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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