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*pedia

hannah ivane bendanio


SILLIMAN UNIVERSITY MEDICAL SCHOOL
NICU
Please admit under RI, LI, PD or AP
TPR q4H
May breastfeed if NSD; NPO x 2hrs if CS
Labs:
NBS at 24 hrs old, secure consent
CBC, BT (if w/ maternal illness, PROM or UTI
HGT now then 1, 3, 6, 12, 24, 48 hrs old (GDM)
HGT now (SGA or LGA)
Medications:
Erythromycin eye ointment both eyes
Vit K 1 mg IM (term); 0.5 mg (PT)
Hep B vaccine 0.5 ml IM, secure consent
BCG 0.05 ml ID (PT); 0.1 ml (term), secure onsent
SO
Routine NB care
Monitor VS q30 mins until stable
Thermoregulate at 36.5 to 37.5C
Place under droplight (NSD); isolette (CS)
Suction secretion prn
Will infrom AP /AP attended delivery

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DENGUE FEVER
Please admit under the service of Dr.
TPR q4H and record
DAT ( No dark colored foods)
Labs:
CBC, Plt (optional APTT and PT)
Blood typing
U/A (MSCC)
IVF:
D5 0.3 NaCl 1P/1L (<40 kg) at 3 5 cc/kg
D5LR 1L (>40 kg) at 3 5 cc/kg
Medications:
Paracetamol prn q4h for T > 37.8C
Omeprazole 1mkdose max 40 mg IVTT OD
SO:
MIO q shift and record
Monitor VS q2h and record, to include BP
Continue TSB for fever
Refer for Hypotension, narrow pulse pressure (< 20mmHg)
Refer for signs of active bleeding like epistaxis, gum bleeding,
melena, coffee ground vomitus
Will inform AP
Pls inform Dr _____ of this admission
Thank you.
FEBRILE SEIZURE
Please admit under the service of Dr.
TPR q4H and record
DAT once fully awake
Labs:
CBC
U/A (MSCC)
IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
Medications:
Paracetamol prn q4h for T > 37.8C

SO:
MIO q shift and record
Monitor VS q2h and record
Monitor neurovital signs q4h and record
Continue TSB for fever
Seizure precaution at bedside as ff:
Suction machine at bedside
O2 with functional gauge; if with active sz give O 2 at 2lpm via NC
Diazepam IVTT (0.3 mkd max of 5 mg IV) prn for seizure
Will inform AP
Pls inform Dr _____ of this admission
Thank you.
AGE
Please admit under the service of Dr.
TPR q4H and record
DAT once fully awake; NPO x 2hrs if with vomiting
Labs:
CBC
U/A (MSCC)
F/A (Concentration Method)
IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
Medications:
Paracetamol prn q4h for T > 37.8C
Zinc (E Zinc)
Drops 10mg/ml 1ml OD (<6 mos)
1ml BID (6 mos 2 yo)
Syrup 20 mg/5ml (>2 yo) 5ml OD
Ranitidine IVTT at 1mkdose (if with abdominal pain)
SO:
MIO q shift and record
Monitor VS q2h and record
Continue TSB for fever
Chart character, frequency and amount of GI losses and replace w/
PLR 1L/1P vol/vol
Will inform AP
Pls inform Dr _____ of this admission
Thank you.
BRONCHIAL ASTHMA
Please admit under the service of Dr.
TPR q4H and record
NPO if dyspneic
Labs:
CBC
U/A (MSCC)
ABG* CXR APL*
IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
Medications:
Paracetamol prn q4h for T > 37.8C (10 15 mkdose)
USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses
Incorporate Budesonide 10 mkd LD (max 200mg IV); then
5mkd q6h IV (max of 100 mg IV)
Ranitidine IVTT at 1mkdose (if on NPO)
SO:
MIO q shift and record
Monitor VS q2h and record
Refer for persistence of tachypnea, alar flaring and retractions
O2 at 2 lpm via NC, refer for desaturations <95%
Will inform AP
Pls inform Dr _____ of this admission
Thank you.
HYPERSENSITIVITY REACTION
Please admit under the service of Dr.
TPR q4H and record
Hypoallergenic diet
Labs:
CBC
U/A (MSCC)
IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
Medications:
*Epinephrine (1:1000) 0.1mg/kg/dose IM anterolateral thigh
(max of 0.3 mg)
*Salbutamol neb x 3 doses q 20 mins
Diphenhydramine 10 mkdose LD (max of 200mg IV); thenmg IV)
5mkdose q6h IV (max of 100
Ranitidine IVTT at 1mkdose q 12h
SO:
MIO q shift and record
Monitor VS q2h and record to include BP
Continue TSB for fever
O2 at 2 lpm via NC, or 6 lpm via facemask
Attach to pulse oximeter, refer for desaturations <95%
Will inform AP
Pls inform Dr _____ of this admission
Thank you.
BPN
Please admit under the service of Dr.
TPR q4H and record
NPO if dyspneic
Labs:
CBC
U/A (MSCC)
ABG* CXR APL*
IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo) OR
D5 IMB/D5 NM at MR if with NO losses
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
Medications:
Paracetamol prn q4h for T > 37.8C (10 15 mkdose)
USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses
then refer
NaCl (Muconase) nasal spray, 2 sprays per nostrils, then suction
using bulb QID
Ranitidine IVTT at 1mkdose (if on NPO)
SO:
MIO q shift and record
Monitor VS q2h and record
Continue TSB for fever
Refer for persistence of tachypnea, alar flaring and retractions
O2 at 2 lpm via NC, or 6 lpm via facemask
Attach to pulse oximeter, refer for desaturations <95%
Will inform AP
Pls inform Dr _____ of this admission
Thank you.
ANTIBIOTICS
Amoxicillin (30 50 mkday) TID
Pediamox Susp : 250mg/5ml
Drops : 100mg/ml
Himox Cap : 250mg, 500mg
Moxicillin Susp : 125mg/5ml 250mg/5ml
Harvimox Drops : 100mg/ml
Novamox
Amoxil Susp : 125mg/5ml 250mg/5ml
Cap : 250mg 500mg
Glamox Drops : 100mg/ml
Globapen
Amoxicillin + Clavulanic acid (30 50 mkday)
Augmentin Tab: 375mg (250mg); 625 (500mg)
Amoclav Susp: 156.25mg/5ml (125mg) TID
228.5mg/5ml (200mg) BID
312.5mg/5ml (250mg) TID
457mg/5ml (400mg) BID
Cloxacillin (50 100 mkday) q6h
Prostaphlin A Tab: 250mg 500mg
Orbinin Susp: 125mg/5ml
Flucloxacillin (50 100 mkday) q6h
Staphloxin Susp: 125mg/5ml
Cap : 250mg 500mg
Chloramphenicol (50 75 mkd) q6h
Pediachlor Susp: 125mg/5ml
Chloramol Tab : 250mg 500mg
Kemicetine
Chloromycetin
CEPHALOSPORINS
1st Generation
Cefalexin (25 100 mkd ) q 6-8 h
Lexum Cap : 250mg; 500mg
Cefalin Susp : 125mg/5ml 250mg/5ml
Keflex Drops : 100mg/ml
Ceporex Cap : 250mg 500mg
Selzef Caplet: 1 gm
Granules: 125mg/5ml 250mg/5ml
Drops: 125mg/1.25ml
2nd Generation
Cefaclor (20 40 mkd ) q 8 12 h
Ceclor Pulvule: 250mg 500mg 375mg
Ceclor CD 750mg
CD ext release Susp: 125mg/5ml 187mg/5ml
250mg/5ml 375mg/5ml
Drops: 50mg/ml
Xelent Cap : 250mg 500mg
Vercef Susp : 125mg/5ml 250mg/5ml

Cefuroxime (20 40mkd) q 12h


Zinnat Cap : 250mg 500mg
Sachet: 125mg/sat 250mg/sat
Susp: 125mg/5ml
Cefprozil (20 40mkd) q 12h
Procef Susp : 125mg/5ml 250mg/5ml
3rd Generation
Cefixime (6 12 mkd) q 12h
Tergecef Susp : 100mg/5ml
Zefral Drops: 20mg/ml
Ultrazime
Cefdinir (7mg/kg q 12h OR 14mg/kg OD)
Omnicef Cap : 100mg
Sachet/ Susp: mg/5ml
COTRIMOXAZOLE (TM 5 8 mkd) q 12h
Bactille TS Susp/5ml SMZ 400mg TM 80mg
Tab 800mg
Bacidal 160mg
Susp/5ml 400mg 80mg
Trizole Susp/5ml 400mg 80mg
Globaxole Tab 800mg
160mg
Susp/5ml 400mg 80mg
Trimethoprim + Sulfadiazone (TM 5 8 mkd)
Triglobe Tab Sdz 410mg TM 90mg
Forte 820mg
180mg
Susp/5ml 205mg 45mg
AMINOGLYCOSIDES
Tetracycline 25 50 mkday q6h
Doxycycline 5 mkday BID
Furaxolidone 5 8 mkday q6h
MACROLIDES
Erythromycin (30 50 mkd) q 6h
Macrocin Susp: 200mg/5ml
Ethiocin Drops: 100mg/2.5ml
Erycin Cap : 250mg 500mg
Susp: 200mg/5ml
Drops: 100mg/2.5ml
Erythrocin Film tab: 250mg 500mg
Granules: 200mg/5ml
DS Granules: 400mg/5ml
Drops: 100mg/2.5ml
Ilosone/ Tab: 500mg
Ilosone DS Pulvule: 250mg
Liquid: 125mg/5ml
DS Liquid: 200mg/5ml
Drops: 100mg/ml
Clarithromycin (6 15 mkday OR 7.5 mkdose q12h)
Klaricid Susp : 125mg/5ml 50mg/5ml
Klaz Tab: 250mg 500mg
Roxithromycin <6 yo 5 8 mkd BID
6 12 yo 100mg/tab BID
Macrol/Rulid Tab: 150mg
Ped Tab: 100mg
Rulid dispensable Tab: 50mg

Azithromycin 3 day regimen: 10 mkday x 3 days


5 day regimen: 10 mkd on day 1
5 mkd on day 2 to 5
Adult: 500mg OD day 1
250mg OD day 2 to 5
Zithromax Susp: 250mg/5ml
Cap : 250mg
Sachet: 200mg/sachet
Clindamycin PO: 20 30 mkday q 6 8h
IV: 25 40vmkday q 6h
Susp: 75mg/5ml
Cap: 150mg 300mg
Amp: 150mg/ml
AMOEBICIDES
Metronidazole PO: 30 50 mkday q 8h
IV: 30 mkday q 8h
Anaerobia Susp : 125mg/5ml
Tab : 250mg
Servizol Susp: 200mg/5ml
Tab : 250mg 500mg
Flagyl Susp : 125mg/5ml
Tab : 250mg 500mg
Etofamide (15 20 mkd) TID
Kitnos Susp : 125mg/5ml
Tab : 200mg 500mg

Diloxanide furoate (20mkd) q8h x 10 days


Furamide Tab : 500mg
Dilfur Susp: 125mg/5ml
Secnidazole
Flagentyl 2 tab now then 2 tabs after 4 hrs
Ercefuryl (20mkday)

ANTIVIRAL
Acyclovir (20 mkdose) q 4 6 h
Max 800mg/day x 5 days
Zovirax Susp: 200mg/5ml
Acevir Blue: 400mg
Pink: 800mg
ORAL ANTIFUNGALS
Ketoconazole (6mkd) q 4 6h
Daktarin Adult & Child: tsp q 6h
Infant: tsp q 6 h
Nystatin
Mucostatin Susp: 100,000 u/5ml
Ready mix susp Tab: 500,000 u
Fluoconazole (3 6 mkd) OD x 2wks
Diflucan Cap: 50mg 150mg 200mg
Vial: 2mg/ml x 100 ml

ANTI-HELMINTHICS
Oxantel + Pyrantel pamoate (10 20 mkd) SD
Trichiuriasis: x 2 days Hookworm: x 3 days
Quantrel Susp : 125mg/5ml
Tab : 125mg 250mg
Mebendazole *not recommended below 2 yo
Antiox Susp: 50 mg/ml 100mg/ml
Tab: 125mg 250mg
100 mg BID x 3 days
500mg SD (>2 yo)
Albendazole <2 yo: 200mg SD
>2yo: 400mg SD
*may give x 3 days if with severe infestation
Zentel Susp: 200mg/5ml
Tab : 400mg

ANTIHISTAMINE
Diphenhydramine HCl (5mkd) q 6h
IM/IV/PO: 1 2 mkdose
Benadryl Syr: 12.5mg/5ml
Cap: 25mg 50mg
Inj: 50mg/ml
Hydroxyzine (1mkd) BID
Adult: 10mg BID 25mg ODHS
Iterax Syr: 2mg/ml
Tab: 10mg 25mg 50mg
Ceterizine (0.25mkdose)
6mos - <12mos : 1ml OD
12mos - <2 yo: 1ml OD/BID
2 5 yo: 2ml OD / 1ml BID
6 12 yo: 10ml (2 tsp)OD/ 5ml BID
1 tab OD/ tab BID
Adult & >12yo: 1 tab OD
Virlix Oral drops: 10mg/ml
Oral soln: 1mg/ml
Tab: 10mg
Allerkid Drops: 2.5mg/ml
Syr: 5mg/5ml
Alnix Drops: 2.5mg/ml
Syr: 5mg/5ml
Tab: 10mg
Loratadine 1 2 yo: 2.5 ml BID
2 12 yo (<30 kg): 5ml OD
(>30 kg): 10ml OD
Adult & > 12 y : 1 tab OD
Claritin Syr: 5mg/ml
Allerta Tab: 10mg
Loradex
Desloratadine 6 12 mos: 2ml OD
1 5 yo: 2.5ml OD
6 12 yo: 5ml OD
Aerius Syr: 2mg/5ml
Tab: 5mg

