ESSENTIAL NEWBORN CARE PROTOCOL [from DOH]

▪ What should be done immediately after birth is to dry the baby because
hypothermia can lead to several risks APGAR SCORE
▪ Delaying the cord clamping to 3 mins after birth (or waiting until the
Evaluates the need for resuscitation
umbilical cord has stopped pulsing)
Taken 1 and 5 minutes after birth
▪ Instead of immediately washing the NB, the baby should be placed on
0 1 2
the mother’s chest or abdomen to provide warmth, increase the
duration of breastfeeding, and allow the “good bacteria” from the Color Blue, pale Body pink, All pink
mother’s skin to infiltrate the NB extremities blue
▪ Washing should be delayed until after 6 hours because this exposes the HR 0 <100 >100
NB to hypothermia and remove vernix. Washing also removes the baby’s Reflex irritability No response Grimace Cough
crawling reflex. Activity Limp Some flexion Active
Respiration Absent Slow, irregular Good
NEWBORN CARE
The APGAR Score
Umbilical Cord
8 – 10 Good cardiopulmonary adaptation
▪ Cut 8 inches above abdomen after 30 sec
4–7 Need for resuscitation, esp ventilatory support
▪ In nursery, cut the umbilical cord 1 ½ inch above the abdomen 0–3 Need for immediate resuscitation
▪ Healing should take place around 7 – 10 days
Eye Prophylaxis NICU
▪ 1% silver nitrate drops [most effective against Neisseria]
▪ Erythromycin 0.5% [Chlamydia] Please admit under RI, LI, PD or AP
TPR q4H
▪ Tetracycline 1% ▪ Povidone iodine 2.5%
May breastfeed if NSD; NPO x 2hrs if CS
Vitamin K Vaccine Labs:
▪ 1 mg Vit K1 ▪ BCG NBS at 24 hrs old, secure consent
▪ PT: 0.5 mg ▪ Hep B CBC, BT (if w/ maternal illness, PROM or UTI
HGT now then 1, 3, 6, 12, 24, 48 hrs old (GDM)
Newborn Screening
HGT now (SGA or LGA)
▪ Done on 16th hr of life . can be repeated after 2 weeks Medications:
▪ Patients w/ CAH will die 7 – 14 days if not treated Erythromycin eye ointment both eyes
▪ Patient w/ CH will have permanent growth defect and MR if not Vit K 1 mg IM (term); 0.5 mg (PT)
treated before 4 weeks Hep B vaccine 0.5 ml IM, secure consent
Effects if Screened & BCG 0.05 ml ID (PT); 0.1 ml (term), secure onsent
Disorder Screened Effects Screened SO
treated
Routine NB care
Congenital Severe MR Normal
Monitor VS q30 mins until stable
Hypothyroidism
Thermoregulate at 36.5 to 37.5°C
Congenital Adrenal Death Alive &Normal Place under droplight (NSD); isolette (CS)
Hyperplasia (CAH) Suction secretion prn
Galactosemia (Gal) Death of Cataract Alive &Normal Will infrom AP /AP attended delivery
Phenylketonuria PKU Severe MR Normal
G6PD Severe Anemia Normal
Kernicterus

IMMUNIZATION NEONATAL JAUNDICE

Min age of 1st # of Risk Factors
Vaccine Interval Booster
dose dose Jaundice visible on first day of life
BCG At birth 1 - - A sibling w/ neonatal jaundice or anemia
Before 1 mo Unrecognized hemolysis
Non-optimal feeding
DPT 6 wks 3 4 wks 18 mos
Deficiency: G6PD
(2, 4, 6 mos) 4 – 6 yo
Infection
OPV/IPV 6 wks 3 4 wks Same as
Cephalhemaoma or bruising / Central hct >65%
2, 4, 6 mos) DPT
East Asian/ Mediteranean in origin
Hep B At birth 3 6 wks from 1st PHYSIOLOGIC vs PATHOLOGIC
(0, 1, 6 mos) dose; 8 wks
EPI (6, 10, 14) from 2nd dose FACTORS PHYSIOLOGIC PATHOLOGIC
Measles 6 – 9 mos 1 - Onset > 24 hrs of life < 24 hrs of life
Rate of inc of TSB < 0.5mg/dl/hr > 0.5mg/dl/hr
MMR 15 mos 1 Persistent < 14 days FT: > 8 days
Hib 2, 4, 6 mos 18 mos PT: > 14 days
Total S. Bilirubn FT: < 12 mg/dl Any level requiring
Pneumococcal 6 mos (PCV7) 18 mos PT: < 14 mg/dl phototherapy
2 yrs (PPV) Signs/Symptoms Vomiting, lethargy, poor
Rotavirus 3 and 5 mos 2 I month feeding, excess wt loss, apnea,
inc RR, temp instability
Hep A 1 yr and up 2 6 – 12 mos
apart KRAMER CLASSIFICATION
Varicella 1st: 12 – 15 mos 2 Bet 1st & 2nd ZONE JAUNDICE mg/dl
2nd: 4 – 6 yo dose: at least I Head/neck 6–8
3 mos II Upper trunk 9 – 12
Flu 6 months yearly III Lower trunk, thigh 12 – 16
IV Arms, leg, below knee 15 – 18
NEONATAL SEPSIS
V Hands/feet > 15
Classification
Early: birth to 7th day of life Late: 8th to 28th day of life BREAST FEEDING vs BREASTMILK JAUNDICE
Risk factors: Parameter BREASTFEEDING BREASTMILK
▪ Maternal infection during pregnancy Onset 3rd to 5th day Late; start to rise on day 4; may reach
▪ Prolongrupture of membranes (18 hrs) of life 20 – 30 mg/dl on day 14 then ↓ slowly
▪ Prematurity Normal by 4 – 12 weeks
Common organism: Patho- ↓ milk intake → Unknown; Prob. due to β – glucoronidase
Bacteria: GBS, E. coli & Listeria (early) Viruses: HSV, enteroviruses physiology ↑ enterohepatic in BM which ↑ enterohepatic circulation
circulation Normal LFT; (-) hemolysis
Signs & symptoms: Non-specific
Mngt Fluid and If breastfeeding is stopped, rapid ↓ in
Dx: CBC, CXR, blood and urine culture, lumbar tap for CSF studies caloric bilirubin level in 48 hrs, if resumed will ↑
Treatment: Empiric antibiotics [Ampicillin + 3rd gen Cephalosporin or supplement to 2 – 4 mg/dl but no precipitating
Aminoglycoside) / Supportive previous events
 MILK FORMULAS TPN for NEONATES
1:1 dilution 1:2 dilution Wt 2kg
Mead-Johnson, Nestle, Glaxo, Wyeth, Abbott, Unilab 1. TFR = 100 ml/kg/day x 2 kg 200 ml
Dumex, Milupa 2. Intralipid 20%
0-6 months (20cal/oz) Lactose free (0-6months) 1 g/kg/day x 2kg = 2g/day 10 ml
2 g = 20g
Mead-johnson: Alacta , Enfalac Mead-johnson: Enfalac lacto-free
x 100ml
Nestle: NAN1, Nestogen Nestle: AL110
Glaxo: Frisolac Milupa: HN25
3. Compute for TFR 1
Dumex: Dulac Wyeth: S26 Lacto-free TFR1 = TFR – Intralipid = 200 -10ml = 90 ml
Abbott: Similac advance 4. Vamin 7%
Milupa: Alaptamil 1 g/kg/day x 2 kg = 2g = 29 ml
Wyeth: S26, Bonna
2 g = 7g
Unilab: Mylac
x 100ml
6months onwards (20cal/oz) Lactose free (6months onwards) 5. Multivitamins Benutrex c 0.5 ml/100ml
Mead-johnson: Enfapro Mead-johnson: Enfapro lacto-free 0.5 ml = x 1 ml
Nestle: NAN2, Nestogen 2 100ml 190 ml
Glaxo: Frisomil 6. Ca gluc 10% 2ml/kg/day x 2 kg 4 ml
Dumex: Dupro 7. Dextrosity (D10) get d50w
Abbott: Gain TFR 1 x dextrosity factor (0.11) 21 ml
Wyeth: Bonnamil. Promil 190 x 0.11
Unilab: Hi-nulac 8 . D5IMB = TFR 1 – (Vamin + MTV + Ca gluc + D50W)
1 year onwards (20 cal/oz) Premature Infant (24cal/oz) 190 – (29 + 1+ 4+ 21) = 135 ml
9. IV rate = TFR 1 / 24H 190 ml/ 24H 8 ml/H
Mead-johnson: Enfagrow, Lactum Mead-johnson: Enfaprem
Nestle: NAN3, Neslac Nestle: PreNAN Order:
Glaxo: Frisorow Abbott: Similac prem Start TPN as ff:
Dumex: Dugrow Milupa: Preaptamil TFR= 100ml/kg/day
Abbott: Gainplus D5 IMB 135 ml
Wyeth: Progress, Promil D50W 21 ml
Unilab: Enervon bright
Vamin 7% 29 ml
Hypoallergenic (20cal/oz) Soy-Based (20cal/oz) Ca Gluc 4 ml
Mead-johnson: Pregestimil Mead-johnson: Prosoybee MTV 1 ml
Nestle: Alfare, NAN HA1, NAN HA2 Abbott: Isomil 190 ml to run at 8 ml/h
Wyeth: Nursoy Intralipid 20% 10 ml to run for 24H

