NICU MIO q shift and record

Please admit under RI, LI, PD or AP Monitor VS q2h and record

TPR q4H Continue TSB for fever
May breastfeed if NSD; NPO x 2hrs if CS Chart character, frequency and amount of GI losses and replace
Labs: w/
NBS at 24 hrs old, secure consent PLR 1L/1P vol/vol
CBC, BT (if w/ maternal illness, PROM or UTI Will inform AP
HGT now then 1, 3, 6, 12, 24, 48 hrs old (GDM) Pls inform Dr _____ of this admission
HGT now (SGA or LGA) Thank you.
Medications:
Erythromycin eye ointment both eyes BRONCHIAL ASTHMA
Vit K 1 mg IM (term); 0.5 mg (PT) Please admit under the service of Dr.
Hep B vaccine 0.5 ml IM, secure consent TPR q4H and record
BCG 0.05 ml ID (PT); 0.1 ml (term), secure onsent NPO if dyspneic
SO Labs:
Routine NB care CBC
Monitor VS q30 mins until stable U/A (MSCC)
Thermoregulate at 36.5 to 37.5°C ABG* CXR APL*
Place under droplight (NSD); isolette (CS) IVF:
Suction secretion prn D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
Will infrom AP /AP attended delivery D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
DENGUE FEVER Medications:
Please admit under the service of Dr. Paracetamol prn q4h for T > 37.8°C (10 – 15 mkdose)
TPR q4H and record USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses
DAT ( No dark colored foods) Incorporate Budesonide 10 mkd LD (max 200mg IV); then
Labs: 5mkd q6h IV (max of 100 mg IV)
CBC, Plt (optional APTT and PT) Ranitidine IVTT at 1mkdose (if on NPO)
Blood typing SO:
U/A (MSCC) MIO q shift and record
IVF: Monitor VS q2h and record
D5 0.3 NaCl 1P/1L (<40 kg) at 3 – 5 cc/kg Refer for persistence of tachypnea, alar flaring and retractions
D5LR 1L (>40 kg) at 3 – 5 cc/kg O2 at 2 lpm via NC, refer for desaturations <95%
Medications: Will inform AP
Paracetamol prn q4h for T > 37.8°C Pls inform Dr _____ of this admission
Omeprazole 1mkdose max 40 mg IVTT OD Thank you.
SO:
MIO q shift and record HYPERSENSITIVITY REACTION
Monitor VS q2h and record, to include BP Please admit under the service of Dr.
Continue TSB for fever TPR q4H and record
Refer for Hypotension, narrow pulse pressure (< 20mmHg) Hypoallergenic diet
Refer for signs of active bleeding like epistaxis, gum bleeding, Labs:
melena, coffee ground vomitus CBC
Will inform AP U/A (MSCC)
Pls inform Dr _____ of this admission IVF:
Thank you. 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)
FEBRILE SEIZURE D5LR 1L at 30cc/kg in 8hif >40 kg
Please admit under the service of Dr. Medications:
TPR q4H and record *Epinephrine (1:1000) 0.1mg/kg/dose IM anterolateral thigh
DAT once fully awake (max of 0.3 mg)
Labs: *Salbutamol neb x 3 doses q 20 mins
CBC Diphenhydramine 10 mkdose LD (max of 200mg IV); thenmg IV)
U/A (MSCC) 5mkdose q6h IV (max of 100
IVF: Ranitidine IVTT at 1mkdose q 12h
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo) SO:
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo) MIO q shift and record
D5LR 1L at 30cc/kg in 8hif >40 kg Monitor VS q2h and record to include BP
Medications: Continue TSB for fever
Paracetamol prn q4h for T > 37.8°C O2 at 2 lpm via NC, or 6 lpm via facemask
Attach to pulse oximeter, refer for desaturations <95%
SO: Will inform AP
MIO q shift and record Pls inform Dr _____ of this admission
Monitor VS q2h and record Thank you.
Monitor neurovital signs q4h and record BPN
Continue TSB for fever Please admit under the service of Dr.
Seizure precaution at bedside as ff: TPR q4H and record
Suction machine at bedside NPO if dyspneic
O2 with functional gauge; if with active sz give O2 at 2lpm via NC Labs:
Diazepam IVTT (0.3 mkd max of 5 mg IV) prn for seizure CBC
Will inform AP U/A (MSCC)
Pls inform Dr _____ of this admission ABG* CXR APL*
Thank you. IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo) OR
AGE D5 IMB/D5 NM at MR if with NO losses
Please admit under the service of Dr. D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
TPR q4H and record D5LR 1L at 30cc/kg in 8hif >40 kg
DAT once fully awake; NPO x 2hrs if with vomiting Medications:
Labs: Paracetamol prn q4h for T > 37.8°C (10 – 15 mkdose)
CBC USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses
U/A (MSCC) then refer
F/A (Concentration Method) NaCl (Muconase) nasal spray, 2 sprays per nostrils, then suction
IVF: using bulb QID
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo) Ranitidine IVTT at 1mkdose (if on NPO)
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo) SO:
D5LR 1L at 30cc/kg in 8hif >40 kg MIO q shift and record
Medications: Monitor VS q2h and record
Paracetamol prn q4h for T > 37.8°C Continue TSB for fever
Zinc (E Zinc) Refer for persistence of tachypnea, alar flaring and retractions
Drops 10mg/ml 1ml OD (<6 mos) O2 at 2 lpm via NC, or 6 lpm via facemask
1ml BID (6 mos – 2 yo) Attach to pulse oximeter, refer for desaturations <95%
Syrup 20 mg/5ml (>2 yo) 5ml OD Will inform AP
Ranitidine IVTT at 1mkdose (if with abdominal pain) Pls inform Dr _____ of this admission
SO: Thank you.
 Ilosone DS Pulvule: 250mg
ANTIBIOTICS Liquid: 125mg/5ml
Amoxicillin (30 – 50 mkday) TID DS Liquid: 200mg/5ml
Pediamox Susp : 250mg/5ml Drops: 100mg/ml
Drops : 100mg/ml Clarithromycin (6 – 15 mkday OR 7.5 mkdose q12h)
Himox Cap : 250mg, 500mg Klaricid Susp : 125mg/5ml 50mg/5ml
Moxicillin Susp : 125mg/5ml 250mg/5ml Klaz Tab: 250mg 500mg
Harvimox Drops : 100mg/ml Roxithromycin <6 yo 5 – 8 mkd BID
Novamox 6 – 12 yo 100mg/tab BID
Amoxil Susp : 125mg/5ml 250mg/5ml Macrol/Rulid Tab: 150mg
Cap : 250mg 500mg Ped Tab: 100mg
Glamox Drops : 100mg/ml Rulid dispensable Tab: 50mg
Globapen
Amoxicillin + Clavulanic acid (30 – 50 mkday) Azithromycin 3 day regimen: 10 mkday x 3 days
Augmentin Tab: 375mg (250mg); 625 (500mg) 5 day regimen: 10 mkd on day 1
Amoclav Susp: 156.25mg/5ml (125mg) TID 5 mkd on day 2 to 5
228.5mg/5ml (200mg) BID Adult: 500mg OD day 1
312.5mg/5ml (250mg) TID 250mg OD day 2 to 5
457mg/5ml (400mg) BID Zithromax Susp: 250mg/5ml
Cloxacillin (50 – 100 mkday) q6h Cap : 250mg
Prostaphlin A Tab: 250mg 500mg Sachet: 200mg/sachet
Orbinin Susp: 125mg/5ml Clindamycin PO: 20 – 30 mkday q 6 – 8h
IV: 25 – 40vmkday q 6h
Flucloxacillin (50 – 100 mkday) q6h
Susp: 75mg/5ml
Staphloxin Susp: 125mg/5ml
Cap: 150mg 300mg
Cap : 250mg 500mg
Amp: 150mg/ml
Chloramphenicol (50 – 75 mkd) q6h
Pediachlor Susp: 125mg/5ml
AMOEBICIDES
Chloramol Tab : 250mg 500mg
Metronidazole PO: 30 – 50 mkday q 8h
Kemicetine
IV: 30 mkday q 8h
Chloromycetin
Anaerobia Susp : 125mg/5ml
CEPHALOSPORINS
Tab : 250mg
1st Generation
Servizol Susp: 200mg/5ml
Cefalexin (25 – 100 mkd ) q 6-8 h
Tab : 250mg 500mg
Lexum Cap : 250mg; 500mg
Flagyl Susp : 125mg/5ml
Cefalin Susp : 125mg/5ml 250mg/5ml Tab : 250mg 500mg
Keflex Drops : 100mg/ml Etofamide (15 – 20 mkd) TID
Ceporex Cap : 250mg 500mg Kitnos Susp : 125mg/5ml
Selzef Caplet: 1 gm Tab : 200mg 500mg
Granules: 125mg/5ml 250mg/5ml
Drops: 125mg/1.25ml
2nd Generation
Diloxanide furoate (20mkd) q8h x 10 days
Cefaclor (20 – 40 mkd ) q 8 – 12 h
Furamide Tab : 500mg
Ceclor Pulvule: 250mg 500mg 375mg 750mg
Dilfur Susp: 125mg/5ml
Ceclor CD Susp: 125mg/5ml 187mg/5ml
Secnidazole
CD ext release 250mg/5ml 375mg/5ml
Drops: 50mg/ml Flagentyl 2 tab now then 2 tabs after 4 hrs
Xelent Cap : 250mg 500mg Ercefuryl (20mkday)
Vercef Susp : 125mg/5ml 250mg/5ml
ANTIVIRAL
Acyclovir (20 mkdose) q 4 – 6 h
Max 800mg/day x 5 days
Cefuroxime (20 – 40mkd) q 12h Zovirax Susp: 200mg/5ml
Zinnat Cap : 250mg 500mg Acevir Blue: 400mg
Sachet: 125mg/sat 250mg/sat Pink: 800mg
Susp: 125mg/5ml
Cefprozil (20 – 40mkd) q 12h ORAL ANTI-FUNGALS
Procef Susp : 125mg/5ml 250mg/5ml Ketoconazole (6mkd) q 4 – 6h
3rd Generation Daktarin Adult & Child: ½ tsp q 6h
Cefixime (6 – 12 mkd) q 12h Infant: ¼ tsp q 6 h
Tergecef Susp : 100mg/5ml Nystatin
Zefral Drops: 20mg/ml Mucostatin Susp: 100,000 u/5ml
Ultrazime Ready mix susp Tab: 500,000 u
Cefdinir (7mg/kg q 12h OR 14mg/kg OD) Fluoconazole (3 – 6 mkd) OD x 2wks
Omnicef Cap : 100mg Diflucan Cap: 50mg 150mg 200mg
Sachet/ Susp: mg/5ml Vial: 2mg/ml x 100 ml
COTRIMOXAZOLE (TM 5 – 8 mkd) q 12h
Bactille – TS Susp/5ml SMZ 400mg TM 80mg ANTI-HELMINTHICS
Tab 800mg 160mg Oxantel + Pyrantel pamoate (10 – 20 mkd) SD
Bacidal Susp/5ml 400mg 80mg Trichiuriasis: x 2 days Hookworm: x 3 days
Trizole Susp/5ml 400mg 80mg Quantrel Susp : 125mg/5ml
Globaxole Tab 800mg 160mg Tab : 125mg 250mg
Susp/5ml 400mg 80mg Mebendazole *not recommended below 2 yo
Trimethoprim + Sulfadiazone (TM 5 – 8 mkd) Antiox Susp: 50 mg/ml 100mg/ml
Triglobe Tab Sdz 410mg TM 90mg Tab: 125mg 250mg
Forte 820mg 180mg 100 mg BID x 3 days
Susp/5ml 205mg 45mg 500mg SD (>2 yo)
AMINOGLYCOSIDES Albendazole <2 yo: 200mg SD
Tetracycline 25 – 50 mkday q6h >2yo: 400mg SD
Doxycycline 5 mkday BID *may give x 3 days if with severe infestation
Furaxolidone 5 – 8 mkday q6h Zentel Susp: 200mg/5ml
Tab : 400mg
MACROLIDES
Erythromycin (30 – 50 mkd) q 6h
ANTIHISTAMINE
Macrocin Susp: 200mg/5ml
Diphenhydramine HCl (5mkd) q 6h
Ethiocin Drops: 100mg/2.5ml
IM/IV/PO: 1 – 2 mkdose
Erycin Cap : 250mg 500mg
Benadryl Syr: 12.5mg/5ml
Susp: 200mg/5ml
Cap: 25mg 50mg
Drops: 100mg/2.5ml
Inj: 50mg/ml
Erythrocin Film tab: 250mg 500mg
Hydroxyzine (1mkd) BID
Granules: 200mg/5ml
Adult: 10mg BID 25mg ODHS
DS Granules: 400mg/5ml
Drops: 100mg/2.5ml Iterax Syr: 2mg/ml
Tab: 10mg 25mg 50mg
Ilosone/ Tab: 500mg
Ceterizine (0.25mkdose) Solmux Tab: 500mg
6mos - <12mos : 1ml OD Chewable tab 1 tab q 8h
12mos - <2 yo: 1ml OD/BID Carbocisteine Infant Drops QID
2 – 5 yo: 2ml OD / 1ml BID <3mos 0.25ml
6 – 12 yo: 10ml (2 tsp)OD/ 5ml BID 3 – 5 mos 0.5ml
1 tab OD/ ½ tab BID 6 – 8 mos 0.75ml
Adult & >12yo: 1 tab OD 9 – 12 mos 1ml
Virlix Oral drops: 10mg/ml
Oral soln: 1mg/ml Ped Syr TID
Tab: 10mg 1 – 3 yo 5 – 7.5ml 1 – 1 ½ tsp
Allerkid Drops: 2.5mg/ml 4 – 7 yo 7.5 – 10ml 1 ½ - 2 tsp
Syr: 5mg/5ml 8 – 12 yo 10 – 15ml 2 – 3 tsp
Alnix Drops: 2.5mg/ml
Syr: 5mg/5ml Adult Susp TID
Tab: 10mg Adult & >12 yo 10 – 15ml 2 – 3 tsp
Loratadine 1 – 2 yo: 2.5 ml BID
2 – 12 yo (<30 kg): 5ml OD Capsule TID
(>30 kg): 10ml OD Adult & >12 yo 1 cap
Adult & > 12 y : 1 tab OD
Claritin Syr: 5mg/ml Lovsicol Infant drops 50mg/ml
Allerta Tab: 10mg Ped Syrup 100mg/5ml
Loradex Adult Susp 250mg/5ml
Desloratadine 6 – 12 mos: 2ml OD Cap 500mg
1 – 5 yo: 2.5ml OD Ambroxol Infant drops 6mg/ml 75mg/ml
6 – 12 yo: 5ml OD BID
Aerius Syr: 2mg/5ml < 6 mo 0.5ml 0.5ml
Tab: 5mg 7 – 12 mo 1 ml 0.75ml
13 – 24 mo 1.25ml 1ml