DECONGESTANT
Nasal
NaCl 2 4 drps/spray per nostril TID/QID
2 sprays/nostril then suction q6h x 3 days
Salinase Nasal spray
Muconase Nasal drops
Oxymetazoline HCl 2 5 yo: 2 3 drops/nostril BID
>5 yo: 2 3 sprays/nostril BID
Drixine Nasal spray: 0.05%
Nasal soln: 0.025%
Xylometazoline < 1 yo: 1 2 drps OD/BID
HCl 1 6 yo: 1 2 drps OD/BID max TID
Adult: 2 3 drps / 1 squirt TID max QID
Otrivin
Oral
Phenylpropanolamine HCl (0.3 0.5 mkdose)
Disudrin 1 3 mos: 0.25 ml
4 6 mos: 0.5 ml
7 12 mos: 0.75 ml
1 2 yo: 1 ml
2 6 yo: 2.5 ml
7 12 yo: 5 ml
Drops: 6.25ml q6h
Syr: 12.5mg/5ml q6h

Brompheniramine maleate + PPA


Dimetapp 1 6 mos: 0.5ml TID/QID
7 24 mos: 1ml TID/QID
2 4 yo: tsp
4 12 yo: 5ml
Adult: 5 10 ml
1 tab BID
Infant drops: (0.1mkdose)
Syr
Extentab
Carbinoxamine maleate + Phenylephrine HCl
Rhinoport 1 5 yo: 5ml BID
6 12 yo: 10ml BID
Adult & > 12yo: 1 cap / 15ml BID
Syrup
Cap
Loratadine + PPA
Loraped <30 kg: 2.5ml BID
>30 kg: 5ml BID
Syrup: 5mg/ml
MUCOLYTIC
Solmux Drops: 40mg/ml
1 3 mos: 0.5ml TID/QID
3 6 mos 0.75ml
6 12 mos 1ml
1 2 yo 1.5 ml

Susp: 100mg/5ml
200mg/5ml
2 3 yo 5ml
2.5ml
4 7 yo 10ml
5 ml
8 12 yo 15ml
7.5ml

Forte: 500mg/5ml
Cap: 500mg
Adult & >12 yo: 5 10ml
1 cap
Solmux Capsule
Broncho Suspension
Solmux Tab: 500mg
Chewable tab 1 tab q 8h
Carbocisteine Infant Drops QID
MUCOLYTIC <3mos 0.25ml
3 5 mos 0.5ml
6 8 mos 0.75ml
9 12 mos 1ml

Ped Syr TID


1 3 yo 5 7.5ml 1 1 tsp
4 7 yo 7.5 10ml 1 - 2 tsp
8 12 yo 10 15ml 2 3 tsp

Adult Susp TID


Adult & >12 yo 10 15ml 2 3 tsp
Capsule TID
Adult & >12 yo 1 cap

Lovsicol Infant drops 50mg/ml


Ped Syrup 100mg/5ml
Adult Susp 250mg/5ml
Cap 500mg
Ambroxol Infant drops 6mg/ml
75mg/ml BID
< 6 mo 0.5ml
0.5ml
7 12 mo 1 ml
0.75ml
13 24 mo 1.25ml 1ml

Pedia Syrup
<2 yo 2.5ml BID
2 5 yo 2.5ml TID
5 10 yo 5ml TID

Adult Syrup
Adult & >10 yo 5ml TID

Retard cap
Adult & >10 yo 1 cao OD

Tab
Adult & >10 yo 1 tab TID

Inhalation
<5 yo 1 2 inhalation of 2ml soln daily
Adult & children >5 yo 1 2 inhalation of 2
3ml soln daily
Mucosolvan Infant drops 6mg/ml
Ped liquid 15mg/5ml
Adult liquid 30mg/5ml
Retard cap 75mg
Tab 30mg
Inhalation Soln 15mg/2ml
Ampule 15mg/2ml
Ambrolex Infant drops 7.5mg/ml
Zobrixol Ped liquid 15mg/5ml
Adult liquid 30mg/5ml
Tab 30mg
B2 AGONIST
Salbutamol (0.1 0.15 mkdose)

Ventolin Tab 2mg


Syr 2mg/5ml
Nebule 2.5mg/2.5ml
Ventar Tab 2mg
Hivent Syrup Syr 2mg/5ml
Salbutamol + Guaifenesin
Asmalin Tab
Broncho 1 tab TID
Syrup
Pulmovent 2 6 yo 5 10 ml BID/TID
7 12 yo 10ml

Terbutaline sulfate ( 0.075 mkdose)


Terbulin Tab 2.5mg
Pulmoxel Tab 2.5mg
Syr 1.5mg/5ml
Nebule 2.5mg/ml
Bricanyl Tab 2.5mg
Syr 1.5mg/5ml
Nebule 5mg/2ml
Expectorant
Doxophelline (6 8 mkdose) BID x 7 10 days
Ansimar Syrup 100mg/5ml
Tab 400mg

Procaterol HCl (0.25ml/kg)


Meptin Syrup 5mcg/ml
Tab 25mcg
Nebuliser soln 100mcg/ml

Theophylline 10 20 mkdose
3 5 mkdose

ANTITUSSIVES
Butamirate citrate 3 yo 5 ml TID
>6 yo 10ml TID
>12 yo 15ml TID
Adult 15ml QID
1 tab TID/QID
Sinecod Forte Syrup 7.5mg/5ml
Tab 50mg

Dextromethorphan + Guaifenesin
Robitussin DM 2 6 yo 2.5 5ml q 6 8h
6 12 yo 5ml q 6 8h
Adult 5 10ml q 6h
Syrup
INHALED STEROIDS
Budesonide
Budecort 250mcg q 12h
500mcg q 12h
500mcg OD for allergic rhinitis
250mcg /ml (2ml)
500mcg /ml (2ml)
Flexotide neb 250mcg /ml (2ml)
250mcg q 12h

ORAL STEROIDS LD: 10mkdose 200mg


MD: 5mkdose
Prednisone 1 2 mkday
Prednisolone 1 2 mkday
Liquidpred Syrup 15mg/5ml
ANTACIDS
Maalox 5ml/10kg
(plain, plus) Available in 180ml bottle
Simethicone
Restime < 2 yo 0.5ml qid
2 12 yo 4ml qid
Oral drops 40mg/ml
ANTISPASMODIC
Dicycloverine 6mos 2 yo 0.5 1ml TID
Relestal Drops 5mg/ml
Syrup 10mg/5ml
Domperidone 0.3 0.6 mkdose q 6 8 h
2.5 5ml/10kg BW TID
Dyspepsia: 2.5/10kg TID
Nausea: 2.5 5ml/kg TID
0.3 0.6 ml/5kg BW TID/QID
Motilium Susp 1mg/ml
Tab 10mg
Vometa Oral drops 5mg/ml
Susp 5mg/5ml
Tab 10mg
H2-BLOCKER
Ranitidine 1 2 mkdose q 12h
Zantac Tab 75mg 150mg 300mg
Cimetidine Neonates: 5 20 mkday q6 12 h
Infants: 10 20 mkday
Child; 20 40 mkday
Adult: 300mkdose QID
400mkdose BID
800mkdose QID
Tagamet Susp: 300mg/5ml
Tab: 100mg 200mg 300mg 400mg
800mg
Famotidine PO: 0.5 mkdose q 12 h
IV: 0.6 0.8 mkday q 8 12h
ANTIPYRETIC
Paracetamol (10 20 mkdose) q 4h
Tempra Drops: 60mg/0.6ml
Syrup: 120mg/5ml
Forte : 250mg/5ml
Tablet: 325mg 500mg
Calpol Drops: 100mg/ml
Syrup: 120mg/5m
250mg/5ml
Defebrol Syrup: 120mg/5m
250mg/5ml
Afebrin Drops: 60mg/0.6ml
Syrup: 120mg/5ml
Forte : 250mg/5ml
Tablet: 600mg
Tylenol Drops: 80mg/ml
Syrup: 160mg/5ml
Naprex Drops: 60mg/0.6ml
Syrup: 250mg/5ml
Inj: 300mg/2ml
Rexidol Drops: 60mg/0.6ml
Syrup: 250mg/5ml
Tablet: 600mg
Biogesic Drops: 100mg/ml
Syrup: 120mg/5m
250mg/5ml
Tablet: 500mg
Aeknil Ampule (2ml) 150mg/ml
Opigesic Suppository: 125mg 250mg
Mefenamic Acid (6 8mkdose) q 6h
Ponstan Suspension: 50mg/5ml
Cap SF: 250mg
Tab: 500mg
Aspirin (60 100 mkd)
Ibuprofen (5 10 mkday) q8h (max 20mkday)
Dolan FP Suspension: 100mg/5ml
Dolan Forte 200mg/5ml
Drops: 100mg/2.5ml
Advil 100mg/5
Tab: 200mg
IV ANTIBIOTICS
Penicillin 50,000 100,000 ukd q 6h
Amoxicillin 50 100 mkd q 6 8 h
Ampicillin 50 100 mkd q 6 8 h
Chloramphenicol 50 100 mkd q 4 6 h
Ampi + Cloxa 50 100 mkd q 6 h
Oxacillin 50 100 mkd q 6 8 h
Flucloxacillin 50 100 mkd q 6 8 h
Gentamicin 5 7.5 mkd OD
Netromycin 5mkd q 12 h
Amikacin 15mkd q 12 h
Cephalexin 50 100 mkd q 6 h
Cefuroxime 50 100 mkd q 6 8 h
Ceftriazone 50 100 mkd OD
Ceftazidime 50 100 mkd q 12 h
HYDROCORTISONE LD: 10 mkdose
MD: 5 mkdose q 6, 8 or 12h
*max dose: LD 200 MD 100
ANTICONVULSANT
Diazepam 0.2 0.3 mkdose
Drip: 1amp in 50cc D5W
10mg/amp
Midazolam 0.15 mkdose OR
0.05 0.2 mkdose
Phenobarbital LD: 10 mkdose q 12h
MD: 5 mkdose q 12h
ANTIHYPERTENSIVES
Hydralazine PO: 0.75 1.0 mkday q 6 12 h
Apresoline IV: 0.1 0.2 mkdose
Spirinolactone 1 3 mkday
ANTI-TB MEDS
Isoniazid (10 12 mkd) ODAC or 2hrs PC
Comprilex Suspension:
Nicetal 200mg/5ml
Trisofort 100mg/5ml
Odinah 200mg/5ml
150mg/5ml
Tablet 400mg
Rifampicin (10 20 mkd) ODAC or 2hrs PC
Natricin 100mg/5ml 200mg/5ml
Rifadin 100mg/5ml
100mg/5ml
Rimactane 200mg/5ml
Rimaped Tablet 300mg 450mg
Pyrazinamide (PZA) (16 30 mkd) BID/TID
CIBA 250mg/5ml
Zcure 500mg/5ml
Zinaplex Tablet 500mg
IMMUNIZATION
Vaccine Min age No of interval booster
1st dose dose
BCG At birth 1 - -
Before 1
mo
DPT 6 wks 3 4 wks 18 mos
(2, 4, 6 4 6 yo
mos)
OPV/IPV 6 wks 3 4 wks Same as
2, 4, 6 DPT
mos)
Hep B At birth 3 6 wks from
(0, 1, 6 1st dose, 8
mos) wksfrom
EPI (6, 10, 2nd dose
14)
Measles 6 9 mos 1 -

MMR 15 mos 1

Hib 2, 4, 6 mos 18 mos

Pneumococcal 6 mos 18 mos


(PCV7)
2 yrs (PPV)
Rotavirus 3 and 5 2 I month
mos
Hep A 1 yr and 2 6 12 mos
up apart
Varicella 1st: 12 2 Bet 1st
15 mos and 2nd
2nd: 4 6 dose: at
yo least 3
mos
Flu 6 months yearly
COMPOSITION OF IV SOLUTION
Fluid Na K Cl HCO3 Dxt
PNSS 154 - 154 - -
0.45 NaCl 77 - 77 - -
D5 0.3 51 - 51 - 5
NaCl
D5 LRS 130 4 109 28 5
D5 NM 40 13 40 16 5
D5 IMB 25 20 22 23 5
D5 NR 140 5 98 27 5

Na requirement : 2 4 meq/k/day
K requirement: 2 3 meq/k/day
KIR: 0.2 0.3 meq/k/hr max of 40 meq

KIR = Rate x incorporation


wt

Electrolyte correction computation

COMPOSITION OF ORS
Na K Cl Glu
Glucolyte 60 20 50 100
Hydrite 90 20 80 111
WHO 75 20 65 75
Pedialyte 30 30 20 30
45 45 20 35
90 90 20 80
Gatorade 41 11 9/100
ASSESSMENT OF DEHYDRATION [CDD]
PARAMEeTER NO SIGN SOME SIGN SEVERE
Condition Well, Alert RestlessI Lethargic
Irritable Unconscious
Floppy
Eyes Normal Sunkem Very sunken
Dry
Tears Present Absent Absent
Mouth/Togue Moist Dry Very dry
Thirst Drinks Thirsty Drinks poorly
normally Drinks Not able to
Not thirsty eagerly drink
Skin pinch Goes back Goes back Goes back very
quicly slowly slowly

