Acetaminophen 10 -15 mkdose q6-8H

Antamin 0.3 mkdose

Acetazolamide 25mg/kg/24H
(500/5, 125mg, 250mg)
ASA 75 - 100 mkd
KD: 80-100 x2wks
or after 3-4days afebrile
Acetylcysteine 2-5ml TID, QID (infant) 3-5m/k/day OD 6-8wks after
6-10ml TID, QID (child)
10 ml TID, QID Atenolol 0.8 – 1.5mkday (max: 2mg/kg)
Acyclovir >6yo- 800mg 4x/D Augmentin Oral:20-40mkay (based:Amox)
(Varicella, HZV) <2yo- 200mg QID or (Co-Amoxiclav) IV:30mkdose
20mkdose QID Prep 156/312 TID (125/250)
Max: 800mg/day 228.5/457 BID (200/400)
375/625 (250/500)
Albendazole >2y.o 400mg SD
< 2y.o 200 SD Amoxicillin- 20-40mkday PO TID based:Amox
Sulbactam 40-50 mkday IV q8 based:Amox
Albumin 0.5- 1g/kg (Ultramox)
prep: 25/100, 12.5/50cc
Azithromycin 10-50 mkdose OD x3days
Aldactone 2-3 mkday (od,bid,tid) Aztreonam 30mkdose q8h
(Spironolactone) 25mg/tab. 50 & 100/tab
Ambroxol 1.2 - 1.6 mkdose Bambec 0.25-0.27mkdose OD
10 yo - 1 tab TID (Bambuterol) Oral sol:1mg/ml, tab 10mg
5 - 10 yo 1/2 tsp BID,TID
2 - 5 yo 1/2 tsp TID
13 - 24 mos 1.25 mlBID Benadryl 0.5-1 mkdose(IV)
7 - 12 mos 1 mlBID 3 - 5 mkday(PO)
< 6 mos 0.5 ml BID
Bisacodyl <2yo– 5mg
Amikacin 15mkd >2yo– 10mg; (5-10mg/tab supp.)
NB: < 29 15 mkdose 48H
14 mkdose 48H
12 mkdose 36H Bromhexine 0.5-0.85 mkday in 3 doses
>38 12 mkdose 24H

Buscopan 0.15 mkd

Aminophylline 3-5mkdose
Dilute to equal amt with IVF Carbamazepine 10-20mkday, then 1.5-3 mkday
Refer: Inc HR, sZ, Hypo/hypertensn,
vomiting Carbocisteine Inf: 10-20 mkday
Child: 30-50 mkday
Ampicillin- At least 100mkday
Sulbactam (based on Ampi) Captopril Premature:0.01m/kdose q8-12H
Adult: 750mg IV q6-8H Neonate:0.05-0.10mkdose q12-24H
po: 20-40mkday Children:0.3–0.5mkdose
Max:6m/k/24H
Amphotericin B 0.3 - 0.7mkd
Cefaclor 20 - 40 mkday
NB: Initial:0.25-0.5mgK IV
Infusion:2-6H
MD:0.5-1mg/kg IvQ24-48H Cefixime Pneumonia:10-12 mkday x7days
Typhoid: 15-20mkday x10-14days
Ampho B 50 mg dilute with 10ml dilute to
make a conc of 5mg/ml Cefalexin 30 - 50 mkday
Test dose...
eg 2.1kg Cefazolin 100mkday q6h IVTT
Day 1:0.25/kg
=(wt x0.25)=0.52mg Cefepime 30mkdose q12 ( < 14days old))
(0.52/ 5)= 0.1ml 50mkdose q8 (meningitic, severe
0.1 ml + 5.2 ml D5water to run for 6h sepsis)
Day2: 0.5ml/kg= 1/05mg
Ampho B 0.21ml + 10.5 ml D5W
Cefuroxime 75- 100 mkday(IV)
Reconstituted solution should be 20-40mkday (po)
wrapped in aluminum foil to protect from
life n store at ref Cefpodoxime 8-10 mkday BID Po
Infusion line wrapped in aluminum foil
Watch out for apnea, bradycardia, Cefotaxime 50 - mkd0se
cyanosis
Be given in AM preferably Ceftriaxone 75- 100 mkday (max: 3g/day)
Ampicillin 100-150 mkd
MeninG: 200-400 mkd Ceftazidime 30mkdose q12(<7days old)
NB: 50mkdose q8 (>7 days old)
Postnatal Age Interval
<29 0-28 12 Cetirizine 0.25mkday OD/BID
>28 8 Oral solution (1mg/ml)
30-36 0-14 12 Drops ( 10mg/ml)
>14 8 - wt(kg) x 0.25 x20
37-44 0-7 12 10
>7 8
>45 All 6 Charcoal 1 – 2 g/kg q2-6H
5 – 10 x wt of ingested poison
Amoxicillin 30-50mkday/ 50-75mkday H.D