DECONGESTANT Pedia Syrup

<2 yo 2.5ml BID
Nasal
2 – 5 yo 2.5ml TID
NaCl 2 – 4 drps/spray per nostril TID/QID
5 – 10 yo 5ml TID
2 sprays/nostril then suction q6h x 3 days
Salinase Nasal spray
Adult Syrup
Muconase Nasal drops
Adult & >10 yo 5ml TID
Oxymetazoline HCl 2 – 5 yo: 2 – 3 drops/nostril BID
>5 yo: 2 – 3 sprays/nostril BID Retard cap
Drixine Nasal spray: 0.05% Adult & >10 yo 1 cao OD
Nasal soln: 0.025%
Xylometazoline < 1 yo: 1 – 2 drps OD/BID Tab
HCl 1 – 6 yo: 1 – 2 drps OD/BID max TID Adult & >10 yo 1 tab TID
Adult: 2 – 3 drps / 1 squirt TID max QID
Otrivin Inhalation
Oral <5 yo 1 – 2 inhalation of 2ml soln daily
Phenylpropanolamine HCl (0.3 – 0.5 mkdose) Adult & children >5 yo 1 – 2 inhalation of 2 – 3ml
Disudrin 1 – 3 mos: 0.25 ml soln daily
4 – 6 mos: 0.5 ml Mucosolvan Infant drops 6mg/ml
7 – 12 mos: 0.75 ml Ped liquid 15mg/5ml
1 – 2 yo: 1 ml Adult liquid 30mg/5ml
2 – 6 yo: 2.5 ml Retard cap 75mg
7 – 12 yo: 5 ml Tab 30mg
Drops: 6.25ml q6h Inhalation Soln 15mg/2ml
Syr: 12.5mg/5ml q6h Ampule 15mg/2ml
Brompheniramine maleate + PPA Ambrolex Infant drops 7.5mg/ml
Dimetapp 1 – 6 mos: 0.5ml TID/QID Zobrixol Ped liquid 15mg/5ml
7 – 24 mos: 1ml TID/QID Adult liquid 30mg/5ml
2 – 4 yo: ¾ tsp Tab 30mg
4 – 12 yo: 5ml B2 AGONIST
Adult: 5 – 10 ml Salbutamol (0.1 – 0.15 mkdose)
1 tab BID Ventolin Tab 2mg
Infant drops: (0.1mkdose) Syr 2mg/5ml
Syr Nebule 2.5mg/2.5ml
Extentab Ventar Tab 2mg
Carbinoxamine maleate + Phenylephrine HCl Hivent Syrup Syr 2mg/5ml
Rhinoport 1 – 5 yo: 5ml BID Salbutamol + Guaifenesin
6 – 12 yo: 10ml BID Asmalin Tab
Adult & > 12yo: 1 cap / 15ml BID Broncho 1 tab TID
Syrup Syrup
Cap Pulmovent 2 – 6 yo 5 – 10 ml BID/TID
Loratadine + PPA 7 – 12 yo 10ml
Loraped <30 kg: 2.5ml BID
>30 kg: 5ml BID
Syrup: 5mg/ml Terbutaline sulfate ( 0.075 mkdose)
MUCOLYTIC Terbulin Tab 2.5mg
Solmux Drops: 40mg/ml Pulmoxel Tab 2.5mg
1 – 3 mos: 0.5ml TID/QID Syr 1.5mg/5ml
3 – 6 mos 0.75ml Nebule 2.5mg/ml
6 – 12 mos 1ml Bricanyl Tab 2.5mg
1 – 2 yo 1.5 ml Syr 1.5mg/5ml
Nebule 5mg/2ml
Susp: 100mg/5ml Expectorant
200mg/5ml Doxophelline (6 – 8 mkdose) BID x 7 – 10 days
2 – 3 yo 5ml 2.5ml Ansimar Syrup 100mg/5ml
4 – 7 yo 10ml 5 ml Tab 400mg
8 – 12 yo 15ml 7.5ml
Procaterol HCl (0.25ml/kg)
Forte: 500mg/5ml Meptin Syrup 5mcg/ml
Cap: 500mg Tab 25mcg
Adult & >12 yo: 5 – 10ml Nebuliser soln 100mcg/ml
1 cap
Theophylline 10 – 20 mkdose
Solmux Capsule 3 – 5 mkdose
Broncho Suspension
 ANTITUSSIVES Opigesic Suppository: 125mg 250mg
Butamirate citrate 3 yo 5 ml TID Mefenamic Acid (6 – 8mkdose) q 6h
>6 yo 10ml TID Ponstan Suspension: 50mg/5ml
>12 yo 15ml TID Cap SF: 250mg
Adult 15ml QID Tab: 500mg
1 tab TID/QID Aspirin (60 – 100 mkd)
Sinecod Forte Syrup 7.5mg/5ml Ibuprofen (5 – 10 mkday) q8h (max 20mkday)
Tab 50mg Dolan FP Suspension: 100mg/5ml
Dolan Forte 200mg/5ml
Dextromethorphan + Guaifenesin Drops: 100mg/2.5ml
Robitussin – DM 2 – 6 yo 2.5 – 5ml q 6 – 8h Advil 100mg/5
6 – 12 yo 5ml q 6 – 8h Tab: 200mg
Adult 5 – 10ml q 6h IV ANTIBIOTICS
Syrup Penicillin 50,000 – 100,000 ukd q 6h
INHALED STEROIDS Amoxicillin 50 – 100 mkd q 6 – 8 h
Budesonide Ampicillin 50 – 100 mkd q 6 – 8 h
Budecort 250mcg q 12h Chloramphenicol 50 – 100 mkd q 4 – 6 h
500mcg q 12h Ampi + Cloxa 50 – 100 mkd q 6 h
500mcg OD for allergic rhinitis Oxacillin 50 – 100 mkd q 6 – 8 h
250mcg /ml (2ml) Flucloxacillin 50 – 100 mkd q 6 – 8 h
500mcg /ml (2ml) Gentamicin 5 – 7.5 mkd OD
Flexotide neb 250mcg /ml (2ml) Netromycin 5mkd q 12 h
250mcg q 12h Amikacin 15mkd q 12 h
Cephalexin 50 – 100 mkd q 6 h
ORAL STEROIDS LD: 10mkdose 200mg Cefuroxime 50 – 100 mkd q 6 – 8 h
MD: 5mkdose Ceftriazone 50 – 100 mkd OD
Prednisone 1 – 2 mkday Ceftazidime 50 – 100 mkd q 12 h
Prednisolone 1 – 2 mkday HYDROCORTISONE LD: 10 mkdose
Liquidpred Syrup 15mg/5ml MD: 5 mkdose q 6, 8 or 12h
*max dose: LD 200 MD 100
ANTACIDS ANTICONVULSANT
Maalox 5ml/10kg Diazepam 0.2 – 0.3 mkdose
(plain, plus) Available in 180ml bottle Drip: 1amp in 50cc D5W
Simethicone 10mg/amp
Restime < 2 yo 0.5ml qid Midazolam 0.15 mkdose OR
2 – 12 yo 4ml qid 0.05 – 0.2 mkdose
Oral drops 40mg/ml Phenobarbital LD: 10 mkdose q 12h
ANTISPASMODIC MD: 5 mkdose q 12h
Dicycloverine 6mos – 2 yo 0.5 – 1ml TID ANTIHYPERTENSIVES
Relestal Drops 5mg/ml Hydralazine PO: 0.75 – 1.0 mkday q 6 – 12 h
Syrup 10mg/5ml Apresoline IV: 0.1 – 0.2 mkdose
Domperidone 0.3 – 0.6 mkdose q 6 – 8 h Spirinolactone 1 – 3 mkday
2.5 – 5ml/10kg BW TID ANTI-TB MEDS
Dyspepsia: 2.5/10kg TID Isoniazid (10 – 12 mkd) ODAC or 2hrs PC
Nausea: 2.5 – 5ml/kg TID Comprilex Suspension:
0.3 – 0.6 ml/5kg BW TID/QID Nicetal 200mg/5ml
Motilium Susp 1mg/ml Trisofort 100mg/5ml
Tab 10mg Odinah 200mg/5ml
Vometa Oral drops 5mg/ml 150mg/5ml
Susp 5mg/5ml Tablet 400mg
Tab 10mg Rifampicin (10 – 20 mkd) ODAC or 2hrs PC
H2-BLOCKER Natricin 100mg/5ml 200mg/5ml
Ranitidine 1 – 2 mkdose q 12h Rifadin 100mg/5ml
Zantac Tab 75mg 150mg 300mg 100mg/5ml
Cimetidine Neonates: 5 – 20 mkday q6 – 12 h Rimactane 200mg/5ml
Infants: 10 – 20 mkday Rimaped Tablet 300mg 450mg
Child; 20 – 40 mkday Pyrazinamide (PZA) (16 – 30 mkd) BID/TID
Adult: 300mkdose QID CIBA 250mg/5ml
400mkdose BID Zcure
800mkdose QID Zinaplex 500mg/5ml
Tagamet Susp: 300mg/5ml Tablet 500mg
Tab: 100mg 200mg 300mg 400mg 800mg
Famotidine PO: 0.5 mkdose q 12 h
IV: 0.6 – 0.8 mkday q 8 – 12h COMPOSITION OF ORS
Na K Cl Glu
ANTIPYRETIC Glucolyte 60 20 50 100
Paracetamol (10 – 20 mkdose) q 4h Hydrite 90 20 80 111
Tempra Drops: 60mg/0.6ml WHO 75 20 65 75
Syrup: 120mg/5ml Pedialyte 30 30 20 30
Forte : 250mg/5ml 45 45 20 35
Tablet: 325mg 500mg 90 90 20 80
Calpol Drops: 100mg/ml Gatorade 41 11 9/100
Syrup: 120mg/5m
250mg/5ml
Defebrol Syrup: 120mg/5m
250mg/5ml IMMUNIZATION
Afebrin Drops: 60mg/0.6ml
Syrup: 120mg/5ml Vaccine Min age 1st No of interval booster
Forte : 250mg/5ml dose dose
Tablet: 600mg BCG At birth 1 - -
Tylenol Drops: 80mg/ml Before 1 mo
Syrup: 160mg/5ml DPT 6 wks 3 4 wks 18 mos
Naprex Drops: 60mg/0.6ml (2, 4, 6 mos) 4 – 6 yo
Syrup: 250mg/5ml OPV/IPV 6 wks 3 4 wks Same as
Inj: 300mg/2ml 2, 4, 6 mos) DPT
Rexidol Drops: 60mg/0.6ml Hep B At birth 3 6 wks from
Syrup: 250mg/5ml (0, 1, 6 mos) 1st dose, 8
Tablet: 600mg EPI (6, 10, 14) wks from 2nd
Biogesic Drops: 100mg/ml dose
Syrup: 120mg/5m Measles 6 – 9 mos 1 -
250mg/5ml
Tablet: 500mg MMR 15 mos 1
Aeknil Ampule (2ml) 150mg/ml
Hib 2, 4, 6 mos 18 mos Signs of Respiratory Failure
Retractions - - Subcostal/ Subcostal/
Pneumococcal 6 mos (PCV7) 18 mos Intercostal Intercostal
2 yrs (PPV) Head babbing - - + +
Rotavirus 3 and 5 mos 2 I month Cyanosis - - + +
Grunting - - - +
Hep A 1 yr and up 2 6 – 12 mos Apnea - - - +
apart Sensorium None Awake Irritable Lethargy /
Varicella 1st: 12 – 15 2 Bet 1st and Stupor
mos 2nd dose: at Coma/
2nd: 4 – 6 yo least 3 mos Complication:
Flu 6 months yearly Effusion None None Present Present
Pneumothorax
Action Plan OPD OPD Admit to Admit to
f/u at end of tx f/u after 3 regulat ward CCU
COMPOSITION OF IV SOLUTION
days Refer to
Fluid Na K Cl HCO3 Dxt specialist
PNSS 154 - 154 - -
0.45 NaCl 77 - 77 - -
D5 0.3 NaCl 51 - 51 - 5 Clinical Practice Guidelines in the Evaluation and Management of PCAP 2004
D5 LRS 130 4 109 28 5 Predictors of CAP in patients with cough
D5 NM 40 13 40 16 5 (3 mos to 5 yrs) – tachypnea &/or chest retractions
D5 IMB 25 20 22 23 5 (5 – 12 yrs) – fever, tachypnea & crackles
D5 NR 140 5 98 27 5 (>12 yo) – (a) fever, tachypnea & tachycardia; (b) at least 1 AbN CXR
WHO Age Specific classification for tachynea
Na requirement : 2 – 4 meq/k/day 2 – 12 mos: >50 RR
K requirement: 2 – 3 meq/k/day 1 – 5 yrs: >40 RR
KIR: 0.2 – 0.3 meq/k/hr max of 40 meq >5 yrs: >30 RR
PCAP A/PCAP B
KIR = Rate x incorporation No diagnostic usually requested
wt PCAP C/PCAP D
The ff shud b routinely requested
Electrolyte correction computation o CXR APL (patchy – viral; consolidated – bacterial)
o WBC
o C/S (blood, Pleural Fluid, tracheal aspirate on initial intubation)
ASSESSMENT OF DEHYDRATION [CDD] o Blood gas/Pulse oximeter
PARAMETER NO SIGN SOME SIGN SEVERE The ff may be requested: C/S sputum
Condition Well, Alert RestlessI Lethargic The ff shud NOT be routinely requested
Irritable Unconscious o ESR
Floppy o CRP
Eyes Normal Sunkem Very sunken
Dry Antibiotic Recommendation
Tears Present Absent Absent 1. PCAP A/PCAP B and is beyond 2 yo & having fever w/o wheeze
Mouth/Togue Moist Dry Very dry 2. PCAP C and is beyond 2 yo, having high grade fever, having alveolar
Thirst Drinks normally Thirsty Drinks poorly consolidation on CXR, having WBC >15,000
Not thirsty Drinks eagerly Not able to drink 3. PCAP D – refer to specialist
Skin pinch Goes back quicly Goes back slowly Goes back very Antibiotic Recommendation
slowly 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
ORAL REHYDRATION THERAPY
PCAP C who had no HiB immunization
PLAN A AGE Amount ORS to give/loose stool o Ampicillin IV (100mkd) QID
50 – 100 ml PCAP D – refer to specialist
100 – 200 ml
As much as wanted
PLAN B Amount of ORS to give in 1st 24 hrs: What should be done if px is not responding to current antibiotics
Weight (kg) x 75ml/kg 1. If PCAP A/PCAP B not responding w/n 72 hrs
PLAN C AGE 30ml/kg 70ml/kg a. Change initial antibiotic
Infants (<1 yo) 1 hr 5 hrs b. Start oral Macrolide
Children (>1 yo) 30 mins 2.5 hrs c. Reevaluate dx
2. PCAP C no responding w/n 72 hrs consult w/ specialisr
In fluid resuscitation: use 20cc/kg as bolus. Usually PLR a. PCN resistant S pneumonia
b. Complication
c. Other dx
3. PCAP D not responding w/n 72hrs, then immediate consultto a specialist is
FLUID MANAGEMENT warranted
Severity Less than 2 yo More than 2 yo Switch from IV to Oral Antibiotic done in 2 – 3 days after initiation in px who:
Mild 50cc/kg 30cc/kg Respond to initial antibiotic
Moderate 100cc/kg 60cc/kg Is able to feed with intact GI tract
Severe 150cc/kg 90cc/kg Does not have any pulmo or extra pulmo complication
To run for 6 – 8 hrs then refer Ancillary Treatments
Usual fluid is D5 0.3 NaCl; if however more than 40 kg then D5 LR O2 and Hydration
Bronchodilators, CPT, steam inhalation and Nebulization
Prevention
Vaccines
PCAP Zinc Supplementation
VARIABLE PCAP A PCAP B PCAP C PCAP D o 10mg for infants
Minimal Risk Low Risk Moderate High Risk o 20mg for children > 2 yo
Risk
Comorbid None Present Present Present
Illness DENGUE HEMORRHAGIC FEVER
Compliant Yes Yes No No Serotype 1, 2, 3, & 4
caregiver Aedes egypti
Ability to Possible Possible Not Not IP: 4 – 6 days (min 3 days; max 10 days)
follow up DHF SEVERITY GRADING
Presence of None Mild moderate Severe
dehydration GRADE MANIFESTATION
Ability to feed Able Able Unable Unable I Fever, non-specific constitutional symptoms such as
Age >11 mos >11 mos <11 mos <11 mos anorexia, vomiting and abdominal pain (+) Torniquet test
RR II Grade I + spontaneous bleeding; mucocutaneous, GI
2 – 12 mos >50/min >50/min >60/min >70/min III Grade II w/ more severe bleeding +
1 – 5 yo >40/min >40/min >50/min >50/min Evidence of circulatory failure: violaceous, cold & clammy
>5 yo >30/min >30/min >35/min >35/min skin, restless, weak to imperceptible pulses, narrowing of
 pulse pressure to < 20mmHg to actualHPON o Adenosine / synchronize cardioversion – SVT
IV Grade III but shock is usually refractory or irreversible and o Defibrillation – Venticular fibrillation
assoc w/ massive bleeding