TPN
Vamin 9% 0.67 cal/ml
Start 0.5 g/k/day inc by 0.5 g until 3 -3.5g/k/day Protein Requirement
Compute = wt x dose x prep (100/9) AGE/WT Dosage (gm/kg/day)
Intralipid 10% 20% VLBW (≤ 1500 gm) 2.25
Start 0.5 g/k/day inc by 0.5 g until 3 g/k/day 0 – 12 months 2.50
Compute = wt x dose x prep (100ml/ 10) = ml/24H 1 – 8 yrs 1.50 – 2.0
Amino acids 8 yrs and above 1.00 – 1.50
Start 0.5 g/k/day inc by 0.5 g until 3 g/k/day With the initiation of PB|N, start w/ 0.5gm/kg/day and gradually increased
Compute = wt x dose x prep (100ml/g) = ml/24H by 0.5gm/kg/day till recommended protein is reached.
TPN shortcut computation Carbohydrate Requirement
Wt 10 kg TFR= 100 ml/k/day TFI = 1000ml/day % dextrose = gram dextrose x 100
Vol infused (ml
Vamin 7% 7 = 2 g/kg x 10kg 285 ml
Should provide 50 – 60 % 0f total non-protein calories
100
Requirement ranges frm 10 to 25 gm/kg/day
CaGluc 2ml/kg 20 ml
Infusion should not exceed 12.5mg/kg/min
D5IMB 485 ml Should be decreased if urinary glucose ≥0.5% (2+) or blood sugar exceeds 7
D50W 0.11 x 1000ml 110 ml mmol/L in neoanate or 9.7 mmol/L I above 1 mo of age
1000ml x 37 cc/h
Fat Requirement
TPN (PEDIATRICS)
AGE Dosage (gm/kg/day)
Energy Requirment 0 – 12 months 2
AGE/WT Caloric Rquirement 1 – 8 yrs 4
Neonates 90-120 kcal/kg 8 yrs and above 2.5
Infants & Older Children 30 – 40 % of total calories shud b provided as fats
<10 kg 10-120 kcal/kg 2 – 4% as EFA
11-20 kg 1000kcal + 50 kcal foe each kg > 10 Start at 0.5 gm/kg/day and gradually increase by 0.5 gm/kg/day till
>20 1500 + 20 for each more than 20 recommended amt is reached
Fluid Requirement Daily Electrolyte Requirements
AGE/WT Fluid Rquirement Elect.
Neonates 1-6 mos 6m-11yrs Adolescents
(mmol/kg)
Neonates: VLBW Initiate at 40 – 60 ml/kg/day and increase by 10
(≤ 1500 gm) ml/kg/day till 120 ml/kg is reached NaCl 3–5 3–4 3–4 60 – 100
Potassium 2–4 2–3 2–3 80 – 120
AGA & LBW Initiate at 60 ml/kg/day and increase by 15 ml/ Cal gluc 0.6 – 1.0 0.25 – 1.2 0.25 – 1.2 4.7
kg/day till 120 ml/kg is reached on the 5th day of (max of 4.7) (max of 4.7)
PN Phosphate 1.0 1–2 1–2 30 – 45
Neonates under radiant heaters/on phototx an extra 30ml/kg/day of water Magnesium 0.125-0.250 0.125-0.250 0.125-0.250 4–8
Infants & Older Children Calcium gluconate contains 100 mg calcium gluconate or 9mg elemental
<10 kg 100 – 120 ml/kg calcium/ml; 1 gm of Ca gluconate contains 4.7mEq or 2.35 mmol of Ca.
11-20 kg 1000ml + 50 ml foe each kg > 10
>20 1500 + 20 for each more than 20
 Trace Elemental Requirements VITAMINS
Trace Prematures Infants & Children Adolescents Stimulants Mosegar Vita 0.25 mg/day prep 0.25 /5 ml
Elemental (ug/kg) (ug/kg) (mg) Buclizine (syrup) Appetens
Zinc 400 100 – 500 2.5 – 4 Propan
Copper 50 20 0.5 – 1.5 Appebon
Chromium 0.3 0.14 – 0.2 0.01 – 0.04 2 - 8yo 5 - 10 ml OD
Manganese 10 2 – 10 0.15 – 0.5 7 - 14yo 10 - 20 ml OD
Iodine 8 8 0.2 w/ Folic acid Molvite
Selenium 4 4 0.3 (Megaloblastic 7 - 12yo 10 - 15 ml OD
Flouride 57 57 0.9 Anemia) 3 - 6yo 5 - 10 ml OD
1 - 2yo 2.5 - 5 ml OD
▪ In the absence of available prep of trace elements; weekly blood Iberet
transfusion may be given at 20 ml/kg Ferlin (10 mcg folic acid)
▪ Iron: 2 mg/kg, with dose increased to 6 mg/kg if Fe def is documntd; Macrobee
provided by adding iron dextran to amino acid sol’n 1 - 2yo 2.5 - 5 cc OD
3 - 6yo 5 - 10 cc OD
OSTERIZED FEEDING 7 - 12yo 10 - 15 cc OD
TFR 60 - 70% = 100/feeding q 6H Pizotifen Mosegor vita syr
10 kg x 60% (drowsiness) Appetens
TFR = 600 MTV w/ Iron Propan w/ iron syr (Fe So4; elem fe 30mg)
CHON 0.5 g/kg inc q other day by 0.5 , max of 2 g/kg Appebon w/ iron syr (FeSo4; elem fe 10mg)
Dose x wt x prep (Vamin 7%, 9%) w/ Serotonin (for Mosegor vita
0.5 x 10 kg x (100 /7) = 71 g/kg migraine + dec Mosegor plain
CHON = 71 g/kg wt) Appeten
If no prep = dose x wt x 4 = 20 g/kg Jagaplex syrup
CHO 60% 1-2yo 5ml OD
(TFR – CHON) x 0.6 3-6yo 10 ml OD
(600- 71) x 0.6 = 317 7-12yo 15 ml OD
CHO = 317 Clusivol Power syrup
Fats 181 (the rest are fats , divided into 6 feedings) syr 100mg/5ml
2-6yo 5 ml OD
COMPOSITION OF ORS 7-12yo 10 ml OD
Zeeplus
ORS Na K Cl Glu
<2yo 2.5 ml OD
Glucolyte 60 20 50 100 2-6yo 5 ml OD
7-12yo 5-10 ml OD
Hydrite 90 20 80 111
Polynerv
WHO 75 20 65 75 1-2yo 2.5 ml OD
Pedialyte 30 30 20 30 3-6yo 5 ml OD
45 45 20 35 7-12yo 10 ml OD
90 90 20 80 0-6mo 0.5 ml-1 ml OD
Gatorade 41 11 9/100 7mo-1yr 1-1.5 ml OD
1-2yrs 1.5-2ml OD

Iron Deficiency Supplemental Iron = FLUID MANAGEMENT

Anemia Therapeutic Dose: 5 - 6 mkday for 3 mos Severity Less than 2 yo More than 2 yo
Maintenance Dose: 3 - 4 mkday Mild 50cc/kg 30cc/kg
Elemental iron
Moderate 100cc/kg 60cc/kg
20% of FeSo4
12% Fe gluconate Severe 150cc/kg 90cc/kg
▪ To run for 6 – 8 hrs then refer
33% Fe fumarate ▪ Usual fluid is D5 0.3 NaCl; if however more than 40 kg then D5 LR
Wt x Dose x Prep
ORAL REHYDRATION THERAPY
Ferlin drops15mg/ml PLAN A AGE Amount ORS to give/loose stool
Fe 75 mg
50 – 100 ml
Prophylactic dose
100 – 200 ml
Term 1 mg/k/Day, start 4 mos-1y
As much as wanted
PT 2 mkD, start 2 mos-1y
Therapeutic dose 3 mkD BID, QID for 4-6mos PLAN B Amount of ORS to give in 1st 24 hrs:Wt (kg) x 75ml/kg
PLAN C AGE 30ml/kg 70ml/kg
Ferlin syrup 30mg/ml Infants (<1 yo) 1 hr 5 hrs
Fe 149.3 mg Children (>1 yo) 30 mins 2.5 hrs
Supplemental dose 10-15 mg OD In fluid resuscitation: use 20cc/kg as bolus. Usually PLR
Therapeutic dose 3 mkD TID, QID for 4-6mos
MAINTENANCE WATER
Sangobion syr (Fe gluc 250mg elem Fe 30mg) HOLLIDAY – SEGAR METHOD
Incremin with Iron Weight [kg] Daily Requirement [ml/kg]
Syrup 30 mg elem Fe 3 – 10 100 ml
10 – 20 1000 + 50ml/kg for each kg >10
ASSESSMENT OF DEHYDRATION [CDD]
>20 1500 + 20ml/kg for each kg >20
PARAMETER NO SIGN SOME SIGN SEVERE Maintenance water rate
Condition Well, Alert Restless Lethargic 0 – 10 4ml/kg/hr
Irritable Unconscious 10 – 20 40 mk/hr + 2ml/kg/hr x wt
Floppy >20 60 mk/hr + 1ml/kg/hr x wt
Eyes Normal Sunken Very sunken
COMPOSITION OF IV SOLUTION
Dry
Fluid Na K Cl HCO3 Dxt
Tears Present Absent Absent
PNSS 154 - 154 - -
0.45 NaCl 77 - 77 - -
Mouth/Togue Moist Dry Very dry
D5 0.3 NaCl 51 - 51 - 5
D5 LRS 130 4 109 28 5
Thirst Drinks normally Thirsty Drinks poorly
D5 NM 40 13 40 16 5
Not thirsty Drinks eagerly Not able to
drink D5 IMB 25 20 22 23 5
Skin pinch Goes back Goes back Goes back very D5 NR 140 5 98 27 5
quickly slowly slowly Na requirement: 2 – 4 meq/k/day K requirement: 2 – 3 meq/k/day
KIR: 0.2 – 0.3 meq/k/hr ; max 40 meq
KIR = Rate x incorporation / wt
 PCAP A/PCAP B
No diagnostic usually requested
PCAP C/PCAP D
CLINICAL FEATURES of PNEUMONIA The ff shud b routinely requested
Bacterial Fever >38.5C CXR APL (patchy – viral; consolidated – bacterial)
Chest recession WBC
Wheeze not a sign of primary bacterial URTI C/S (blood, Pleural Fluid, tracheal aspirate on initial intubation)
Viral Wheeze Marked recession Blood gas/Pulse oximeter
Fever < 38.5 RR normal or increased The ff may be requested: C/S sputum
The ff shud NOT be routinely requested: ESR & CRP
Mycoplasma School children
Antibiotic Recommendation
Cough
PCAP A/PCAP B and is beyond 2 yo & having fever w/o wheeze
wheeze
PCAP C and is beyond 2 yo, having high grade fever, having alveolar
CXR in assessing CAP etiology
consolidation on CXR, having WBC >15,000
Alveolar infltrates Bacterial pneumonia PCAP D – refer to specialist
Interstitial infiltrates Viral pneumonia Antibiotic Recommendation
Both infiltrates Viral, Bacterial, or Mixed PCAP A/PCAP B w/o previous antibiotic
Amoxicillin (40 – 50 mkday) TID
PCAP C – Pen G IV (100,000 IU/k/d) QID
Microbial causes of CAP according to Age PCAP C who had no HiB immunization
Birth to 20 days Grp B Strep CMV Ampicillin IV (100mkd) QID
Gram (-) enterobacteria L. monocytogenesis PCAP D – refer to specialist
3 weeks to 3 RSV B. pertussis What should be done if px is not responding to current antibiotics?
months Parainfluenza virus S. aureus If PCAP A/PCAP B not responding w/n 72 hrs
S. pneumonia Change initial antibiotic
4 months to 4 yo RSV, Parainfluenza virus H. influenzae Start oral Macrolide
Influenza virus, Adeno, Rhinovirus M.tuberculosis Reevaluate dx
S. Pneumonia M.pneumoniae PCAP C no responding w/n 72 hrs consult w/ specialisr
5 years to M.pneumoniae S. pneumonia PCN resistant S pneumonia
15 years C. Pneumoniae M.tuberculosis Complication
Other dx
PCAP D not responding w/n 72hrs, then immediate consultto a specialist is
Clinical Practice Guidelines in the Evaluation and Management of PCAP
warranted
Predictors of CAP in patients with cough Switch from IV to Oral Antibiotic done in 2 – 3 days after initiation in px who:
(3 mos to 5 yrs) – tachypnea &/or chest retractions Respond to initial antibiotic
(5 – 12 yrs) – fever, tachypnea & crackles Is able to feed with intact GI tract
(>12 yo) – (a) fever, tachypnea & tachycardia; (b) at least 1 AbN CXR Does not have any pulmo or extra pulmo complication
WHO Age Specific classification for tachpynea Ancillary Treatments
2 to 12 mos: >50 RR O2 and Hydration
1 to 5 yrs: >40 RR Bronchodilators, CPT, steam inhalation and Nebulization
>5 yrs: >30 RR
Prevention
Vaccines
Zinc Supplementation (10mg for infants / 20mg for children > 2 yo)

THERAPEUTIC MANAGEMENT OF CAP Signs of Respiratory Failure

OPD MANAGEMENT VARIABLE A (Min Risk) B (Low Risk) C (Mod Risk) D (High Risk)
Birth to 20 days Admit
Retractions - - Subcostal/ Subcostal/
3 weeks to 3 months Afebrile: Oral Erythromycin (30-40mkd) Intercostal Intercostal
Oral Azithromycin (10 mg/kg/day) day 1 Head - - + +
5 mkday for day 2 to 5 bobbing
Admit: febrile or toxic Cyanosis - - + +
4 months to 4 yo Oral Amoxicillin (90mkd/3doses) Grunting - - - +
Alternative: Amox-Clav, AZM, Cefaclor Apnea - - - +
Clarithromycin, Erythromycin Sensorium None Awake Irritable Lethargy /
5 years to 15 years Oral Erythromycin (30-40mkd) Stupor
Oral AZM 10mkday day 1, 5mkday day 2-5 Coma/
Clarithromycin 15mkday/2 doses Comp:
Pneumococcal infxn: Amoxicillin alone Effusion
IN-PATIENT MANAGEMENT None None Present Present
Pneumo
Birth to 20 days Ampicillin + Gentamicin w or w/o Cefotaxime -thorax
3 weeks to 3 months Afebrile: IV Erythromycin (30-40mkd)
Febrile: add Cefotaxime 200mkd Action Plan OPD OPD Admit to Admit to
Cefuroxime 150 mkd f/u at end f/u after 3 regulat ward CCU; Refer
4 months to 4 yo If w/ pneumococcal infection: of tx days to specialist
IV Ampicillin (200mkd) Cefotaxime 200mkd
Cefuroxime 150 mkd BRONCHIOLITIS
5 years to 15 years Cefuroxime 150 mkd + Erythromycin 40mkd Acute inflammation of the small airways in children <2 yrs
IV or orally for 10-14 days Most commonly caused by RSV
If pneumococcal is confirmed: Ampicillin 200mkd Related to exposure to cigarette smoke
Risk factors for severe dse:
PCAP <6 mos Heart or lung disease
VARIABLE A (Min Risk) B (Low Risk) C (Mod Risk) D (High Risk) Prematurity Immunodeficiency
Signs/Symptoms
Comorbid
None Present Present Present low grade fever, rhinorrhea, cough, wheezing
Illness
hyperresonance to percussion
Compliant
Yes Yes No No CXR: hyperinflation, interstitial infiltrates
caregiver
Treatment
Ability to
Possible Possible Not Not Mild [at home]:
follow up
Increased fluids, trial of inhaled bronchodilators, aerosolized epinephrine
DHN None Mild Moderate Severe Severe:
Feeding Able Able Unable Unable Admit to hospital if: Marked respratory distress; Poor feeding; O2 sat <92%;
Age >11 mos >11 mos <11 mos <11 mos hx of prematurity < 34 wks; underlying cardiopulmonary dse;
RR unreliable caregivers
2 – 12 m >50/min >50/min >60/min >70/min Manage with ventilatory and O2 support, hydration, inhaled
1 – 5 yo >40/min >40/min >50/min >50/min bronchodilators and ribavirin
>5 yo >30/min >30/min >35/min >35/min
 SEVERITY OF ASTHMA EXACERBATION
RESPIRATORY
VIRAL CROUP vs EPIGLOTTITIS MILD MODERATE SEVERE ARREST
VIRAL CROUP EPIGLOTTITIS IMMINENT
Age group 3 mos to 3 yrs 3 – 7 yrs Breathless Walking Talking At rest
Stridor 88% 8% Infant –softer Infant
Pathogen Parainfluenza virus H. influenzae type B shorter cry stops
Onset Prodrome (1 – 7 days) Rapid (4 – 12 hrs) Difficult feeding
Fever Severity Low grade High grade feeding
Associated symptom Barking cough, Muffled voice, Can lie
hoarseness Droolong Prefers sitting Hunched
Respond to racemic Stridor improves None Talks in Sentences Phrases Words
epinephrine Alertness May be Usually Usually Drowsy or
CXR “steeple sign” “thumbprint sign” agitated agitated agitated confused