Chloramphenicol IV: 50-100mkday q6h (>75

Ansimar 10 mkdose BID mkday:Typhoid)
PO: 30-50mkday
 PreMature/NB: 25 mkday 30 mos-9 yrs: 1 sachet/dose
>9yrs: 2 sachets/dose

Chlorphenamine 0.35mg/kg/24H Hydroxyzine 1mkday

Maleate

Cimetidine 5 mkdose Q6-8H

IVIg Prep: 2.5g/50cc vial
10g/200cc vial
RD: 2g/kg/dose, infuse x12hrs
Test dose: 0.01-0.02 cc/kg/min
infuse for 30 mins
Ciprofloxacin 20-40 mkday
Typhiod relapse: 10-20mkday INH 5-10mkday
Max: 500mg q12h

Clarithromycin 15mkday Lanoxin 0.003 mkdose

Mannitol 2.5-5cc/K/dose
Clindamycin 10-20mkday mild
20-40mkday severe
Mebendazole 500 SD
Clonazepam 0.01– 0.03m/k/24h in 2-3 divided doses 100mkd x 3days (bid)

Meclizine 12.5 - 50 mkd

Cloxacillin 50-100 mkday
Meropenem 20mkdose q12
Co-Amoxiclav 20-40 mkday q8h IV 40mkdose q8 meningitic
30-50 mkday BID PO
Meperidine 0.5 mkdose

CoTrimoxazole 8-10 mkday BID PO Metoclopromide 1 mkd(PO)

Based on Trimethoprim 0.5 mkday (IV) q8

Metronidazole 30 - 50 mkday (TID)

Dexamethasone 0.5-1 mkday (LD)
0.2-0.4 mkday (MD) Mefenamic Acid 6.5 mkdose
Prep: 50mg/ml

Dicycloverine 1 mkdose q6h PO Motilium 0.15-0.4mkdose q6h

(Domperidone) not to exceed 1mkday

Digoxin Neonate: 10-30mcg (LD) Nystatin 1.2 M units/day

5-10mcg (MD) 400,000 U/day
1mos-2yr: 30mcg (LD)
10-15mcg (MD) Nalbuphine 0.1 - 0.2 mkdose
Child >10yo: 10mcg (LD)
2-5 mcg/k/day (MD) Nifedipine 0.25 mkdose

Diphenhydramine 1 mkdose q8h IV Phenobarbital 15mg/tab (gr ¼)

3-5 mkdose q8h PO 30mg/tab (gr1/2)
60 mg/tab(gr 1)
Doxycycline 2 - 4 mkd 90 mg/tab (gr1 ½)
RD: MD: 5 mkday
Dimetapp 0.1 mg /k/dose(drops) LD: 10-15 mkdose
1 - 6 mos -0.5ml TID
2 - 24 mos 1ml TID Piperazine 75mkday x3days
syrup: 2 - 4yo 3/4 tsp TID
4 - 12 yo 5ml TID Piperacillin- 150-200MKday (based on piperacillin)
Tazobactam
Diazepam 0.2 mkdose
Prednisone 1 - 2 mkd(preferably BID)
Erdostein 15mkday(BID)
Phenobarbital 5 mkd(MD)
Erythromycin 30 - 50 mkday

Ethambutol 15 mkday Neonate: 15–20m/k/day (LD)

Phenytoin 5m/k/day q12-24H (MD)
Fluconazole 4-6mkday OD

Furosemide 0.5-1.0 mkdose (max:4mkdose) PZA 15-30 mkday

FeSO4 4 - 6 mkday (Therapeutic) Pen G 50, - 100,000 U/kday

1-3 mkday (Prophylactic)
Rifampicin 10 – mkday

Gentamycin 5 - 8 mkday Ranitidine 2 - 2 mkdose

Theophylline 20 mkd
Hemostan 10mg/kg/dose

Terbutalline 0.075 mkdose

Hydrocortisone 4-6 mkdose

Timentin 80mg/k Q6-8H

Hydralazine 0.15mkdose(IV) 80mkdose q12H (termNB)
0.75mkd(PO)
Racecadotril 1.5mkdose(TID)
(Hidrasec) 1 mo-9 mos: 1 sachet/dose Tobramycin <7days 5 mkdq12
9 mos-30 mos: 2 sachets/dose <5y 7.5 mkdq8
 5 -10y 6 mkd q8 Epinephrine 0.01 mkdose (1:1000)
0.1 mkdose (1:10000)
Valproic Acid 15 mkday max. 3 ml q5-10 mins