MUMPS [Paramyxoviridae]
MOT Direct contact, airborne droplets, fomites contaminated by
CRITERIA FOR CLINICAL DX (WHO) saliva
DHF DSS IP 16 – 18 days
Fever, acute onset, high, lasting 2 Above criteria Prd of comm 1 – 2 days before onset of parotid swelling until 5 days after the
– 7 days Plus onset of swelling
Hemorrhagic man: Hypotension or narrow pulse Prodorme Fever, neck muscle pain, headache, malaise
o (+) Torniquet test pressure [SBP – DBP] Parotid gland Peak in 1 – 3 days
o Minor & Major <20mmHg swelling 1st in the space between posterior border of mandible &
bleeding phenomenon mastoid then extends being limited above zygoma
3
Thrombocytopenia <100,000/mm Complications Meningoenephalitis - most frequent, about 10 days; M>F
Orchitis & Epididymitis
Oophoritis
LEVELS OF ASTHMA CONTROL [GINA GUIDELINES] Dacryoadenitis or optic neuritis
CONTROLLED PARTLY UNCONTROLLED
Daytime symptom None [2x or More than 2x a Three or more
less/week] week features of partly ANAPHYLAXIS
Limitation of None Any controled asthma A syndrome involving a rapid & generalized immunologically mediated rxn
activities present in any After exposure to foreign allergens in previously sensitized individuals
Nocturnal None Any week A true emergency when cardio and respi system are involved
sx/awakening ED Management
Need for None More than 2x a o O2
reliever/recue tx week o Aqueous Epinephrine 1:1000 IM (0.01ml/kg with 0.5ml max)
Lung function Normal 80% predicted o Prepare intubation if w/ stridor & if initial therapy of epi is not
(PEF OR FEV1) effective
Exacerbation None One or more/yr One in any week 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
ATOPIC DERMATITIS CONTACT SEBORRHEIC (Hydrocortisone 5mg/kg/dose)
DERMATITIS DERMATITS o Epinephrine 1:10,000 IV (0.1ml/kg; 10ml max)
Hereditary, AR Irritant – strong excessive sebum o Epinephrine drip (0.01ml/kg/min)
hx of Asthma chem. accumulation on Indication for Admission
thickened, shiny, e.g. diaper rash scalp, face, o Persistent bronchospasm
red remove reactant midchest, o Hypotension requiring vasopressors
exacerbated by perineum o Significant hypoxia
dry skin, contact Allergic greasy scalp o Patient resides some distance from a hospital facility
sty, & anxiety (cradle cap)
tx: e.g. cosmetic, physiologic 1st
hydrocortisone/ perfume 6mos
fluocinolone tx: high/mod tx: low potency
moisturizer petency steroid steroid
cloxa/cefalexin if VIRAL INFECTIONS
with infxn MEASLES (Rubeola) [Paramyxoviridae]
MOT Droplet spray
SHOCK IP 10 – 12 days
CO = HR x SV Prd of comm 4 days before & 4 days after onset of rash
CO is primarily maintained by changes in HR Enanthem Koplik spots (opposite lower molars)
HYPOVOLEMIC Pump empty MC in infant Prodrome High grade fever, conjunctivitis, catharr (3 – 5 days)
Truma, hemorrhage, &children Rash Appear during height of fever
DHN Normal BV of Cephalocaudal[1st along hairline, face, chest]
(diarrhea/vomiting), children 80ml/kg [+] brawny desquamation – disappear w/n 7 – 10 days
Metabolic dse (DM) Complication 1. Otitis media
Excessive sweating 2. Pneumonia
CARDIOGENIC Weak/sick pump Compromise 3. Encephalitis
CHF, cardiomegaly, CO 4. Diarrhea
drug intoxication, 5. Exacerbation of M tb infection
hypothermia, after Tx Vit A SD 100,000 IU orally for 6 mos – 1 yo
cardiac surgery 200,000 IU >1 yo
DISTRIBUTIVE Sepsis Redistribution of Post Ig w/n 6 days of exposure
Anaphylaxis fluid w/n exposure (0.25ml/kg max 15 ml) IM
Barbiturate intox vascular space prophylaxis
CNS injury (SCI) Vaccine Susceptible children >1 yo w/n 72 hrs
SIGNS OF SHOCK SSPE Chronic condition due to persistent measles infxn
EARLY LATE Rare but found in 6 mo to >30 yrs of age
Narrowed pulse pressure Decrease systolic pressure Subtle change in behavior & deterioration o schoolwork
Orthostatic changes Decrease diastolic pressure followed by bizarre behavior
Delayed capillary filling Cold, pale skin Elevated titers of Ab to measles virus(IgG, IgM)
Tachycardia Altered mental state Inosiplex (100mg/kg/day) may prolong survival
Hyperventilation Diaphoresis GERMAN OR 3 DAY MEASLES [RUBELLA] [Togaviridae]
Decrease urine output MOT Oral Droplet; transplacentally to fetus
ED 1. Position IP 14 – 21 days
MNGT 2. Oxygen Prd of comm 7 days before &7 days after onset of rash
3. Assisted ventilation Enanthem Forchheimer spots [soft palate] just b4 onset of rash
4. Intravenous access Rash Cephalocaudal
5. Fluid (isotonic crystalloid)
Characteristic Retroauricular, posterior cervical & postoccipital LAD [24 hrs
6. Reassess (look for improvement in VS, skin signs, mental
sign before rash & remains for 1 wk]
status; insert foley cath & monitor UO)
Tx Vit A SD 100,000 IU orally for 6 mos – 1 yo
7. Inotropes – help stabilize BP
200,000 IU >1 yo
o Epinephrine - (0.1 – 1 ug/kg/min)
Infusion of choice for Hypotensive pxs Post Immunoglobulin [not routine]
o Dobutamine - (5 – 20 ug/kg/min) exposure Considered if termination of preg is not an option
Cardiogenic shock but not severely hypotensive prophylaxis 0.55ml/kg) IM
o Dopamine – [(5 – 20 ug/kg/min αconstrictor Vaccine w/n 72 hrs of exposure
effect) [(10 – 15 ug/kg/min] Congenital Greatest during 1st trimester
Distributive shock after successful fluid Rubella IUGR
resuscitation Congenital cataract, microcephaly, PDA, “blueberry
8. Cardiogenic shock muffin” skin lesions
o Diuretic – pxs may get worse after fluid challenge Congenital or profound SNHL
 Motor or mental retardation HENOCH – SCHONLEIN PURPURA [HSP]
ROSEOLA [HSV 6] Exanthem subitum Most common cause of nonthrombocytopenic purpura in children
Age of onset < 3 yo with peak at 6 – 15 months Typically follows URTI
High grade fever for 3 – 5 days but behave normally 2 – 8 years old
Rash Appears 12 – 24 hrs of fever resolution fades in 1 – 3 days Hallmark Rash – palpable petechia or purpura, evolve from red to
HERPANGINA [Coxsackie A] brown; last from 3 – 10 days [LE and buttocks]
Sudden onset of fever with vomiting Arthritis of knees and ankles
Small vesicles & ulcers w/ red ring found in anterior tonsillar pillars, Intermittent abdominal pain due to edema & damage to
may also seen on the soft palate, uvula & pharyngeal wall the vasculatue of the GIT
Mngt Symptomatic
Steroid for severe abdominal pain
VARICELLA [HSV]
MOT Direct contact
IP 14 days MAINTENANCE WATER
Prd of comm 1 – 2 days before the onset of the rash until 5 – 6 days after HOLLIDAY – SEGAR METHOD
onset & all the lesions have crusted Weight [kg] Daily Requirement [ml/kg]
Rash Start from the trunk then spread to othe parts of the body 3 – 10 100 ml
All stages present; pruritic 10 – 20 1000 + 50ml/kg for each kg >10
Macule/papule → vesicle →crust >20 1500 + 20ml/kg for each kg >20
Complication Secondary bacterial infection Maintenace water rate
Encephalitis or meningitis 0 – 10 4ml/kg/hr
Pneumonia 10 – 20 40 mk/hr + 2ml/kg/hr x wt
Reye syndrome >20 60 mk/hr + 1ml/kg/hr x wt
GN
Congenital 6 -12 wks AOG: maximal interruption w/ limb devt with
Varicella cicatrix(ski lesion w/ zigzag scarring)
16 – 20 wks: eye and brain involvement Microbial causes of CAP accrdng to Age
Tx Acyclovir 15 – 30 mg/kg/day IV or 200 – 400 mg tab q 4hrs Birth to 20 o Grp B Strep
minus midnight dose x 5 days: increased risk o severity days o Gram (-) enterobacteria
Post VZIg 1 dose up to 96 hrs after exposure o CMV
exposure Dose: 125 U/10 kg (max 625 U) IM o L. monocytogenesis
prophylaxis NB whos mother develop varicella 5 days before to 2 days after 3 weeks to 3 o RSV
delivery shud recv 1 vial months o Parainfluenza virus
Vaccine Susceptible children >1 yo w/n 72 hrs o S. pneumonia
ERYTHEMA INFECTIOSUM [Parvovirus B 19] FIFTH DISEASE o B. pertussis
MOT Droplet spread & blood & blood products o S. aureus
IP 16 – 17 Days average 4 months to 4 o RSV, Parainfluenza virus
yo o Influenza virus, Adeno, Rhinovirus
Prodrome Low grade fever, headache, URTI
o S. pneumonia
Rash Erythematous facial flushing “slapped cheek” and spreads
o H. influenzae
rapidly to the trunk & proximal extremities as a diffuse macular
o M.pneumoniae
erythema
o M.tuberculosis
Palms & soles are spared
5 years to o M.pneumoniae
Resolves w/o desquamation but tend to wax and wane in 1 – 3
15 years o C. pneumoniae
wks
o S. pneumonia
o M.tuberculosis
Dengue insert
Rabies
Therapeutic Mgt of CAP
JUVENILE RHEUMATOID ARTHRITIS [JRA]
Criteria Age of onset <16 yo OPD Mngt
Arthritis (swelling or effusion or presence of 2 or more of: Birth to 20 Admit
limitation of range of motion, tenderness or pain on days
motion, increased heat in one or more joints. 3 weeks to 3 Afebrile: Oral Erythromycin (30-40mkd)
Duration: 6 wks or longer months Oral Azithromycin (10 mg/kg/day) day 1
Onset type defined in the 1st 6mos 5mkday day2 to 5
o Polyarthritis: (5 or more inflamed joints) Admit: febrile or toxic
o Oligoarthritis (<5)
o Systemic arthritis w/ characteristic fever 4 months to 4 Oral Amoxicillin (90mkd/3doses)
CM Morning stiffness, ease of fatigue esp. after school in the yo Alternative: Amox-Clav, AZM, Cefaclor
early afternoon, joint pain later in the day, joint swelling Clarithromycin, Erythromycin
Pauci: LE, assoc w/ chronic uvietis 5 years to Oral Erythromycin (30-40mkd)
Poly: both large & small joints more severe if extensors 15 years Oral AZM 10mkday day 1, 5mkday day 2-5
of elbow and Achilles tendon are involved Clarithromycin 15mkday/2 doses
Systemic: quotidian fever w/ daily temp spikes of 39°C Pneumococcal infxn: Amoxicillin alone
for 2 wks; faint red macular rash over the trunk &
proximal extremities IN-PATIENT
Mngt NSAIDS then Methotrexate Birth to 20 Ampicillin + Gentamicin w or w/o Cefotaxime
Seroid for overwhelming systemic illness days
3 weeks to 3 Afebrile: IV Erythromycin (30-40mkd)
SYSTEMIC LUPUS ERYTHEMATOSUS [SLE] months Febrile: add Cefotaxime 200mkd
Criteria Malar rash Cefuroxime 150 mkd
Discoid rash
Photosensitivity 4 months to 4 If w/ pneumococcal infection:
yo IV Ampicillin (200mkd) Cefotaxime 200mkd
Oral ulcers (painless)
Cefuroxime 150 mkd
Nonerosive arthritis (2 or more joints)
Serositis (pleuritis, serous pericarditis,Libman sacks 5 years to Cefuroxime 150 mkd + Erythromycin 40mkd
endocarditis 15 years IV or orally for 10-14 days
Renal disorder If pneumococcal is confirmed:
Neurologic disorder Ampicillin 200mkd
Hematologic disorder
Immunologic disorder
ANA abormal titer
Dx Presence of 4 of 11 criteria [ANA not required dx] CLINICAL FEATURES of PNEUMONIA
(+) ANA – screening Bacterial o Fever >38.5C
Anti ds DNA – more specific; reflects the degree of o Chest recession
disease activity o Wheeze not a sign of primary
Decrease C3, C4 in active dse bacterial URTI
Anti Sm Ab (most specific) Viral o Wheeze
Mngt NSAIDS use w/ caution o fever < 38.5
Prednisone (1 – 2 mkday) o marked recession
Severely ill: pulse IV steroid (30mkdose) max 1 gm over o RR normal or increased
60 mins OD x 3 days Mycoplasma o School children
Severe dse: Pulse IV Cyclophosphamide to maintain o Cough
renal fxn & prevent progression o wheeze
CXR in assessing CAP etiology <3
Alveolar infltrates Bacterial pneumonia > No No No No
Interstitial infiltrates Viral pneumonia < 7 yo Dtap is recommended
Both infiltrates Viral, Bacterial or mixed viral > 7 yo Td is recommended
bacterial pneumonia 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)
PHOTOTHERAPY Give TT (all clean wds) if > 5 yrs since last dose
o 10 Bulbs
o 20 watts BILIRUBIN METABOLISM
o 200 hrs RBC
o 30 cms
o Bilirubin in the skin absorbs light energy Heme +Globin
o Photo-isomerization reaction converting the toxic native Heme
unconjugated 4Z, 15Z-bilirubin into an unconjugated oxygenase
configurational isomer 4Z,15E-bilirubin, which can then be
excreted in bile without conjugation Biliverdin
o major product from phototherapy is lumirubin, which is an Bilirubin
irreversible structural isomer converted from native bilirubin and reductase
can be excreted by the kidneys in the unconjugated state
o Complications Unconjugated bilirubin
o loose stools, erythematous macular rash, purpuric rash
associated with transient porphyrinemia, overheating, Enterohepatic pathway
dehydration (increased insensible water loss, diarrhea), Liver SER
hypothermia from exposure, and a benign condition called Glucoronyl transferase B-
bronze baby syndrome dark, grayish-brown skin discoloration in glucoronidase
infants
Conjugated bilirubin