BRONCHIAL ASTHMA RR Inc Inc >30/min

Please admit under the service of Dr. _____________
Normal RR
TPR q4H and record
<2 mo <60/min
NPO if dyspneic 2-12 mo <50/min
Labs:
1-2 y <40/min
CBC
2-8 y <30/min
U/A (MSCC)
Accessory Usually Usually Usually Paradoxical
ABG* CXR APL*
ms not Thoracoabd
IVF:
movt
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) Wheeze Moderate Loud Usually Absence of
D5LR 1L at 30cc/kg in 8hif >40 kg loud wheeze
Medications: Pulse Rat <100 100-200 >120 Bradycardia
Paracetamol prn q4h for T > 37.8°C (10 – 15 mkdose) Normal PR
USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses 2-12 mo <160/min
Incorporate Budesonide 10 mkd LD (max 200mg IV); then 1-2 y <120/min
5mkd q6h IV (max of 100 mg IV) 2-8 y <110/min
Ranitidine IVTT at 1mkdose (if on NPO) Pulsus Absent Maybe Present Absence
SO: paradoxus present 20-40 suggests resp
MIO q shift and record <10mmHg 10-25mmHg mmHg ms fatigue
Monitor VS q2h and record
Refer for persistence of tachypnea, alar flaring and retractions PEF >80% 60-80% <60%
O2 at 2 lpm via NC, refer for desaturations <95%
Will inform AP
PaO2 Normal >60 mmHg <60 mmHg
Pls inform Dr _____ of this admission
Thank you. PaCO2 <45 mmHg <45 mmHg >45 mmHg
O2 Sat >95% 91-95% <90%

SEBORRHEIC
ATOPIC DERMATITIS CONTACT DERMATITIS
DERMATITS
MANAGEMENT APPROACH BASED ON CONTROL ▪ Hereditary, AR ▪ Irritant – strong chem. ▪ excessive
Step 1 Step 2 Step 3 Step 4 Step 5 ▪ hx of Asthma ▪ e.g. diaper rash sebum
▪ thickened, shiny, red ▪ remove reactant accumulation
PRN B2 Asthma education and Environmental control on scalp, face,
As needed rapid acting B2 agonist ▪ exacerbated by dry ▪ Allergic
Agonist midchest,
skin, contact sty, & ▪ e.g. cosmetic, perineum
Select 1 Select 1 Add 1 or Add 1 or anxiety perfume ▪ greasy scalp
more more ▪ tx:hydrocortisone or ▪ tx: high/mod (cradle cap)
C Low dose Low dose ICS + Med to Hi Oral fluocinolone potency steroid
O ICS LABA dose steroids ▪ physiologic for
▪ moisturizer
N ICS + LABA 1st 6mos
T ▪ cloxa/cefalexin if with ▪ tx: ↓ potency
Leukotriene Medium or Hi Leukotriene
R infxn steroid
modifier dose ICS Modifier Anti-IgE
O Low dose Sustained treatment
L HYPERSENSITIVITY REACTION
ICS + Release
L Leukotriene theophylline Please admit under the service of Dr. __________________
E Modifier TPR q4H and record
R Low dose Hypoallergenic diet
ICS + Labs:
Salbutamol CBC
Release U/A (MSCC)
theophylline IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
LEVELS OF ASTHMA CONTROL [GINA GUIDELINES] D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
CONTROLLED PARTLY UNCONTROLLED Medications:
None [2x or More than 2x *Epinephrine (1:1000) 0.1mg/kg/dose IM anterolateral thigh
Daytime symptom
less/week] a week (max of 0.3 mg)
Limitation of *Salbutamol neb x 3 doses q 20 mins
None Any Three or more Diphenhydramine 10 mkdose LD (max of 200mg IV); thenmg IV)
activities
features of 5mkdose q6h IV (max of 100
Nocturnal sx/ Ranitidine IVTT at 1mkdose q 12h
None Any partly controled
awakening SO:
asthma present
Need for reliever/ More than 2x in any week MIO q shift and record
None
recue tx a week Monitor VS q2h and record to include BP
Lung function Continue TSB for fever
Normal 80% predicted O2 at 2 lpm via NC, or 6 lpm via facemask
(PEF OR FEV1)
One or more/ One in any Attach to pulse oximeter, refer for desaturations <95%
Exacerbation None Will inform AP
yr week
Pls inform Dr _____ of this admission
Thank you.
 ANAPHYLAXIS SEIZURE Simple Complex
A syndrome involving a rapid & generalized immunologically mediated rxn Type GTC Focal then gen post ictal
After exposure to foreign allergens in previously sensitized individuals
Duration < 15 min > 15 min or may go into
A true emergency when cardio and respi system are involved
status
ED Management
Recurrence None Recurrent (w/in 24H)
▪ O2
CNS exam Normal Abnormal
▪ Aqueous Epinephrine 1:1000 IM (0.01ml/kg with 0.5ml max)
Sequelae None Neurodev abnormalities
▪ Prepare intubation if w/ stridor & if initial therapy of epi is not effective
▪ Continuous monitor ECG and O2 sat & establish IV access FEBRILE SEIZURE
▪ Antihistamine to prevent progression Please admit under the service of Dr. ______________
▪ H1 & H2 blocker TPR q4H and record
DAT once fully awake
▪ Diphenhydramine (1mg/kg) IM
Labs:
▪Steroids may modify late phase or recurrent reaction (Hydrocortisone CBC
5mg/kg/dose) U/A (MSCC)
▪ Epinephrine 1:10,000 IV (0.1ml/kg; 10ml max) IVF:
▪ Epinephrine drip (0.01ml/kg/min) D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
Indication for Admission D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
▪ Persistent bronchospasm
Medications:
▪ Hypotension requiring vasopressors Paracetamol prn q4h for T > 37.8°C
▪ Significant hypoxia SO:
▪ Patient resides some distance from a hospital facility MIO q shift and record
Monitor VS q2h and record
SEIZURE Monitor neurovital signs q4h and record
BENIGN FEBRILE SEIZURE CRITERIA Continue TSB for fever
▪ 6 mos – 6 yrs Seizure precaution at bedside as ff:
Suction machine at bedside
▪ < 15 mins
O2 with functional gauge; if with active sz give O2 at 2lpm via NC
▪ Febrile Diazepam IVTT (0.3 mkd max of 5 mg IV) prn for seizure
▪ Family history of febrile seizure Will inform AP
▪ GTC Pls inform Dr _____ of this admission
Thank you.
▪ Not > 1 episode in 1 febrile episode; EEG done after 2 wks of seizure
episode BELLS PALSY
▪ 3% of general population develop epilepsy ▪ Acute unilateral facial nerve palsy that is not associated with other
▪ 1 – 2 % of BFS develop epilepsy cranial neuropathies or brainstem dysfunction
▪ 25% recurrence of seizure ▪ Usually develops abruptly about 2 wks after SVI [EBV, HSV, mumps]
Seizure – paroxysmal, time limited change in motor activity and/or behavior ▪ Upper and lower portions of the face are paretic; corner of the mouth
that results from abnormal electrical activity in the brain drops; unable to close the eye on the involved side
Epilepsy – present when 2 or more unprovoked seizure/s occur at an interval ▪ Protection of cornea with methylcellulose eye drops or an ocular
greater than 24 hrs apart lubricant; excellent prognosis

