Professional Documents
Culture Documents
APGAR
LENGTH / HEIGHT
(50 cm) Age Transverse-AP 0 1 2
Inches Blue / Pink body/ Blue Completely
Diameter ratio A
Age Centimeters Inches At Birth 1.0 Transverse = AP Pale extremities pink
At Birth 50 20 1y 1.25 Transverse > AP P Absent Slow (<100) > 100
1y 75 30 6y 1.35 Transverse >>> AP Coughs,
(-)
2-12 mo Age x 6 + 77 Age x 2.5 + 30 G Grimaces Sneezes,
Response
Cries
FONTANELS (-) Some flexion / Active
A
Age Gain in 1st Year is ~ 25cm Movement extension movement
0-3 mo + 9 cm 3 cm per mo Appropriate size at birth: 2 x 2 cm (anterior) Good,
R Absent Slow / Irregular
3-6 mo + 8 cm 2.67 per mo Closes at: Anterior = 18 months, or as early strong cry
6-9 mo + 5 cm 1.6 cm per mo as 9-12 months
Posterior = 6 – 8 weeks or 8 – 10: Normal
9-12 mo + 3 cm 1 cm per mo 4 – 7: Mild / Moderate Asphyxia
2 – 4 months
0 – 3: Severe asphyxia
Habit 1: Be Proactive
Habit 2: Begin with the end in mind
Habit 3: Put First Things First
Habit 4: Think Win-Win
Habit 5: Seek first to understand and
then to be understood
Habit 6: Synergize
Habit 7: Sharpen the saw
EXPECTED LA SALLIAN
GRADUATE ATTRIBUTES
(ELGA)
Up to 6 mo: 1 half tab per day for 10-14 days ◦ reassess after 6 hrs (infant) & 3 hrs (child)
6 months or more: 1 tab or 20mg
OD x 10-14 days
3. Continue feeding
4. Know when to return
TREATMENT PLAN B
CHILDS WT (kg) x 25
◦ if the child wants more ORS than shown, give more
◦ give frequent small sips from a cup
◦ if the child vomits, wait for 10 min then resume
◦ continue breastfeeding whenever the child wants
AFTER 4 HOURS
◦ reassess the child & classify dehydration status
◦ select the appropriate plan to continue treatment
◦ begin feeding the child while at the clinic
ORS
• Glucolyte 60 • Pedialyte 45 0r 90
ETIOLOGY OF PNEUMONIA
Bacterial
- Streptococcus pneumoniae
- Group B streptococci (neonates)
ARI PROTOCOL (PROGRAM FOR THE CONTROL OF ARI)
- Group A streptococci
- Mycoplasma pnemoniae (adolescents)
- Chlamydia trachomatis (infants)
- Mixed anearobes (aspiration pneumonia)
- Gram negative enteric (nosocomial pneumonia)
Viral
- Respiratory syncitial virus
- Parainfluenza type 1-3 (Croup)
- Influenza types A, B
- Adenovirus
- Metapneumovirus
Fungal
- Histoplasma capsulatum (bird, bat contact)
- Cryptococcus neoformans (bird contact)
Child Age 2months up to 5years
- Mucormycosis (immunosuppressed)
- Coccidioides immitis
- Blastomyces dermatitides
- Pneumocystis carinii (immunosuppressed,
HIV, steroids)
SMR GIRLS
LUDAN’S METHOD (HYDRATION THERAPY) Stage Pubic Hair Breasts
1 Preadolescent Preadolescent
MILD MODERATE SEVERE Sparse, lightly pigmented, straight, Breast & papilla elevated, as small
DEHYDRATION DEHYRATION DEHYDRATION 2
medial border of labia mound, areola diameter increased
< 15 kg, < 2 y/o 50 cc/kg 100 cc/kg 150 cc/kg Breast & areola enlarged, no contour
3 Darker, beginning to curl, ▲amount
> 15 kg, 2 y/o 30 cc/kg 60 cc/kg 90 cc/kg separation
D5 0.3% in st
1 hr: ¼ Plain LR 1st hr: ⅓ Plain LR Course, curly, abundant but amount < Areola & papilla formed secondary
4
6-8 hours Next 5-7 hrs: Next 5-7 hrs: adult mound
¾ D5 0.3% in ⅔ D5 0.3% in Adult, feminine triangle, spread to Mature, nipple projects, areola part of
5
5-7 hours 5-7 hours medial surface of thigh general breast contour
DENGUE PATHOPHYSIOLOGY
> Neonates (<1mo) - RSV
- GBS - Other respiratory viruses
- E. coli - Streptococcus pneumoniae
