue
Dexamethason
e
Orazone
Deltazone
Corticosteroid
-234-
Drug
Dextran
Dextrome-
Medical use
Plasma volume
Dose
,
20 .mVkg on day 1 then 10 mV kg/24 '-
expander
Antitussive
thorphan
Anticonvulsant
Valpam
Valium
minutes.
0.5 mg/kgldose rectally.
Diclofenac
Non-steroidal
sodium
anti-
doses.
Cataflam
inflammatory
Dicloxacillin
Antibiotic
Digoxin
Heart failure
Dimenhydrinat
Motion
sickness
Hypotension &
Dobutrex
cardiac shock
Children: 2.5 - 40
~g/kglniin.
l.V.
drip.
Epinephrine
-Bronchospasm
Adrenaline
-cardiac arrest -
anaphylaxis
Ei-ythromycin
Antibiotic
0.01
Neonates:
mVkgldose of 1:
20-30
mglkg/24
hours
-235-
1000
Drug
Ethambutol
Medical use
Antituberclous
Etibi
Dose
10-15 mglkg/24 hours (max. 2.5 gm).
25-50 . mg/kg/twice weekly (max. 2.5
gm). It is given orally as a single
dose/day.
Ethionamide
Antituberclous
Factor
(human)
IIIV
Fluconazole
Antihemophilic
agent
20-25
unitslkg/do.se
repeated
according to the need of the patient.
Antifungal
Neonates:
Diflucan
Systemic
infections:
6-12
mg/kg/24 hours
- Children: 6-12 mg/kg/24 hours LV. or
oral once every day.
Folic acid
Megaloblastic
anaemia
Furosemide
Diuretic
Lasix
Antiepileptic
-236-
Drug
, Gentamicin
Medical use
Antibiotic
Garamycin
Dose
3-7 mglkg/24 hours divided into 2-3
doses.
Antifungal
Haloperidol
Rheumatic
Safinace
chroea
6-12
Griseofulvin
into 2 doses.
years:
1-3
rnglkg/24
hours
Anticoagulant
Hydrochloro-
Diuretic
thiazide
Corticosteroid
every 6 hours.
Anti-inflammatory:
1-S
mg/kg/24
lbuprofea
Non-steroidal
Brufen
antinflammator
Marco fen
Imipramine
Anti-
Antidepressant:
Tofranil
depressant and
noct-enuresis
1.5
mglkglkgl
24 ,
-237-
I.V.
Medical use
Immune-medi-
Dose
Neonates: 500-750 mg/kg once.
immunoglo-
ated diseases
Children:
Drug
bulin (IVIG)
-1000 mg/kglweek.
syndrome:
Non-steroidl!l -.
antinflammator . doses.
y
Iron
Iron
Fer-in-Sol
deficiency:
Sytron
Anemia
. 3 doses orally.
Isoniazid
I.N.H.
us
mg/24 hrs).
20-30 mglk:gltWice weekly (max.. 900
Isocid
. mgldose).
It is given orally divided into 1-2 doses/day.
Isoproterenol
Kanamycin
Bronchial
asthma
Antibiotic
-238-
Drug
Ketamine
Medical use
Anesthetic
Dose
Lamotrigine
Antiepileptic in
Lamictal
children >2yrs
Levothyroxine
L-thyroxine
Throid
replacement
therapy
Lidocaine
Local
anesthetic
In combination with
antiepileptics:
other
antiarrythmic
every 5-l 0
of
continuous
minutes
mglkg).
infusion
to
I.V.
20-50
J.lgtkgfminute.
Loratadine
Antihistaminic
Claritine
Magnesium
Replacement
sulfate
therapy
hypomagnese-
Children:
mia
-239-
Drug
Medical use
Dose
. Oral: 100-200 mglkgldose divided into
4 doses.
Diure
Mannitol
tic
-For decrease
I.Cr. pressure
Mebendazole
Broad
spectrum
Antiver
antiparasitic
100 mg orally twice daily for 3 days in
Vermin
Methylphenida
Attention-
te
deficit
hyperactive
Ritalin
disorder
Metoclopramid
Antiemetic
e
erimperam
-Anti-amebic
-Anti-anerobic
Flagyl
bacterial.
Elyzole
Infection.
Metronidazole
Anticonvulsant
-240-
Drug
Morphine
Nafcillin .