Vancomycin 10 q 12 mkdose (severe:15mkdose q8) DRIP:

0.6 x wt(kg) x ug/k/min = __mg in 100mL of
mL/Hr D5W/NS
Zafirlukast 40mg/day PO q12H (20mg/tab)
(Accolate) = 1mL/Hr will deliver 0.1 ug/k/min

Zertin/Erdostein 7.5 mkdose q12

Naloxone 0.1 mkdose

Mannitol 0.5-2 gkdose

AGE Drugs 1g= 5cc
Infloran Berna dissolve contents of 1 cap in
15 ml of diluted formula TID
Albumin 0.5-1 g/K
Furazolidone (Furoxone) Prep: 50mg/ml, 16.7,g/5 ml Prep: 25g/100cc
RD= 4-7 mkday 12.5/50cc
Dilute in 50cc D5W x20-25 ugtts/min
Ercefuryl (40-60/ 60-100)

OD(60-100mkd) Dobutamine Prep: 250mg/20cc

Prep.: 220 mg/5 ml 12.5 mg/cc
cc/Hr = wt x ugm x 60
Etofamide (kitnos) Prep. 100 mg/5ml 500
RD= 20-40 mkday = 2 CC+ 48 cc D5W

Metronidazole Prep 125mg/5ml DRIP:

RD= 30-50mkday 2.5 – 15 ug/kg/min (max: 40ug/kg/min)
Peak effect: 10-20 min
Diloxanide Furamide Prep 125mg/5ml Preparation:
12.5mg/mL x 20mL/_ = 250mg/mL
RD= 20 mkday
Premix:
1000ug/mL x 250mL = 250mg/250mL
Secnedazole Prep:
2000ug/mL in 250mL = 500ug/250mL
RD= 30 mkday
= 6 x wt(kg) = __mg in 100mL
* 250mg in D5W 250cc (1mg/mL)
ANTISPASMODICS Ugtts/min = wt(kg) x DD
Dicycloverine - 0.15mkday 16.6
Bentyl 10 mg/tab, 20mg/ml = wt(kg) x DD x 0.06
Relestal 10mg/5ml, 5 mg/ml * 500mg in D5W 250cc (2mg/mL)
Ugtts/min = wt(kg) x DD
Hyoscine Butyl Bromide 10mg/tab, 5 mg/ml 33.2
(Buscopan) = wt(kg) x DD x 0.03
Dopamine Prep: 40, 80, 160 mg/ml
Diphenhydramine Syrup: 12.5 mg/5ml Cc/hr = wt x ugm x60
(BENDARYL) Cap - 25 mg (200/250) 400 or 800 (400/250)
Inj - 50 mg/ml (1:100) (1:50)
3-5 mkday po DRIP:
1 mkdose IV Premix: 200mg/250mL; 400mg/250mL
Prep: 40mg/mL x 5mL/amp = 200mg/mL
ANTIFUNGAL
Mycostatin Tab: 1-2 tabs TID = 6 x wt(kg) = __mg in 100mL
Susp: infant 2ml QID (1mL/Hr = 1 ug/kg/min)
Children- 4-6 ml QID *200mg in D5W 250cc
Oral Susp : 2 ml QID Ugtts/mins = wt(kg) x desired dose(DD)
to be swabbed on lips and 13.3
buccal mucosa = wt(kg) x DD x 0.075
*400mg in D5W 250cc
Ugtts/mins = wt(kg) x DD
Difflucan (Fluconazole) 4-6 mkday 26.6
50 mg/tab 1 tab divided into = wt(kg) x DD x 0.0375
4pptabs 1pptab OD with Dopamine/Dobutamine
milk Wt x desired x 60 x24
PO/IV=3-6mkday OD/q12H Concentration
Ca 100-300 mkday (oral)
Gluconate 1cc/kg (LD-IV)
Bronchodilators 1 cc/kg/day (MD-IV)
Aminophylline RD= 3-5 mkdose Epinephrine (mg)/100cc x X/1cc x 100
dilute with equal amt of IVF Drip
refer for vomiting, cc/Hr= wt. X 0.3 -1 x 60
hypotension, H/A, Sz, 40
tachycardia Prep: 1 amp in 25cc D5W
Acetazola- 250mg/tab
mide 30 mkday q8H
Theophylline syrup 80mg/15ml NaHCO3 325mg/tab
(Nuellin) Tab= 50 mg, 125 mg 8-10 mkday q8H
RD= 4 mkdose Furosemide Drip:
Prep: 10 mg/mL ampule
Dose:
Infant/Child: 0.05m/k/hr (titrate to clinical effect)
Emergency Drugs Adult: 0.1 m/k/hr (max: 0.4 m/k/hr
NaHCO3 1-2 meq/kg/dose
Wt(kg) x DD x 24h = __mg in 24 mL of NS to
Atropine 0.04 mk SQ
make 1 cc/hr = 0.1 mg/kg/hr
0.02 mkdose IV
OR
Wt(kg) x DD x 24 x 5 = __mg in 120mL of NS to
 make 5 mL/hr = 0.1mg/kg/hr Infant - 139- 146
IV infusions = 6 x Desired dose(ug/k/min) x wt(kg) = mg drug Child - 138 - 145
Desired rate(mL/Hr) 100mL fld Thereafter - 136 - 146