- other gram (-) bacilli - Haemophilus influenzae (Type B)
- Streptococcus pneumoniae - C. trachomatis
- Haemophilus influenza (Type B) - M. pneumoniae
- Group A Streptococcus
> 1-3 months - Staph aureus
* Febrile pneumonia
- RSV > 2-5 yrs
- Other respiratory viruses - Streptococcus pneumoniae
- Streptococcus pneumoniae - Haemophilus influenzae (Type B)
- Haemophilus influenza (Type B) - C. trachomatis
- M. pneumoniae
* Afebrile pneumonia - Group A Streptococcus
- Chlamydia trachomatis - Staph aureus
- Mycoplasma homilis
- CMV
> MOT: mosquito bite (man as reservior) Biphasic fever (2-7 days) with 2 or more of the ff: Manifestations of DHF plus signs of circulatory failure
1. rapid & weak pulse
> Vector: Aedes aegypti 1. headache 2. narrow pulse pressure (<20mmHg)
2. myalgia or arthralgia 3. hypotension for age
> Factors affecting transmission: 3. retroorbital pain 4. cold, clammy skin & irritability / restlessness
- breeding sites, high human population density, 4. hemorrhagic manifestations
mobile viremic human beings [petechiae, purpura, (+) torniquet test]
5. leukopenia DANGER SIGNS OF DHF
> Age incidence peaks at 4-6 yrs
1. abdominal pain (intense & sustained)
> Incubation period: 4-6 days Dengue Hemorrhagic Fever (DHF) 2. persistent vomiting
3. abrupt change from fever to hypothermia
> Serotypes: 1. fever, persistently high grade (2-7 days) with sweating
- Type 2 – most common 2. hemorrhagic manifestations 4. restlessness or somnolence
- Types 1& 3 - (+) torniquet test
- Type 4– least common but most severe - petechiae, ecchymoses, purpura
- bleeding from mucusa, GIT, puncture sites Grading of Dengue Hemorrhagic Fever
> Main pathophysiologic changes: - melena, hematemesis
a. increase in vascular permeability 3. Thrombocytopenia (< 100,000/mm3)
▼ 4. Hemoconcentration
extravasation of plasma - hematocrit >40% or rise of >20% from baseline
- hemoconcentration - a drop in >20% Hct (from baseline) following
- 3rd spacing of fluids volume replacement
- signs of plasma leakage
b. abnormal hemostasis [pleural effusion, ascites, hypoproteinemia]
- vasculopathy
- thrombocytopenia
- coagulopathy
B. Secondary Prevention
BRONCHIAL ASTHMA (GINA GUIDELINES)
Clinical Features:
TUBERCULOSIS RESPIRATORY DISTRESS SYNDROME
(Hyaline Membrane Disease) 1. Tachypnea, nasal flaring, subcostal and
A. Pulmonary TB
intercostal retractions, cyanosis, grunting
– fully susceptible M. tuberculosis, o Male, preterm, low BW, maternal DM, & perinatal 2. Pallor – from anemia,
– no history of previous anti-TB drugs asphyxia peripheral vasoconstriction
– low local persistence of primary resistance to
3. Onset – within 6 hours of life
Isoniazid (H) o Corticosteroids: Peak severity – 2-3 days
• most successful method to induce fetal lung Recovery – 72 hours
2HRZ OD then 4HR OD or 3x/wk DOT maturation
• Administered 24-48 hours before delivery Retractions:
– Microbial susceptibility unknown or initial drug decrease incidence of RDS o Due to (-) intrapleural pressure produced by
resistance suspected (e.g. cavitary) • Most effective before 34 weeks AOG interaction b/w contraction of diaphragm & other
– previous anti-TB use
respiratory muscles and mechanical properties of
– close contact w/ resistant source case or living o Microscopically: diffuse atelectasis, eosinophilic the lungs & chest wall
in high areas w/ high pulmonary resistance to membrane
H.