ORAL REHYDRATION THERAPY


PLAN A AGE Amount ORS to give/loose stool
50 100 ml
100 200 ml
As much as wanted
PLAN B Amount of ORS to give in 1st 24 hrs:
Weight (kg) x 75ml/kg
PLAN C AGE 30ml/kg 70ml/kg
Infants (<1 yo) 1 hr 5 hrs
Children (>1 yo) 30 mins 2.5 hrs

In fluid resuscitation: use 20cc/kg as bolus. Usually PLR

FLUID MANAGEMENT
Severity Less than 2 yo More than 2 yo
Mild 50cc/kg 30cc/kg
Moderate 100cc/kg 60cc/kg
Severe 150cc/kg 90cc/kg
To run for 6 8 hrs then refer
Usual fluid is D5 0.3 NaCl; if however more than 40 kg then D5 LR
PCAP
VARIABLE PCAP A PCAP B PCAP C PCAP D
Minimal Low Risk Moderate High Risk
Risk Risk
Comorbid None Present Present Present
Illness
Compliant Yes Yes No No
caregiver
Ability to Possible Possible Not Not
follow up
Presence of None Mild moderate Severe
dehydration
Ability to feed Able Able Unable Unable
Age >11 mos >11 mos <11 mos <11 mos
RR
2 12 mos >50/min >50/min >60/min >70/min
1 5 yo >40/min >40/min >50/min >50/min
>5 yo >30/min >30/min >35/min >35/min
Signs of Respiratory Failure
Retractions - - Subcostal/ Subcostal/
Intercostal Intercostal
Head babbing - - + +
Cyanosis - - + +
Grunting - - - +
Apnea - - - +
Sensorium None Awake Irritable Lethargy /
Stupor
Coma/
Complication:
Effusion None None Present Present
Pneumothorax
Action Plan OPD OPD Admit to Admit to
f/u at f/u after regulat CCU
end of tx 3 days ward Refer to
specialist
Clinical Practice Guidelines in the Evaluation and Management of PCAP
2004
Predictors of CAP in patients with cough
(3 mos to 5 yrs) tachypnea &/or chest retractions
(5 12 yrs) fever, tachypnea & crackles
(>12 yo) (a) fever, tachypnea & tachycardia; (b) at least 1 AbN
CXR
WHO Age Specific classification for tachynea
2 12 mos: >50 RR
1 5 yrs: >40 RR
>5 yrs: >30 RR
PCAP A/PCAP B
No diagnostic usually requested
PCAP C/PCAP D
The ff shud b routinely requested
o CXR APL (patchy viral; consolidated bacterial)
o WBC
o C/S (blood, Pleural Fluid, tracheal aspirate on initial
intubation)
o Blood gas/Pulse oximeter
The ff may be requested: C/S sputum
The ff shud NOT be routinely requested
o ESR
o CRP

Antibiotic Recommendation
1. PCAP A/PCAP B and is beyond 2 yo & having fever w/o wheeze
2. PCAP C and is beyond 2 yo, having high grade fever, having
alveolar consolidation on CXR, having WBC >15,000
3. PCAP D refer to specialist
Antibiotic Recommendation
PCAP A/PCAP B w/o previous antibiotic
o Amoxicillin (40 50 mkday) TID
PCAP C
o Pen G IV (100,000 IU/k/d) QID
PCAP C who had no HiB immunization
o Ampicillin IV (100mkd) QID
PCAP D refer to specialist
What shud b done if px is not responding to current antibiotics
1. If PCAP A/PCAP B not responding w/n 72 hrs
a. Change initial antibiotic
b. Start oral Macrolide
c. Reevaluate dx
2. PCAP C no responding w/n 72 hrs consult w/ specialisr
a. PCN resistant S pneumonia
b. Complication
c. Other dx
3. PCAP D not responding w/n 72hrs, then immediate consultto a
specialist is warranted
Switch from IV to Oral Antibiotic done in 2 3 days after initiation in px
who:
Respond to initial antibiotic
Is able to feed with intact GI tract
Does not have any pulmo or extra pulmo complication
Ancillary Treatments
O2 and Hydration
Bronchodilators, CPT, steam inhalation and Nebulization
Prevention
Vaccines
Zinc Supplementation
o 10mg for infants
o 20mg for children > 2 yo
DENGUE HEMORRHAGIC FEVER
Serotype 1, 2, 3, & 4
Aedes egypti
IP: 4 6 days (min 3 days; max 10 days)
DHF SEVERITY GRADING

GRADE MANIFESTATION
I Fever, non-specific constitutional symptoms such as
anorexia, vomiting and abdominal pain (+) Torniquet
test
II Grade I + spontaneous bleeding; mucocutaneous, GI
III Grade II w/ more severe bleeding +
Evidence of circulatory failure: violaceous, cold &
clammy skin, restless, weak to imperceptible pulses,
narrowing of pulse pressure to < 20mmHg to
actualHPON
IV Grade III but shock is usually refractory or
irreversible and assoc w/ massive bleeding

CRITERIA FOR CLINICAL DX (WHO)


DHF DSS
Fever, acute onset, high, lasting 2 Above criteria
7 days Plus
Hemorrhagic man: Hypotension or
o (+) Torniquet test narrow pulse
o Minor & Major pressure [SBP
bleeding DBP] <20mmHg
phenomenon
3
Thrombocytopenia <100,000/mm
LEVELS OF ASTHMA CONTROL [GINA GUIDELINES]
CONTROLLED PARTLY UNCONTROLLED
Daytime None [2x or More than Three or more
symptom less/week] 2x a week features of partly
Limitation of None Any controled
activities asthma present
Nocturnal None Any in any week
sx/awakening
Need for None More than
reliever/recue 2x a week
tx
Lung function Normal 80%
(PEF OR FEV1) predicted
Exacerbation None One or One in any week
more/yr
ATOPIC DERMATITIS CONTACT SEBORRHEIC
DERMATITIS DERMATITS

Hereditary, AR Irritant strong excessive sebum

hx of Asthma
chem. accumulation on

thickened, shiny,
e.g. diaper rash
scalp,
midchest,
face,

red remove reactant


perineum

exacerbated by dry
greasy scalp
skin, contact sty, & Allergic
(cradle cap)
anxiety physiologic 1st
tx: hydrocortisone/ e.g. cosmetic,
6mos
fluocinolone perfume tx: low potency
moisturizer tx: high/mod
steroid

cloxa/cefalexin if
petency steroid

with infxn

SIGNS OF SHOCK

EARLY LATE

Narrowed pulse pressure Decrease systolic pressure


Orthostatic changes Decrease diastolic pressure
Delayed capillary filling Cold, pale skin
Tachycardia Altered mental state
Hyperventilation Diaphoresis
Decrease urine output


DISTRIBUTIVE CARDIOGENIC HYPOVOLEMIC
Sepsis Weak/sick Pump
Anaphylaxis pump empty
Barbiturate intox CHF, Truma,
CNS injury (SCI) cardiomegaly, hemorrhag
drug e, DHN
CO = HR x SV

intoxication, (diarrhea/
hypothermia, vomiting),
after cardiac Metabolic
surgery dse (DM)
Excessive
sweating
SHOCK

Redistribution of fluid w/n Compromise MC in


vascular space CO infant
CO is primarily maintained by changes in HR

&children
Normal BV
of children
80ml/kg
ED MNG
1. Position
2. Oxygen
3. Assisted ventilation
4. Intravenous access
5. Fluid (isotonic crystalloid)
6. Reassess (look for improvement in VS, skin signs, mental status; insert foley cath &
monitor UO)
7. Inotropes help stabilize BP
o Epinephrine - (0.1 1 ug/kg/min)
Infusion of choice for Hypotensive pxs
o Dobutamine - (5 20 ug/kg/min)
Cardiogenic shock but not severely hypotensive
o Dopamine [(5 20 ug/kg/min constrictor effect) *(10 15 ug/kg/min]
Distributive shock after successful fluid resuscitation
8. Cardiogenic shock
o Diuretic pxs may get worse after fluid challenge
o Adenosine / synchronize cardioversion SVT
o Defibrillation Venticular fibrillation
MUMPS [Paramyxoviridae]
MOT Direct contact, airborne droplets, fomites
contaminated by saliva
IP 16 18 days
Prd of comm 1 2 days before onset of parotid swelling until 5
days after the onset of swelling
Prodorme Fever, neck muscle pain, headache, malaise
Parotid gland Peak in 1 3 days
swelling 1st in the space between posterior border of
mandible & mastoid then extends being
limited above zygoma
Complications Meningoenephalitis - most frequent, about
10 days; M>F
Orchitis & Epididymitis
Oophoritis
Dacryoadenitis or optic neuritis
ANAPHYLAXIS
A syndrome involving a rapid & generalized immunologically
mediated rxn
After exposure to foreign allergens in previously sensitized
individuals
A true emergency when cardio and respi system are involved
ED Management
o O2
o Aqueous Epinephrine 1:1000 IM (0.01ml/kg with
0.5ml max)
o Prepare intubation if w/ stridor & if initial therapy
of epi is not effective
o Continuous monitor ECG and O2 sat & establish IV
access
o Antihistamine to prevent progression
o H1 & H2 blocker
o Diphenhydramine (1mg/kg) IM
o Steroids may modify late phase or recurrent
reaction (Hydrocortisone 5mg/kg/dose)
o Epinephrine 1:10,000 IV (0.1ml/kg; 10ml max)
o Epinephrine drip (0.01ml/kg/min)
Indication for Admission
o Persistent bronchospasm
o Hypotension requiring vasopressors
o Significant hypoxia
o Patient resides some distance from a hospital
facility
VIRAL INFECTIONS
MEASLES (Rubeola) [Paramyxoviridae]
MOT Droplet spray
IP 10 12 days
Prd of comm 4 days before & 4 days after onset of rash
Enanthem Koplik spots (opposite lower molars)
Prodrome High grade fever, conjunctivitis, catharr (3 5 days)
Rash Appear during height of fever
Cephalocaudal[1st along hairline, face, chest]
[+] brawny desquamation disappear w/n 7 10
days
Complication 1. Otitis media
2. Pneumonia
3. Encephalitis
4. Diarrhea
5. Exacerbation of M tb infection
Tx Vit A SD 100,000 IU orally for 6 mos 1 yo
200,000 IU >1 yo
Post exposure Ig w/n 6 days of exposure
prophylaxis (0.25ml/kg max 15 ml) IM
Vaccine Susceptible children >1 yo w/n 72 hrs
SSPE Chronic condition due to persistent measles
infxn
Rare but found in 6 mo to >30 yrs of age
Subtle change in behavior & deterioration o
schoolwork followed by bizarre behavior
Elevated titers of Ab to measles virus(IgG,
IgM)
Inosiplex (100mg/kg/day) may prolong
survival
GERMAN OR 3 DAY MEASLES [RUBELLA] [Togaviridae]
MOT Oral Droplet; transplacentally to fetus
IP 14 21 days
Prd of comm 7 days before &7 days after onset of rash
Enanthem Forchheimer spots [soft palate] just b4 onset of rash
Rash Cephalocaudal
Characteristic Retroauricular, posterior cervical & postoccipital
sign LAD [24 hrs before rash & remains for 1 wk]
Tx Vit A SD 100,000 IU orally for 6 mos 1 yo
200,000 IU >1 yo
Post exposure Immunoglobulin [not routine]
prophylaxis Considered if termination of preg is not an option
0.55ml/kg) IM
Vaccine w/n 72 hrs of exposure
Congenital Greatest during 1st trimester
Rubella IUGR
Congenital cataract, microcephaly, PDA,
blueberry muffin skin lesions
Congenital or profound SNHL
Motor or mental retardation
ROSEOLA [HSV 6] Exanthem subitum
Age of onset < 3 yo with peak at 6 15 months
High grade fever for 3 5 days but behave normally
Rash Appears 12 24 hrs of fever resolution fades in 1
3 days
HERPANGINA [Coxsackie A]
- Sudden onset of fever with vomiting
- Small vesicles & ulcers w/ red ring found in anterior tonsillar pillars, may
also seen on the soft palate, uvula & pharyngeal wall

VARICELLA [HSV]
MOT Direct contact
IP 14 days
Prd of comm 1 2 days before the onset of the rash until 5 6
days after onset & all the lesions have crusted
Rash Start from the trunk then spread to othe parts of
the body
All stages present; pruritic
Macule/papule vesicle crust
Complication Secondary bacterial infection
Encephalitis or meningitis
Pneumonia
Reye syndrome
GN
Congenital 6 -12 wks AOG: maximal interruption w/ limb
Varicella devt with cicatrix(ski lesion w/ zigzag
scarring)
16 20 wks: eye and brain involvement
Tx Acyclovir 15 30 mg/kg/day IV or 200 400 mg tab
q 4hrs minus midnight dose x 5 days: increased risk
o severity
Post exposure VZIg 1 dose up to 96 hrs after exposure
prophylaxis Dose: 125 U/10 kg (max 625 U) IM
NB whos mother develop varicella 5 days before to
2 days after delivery shud recv 1 vial
Vaccine Susceptible children >1 yo w/n 72 hrs
ERYTHEMA INFECTIOSUM [Parvovirus B 19] FIFTH DISEASE
MOT Droplet spread & blood & blood products
IP 16 17 Days average
Prodrome Low grade fever, headache, URTI
Rash Erythematous facial flushing slapped cheek and
spreads rapidly to the trunk & proximal extremities
as a diffuse macular erythema
Palms & soles are spared
Resolves w/o desquamation but tend to wax and
wane in 1 3 wks