SHOCK CEREBRAL PALSY

CO = HR x SV / CO is primarily maintained by changes in HR Non-progressive disorder of posture & movement often associated with
HYPOVOLEMIC Pump empty MC in infant &children epilepsy & abnormalities of speech, vision & intellect resulting from
Truma, hemorrhage, Normal BV of children defect or lesion of the developing brain
DHN (diarrhea/ 80ml/kg Etiology: infections, toxins, metabolic, ischemia
vomiting) Classifications
Metabolic dse (DM) Physiologic Topogrphic
Excessive sweating [major motor abnormality] [involved extremities]
CARDIOGENIC Weak/sick pump Compromise CO
Spastic Monoplegia [1 side/portion]
CHF, cardiomegaly,
Athetoid –worm like Paraplegia
drug intoxication,
Rigid Hemiplegia
hypothermia,
Ataxic Triplegia [3 limbs]
after cardiac
Tremor Quadriplegia [all]
surgery
Atonic Diplegia [LE/UE]
DISTRIBUTIVE Sepsis Redistribution of fluid w/n Mixed Double hemiplegia
Anaphylaxis vascular space unclassified
Barbiturate intox Clinical Manifestations
CNS injury (SCI)
Spastic Arms > legs
SIGNS OF SHOCK
hemiplegia Dificulty in hand manipulation obviously by 1 yo
EARLY LATE Delayed walking or walk on tiptoes
Narrowed pulse pressure Decrease systolic pressure Spasticity apparent esp. in ankles
Orthostatic changes Decrease diastolic pressure Seizure & cognitivr impairment
Delayed capillary filling Cold, pale skin Spastic diplegia Bilateral spasticity of the legs
Tachycardia Altered mental state Commando crawl
Hyperventilation Diaphoresis Increased DTRs & (+) Babinski sign
Decrease urine output Normal intellect
ED Position Spastic Most severe form, due to marked motor impairment
MNGT Oxygen & Assisted ventilation quadriplegia of all extremities & high association with MR &
Intravenous access & Fluid (isotonic crystalloid) seizures
Reassess (look for improvement in VS, skin signs, mental status; Swallowing difficulties
insert foley cath & monitor UO) Management
Inotropes – help stabilize BP
Baseline EEG & cranial CT scan
Epinephrine - (0.1 – 1 ug/kg/min) - Infusion of choice for
Hearing & visual function tests
Hypotensive pxs
Multidisciplinary approach in the assessment & treatment
Dobutamine - (5 – 20 ug/kg/min)
For tight heel cord: tenotomy of the Achilles tendon
Cardiogenic shock but not severely hypotensive
Dopamine – [(5 – 20 ug/kg/min αconstrictor effect) [(10 – 15 CSF PATHWAY
ug/kg/min]
Distributive shock after successful fluid resuscitation Choroid plexus (lateral ventricle) → Foramen of Monroe → 3 rd ventricle
Cardiogenic shock → Aqueduct of sylvius → 4th ventricle →Foramina of Luschka (2 laterals)
Diuretic – pxs may get worse after fluid challenge → & Magendie (median) → SAS → Absorbed in the arachnoid villi,
Adenosine / synchronize cardioversion – SVT then in the Venous System
Defibrillation – Venticular fibrillation
 CRANIUM
Caput succedaneum
▪ Diffuse edematous swelling of soft tissues of scalp
HYDROCEPHALUS
▪ Extend across midline
Result from impaired circulation & absorption of CSF or from inceased
production ▪ Edema disappears w/in 1st few days of life
Obstructive or Noncommunicating ▪ Molding and overriding of parietal bones-frequent
▪ Due to obstruction w/n ventricular system ▪ Disappear during 1st wks of life
▪ Abnormality of the aqueduct or a lesion in the 4th venticle ▪No specific tx
(aqueductal stenosis) Cephalhematoma
Non-obstructive or Communicating ▪ Subperiosteal hemorrhage; limited to1 cranial bone
▪ Obliteration of the subarachnoid cisterns or malfunction of the ▪ Occur 1-2 % cases
arachnoid villi
▪ No discoloration of overlying scalp
▪ Follows SAH that obliterates arachnoid villi; leukemic infiltrates
▪ Swelling not visible for several hours after birth (blding slow process)
Clinical Manifestations
▪ Firm tense mass with palpable rim localized over 1 area of skull
▪ Infant: accelerated rate of enlargement of the head; wide anterior
▪ Resorbed w/in 2wk- 3mos and calcify by end of 2nd wk
fontanel & bulging [Normal fontanel size: 2 x 2 cm]
▪ Eyes may deviate downward: due to impingement of the dilated ▪ Few remain for years
suprapineal recess on the tectum [setting – sun sign] ▪ 10-25% cases underlying linear skull fracture
▪ Long – tract sign: [brisk DTR, spasticity, clonus, Babinski sign] ▪ No tx but phototherapy in hyperbilirubinemia
▪ Percussion of skull produce a “crackedpot” or Macewen sign Pre Lumbar Tap
[separation of sutures] NPO
▪ Foreshortened occiput [Chiari malformation] RBS by gluco prior to lumbar tap
▪ Prominent occiput [Dandy-Walker malformation] Prepare lumbar tap set
Treatment ▪ 2% Lidocaine # 1 ▪ sterile bottles # 3
▪ Depends on the cause ▪ G 23 spinal needle ▪ sterile gloves # 2
▪ Extracranial shunt ▪ Mannitol 250 cc 1 bot - do not open ▪ Sterile gauze # 1
▪ Acetazolamide & Furosemide [provide temporary relief by reducing ▪ Solvent ▪ Sterile gauze w/ Betadine #1
the rate of CSF production] ▪ Diazepam 1 amp ▪ Sterile towel w/ hole #1
▪ 3 cc syringe #2 ▪ Sterile clamp #1
MOTOR DEEP TENDON REFLEXES
▪ 2 manometers ▪ 3-way stopcock #1
Full resistance with gravity 5/5
Very brisk +4
Some resistance with gravity 4/5 Post Lumbar Tap
Brisker than average +3
Movement with gravity 3/5 NPO x 4H; Flat on bed
Normal +2
Movement w/o gravity 2/5 Monitor NVS to include BP q 30mins x 4H, then qH
Diminished +1
Flicker 1/5 CSF exams
No response 0
No movement 0/5 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 CARBAMAZEPINE
▪ Severe CP compromise Tegretol Tab 200mg, 100mg chew
▪ Skin infection at site of puncture XR 100mg, 200mg, 400mg
Susp 100mg/ 5ml (QID)
ANTICONVULSANTS Initial Increment Maintenance
DIAZEPAM 0.2 – 0.3 mkdose < 6 yo 10 - 20 mkD BID /TID q wkly til 35 mkD
Drip: 1amp in 50cc D5 W 6 - 12 yo 10 mkD BID 100 mg/ 24H at 20 - 30 mkD BID/
10mg/amp 1 wk interval QID
MIDAZOLAM 0.15 mkdose prn 2 – 3 mins interval IV (1, 5mg/ml) > 12 y 200 mg BID 200 mg/ 24H at 800 - 1200
6 mos - 5 yo 0.05 - 0.10 max of 0.6 mg/kg 1 wk interval mg/24H
6 yo - 12 yo 0.25 - 0.05 max of 0.4 mg/kg BID/ QID
>12 yo 0.50 - 2 mg/dose over 2 mins OXCARBAMAZEPINE (8 - 10 mkd BID)
PHENOBARBITAL LD: 15 – 20 mkd MD: 5 mkdose q 12h Initial: 8 -10 mkD PO BID then
(max load 20 mkday IV Increment: increase over 2 week pd to
Maintenance doses:
Tabs: 15, 30, 60, 90, 100 mg 20 -29 kg: 900 mg/24H PO BID
Caps: 16 mg 29.1 -39 kg: 1200 mg/24H PO BID
ELIXIR 20mg/5ml >39 kg: 1800 mg/24H PO BID
Inj: 30, 60, 65, 130 mg/ml Trileptal Tab 150 mg 300mg 600 mg
Susp 300mg/5ml
MD: PO/ IV
VALPROIC ACID PO:
Neonate: 3 - 5 mkD QID/ BID
Initial : 10 - 15 mkD OD - TID
Infant/child: 5 - 6 mkD
Increment: 10 mkD at wkly interval BID
1 - 5 yo: 6 - 8 mkD
Maintenance: 30 - 60 mkD BID/TID
6 - 12 yo: 4 - 6 mkD
IV: same dose as PO q 6H
> 12 yo: 1 - 3 mkD
Rectal : (syrup mix with water 1:1)
Hyperbil < 12 yo: 3 - 8 mkD BID/TID
LD: 20 mkd
PHENYTOIN LD: 15 – 20 mg/kg/IV MD: 10 -15mkd TID
MD: Depakene Tab 250 mg
Neonate: 5 mkD PO/ IV BID Syr 250mg/5ml
Infant/child: 5 7mkD BID/ TID
Depacon IV 100mg/ml
6mos – 3y: 8 – 10 mkD
4 – 6y: 7.5 – 9 mkD TOPIRAMATE 2 - 16 yo
7 – 9y: 7 – 8 mkD Initial: 1 - 3 mkd PO q HS x 7 days then Increment:
10 – 16 y: 6 – 7 mkD Increase by 1 - 3 mkday for 1 - 2 wks then
Maintenance: 5 -9 mkD BID
Dilantin Tab: 50mg 100mg TID
Topamax Caps: 15 mg, 25 mg
Extended release caps 30, 100, 200, 300 mg OD, BID
Tabs: 25, 50, 100, 200mg
Inj: 50 mg/ml
 Glasgow Coma Scale GCS for Infants VIRAL INFECTIONS
Activity Activity MEASLES (Rubeola) [Paramyxoviridae]
Eye Opening MOT Droplet spray
Spontaneous 4 Spontaneous 4 IP 10 – 12 days
To speech 3 To speech 3 Prd of comm 4 days before & 4 days after onset of rash
To pain 2 To pain 2 Enanthem Koplik spots (opposite lower molars)
None 1 None 1
Prodrome High grade fever, conjunctivitis, catharr (3 – 5 days)
Verbal
Rash Appear during height of fever
Oriented 5 Coos, babbles 5
Cephalocaudal[1st along hairline, face, chest]
Confused 4 Irritable 4
[+] brawny desquamation – disappear w/n 7 – 10 days
Inappropriate words 3 Cries to pain 3
Inappropriate sounds 2 Moans to pain 2 Complication Otitis media Diarrhea
None 1 None 1 Pneumonia Exacerbation of M tb infection
Motor Encephalitis
Follows command 6 N spontaneous movt 6 Tx Vit A SD 100,000 IU orally for 6 mos – 1 yo / 200,000 IU >1 yo
Localizes pain 5 Withdraws to touch 5 Post exposure Ig w/n 6 days of exposure
Withdraws to pain 4 Withdraws to pain 4 prophylaxis (0.25ml/kg max 15 ml) IM
Abnormal flexion 3 Abnormal flexion 3 Vaccine Susceptible children >1 yo w/n 72 hrs
Abnormal extension 2 Abnormal extension 2 SSPE Chronic condition due to persistent measles infxn
None 1 None 1 Rare but found in 6 mo to >30 yrs of age
Subtle change in behavior & deterioration o schoolwork
CSF ANALYSIS followed by bizarre behavior
Diff Elevated titers of Ab to measles virus(IgG, IgM)
Color RBC WBC Sugar CHON Inosiplex (100mg/kg/day) may prolong survival
ct
GERMAN OR 3 DAY MEASLES [RUBELLA] [Togaviridae]
Infant (Term) Xantho 0- 0 -32 L 70 to 60 -
100 100 80% 150 MOT Oral Droplet; transplacentally to fetus
% IP 14 – 21 days
Infant (Preterm) Clear 0- 0 -15 L 70 to 60 - Prd of comm 7 days before &7 days after onset of rash
100 100 80% 200 Enanthem Forchheimer spots [soft palate] just b4 onset of rash
% Rash Cephalocaudal
Older child Clear 0 0 -10 L > 50% 10 - 20 Charac. sign Retroauricular, posterior cervical & postoccipital LAD [24
100 hrs before rash & remains for 1 wk]
% Tx Vit A SD 100,000 IU orally for 6 mo –1 y / 200,000 IU >1 yo
Viral Meningitis Clear 0 0 -20 L 40 to 40 - 60 Post exposure Immunoglobulin [not routine]
100 60% prophylaxis Considered if termination of preg is not an option
% 0.55ml/kg) IM
TB/Fungal Clear 0 20 - L> < 40% > 100 Vaccine w/n 72 hrs of exposure
500 N g% Congenital Greatest during 1st trimester; IUGR
Bacterial Purulent 0 > N> < 50% > 100 Rubella Congenital cataract, microcephaly, PDA, “blueberry
Meningitis 1000 L g% muffin” skin lesions
Partially tx BM Clear 0 100 L> > 50% Dec Congenital or profound SNHL | Motor/mental retardation
N
MUMPS [Paramyxoviridae]
ROSEOLA [HSV 6] Exanthem subitum MOT Direct contact, airborne droplets, fomites
Age of onset < 3 yo with peak at 6 – 15 months contaminated by saliva
High grade fever for 3 – 5 days but behave IP 16 – 18 days
normally Period of 1 – 2 days before onset of parotid swelling until 5 days
Rash Appears 12 – 24 hrs of fever resolution fades in 1 – communicability after the onset of swelling
3 days Prodrome Fever, neck muscle pain, headache, malaise
HERPANGINA [Coxsackie A] Parotid gland Peak in 1 – 3 days
Sudden onset of fever with vomiting swelling 1st in the space between posterior border of mandible
Small vesicles & ulcers w/ red ring found in anterior tonsillar pillars, may also & mastoid then extends being limited above zygoma
seen on the soft palate, uvula & pharyngeal wall Complications Meningoenephalitis - most frequent, 10 days; M>F
VARICELLA [HSV] Orchitis & Epididymitis
MOT Direct contact Oophoritis
Dacryoadenitis or optic neuritis
IP 14 days
Prd of comm 1 – 2 days before the onset of the rash until 5 – 6
Hx of
days after onset & all the lesions have crusted Clean minor Wound All other Wounds
Absorbed TT
Rash Start from the trunk then spread to othe parts of the
Td TIG Td TIG
body
All stages present; pruritic Unknown or Yes No Yes Yes
Macule/papule → vesicle →crust <3
Complication Secondary bacterial infection Reye syndrome > No No No No
Encephalitis or meningitis GN
Pneumonia < 7 yo Dtap is recommended
> 7 yo Td is recommended
Congenital 6 -12 wks AOG: maximal interruption w/ limb devt
If ony 3 doses of TT received, a 4th dose should be given
Varicella with cicatrix(ski lesion w/ zigzag scarring)
Give TT (clean minor wounds) if > 10 y since last dose
16 – 20 wks: eye and brain involvement
All other wounds (punctured wds, avulsions, burn)
Tx Acyclovir 15 – 30 mg/kg/day IV or 200 – 400 mg tab Give TT (all clean wounds) if > 5 yrs since last dose
q 4hrs minus midnight dose x 5 days: ↑ risk of severity
Post exposure VZIg 1 dose up to 96 hrs after exposure RABIES VACCINE
prophylaxis Dose: 125 U/10 kg (max 625 U) IM VERORAB 0.5 cc/amp; 1 amp IM
NB whos mother develop varicella 5 days before to 2 Day: 0 3 7 14 and 28
days after delivery shud recv 1 vial BERIRAB RD: 20 iu/kg
Vaccine Susceptible children >1 yo w/n 72 hrs 300 iu/vial 1 vial = 2ml
ERYTHEMA INFECTIOSUM [Parvovirus B 19] FIFTH DISEASE ½ at wound site
MOT Droplet spread & blood & blood products ½ deep IM
IP 16 – 17 Days average Reqd amt in IU: wt x RD (20IU)
Amount in ml = wt x RD (20) x 2
Prodrome Low grade fever, headache, URTI
300
Rash Erythematous facial flushing “slapped cheek” and
Ig (Human) 20 iu/kg
spreads rapidly to the trunk & proximal extremities as
Bayrab 300 iu/2ml | Berirab 300 iu/2ml
a diffuse macular erythema; palms & soles spared
40 iu/kg
Resolves w/o desquamation but tend to wax and
Equine Favirab 200 – 400 iu/5ml
wane in 1 – 3 wks
1000 – 2000 iu/5ml
 VACCINES
BCG Live attenuated M bovis DENGUE HEMORRHAGIC FEVER
DPT Diptheria and TT – inactivated B pertussis Serotype 1, 2, 3, & 4
OPV Sabin trivalent live attenuated virus Aedes egypti
IPV Salk inactivated virus IP: 4 – 6 days (min 3 days; max 10 days)
MMR, Measles Live attenuated virus DHF SEVERITY GRADING
Varicella
GRADE MANIFESTATION
Hep B Recombinant DNA, plasma derived
I Fever, non-specific constitutional symptoms such as
Hep A Inactivated virus
anorexia, vomiting and abdominal pain (+) Torniquet
Hib Capsular polysacc linked to carrier CHON
Typ Live typhoid vaccine – 3 doses x 2 days test
IMSC – Vi antigen typ vaccine II Grade I + spontaneous bleeding; mucocutaneous, GI
Pneumococcal Capsular polysaccharide 0.5 ml III Grade II w/ more severe bleeding +
SC /IM – 23 valent purified cap Evidence of circulatory failure: violaceous, cold &
Polysacc Antigen of 23 serotyp clammy skin, restless, weak to imperceptible pulses,
Influenza Split or whole virus IM narrowing of pulse pressure to < 20mmHg to
actualHPON
DENGUE FEVER IV Grade III but shock is usually refractory or irreversible
and assoc w/ massive bleeding
Please admit under the service of Dr. ________________
TPR q4H and record CRITERIA FOR CLINICAL DX (WHO)
DAT (No dark colored foods) DHF DSS
Labs:
Fever, acute onset, high, lasting 2 – 7 Above criteria
CBC, Plt (optional APTT and PT)
days Plus
Blood typing
Hemorrhagic manif: Hypotension or narrow pulse
U/A (MSCC)
(+) Torniquet test pressure [SBP – DBP]
IVF:
Minor & Major bleeding <20mmHg
D5 0.3 NaCl 1P/1L (<40 kg) at 3 – 5 cc/kg
phenomenon
D5LR 1L (>40 kg) at 3 – 5 cc/kg
Thrombocytopenia <100,000/mm3
Medications:
Paracetamol prn q4h for T > 37.8°C Dengue Drips
Omeprazole 1mkdose max 40 mg IVTT OD
Furosemide drip
SO:
MIO q shift and record Dose: 0.04 - 0.5
Monitor VS q2h and record, to include BP 80 mg + 32 cc
Continue TSB for fever Wt x dose = rate (cc/h)
Refer for Hypotension, narrow pulse pressure (< 20mmHg) 2
Refer for signs of active bleeding like epistaxis, gum bleeding, Furo drip = 0.1 - 0.5mg/k/hr
melena, coffee ground vomitus Prep: 20mg/2ml (2mg/ml)
Will inform AP Rate: (wt x dose)/2 = cc/hr ex. 14.5kg x 0.45 = 3.2cc/hr
Pls inform Dr _____ of this admission To order: 8ml Furo + 32ml D5W +40 cc to run at 3.2cc/hr
Thank you.