Nasal flaring:
–
o Due to contraction of alae nasi muscles leading to
2HRZ + E/S OD, then 4 HR + E/S OD or Pathophysiology: marked reduction in nasal resistance
3x/week DOT
1. Impaired/delayed surfactant synthesis & secretion Grunting:
2. V/Q (ventilation/perfusion) imbalance due to o Expiration through partially closed vocal cords
B. Extrapulmonary TB deficiency of surfactant and decreased lung • Initial expiration: glottis closed
– Same in PTB compliance lungs w/ gas
3. Hypoxemia and systemic hypoperfusion inc. transpulmo P w/o airflow
– For severe life threatening disease 4. Respiratory and metabolic acidosis • Last part of expiration: gas expelled against
(e.g. miliary, meningitis, bone, etc) 5. Pulmonary vasoconstriction partially closed cords
6. Impaired endothelial &epithelial integrity
2HRZ + E/S OD, then 10HR + E/S OD or 7. Proteinous exudates Cyanosis:
3x/wk DOT 8. RDS o Central – tongue & mnucosa (imp. Indicator of
impaired gas exchange); depends on
total amount of desaturated Hgb
UMBILICAL CATHERIZATION
NEWBORN RESUSCITATION Cathether length
Indications • Standardize Graph
AIRWAY: open & clear • Vascular access (UV) – Perpedicular line from the tip of the shoulder to
Positioning • Blood Pressure (UA) and blood gas monitoring in the umbilicus
Suctioning critically ill infants • Measure length from Xiphoid to umbilicus and add
Endotracheal intubation (if necessary) 0.5 to 1cm.
Complications • Birth weight regression formula
BREATHING is spontaneous or assisted • Infection – Low line : UA catheter in cm = BW + 7
Tactile stimulation (drying, rubbing) • Bleeding – High line : UA catheter = [3xBW] + 9
Positive-pressure ventilation • Hemorrhage – UV catheter length = [0.5xhigh line] + 1
• Perforation of vessel
CIRCULATION of oxygenated blood is adequate • Thrombosis w/ distal embolization Procedure
Chest compressions • Ischemia or infarction of lower extremities, bowel • Determine the length of the catheter
Medication and volume expansion or kidney • Restrain infant and prep the area using sterile
• Arrhythmia technique
• Air embolus • Flush catheter with sterile saline solution
• Place umbilical tape around the cord. Cut cord
RESUSCITAION MEDICATIONS Cautions about 1.5-2cm from the skin.
• Never for: • Identify the blood vessels.
– Omphalitis (1thin=vein, 2thick=artery)
Atropine 0.02 ml/k IM, IV, ET
– Peritonitis • Grasp the catheter 1cm from the tip. Insert into the
Bicarbonate 1-2 meq/k • Contraindicated in vein, aiming toward the feet.