Dengue insert
Rabies
JUVENILE RHEUMATOID ARTHRITIS [JRA]
Criteria Age of onset <16 yo
Arthritis (swelling or effusion or presence of 2 or
more of: limitation of range of motion, tenderness
or pain on motion, increased heat in one or more
joints.
Duration: 6 wks or longer
Onset type defined in the 1st 6mos
o Polyarthritis: (5 or more inflamed
joints)
o Oligoarthritis (<5)
o Systemic arthritis w/ characteristic
fever
CM Morning stiffness, ease of fatigue esp. after school
in the early afternoon, joint pain later in the day,
joint swelling
Pauci: LE, assoc w/ chronic uvietis
Poly: both large & small joints more severe if
extensors of elbow and Achilles tendon are
involved
Systemic: quotidian fever w/ daily temp spikes of
39C for 2 wks; faint red macular rash over the
trunk & proximal extremities
Mngt NSAIDS then Methotrexate
Seroid for overwhelming systemic illness

SYSTEMIC LUPUS ERYTHEMATOSUS [SLE]


Criteria Malar rash
Discoid rash
Photosensitivity
Oral ulcers (painless)
Nonerosive arthritis (2 or more joints)
Serositis (pleuritis, serous pericarditis,Libman
sacks endocarditis
Renal disorder
Neurologic disorder
Hematologic disorder
Immunologic disorder
ANA abormal titer
Dx Presence of 4 of 11 criteria [ANA not required
dx]
(+) ANA screening
Anti ds DNA more specific; reflects the degree
of disease activity
Decrease C3, C4 in active dse
Anti Sm Ab (most specific)
Mngt NSAIDS use w/ caution
Prednisone (1 2 mkday)
Severely ill: pulse IV steroid (30mkdose) max 1
gm over 60 mins OD x 3 days
Severe dse: Pulse IV Cyclophosphamide to
maintain renal fxn & prevent progression
HENOCH SCHONLEIN PURPURA [HSP]
Most common cause of nonthrombocytopenic purpura in children
Typically follows URTI
2 8 years old
Hallmark Rash palpable petechia or purpura, evolve
from red to brown; last from 3 10 days [LE
and buttocks]
Arthritis of knees and ankles
Intermittent abdominal pain due to edema &
damage to the vasculatue of the GIT
Mngt Symptomatic
Steroid for severe abdominal pain
MAINTENANCE WATER
HOLLIDAY SEGAR METHOD
Weight [kg] Daily Requirement [ml/kg]
3 10 100 ml
10 20 1000 + 50ml/kg for each kg >10
>20 1500 + 20ml/kg for each kg >20
Maintenace water rate
0 10 4ml/kg/hr
10 20 40 mk/hr + 2ml/kg/hr x wt
>20 60 mk/hr + 1ml/kg/hr x wt

Microbial causes of CAP accrdng to Age


Birth to 20 days o Grp B Strep
o Gram (-) enterobacteria
o CMV
o L. monocytogenesis
3 weeks to 3 o RSV
months o Parainfluenza virus
o S. pneumonia
o B. pertussis
o S. aureus
4 months to 4 o RSV, Parainfluenza virus
yo o Influenza virus, Adeno, Rhinovirus
o S. pneumonia
o H. influenzae
o M.pneumoniae
o M.tuberculosis
5 years to o M.pneumoniae
15 years o C. pneumoniae
o S. pneumonia
o M.tuberculosis
Therapeutic Mgt of CAP
OPD Mngt
Birth to 20 days Admit

3 weeks to 3 Afebrile: Oral Erythromycin (30-40mkd)


months Oral Azithromycin (10 mg/kg/day) day 1
5mkday day2 to 5
Admit: febrile or toxic

4 months to 4 Oral Amoxicillin (90mkd/3doses)


yo Alternative: Amox-Clav, AZM, Cefaclor
Clarithromycin, Erythromycin
5 years to Oral Erythromycin (30-40mkd)
15 years Oral AZM 10mkday day 1, 5mkday day 2-5
Clarithromycin 15mkday/2 doses
Pneumococcal infxn: Amoxicillin alone

IN-PATIENT
Birth to 20 days Ampicillin + Gentamicin w or w/o Cefotaxime

3 weeks to 3 Afebrile: IV Erythromycin (30-40mkd)


months Febrile: add Cefotaxime 200mkd
Cefuroxime 150 mkd
4 months to 4 If w/ pneumococcal infection:
yo IV Ampicillin (200mkd) Cefotaxime 200mkd
Cefuroxime 150 mkd
5 years to Cefuroxime 150 mkd + Erythromycin 40mkd
15 years IV or orally for 10-14 days
If pneumococcal is confirmed:
Ampicillin 200mkd
CLINICAL FEATURES of PNEUMONIA
Bacterial o Fever >38.5C
o Chest recession
o Wheeze not a sign of primary bacterial URTI
Viral o Wheeze
o fever < 38.5
o marked recession
o RR normal or increased
Mycoplasma o School children
o Cough
o wheeze
CXR in assessing CAP etiology
Alveolar infltrates Bacterial pneumonia
Interstitial infiltrates Viral pneumonia
Both infiltrates Viral, Bacterial or mixed viral bacterial
pneumonia

PHOTOTHERAPY
o 10 Bulbs
o 20 watts
o 200 hrs
o 30 cms
o Bilirubin in the skin absorbs light energy
o Photo-isomerization reaction converting the toxic native
unconjugated 4Z, 15Z-bilirubin into an unconjugated
configurational isomer 4Z,15E-bilirubin, which can then be
excreted in bile without conjugation
o major product from phototherapy is lumirubin, which is an
irreversible structural isomer converted from native bilirubin and
can be excreted by the kidneys in the unconjugated state
o Complications
o loose stools, erythematous macular rash, purpuric rash associated
with transient porphyrinemia, overheating, dehydration
(increased insensible water loss, diarrhea), hypothermia from
exposure, and a benign condition called bronze baby syndrome
dark, grayish-brown skin discoloration in infants
Treatment of Hyperbilirubinemia
Phototherapy
Exchange o Complications: metabolic acidosis,
transfusion electrolyte abnormalities, hypoglycemia,
hypocalcemia, thrombocytopenia, volume
overload, arrhythmias, NEC, infection, graft
versus host disease, and death

IV Ig o Adjunctive treatment for


hyperbilirubinemia due to isoimmune
hemolytic disease
o (0.51.0 g/kg/dose; repeat in 12 hr)
o Reducing hemolysis
Metalloporphyrins o Competitive enzymatic inhibition of the
rate limiting conversion of heme-protein to
biliverdin (an intermediate metabolite to
the production of unconjugated bilirubin)
by heme-oxygenase
o Patients with ABO incompatibility or G6PD
deficiency or when blood products are
discouraged as with Jehovah's Witness
patients

VACCINES
BCG Live attenuated M bovis
DPT Diptheria and TT inactivated B pertussis
OPV Sabin trivalent live attenuated virus
IPV Salk inactivated virus
MMR, Measles Live attenuated virus
Varicella
Hep B Recombinant DNA, plasma derived
Hep A Inactivated virus
Hib Capsular polysacc linked to carrier CHON
Typ Live typhoid vaccine 3 doses x 2 days
IMSC Vi antigen typ vaccine
Pneumococcal Capsular polysaccharide 0.5 ml
SC /IM 23 valent purified cap
Polysacc Antigen of 23 serotyp
Influenza Split or whole virus IM
RABIES VACCINE
VERORAB 0.5 cc/amp; 1 amp IM
Day: 0 3 7 14 and 28
BERIRAB RD: 20 iu/kg
300 iu/vial 1 vial = 2ml
at wound site
deep IM
Reqd amt in IU: wt x RD (20IU)
Amount in ml = wt x RD (20) x 2
300
Ig (Human) 20 iu/kg
Bayrab 300 iu/2ml
Equine Berirab 300 iu/2ml
40 iu/kg
Favirab 200 400 iu/5ml
1000 2000 iu/5ml

Hx of Clean minor Wound All other Wounds


Absorbed TT
Td TIG Td TIG
Unknown or Yes No Yes Yes
<3
> No No No No
< 7 yo Dtap is recommended
> 7 yo Td is recommended
If ony 3 doses of TT received, a 4th dose should be given
Give TT (clean minor wounds) if > 10 y since last dose
All other wounds (punctured wds, avulsions, burn)
Give TT (all clean wds) if > 5 yrs since last dose
BILIRUBIN METABOLISM
RBC

Heme +Globin
Heme oxygenase

Biliverdin
Bilirubin reductase

Unconjugated bilirubin

Enterohepatic pathway
Liver SER
Glucoronyl transferase B-glucoronidase

Conjugated bilirubin

Kidney Small intestine


Urobilinogen Stercobilinogen
Urobilin Stercobilin
Urine Stool
Pathogenesis of Dengue Hemorrhagic Fever

Dengue Virus

Liver Lymphoblast/plasma Platelet


Cell

Liver injury Ag-Ab reaction Dec maturation


Megakaryocyte
Inc plt destruction

Dec coagulation Inc Vascular Thrombocytopenia


Factors Permeability

Inc. Bleeding Hypoalbuminemia Bleeding


Tendency Hemoconc.
Pleural Effusion

Hypotension
MANAGEMENT APPROACH BASED ON CONTROL
Step 1 Step 2 Step 3 Step 4 Step 5
PRN B2 Asthma education and Environmental control
agonist As needed rapid acting B2 agonist
Select one Select one Add one or Add one
more or more
C Low dose Low dose Med to Hi Oral
O ICS ICS + LABA dose steroids
N ICS + LABA
T Leukotriene Medium or Leukotriene
R modifier Hi dose ICS Modifier Anti
O Low dose Sustained IgE
L ICS + Release treatment
L Leukotriene theophylline
E Modifier
R Low dose
ICS +
Salbutamol
Release
theophylline
SEVERITY OF ASTHMA EXACERBATION
MILD MODERATE SEVERE RESPIRAT
ORY
ARREST
IMMINEN
T
Breathless Walking Talking At rest
Infant Infant stops
softer feeding
shorter cry
Diff
Can lie feeding Hunched

Prefers
sitting
Talks in Sentences Phrases Words

Allertness May b Usually Usually Drowsy or


agitated agitated agitated confused

RR Inc Inc >30/min


Normal RR
<2 mo <60/min
2-12 mo <50/min
1-2 y <40/min
2-8 y <30/min
Acessory Usually Usually Usually Paradoxic
ms not al
Thoracoab
d movt
Wheeze Moderate Loud Usually Absence
loud of wheeze
Pulse <100 100-200 >120 Bradycard
Normal PR ia
2-12 mo <160/min
1-2 y <120/min
2-8 y <110/min
Pulsus Absent Maybe Often Absence
paradoxus <10mmH present present suggests
g 10- 20-40 resp ms
25mmHg mmHg fatigue
PEF >80% 60-80% <60%
PaO2 Normal >60 mmHg <60mmHg

PaCO2 <45 <45 mmHg >45 mmHg


mmHg
O2 Sat >95% 91-95% <90%

SEIZURE
BENIGN FEBRILE SEIZURE CRITERIA
6 mos 6 yrs
< 15 mins
Febrile
Family history of febrile seizure
GTC
Not > 1 episode in 1 febrile episode; EEG done after 2 wks of
seizure episode
3% of general population develop epilepsy
1 2 % of BFS develop epilepsy
25% recurrence of seizure
Seizure paroxysmal, time limited change in motor activity and/or
behavior that results from abnormal electrical activity in the brain
Epilepsy present when 2 or more unprovoked seizure s occur at
an interval greater than 24 hrs apaet
HYDROCEPHALUS
Result from impaired circulation & absorption of CSF or from
inceased production
Obstructive or Noncommunicating
o Due to obstruction w/n ventricular system
o Abnormality of the aqueduct or a lesion in the 4th
venticle (aqueductal stenosis)
Non-obstructive or Communicating
o Obliteration of the subarachnoid cisterns or
malfunction of the arachnoid villi
o Follows SAH that obliterates arachnoid villi;
leukemic infiltrates
Clinical Manifestation
Infant: accelerated rate of enlargement of the head; wide anterior
fontanel & bulging [Normal fontanel size: 2 x 2 cm]
Eyes may deviate downward: due to impingement of the dilated
suprapineal recess on the tectum [setting sun sign]
Long tract sign: [brisk DTR, spasticity, clonus, Babinski sign]
Percussion of skull produce a crackedpot or Macewen sign
[separation of sutures]
Foreshortened occiput [Chiari malformation]
Prominent occiput [Dandy-Walker malformation]
Treatment
Depends on the cause
Extracranial shunt
Acetazolamide & Furosemide [provide temporary relief by
reducing the rate of CSF production]
BELLS PALSY
Acute unilateral facial nerve palsy that is not associated with
other cranial neuropathies or brainstem dysfunction
Usually develops abruptly about 2 wks after SVI [EBV, HSV,
mumps]
Upper and lower portions of the face are paretic
Corner of the mouth droops
Unable to close the eye on the involved side
Protection of cornea with methylcellulose eye drops or an ocular
lubricant
Excellent prognosis