K
Medication Usual Dilution in IV Infusion Rate <2mos 3.0 - 7.0
Dose 100mL 2- 12 m 3.5 - 6.0
D5W >12m 3.5 - 5.0
Dopamine 2-20 6mg/kg 1 mL/Hr=1ug/kg/min
Dobutamine 2.5- 6mg/kg 1mL/Hr=1ug/kg/min Ca
15 Cordblood - 2.25 - 2.88
Epinephrine 0.1-1 0.6mg/kg 1mL/Hr=0.1ug/kg/min NB - 2.3 - 2.65
Lidocaine 20-50 0.6mg/kg 1mL/Hr=1ug/kg/min 24-48H - 1.75 - 3.0
4-7d - 2.25 - 2.73
Prostaglandin 0.05- 0.3mg/kg 1mL/Hr=0.05ug/kg/min
Child - 2.2 - 2.7
E 0.1 For Patency of PDA:
Thereaftr - 2.1 - 2.55
-IV: begin infusion at
0.05-0.1ug/kg/min,
when desired effect is
Crea Mg/dl (x88.4) umol/L
achieved, dec to 0.05-
Cordbld 0.6 -1.2 === 53 -106
0.025-0.01ug/kg/min
NB 0.3 -1.0 === 27-88
-if unresponsive, inc to
Infant 0.2 - 0.4 === 18 -35
0.4ug/kg/min
Child 0.3 - 0.7 === 27 -62
-Ampule: 500ug/mL
Eg. 2.6kg
Adolescent 0.5-1.0 === 44 -88
2.6kg x 0.05ug/kg/min x60 Adult M: 0.6-1.2 == 53-106
500ug/mL F: 0.5 - 1.1== 44-97
=0.02
Terbutaline 0.1- 0.6mg/kg 1mL/Hr=0.1ug/kg/min BUN Mg/dL (x0.357) mmol/L
0.4 Cordbld 21-40 ***** 7.5 - 14.3
Prem 3 - 25 ***** 1.1 - 9
NB 3 -12 ***** 1.1 - 4.3
Inf/Child 5 -18 ***** 1.8 - 6.4
PH<7.35 PH7.35- PH7.40- PH>7.45
7.45 7.45 IVF Na Cl K Ca Lactatea
Composition cetate
PCO2 Part Comp Comp Resp alk
<35 comp met acid resp alk 0.9NSS 154 154
met acid 0.3NaCl 51 51
PCO2 Met acid Normal Normal Met alka LR 130 109 4 1.5 28lact
35-45 NR 140 98 5 1.5 27acet
PCO2 Resp Comp Comp Part 23gluc
>45 acid resp acid met alka comp NM 40 40 13 1.5 16lact
met alka Imb 25 22 20 1.5 23acet
Thereafter 7-18 ***** 2.5 - 6.4