Calcium 10 mg elem Ca/k slow IV – NEC • Secure the catheter
Calcium chloride 0.33/k (27 mg Ca/cc) – Intestinal hypoperfusion • Observe for possible complications
Calcium gluconate 1 cc/k (9 mg Ca/cc)
1g/k = 2 cc/k D50 Line Placement
Dextrose
4 cc/k D25 • Arterial line
Epinephrine 0.01 cc/k IV, ET • Low line
– Tip lie above the bifurcation between L3 & L5
• High line
– Tip is above the diaphram between T6 & T9
BILIRUBIN
PRETERM:
mg/dl mmol/L
0-1 hr 1-6 17-100
1-2 d 6-8 100-140
3-5 d 10-12 170-200
TERM
mg/dl mmol/L
0-1 hr 2-6 34-100
1-2 d 6-7 100-120
3-5 d 4-12 70-200
1 mo <1 <17
SERUM
ZONE JAUNDICE
BILIRUBIN
I Head & neck 6-8
Upper trunk
II 9-12
to umbilicus
Empirical dose Lower trunk
III 12-16
6 months ¼ tsp TID QID to thigh
6 mos – 2 yrs ½ tsp Arms, legs,
IV 15
2-6 1 tsp below
6-9 1 ½ tsp V Hands & feet 15
9-12 2 tsp
MKD COMPUTATION
LUMBAR PUNCTURE • To diagnose other medical conditions such as:
– viral and bacterial meningitis Wt x mkd x preparation [mg/mL] = mL per dose
• the technique of using a needle to withdraw – syphilis, a sexually transmitted disease
cerebrospinal fluid (CSF) from the spinal canal. – bleeding around the brain and spinal cord e.g. 12kg x 10mg x 5ml = 5mL per dose
– multiple sclerosis, (affects the myelin coating of 120mg
SPINE the nerve fibers of the brain and spinal cord)
• spinal cord stops near L2 – Guillain-Barré syndrome, (inflammation of the * If per day, divide total (mL) by the # of divided doses
• lower lumbar spine (usually between L3-L4 or nerves)
L4–5) is preferable Dose x preparation x frequency = mkd
Complication weight
CSF • Local pain
• clear, watery liquid that protects the central • Infection
nervous system from injury • Bleeding Paracetamol Drops = Wt: move 1 decimal
• cushions the brain from the surrounding bone. • Spinal fluid leak point to the left
• It contains: • Hematoma (spinal subdural hematoma Age Wt
– glucose (sugar) • Spinal headache 1 10 kg
– protein • Acquired epidermal spinal cord tumor 2 12
– white blood cells 3 14
• Rate : 500ml/day or 0.35ml/min Caution & Contraindications 4 16
• Range : 0.3-04 ml/min • Increased ICP 5 18
• Volume : 50ml (infants) • Bleeding diasthesis 6 20
150ml (adults) • Traumatic Tap
• Overlying skin infection 1 drop = 1/20 mL
Indication • Unstable patient 1 teaspoonful = 5 mL
• to diagnose some malignancies (brain cancer and 1 tablespoonful = 15 mL
leukemia) 1 wineglassful = 60 mL = 2 ounces
• to assess patients with certain psychiatric 1 glassful = 250 mL = 8 ounces
symptoms and conditions. 1 grain = 60 mg
• for injecting chemotherapy directly into the CSF 1 pint = 500 mL
(intrathecal therapy) 1 quart = 1000 mL
1 ounce = 30 mL
1 Kg = 2.2 lbs
1 lb = 0.45359 Kg
Criteria for Respiratory Distress in Children With Pneumonia
Signs of Respiratory Distress
1. Tachypnea, respiratory rate, breaths/mina
Age 0–2 months: >60
Age 2–12 months: >50
Age 1–5 Years: >40
Age >5 Years: >20
2. Dyspnea
3. Retractions (suprasternal, intercostals, or subcostal)
4. Grunting
5. Nasal flaring
6. Apnea
7. Altered mental status
8. Pulse oximetry measurement <90% on room air
Simple febrile seizures Complex febrile seizures Newborn Screening in the Philippines
Self – limiting Longer duration (>15 minutes) Congenital hypothyroidism
Short duration (<15 minutes) May present as series of seizures with limited time Congenital adrenal hyperplasia
Tonic – clonic features interval Galactosemia
No reoccurrence within the next 24 New events may reoccur within the next 24 hours Phenylketonuria
hours Focal seizures, with several possible features: G6PD deficiency
No post – ictal pathology Clonic and/or tonic movements
Loss of muscle tone
Beginning on one side of the body, with
or without secondary generalization
Head and/or eye deviation to one side
Seizure activity followed by transient
unilateral paralysis (lasting minutes to
hours, occasionally days)
Typhoid Fever NTS Gastroenteritis Nephrotic Nephritic
Etiology S. Typhi Nontyphoidal Salmonella
serovars (eg, S. Massive proteinuria Hematuria
typhimurium, S. enteritidis) Hypoalbuminemia Oliguria
Distribution of bacteria in Systemic infection Infection remains localized Edema Azotemia
immunocompetent host to intestine and mesenteric Hyperlipidemia/hyperlipiduria hypertension
lymph nodes
Incubation period 14 days <1 day
Common symptoms Fever, relative Diarrhea, abdominal pain,
bradycardia fever, headache, muscle
pains
Duration of symptoms 3 weeks <10 days
Predominant cell type in Mononuclear cells and Neutrophils
intestinal infiltrates lymphocytes
Fecal leukocytes Mononuclear cells Neutrophils
TRANSIENT TACHYPNEA OF THE NEWBORN
Overview Presentation Differential Diagnosis Workup Treatment Medication
Self – limited disease in Tachypnea with Congenital pneumonia ABG Supportive: Minimal medication.