Treatment of Hyperbilirubinemia Kidney Small intestine

Phototherapy Urobilinogen Stercobilinogen
Exchange o Complications: metabolic acidosis, Urobilin Stercobilin
transfusion electrolyte abnormalities, Urine Stool
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 Pathogenesis of Dengue Hemorrhagic Fever
o (0.5–1.0 g/kg/dose; repeat in 12 hr)
o Reducing hemolysis Dengue Virus
Metalloporphyrins o Competitive enzymatic inhibition of the
rate limiting conversion of heme-protein
to biliverdin (an intermediate metabolite Liver Lymphoblast/plasma Platelet
to the production of unconjugated Cell
bilirubin) by heme-oxygenase
o Patients with ABO incompatibility or
G6PD deficiency or when blood Liver injury Ag-Ab reaction Dec
products are discouraged as with maturation
Jehovah's Witness patients
Megakaryocyte
VACCINES Inc plt
BCG Live attenuated M bovis destruction
DPT Diptheria and TT – inactivated B pertussis
OPV Sabin trivalent live attenuated virus
IPV Salk inactivated virus Dec coagulation Inc Vascular
MMR, Live attenuated virus Thrombocytopenia
Measles Factors Permeability
Varicella Recombinant DNA, plasma derived
Hep B Inactivated virus
Hep A Capsular polysacc linked to carrier CHON Inc. Bleeding Hypoalbuminemia
Hib Live typhoid vaccine – 3 doses x 2 days Bleeding
Typ IMSC – Vi antigen typ vaccine Tendency Hemoconc.
Capsular polysaccharide 0.5 ml Pleural Effusion
Pneumococcal SC /IM – 23 valent purified cap
Polysacc Antigen of 23 serotyp
Split or whole virus IM Hypotension
Influenza

MANAGEMENT APPROACH BASED ON CONTROL

RABIES VACCINE Step 1 Step 2 Step 3 Step 4 Step 5
VERORAB 0.5 cc/amp; 1 amp IM PRN Asthma education and Environmental
Day: 0 3 7 14 and 28 B2 control
BERIRAB RD: 20 iu/kg agonist As needed rapid acting B2 agonist
300 iu/vial 1 vial = 2ml Select one Select one Add one or Add one
½ at wound site more or more
½ deep IM C Low dose Low dose Med to Hi Oral
Reqd amt in IU: wt x RD (20IU) O ICS ICS + dose steroids
Amount in ml = wt x RD (20) x 2 N LABA ICS +
300 T LABA
Ig (Human) 20 iu/kg R Leukotriene Medium or Leukotriene
Bayrab 300 iu/2ml O modifier Hi dose ICS Modifier Anti
Equine Berirab 300 iu/2ml L Low dose Sustained IgE
40 iu/kg L ICS + Release treatment
Favirab 200 – 400 iu/5ml E Leukotriene theophylline
1000 – 2000 iu/5ml R Modifier
Low dose
Hx of Clean minor Wound All other Wounds ICS +
Absorbed Salbutamol
TT Release
Td TIG Td TIG theophylline
Unknown or Yes No Yes Yes
 BELLS PALSY
SEVERITY OF ASTHMA EXACERBATION Acute unilateral facial nerve palsy that is not associated with other
MILD MODERATE SEVERE RESPIRATORY cranial neuropathies or brainstem dysfunction
ARREST Usually develops abruptly about 2 wks after SVI [EBV, HSV, mumps]
IMMINENT Upper and lower portions of the face are paretic
Breathless Walking Talking At rest Corner of the mouth droops
Infant –softer Infant Unable to close the eye on the involved side
shorter cry stops Protection of cornea with methylcellulose eye drops or an ocular
Diff feeding feeding lubricant
Excellent prognosis
Can lie Prefers sitting
Hunched CEREBRAL PALSY
Talks in Sentence Phrases Words Non-progressive disorder of posture & movement often associated with
s epilepsy & abnormalities of speech, vision & intellect resulting from
Allertness Usually Usually Drowsy or defect or lesion of the developing brain
May b agitated agitated confused Etiology: infections, toxins, metabolic, ischemia
agitated
Classification
RR Inc >30/min
Normal RR Inc Physiologic Topogrphic
<2 mo [major motor abnormality] [involved extremities]
2-12 mo <60/min 1. Spastic 1. Monoplegia [1 side/portion]
1-2 y <50/min 2. Athetoid –worm like 2. Paraplegia
2-8 y <40/min 3. Rigid 3. Hemiplegia
<30/min 4. Ataxic 4. Triplegia [3 limbs]
Acessory Usually Usually Usually Paradoxical 5. Tremor 5. Quadriplegia [all]
ms not Thoracoabd movt 6. Atonic 6. Diplegia [LE/UE]
Wheeze Moderate Loud Usually Absence of 7. Mixed 7. Double hemiplegia
loud wheeze 8. unclassified
Pulse <100 100-200 >120 Bradycardia Clinical Manifestaion
Normal PR Spastic hemiplegia Arms > legs
2-12 mo <160/min Dificulty in hand manipulation obviously by 1 yo
1-2 y <120/min Delayed walking or walk on tiptoes
2-8 y <110/min Spasticity apparent esp. in ankles
Pulsus Absent Maybe present Often Absence Seizure & cognitivr impairment
paradoxus 10-25mmHg present suggests resp ms Spastic diplegia Bilateral spasticity of the legs
<10mmH 20-40 fatigue Commando crawl
g mmHg Increased DTRs & (+) Babinski sign
PEF >80% 60-80% <60% Normal intellect
PaO2 Normal >60 mmHg <60mmH Spastic Most severe form, due to marked motor
g quadriplegia impairment of all extremities & high association
PaCO2 <45 <45 mmHg with MR & seizures
mmHg >45 Swallowing difficulties
O2 Sat 91-95% mmHg Management
>95% Baseline EEG & cranial CT scan
<90% Hearing & visual function tests
Multidisciplinary approach in the assessment & treatment
For tight heel cord: tenotomy of the Achilles tendon