CEREBRAL PALSY
Non-progressive disorder of posture & movement often
associated with epilepsy & abnormalities of speech, vision &
intellect resulting from defect or lesion of the developing brain
Etiology: infections, toxins, metabolic, ischemia
Classification
Physiologic Topogrphic
[major motor abnormality] [involved extremities]
1. Spastic 1. Monoplegia [1
2. Athetoid worm like side/portion]
3. Rigid 2. Paraplegia
4. Ataxic 3. Hemiplegia
5. Tremor 4. Triplegia [3 limbs]
6. Atonic 5. Quadriplegia [all]
7. Mixed 6. Diplegia [LE/UE]
8. unclassified 7. Double hemiplegia
Clinical Manifestaion
Spastic hemiplegia Arms > legs
Dificulty in hand manipulation obviously
by 1 yo
Delayed walking or walk on tiptoes
Spasticity apparent esp. in ankles
Seizure & cognitivr impairment
Spastic diplegia Bilateral spasticity of the legs
Commando crawl
Increased DTRs & (+) Babinski sign
Normal intellect
Spastic quadriplegia Most severe form, due to marked motor
impairment of all extremities & high
association with MR & seizures
Swallowing difficulties
Management
Baseline EEG & cranial CT scan
Hearing & visual function tests
Multidisciplinary approach in the assessment & treatment
For tight heel cord: tenotomy of the Achilles tendon

ESSENTIAL NEWBORN CARE PROTOCOL [from DOH]


o What should be done immediately after birth is to dry the baby
because hypothermia can lead to several risks
o Delaying the cord clamping to 3 mins after birth (or waiting until
the umbilical cord has stopped pulsing)
o Instead of immediately washing the NB, the baby should be
placed on the mothers chest or abdomen to provide warmth,
increase the duration of breastfeeding, and allow the good
bacteria from the mothers skin to infiltrate the NB
o Washing should be delayed until after 6 hours because this
exposes the NB to hypothermia and remove vernix. Washing also
removes the babys crawling reflex.
APGAR SCORE
o Evaluates the need for resuscitation
o Taken 1 and 5 minutes after birth
0 1 2
Color Blue, pale Body pink, All pink
extremities blue
HR 0 <100 >100
Reflex No response Grimace Cough
irritability
Activity Limp Some flexion Active
Respiration Absent Slow, irregular Good
The APGAR Score
8 10 Good cardiopulmonary adaptation
47 Need for resuscitation, esp ventilatory support
03 Need for immediate resuscitation

NORMAL VALUES
AVERAGE WEIGHT (3,000 grams)
0 6 mos Age in months x 600 + BW
7 12 mos Age in months x 500 + BW
Children
1 6 yo Age in years x 2+ 8
7 12 yo Age in years x 7 5 / 2
HEAD CIRCUMFERENCE [35 cm (+ 2cm)] (inch =
2.54cm)
1 4 months inch per month
5 12 mos inch per month
2 years old 1 inch per year
3 5 yo inch per year
6 20 yo inch per 5 years
LENGTH (50 cm)
0 3 months 9 cm
46 8 cm
79 5 cm
10 12 3cm
NEWBORN CARE
Umbilical Cord
Cut 8 inches above abdomen after 30 sec
In nursery, cut the umbilical cord 1 inch above the abdomen
Healing should take place around 7 10 days
Eye Prophylaxis
1% silver nitrate drops [most effective against Neisseria]
Erythromycin 0.5% [Clamydia]
Tetracycline 1%
Povidone iodine 2.5%
Vitamin K
1 mg Vit K1
PT: 0.5 mg
Vaccine
BCG
Hep B
Newborn Screening
Done on 16th hr of life . can be repeated after 2 weeks
Patients w/ CAH will die 7 14 days if not treated
Patient w/ CH will have permanent growth defect and MR if not
treated before 4 weeks
Disorder Screened Effects Screened Effects if Screened
& treated
Congenital Severe MR Normal
Hypothyroidism (CH)
Congenital Adrenal Death Alive &Normal
Hyperplasia (CAH)
Galactosemia (Gal) Death of Cataract Alive &Normal
Phenylketonuria PKU Severe MR Normal
G6PD Severe Anemia Normal
Kernicterus
NEONATAL JAUNDICE
Risk Factors
o Jaundice visible on first day of life
o A sibling w/ neonatal jaundice or anemia
o Unrecognized hemolysis
o Non-optimal feeding
o Deficiency: G6PD
o Infection
o Cephalhemaoma or bruising / Central hct >65%
o East Asian/ Mediteranean in origin
PHYSIOLOGIC vs PATHOLOGIC
FACTORS PHYSIOLOGIC PATHOLOGIC
Onset > 24 hrs of life < 24 hrs of life
Rate of inc of TSB < 0.5mg/dl/hr > 0.5mg/dl/hr
Persistent < 14 days FT: > 8 days
PT: > 14 days
Total S. Bilirubn FT: < 12 mg/dl Any level requiring
PT: < 14 mg/dl phototherapy
Sign/ Symptom Vomiting, lethargy,
poor feeding, excess
wt loss, apnea, inc
RR, temp instability
KRAMER CLASSIFICATION
ZONE JAUNDICE mg/dl
I Head/neck 68
II Upper trunk 9 12
III Lower trunk, thigh 12 16
IV Arms, leg, below knee 15 18
V Hands/feet > 15
BREAST FEEDING vs BREASTMILK JAUNDICE
Parameter BREASTFEEDING BREASTMILK
Onset 3rd to 5th day of life Late; start to rise on
day 4; may reach 20
30 mg/dl on day 14
then slowly
Normal by 4 12
weeks
Pathophysio Decrease milk intake Unknown
enterohepatic Prob. due to
circulation glucoronidase in BM
which
enterohepatic
circulation
Normal LFT;
(-) hemolysis
Mngt Fluid and If breastfeeding is
caloricsupplement stopped, rapid
decrease in bilirubin
level in 48 hrs, if
resumed will rise to 2
4 mg/dl but no
precipitating previous
events
NEONATAL SEPSIS
Classification
Early: birth to 7th day of life
Late: 8th to 28th day of life
Risk factors
Maternal infection during pregnancy
Prolongrupture of membranes (18 hrs)
Prematurity
Common organism:
Bacteria: GBS, E. coli & Listeria (early)
Viruses: HSV, enteroviruses
Signs & symptom
Non-specific
Dx:
CBC, CXR, blood and urine culture, lumbar tap for CSF studies
Treatment
Empiric antibiotics [Ampicillin + 3rd gen Cephalosporin or
Aminoglycoside)
supportive

VIRAL CROUP vs EPIGLOTTITIS


VIRAL CROUP EPIGLOTTITIS
Age group 3 mos to 3 yrs 3 7 yrs
Stridor 88% 8%
Pathogen Parainfluenza virus H. influenzae type B
Onset Prodrome (1 7 Rapid (4 12 hrs)
days)
Fever Severity Low grade High grade
Associated sympto Barking cough, Muffled voice,
hoarseness Droolong
Respond to racemic Stridor improves None
epinephrine
CXR steeple sign thumbprint sign
BRONCHIOLITIS
Acute inflammation of the small airways in children <2 yrs
Most commonly caused by RSV
Related to exposure to cigarette smoke
Risk factors for severe dse:
o <6 mos
o Prematurity
o Heart or lung disease
o immunodeficiency
Signs /Symptoms
low grade fever, rhinorrhea, cough, wheezing
hyperresonance to percussion
CXR
hyperinflation, interstitial infiltrates
Treatment
Mild [at home]:
o Increased fluids, trial of inhaled
bronchodilators, aerosolized epinephrine
Severe:
o Admit to hospital if: Marked respratory
distress; Poor feeding; O2 sat <92%; hx of
prematurity < 34 wks; underlying
cardiopulmonary dse; unreliable caregivers
o Manage with ventilatory and O2 support,
hydration, inhaled bronchodilators and
ribavirin
Age Ht (cm) Ht (cm) Wt for Ht Boys Girls
mo boys girls (cm) (kg) (kg)
0 50.5 49.9 49 3.1 3.3
1 54.6 53.5 50 3.3 3.4
2 58.1 56.8 51 3.5 3.5
3 61.1 59.5 52 3.7 3.7
4 63.7 62.0 53 3.9 3.9
5 65.9 64.1 54 4.1 4.1
6 67.8 65.9 55 4.3 4.3
7 69.5 67.6 56 4.6 4.5
8 71.0 69.1 57 4.8 4.8
9 72.3 70.4 58 5.1 5.0
10 73.6 71.8 59 5.4 5.3
11 74.9 73.1 60 5.7 5.5
12 76.1 74.3 61 5.9 5.8
13 77.2 75.5 62 6.2 6.1
14 78.3 76.7 63 6.5 6.4
15 79.4 77.8 64 6.8 6.7
16 80.4 78.9 65 7.1 7.0
17 81.4 79.9 66 7.4 7.3
18 82.4 80.9 67 7.7 7.5
19 83.3 81.9 68 8.0 7.8
20 84.2 82.9 69 8.3 8.1
21 85.1 83.8 70 8.5 8.4
22 86.0 84.7 71 8.8 8.6
23 86.8 85.6 72 9.1 8.9
24 87.6 86.5 73 9.3 9.1
25 88.5 87.3 74 9.6 9.4
26 89.2 88.2 75 9.8 9.6
27 90.0 89.0 76 10.0 9.8
28 90.8 89.8 77 10.3 10.0
29 91.6 90.6 78 10.5 10.2
30 92.3 91.3 79 10.7 10.4
31 93.0 92.1 80 10.9 10.6
32 93.7 92.8 81 11.1 10.8
33 94.5 93.5 82 11.3 11.0
34 95.2 94.2 83 11.5 11.2
35 95.8 94.9 84 11.7 11.4
36 96.5 95.6 85 11.9 11.6
3.5 98.4 97.3 86 12.3 11.8
4 yo 102.9 101.6 87 12.3 11.9
4.5 106 104.5 88 12.5 12.2
5 109.9 108.4 89 12.8 12.4
5.5 112.6 111.0 90 13.0 12.6
6 116.1 114.6 91 13.2 12.8
6.5 118.5 117.1 92 13.4 13.0
7 121.7 120.6 93 13.7 13.3
7.5 123.9 123.0 94 13.9 13.5
8 127.0 126.4 95 14.1 13.8
8.5 129.1 128.8 96 14.4 14.0
9 132.2 132.2 97 14.7 14.3
9.5 134.4 134.7 98 14.9 14.6
10 137.5 138.3 99 15.2 14.9
10.5 139.9 140.9 100 15.5 15.2
11 143.3 144.8 101 101.0 15.5
11.5 145.8 147.6 102 16.1 15.9
12 149.7 151.5 103-105 16.5-17.1 16.2-16.7
12.5 152.5 154.1 106-108 17.4-18.0 17.0-17.6
13 156.5 157.1 109-111 18.3-19.0 17.9-18.6
13.5 159.3 158.8 112-114 19.3-20.0 18.9-19.5
14 163.1 160.4 115-117 20.3-21.1 19.9-20.6
14.5 165.7 161.1 118-120 21.4-22.2 21.0-21.8
15 169.0 161.8 121-123 22.6-23.4 22.2-23.1
15.5 171.1 162.1 124-126 23.9-24.8 23.6-24.6
16 173.5 162.4 127-129 25.2-26.2 25.1-26.2
16.5 174.9 162.7 130-132 26.8-27.8 26.8-28.0
17 176.2 163.1 133-135 28.4-29.6 28.7-30.1
17.5 176.7 163.3 136-140 30.2-33.0 30.8-32
18 176.8 163.7 141-145 33.7-36.9
Weight for Height = Actual BW (kg)
P50 Wt for Ht (kg)

Height for Age = Actual Height (cm)


P50 Ht for Age
Waterloo Wasting Stunting
Classification (Wt for Ht) (Ht for Age)
Normal >90 >95
Mild 81 90 90 95
Moderate 70 80 85 89
Severe <70 <85

RHEUMATIC HEART DISEASE


JONES CRITERIA
Major Manifestation
1. Arthritis (70%)
2. Carditis (50%)
a. Tachycardia
b. Heart murmur of valvulitis
c. Pericarditis
d. Cardiomegaly
e. Signs of CHF [gallop rhythm, distant heart
sounds, cardiomegaly]
3. Erythema marginatum (10%)
4. Subcutaneous nodules (2 10%)
5. Sydenhams chorea (15%)
Minor manifestation
1. Arthralgia
2. Fever at least 38.8C
3. Elevated Acute Phase Reactants (CRP & ESR)
4. Prolonged PR interval on the ECG
Diagnosis
1. Highly probable : 2 major OR 1 major and 2 minor manifestation
INFECTIVE ENDOCARDITIS
DUKE CRITERIA
Major Manifestation
1.
Minor manifestation

Diagnosis
2. Highly probable : 2 major OR 1 major and 2 minor manifestation
NURSERY NOTES
Dextrosity

(to get factor: Desired D5


D50- D5
D 7.5 = 0.055
D10 = 0.11
D 12.5 = 0.166
D15 = 0.22
D 17.5 = 0.28

Limits of Dextrosity:
Peripheral line = D12
Central line = D20
Total Fluid Intake (TFI):
Preterm: start at 60 cckd
Term: start at 80 cckd

To check TFI = rate x 24 wt

ex. Preterm: wt: 1.129

Day 1: start IVF with D10 water


60 x 1.219 24 = 3.1 cc/hr x 24 hrs
Add Calcium gluconate at 200 mkd q8h
Ca gluc = 1.129 x 200 3 = 75mg q8hrs for 3 doses
Start antibiotics
Give ranitidine
HGT q 8/12 hrs
OGT
CBC
Na, K, Ca at 48 hrs
Blood c/s depends on AP
Day 2: increase TFI by 10-20 (depends on AP)
70 x 1.129 24 = 3.3 cc/hr x 24 hrs
incorporate ca gluc 200 mkd to IV
ex.
D10 water 80 cc
Ca gluc 2.2cc
82.2cc to run at 3.3ccx24hrs

Day 3: increase TFI by 10-20 (depends on AP)


If electrolytes are N, may use D10IMB
80 x 1.129 24 = rate
80 x 1.129 x factor to get value of D50 water (to make D10 use 0.11)
Cont Ca gluc incorporation (if feeding may discontinue)
D50 water 9.9cc
D5 IMB 77.9cc = D10 IMB
Ca gluc 2.2cc (200mkd)
90 cc to run at 3.7cc/hrx24h
If feeding already:
Total volume of milk wt = cc/kg/day
Subtract this amount to TFI to get value for IV
(if Dr. Reinoso, divide by 2 before subtracting to TFI)
ex. MF 3cc q3hrs = 24 cc in 24 hrs
24 1.129 = 21.2 cckd from milk
80 21.2 = 58.8cckd (use this for IVF)
58.8 x 1.129 24 = rate
D50 water 7.3cc
D5 IMB 56.5cc = D10 IMB
Ca gluc 2.2cc (200mkd)
66 cc to run at 2.7cc/hrx24h

Subsequent days depend on infants status..