infants occurring within variable grunting, Meconium aspiration Pulse Ox IVF and Antibiotics (Ampicillin
the first few hours of flaring, and retracting. syndrome CXR lavage or Gentamicin) may
life. Usually a result of Maternal history of Neonatal sepsis feedings. be used for 48 hours
delayed clearance of caesarean delivery Pneumomediastinum Rarely an after birth until
fetal lung liquid. without labor or Pneumothorax infant sepsis is ruled out.
precipitous delivery. Persistent newborn develops a
Resolution usually pulmonary hypertension picture of
occurs 72 hours after Respiratory distress worsening
birth. syndrome respiratory
distress.
NEONATAL PNEUMONIA
Can be acquired 1 of 3 Sudden onset of Foreign body aspiration, ABG Empiric Outpatient: Not
ways: congenital, fever, cough, and heart failure, malignancy, Pulse Ox antibiotic recommended for first 3
months of age. 1st line
during birth, or after tachypnea. Clinical atelectasis, pulmonary CXR treatment x drug is Amoxicillin. If
birth. Congenital exam findings include embolus, pulmonary Blood 10 – 14 days. penicillin allergic,
causes include tachypnea, rales, and hemorrhage, and cultures in Patient may clindamycin, levofloxacin,
Toxoplasmoa gondii, retractions. sarcoidosis. Collagen hospitalize be switched to 3rd gen cephalosporins,
rubella, HSV, mumps, Abdominal pain is vascular disease. d patients. PO at time of or macrolides
adenoviruses, Listeria common with basilar Environmental irritants, CBC with discharge. Inpatient: Neonate 1st
monocytogenes, and pneumonia. Atypical congenital lung anomalies. diff line is Ampicillin +
Mycobacterium pneumonia may aminoglycoside. 1 month
tuberculosis. present with dry, and up Ampicillin.
nonproductive cough,
For moderately or
Group B strep are headache, malaise, severely ill patients,
responsible for most fever, and cefotaxime, ceftriaxone,
cases acquired at pharyngitis. and levofloxacin provided
delivery. broader coverage against
PCN$ pneumococci.
Azithromycin,
Chlamydia trachomatis clarithromycin, or
is acquired during levofloxacin should be
passage through an added to cover atypical
infected birth canal, pathogens. Vanco for
though it can also occur MRSA.
after prolonged
membrane rupture.
NECROTIZING ENTEROCOLITIS
Overview Presentation Differential Diagnosis Workup
Most common GI Presentation: nonspecific findings such Hypoplastic left heart syndrome ABG
medical/surgical as vomiting, diarrhea, feeding Intestinal malrotation Abdominal
emergency occurring in intolerance and high gastric residuals. Intestinal volvulus radiograph
neonates. Multifactorial Also may have abdominal distention Bacterial meningitis Abdominal US
etiology. and blood in stools. Neonatal sepsis Upper GI series
Omphalitis Paracentesis
Characterized by variable PE: ↑abdominal girth, visible intestinal Prematurity
damage to the intestinal loops, obvious abdominal distention, Urinary tract infection
tract. ↓bowel sounds, change in stool Volvulus
pattern, hematochezia, erythema of GERD
Most commonly affects abdominal wall, palpable abdominal Hirschsprung’s
the terminal ileum and mass. Systemic signs include Bacteremia
ascending colon. respiratory failure, ↓peripheral Coarctation of the aorta
perfusion, circulatory collapse.
Infants with compromised
placental blood flow are
prone to NEC. Also prone
are preemies.