SEIZURE
BENIGN FEBRILE SEIZURE CRITERIA
6 mos – 6 yrs
< 15 mins ESSENTIAL NEWBORN CARE PROTOCOL [from DOH]
Febrile o What should be done immediately after birth is to dry the baby because
Family history of febrile seizure hypothermia can lead to several risks
GTC o Delaying the cord clamping to 3 mins after birth (or waiting until the
Not > 1 episode in 1 febrile episode; EEG done after 2 wks of umbilical cord has stopped pulsing)
seizure episode o Instead of immediately washing the NB, the baby should be placed on
3% of general population develop epilepsy the mother’s chest or abdomen to provide warmth, increase the duration
1 – 2 % of BFS develop epilepsy of breastfeeding, and allow the “good bacteria” from the mother’s skin to
25% recurrence of seizure infiltrate the NB
Seizure – paroxysmal, time limited change in motor activity and/or o Washing should be delayed until after 6 hours because this exposes the
behavior that results from abnormal electrical activity in the brain NB to hypothermia and remove vernix. Washing also removes the baby’s
Epilepsy – present when 2 or more unprovoked seizure s occur at crawling reflex.
an interval greater than 24 hrs apaet

HYDROCEPHALUS APGAR SCORE

Result from impaired circulation & absorption of CSF or from inceased o Evaluates the need for resuscitation
production o Taken 1 and 5 minutes after birth
Obstructive or Noncommunicating 0 1 2
o Due to obstruction w/n ventricular system Color Blue, pale Body pink, All pink
o Abnormality of the aqueduct or a lesion in the 4th venticle extremities blue
(aqueductal stenosis) HR 0 <100 >100
Non-obstructive or Communicating Reflex irritability No response Grimace Cough
o Obliteration of the subarachnoid cisterns or malfunction of Activity Limp Some flexion Active
the arachnoid villi Respiration Absent Slow, irregular Good
o Follows SAH that obliterates arachnoid villi; leukemic The APGAR Score
infiltrates 8 – 10 Good cardiopulmonary adaptation
Clinical Manifestation 4–7 Need for resuscitation, esp ventilatory support
Infant: accelerated rate of enlargement of the head; wide anterior 0–3 Need for immediate resuscitation
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] NORMAL VALUES
Percussion of skull produce a “crackedpot” or Macewen sign [separation AVERAGE WEIGHT (3,000 grams)
of sutures] 0 – 6 mos Age in months x 600 + BW
Foreshortened occiput [Chiari malformation] 7 – 12 mos Age in months x 500 + BW
Prominent occiput [Dandy-Walker malformation] Children
Treatment 1 – 6 yo Age in years x 2+ 8
Depends on the cause 7 – 12 Age in years x 7 – 5 / 2
Extracranial shunt yo
Acetazolamide & Furosemide [provide temporary relief by reducing the HEAD CIRCUMFERENCE [35 cm (+ 2cm)] (inch =
rate of CSF production] 2.54cm)
1 – 4 months ½ inch per month
5 – 12 mos ¼ inch per month
2 years old 1 inch per year NEONATAL SEPSIS
3 – 5 yo ½ inch per year Classification
6 – 20 yo ½ inch per 5 years Early: birth to 7th day of life
LENGTH (50 cm) Late: 8th to 28th day of life
0 – 3 months 9 cm Risk factors
4–6 8 cm Maternal infection during pregnancy
7–9 5 cm Prolongrupture of membranes (18 hrs)
10 – 12 3cm Prematurity
Common organism:
NEWBORN CARE Bacteria: GBS, E. coli & Listeria (early)
Umbilical Cord Viruses: HSV, enteroviruses
Cut 8 inches above abdomen after 30 sec Signs & symptom
In nursery, cut the umbilical cord 1 ½ inch above the abdomen Non-specific
Healing should take place around 7 – 10 days Dx:
Eye Prophylaxis CBC, CXR, blood and urine culture, lumbar tap for CSF studies
1% silver nitrate drops [most effective against Neisseria] Treatment
Erythromycin 0.5% [Clamydia] Empiric antibiotics [Ampicillin + 3rd gen Cephalosporin or
Tetracycline 1% Aminoglycoside)
Povidone iodine 2.5% supportive
Vitamin K
1 mg Vit K1
PT: 0.5 mg
Vaccine VIRAL CROUP vs EPIGLOTTITIS
BCG VIRAL CROUP EPIGLOTTITIS
Hep B Age group 3 mos to 3 yrs 3 – 7 yrs
Newborn Screening Stridor 88% 8%
Done on 16th hr of life . can be repeated after 2 weeks Pathogen Parainfluenza virus H. influenzae type B
Patients w/ CAH will die 7 – 14 days if not treated Onset Prodrome (1 – 7 days) Rapid (4 – 12 hrs)
Patient w/ CH will have permanent growth defect and MR if not treated Fever Severity Low grade High grade
before 4 weeks Associated sympto Barking cough, Muffled voice,
Disorder Screened Effects Screened Effects if Screened & hoarseness Droolong
treated Respond to Stridor improves None
Congenital Severe MR Normal racemic
Hypothyroidism (CH) epinephrine
Congenital Adrenal Death Alive &Normal CXR “steeple sign” “thumbprint sign”
Hyperplasia (CAH)
Galactosemia (Gal) Death of Cataract Alive &Normal BRONCHIOLITIS
Phenylketonuria PKU Severe MR Normal Acute inflammation of the small airways in children <2 yrs
G6PD Severe Anemia Normal Most commonly caused by RSV
Kernicterus Related to exposure to cigarette smoke
Risk factors for severe dse:
o <6 mos
o Prematurity
o Heart or lung disease
NEONATAL JAUNDICE o immunodeficiency
Risk Factors Signs /Symptoms
o Jaundice visible on first day of life low grade fever, rhinorrhea, cough, wheezing
o A sibling w/ neonatal jaundice or anemia hyperresonance to percussion
o Unrecognized hemolysis CXR
o Non-optimal feeding hyperinflation, interstitial infiltrates
o Deficiency: G6PD Treatment
o Infection Mild [at home]:
o Cephalhemaoma or bruising / Central hct >65% o Increased fluids, trial of inhaled bronchodilators,
o East Asian/ Mediteranean in origin aerosolized epinephrine
PHYSIOLOGIC vs PATHOLOGIC Severe:
FACTORS PHYSIOLOGIC PATHOLOGIC o Admit to hospital if: Marked respratory distress;
Onset > 24 hrs of life < 24 hrs of life Poor feeding; O2 sat <92%; hx of prematurity < 34
Rate of inc of TSB < 0.5mg/dl/hr > 0.5mg/dl/hr wks; underlying cardiopulmonary dse; unreliable
Persistent < 14 days FT: > 8 days caregivers
PT: > 14 days o Manage with ventilatory and O2 support, hydration,
Total S. Bilirubn FT: < 12 mg/dl Any level requiring inhaled bronchodilators and ribavirin
PT: < 14 mg/dl phototherapy
Sign/ Symptom Vomiting, lethargy, poor
feeding, excess wt loss, Age Ht Ht Wt for Boys Girls
apnea, inc RR, temp mo (cm) (cm) Ht (kg) (kg)
instability boys girls (cm)
KRAMER CLASSIFICATION 0 50.5 49.9 49 3.1 3.3
ZONE JAUNDICE mg/dl 1 54.6 53.5 50 3.3 3.4
I Head/neck 6–8 2 58.1 56.8 51 3.5 3.5
II Upper trunk 9 – 12 3 61.1 59.5 52 3.7 3.7
III Lower trunk, thigh 12 – 16 4 63.7 62.0 53 3.9 3.9
IV Arms, leg, below knee 15 – 18 5 65.9 64.1 54 4.1 4.1
V Hands/feet > 15 6 67.8 65.9 55 4.3 4.3
7 69.5 67.6 56 4.6 4.5
BREAST FEEDING vs BREASTMILK JAUNDICE 8 71.0 69.1 57 4.8 4.8
Parameter BREASTFEEDING BREASTMILK 9 72.3 70.4 58 5.1 5.0
Onset 3rd to 5th day of life Late; start to rise on day 4; 10 73.6 71.8 59 5.4 5.3
may reach 20 – 30 mg/dl 11 74.9 73.1 60 5.7 5.5
on day 14 then ↓ slowly 12 76.1 74.3 61 5.9 5.8
Normal by 4 – 12 weeks 13 77.2 75.5 62 6.2 6.1
Pathophysio Decrease milk intake → Unknown 14 78.3 76.7 63 6.5 6.4
↑enterohepatic circulation Prob. due to β – 15 79.4 77.8 64 6.8 6.7
glucoronidase in BM which 16 80.4 78.9 65 7.1 7.0
↑ enterohepatic circulation 17 81.4 79.9 66 7.4 7.3
Normal LFT;
18 82.4 80.9 67 7.7 7.5
(-) hemolysis
19 83.3 81.9 68 8.0 7.8
Mngt Fluid and caloricsupplement If breastfeeding is stopped,
20 84.2 82.9 69 8.3 8.1
rapid decrease in bilirubin
level in 48 hrs, if resumed 21 85.1 83.8 70 8.5 8.4
will rise to 2 – 4 mg/dl but 22 86.0 84.7 71 8.8 8.6
no precipitating previous 23 86.8 85.6 72 9.1 8.9
events 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 INFECTIVE ENDOCARDITIS
27 90.0 89.0 76 10.0 9.8 DUKE CRITERIA
28 90.8 89.8 77 10.3 10.0 Major Manifestation
29 91.6 90.6 78 10.5 10.2 1.
30 92.3 91.3 79 10.7 10.4 Minor manifestation
31 93.0 92.1 80 10.9 10.6
32 93.7 92.8 81 11.1 10.8 Diagnosis
33 94.5 93.5 82 11.3 11.0 2. Highly probable : 2 major OR 1 major and 2 minor manifestation
34 95.2 94.2 83 11.5 11.2
35 95.8 94.9 84 11.7 11.4 NURSERY NOTES
36 96.5 95.6 85 11.9 11.6 Dextrosity
3.5 98.4 97.3 86 12.3 11.8
4 yo 102.9 101.6 87 12.3 11.9 (to get factor: Desired – D5
D50- D5
4.5 106 104.5 88 12.5 12.2
D 7.5 = 0.055
5 109.9 108.4 89 12.8 12.4
D10 = 0.11
5.5 112.6 111.0 90 13.0 12.6 D 12.5 = 0.166
6 116.1 114.6 91 13.2 12.8 D15 = 0.22
6.5 118.5 117.1 92 13.4 13.0 D 17.5 = 0.28
7 121.7 120.6 93 13.7 13.3
7.5 123.9 123.0 94 13.9 13.5 Limits of Dextrosity:
8 127.0 126.4 95 14.1 13.8 Peripheral line = D12
8.5 129.1 128.8 96 14.4 14.0 Central line = D20
9 132.2 132.2 97 14.7 14.3 Total Fluid Intake (TFI):
9.5 134.4 134.7 98 14.9 14.6 Preterm: start at 60 cckd
10 137.5 138.3 99 15.2 14.9 Term: start at 80 cckd
10.5 139.9 140.9 100 15.5 15.2
11 143.3 144.8 101 101.0 15.5 To check TFI = rate x 24 ÷ wt
11.5 145.8 147.6 102 16.1 15.9
12 149.7 151.5 103-105 16.5- 16.2- ex. Preterm: wt: 1.129
17.1 16.7
12.5 152.5 154.1 106-108 17.4- 17.0- Day 1: start IVF with D10 water
18.0 17.6 60 x 1.219 ÷ 24 = 3.1 cc/hr x 24 hrs
13 156.5 157.1 109-111 18.3- 17.9- Add Calcium gluconate at 200 mkd q8h
19.0 18.6 Ca gluc = 1.129 x 200 ÷ 3 = 75mg q8hrs for 3 doses
13.5 159.3 158.8 112-114 19.3- 18.9- Start antibiotics
20.0 19.5 Give ranitidine
14 163.1 160.4 115-117 20.3- 19.9- HGT q 8/12 hrs
21.1 20.6 OGT
14.5 165.7 161.1 118-120 21.4- 21.0- CBC
22.2 21.8 Na, K, Ca at 48 hrs
15 169.0 161.8 121-123 22.6- 22.2- Blood c/s depends on AP
23.4 23.1 Day 2: increase TFI by 10-20 (depends on AP)
15.5 171.1 162.1 124-126 23.9- 23.6- 70 x 1.129 ÷ 24 = 3.3 cc/hr x 24 hrs
24.8 24.6 incorporate ca gluc 200 mkd to IV
16 173.5 162.4 127-129 25.2- 25.1- ex.
26.2 26.2 D10 water 80 cc
16.5 174.9 162.7 130-132 26.8- 26.8- Ca gluc 2.2cc
27.8 28.0 82.2cc to run at 3.3ccx24hrs
17 176.2 163.1 133-135 28.4- 28.7-
29.6 30.1 Day 3: increase TFI by 10-20 (depends on AP)
If electrolytes are N, may use D10IMB
17.5 176.7 163.3 136-140 30.2- 30.8-32
80 x 1.129 ÷ 24 = rate
33.0
80 x 1.129 x factor to get value of D50 water (to make D10 use 0.11)
18 176.8 163.7 141-145 33.7-
Cont Ca gluc incorporation (if feeding may discontinue)
36.9
D50 water 9.9cc
D5 IMB 77.9cc = D10 IMB
Weight for Height = Actual BW (kg) Ca gluc 2.2cc (200mkd)
P50 Wt for Ht (kg) 90 cc to run at 3.7cc/hrx24h
If feeding already:
Height for Age = Actual Height (cm)
Total volume of milk ÷ wt = cc/kg/day
P50 Ht for Age
Subtract this amount to TFI to get value for IV
(if Dr. Reinoso, divide by 2 before subtracting to TFI)
Waterloo Wasting Stunting ex. MF 3cc q3hrs = 24 cc in 24 hrs
Classification (Wt for Ht) (Ht for Age) 24 ÷ 1.129 = 21.2 cckd from milk
Normal >90 >95 80 – 21.2 = 58.8cckd (use this for IVF)
Mild 81 – 90 90 – 95 58.8 x 1.129 ÷ 24 = rate
Moderate 70 – 80 85 – 89 D50 water 7.3cc
Severe <70 <85 D5 IMB 56.5cc = D10 IMB
Ca gluc 2.2cc (200mkd)
66 cc to run at 2.7cc/hrx24h
RHEUMATIC HEART DISEASE
JONES CRITERIA Subsequent days depend on infants status…..
Major Manifestation Electrolyte requirements:
1. Arthritis (70%) Na: 2-4 mkd prep’n 2.5 mg/ml
2. Carditis (50%) Ca: 100-200mkd prep’n 100mg/ml
a. Tachycardia K: 2-4 mkd prep’n 2mg/ml
b. Heart murmur of valvulitis Glucose Infusion Rate:
c. Pericarditis
d. Cardiomegaly Dextrosity x IVF rate x 10 ÷ 10
e. Signs of CHF [gallop rhythm, distant heart Wt
sounds, cardiomegaly] Ex. 10 kg; IVF D10 IMB at 40cc/h
3. Erythema marginatum (10%)
4. Subcutaneous nodules (2 – 10%) GIR = 10 x 10 x 40 ÷ 10 = 6.6mkmin