Daily Fluid Requirement

Weight (kg) D0-2 D3-4 D14-30
Ph PCO2 HCO3 BE 750g – 1kg 110 140 150
Met Acid 1 - 1.25 100 130 140
Uncompensatd  N   (-) 1.25 – 1.5 90 120 130
Partly comp     (-) >1.5 80 110 130
Complt comp N    (-) Add 25% if with PHOTO
Met Alka
Uncompnsatd  N   (+)
Partly Comp    (+) PPN
Complt Comp N    (+) Vamin : 100 x wt x dose
Preparation(%)
Resp Acid
Ca Gluc: 2cc/kg/day
Uncompnstd   N N
BNC: 0.5-1cc/day
Partly Comp     IVF: accdg to TFI
Complt Comp N   
Resp Alka Cholesterol
Uncomp   N N Total mg/dl = mmol/L
Partly comp     1-3yr : 45-182 = 1.15 - 4.70
4-6yr 109-189 = 2.80 - 4.80
Complt Comp N   
6-9yr 5-75-95 5 -75- 95
M 126-172-191 = 3.26- 4.45-4.94
Caloric Equivalent: F 122- 173- 204= 3.16- 4.47-5.41
D50 2 10-14yr
D10 0.4 M 130-179-204 = 3.36-4.63-5.28
D5 0.2 F 124-174-217 = 3.21-4.50- 5.61
D7.5 0.3
D12.5 0.6 15-19yr
Amino acid 0.2 M 114-167-198 = 2.95-4.32-5.12
Intralipid 1.1 F 125-175-212 = 3.23-4.53-5.45
Vamin 0.67
Albumin
Corn oil 8.4 Prem 1 day - 1.8 -3.0 g/dl -- 18-30g/L
Karo, Aminosteril 4 Fullterm <6days 2.5 - 3.4g/dl -- 25-34g/L
MCT 7.6 <5 yr 3.9 - 5.0g/dl -- 39 - 50g/L
Olive Oil 9 5-19yr 4.0 - 5.3g/dl --- 40 - 53g/L
Breastmilk 20 /oz
PreNan 24 Protein
NAN 22 Prem 4.3 -- 7.6g/dl --- 43-76g/L
Enfalac 24 Newborn: 4.6 -- 7.4 g/dl --- 46 - 74g/L
Pediasure 225kcal/225mL 1--7 yr 6.1 -- 7.9 g/dl -- 46-74g/L
8-12yr 6.4 -- 8.1 g/dl -- 64 - 81g/L
Na 13 -19yr 6.6 -- 8.2 -- 66 - 82 g/L
NB - 134- 146
Corrected Reticulocyte: observed retic x observed hct
 Normal hct for age 3. Meconium aspiration
4. Pulmo edema with or without assoc. CHF
Dextrosity: 5. Fluid overload
D5 = 50 glucose D10 = 100 glucose D12.5 = 125 glucose 6. General atelectasis
Limits of Dextrosity: Peripheral Line: D12 7. Infants with apnea of prematurity
Central Line: D20 8. Infants with ARDS
9. PaO2 < 50-60 mmHg, breathing
Total Fluid Intake (TFI): Term: 60-80; Preterm: 80-100  60-70 with recurrent apnea
TFI: Rate (cc) x 24 hr
Wt(kg) WEANING
Computation: 1. Improvement in CXR
Wt(kg) x TFI = ___ divide 3 (soluset: 100cc) 2. ABG with PO2 > 50 mmHg
3. Blood pH > 7.3
To adjust dextrosity 10: eg. TFI: 90 4. PCO2 < 55 mmHg
D5IMB 80 x 0.05 = 4 5. Hg 12-15 gm/Hct 36-45
D50W 10 x 0.50 = 5
90 9
Check: 9 / 90 x 100 = 10 = Dextrosity: 10 GUIDELINES
Then, 90 x 3 (q8h cycle) = 11.25cc/hr 1. DEC. FiO2 by 3-5% every time PO2 . 70
24h 2. With FiO2 = 40%, dec. Pressure by increments of 2 cm
“chart”: 90cc x 11cc/hr q8h H2O if 2-4H until 2-3 cm is reached
3. Transfer patient to O2 hood with FiO2 of 15-50%
Then, compute for:
Extubation
GIR: Rate(cc) x dextrosity x0.167 1. Dexa 0.5mkd IVTT Q12H x2 doses prior to extubation
Wt 2. Salbuamol 0.5cc + NSS 0.5cc Q8H
OR 3. Epinephrine 0.2mkd Q4H x 2 doses
Dextrosity x IVF rate x10 4. Dexamethasone Q12H x 2doses after extubation
Wt(kg) x 60 5. Chest physiothearpy
6. Keep on right side position
7. NPO x 2h
Normal Values:  PAI with 4.7cc NSS + 0.3cc Epinephrine QH x3 doses
NB/Infants: 6-8 mg/kg/min then maintain on PAI with 2cc NSS Q6H.
Children: 4-6 mg/kg/min VENTILATOR PLANS
If hypoglycemic, may increase GIR to 15 mg/kg/min HMD PEEP = 4-6 cm H20 PFC PEEP= 2 cm
H20
PIP = 18-30 cm H20
Blood glucose monitoring:
- Monitor CBG q6-8h Oxygenation Status
- if CBG≤40mg/dL, give d10W 2cc/k/dose as slow IV push, get At room air, sea level:
CBG q15 mins, then q1Hr until stable PaO2 80 -100 Normal or acceptable
- if feeding, no need to monitor <80 mild hypoxemia
- if CBG is persistently LOW, check IV line <60 moderate hypoxemia
- may need to increase dextrosity <40 severe hypoxemia
On oxygen support:
Peak Flow: PaO2 80 - 100 corrected hypoxemia
Ht in cm - 100 x5 +175(M) >N overcorrected hypoxemia
170(F) <N uncorrected hypoxemia