Electrolyte requirements:
Na: 2-4 mkd prepn 2.5 mg/ml
Ca: 100-200mkd prepn 100mg/ml
K: 2-4 mkd prepn 2mg/ml
Glucose Infusion Rate:

Dextrosity x IVF rate x 10 10


Wt
Ex. 10 kg; IVF D10 IMB at 40cc/h

GIR = 10 x 10 x 40 10 = 6.6mkmin
60
NV: Newborn & Infants 6-8 mg/kg/min
Children 4-6 mg/kg/min

If HGT <40 mg/dl, give D10 water slow IV push at 2cc/kg and
repeat HGT after 30 mins-1 hr (may do 3 boluses if still low, may inc
dextrosity or rate)

Level of Umbilical Cathetherization: (cm)


If arterial between T6-T9
Wt x 3 x 8

If venous: (wt x 3) + 8 +1
2

ET tube size: age in yrs +4


4
ET level:
if >2yo: age(yrs) +12
2
Or ET size x 3
Total Flow Rate = Tidal volume x wt x RR x I.E ratio + 2000
I.E = 2
Dead space = 2000
RR = 40-60
Tidal volume = Newborn: 6-10cck
Child: 10-15cck
Adult: 15cck

FiO2
Nasopharyngeal cathether = Flow rate x 20 + 20
Ex. 1L Fio2 = 40
Nasal catheter = Flow rate x 4 + 20
Ex. 1L FiO2 = 24
Extubation:
Give Dexamethasone at 0.1 mkdose q 6 hours for 24 hours prior
to extubation
USN with epinephrine 0.5 cc + 1.5 cc PNSS q 15 mins x 3 doses
then extubate then USN with Salbutamol nebule + 1.5 cc PNSS q
6 hours x 24 hours
O2 at 10 lpm then decrease as necessary
Regular milk: 20 cal/oz
Preterm milk: 24 cal/oz

Total Caloric Intake: rate x 24 x caloric content of IVF wt

To get factor: Dextrosity x 0.04 = cal/cc

Caloric content of IVF


D5 = 0.2 cal/cc
D7.5 = 0.3 cal/cc
D10 = 0.4 cal/cc
D15 = 0.6 cal/cc
Caloric requirement & Protein requirement
Cal/kg g/kg
0-5mo 115 3.5
6-11mo 110 3
1-2 yo 110 2.5
3-6 yo 90 100 2
7-9 yo 80 90 1.5
10 12 yo 70 80 1.5
13-15 yo 55 65 1.5
16 19 yo 45 50 1.5
Approximate Daily Water Requirement
0 3 do 120cc/k/d 4 6 yo 100 cc/k/d
10 do 150cc/k/d 7 9 yo 90 cc/k/d
1 5 mo 150cc/k/d 10 12 yo 80 cc/k/d
6 12 mo 140cc/k/d 13 15 yo 70 cc/k/d
1 3 yo 120cc/k/d 16 19 yo 50 cc/k/d
Estimated Catch up Growth Requirement
= cal/k/day (age for wt) x IBW (wt for ht)
Actual BW

CHON reqt = CHON reqt for age x IBW


Actual BW

Growth and Caloric requirements


AGE RDA kcal/kg/day
0 3 mos 115
3 6 mos 110
6 9 mos 100
9 12 mos 100
1 3 yo 100
4 6 yo 90 100
Double Volume Exchange Therapy (DVET)
Wt x 80 x 2 = Volume/ amt of fresh whole blood
(Use mothers blood type)

Volume _ = # of exchange
aliquots per exchange

> 3 kg 20 ml
2-3 kg 15 ml
1-2 kg 10 ml
850g-1kg 5 ml
< 850 g 1-3 ml

Prepare the ff:


2 pcs 3 way stopcock
1 pc 5 cc syringe
1 pc BT set
1 pc IV tubing
1 pc empty bottle
Gloves
Calcium gluconate 100 mg every 10 exchanges
Criteria for Hypoxic Ischemic Encephalopathy
pH < 7 (profound met. Acidosis)
Apgar <3 more than 5 mins
Neurologic sequelae (coma; sz)
Multiorgan involvement
Difficult delivery

Medications
Dopamine: wt x dose x 0.075
Prepn : Single Strength: 200mg/250ml;
Double Strength: 400/250ml
if using double strength: wt x dose x 0.0752
(Dose = 5-20)
Dobutamine: wt x dose x 0.06
Prepn: 250mg/250 ml; Dobuject 50mg/ml
(Dose = 5-20)

If using Dobuject: Wt x dose x 60 concentration


Concentrations: 5mg/ml = 5000
50mg/50ml = 1000
50mg/20ml = 2500
To make 5mg/ml: Dobuject 5cc
D5 water 45cc
To make 50mg/50ml: Dobuject 1cc
D5 water 49cc
To make 50mg/20ml: Dobuject 1cc
D5 water 19cc
Diflucan: 6 mkd OD prepn 50mg/tab divide into pptabs and give 1
pptab OD x 2 weeks
Aminophylline: 5mkd (loading dose) then 1.6 mkd q 8 hrs
(maintenance)
Phenobarbital 20 mkd (loading dose) then 5 mkd (maintenance)
Dexamethasone 0.1 mkdose q6hrs x 24 hours
For other meds, please see NEOFAX
NEWBORN CARE
Hypothermia
hypoxia
metabolic acidosis
hyperglycemia
Erythromycin ointment
should be given an hour after birth
gonococcal/chlamydial conjunctivitis
Gonococcal Conjunctivitis
within 7days
Chemical conjunctivitis
disappears within 48H
Other bacterial conjunctivitis
Chlamydial >10-14 days
th
Staph 48H-5 day (2-5days)
Herpes
Pseudomonas-give Gentamycin
Umbilical stump - sloughed off <14 days
Alcohol - drying effect
Cows milk allergy
rd
Onset- 3 wk
Rashes on cheeks eyebrows cradle cap

CRANIUM
Caput succedaneum
diffuse edematous swelling of soft tses of scalp
extend across midline
st
edema disappears w/in 1 few days of life
molding and overriding of parietal bones-frequent
st
disappear during 1 wks of life
no specific tx
Cephalhematoma
subperiosteal hemorrhage
limited to1 cranial bone
occur 1-2 % cases
no discoloration of overlying scalp
swelling not visible for several hours after birth ( blding
slow process)
firm tense mass with palpable rim localized over 1 area of
skull
resorbed w/in 2wk- 3mos
nd
calcify by end of 2 wk
few remain for years
10-25% cases underlying linear skull fracture
No tx but photo in hyperbil

seizure
Simple Complex

Type GTC Focal then gen post ictal

Duration < 15 min > 15 min or may go into


status
Recurrence None Recurrent (w/in 24H)
CNS exam Normal Abnormal
Sequelae None Neurodev abn

ANTICONVULSANT
DIAZEPAM 0.2 0.3 mkdose
Drip: 1amp in 50cc D5W
10mg/amp
MIDAZOLAM 0.15 mkdose prn 2 3 mins interval IV (1,
5mg/ml)
6 mos - 5 yo 0.05 - 0.10 max of 0.6 mg/kg
6 yo - 12 yo 0.25 - 0.05 max of 0.4 mg/kg
>12 yo 0.50 - 2 mg/dose over 2 mins
PHENOBARBITAL LD: 15 20 mkd MD: 5 mkdose
q 12h
(max load 20 mkday IV

Tabs: 15, 30, 60, 90, 100 mg


Caps: 16 mg
ELIXIR 20mg/5ml
Inj: 30, 60, 65, 130 mg/ml

MD: PO/ IV
Neonate: 3 - 5 mkD QID/ BID
Infant/child: 5 - 6 mkD
1 - 5 yo: 6 - 8 mkD
6 - 12 yo: 4 - 6 mkD
> 12 yo: 1 - 3 mkD
Hyperbil < 12 yo: 3 - 8 mkD BID/TID
PHENYTOIN LD: 15 20 mg/kg/IV
MD:
Neonate: 5 mkD PO/ IV BID
Infant/child: 5 7mkD BID/ TID
6mos 3y: 8 10 mkD
4 6y: 7.5 9 mkD
7 9y: 7 8 mkD
10 16 y: 6 7 mkD
Dilantin Tab: 50mg 100mg TID
Extended release caps 30, 100, 200, 300 mg
OD, BID ; Inj: 50 mg/ml
CARBAMAZEPINE
Tegretol Tab 200mg, 100mg chew
XR 100mg, 200mg, 400mg
Susp 100mg/ 5ml (QID)
Initial Increment Maintenance
< 6 yo 10 - 20 mkD BID /TID q wkly til 35 mkD
6 - 12 yo 10 mkD BID 100 mg/ 24H at 20 - 30 mkD
1 wk interval BID/ QID
> 12 y 200 mg BID 200 mg/ 24H at 800 - 1200 mg/24H
1 wk interval BID/ QID

OXCARBAMAZEPINE (8 - 10 mkd BID)


Initial: 8 -10 mkD PO BID then
Increment: increase over 2 week pd to
Maintenance doses:
20 -29 kg: 900 mg/24H PO BID
29.1 -39 kg: 1200 mg/24H PO BID
>39 kg: 1800 mg/24H PO BID

Trileptal Tab 150 mg 300mg 600 mg


Susp 300mg/5ml
VALPROIC ACID PO:
Initial : 10 - 15 mkD OD - TID
Increment: 10 mkD at wkly interval BID
Maintenance: 30 - 60 mkD BID/TID
IV: same dose as PO q 6H
Rectal : (syrup mix with water 1:1)
LD: 20 mkd
MD: 10 -15mkd TID
Depakene Tab 250 mg
Syr 250mg/5ml
Depacon IV 100mg/ml
TOPIRAMATE 2 - 16 yo
Initial: 1 - 3 mkd PO q HS x 7 days
then Increment: increase by 1 - 3 mkday
for 1 - 2 wks then
Maintenance: 5 -9 mkD BID
Topamax Cap 15 mg, 25 mg
Tabs 25 50 100
200mg

Glasgow Coma Scale Infants


Activiy Response Activity Response
Eye Opening
Spontaneous 4 Spontaneous 4
To speech 3 To speech 3
To pain 2 To pain 2
None 1 None 1
Verbal
Oriented 5 Coos, babbles 5
Confused 4 Irritable 4
Inappropriate 3 Cries to pain 3
words 2 Moans to pain 2
Inappropriate 1 None 1
sounds
None
Motor Normal
Follows command 6 spontaneous 6
movement
Localizes pain 5 Withdraws to 5
Withdraws to pain 4 touch 4
Abnormal flexion 3 Withdraws to pain 3
Abnormal 2 Abnormal flexion 2
extension 1 Abnormal 1
None extension
None
MOTOR DTR
full resistance with 5/5 very brisk +4
gravity 4/5 brisker than average +3
some resistance with normal +2
gravity 3/5 diminished +1
movement with gravity 2/5 no response 0
movement w/o gravity 1/5
flicker 0/5
no movement

Bilirubin (Total)