5. Sydenham’s chorea (15%) 60
Minor manifestation NV: Newborn & Infants 6-8 mg/kg/min
1. Arthralgia Children 4-6 mg/kg/min
2. Fever at least 38.8°C
3. Elevated Acute Phase Reactants (CRP & ESR) If HGT <40 mg/dl, give D10 water slow IV push at 2cc/kg and
4. Prolonged PR interval on the ECG repeat HGT after 30 mins-1 hr (may do 3 boluses if still low, may inc
Diagnosis dextrosity or rate)
1. Highly probable : 2 major OR 1 major and 2 minor manifestation
Level of Umbilical Cathetherization: (cm)
If arterial between T6-T9
Wt x 3 x 8 Prepare the ff:
2 pcs 3 way stopcock
If venous: (wt x 3) + 8 +1 1 pc 5 cc syringe
2 1 pc BT set
1 pc IV tubing
ET tube size: age in yrs +4 1 pc empty bottle
4 Gloves
ET level: Calcium gluconate 100 mg every 10 exchanges
if >2yo: age(yrs) +12
2 Criteria for Hypoxic Ischemic Encephalopathy
Or ET size x 3
pH < 7 (profound met. Acidosis)
Total Flow Rate = Tidal volume x wt x RR x I.E ratio + 2000
Apgar <3 more than 5 mins
I.E = 2
Neurologic sequelae (coma; sz)
Dead space = 2000
RR = 40-60 Multiorgan involvement
Tidal volume = Newborn: 6-10cck Difficult delivery
Child: 10-15cck
Adult: 15cck Medications
Dopamine: wt x dose x 0.075
FiO2 Prep’n : Single Strength: 200mg/250ml;
Nasopharyngeal cathether = Flow rate x 20 + 20 Double Strength: 400/250ml
Ex. 1L Fio2 = 40 if using double strength: wt x dose x 0.075÷2
Nasal catheter = Flow rate x 4 + 20 (Dose = 5-20)
Ex. 1L FiO2 = 24 Dobutamine: wt x dose x 0.06
Extubation: Prep’n: 250mg/250 ml; Dobuject 50mg/ml
(Dose = 5-20)
Give Dexamethasone at 0.1 mkdose q 6 hours for 24 hours prior to
extubation
If using Dobuject: Wt x dose x 60÷ concentration
USN with epinephrine 0.5 cc + 1.5 cc PNSS q 15 mins x 3 doses then
Concentrations: 5mg/ml = 5000
extubate then USN with Salbutamol ½ nebule + 1.5 cc PNSS q 6
50mg/50ml = 1000
hours x 24 hours
50mg/20ml = 2500
O2 at 10 lpm then decrease as necessary To make 5mg/ml: Dobuject 5cc
Regular milk: 20 cal/oz D5 water 45cc
Preterm milk: 24 cal/oz To make 50mg/50ml: Dobuject 1cc
D5 water 49cc
Total Caloric Intake: rate x 24 x caloric content of IVF ÷ wt To make 50mg/20ml: Dobuject 1cc
D5 water 19cc
To get factor: Dextrosity x 0.04 = cal/cc
Diflucan: 6 mkd OD prep’n 50mg/tab divide into pptabs and give 1
pptab OD x 2 weeks
Caloric content of IVF
Aminophylline: 5mkd (loading dose) then 1.6 mkd q 8 hrs
D5 = 0.2 cal/cc
(maintenance)
D7.5 = 0.3 cal/cc
D10 = 0.4 cal/cc Phenobarbital 20 mkd (loading dose) then 5 mkd (maintenance)
D15 = 0.6 cal/cc Dexamethasone 0.1 mkdose q6hrs x 24 hours
Caloric requirement & Protein requirement For other meds, please see NEOFAX
Cal/kg g/kg NEWBORN CARE
0-5mo 115 3.5 Hypothermia
6-11mo 110 3 hypoxia
1-2 yo 110 2.5 metabolic acidosis
3-6 yo 90 – 100 2 hyperglycemia
7-9 yo 80 – 90 1.5 Erythromycin ointment
10 – 12 yo 70 – 80 1.5 should be given an hour after birth
13-15 yo 55 – 65 1.5 gonococcal/chlamydial conjunctivitis
16 – 19 yo 45 – 50 1.5 Gonococcal Conjunctivitis
Approximate Daily Water Requirement within 7days
Chemical conjunctivitis
0 – 3 do 120cc/k/d 4 – 6 yo 100 cc/k/d
disappears within 48H
10 do 150cc/k/d 7 – 9 yo 90 cc/k/d
Other bacterial conjunctivitis
1 – 5 mo 150cc/k/d 10 – 12 yo 80 cc/k/d
Chlamydial >10-14 days
6 – 12 mo 140cc/k/d 13 – 15 yo 70 cc/k/d
Staph 48H-5th day (2-5days)
1 – 3 yo 120cc/k/d 16 – 19 yo 50 cc/k/d
Herpes
Estimated Catch up Growth Requirement Pseudomonas-give Gentamycin
= cal/k/day (age for wt) x IBW (wt for ht) Umbilical stump - sloughed off <14 days
Actual BW
Alcohol - drying effect
Cows milk allergy
CHON reqt = CHON reqt for age x IBW
Onset- 3rd wk
Actual BW
Rashes on cheeks → eyebrows → cradle cap
Growth and Caloric requirements
AGE RDA kcal/kg/day
CRANIUM
0 – 3 mos 115
Caput succedaneum
3 – 6 mos 110
diffuse edematous swelling of soft tses of scalp
6 – 9 mos 100
extend across midline
9 – 12 mos 100
edema disappears w/in 1st few days of life
1 – 3 yo 100
molding and overriding of parietal bones-frequent
4 – 6 yo 90 – 100
disappear during 1st 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
Double Volume Exchange Therapy (DVET)
slow process)
Wt x 80 x 2 = Volume/ amt of fresh whole blood firm tense mass with palpable rim localized over 1 area
(Use mother’s blood type) of skull
resorbed w/in 2wk- 3mos
Volume _ = # of exchange calcify by end of 2nd wk
aliquots per exchange few remain for years
10-25% cases underlying linear skull fracture
> 3 kg 20 ml No tx but photo in hyperbil
2-3 kg 15 ml
1-2 kg 10 ml
850g-1kg 5 ml
< 850 g 1-3 ml
SEIZURE Simple Complex Verbal
Oriented 5 Coos, babbles 5
Type GTC Focal then gen post ictal Confused 4 Irritable 4
Inappropriate words 3 Cries to pain 3
Duration < 15 min > 15 min or may go into Inappropriate sounds 2 Moans to pain 2
None 1 None 1
status
Motor
Recurrence None Recurrent (w/in 24H) Follows command 6 Normal spontaneous 6
CNS exam Normal Abnormal movement
Sequelae None Neurodev abn Localizes pain 5 Withdraws to touch 5
Withdraws to pain 4 Withdraws to pain 4
ANTICONVULSANT Abnormal flexion 3 Abnormal flexion 3
DIAZEPAM 0.2 – 0.3 mkdose Abnormal extension 2 Abnormal extension 2
Drip: 1amp in 50cc D5W None 1 None 1
10mg/amp
MIDAZOLAM 0.15 mkdose prn 2 – 3 mins interval IV (1, 5mg/ml) MOTOR DTR
6 mos - 5 yo 0.05 - 0.10 max of 0.6 mg/kg full resistance with gravity 5/5 very brisk +4
6 yo - 12 yo 0.25 - 0.05 max of 0.4 mg/kg some resistance with 4/5 brisker than average +3
>12 yo 0.50 - 2 mg/dose over 2 mins gravity normal +2
PHENOBARBITAL LD: 15 – 20 mkd MD: 5 mkdose q movement with gravity 3/5 diminished +1
12h movement w/o gravity 2/5 no response 0
(max load 20 mkday IV flicker 1/5
no movement 0/5
Tabs: 15, 30, 60, 90, 100 mg
Caps: 16 mg Bilirubin (Total)
ELIXIR 20mg/5ml Cord
Inj: 30, 60, 65, 130 mg/ml
Preterm <2 mg/dl <34 µmol/L
MD: PO/ IV Term <2 mg/dl <34 µmol/L
Neonate: 3 - 5 mkD QID/ BID 0 – 1 days
Infant/child: 5 - 6 mkD Preterm <8 mg/dl <137 µmol/L
1 - 5 yo: 6 - 8 mkD Term <8.7 mg/dl <149 µmol/L
6 - 12 yo: 4 - 6 mkD
1 – 2 days
> 12 yo: 1 - 3 mkD
Hyperbil < 12 yo: 3 - 8 mkD BID/TID Preterm <12 mg/dl <205 µmol/L
PHENYTOIN LD: 15 – 20 mg/kg/IV Term <11.5 mg/dl <197µmol/L
MD: 3 – 5 days
Neonate: 5 mkD PO/ IV BID Preterm <16 mg/dl <274 µmol/L
Infant/child: 5 7mkD BID/ TID Term <12 mg/dl <205µmol/L
6mos – 3y: 8 – 10 mkD Older Infants
4 – 6y: 7.5 – 9 mkD
7 – 9y: 7 – 8 mkD Preterm <2 mg/dl <34 µmol/L
10 – 16 y: 6 – 7 mkD Term <1.2 mg/dl <21 µmol/L
Dilantin Tab: 50mg 100mg TID Adult 0.3 – 1.2 mg/dl 5 – 12 µmol/L
Extended release caps 30, 100, 200, 300 mg OD, BID Bilirubin (Conjugated)
Inj: 50 mg/ml Neonate <0.6 mg/dl <10 µmol/L
Infants/Children <0.2 mg/dl <3.4 µmol/L
CARBAMAZEPINE
Tegretol Tab 200mg, 100mg chew
XR 100mg, 200mg, 400mg Pre Lumbar Tap
Susp 100mg/ 5ml (QID) NPO
Initial Increment Maintenance RBS by gluco prior to lumbar tap
< 6 yo 10 - 20 mkD BID /TID q wkly til 35 mkD Prepare lumbar tap set
2% Lidocaine # 1
6 - 12 yo 10 mkD BID 100 mg/ 24H at 20 - 30 mkD BID/
G 23 spinal needle
1 wk interval QID
Mannitol 250 cc 1 bottle - do not open
> 12 y 200 mg BID 200 mg/ 24H at 800 - 1200 mg/24H
Solvent
1 wk interval BID/ QID
Diazepam 1 amp
3cc syringe #2
OXCARBAMAZEPINE (8 - 10 mkd BID) 2 manometers
Initial: 8 -10 mkD PO BID then sterile bottles # 3
Increment: increase over 2 week pd to sterile gloves # 2
Maintenance doses: Sterile gauze # 1
20 -29 kg: 900 mg/24H PO BID Sterile gauze w/ Betadine #1
29.1 -39 kg: 1200 mg/24H PO BID Sterile towel w/ hole #1
>39 kg: 1800 mg/24H PO BID Sterile clamp #1
3-way stopcock #1
Trileptal Tab 150 mg 300mg 600 mg
Susp 300mg/5ml Post Lumbar Tap
VALPROIC ACID PO: NPO x 4H
Initial : 10 - 15 mkD OD - TID Flat on bed
Increment: 10 mkD at wkly interval BID Monitor NVS to include BP q 30mins x 4H, then qH
Maintenance: 30 - 60 mkD BID/TID CSF exams
IV: same dose as PO q 6H Bottle # 1 – Gm stain, AFB, India ink, KOH
Rectal : (syrup mix with water 1:1) Bottle # 2 – Cell count, CHON, Sugar
LD: 20 mkd Bottle # 3 – C/S, save remaining specimen
MD: 10 -15mkd TID Watch out for vomiting, HA and hypotension
Depakene Tab 250 mg
Syr 250mg/5ml
Depacon IV 100mg/ml Contraindications to LP
TOPIRAMATE 2 - 16 yo evidence of Inc ICP
Initial: 1 - 3 mkd PO q HS x 7 days then severe CP compromise
Increment: increase by 1 - 3 mkday for 1 - 2 wks Skin infection at site of puncture
then
Maintenance: 5 -9 mkD BID
Topamax Cap 15 mg, 25 mg CSF ANALYSIS
Tabs 25 50 100 200mg
Color Rbc Wbc Diff sugar CHON
ct
Glasgow Coma Scale Infants
Activiy Response Activity Response Normal
Eye Opening Infant Xantho 0- 0 -32 L 70 - 60 -
Spontaneous 4 Spontaneous 4 (Term) 100 100% 80% 150
To speech 3 To speech 3 Infant Clear 0- 0 -15 L 70 - 60 -
To pain 2 To pain 2 (Preterm) 100 100% 80% 200
None 1 None 1
Older Clear 0 0 -10 L > 10-20 Urine alkalinization
child 100% 50% Ca Gluc = Children: 1cc/k/dose x 84 – 840 mg (1- 10 meq)/kg/D PO
Viral Clear 0 0 -20 L 40- 40 -60 3doses; QID
Mening 100% 60% Max: 10cc/dose + equal amt of
sterile water
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 LYSMIX 0.3 cc/k/dose TID Ceiling = 0.4
tx BM 50% Prozinc drops 10 mg/ml
< 6 mos 1 ml OD
< 6 mos – 2 yo 1 ml BID
CSF PATHWAY syrup 20 mg/5ml
Choroid plexus (lateral ventricle) → Foramen of Monroe → 3rd ventricle > 2 yo 5ml OD
→ Aqueduct of sylvius → 4th ventricle →Foramina of Luschka (2 laterals) Ercefuryl 20 mkday
→ & Magendie (median) → SAS → Absorbed in the arachnoid villi, Erceflora 1-2 vials/day OD for 2 wks
then in the Venous System mix with water, milk or juice
Dengue Drips Protexin Restore 1 sachet mix with milk OD
Furosemide drip Racecadotril 1.5 mg/kg for 1 wk
Dose: 0.04 - 0.5 (Hidrasec)
80 mg + 32 cc < 9 kg 10 mg sachet 1 sachet TID
Wt x dose = rate (cc/h) 9 – 13 kg 10 mg sachet 2 sachets TID
2
13 – 27kg 30 mg sachet 1 sachet TID
Furo drip = 0.1 - 0.5mg/k/hr
> 27 kg 30 mg sachet 2 sachets TID
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
FWB 10 - 20 cc/kg 3 – 4H
Dose: 0.2 - 0.7
1ml + 99cc D5W to run at cc/h PRBC 5 - 10 3 – 4H
Wt x dose = rate (cc/h) Plasma 10 - 15 1–2H
Noradrenaline (Levophed) 1mg/ml dose :(0.5 – 1 ml/kg) PRP 10 - 15 1–2H
Wt x dose ( each ml contains 4 mcg Noradrenaline) Plt conc 1 u/ 7 -10 kg FD
4 mcg ( for acute hypotension) Cryoprecipitate 1 u/kg FD
2ml + 500cc D5W x 2cc/H (0.5 cc/H) Hemophilia A 1 bag
(200mg fibrinogen)
Dopamine ( 5 -20 mcg/kg/min) 200 mg/250ml Single strength VW dse 50 -100 mg/kg
400 mg/250ml DS (div by 2) Fibrinogen dse 100 cc
Wt x dose x 0.075 (2-5 kg)
Dobutamine 250 mg/5ml SS Factor 8 Hemophilia A 50 u/kg
500 mg/250ml DS(div by 2) Hemophilia B 100 u/kg
Wt x dose x 0.06
Terbutaline Bricanyl SC Inj: 1 mg/ml 1 u FWB = 200 cc PRBC
< 12y – 0.005 – 0.01 mkd x 3 doses q = 50 cc platelet concentrate
15 = 150 – 200cc PRP
-20 min then q2-6H = 150 cc FFP
> 12y – 0.25 mkd MCV Hgb / rbc x 10 80 -94
Terbutaline drip LD: 2 – 10 mcg/kg then MCH Hgb / rbc x 10 27 - 32
0.1 – 0.4 mcg/kg/min MCHC Hgb/ hct x 10 32 – 38
Ketamine (Ketalar) 10, 50, 100 mg/ml Absolute reticulocyte count = pt’s hct x retic %
PO: 5mg/kg x 1 N hct for age
IV 0.25 - 0.5 mg/kg
IM 1.5 - 2 mg/kg x 1 Reticulocyte Index
Morphine IV 0.1 – 0.2 mkd q2-4H prn Absolute Retic Ct > 2 hemorrhage
Naproxen 250, 375, 500mg tab 2 < 2 rbc production abn
125mg/5ml
> 2yo – 5-7 mkd TID, BID PO PRBC to be transfused for correction = 40 – hct x wt