RHEUMATIC HEART DISEASE

JONES CRITERIA
Precedex drip Major Manifestations
Dose: 0.2 - 0.7 Arthritis (70%)
1ml + 99cc D5W to run at cc/h Carditis (50%)
Wt x dose = rate (cc/h) Tachycardia Pericarditis
Noradrenaline (Levophed) 1mg/ml dose :(0.5 – 1 ml/kg) Heart murmur of valvulitis Cardiomegaly
Signs of CHF [gallop rhythm, distant heart sounds, cardiomegaly]
Wt x dose ( each ml contains 4 mcg Noradrenaline)
Erythema marginatum (10%)
4 mcg ( for acute hypotension)
Subcutaneous nodules (2 – 10%)
2ml + 500cc D5W x 2cc/H (0.5 cc/H)
Sydenham’s chorea (15%)
Dopamine ( 5 -20 mcg/kg/min) 200 mg/250ml Single strength
400 mg/250ml DS (div by 2) Minor manifestations
Wt x dose x 0.075 Arthralgia ↑ Acute Phase Reactants (CRP & ESR)
Dobutamine 250 mg/5ml SS Fever at least 38.8°C Prolonged PR interval on the ECG
500 mg/250ml DS(div by 2) Diagnosis: Highly probable : 2 major OR 1 major and 2 minor manifestation
Wt x dose x 0.06
Terbutaline Bricanyl SC ACUTE GASTROENTERITIS
Inj: 1 mg/ml
< 12y – 0.005 – 0.01 mkd x 3 doses q 15 Please admit under the service of Dr. ________________
-20 min then q2-6H TPR q4H and record
> 12y – 0.25 mkd DAT once fully awake; NPO x 2hrs if with vomiting
Terbutaline drip LD: 2 – 10 mcg/kg then Labs:
0.1 – 0.4 mcg/kg/min CBC
Ketamine (Ketalar) 10, 50, 100 mg/ml U/A (MSCC)
PO: 5mg/kg x 1 F/A (Concentration Method)
IV 0.25 - 0.5 mg/kg IVF:
IM 1.5 - 2 mg/kg x 1 D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
Morphine IV D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
0.1 – 0.2 mkd q2-4H prn
D5LR 1L at 30cc/kg in 8hif >40 kg
Naproxen 250, 375, 500mg tab Medications:
125mg/5ml Paracetamol prn q4h for T > 37.8°C
> 2yo – 5-7 mkd TID, BID PO Zinc (E Zinc)
Drops 10mg/ml 1ml OD (<6 mos) | 1ml BID (6 mos – 2 yo)
Syrup 20 mg/5ml (>2 yo) 5ml OD
INFECTIVE ENDOCARDITIS
Ranitidine IVTT at 1mkdose (if with abdominal pain)
DUKE CRITERIA SO:
Major Manifestation MIO q shift and record
Minor manifestation Monitor VS q2h and record
Continue TSB for fever
Diagnosis Chart character, frequency and amount of GI losses and replace w/
Highly probable: 2 major OR 1 major and 2 minor manifestation PLR 1L/1P vol/vol
Will inform AP
Pls inform Dr _____ of this admission
Thank you.
 BPN
JUVENILE RHEUMATOID ARTHRITIS [JRA]
Please admit under the service of Dr. ______________
Criteria Age of onset <16 yo
TPR q4H and record
Arthritis (swelling or effusion) or presence of 2 or more of:
NPO if dyspneic
Labs:
▪ limitation of range of motion, tenderness or pain on
CBC motion
U/A (MSCC) ▪ increased heat in one or more joints.
ABG* CXR APL* Duration: 6 wks or longer
IVF: Onset type defined in the 1st 6mos
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo) OR Polyarthritis: (5 or more inflamed joints)
D5 IMB/D5 NM at MR if with NO losses Oligoarthritis (<5)
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo) Systemic arthritis w/ characteristic fever
D5LR 1L at 30cc/kg in 8hif >40 kg Clinical Morning stiffness, ease of fatigue esp. after school in the
Medications: Manifestations early afternoon, joint pain later in the day, joint
Paracetamol prn q4h for T > 37.8°C (10 – 15 mkdose) swelling
USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses Pauci: LE, assoc w/ chronic uvietis
then refer Poly: both large & small joints more severe if extensors of
NaCl (Muconase) nasal spray, 2 sprays per nostrils, then suction elbow and Achilles tendon are involved
using bulb QID Systemic: quotidian fever w/ daily temp spikes of 39°C
Ranitidine IVTT at 1mkdose (if on NPO) for 2 wks; faint red macular rash over the trunk &
SO: proximal extremities
MIO q shift and record Mngt NSAIDS then Methotrexate
Monitor VS q2h and record Seroid for overwhelming systemic illness
Continue TSB for fever
Refer for persistence of tachypnea, alar flaring and retractions SYSTEMIC LUPUS ERYTHEMATOSUS [SLE]
O2 at 2 lpm via NC, or 6 lpm via facemask Criteria Malar rash Renal disorder
Attach to pulse oximeter, refer for desaturations <95% Discoid rash Neurologic disorder
Will inform AP Photosensitivity Hematologic disorder
Pls inform Dr _____ of this admission Oral ulcers (painless) Immunologic disorder
Thank you. Nonerosive arthritis (2 or more joints) ANA abormal titer
Serositis (pleuritis, serous pericarditis, Libman sacks endocarditis)
HENOCH – SCHONLEIN PURPURA [HSP]
Dx Presence of 4 of 11 criteria [ANA not required dx]
Most common cause of nonthrombocytopenic purpura in children (+) ANA – screening
Typically follows URTI Anti ds DNA – more specific; reflects the degree of disease
2 – 8 years old activity
Hallmark Rash – palpable petechia or purpura, evolve from red to Decrease C3, C4 in active dse
brown; last from 3 – 10 days [LE and buttocks] Anti Sm Ab (most specific)
Arthritis of knees and ankles Mngt NSAIDS use w/ caution
Intermittent abdominal pain due to edema & damage to the Prednisone (1 – 2 mkday)
vasculatue of the GIT Severely ill: pulse IV steroid (30mkdose) max 1 gm over 60 mins
Mngt Symptomatic OD x 3 days
Steroid for severe abdominal pain Severe dse: Pulse IV Cyclophosphamide to maintain renal fxn &
prevent progression

ACUTE GLOMERULONEPHRITIS Computation for OFI (AGN & limiting OFI)

Inflamm. process affecting the kidney, lesions predominate in glomerulus BSA x 400 + UO – IVF (half if w/ Furo) = OFI (then divide to 3 shifts)
Etiology: Infections: 20cc x wt x UO – IVF
Bacterial: Grp A β hemolytic strep, S viridans, S pneumo, S. aureus, S
BILIRUBIN METABOLISM
epidermidis, S typhi , T pallidum, Leptospira
Viral: HBV, Mumps, Measles, CMV, Enterovirus
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 ▪ Nausea and Vomiting
▪ HPN 82% ▪ Dull lumbar pain
Typical course
Latent: few days – 3wks Diuretic: 7 – 10 days
Oliguric: 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 Treatment of Hyperbilirubinemia
Serology – culture of GABS, ASO, C3 ( dec in acute phase, rises during Phototherapy
convalescensce) Exchange Complications: met. acidosis, electrolyte abn,
Renal fxn – bun crea- normal, hyponat transfusion hypoglycemia, hypocalcemia, thrombocytopenia, vol.
Hematology – dilutional anemia, transient hypoalbuminemia overload, arrhythmias, NEC, infection, GVHD, and death
Radiography – CXR , renal utz IV Ig Adjunctive treatment for hyperbilirubinemia due to
Management: isoimmune hemolytic disease
Bed rest (0.5–1.0 g/kg/dose; repeat in 12 hr) | Reducing hemolysis
Fluid and salt restriction Metallo- Competitive enzymatic inhibition of the rate limiting
Fluids: 400 – 600 ml/m2/day + UO 24H conversion of heme-protein to biliverdin (an intermediate
porphyrins
NaCl < 2 g/day K < 40 meq/day metabolite to the production of unconjugated bilirubin)
Penicillin 50 – 100,000 u/kg/day TID/QID x 10 days by heme-oxygenase
HPN, CHF - Furosemide 2 mg/k/dose Patients with ABO inc or G6PD deficiency or when blood
Prognosis – complete resolution, 5 – 10 % progress to chronic state products are discouraged (Jehovah’s witness)
 BICARB DEFICIT CORRECTION
Ex: wt 4.9kg
pH = 7.10
PHOTOTHERAPY pCO2 = 9.1
10 Bulbs; 20 watts; 200 hrs; 30 cms pO2 = 36.5
Bilirubin in the skin absorbs light energy HCO3 = 2.8
▪ Photo-isomerization reaction converting the toxic native unconjugated BE = -26.8
4Z, 15Z-bilirubin into an unconjugated configurational isomer 4Z,15E- O2 Sat = 53.6%
bilirubin, which can then be excreted in bile without conjugation BE x Wt x 0.3 = 26.8 x 4.9 x 0.3 = 39.39meqs
▪ Major product from phototherapy is lumirubin, which is an irreversible Half correction: 39.39/2 = 19.69 meqs
To order: Give 20 meqs NaHCO3 + equal amt of sterile water to be given
structural isomer converted from native bilirubin and can be excreted by
slow IVTT over 30mins.
the kidneys in the unconjugated state
Infuse another 20 meqs NaHCO3 + equal amt sterile water as drip for 1-2 hrs.
Complications
EMPIRIC: NaHCO3 1-2mkdose even w/o ABG.
Loose stools, erythematous macular rash, purpuric rash associated with
transient porphyrinemia, overheating, dehydration (increased insensible HCO3 correction in ABG:
water loss, diarrhea), hypothermia from exposure, and a benign Half correction: Base x’s x 0.3 x wt ÷ 2
condition called bronze baby syndrome dark, grayish-brown skin (+ equal amount of sterile water)
discoloration in infants
Full correction: Base x’s x 0.3 x wt ÷ 2
(1/2 via IV push, ½ via IV drip)
Bilirubin (Total)
Cord Full correction: Base x’s x 0.3 x wt ÷ 2
Preterm <2 mg/dl <34 µmol/L (1/2 via IV push, ½ via IV drip)
Term <2 mg/dl <34 µmol/L BUN/ crea ratio
0 – 1 days Normal 10 -20
Preterm <8 mg/dl <137 µmol/L > 20 suggest DHN, pre renal azotemia or GIB
Term <8.7 mg/dl <149 µmol/L < 5 – liver disease, inborn error of metabolism
1 – 2 days
Preterm <12 mg/dl <205 µmol/L GFR (based on plasma creatinine and ht)
Term <11.5 mg/dl <197µmol/L GFR = k x L = ml/min/1.73 m 2 SA
3 – 5 days sCr
Preterm <16 mg/dl <274 µmol/L L = body length (cm)
Term <12 mg/dl <205µmol/L Scr = mg/dL ; divide by 88.4 if units in mmol/L
Older Infants
Preterm <2 mg/dl <34 µmol/L NURSERY NOTES
Term <1.2 mg/dl <21 µmol/L Dextrosity
Adult 0.3 – 1.2 mg/dl 5 – 12 µmol/L to get factor: Desired – D5
Bilirubin (Conjugated) D50- D5
D 7.5 = 0.055
Neonate <0.6 mg/dl <10 µmol/L D10 = 0.11D 12.5 = 0.166
Infants/Children <0.2 mg/dl <3.4 µmol/L D15 = 0.22
D 17.5 = 0.28
Limits of Dextrosity: Peripheral line = D12 | Central line = D20