Albumin: wt (g/Kg) x quantity of Stock(50cc or 100cc) ROMS - resp opposite; metabolic same
% Metabolic Acidosis:
1. RTA
IVF: cc/h x 24h x Dextrosity x 3.4 2. DKA; Starvation
100 3. Lactic acidosis

Aminosteril: wt x g/k x 100

% Metabolic Alkalosis:
Cal: cc/day x % X 4 1. Hypokalemia
100 2. Hypochloremia
3. Vomiting
Materials for Surfactant instillation: 4. Massive steroid administration
- Gloves #3 - OGT F8 5. NaHCO3 administration
- Syringe 10cc (2) - Ruler
- Betadine - Cotton balls Respiratory Acidosis:
- ET size (same brand as inserted) - Ambubag 1. Hypoventilation
a. inadequate resp effort
Post Surfactant CNS problem
- Maintain on NPO Neuromuscular disease
- CXR-APL Mechanical ventilator setting
- VBG/ABG 1 hr after b. upper airway not patent
- B1B2, BUN, Crea, with S. Na, K, Ca c. decreased lung tissue
- Wean FiO2 by 5% every 1-2 hrs pulse ox guided for O2 d. decreased lung compliance
Sat >95% until 40 - 50% 2. Abnormal ventilation perfusion ratio
- No suctioning at least 1 hour aftre instillation unless with a. obstruction of small airway
bradycardia, cyanosis, hypotension, or obstruction b. atelectasis
- Watch out for pneumothorax c. pneumonia
- Standby butterfly G23, 10cc syringe, 3-way stopcock, d. pulmonary edema
betadine, cotton applicator, gloves

PNUEMONIA IN CHILDREN 3. Increased extrapulmonary shunt

0-3 mos C. trachomatis, S. aureus, Gr neg a. pulmonary vasoconstriction
4-11 mos S. Penumonia, H. influenzae * RDS, severe infection
12-59 mos S. Pneumonia, H. influenza b. Pulmonary hypoplasia
>60 mos M. Pneumonia, S. pneumonia c. Cyanotic heart disease
CPAP Respiratory Alkalosis
Requirement : adequate spon. Respiration 1. with hypoxamia
Components : O2 pressure a. acute pulmonary disease -
Indications: - pneumonia and atelectasis, RDS, acute asthma
0. HMD b. Acute myocardial disease
1. Inhalation/chemical pneumonitis - MI, pulmonary edema, heart failure, CP bypass
2. Severe pneumonia 2. Without hypoxemia
 a. anxiety, neurosis, psychosis I - normal
b. pain II - pure Mesangiopathy (mesangial 19-27%
c. CNS disease III - Segmental & Proliferaive GN (Focal Segmental
d. Anemia - 18 - 24%)
e. Carbon monoxide poisoning IV - Diffuse Proliferative Lupus Nephritis (39-44%)
NEPHROTIC SYNDROME V - Diffuse Membranous GN - (8-22%)
TREATMENT: 1st Episode VI - Advanced Sclerosing GN
4weeks: 60mg/m2/day divided doses (max 80md/day)
4weeks: 40mg/ m2 / alt days single am dose (max 60mg) Seroassay-
8days: 20mg/ m2 / alt days single am dose (max 20mg) 1. ANA - unusual in children
8 days: 10 mg/ m2 / alt days single am dose (max 10mg) - ANA titer does not correlate with disease severity