IVIG infusion 1 - 3 days 1 mo 2mos 6 – 12y >12y

Preparation: Hgb 14.5 – 22.5 9 -14 11.5 -15.5 13-16
2.5g/50cc 500g/10cc 25g/100cc Hct .48 - .69 .28 - .42 .35 - .45 .37 - .49
5g/100cc 10g/250cc Wbc 9 -30 birth 5 – 19.5 6 -17.5 4.5 -
Computation: 13.5
Wt x 2 g /kg IVIG Plt 84 – 478 After 1 wk, same as adult
Ex wt: 7.2 kg NB 150 - 400
7.2 x 2 + 16 g IVIG Retic 0.4 - 0.6 < 1 -1.2 0.1 -2.9
16 gIVIG 2. 5 g = 320 cc
Cc 50cc Glucose PT 20 -60 Child Adult
# of vials = total cc 320cc = 6.4 vials NB 30 – 60 60 -100 70 -105
50cc 50cc 1 d 40 -60
320cc x 0.03 = 9. 6 cc/h for 30 mins > 1d 50 -90
Transfuse 9 – 10cc/h IVIG for the 1st 30mins if no reaction, run the
remaining volume for 12H ANC - % of neutrophils & cells that become neutrophils – multiplied by
Refer for any infusion reactions wbc
Close ML ANC = wbc x (% seg + % stabs + % meta)
Monitor v/s q 30 mins while on infusion Other formula: wbc x (seg + meta + stabs ) x 10
If after IVIG if still febrile, rpt IVIG after 3 D Ex 2.1 x 53 (seg) x 10 = 1113
If after 2nd IVIG still febrile – start Prednisone ANC > 1000 Normal
Aspirin 80 mkD QID ANC < 2000 Neutropenia
30 mg, 80, 100, 300 mg ANC 1000 -1500 Low risk of infection
ANC 500 -1000 Mod risk of infection
KCl NaHCO3 ANC < 500 High risk of infection
IV 2 meq/ml Inj premixed: 5% (0.6 meq/ml) IT ratio > 0.25 sepsis
Child: 0.5 – 1meq/k/dose infusion of 500ml > 0.80 higher risk of death fr sepsis
0.5 meq/k/h for 1-2 h Tabs: 325 mg (3.8 meq), 650 mg
Tabs: 8, 10, 15, 20 meq (7.6 meq) Anemia
Oral soln < 10 g mild anemia
10% ( 6.7 meq/5ml) 8-9g mod anemia
15% (10 meq/5ml) <8 g severe anemia
20% (13.3 meq/5ml)
PO : 1-4 meq/kg/24H QID
IV: 0.5 – 1meq/k/dose
 EMERGENCY Age GFR Range
ET tube age in years + 4
4 PT
ET diameter x 3 2- 8 d 11 11 – 15
>10 yo cuffed 4 - 28 d 20 15 – 28
30 -90 d 50 40 – 65
Laryngoscope sizes Term
PT Miller 00 or 0 2- 8 d 39 17 – 60
4 - 28 d 47 26 – 68
Term Miller 0
30 - 90 d 58 30 – 86
0-6mos Miller 1 1- 6mo 77 39 -114
6 - 12 mo 103 49 – 157
6-24 mos Miller 2
2 - 19mo 127 62 – 191
>24 mos Miller 2 or Mac 2 2 - 12y 127 89 – 165
Adult males 131 88 – 174
Adult females 117 87 – 147
EMERGENCY MEDS
Epinephrine (bradycardia, asystole)
(1:1000) 0.1 ml/kg q 3- 5 mins
BSA
Amiodarone 5 mg/kg rapid IV push
Weight in (kg)
Cardioversion 2 J/kg then 4 J/kg then rpt 2x 0–5 wt x 0.05 + 0.05
Albumin 1gm x wt given in 2-4hrs. 6 – 10 wt x 0.04 + 0.10
Prep: 12.5g/50ml 11 – 20 wt x 0.03 + 0.20
Vol expander: 20ml/kg 20 – 40 wt x 0.02 + 0.40
HypoCHONemia – 1gm/k/dose x 4H >40 wt x 0.01 + 0.80
Epinephrine Drip 0.1 – 1mg/k/min; 1amp = 1mg/ml
Rate = (wt x dose x 60)/desired Computation for OFI (AGN & limiting OFI)
Ex: (18kg x 0.1 x 60)/100 = 2cc/hr
1. BSA x 400 + UO – IVF (half if w/ Furo) = OFI (then divide to 3
To order: 5 amps Epi + 50cc D5W to rum at 2cc/hr
shifts)
(0.1mg/k/min)
2. 20cc x wt x UO – IVF
Levophed 0.3-2mcg/k/min
Prep: 4mg/amp (1mg/ml)
Rate = (wt x dose x 60)/desired
Ex. Dose 0.5
OSTERIZED FEEDING
1mg/20 = 0.05 x 1000 = 50mcg/ml
(18kg x 0.5 x 60)/50 = 10.8cc/hr TFR 60 - 70% = 100/feeding q 6H
To order: 1 amp levophed + 80 cc D5W to run at 10 kg x 60%
11cc/hr TFR = 600
Dopamine Renal dose 3-5 CHON 0.5 g/kg inc q other day by 0.5 , max of 2 g/kg
Pressor >5 - <15 Dose x wt x prep (Vamin 7%, 9%)
alpha effect >15 0.5 x 10 kg x (100 /7) = 71 g/kg
CHON = 71 g/kg
ANAPHYLAXIS
If no prep = dose x wt x 4 = 20 g/kg
Epinephrine 0. 01ml/kg max of 0.5 mg/dose SC
CHO 60%
(1:1000) < 30 kg 0.15 mg
(TFR – CHON) x 0.6
> 30 kg 0.3 mg
(600- 71) x 0.6 = 317
Diphen = 50mg IM (1mkdose) CHO = 317
USN w/ Salbu x 3 doses
Fats 181 (the rest are fats , divided into 6 feedings)
BICARB DEFICIT CORRECTION:
TPN
Ex: wt 4.9kg
Vamin 9% 0.67 cal/ml
pH = 7.10
Start 0.5 g/k/day inc by 0.5 g until 3 -3.5g/k/day
pCO2 = 9.1
Compute = wt x dose x prep (100/9)
pO2 = 36.5
HCO3 = 2.8
Intralipid 10% 20%
BE = -26.8
Start 0.5 g/k/day inc by 0.5 g until 3 g/k/day
O2 Sat = 53.6%
Compute = wt x dose x prep (100ml/ 10) = ml/24H
BE x Wt x 0.3 = 26.8 x 4.9 x 0.3 = 39.39meqs
Half correction: 39.39/2 = 19.69 meqs Amino acids
To order: Give 20 meqs NaHCO3 + equal amt of sterile water to be given Start 0.5 g/k/day inc by 0.5 g until 3 g/k/day
slow IVTT over 30mins. Compute = wt x dose x prep (100ml/g) = ml/24H
Infuse another 20 meqs NaHCO3 + equal amt sterile water as drip for 1-2
hrs. TPN shortcut computation
EMPIRIC: NaHCO3 1-2mkdose even w/o ABG. Wt 10 kg TFR= 100 ml/k/day TFI = 1000ml/day
HCO3 correction in ABG:
Vamin 7% 7 = 2 g/kg x 10kg 285 ml
Half correction: Base x’s x 0.3 x wt ÷ 2
100
(+ equal amount of sterile water)
CaGluc 2ml/kg 20 ml
D5IMB 485 ml
Full correction: Base x’s x 0.3 x wt ÷ 2
D50W 0.11 x 1000ml 110 ml
(1/2 via IV push, ½ via IV drip)
1000ml x 37 cc/h
Full correction: Base x’s x 0.3 x wt ÷ 2
(1/2 via IV push, ½ via IV drip)
TPN for NEONATES
BUN/ crea ratio
Wt 2kg
Normal 10 -20
1. TFR = 100 ml/kg/day x 2 kg 200 ml
> 20 suggest DHN, pre renal azotemia or GIB
2. Intralipid 20%
< 5 – liver disease, inborn error of metabolism
1 g/kg/day x 2kg = 2g/day 10 ml
2 g = 20g
GFR (based on plasma creatinine and ht)
x 100ml
GFR = k x L = ml/min/1.73 m2 SA
sCr 3. Compute for TFR 1
L = body length (cm) TFR1 = TFR – Intralipid = 200 -10ml = 90 ml
Scr = mg/dL ; divide by 88.4 if units in mmol/L 4. Vamin 7%
1 g/kg/day x 2 kg = 2g = 29 ml
Age K (mean value) KI 2 g = 7g
LBW < 1 yr 0.33 29.17 x 100ml
FT < 1 yr 0.45 39.78 5. Multivitamins Benutrex c 0.5 ml/100ml
2-12 y 0.55 48.62 0.5 ml = x 1 ml
13-21 y (female) 0.55 48.62 100ml 190 ml
13 -21 y (male) 0.70 61.88 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) Complement level 6 – 8 wks
190 – (29 + 1+ 4+ 21) = 135 ml Proteinuria 3 – 6 mos
9. IV rate = TFR 1 / 24H 190 ml/ 24H 8 ml/H Micro hematuria 6 – 12mos
Lab Dx:
Order: U/A – spec grav,cast, hematuria, chonuria
Start TPN as ff: Serology – culture of GABS, ASO, C3 ( dec in acute phase, rises
TFR= 100ml/kg/day during convalescensce)
D5 IMB 135 ml Renal fxn – bun crea- normal, hyponat
D50W 21 ml Hematology – dilutional anemia, transient hypoalbuminemia
Vamin 7% 29 ml Radiography – CXR , renal utz
Ca Gluc 4 ml Management:
MTV 1 ml Bed rest
190 ml to run at 8 ml/h Fluid and salt restriction
Intralipid 20% 10 ml to run for 24H 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
Peak Flow (6 – 7 yo) HPN, CHF
(Ht cm – 100) x 5 + 170 female o Furosemide 2 mg/k/dpse
+ 175 male Prognosis – complete resolution, 5 – 10 % progress to chronic state
Nasopharyngeal catheter = flow rate x 20 + 20
Nasal cannula = flow rate X 4 + 21 VITAMINS
Stimulants Mosegar Vita 0.25 mg/day prep 0.25 /5 ml