Total Fluid Intake (TFI): Electrolyte requirements:

Preterm: start at 60 cckd Na: 2-4 mkd prep’n 2.5 mg/ml
Term: start at 80 cckd Ca: 100-200mkd prep’n 100mg/ml
To check TFI = rate x 24 ÷ wt K: 2-4 mkd prep’n 2mg/ml
ex. Preterm: wt: 1.129 Glucose Infusion Rate:
Day 1: start IVF with D10 water
60 x 1.219 ÷ 24 = 3.1 cc/hr x 24 hrs Dextrosity x IVF rate x 10 ÷ 10
Add Calcium gluconate at 200 mkd q8h Wt
Ca gluc = 1.129 x 200 ÷ 3 = 75mg q8hrs for 3 doses Ex. 10 kg; IVF D10 IMB at 40cc/h
Start antibiotics
Give ranitidine GIR = 10 x 10 x 40 ÷ 10 = 6.6mkmin
HGT q 8/12 hrs 60
OGT, CBC NV: Newborn & Infants 6-8 mg/kg/min
Na, K, Ca at 48 hrs Children 4-6 mg/kg/min
Blood c/s depends on AP
If HGT <40 mg/dl, give D10 water slow IV push at 2cc/kg and
Day 2: increase TFI by 10-20 (depends on AP) repeat HGT after 30 mins-1 hr (may do 3 boluses if still low, may inc dextrosity
70 x 1.129 ÷ 24 = 3.3 cc/hr x 24 hrs or rate)
incorporate ca gluc 200 mkd to IV
Level of Umbilical Cathetherization: (cm)
ex.
If arterial between T6-T9 = Wt x 3 x 8
D10 water 80 cc
If venous: (wt x 3) + 8 +1
Ca gluc 2.2cc
2
82.2cc to run at 3.3ccx24hrs
ET tube size: age in yrs +4
Day 3: increase TFI by 10-20 (depends on AP)
4
If electrolytes are N, may use D10IMB ET level:
80 x 1.129 ÷ 24 = rate
if >2yo: age(yrs) +12 or ET size x 3
80 x 1.129 x factor to get value of D50 water (to make D10 use 0.11)
2
Cont Ca gluc incorporation (if feeding may discontinue)
D50 water 9.9cc Total Flow Rate = Tidal volume x wt x RR x I.E ratio + 2000
D5 IMB 77.9cc = D10 IMB I.E = 2 Dead space = 2000
Ca gluc 2.2cc (200mkd) RR = 40-60
90 cc to run at 3.7cc/hrx24h Tidal volume = Newborn: 6-10cck
If feeding already: Child: 10-15cck
Total volume of milk ÷ wt = cc/kg/day Adult: 15cck
FiO2
Subtract this amount to TFI to get value for IV
Nasopharyngeal cathether = Flow rate x 20 + 20
(if Dr. Reinoso, divide by 2 before subtracting to TFI)
ex. MF 3cc q3hrs = 24 cc in 24 hrs Ex. 1L Fio2 = 40
Nasal catheter = Flow rate x 4 + 20
24 ÷ 1.129 = 21.2 cckd from milk
Ex. 1L FiO2 = 24
80 – 21.2 = 58.8cckd (use this for IVF)
58.8 x 1.129 ÷ 24 = rate Extubation:
D50 water 7.3cc Give Dexamethasone at 0.1 mkdose q6h for 24 hours prior to extubation
D5 IMB 56.5cc = D10 IMB USN with epinephrine 0.5 cc + 1.5 cc PNSS q15 mins x 3 doses then extubate
Ca gluc 2.2cc (200mkd) then USN with Salbutamol ½ nebule + 1.5 cc PNSS q6h x 24 hours
66 cc to run at 2.7cc/hrx24h O2 at 10 lpm then decrease as necessary
Subsequent days depend on infants status.
Regular milk: 20 cal/oz Double Volume Exchange Therapy (DVET)
Preterm milk: 24 cal/oz Wt x 80 x 2 = Volume/ amt of fresh whole blood
(Use mother’s blood type)
Total Caloric Intake: rate x 24 x caloric content of IVF ÷ wt
To get factor: Dextrosity x 0.04 = cal/cc Volume _ = # of exchange
aliquots per exchange
Caloric content of IVF
D5 = 0.2 cal/cc > 3 kg 20 ml
D7.5 = 0.3 cal/cc 2-3 kg 15 ml
D10 = 0.4 cal/cc 1-2 kg 10 ml
D15 = 0.6 cal/cc 850g-1kg 5 ml
Caloric requirement & Protein requirement < 850 g 1-3 ml
Cal/kg g/kg
Prepare the ff:
0-5mo 115 3.5 2 pcs 3 way stopcock
6-11mo 110 3 1 pc 5 cc syringe
1-2 yo 110 2.5 1 pc BT set
3-6 yo 90 – 100 2 1 pc IV tubing
7-9 yo 80 – 90 1.5 1 pc empty bottle
10 – 12 yo 70 – 80 1.5 Gloves
13-15 yo 55 – 65 1.5 Calcium gluconate 100 mg every 10 exchanges
16 – 19 yo 45 – 50 1.5
Approximate Daily Water Requirement Criteria for Hypoxic Ischemic Encephalopathy
0 – 3 do 120cc/k/d 4 – 6 yo 100 cc/k/d ▪ pH < 7 (profound met. Acidosis)
10 do 150cc/k/d 7 – 9 yo 90 cc/k/d ▪ Apgar <3 more than 5 mins
1 – 5 mo 150cc/k/d 10 – 12 yo 80 cc/k/d ▪ Neurologic sequelae (coma; sz)
6 – 12 mo 140cc/k/d 13 – 15 yo 70 cc/k/d ▪ Multiorgan involvement
1 – 3 yo 120cc/k/d 16 – 19 yo 50 cc/k/d ▪ Difficult delivery
Medications
Estimated Catch up Growth Requirement
Dopamine: wt x dose x 0.075
= cal/k/day (age for wt) x IBW (wt for ht)
Prep’n : Single Strength: 200mg/250ml;
Actual BW
Double Strength: 400/250ml
if using double strength: wt x dose x 0.075÷2
CHON reqt = CHON reqt for age x IBW
(Dose = 5-20)
Actual BW
Dobutamine: wt x dose x 0.06
Growth and Caloric requirements Prep’n: 250mg/250 ml; Dobuject 50mg/ml
(Dose = 5-20)
AGE RDA kcal/kg/day
If using Dobuject: Wt x dose x 60÷ concentration
0 – 3 mos 115
Concentrations: 5mg/ml = 5000
3 – 6 mos 110
50mg/50ml = 1000
6 – 9 mos 100
50mg/20ml = 2500
9 – 12 mos 100
To make 5mg/ml: Dobuject 5cc
1 – 3 yo 100
D5 water 45cc
4 – 6 yo 90 – 100

▪ Diflucan: 6 mkd OD prep’n 50mg/tab divide into pptabs and give 1 BLOOD TRANSFUSION
pptab OD x 2 weeks FWB 10 - 20 cc/kg 3 – 4H
▪ Aminophylline: 5mkd (loading dose) then 1.6 mkd q 8 hrs PRBC 5 - 10 3 – 4H
(maintenance) Plasma 10 - 15 1–2H
▪ Phenobarbital 20 mkd (loading dose) then 5 mkd (maintenance) PRP 10 - 15 1–2H
▪ Dexamethasone 0.1 mkdose q6hrs x 24 hours Plt conc 1 u/ 7 -10 kg FD
▪ For other meds, please see NEOFAX Cryoprecipitate 1 u/kg FD
Hemophilia A 1 bag
EMERGENCY (200mg fibrinogen)
ET tube age in years + 4 VW dse 50 -100 mg/kg
4 Fibrinogen dse 100 cc
ET diameter x 3 (2-5 kg)
>10 yo cuffed Factor 8 Hemophilia A 50 u/kg
Laryngoscope sizes Hemophilia B 100 u/kg

PT Miller 00 or 0 1 - 3 days 1 mo 2mos 6 – 12y >12y

Term Miller 0
Hgb 14.5 – 22.5 9 -14 11.5 -15.5 13-16
0-6mos Miller 1
Hct .48 - .69 .28 - .42 .35 - .45 .37 - .49
6-24 mos Miller 2
Wbc 9 -30 birth 5 – 19.5 6 -17.5 4.5 -13.5
>24 mos Miller 2 or Mac 2
Plt 84 – 478 NB After 1 wk, same as adult
NORMAL VALUES 150 - 400
AVERAGE WEIGHT (3,000 grams) Retic 0.4 - 0.6 < 1 -1.2 0.1 -2.9
0 – 6 mos Age in months x 600 + BW
1 u FWB = 200 cc PRBC
7 – 12 mos Age in months x 500 + BW
= 50 cc platelet concentrate
Children = 150 – 200cc PRP
1 – 6 yo Age in years x 2+ 8 = 150 cc FFP
7 – 12 Age in years x 7 – 5 / 2 MCV Hgb / rbc x 10 80 -94
yo MCH Hgb / rbc x 10 27 - 32
HEAD CIRCUMFERENCE [35 cm (+ 2cm)] (inch = 2.54cm) MCHC Hgb/ hct x 10 32 – 38
1 – 4 months ½ inch per month Absolute reticulocyte count = pt’s hct x retic %
5 – 12 mos ¼ inch per month N hct for age
2 years old 1 inch per year Reticulocyte Index
3 – 5 yo ½ inch per year
Absolute Retic Ct > 2 hemorrhage
6 – 20 yo ½ inch per 5 years
2 < 2 rbc production abn
LENGTH (50 cm) PRBC to be transfused for correction = 40 – hct x wt
0 – 3 months 9 cm
4–6 8 cm PT 20 -60 Child = 60 -100
7–9 5 cm GLUCOSE NB 30 – 60
10 – 12 3cm 1 d 40 -60 Adult = 70-105
> 1d 50 -90
ANC - % of neutrophils & cells that become neutrophils – multiplied by wbc Age K (mean value) KI
ANC = wbc x (% seg + % stabs + % meta) LBW < 1 yr 0.33 29.17
Other formula: wbc x (seg + meta + stabs ) x 10
Ex 2.1 x 53 (seg) x 10 = 1113 FT < 1 yr 0.45 39.78
ANC > 1000 Normal 2-12 y 0.55 48.62
ANC < 2000 Neutropenia
13-21 y (female) 0.55 48.62
ANC 1000 -1500 Low risk of infection
ANC 500 -1000 Mod risk of infection 13 -21 y (male) 0.70 61.88
ANC < 500 High risk of infection
Age GFR Range
IT ratio > 0.25 sepsis
> 0.80 higher risk of death from sepsis Preterm
Anemia 2- 8 d 11 11 – 15
< 10 g mild anemia 4 - 28 d 20 15 – 28
30 -90 d 50 40 – 65
8-9g mod anemia
<8 g severe anemia Term
2- 8 d 39 17 – 60
IVIG infusion 4 - 28 d 47 26 – 68
Preparation: 30 - 90 d 58 30 – 86
2.5g/50cc 500g/10cc 25g/100cc 1- 6mo 77 39 -114
5g/100cc 10g/250cc
6 - 12 mo 103 49 – 157
Computation:
Wt x 2 g /kg IVIG 2 - 19mo 127 62 – 191
Ex wt: 7.2 kg 2 - 12y 127 89 – 165
7.2 x 2 + 16 g IVIG
16 gIVIG 2. 5 g = 320 cc Adult males 131 88 – 174
Cc 50cc Adult females 117 87 – 147
# of vials = total cc 320cc = 6.4 vials
50cc 50cc Age Ht (cm) Ht (cm) Wt for Ht Boys Girls
320cc x 0.03 = 9. 6 cc/h for 30 mins (months) boys girls (cm) (kg) (kg)
Transfuse 9 – 10cc/h IVIG for the 1st 30mins if no reaction, run the remaining 0 50.5 49.9 49 3.1 3.3
volume for 12H
Refer for any infusion reactions 1 54.6 53.5 50 3.3 3.4
Close ML
2 58.1 56.8 51 3.5 3.5
Monitor v/s q 30 mins while on infusion
If after IVIG if still febrile, rpt IVIG after 3 D 3 61.1 59.5 52 3.7 3.7
If after 2nd IVIG still febrile – start Prednisone
4 63.7 62.0 53 3.9 3.9
Aspirin 80 mkD QID (30 mg, 80, 100, 300 mg)
BSA 5 65.9 64.1 54 4.1 4.1