MCNS: relapse treatment (Eddy) 2. Antibodies to ds DNA & Smith (Sm) Antigen more specific
Until urine remission: 60mg/ m2 /day in divided doses level may present in 70% of 25%
8 days: 60mg/ m2 alt days single am dose
8 days: 40mg/ m2 alt days single am dose Anti ds DNA + Anti-Sm Ab + Serum C3 -
8 days: 30mg/ m2 alt days single am dose
8 days: 20mg/ m2 alt days single am dose Renal Disease Activity
8 days: 10mg/ m2 alt days single am dose C3
Remission - absence of proteinuria 5 consecutive days
Difficult patients: C3a, C5a C5b-a
1. Steroid resistent
2. Steroid dependent - 2 relapses/ 14 days after
discontinuation od decrease in dose Leukocytes membrane attack
3. Steroid toxic
4. Steroid Dependent/ Frequent relapsers - 2 relapses in 6 Hyperkalemia
mos. Serum K >5.5meq
1. Sodium Bicarbonate - shifts K into cells
Dr. James Woo - 1 meq/kg IV over 10 - 30 min
BSA: wt X 4 +9 TFR: BSAx 500(<20k)/400 (>20k) + U.O - onset 15-30 min
100 2. Calcium Carbonate - (10%) - stabilizes membrane
potential
Dr Alcala/Caso BSA- Wt in Kg x Ht in CM - 0.5 -1ml/kg over 5-15 min
3600 - onset immediate
3. Glucose and Insulin - stimulates cellular uptake of K
Post Streptococcal Acute Glomerulonephritis - glucose 0.5 mg/kg witn insulin
Diet: Low Salt diet 0.1mg/kg over 30 min
Labs: CBC,plt Na, K - onset: 30 - 120 min
BUN, Crea C3 4. B - Agonist (Albuterol/Salbutamol) - stimulates cellular
ASOT uptake of K
IVF: D5.03 NaCl (no KCl first)
Furosemide (1-2mkdose, HYPOKALEMIA - 0.5-1 meq/kg/dose X 1h
max:4mkdose);Hold:BP<80sys - continuous correction: 0.2-0.3 meq/kg/hr
Pen G/ Ampicillin-Sulbactam - fast correction K (symptomatic)
Limit Oral intake to TFR 0.5meq/kg/hr (child) x10 meq KCl in 166 ml
Watch out for HPN fluid x 1-2hr[s
Weigh Patient daily pre-breakfast/post-voiding max 40meq KCL/500cc PNSS x 1-2 hrs
- ICU - 10meq/10cc (1:1) central line
TFR: BSA x Insensible water loss + UO - Oral: 10% oral KCl soln has 1.34meq/ml
UO- if with Furosemide divide by 2