ACUTE GLOMERULONEPHRITIS
Overview Presentation PE Differential Workup Medication
Diagnosis
Sudden onset of Symptoms: Periorbital and/or Anaphylactoid CBC Antibiotics for
hematuria, Hematuria pedal edema purpura with Electrolytes underlying
proteinuria, and RBC Oliguria Edema and HTN due nephritis BUN/Creatinine infection.
casts. Clinical Edema (peripheral or to fluid overload Chronic GN Complement Loop diuretics
picture is often periorbital) Crackles with an acute levels for edema
accompanied by Headache Elevated JVP exacerbation U/A and HTN.
hypertension, edema, Shortness of breath or Ascites and pleural Idiopathic 24 hr urine Vasodilator
azotemia (↓GFR), dyspnea on exertion effusion (possible) hematuria study for severe
and renal salt and Possible flank pain Maybe: Familial Streptozyme/AS HTN and
water retention. Most Rash nephritis O titer encephalopat
common etiology is Symptoms of systemic dz Pallor IgA nephritis Nephritis- hy.
following that can ppt AGN: MPGN associated
Renal angle fullness
streptococcal Triad of sinusitis, Lupus nephritis protease
or tenderness, joint
infection (PSGN). pulmonary infiltrates, GN of chronic (NAPR) TREATMENT
swelling, or
and nephritis infection elevated in pts :
tenderness
Most often, patient is (suggesting Wegener’s VasculitiS with Mainly
Hematuria
a boy, 2-14 years, granulomatosis) streptococcal supportive.
who suddenly Abnormal neurologic infxn with GN Sodium and
Nausea and vomiting, examination or altered
develops puffiness of US to evaluate fluid
abdominal pain, and LOC
the eyelids and facial kidney size. <9 restriction.
purpura (Henoch- Arthritis
edema in the setting cm suggests Bed rest until
Schonlein purpura) Other signs:
of a extensive signs of
Arthralgias (SLE) Pharyngitis
poststreptococcal scarring and glomerular
infection. Urine is Hemoptysis Impetigo low likelihood of inflammation
dark and scanty. BP (Goodpasture’s or Respiratory infection reversibility. and
may be elevated. idiopathic progressive Pulmonary circulatory
Nonspecific infection glomerulonephritis) hemorrhage congestion
include weakness, Skin rashes Heart murmur subside.
fever, abdominal (Hypersensitivity Scarlet fever
pain, and malaise. vasculitis, SLE, HSP, Weight gain
There is a latent or cryoglobulinemia)
Abdominal pain
period of 3 weeks Anorexia
following strep Back pain
infection. Oral ulcers
Defibrillation: 2.5joules/kg x 3
FLUIDS ARTERIAL BLOOD GAS
IVF Dext Na Cl K Lac Kcal/L HCO3
Acidosis ph<7.35
D5W 50g 170 Alkalosis ph>7.45
DEXTROSITY
D5 D7.5 D10 D12.5 D15 D17.5 D20 D50
0 .055 .11 .17 .22 .28 .33 1.0
NEWBORN WEIGHT GAIN MAGNESIUM SULFATE
Prep: 250mg/ml
Birth weight regained on 10th DOL; 2-3 wks preterm LD: 100-200mg/kg/dose over 30mins
MD: 20-30mg/kg/day
Preterm: 15-20gm/day
Term: 20-30gm/day Ex: wt = 3.2kg
D. TPN CPAP
Electrolytes Preparation Normal Settings
FiO2 CA O2 PEEP
NaCl 2.5mEq/mL 2-4 mEq/kg/day 60% 3 3 6
KCl 2 mEq/mL 1-3 mEq/kg/day 80% 1.5 4.5
10% Cagluc100mg/mL 100-400 g/kg/d
7% AA 7g/100mL 0.5-3 g/kg/day FiO2 and PEEP = already set
Normal:135-145 meq/L
INTRALIPID Significant hyponatremia: 120 meq/L