0 – 5 kg wt x 0.05 + 0.05 6 67.8 65.9 55 4.3 4.3

6 – 10 kg wt x 0.04 + 0.10
7 69.5 67.6 56 4.6 4.5
11 – 20 kg wt x 0.03 + 0.20
20 – 40 kg wt x 0.02 + 0.40 8 71.0 69.1 57 4.8 4.8
>40 kg wt x 0.01 + 0.80

Age Ht (cm) Ht (cm) Wt for Ht Boys Girls Age Ht (cm) Ht (cm) Wt for Ht Boys Girls
(months) boys girls (cm) (kg) (kg) (months) boys girls (cm) (kg) (kg)
9 72.3 70.4 58 5.1 5.0 35 95.8 94.9 84 11.7 11.4
10 73.6 71.8 59 5.4 5.3 36 96.5 95.6 85 11.9 11.6
11 74.9 73.1 60 5.7 5.5 3.5 yo 98.4 97.3 86 12.3 11.8

12 76.1 74.3 61 5.9 5.8 4 102.9 101.6 87 12.3 11.9

13 77.2 75.5 62 6.2 6.1 4.5 106 104.5 88 12.5 12.2

14 78.3 76.7 63 6.5 6.4 5 109.9 108.4 89 12.8 12.4

15 79.4 77.8 64 6.8 6.7 5.5 112.6 111.0 90 13.0 12.6
16 80.4 78.9 65 7.1 7.0 6 116.1 114.6 91 13.2 12.8
17 81.4 79.9 66 7.4 7.3 6.5 118.5 117.1 92 13.4 13.0

18 82.4 80.9 67 7.7 7.5 7 121.7 120.6 93 13.7 13.3

19 83.3 81.9 68 8.0 7.8 7.5 123.9 123.0 94 13.9 13.5

20 84.2 82.9 69 8.3 8.1 8 127.0 126.4 95 14.1 13.8

21 85.1 83.8 70 8.5 8.4 8.5 129.1 128.8 96 14.4 14.0

22 86.0 84.7 71 8.8 8.6 9 132.2 132.2 97 14.7 14.3

23 86.8 85.6 72 9.1 8.9 9.5 134.4 134.7 98 14.9 14.6
24 87.6 86.5 73 9.3 9.1 10 137.5 138.3 99 15.2 14.9
25 88.5 87.3 74 9.6 9.4 10.5 139.9 140.9 100 15.5 15.2

26 89.2 88.2 75 9.8 9.6 11 143.3 144.8 101 101.0 15.5

27 90.0 89.0 76 10.0 9.8 11.5 145.8 147.6 102 16.1 15.9

28 90.8 89.8 77 10.3 10.0 12 149.7 151.5 103-105 16.5-17.1 16.2-16.7

29 91.6 90.6 78 10.5 10.2 12.5 152.5 154.1 106-108 17.4-18.0 17.0-17.6

30 92.3 91.3 79 10.7 10.4 13 156.5 157.1 109-111 18.3-19.0 17.9-18.6

31 93.0 92.1 80 10.9 10.6 13.5 159.3 158.8 112-114 19.3-20.0 18.9-19.5

32 93.7 92.8 81 11.1 10.8 14 163.1 160.4 115-117 20.3-21.1 19.9-20.6

33 94.5 93.5 82 11.3 11.0 14.5 165.7 161.1 118-120 21.4-22.2 21.0-21.8

34 95.2 94.2 83 11.5 11.2 15 169.0 161.8 121-123 22.6-23.4 22.2-23.1

 Age Ht (cm) Ht (cm) Wt for Ht Boys Girls
(months) boys girls (cm) (kg) (kg) Dopamine Renal dose 3-5
15.5 171.1 162.1 124-126 23.9-24.8 23.6-24.6 Pressor >5 - <15
alpha effect >15
16 173.5 162.4 127-129 25.2-26.2 25.1-26.2
ANAPHYLAXIS
16.5 174.9 162.7 130-132 26.8-27.8 26.8-28.0
Epinephrine 0. 01ml/kg max of 0.5 mg/dose SC
17 176.2 163.1 133-135 28.4-29.6 28.7-30.1 (1:1000) < 30 kg 0.15 mg
> 30 kg 0.3 mg
17.5 176.7 163.3 136-140 30.2-33.0 30.8-32
Diphen = 50mg IM (1mkdose)
18 176.8 163.7 141-145 33.7-36.9 USN w/ Salbu x 3 doses
ANTIBIOTICS
Weight for Height = Actual BW (kg) Height for Age = Actual Height (cm) Amoxicillin (30 – 50 mkday) TID
P50 Wt for Ht (kg) P50 Ht for Age
Pediamox Susp : 250mg/5ml
Waterloo Wasting Stunting Drops : 100mg/ml
Classification (Wt for Ht) (Ht for Age) Himox Cap : 250mg, 500mg
Normal >90 >95 Moxicillin Susp : 125mg/5ml 250mg/5ml
Mild 81 – 90 90 – 95 Harvimox Drops : 100mg/ml
Moderate 70 – 80 85 – 89 Novamox
Severe <70 <85 Amoxil Susp : 125mg/5ml 250mg/5ml
EMERGENCY MEDS Cap : 250mg 500mg
Epinephrine (bradycardia, asystole) (1:1000) 0.1 ml/kg q 3- 5 mins Glamox Drops : 100mg/ml
Amiodarone Globapen
5 mg/kg rapid IV push
Amoxicillin + Clavulanic acid (30 – 50 mkday)
Cardioversion 2 J/kg then 4 J/kg then rpt 2x
Albumin Augmentin Tab: 375mg (250mg); 625 (500mg)
1gm x wt given in 2-4hrs.
Prep: 12.5g/50ml Amoclav Susp: 156.25mg/5ml (125mg) TID
Vol expander: 20ml/kg 228.5mg/5ml (200mg) BID
HypoCHONemia – 1gm/k/dose x 4H 312.5mg/5ml (250mg) TID
457mg/5ml (400mg) BID
Epinephrine Drip 0.1 – 1mg/k/min; 1amp = 1mg/ml Cloxacillin (50 – 100 mkday) q6h
Rate = (wt x dose x 60)/desired
Prostaphlin A Tab: 250mg 500mg
Ex: (18kg x 0.1 x 60)/100 = 2cc/hr
To order: 5 amps Epi + 50cc D5W to rum at 2cc/hr Orbinin Susp: 125mg/5ml
(0.1mg/k/min) Flucloxacillin (50 – 100 mkday) q6h
Levophed Staphloxin Susp: 125mg/5ml
0.3-2mcg/k/min
Cap : 250mg 500mg
Prep: 4mg/amp (1mg/ml)
Rate = (wt x dose x 60)/desired Chloramphenicol (50 – 75 mkd) q6h
Ex. Dose 0.5 Pediachlor Susp: 125mg/5ml
1mg/20 = 0.05 x 1000 = 50mcg/ml Chloramol Tab : 250mg 500mg
(18kg x 0.5 x 60)/50 = 10.8cc/hr Kemicetine
To order: 1 amp levophed + 80 cc D5W to run at Chloromycetin
11cc/hr

CEPHALOSPORINS Trimethoprim + Sulfadiazone (TM 5 – 8 mkd)

1st Generation Triglobe Tab Sdz 410mg TM 90mg
Cefalexin (25 – 100 mkd ) q 6-8 h Forte 820mg 180mg
Lexum Cap : 250mg; 500mg Susp/5ml 205mg 45mg
Cefalin Susp : 125mg/5ml 250mg/5ml AMINOGLYCOSIDES
Keflex Drops : 100mg/ml Tetracycline 25 – 50 mkday q6h
Ceporex Cap : 250mg 500mg Doxycycline 5 mkday BID
Selzef Caplet: 1 gm Furaxolidone 5 – 8 mkday q6h
Granules: 125mg/5ml 250mg/5ml MACROLIDES
Drops: 125mg/1.25ml Erythromycin (30 – 50 mkd) q 6h
2nd Generation Macrocin Susp: 200mg/5ml
Cefaclor (20 – 40 mkd ) q 8 – 12 h Ethiocin Drops: 100mg/2.5ml
Ceclor Pulvule: 250mg 500mg 375mg Erycin Cap : 250mg 500mg
Ceclor CD 750mg Susp: 200mg/5ml
CD ext release Susp: 125mg/5ml 187mg/5ml Drops: 100mg/2.5ml
250mg/5ml 375mg/5ml Erythrocin Film tab: 250mg 500mg
Drops: 50mg/ml Granules: 200mg/5ml
Xelent Cap : 250mg 500mg DS Granules: 400mg/5ml
Vercef Susp : 125mg/5ml 250mg/5ml Drops: 100mg/2.5ml
Cefuroxime (20 – 40mkd) q 12h
Ilosone/ Tab: 500mg DS Liquid: 200mg/5ml
Zinnat Cap : 250mg 500mg Ilosone DS Pulvule: 250mg Drops: 100mg/ml
Sachet: 125mg/sat 250mg/sat Liquid: 125mg/5ml
Susp: 125mg/5ml Clarithromycin (6 – 15 mkday OR 7.5 mkdose q12h)
Cefprozil (20 – 40mkd) q 12h
Klaricid Susp : 125mg/5ml 50mg/5ml
Procef Susp : 125mg/5ml 250mg/5ml Klaz Tab: 250mg 500mg
3rd Generation Roxithromycin <6 yo 5 – 8 mkd BID
Cefixime (6 – 12 mkd) q 12h 6 – 12 yo 100mg/tab BID
Tergecef Susp : 100mg/5ml Macrol/Rulid Tab: 150mg
Zefral Drops: 20mg/ml Ped Tab: 100mg
Ultrazime Rulid dispensable Tab: 50mg
Cefdinir (7mg/kg q 12h OR 14mg/kg OD) Azithromycin 3 day regimen: 10 mkday x 3 days
Omnicef Cap : 100mg 5 day regimen: 10 mkd on day 1
Sachet/ Susp: mg/5ml 5 mkd on day 2 to 5
COTRIMOXAZOLE (TM 5 – 8 mkd) q 12h Adult: 500mg OD day 1/250mg OD day 2 to 5
Bactille – TS Susp/5ml SMZ 400mg TM 80mg Zithromax Susp: 250mg/5ml Sachet: 200mg/sachet
Tab 800mg 160mg Cap : 250mg
Bacidal Susp/5ml 400mg 80mg Clindamycin PO: 20 – 30 mkday q 6 – 8h
Trizole Susp/5ml 400mg 80mg IV: 25 – 40vmkday q 6h
Globaxole Tab 800mg 160mg Susp: 75mg/5ml
Susp/5ml 400mg 80mg Cap: 150mg 300mg
Amp: 150mg/ml
 ANTI-HELMINTHICS
IV ANTIBIOTICS Oxantel + Pyrantel pamoate (10 – 20 mkd) SD
Penicillin 50,000 – 100,000 ukd q 6h Trichiuriasis: x 2 days Hookworm: x 3 days
Quantrel Susp : 125mg/5ml
Amoxicillin 50 – 100 mkd q 6 – 8 h
Tab : 125mg 250mg
Ampicillin 50 – 100 mkd q 6 – 8 h Mebendazole *not recommended below 2 yo
Chloramphenicol 50 – 100 mkd q 4 – 6 h Antiox Susp: 50 mg/ml 100mg/ml
Ampi + Cloxa 50 – 100 mkd q 6 h Tab: 125mg 250mg
Oxacillin 50 – 100 mkd q 6 – 8 h 100 mg BID x 3 days
500mg SD (>2 yo)
Flucloxacillin 50 – 100 mkd q 6 – 8 h
Albendazole <2 yo: 200mg SD
Gentamicin 5 – 7.5 mkd OD >2yo: 400mg SD
Netromycin 5mkd q 12 h *may give x 3 days if with severe infestation
Amikacin 15mkd q 12 h Zentel Susp: 200mg/5ml
Tab : 400mg
Cephalexin 50 – 100 mkd q 6 h
Cefuroxime 50 – 100 mkd q 6 – 8 h AMOEBICIDES
Metronidazole PO: 30 – 50 mkday q 8h
Ceftriazone 50 – 100 mkd OD
IV: 30 mkday q 8h
Ceftazidime 50 – 100 mkd q 12 h
Anaerobia Susp : 125mg/5ml
HYDROCORTISONE LD: 10 mkdose Tab : 250mg
MD: 5 mkdose q 6, 8 or 12h Servizol Susp: 200mg/5ml
*max dose: LD 200 MD 100 Tab : 250mg 500mg
ANTIVIRAL Flagyl Susp : 125mg/5ml
Acyclovir (20 mkdose) q 4 – 6 h Tab : 250mg 500mg
Max 800mg/day x 5 days Etofamide (15 – 20 mkd) TID
Zovirax Susp: 200mg/5ml Kitnos Susp : 125mg/5ml
Acevir Blue: 400mg Tab : 200mg 500mg
Pink: 800mg Diloxanide furoate (20mkd) q8h x 10 days
ORAL ANTIFUNGALS Furamide Tab : 500mg
Dilfur Susp: 125mg/5ml
Ketoconazole (6mkd) q 4 – 6h
Secnidazole
Daktarin Adult & Child: ½ tsp q 6h Flagentyl 2 tab now then 2 tabs after 4 hrs
Infant: ¼ tsp q 6 h Ercefuryl (20mkday)
Nystatin
ANTICONVULSANT
Mucostatin Susp: 100,000 u/5ml Diazepam 0.2 – 0.3 mkdose
Ready mix susp Tab: 500,000 u Drip: 1amp in 50cc D5 W
Fluoconazole (3 – 6 mkd) OD x 2wks 10mg/amp
Diflucan Cap: 50mg 150mg 200mg Midazolam 0.15 mkdose OR
Vial: 2mg/ml x 100 ml 0.05 – 0.2 mkdose
Phenobarbital LD: 10 mkdose q 12h
MD: 5 mkdose q 12h