TUNE/MENDOZA PROTOCOL
WK Methylpred Dose PRED
1-2 30mg/kg 6 none
2x/wk FT Consider Photo # *
3-10 30mg/kg 8 2mg/kg/48 Photo
wkly h ≤24H
11-18 30mg/kg 4 W/ or w/o 25-48H ≥12 ≥15 ≥20 ≥25
q2wks tapering
19-50 30mg/kg 8 Slow 49-72H ≥15 ≥18 ≥25 ≥30
q4wks tapering
51-82 30mg/kg 4 Slow >72H ≥17 ≥20 ≥25 ≥30
q8wks tapering # DVET if photo fails
* DVET and intensive photo
Elises Protocol: Photo for 1500g 1500- >2000
12 months - Monthly--- 3 consecutive days Preterms 2000
6 months - 1 dose/ monthly --- cont prednisone 2 mg/kg <24H >4 >4 >5
q other tapering
24-48H >5 >7 >8
Alkylating Agents 49-72H >7 >9 >12
 Cyclophosphamide - 2.5mg/kg/day X 8wks ≥72H >8 >10 >14
- (Nelson) 3mg/kg/24h x 12wks
- (Total 140mg/kg) DVET for 1500g 1500- >2000g
- 500mg/m2 (BSA) 750mg 1g Preterms 2000g
 Cyclosporine - 5mg/kg/day <24H >10-15 >15 >16-18
- immunosuppressive, altered 24-48H >10-15 >15 >16-18
perselectivity 49-72H >10-15 >16 >17-19
- steroid- sparing drug
>72H >15 >17 >18-20
- high relapse rate when D/C
Polin
 Chlorambucin - 0.2mg/kg/day x 8-12 wks
- hematologic malignancy Wt (PT) Photo DVET
<1.25 5-7 10-13
 Nitrogen Mustard - 1958 1.25-1.49 7-10 13-16
 LTVamisole - 2.5mg/kg/alternate days 1.5-1.99 10-12 16-18
- maintain in remission in about 50% of 2.0-2.5 12-14 18-20
losses of steroid - dependent NS
 RENAL BIOPSY Sick Infant
Age Photo Exchange
LUPUS NEPHRITIS IN CHILDHOOD <24H 10-14 20
Classification >24h 15 20
 Diarrheal Ciprofloxacin is the most appropriate
Healthy Disease drug in place of nalidixic acid which
Age Photo ET if Photo fails DVET leads to rapid development of
25-48 >15 >20 >25 resistance
49-72 >18 >25 >30
>72 >20 >25 >30
RTD: “Clinical Practice Guidelines in Pediatric Pulmonary
ECG Tuberculosis” - Dr. A. Jiao
Latent TB
- infection with MTB, (+)Mantoux test, no clinical s/sx or CXR
AVR AVL of TB
- implies devt of antibody of TB, exposure to TB
(+)I - carries high risk of progressing to TB disease
- carries high risk of progressing to TB disease
No CUT-OFF
(+)150 (+30)
(+120) (+)60
III (+90) II Bedside NEPHROLOGY
AVF Urinalysis
- examined within 30 min
QT - - can be preserved for up to 6 hours in 4⁰C
PR
Interpretation of Urinalysis:
QT
COLOR:
Rate
Yellow – Normal Dark red –
Axis
Hemoglobin/Myoglobin
Tea-colored – Blood Black – Hemolysis
AGE Preterm Newborn Infant 1 year
Greenish – Bile Milky – Fat/Chyle
Wt (kg) 1.5 3 5 10 Brown – Nitrofurantoin Red – Rifampicin
ETT size 2.5-3.0, 3.0-3.5, 3.5-4.0, 4.0-4.5, CLARITY:
uncuff uncuff uncuff uncuff Clear – Normal Cloudy – Infection, casts,
Suction 5 6 8 8 protein
catheter pH: N= 4.5-6.5
Chest tube 8-10 10-12 10-12 16-20 Acidic Alkalotic
NGT/Foley 5 5-8 5-8 8 Resp/ Metab acidosis Resp/ Metab acidosis
Laryngoscope 0 1 1 1-2 UTI by E. coli UTI w/ urea-splitting org
Mask NB NB NB- Infant HypoKalemia Renal tubular acidosis
infant Starvation Vegetarian diet
High protein diet Prolonged urine storage
AGE 3 yr 6 yr 10 yr Adolescent PROTEIN:
Wt (kg) 15 20 30 50 T race = <0.2 g/L protein 1+ = 0.3
ETT size 4.5-5.0, 5.0-5.5, 6.0- >6.5, cuffed 2+ = 1 3+ = 3
uncuff uncuff 6.5, 4+ = >20
cuffed
Suction 8-10 10 10 10
catheter
Chest tube 16-20 20-28 28-32 32-40
NGT/Foley 8-10 10-12 12-14 14-18
Laryngoscope 2 2 2-3 3
Mask Child Child Adult Adult

Technical Updates of the Guidelines on Integrated

Management of Childhood Illnesses (IMCI)
Acute Oral amoxicillin should be used in
Respiratory 25mg/kg/dose twice daily for the
Infections treatment of non-severe pneumonia
Oral amoxicillin should be given for
three days for non-severe
pneumonia in children 2-59 months
of age
Where referral is difficult and
injection is not available, oral
amoxicillin in 45mg/kg/dose twice
daily should be given to children with
severe pneumonia for 5 days
Injectable Ampicillin plus
injectable gentamicin is a better
choice than injectable
chloramphenicol for very severe
pneumonia in children 2-59 months
of age. A pre-referral dose of
7.5mg/kg intramuscular injection
gentamicin and 50 mg/kg injection
Ampicillin can be used
Children with wheeze and fast
breathing and/or lower chest
indrawing should be given a trial of
rapid-acting inhaled bronchodilator
(up to 3 cycles) before they are
classified as pneumonia &
prescribed antibiotics. 0.5ml
Salbutamol diluted in 2 mL of sterile
water per dose nebulization should
be used.