TFR= TV x RR x IE ratio + dead space (2000) Buclizine (syrup) Appetens
TV= 10 ml x wt Propan
TFR Short cut: wt x 10 + 40 ml divide by 0.5 Appebon
16.77 2 - 8yo 5 - 10 ml OD
7 - 14yo 10 - 20 ml OD
MILK FORMULAS w/ Folic acid Molvite
1:1 dilution 1:2 dilution (Megaloblastic 7 - 12yo 10 - 15 ml OD
Mead-Johnson, Nestle, Glaxo, Wyeth, Abbott, Unilab Anemia) 3 - 6yo 5 - 10 ml OD
Dumex, Milupa 1 - 2yo 2.5 - 5 ml OD
0-6 months (20cal/oz) Lactose free (0-6months) Iberet
Mead-johnson: Alacta , Enfalac Mead-johnson: Enfalac lacto-free Ferlin (10 mcg folic acid)
Nestle: NAN1, Nestogen Nestle: AL110 Macrobee
Glaxo: Frisolac Milupa: HN25 1 - 2yo 2.5 - 5 cc OD
Dumex: Dulac Wyeth: S26 Lacto-free 3 - 6yo 5 - 10 cc OD
Abbott: Similac advance 7 - 12yo 10 - 15 cc OD
Milupa: Alaptamil Pizotifen Mosegor vita syr
Wyeth: S26, Bonna (drowsiness) Appetens
Unilab: Mylac MTV w/ Iron Propan w/ iron syr (Fe So4; elem fe 30mg)
6months onwards (20cal/oz) Lactose free (6months Appebon w/ iron syr (FeSo4; elem fe 10mg)
onwards) w/ Serotonin (for Mosegor vita
Mead-johnson: Enfapro Mead-johnson: Enfapro lacto- migraine + dec wt) Mosegor plain
Nestle: NAN2, Nestogen 2 free Appeten
Glaxo: Frisomil Jagaplex syrup
Dumex: Dupro 1-2yo 5ml OD
Abbott: Gain 3-6yo 10 ml OD
Wyeth: Bonnamil. Promil 7-12yo 15 ml OD
Unilab: Hi-nulac Clusivol Power syrup
1 year onwards (20 cal/oz) Premature Infant (24cal/oz) syr 100mg/5ml
Mead-johnson: Enfagrow, Mead-johnson: Enfaprem 2-6yo 5 ml OD
Lactum Nestle: PreNAN 7-12yo 10 ml OD
Nestle: NAN3, Neslac Abbott: Similac prem Zeeplus
Glaxo: Frisorow Milupa: Preaptamil <2yo 2.5 ml OD
Dumex: Dugrow 2-6yo 5 ml OD
Abbott: Gainplus 7-12yo 5-10 ml OD
Wyeth: Progress, Promil Polynerv
Unilab: Enervon bright 1-2yo 2.5 ml OD
Hypoallergenic (20cal/oz) Soy-Based (20cal/oz) 3-6yo 5 ml OD
Mead-johnson: Pregestimil Mead-johnson: Prosoybee 7-12yo 10 ml OD
Nestle: Alfare, NAN HA1, NAN Abbott: Isomil 0-6mo 0.5 ml-1 ml OD
HA2 Wyeth: Nursoy 7mo-1yr 1-1.5 ml OD
1-2yrs 1.5-2ml OD
AGN Iron Deficiency Supplemental Iron =
inflam process affecting the kidney, lesions predom in the Anemia Therapeutic Dose: 5 - 6 mkday for 3 mos
glomerulus Maintenance Dose: 3 - 4 mkday
Etiology Elemental iron
Infections: 20% of FeSo4
a. Bacterial: Grp A B hemolytic strep, S viridans, S pneumo, 12% Fe gluconate
Staph 33% Fe fumarate
aureus, S epidermidis, S typhi , T pallidum, Leptospira Wt x Dose x Prep
b. Viral: HBV, Mumps, Measles, CMV, Enterovirus
c. Parasitic: Toxoplasm, Malaria, Schistosoma Ferlin drops15mg/ml
Drugs: Toxins, Antisera, Vaccines (DPT) Fe 75 mg
Miscellaneous: Tumor Ag, Thyroglobulin Prophylactic dose
Term 1 mg/k/Day, start 4 mos-1y
GABS Nephritogenic Strains
PT 2 mkD, start 2 mos-1y
Sites: URT - pharyngitis - M1 2 4 12 18 25
Therapeutic dose 3 mkD BID, QID for 4-6mos
Skin pyoderma - M49 55 57 60
Pathophysio – Immune complex disease
Ferlin syrup 30mg/ml
Clinical & Lab
Fe 149.3 mg
-hematuria -hypocomplementenemia
Supplemental dose 10-15 mg OD
-proteinuria -oliguria
Therapeutic dose 3 mkD TID, QID for 4-6mos
-edema -n & v
-hpn 82% -dull lumbar pain
Sangobion syr (Fe gluc 250mg elem Fe 30mg)
Typical course Incremin with Iron
Latent: few days – 3wks Syrup 30 mg elem Fe
Oliguric: 7 – 10 days
Diuretic: 7 – 10 days
Convalescent: 7 – 10 days

Normalization of urine sediment

Parameter Resolved by
Gross hematuria 2 – 3 wks
 TPN in Pediatrics F. Daily Electrolyte Requirements
Electrolytes Neonates 1-6 mos 6 mo -11 Adolescents
A. Energy Requirment yr
AGE/WT Caloric Rquirement (mmol/kg) (mmol/kg) (mmol/kg)
(mmol/kg)
Neonates 90-120 kcal/kg NaCl 3–5 3–4 3–4 60 – 100

Potassium 2–4 2–3 2–3 80 – 120

Infants & Older Children

Cal gluc 0.6 – 1.0 0.25 – 1.2 0.25 – 1.2 4.7

<10 kg 10-120 kcal/kg
(max of (max of
4.7) 4.7)
11-20 kg 1000kcal + 50 kcal foe each kg > 10

Phosphate 1.0 1–2 1–2 30 – 45

>20 1500 + 20 for each more than 20

Magnesium 0.125- 0.125- 0.125- 4–8

B. Fluid Requirement 0.250 0.250
0.250
AGE/WT Fluid Rquirement
Calcium gluconate contains 100 mg calcium gluconate or 9 mg
elemental calcium/ml
Neonates 1 gm of calcium gluconate contains 4.7 mEq or 2.35 mmol of Ca.
G. Trace Elemental Requirements
VLBW (≤ 1500 gm) Initiate at 40 – 60 ml/kg/day and increase by 10 Trace Prematures Infants & Adolescents
ml/kg/day till 120 ml/kg is reached Elemental Children
(ug/kg) (mg)
(ug/kg)
Zinc 400 100 – 500 2.5 – 4
Initiate at 60 ml/kg/day and increase by 15
AGA & LBW ml/kg/day till 120 ml/kg is reached on the 5th Copper 50 20 0.5 – 1.5
day of PN
Chromium 0.3 0.14 – 0.2 0.01 – 0.04

Neonates under radiant heaters or on phototx an extra 30ml/kg/day Manganese 10 2 – 10 0.15 – 0.5
of water
Infants & Older Children
Iodine 8 8 0.2

<10 kg 100 – 120 ml/kg

Selenium 4 4 0.3

11-20 kg 1000ml + 50 ml foe each kg > 10

Flouride 57 57 0.9

>20 1500 + 20 for each more than 20

In the absence of available prep of trace elements; weekly blood
transfusion may be given at 20 ml/kg
C. Protein Requirement Iron: 2 mg/kg, with dose increased to 6 mg/kg if Fe def is documntd;
AGE/WT Dosage (gm/kg/day) provided by adding iron dextran to amino acid soln

VLBW (≤ 1500 gm) 2.25

Sample Solving:
0 – 12 months 2.50
Wt 15 80kcal/kg
1 – 8 yrs 1.50 – 2.0
A. Energy: 15 x 80 = 1, 200 kcal/day
8 yrs and above 1.00 – 1.50 B. TFR: 1,250 ml/day
C. CHON: (1gm/day) 15 x 1
Prep: Aminosteril 6% (6gms/100ml)
With the initiation of PB|N, start w/ 0.5gm/kg/day and gradually
6gms x 15 gms = 250 ml
increased by 0.5gm/kg/day till recommended protein is reached.
D. Carbohydrate Requirement 100 x
% dextrose = gram dextrose x 100 D. CHO: % = gm x 100 10% x = 125 gms
Vol 1250
Prep: D50W
Vol infused (ml 50 gm = 125gm
100 ml x
Shud provide 50 – 60 % 0f total non-protein calories E. Lipids: ( 1 gm) 15 x 1 =15
Requirement ranges frm 10 to 25 gm/kg/day Prep: 10% Intralipid (10gms/100ml)
Infusion shud not exceed 12.5mg/kg/min 10 gms x 15 gm = 150
Shud b decreased if urinary glucose ≥0.5% (2+) or blood sugar 100 ml x
exceeds 7 mmol/L in neoanate or 9.7 mmol/L I above 1 mo of age

E. Fat Requirement F. Sodium: (3 mmol/kg) 15 x 3 = 45 mmol/kg

AGE Dosage (gm/kg/day) Prep: 2.5 mmol/ml
2.5 mmol x 45 = 18 ml
0 – 12 months 2 ml x
G. Potassium: (2 mmol/kg) 15 x 2 = 30 mmol/kg
Prep; 2 mmol/ml
1 – 8 yrs 4 2.0mmol x 30 = 15 ml
ml x
8 yrs and above 2.5
H. Calcium gluc: (0.25 mmol/kg) 15 x 0.25 = 3.75
Prep: 10% Cal gluc
30 – 40 % of total calories shud b provided as fats
2 – 4% as EFA 0.25 mmol x 3.75 = 15 ml
Start at 0.5 gm/kg/day and gradually increase by 0.5 gm/kg/day till ml x
recommended amt is reached

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