ANTI-TB MEDS Carbocisteine Infant Drops QID

Isoniazid (10 – 12 mkd) ODAC or 2hrs PC <3mos 0.25ml
Comprilex Suspension: 3 – 5 mos 0.5ml
Nicetal 200mg/5ml 6 – 8 mos 0.75ml
Trisofort 100mg/5ml 9 – 12 mos 1ml
Odinah 200mg/5ml Ped Syr TID
150mg/5ml 1 – 3 yo 5 – 7.5ml 1 – 1 ½ tsp
Tablet 400mg 4 – 7 yo 7.5 – 10ml 1 ½ - 2 tsp
Rifampicin (10 – 20 mkd) ODAC or 2hrs PC 8 – 12 yo 10 – 15ml 2 – 3 tsp
Adult Susp TID
Natricin 100mg/5ml 200mg/5ml
Adult & >12 yo 10 – 15ml 2 – 3 tsp
Rifadin 100mg/5ml
Capsule TID
100mg/5ml
Adult & >12 yo 1 cap
Rimactane 200mg/5ml
Rimaped Tablet 300mg 450mg Lovsicol Infant drops 50mg/ml
Pyrazinamide (PZA) (16 – 30 mkd) BID/TID Ped Syrup 100mg/5ml
CIBA 250mg/5ml Adult Susp 250mg/5ml
Zcure Cap 500mg
Zinaplex 500mg/5ml Ambroxol Infant drops 6mg/ml 75mg/ml BID
Tablet 500mg < 6 mo 0.5ml 0.5ml
7 – 12 mo 1 ml 0.75ml
MUCOLYTIC
13 – 24 mo 1.25ml 1ml
Solmux Drops: 40mg/ml Pedia Syrup
1 – 3 mos: 0.5ml TID/ <2 yo 2.5ml BID
QID 2 – 5 yo 2.5ml TID
3 – 6 mos 0.75ml 5 – 10 yo 5ml TID
6 – 12 mos 1ml Adult Syrup: Adult & >10 yo = 5ml TID
1 – 2 yo 1.5 ml Retard cap: Adult & >10 yo = 1 cap OD
Susp: 100mg/5ml Tab: Adult & >10 yo = 1 tab TID
200mg/5ml Inhalation
2 – 3 yo 5ml <5 yo 1 – 2 inhalation of 2ml soln daily
2.5ml Adult & children >5 yo = 1 – 2 inhalation of
4 – 7 yo 10ml 2 – 3ml soln daily
5 ml Mucosolvan Infant drops 6mg/ml
8 – 12 yo 15ml Ped liquid 15mg/5ml
7.5ml Adult liquid 30mg/5ml
Forte: 500mg/5ml
Retard cap 75mg
Cap: 500mg
Tab 30mg
Adult & >12 yo: 5 – 10ml Inhalation Soln 15mg/2ml
1 cap Ampule 15mg/2ml
Solmux Capsule Ambrolex Infant drops 7.5mg/ml
Broncho Suspension Zobrixol Ped liquid 15mg/5ml
Solmux Tab: 500mg Adult liquid 30mg/5ml
Chewable tab 1 tab q 8h Tab 30mg
 B2 AGONIST DECONGESTANT
Salbutamol (0.1 – 0.15 mkdose) Nasal
Ventolin Tab 2mg NaCl 2 – 4 drps/spray per nostril TID/QID
Syr 2mg/5ml 2 sprays/nostril then suction q6h x 3 days
Nebule 2.5mg/2.5ml Salinase Nasal spray
Ventar Tab 2mg Muconase Nasal drops
Hivent Syrup Syr 2mg/5ml Oxymetazoline HCl 2 – 5 yo: 2 – 3 drops/nostril BID
Salbutamol + Guaifenesin >5 yo: 2 – 3 sprays/nostril BID
Asmalin Tab Drixine Nasal spray: 0.05%
Broncho 1 tab TID Nasal soln: 0.025%
Syrup Xylometazoline < 1 yo: 1 – 2 drps OD/BID
Pulmovent 2 – 6 yo 5 – 10 ml BID/TID HCl 1 – 6 yo: 1 – 2 drps OD/BID max TID
7 – 12 yo 10ml Adult: 2 – 3 drps / 1 squirt TID max QID
Terbutaline sulfate ( 0.075 mkdose) Otrivin
Terbulin Tab 2.5mg Oral Phenylpropanolamine HCl (0.3 – 0.5 mkdose)
Pulmoxel Tab 2.5mg Nebule 2.5mg/ml Disudrin 1 – 3 mos: 0.25 ml
Syr 1.5mg/5ml 4 – 6 mos: 0.5 ml
Bricanyl Tab 2.5mg Nebule 5mg/2ml 7 – 12 mos: 0.75 ml
Syr 1.5mg/5ml Expectorant 1 – 2 yo: 1 ml
2 – 6 yo: 2.5 ml
Doxophelline (6 – 8 mkdose) BID x 7 – 10 days
7 – 12 yo: 5 ml
Ansimar Syrup 100mg/5ml Tab 400mg
Drops: 6.25ml q6h
Procaterol HCl (0.25ml/kg) Syr: 12.5mg/5ml q6h
Meptin Syrup 5mcg/ml Brompheniramine maleate + PPA
Tab 25mcg Dimetapp 1 – 6 mos: 0.5ml TID/QID
Nebuliser soln 100mcg/ml 7 – 24 mos: 1ml TID/QID
Theophylline 10 – 20 mkdose 3 – 5 mkdose 2 – 4 yo: ¾ tsp
4 – 12 yo: 5ml
H2-BLOCKER Adult: 5 – 10 ml
Ranitidine 1 – 2 mkdose q 12h 1 tab BID
Zantac Tab 75mg 150mg 300mg Infant drops: (0.1mkdose)
Cimetidine Neonates: 5 – 20 mkday q6 – 12 h Syr
Infants: 10 – 20 mkday Extentab
Child; 20 – 40 mkday Carbinoxamine maleate + Phenylephrine HCl
Adult: 300mkdose QID Rhinoport 1 – 5 yo: 5ml BID
400mkdose BID 6 – 12 yo: 10ml BID
800mkdose QID Adult & > 12yo: 1 cap / 15ml BID
Tagamet Susp: 300mg/5ml Syrup Cap
Tab: 100mg 200mg 300mg 400mg Loratadine + PPA
800mg
Loraped <30 kg: 2.5ml BID
Famotidine PO: 0.5 mkdose q 12 h
>30 kg: 5ml BID
IV: 0.6 – 0.8 mkday q 8 – 12h
Syrup: 5mg/ml

ANTITUSSIVES
Butamirate citrate 3 yo 5 ml TID ANTIPYRETIC
>6 yo 10ml TID Paracetamol (10 – 20 mkdose) q 4h
>12 yo 15ml TID Tempra Drops: 60mg/0.6ml
Adult 15ml QID Syrup: 120mg/5ml
1 tab TID/QID Forte : 250mg/5ml
Sinecod Forte Syrup 7.5mg/5ml Tab 50mg Tablet: 325mg 500mg
Dextromethorphan + Guaifenesin Calpol Drops: 100mg/ml
Robitussin – DM 2 – 6 yo 2.5 – 5ml q 6 – 8h Syrup: 120mg/5m
6 – 12 yo 5ml q 6 – 8h 250mg/5ml
Adult 5 – 10ml q 6h Defebrol Syrup: 120mg/5m
Syrup 250mg/5ml
Afebrin Drops: 60mg/0.6ml
ANTIHISTAMINE Syrup: 120mg/5ml
Diphenhydramine HCl (5mkd) q 6h | IM/IV/PO: 1 – 2 mkdose Forte : 250mg/5ml
Benadryl Syr: 12.5mg/5ml Inj: 50mg/ml Tablet: 600mg
Cap: 25mg 50mg Tylenol Drops: 80mg/ml
Hydroxyzine (1mkd) BID Syrup: 160mg/5ml
Adult: 10mg BID 25mg ODHS Naprex Drops: 60mg/0.6ml
Iterax Syr: 2mg/ml Syrup: 250mg/5ml
Tab: 10mg 25mg 50mg Inj: 300mg/2ml
Ceterizine (0.25mkdose) Rexidol Drops: 60mg/0.6ml
6mos - <12mos : 1ml OD Syrup: 250mg/5ml
12mos - <2 yo: 1ml OD/BID Tablet: 600mg
2 – 5 yo: 2ml OD / 1ml BID Biogesic Drops: 100mg/ml
6 – 12 yo: 10ml (2 tsp)OD/ 5ml BID Syrup: 120mg/5m
1 tab OD/ ½ tab BID 250mg/5ml
Adult & >12yo: 1 tab OD Tablet: 500mg
Virlix Oral drops: 10mg/ml Tab: 10mg Aeknil Ampule (2ml) 150mg/ml
Oral soln: 1mg/ml Opigesic Suppository: 125mg 250mg
Allerkid Drops: 2.5mg/ml Syr: 5mg/5ml Mefenamic Acid (6 – 8mkdose) q 6h
Alnix Drops: 2.5mg/ml Tab: 10mg Ponstan Suspension: 50mg/5ml
Syr: 5mg/5ml Cap SF: 250mg
Loratadine 1 – 2 yo: 2.5 ml BID Tab: 500mg
2 – 12 yo (<30 kg): 5ml OD Aspirin (60 – 100 mkd)
(>30 kg): 10ml OD Ibuprofen (5 – 10 mkday) q8h (max 20mkday)
Adult & > 12 y : 1 tab OD
Dolan FP Suspension: 100mg/5ml
Claritin/Allerta/Loradex Syr: 5mg/ml Tab: 10mg
Dolan Forte 200mg/5ml
Desloratadine 6 – 12 mos: 2ml OD
Drops: 100mg/2.5ml
1 – 5 yo: 2.5ml OD
Advil 100mg/5
6 – 12 yo: 5ml OD
Tab: 200mg
Aerius Syr: 2mg/5ml Tab: 5mg
 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 Tab 10mg
Susp 5mg/5ml
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
ANTIHYPERTENSIVES
Hydralazine PO: 0.75 – 1.0 mkday q 6 – 12 h
Apresoline IV: 0.1 – 0.2 mkdose
Spirinolactone 1 – 3 mkday
Edited by:
frankydinks (2015)