Medical use
Narcotic
Dose
0.1-0.2 mglkg/dose LV., l.M. or SC &
analgesic
Antibiotic
sodium
U.T.I.
Naloxone
Opiate
antagonist
Narcan
Naproxen
Neomycin
Non-steroidal
anti. inflammatory
Antibiotic
sulfate
doses.
Neostigmine
Myathenia
gravis
Niclosamide
Tapewonn
Yomesan
infection
Nitrofurantoin
U.T.I.
Oxacillin
Antibiotic
into 4 doses
Prostaphlin
Oxcarbazepine
Antiepileptic
-241-
Drug
Penicillamine
Medical use
Metal chelating
agent
Dose
Lead intoxication: 30-40 mglkgl24
hours orally divided into 2-3 doses
(max: 2 gm/24 hours).
Wilson disease: 20 m!Vkg/24
hours orally (max: 2 gm/24 hours)
Rheumatoid arthritis: 3-10 mglkg/24
hours.
Penicillin.G.
Penicillin
Antibiotics
V.
Procaine Pen.
Benzathine Pen
Phenobarbitone
Anticonvulants
Sedation: 2 mglkgldose
Sominaletta
& hypnotic
Sominal
Anticonvulsants:
Anti epileptic
Epanutin
S-10 mglkglday
Antibiotic
Piperazine
Antiparasitic
daily
citrate
Piroxicam
~4
Non-steroidal
0.2-0.3
anti-
inflammatory
doses.
-242-
hours (max:
IS
Drug
Praziquantel
Medical use
Anti-bilharzia!
Distocid
Prednisone
Dose
40 mglkg/dose orally repeated every 8
hours for one day.
Steroid
Hostacortin
Procarbazine
Antineoplastic
agent
Propranolol
B-adrenergic
Arrhythmias/hypertension:
Indral
blocker
1-2
prophylaxis:
0.5-2
mglkg/24
hours
orally.
Pyrazinamide
Anti-tuberclous
PTB
15-40 mgl_kg/24
ho~
orally as a
Pyridoxine
mi/
kg/24
Anti-
arrhythmic
20-50
to exclude idiosyncrasy.
then
.
.
drug
-243-
Drug
Quinine
Medical use
Antimalarial
Dose
30 mglkg/24 hours orally divided into
3 doses for 3-7 days.
Ranitidine
Antacid
Zantac
Rifampin
Anti-tuberclous
Rimactan
dose.
Salmeterol
Senna
Bronchodilator
long acting
Constipation
2 puffs/12 hrs
10-20 mglkgldose orally every 12
hours or once daily
Simetbicone
Antiflatulent
Spironolactone
K-sparing
Aldactone
diumic
Streptomycin
Sulfadiazine
Antibiotic
Toxoplasma:
_Neonates: 100 mglkg/24 hours.
Antibiotic
-244-
Drug
Sulfasalzine
Medical use
Inflammatory
Dose
Intial: 40-75 mg/k:g/24 hours oral.
bowel disease
Terbutaline
Bronchodilator
Bricanyl
Aironyl
Testosterone
Male
hypogonadism
Tetanus
Prevention
&
antitoxin
treatment
of
tetanus
Prevention
&
Prophylaxis: 4 units/kg.
immunoglobuli
Treatment
of
tetanus
Theophylline
Bronchodilator
Neonatalapnea:
&
Maintenance:
respiratory
stimulant
2-4
mg/k:gldose
Thiamine
Anti-beriberi
-245-
Drug
Tobramycin
Medical use
Antibiotic
Dose
2.5-5
mg/kgf24
hours
I.v..
I.M.
Antiepileptic
2-l6years:
initially
l-3
mg!kg/24
Antiepileptic
Depakine
Vancomycin
Antibiotic
Verapamil
Diabetes
insipidus
times/24 hours.
Hypertension
Infants:
0.1-0.2
mWkg/dose
and
Epilat
effect (I.V.)
Children: 4-8 mglkg/24 hours I.V. or
Antiepileptic
into 2 doses.
SabriI
Vitamin "A"
Vitamin
supplementation
Vitamin "E"
Vitamin
supplementation
-246-
Drua
Warfarin
Medical use
Anticoagulant
Dose
Initial dose: 0.2 mglkg once orally.
Maintenance dose:O. l mg/kg/24
hours orally guided by the desired
prothrombin time.
Zinc
supplements
Mineral
replacement
therapy
-247-
--