Cord
Preterm <2 mg/dl <34 mol/L
Term <2 mg/dl <34 mol/L
0 1 days
Preterm <8 mg/dl <137 mol/L
Term <8.7 mg/dl <149 mol/L
1 2 days
Preterm <12 mg/dl <205 mol/L
Term <11.5 mg/dl <197mol/L
3 5 days
Preterm <16 mg/dl <274 mol/L
Term <12 mg/dl <205mol/L
Older Infants
Preterm <2 mg/dl <34 mol/L
Term <1.2 mg/dl <21 mol/L
Adult 0.3 1.2 mg/dl 5 12 mol/L
Bilirubin (Conjugated)
Neonate <0.6 mg/dl <10 mol/L
Infants/Children <0.2 mg/dl <3.4 mol/L
Pre Lumbar Tap
NPO
RBS by gluco prior to lumbar tap
Prepare lumbar tap set
2% Lidocaine # 1
G 23 spinal needle
Mannitol 250 cc 1 bottle - do not open
Solvent
Diazepam 1 amp
3cc syringe #2
2 manometers
sterile bottles # 3
sterile gloves # 2
Sterile gauze # 1
Sterile gauze w/ Betadine #1
Sterile towel w/ hole #1
Sterile clamp #1
3-way stopcock #1

Post Lumbar Tap


NPO x 4H
Flat on bed
Monitor NVS to include BP q 30mins x 4H, then qH
CSF exams
Bottle # 1 Gm stain, AFB, India ink, KOH
Bottle # 2 Cell count, CHON, Sugar
Bottle # 3 C/S, save remaining specimen
Watch out for vomiting, HA and hypotension

Contraindications to LP
evidence of Inc ICP
severe CP compromise
Skin infection at site of puncture
CSF ANALYSIS
Color Rbc Wbc Diff sugar CHON
ct
Normal
Infant Xantho 0- 0 -32 L 70 - 60 -
(Term) 100 100% 80% 150
Infant Clear 0- 0 -15 L 70 - 60 -
(Preterm) 100 100% 80% 200
Older Clear 0 0 -10 L > 10-20
child 100% 50%
Viral Clear 0 0 -20 L 40- 40 -60
Mening 100% 60%
TB/Fungal Clear 0 20 - L>N < > 100
500 40% g%
Bacterial Purulent 0 > N>L < > 100
Mening 1000 50% g%
Partially Clear 0 100 L>N > Dec
tx BM 50%

CSF PATHWAY
rd
Choroid plexus (lateral ventricle) Foramen of Monroe 3
th
ventricle Aqueduct of sylvius 4 ventricle Foramina of
Luschka (2 laterals) & Magendie (median) SAS Absorbed in
the arachnoid villi, then in the Venous System

Dengue Drips
Furosemide drip
Dose: 0.04 - 0.5
80 mg + 32 cc
Wt x dose = rate (cc/h)
2
Furo drip = 0.1 - 0.5mg/k/hr
Prep: 20mg/2ml (2mg/ml)
Rate: (wt x dose)/2 = cc/hr ex. 14.5kg x 0.45 = 3.2cc/hr
To order: 8ml Furo + 32ml D5W +40 cc to run at 3.2cc/hr
Precedex drip
Dose: 0.2 - 0.7
1ml + 99cc D5W to run at cc/h
Wt x dose = rate (cc/h)
Noradrenaline (Levophed) 1mg/ml dose :(0.5 1 ml/kg)
Wt x dose ( each ml contains 4 mcg Noradrenaline)
4 mcg ( for acute hypotension)
2ml + 500cc D5W x 2cc/H (0.5 cc/H)

Dopamine ( 5 -20 mcg/kg/min) 200 mg/250ml Single strength


400 mg/250ml DS (div by 2)
Wt x dose x 0.075
Dobutamine 250 mg/5ml SS
500 mg/250ml DS(div by 2)
Wt x dose x 0.06
Terbutaline Bricanyl SC Inj: 1 mg/ml
< 12y 0.005 0.01 mkd x 3 doses q
15
-20 min then q2-6H
> 12y 0.25 mkd
Terbutaline drip LD: 2 10 mcg/kg then
0.1 0.4 mcg/kg/min
Ketamine (Ketalar) 10, 50, 100 mg/ml
PO: 5mg/kg x 1
IV 0.25 - 0.5 mg/kg
IM 1.5 - 2 mg/kg x 1
Morphine IV 0.1 0.2 mkd q2-4H prn
Naproxen 250, 375, 500mg tab
125mg/5ml
> 2yo 5-7 mkd TID, BID PO
IVIG infusion
Preparation:
2.5g/50cc 500g/10cc 25g/100cc
5g/100cc 10g/250cc
Computation:
Wt x 2 g /kg IVIG
Ex wt: 7.2 kg
7.2 x 2 + 16 g IVIG
16 gIVIG x 2. 5 g = 320 cc
Cc 50cc
# of vials = total cc 320cc = 6.4 vials
50cc 50cc
320cc x 0.03 = 9. 6 cc/h for 30 mins
st
Transfuse 9 10cc/h IVIG for the 1 30mins if no reaction, run the
remaining volume for 12H
Refer for any infusion reactions
Close ML
Monitor v/s q 30 mins while on infusion
If after IVIG if still febrile, rpt IVIG after 3 D
nd
If after 2 IVIG still febrile start Prednisone
Aspirin 80 mkD QID
30 mg, 80, 100, 300 mg

KCl NaHCO3
IV 2 meq/ml Inj premixed: 5% (0.6 meq/ml)
Child: 0.5 1meq/k/dose infusion 500ml
of Tabs: 325 mg (3.8 meq), 650 mg
0.5 meq/k/h for 1-2 h (7.6 meq)
Tabs: 8, 10, 15, 20 meq
Oral soln
10% ( 6.7 meq/5ml)
15% (10 meq/5ml)
20% (13.3 meq/5ml)
PO : 1-4 meq/kg/24H QID
IV: 0.5 1meq/k/dose
Urine alkalinization
Ca Gluc = Children: 1cc/k/dose x 84 840 mg (1- 10 meq)/kg/D PO
3doses; QID
Max: 10cc/dose + equal amt of
sterile water

LYSMIX 0.3 cc/k/dose TID Ceiling = 0.4


Prozinc drops 10 mg/ml
< 6 mos 1 ml OD
< 6 mos 2 yo 1 ml BID
syrup 20 mg/5ml
> 2 yo 5ml OD
Ercefuryl 20 mkday
Erceflora 1-2 vials/day OD for 2 wks
mix with water, milk or juice
Protexin Restore 1 sachet mix with milk OD
Racecadotril 1.5 mg/kg for 1 wk
(Hidrasec)
< 9 kg 10 mg sachet 1 sachet TID
9 13 kg 10 mg sachet 2 sachets TID
13 27kg 30 mg sachet 1 sachet TID
> 27 kg 30 mg sachet 2 sachets TID

FWB 10 - 20 cc/kg 3 4H
PRBC 5 - 10 3 4H
Plasma 10 - 15 12H
PRP 10 - 15 12H
Plt conc 1 u/ 7 -10 kg FD
Cryoprecipitate 1 u/kg FD
Hemophilia A 1 bag
(200mg fibrinogen)
VW dse 50 -100 mg/kg
Fibrinogen dse 100 cc
(2-5 kg)
Factor 8 Hemophilia A 50 u/kg
Hemophilia B 100 u/kg
1 u FWB = 200 cc PRBC
= 50 cc platelet concentrate
= 150 200cc PRP
= 150 cc FFP
MCV Hgb / rbc x 10 80 -94
MCH Hgb / rbc x 10 27 - 32
MCHC Hgb/ hct x 10 32 38
Absolute reticulocyte count = pts hct x retic %
N hct for age

Reticulocyte Index
Absolute Retic Ct > 2 hemorrhage
2 < 2 rbc production abn

PRBC to be transfused for correction = 40 hct x wt

1 - 3 days 1 mo 2mos 6 12y >12y


Hgb 14.5 22.5 9 -14 11.5 - 13-16
15.5
Hct .48 - .69 .28 - .42 .35 - .45 .37 - .49
Wbc 9 -30 birth 5 19.5 6 -17.5 4.5 -
13.5
Plt 84 478 After 1 wk, same as adult
NB 150 - 400
Retic 0.4 - 0.6 < 1 -1.2 0.1 -2.9

ANC - % of neutrophils & cells that become neutrophils multiplied by


wbc
ANC = wbc x (% seg + % stabs + % meta)
Other formula: wbc x (seg + meta + stabs ) x 10
Ex 2.1 x 53 (seg) x 10 = 1113
ANC > 1000 Normal
ANC < 2000 Neutropenia
ANC 1000 -1500 Low risk of infection
ANC 500 -1000 Mod risk of infection
ANC < 500 High risk of infection

IT ratio > 0.25 sepsis


> 0.80 higher risk of death fr sepsis

Anemia
< 10 g mild anemia
8-9g mod anemia
<8 g severe anemia

Glucose PT 20 -60 Child Adult


NB 30 60 60 -100 70 -105
1 d 40 -60
> 1d 50 -90

EMERGENCY
ET tube age in years + 4
4
ET diameter x 3
>10 yo cuffed

Laryngoscope sizes
PT Miller 00 or 0

Term Miller 0

0-6mos Miller 1

6-24 mos Miller 2

>24 mos Miller 2 or Mac 2

EMERGENCY MEDS
Epinephrine (bradycardia, asystole)
(1:1000) 0.1 ml/kg q 3- 5 mins
Amiodarone 5 mg/kg rapid IV push
Cardioversion 2 J/kg then 4 J/kg then rpt 2x
Albumin 1gm x wt given in 2-4hrs.
Prep: 12.5g/50ml
Vol expander: 20ml/kg
HypoCHONemia 1gm/k/dose x 4H
Epinephrine Drip 0.1 1mg/k/min; 1amp = 1mg/ml
Rate = (wt x dose x 60)/desired
Ex: (18kg x 0.1 x 60)/100 = 2cc/hr
To order: 5 amps Epi + 50cc D5W to rum at
2cc/hr
(0.1mg/k/min)
Levophed 0.3-2mcg/k/min
Prep: 4mg/amp (1mg/ml)
Rate = (wt x dose x 60)/desired
Ex. Dose 0.5
1mg/20 = 0.05 x 1000 = 50mcg/ml
(18kg x 0.5 x 60)/50 = 10.8cc/hr
To order: 1 amp levophed + 80 cc D5W to run at
11cc/hr
Dopamine Renal dose 3-5
Pressor >5 - <15
alpha effect >15
ANAPHYLAXIS
Epinephrine 0. 01ml/kg max of 0.5 mg/dose SC
(1:1000) < 30 kg 0.15 mg
> 30 kg 0.3 mg
Diphen = 50mg IM (1mkdose)
USN w/ Salbu x 3 doses

BICARB DEFICIT CORRECTION:


Ex: wt 4.9kg
pH = 7.10
pCO2 = 9.1
pO2 = 36.5
HCO3 = 2.8
BE = -26.8
O2 Sat = 53.6%
BE x Wt x 0.3 = 26.8 x 4.9 x 0.3 = 39.39meqs
Half correction: 39.39/2 = 19.69 meqs
To order: Give 20 meqs NaHCO3 + equal amt of sterile water to be given
slow IVTT over 30mins.
Infuse another 20 meqs NaHCO3 + equal amt sterile water as drip for 1-2
hrs.
EMPIRIC: NaHCO3 1-2mkdose even w/o ABG.
HCO3 correction in ABG:
Half correction: Base xs x 0.3 x wt 2
(+ equal amount of sterile water)

Full correction: Base xs x 0.3 x wt 2


(1/2 via IV push, via IV drip)

Full correction: Base xs x 0.3 x wt 2


(1/2 via IV push, via IV drip)
BUN/ crea ratio
Normal 10 -20
> 20 suggest DHN, pre renal azotemia or GIB
< 5 liver disease, inborn error of metabolism
GFR (based on plasma creatinine and ht)
2
GFR = k x L = ml/min/1.73 m SA
sCr
L = body length (cm)
Scr = mg/dL ; divide by 88.4 if units in mmol/L

Age K (mean value) KI


LBW < 1 yr 0.33 29.17
FT < 1 yr 0.45 39.78
2-12 y 0.55 48.62
13-21 y (female) 0.55 48.62
13 -21 y (male) 0.70 61.88

Age GFR Range


PT
2- 8 d 11 11 15
4 - 28 d 20 15 28
30 -90 d 50 40 65
Term
2- 8 d 39 17 60
4 - 28 d 47 26 68
30 - 90 d 58 30 86
1- 6mo 77 39 -114
6 - 12 mo 103 49 157
2 - 19mo 127 62 191
2 - 12y 127 89 165
Adult males 131 88 174
Adult females 117 87 147

BSA
Weight in (kg)
05 wt x 0.05 + 0.05
6 10 wt x 0.04 + 0.10
11 20 wt x 0.03 + 0.20
20 40 wt x 0.02 + 0.40
>40 wt x 0.01 + 0.80

Computation for OFI (AGN & limiting OFI)


1. BSA x 400 + UO IVF (half if w/ Furo) = OFI (then divide to 3 shifts)
2. 20cc x wt x UO IVF

OSTERIZED FEEDING
TFR 60 - 70% = 100/feeding q 6H
10 kg x 60%
TFR = 600
CHON 0.5 g/kg inc q other day by 0.5 , max of 2 g/kg
Dose x wt x prep (Vamin 7%, 9%)
0.5 x 10 kg x (100 /7) = 71 g/kg
CHON = 71 g/kg
If no prep = dose x wt x 4 = 20 g/kg
CHO 60%
(TFR CHON) x 0.6
(600- 71) x 0.6 = 317
CHO = 317
Fats 181 (the rest are fats , divided into 6 feedings)
TPN
Vamin 9% 0.67 cal/ml
Start 0.5 g/k/day inc by 0.5 g until 3 -3.5g/k/day
Compute = wt x dose x prep (100/9)