Prep: 10% , 20% Maintenance dose: 2-3 meq/kg/24 hr
Dose: 0.5-3g/kg/day ; inc by 0.5 until 3 is reached
20% = 20g/100ml Prep: 2.5meq/ml/amp
Fast Correction: (values <120meq)
Ex: Wt 2.35kg 4ml/kg of 2.5 meq/ml prep
Wt x 3 x 100 x 1.1 (For every ml of NaCl = 4ccsterile water)
20
K= 29 (<2.5 kg)
URINE CONCENTRATING ABILITY
40 (0-18mos)
49 (2-16yrs girls) Osmolality
49 (2-13yrs boys) Urine osmolality : more precise than usg
62 (13-16 yrs boys) Urine osmolality = (usg-1.000) x 40000
Normal = 400to 600 mOsm/L
Normal 80-120
Renal impairment 50-80 Serum osmolality = 2Na + {glucose (mg/dl)/18} + {bun
Renal insufficiency 20-50 (mg/dl)/2.8}
Renal failure5-20 Normal = 230 to 300 mOsm
Uremia <5
Urine Specific Gravity
To get % = creatinine clearance divided by 120 Each 15 mmol/L (2.7 g) glucose : inc USG by 0.001
Creatinine divided by 88.4; K in decimal point (0.29); Each 4 g/L Protein : inc USG by 0.001
if >3 renal failure
PHLEBOTOMY
ANION GAP
FFP transfusion:
Normal : 20 Wt x EBV (70-80) x 0.15 (.10-.15)
Give ½ 30-1hr before phlebo, then remaining
Na - ( HCO3 + Cl ) during phlebotomy
134 – (12 + 98) = 24
PNSS can be also be used
1meq/kg NaHCO3 if with hypoxic spells
ACUTE GLOMERULONEPHRITIS DIABETIC KETOACIDOSIS2
TYPICAL COURSE Insulin drip:
Latent : few days- 3 wks >2yo = 0.1u/kg/hr
Oliguric : 7 - 10 days <2yo = 0.05u/kg/hr
Diuretic : 7- 10 days
Convalescent : 7 - 10 days make 5u in 50cc pnss or
10u in 100cc pnss to run __cc/hr (running rate is
NORMALIZATION OF URINE SEDIMENT equivalent to weight in kg)
Gross hematuria : 2 - 3 wks
Complement level : 6 - 8 wks ECG
Protenuria : 3 - 6 mos Na, K, Phos, Mg, Ca
Micro- hematuria : 6 - 12 mos Hba1c
FBS
Bladder Capacity: age x 2 oz x 30 BUN, Crea
ABG
Normal bladder residual <5cc or 10% of bladder Urine ketones
capacity means greater risk for UTI
Strict uo q1 with monitoring sheet at bedside
Clean catch : >100,000/ml
Catheter : >100/ml May start NaHCO3 at 1meq/kg sivp to run for 30 mins
Suprapubic : 1 col/ml
DIABETIC KETOACIDOSIS3
NEPHROTIC SYNDROME
If plasma glucose =14-17mmol/L (250-300) give PNSS
Remission: protein free/ edema free x 3-4 mos
Relapse: recurrence of edema & or proteinuria If less than 250 CBG give D5 0.45nacl to prevent rapid
Steroid Responsive: (-) protein after 4-6 weeks decrease in plasma glucose conc and hypoglycemia:
Steroid Resistant: (+) protein after 4-6 weeks of
continuous daily divided doses of prednisone (60mkd); 500 d5 0.9 nacl + 500 d5w = d5 0.45 nacl
use methyl prednisolone
If less than 100 CBG give D10 0.45 NaCl
Steroid Dependent:
- if you withdraw the tx, protenuria recur When rbs is decreasing by > or = 100mg/hr, may titrate
- 2 consecutive relapses occurring during therapy insulin drip by 25% until 0.05u/kg/hr
or w/in 14 days of completing steroid therapy
Frequent Relapser
- responds to corticosteroid treatment but DIABETIC KETOACIDOSIS4
experiences 2 relapses w/in 6 mos after the Transition of Insulin IV to SQ
initial response Clinical improvement
- has 4 relapses w/in any 1 yr No acidosis
Oral intake
1g cho = 4 cal
1g chon =4 cal
1g fats = 8 cal
1000cal = 1kcal
1kcal = 4.184 kj