Intralipid 10% 20%


Start 0.5 g/k/day inc by 0.5 g until 3 g/k/day
Compute = wt x dose x prep (100ml/ 10) = ml/24H
Amino acids
Start 0.5 g/k/day inc by 0.5 g until 3 g/k/day
Compute = wt x dose x prep (100ml/g) = ml/24H
TPN shortcut computation
Wt 10 kg TFR= 100 ml/k/day TFI = 1000ml/day

Vamin 7% 7 = 2 g/kg x 10kg 285 ml


100
CaGluc 2ml/kg 20 ml
D5IMB 485 ml
D50W 0.11 x 1000ml 110 ml
1000ml x 37 cc/h
TPN for NEONATES
Wt 2kg
1. TFR = 100 ml/kg/day x 2 kg 200 ml
2. Intralipid 20%
1 g/kg/day x 2kg = 2g/day 10 ml
2 g = 20g x 100ml
3. Compute for TFR 1
TFR1 = TFR Intralipid = 200 -10ml = 90 ml
4. Vamin 7%
1 g/kg/day x 2 kg = 2g = 29 ml
2 g = 7g
x 100ml
5. Multivitamins Benutrex c 0.5 ml/100ml
0.5 ml = x 1 ml
100ml 190 ml
6. Ca gluc 10% 2ml/kg/day x 2 kg 4 ml
7. Dextrosity (D10) get d50w
TFR 1 x dextrosity factor (0.11) 21 ml
190 x 0.11
8 . D5IMB = TFR 1 (Vamin + MTV + Ca gluc + D50W)
190 (29 + 1+ 4+ 21) = 135 ml
9. IV rate = TFR 1 / 24H 190 ml/ 24H 8 ml/H
Order:
Start TPN as ff:
TFR= 100ml/kg/day
D5 IMB 135 ml
D50W 21 ml
Vamin 7% 29 ml
Ca Gluc 4 ml

MTV 1 ml
190 ml to run at 8 ml/h
Intralipid 20% 10 ml to run for 24H

Peak Flow (6 7 yo)


(Ht cm 100) x 5 + 170 female
+ 175 male
Nasopharyngeal catheter = flow rate x 20 + 20
Nasal cannula = flow rate X 4 + 21

TFR= TV x RR x IE ratio + dead space (2000)


TV= 10 ml x wt
TFR Short cut: wt x 10 + 40 ml divide by 0.5
16.77

MILK FORMULAS
1:1 dilution 1:2 dilution
Mead-Johnson, Nestle, Glaxo, Wyeth, Abbott, Unilab
Dumex, Milupa
0-6 months (20cal/oz) Lactose free (0-6months)
Mead-johnson: Alacta , Enfalac Mead-johnson: Enfalac lacto-free
Nestle: NAN1, Nestogen Nestle: AL110
Glaxo: Frisolac Milupa: HN25
Dumex: Dulac Wyeth: S26 Lacto-free
Abbott: Similac advance
Milupa: Alaptamil
Wyeth: S26, Bonna
Unilab: Mylac
6months onwards (20cal/oz) Lactose free (6months onwards)
Mead-johnson: Enfapro Mead-johnson: Enfapro lacto-
Nestle: NAN2, Nestogen 2 free
Glaxo: Frisomil
Dumex: Dupro
Abbott: Gain
Wyeth: Bonnamil. Promil
Unilab: Hi-nulac
1 year onwards (20 cal/oz) Premature Infant (24cal/oz)
Mead-johnson: Enfagrow, Lactum Mead-johnson: Enfaprem
Nestle: NAN3, Neslac Nestle: PreNAN
Glaxo: Frisorow Abbott: Similac prem
Dumex: Dugrow Milupa: Preaptamil
Abbott: Gainplus
Wyeth: Progress, Promil
Unilab: Enervon bright
Hypoallergenic (20cal/oz) Soy-Based (20cal/oz)
Mead-johnson: Pregestimil Mead-johnson: Prosoybee
Nestle: Alfare, NAN HA1, NAN Abbott: Isomil
HA2 Wyeth: Nursoy
AGN
inflam process affecting the kidney, lesions predom in the
glomerulus
Etiology
Infections:
a. Bacterial: Grp A B hemolytic strep, S viridans, S pneumo,
Staph
aureus, S epidermidis, S typhi , T pallidum, Leptospira
b. Viral: HBV, Mumps, Measles, CMV, Enterovirus
c. Parasitic: Toxoplasm, Malaria, Schistosoma
Drugs: Toxins, Antisera, Vaccines (DPT)
Miscellaneous: Tumor Ag, Thyroglobulin
GABS Nephritogenic Strains
Sites: URT - pharyngitis - M1 2 4 12 18 25
Skin pyoderma - M49 55 57 60
Pathophysio Immune complex disease
Clinical & Lab
-hematuria -hypocomplementenemia
-proteinuria -oliguria
-edema -n & v
-hpn 82% -dull lumbar pain
Typical course
Latent: few days 3wks
Oliguric: 7 10 days
Diuretic: 7 10 days
Convalescent: 7 10 days

Normalization of urine sediment


Parameter Resolved by
Gross hematuria 2 3 wks
Complement level 6 8 wks
Proteinuria 3 6 mos
Micro hematuria 6 12mos
Lab Dx:
U/A spec grav,cast, hematuria, chonuria
Serology culture of GABS, ASO, C3 ( dec in acute phase, rises
during convalescensce)
Renal fxn bun crea- normal, hyponat
Hematology dilutional anemia, transient hypoalbuminemia
Radiography CXR , renal utz
Management:
Bed rest
Fluid and salt restriction
o Fluids: 400 600 ml/m2/day + UO 24H
o NaCl < 2 g/day
o K < 40 meq/day
Penicillin 50 100,000 u/kg/day TID/QID x 10 days
HPN, CHF
o Furosemide 2 mg/k/dpse
Prognosis complete resolution, 5 10 % progress to chronic state
VITAMINS
Stimulants Mosegar Vita 0.25 mg/day prep 0.25 /5 ml
Buclizine (syrup) Appetens
Propan
Appebon
2 - 8yo 5 - 10 ml OD
7 - 14yo 10 - 20 ml OD
w/ Folic acid Molvite
(Megaloblastic 7 - 12yo 10 - 15 ml OD
Anemia) 3 - 6yo 5 - 10 ml OD
1 - 2yo 2.5 - 5 ml OD
Iberet
Ferlin (10 mcg folic acid)
Macrobee
1 - 2yo 2.5 - 5 cc OD
3 - 6yo 5 - 10 cc OD
7 - 12yo 10 - 15 cc OD
Pizotifen Mosegor vita syr
(drowsiness) Appetens
MTV w/ Iron Propan w/ iron syr (Fe So4; elem fe 30mg)
Appebon w/ iron syr (FeSo4; elem fe 10mg)
w/ Serotonin (for Mosegor vita
migraine + dec wt) Mosegor plain
Appeten
Jagaplex syrup
1-2yo 5ml OD
3-6yo 10 ml OD
7-12yo 15 ml OD
Clusivol Power syrup
syr 100mg/5ml
2-6yo 5 ml OD
7-12yo 10 ml OD
Zeeplus
<2yo 2.5 ml OD
2-6yo 5 ml OD
7-12yo 5-10 ml OD
Polynerv
1-2yo 2.5 ml OD
3-6yo 5 ml OD
7-12yo 10 ml OD
0-6mo 0.5 ml-1 ml OD
7mo-1yr 1-1.5 ml OD
1-2yrs 1.5-2ml OD
Iron Deficiency Supplemental Iron =
Anemia Therapeutic Dose: 5 - 6 mkday for 3 mos
Maintenance Dose: 3 - 4 mkday
Elemental iron
20% of FeSo4
12% Fe gluconate
33% Fe fumarate
Wt x Dose x Prep

Ferlin drops15mg/ml
Fe 75 mg
Prophylactic dose
Term 1 mg/k/Day, start 4 mos-1y
PT 2 mkD, start 2 mos-1y
Therapeutic dose 3 mkD BID, QID for 4-6mos

Ferlin syrup 30mg/ml


Fe 149.3 mg
Supplemental dose 10-15 mg OD
Therapeutic dose 3 mkD TID, QID for 4-6mos

Sangobion syr (Fe gluc 250mg elem Fe 30mg)


Incremin with Iron
Syrup 30 mg elem Fe
TPN in Pediatrics
A. Energy Requirment
AGE/WT Caloric Rquirement
Neonates 90-120 kcal/kg
Infants & Older
Children
<10 kg 10-120 kcal/kg
11-20 kg 1000kcal + 50 kcal foe each kg > 10
>20 1500 + 20 for each more than 20
B. Fluid Requirement
AGE/WT Fluid Rquirement

Neonates
VLBW ( 1500 gm) Initiate at 40 60 ml/kg/day and increase by
10 ml/kg/day till 120 ml/kg is reached

Initiate at 60 ml/kg/day and increase by 15


th
AGA & LBW ml/kg/day till 120 ml/kg is reached on the 5
day of PN

Neonates under radiant heaters or on phototx an extra


30ml/kg/day of water
Infants & Older
Children
<10 kg 100 120 ml/kg
11-20 kg 1000ml + 50 ml foe each kg > 10
>20 1500 + 20 for each more than 20
C. Protein Requirement
AGE/WT Dosage (gm/kg/day)

VLBW ( 1500 gm) 2.25


0 12 months 2.50
1 8 yrs 1.50 2.0
8 yrs and above 1.00 1.50
With the initiation of PB|N, start w/ 0.5gm/kg/day and gradually
increased by 0.5gm/kg/day till recommended protein is reached.
D. Carbohydrate Requirement
% dextrose = gram dextrose x 100

Vol infused (ml

Shud provide 50 60 % 0f total non-protein calories


Requirement ranges frm 10 to 25 gm/kg/day
Infusion shud not exceed 12.5mg/kg/min
Shud b decreased if urinary glucose 0.5% (2+) or blood sugar
exceeds 7 mmol/L in neoanate or 9.7 mmol/L I above 1 mo of age
E. Fat Requirement
AGE Dosage (gm/kg/day)
0 12 months 2
1 8 yrs 4
8 yrs and above 2.5
30 40 % of total calories shud b provided as fats
2 4% as EFA
Start at 0.5 gm/kg/day and gradually increase by 0.5 gm/kg/day
till recommended amt is reached
F. Daily Electrolyte Requirements
Electrolytes Neonates 1-6 mos 6 mo -11 yr Adolescents
mmol/kg mmol/kg mmol/kg mmol/kg
NaCl 35 34 34 60 100
K 24 23 23 80 120
Ca 0.6 1.0 0.25 1.2 0.25 1.2 4.7
(max of (max of
4.7) 4.7)
Glucos 1.0 12 12 30 45
PO4 0.125- 0.125- 0.125- 48
0.250 0.250 0.250
Ma
Calcium gluconate contains 100 mg calcium gluconate or 9 mg
elemental calcium/ml
1 gm of calcium gluconate contains 4.7 mEq or 2.35 mmol of Ca.
G. Trace Elemental Requirements
Trace Elemental Prematures Infants & Adolescents
Children
(ug/kg) (mg)
(ug/kg)
Zinc 400 100 500 2.5 4
Copper 50 20 0.5 1.5
Chromium 0.3 0.14 0.2 0.01 0.04
Manganese 10 2 10 0.15 0.5
Iodine 8 8 0.2
Selenium 4 4 0.3
Flouride 57 57 0.9
In the absence of available prep of trace elements; weekly blood
transfusion may be given at 20 ml/kg
Iron: 2 mg/kg, with dose increased to 6 mg/kg if Fe def is
documntd; provided by adding iron dextran to amino acid soln

Sample Solving:
Wt 15 80kcal/kg
A. Energy: 15 x 80 = 1, 200 kcal/day
B. TFR: 1,250 ml/day
C. CHON: (1gm/day) 15 x 1
Prep: Aminosteril 6% (6gms/100ml)
6gms x 15 gms = 250 ml
100 x
D. CHO: % = gm x 100 10% x = 125 gms
Vol 1250
Prep: D50W
50 gm = 125gm
100 ml x
E. Lipids: ( 1 gm) 15 x 1 =15
Prep: 10% Intralipid (10gms/100ml)
10 gms x 15 gm = 150
100 ml
F. Sodium: (3 mmol/kg) 15 x 3 = 45 mmol/kg
Prep: 2.5 mmol/ml
2.5 mmol x 45 = 18 ml
ml x
G. Potassium: (2 mmol/kg) 15 x 2 = 30 mmol/kg
Prep; 2 mmol/ml
2.0mmol x 30 = 15 ml
ml x
H. Calcium gluc: (0.25 mmol/kg) 15 x 0.25 = 3.75
Prep: 10% Cal gluc
0.25 mmol x 3.75 = 15 ml
ml x
I. Magnesium: (0.25 mmol/kg) 15 x 0.25 = 3.75
Prep: 25% MgSO4
2 mmol x 3.75 = 1.9 ml x 2 = 4 ml
ml x
J. Total Mixture:
24 hrs 12 hrs
Aminostril 250 125
D50W 250 125
Na 18 9
K 15 7.5
Cal gluc 15 7.5
MgSO4 4 ml 2 ml
Total 552 276

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