bbgg ပပ်ႉပၢႆးယူႇလီ

BURMESE BORDER GUIDELINES
BBG 2007
MEDICAL EDITING REALIZATION

The medical editing has been supervised by The realization has been supervised by
Dr. Marcus Rijken - Shoklo Malaria Research Unit. Yann Santin - Aide Medicale Internationale.
Agencies who have contributed to this edition Contributors:

include:
 Aide Medicale Internationale (AMI)  Translation - Dr. Khin Cho, Dr. Khin Thi,
 American Refugee Committee (ARC) Dr. Khin Zaw, Dr. Sandar, Dr. Soe Soe, Dr.Ye,
Dr. Yin
 International Rescue Committee (IRC)
 Proofreading - Hannah Mundy, Dr. Htwe, Dr.
 Malteser International (MI) Moe, Myo Myo
 Medecins Sans Frontieres – France (MSF)  Design - Patrice Leroy, Sylvain Sylleran
 Mae Tao Clinic  Drawings: Anchalee Areewong
 Shoklo Malaria Research Unit (SMRU)  Layout - Kyaw Ehna, Dr. Min
 Thailand Burma Border Consortium (TBBC)
 United Nations High Commissioner for

Refugees(UNHCR)
FINANCIAL ASSISTANCE
This guideline was funded by:
The United States Agency for International Development (USAID)
The International Rescue Committee (IRC)
This publication is made possible by the generous support of the American people through a grant from
the United States Agency for International Development (USAID) to the International Rescue Committee
(IRC) for the program in Thailand. The contents do not necessary reflect the views of USAID or the United
States Government.
1
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3
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nn]. KC]:pgc],Tiuc]wL: Management nC];pp].n}.etpgc],wL: lgc]:yUt];yLhUm]:tc];lum];lL;sgm];tUv];
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4
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sC]lgc]:yUt];yLnn].kUv];"
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l}:sC].tiuw];nc],eKL:kCam];T}; eKL:kCam];pL,li sgm];nc],lk];piUc]pin],PL,SL, An]l}:tm];wam];w}.nn].El:
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pp].Kw] mI;eKL:An]KC]:Ennm]; (En.nm];) pn]tac];hn]Tuic]n}siuc] tqm]:SUc],mL;tI:ekL,mtI,p}a;yU,lIt};
bbgtai2007@gmail.com l}:yU,eAL:" pqk].Sm].wL:Agn]kn]Tt];l}al}apgk]:l}al}akm];yw].n}eStL. Sc]
mI;eKL:kaCm];' tUw]lik]: An]Am],Tuk],n}siuc] Kqn];etL:wac];KCac].pn]El:Ennm].tqm]:sU;Tiuc]mL;eSkm];"
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pn]hqc];hG]:pin],pp].pQn]P}a,t};Agk],mL;' muk].sum]; Tai Hope An]km].s}g:Ait],Agk],pp].pn]' nac];eAKm];
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pn] hUm]:tc]; nac];yic];han] nac];mUv]ciun]; El: nac];liUn]SC] An]s}g:pin],PL,SL,pn]El: emLyL
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(Epl]pQn]f}a,t};) hG]:lUc}a:w}.sgm];"
eKL:tqk]:niUc];tc];pp].piUc]nm];An]Kp];Kiuc]Ait],Agk],kL:pUn].mL;El:pgk]:km];n}."
 Am],wL:miUw]:tqm]:piUc]liUc];pp].kU:An]El: eKL:kCam];sC].PL,SL,Aic];klQt]:etc}a:siUw];n}. emLyLKw]l}:Kw]:

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 eKL:piUt],tI:pgc],' Pac]hac]:tac];pQn]' lgc]:KUn].hLmk];mn]:tac];pQn]' lgc]:yUt];yL' lgc]:eh.kc]:' yL
eh.kc]: (wk].Sin];)El: lgc]:Aac]:Aic]siUw];n}. l}:Kt];sC]st];hQt];hC]:miUn]kn]w}.kU:kn]"
 sgm];nc],lgc]:tUk];ygn];Kgc]emLyLKw]eSl}:SC],tWn]:mC], (kn] Am],nn] Kp].lik]:) miUn]nc], lgc]:
Tuk],lIfac].An]sC].kn]tc];lum]:fL.' hUc];Kw]:sQp];' hUw]K}:' tac];pQn]eKL;nQc]' tac];pQn] kQw],lUv]:tL'
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Piw]nc]mac]siUw];El: lgc]:AUm]pU.pUn].tI:siUw];n}.w}." l}a;Sgn],np].nm].nk];El: tac];Suc]kUn];
nn].ekL:l}:EneKL:m}aSqt].w}." lgk];Kgc]: SUn,] Suc] tUw]kUn];' l}a;KUn].elL; nm]kiUw]tL,pn]kin] miUw]:
Tat]:nm].nC];tUw]hqc]:' piUc]nm];l}a;hQt];hG]:hUw]sC]El: pgt],Kiun];hQt];kan]l}:Kiun];' lgc]:luk]:Agn],kiUt],
mC],El: niuc]:pI<lUc];tC]:siUw];n}.ekL:l}:SC],w}. nC];eKL:PiUm].Tqm]w}."
 l}:Kiun];lUEl:Tt];w}.kU:kn]eS An]Tuk],lIl}:lqk]:l}a:kQw],lUv]:lgc]:yUt];yLnn].ekL:l}:Kiun];
lqk]:l}a:w}. sgm];nc],piUc]nm];l}a;yUt];yLkU:siuc]:miUc];An]l}:hQt];lgc]:lqk]:l}a:w}. (miUn]nc],-hqc];hUw]sC]
eA,'tac];pQn]mL:mU' tac];pQn]yQw]:wan]' tac];pQn]naw]nUk].' tac];pQn]yC];hUm],Agk];eALkC]:' sp];tit];
siUw].mqc];sgm];SQn]:tac];kiUt],luk]:' p}a;yU,lIsit];sC]' pn]hLkQw],lUv]:lgc]:kiUt],luk]:' tac];pQn]SQn]:
tac];TUv]:sC]' tac];pQn]Piw]nc] siUw];n}.yw]:)"
6
kQw],lUv]:lgc]:fim];Agk],pp].pgk]:km]; 4 1
 lgc]:etl}:fac].tUv];sgm];tac];pQn]tI:lm],lgc]:sUiw];n}.sgm];lqn]lin]miUc];T};-miUc];man]: sc],hLEt,sC].kn]
mL;kUv];" kgp]:n}nC];pp].piUc]nm];n}. tac];pQn]tI:etl}:fac].tUv];sgm];n}ekL:etSC],KiUc]:m}atac];pQn] tI:
etl}:fac].tUv];sgm];nc],pL:tC]:n}."
lgc]:etl}:fac].tUv];sgm]; lgc]:etl}:SUc],Kaw], Kn]w};

tUv];tI: eKL:PiUm].Tqm] tUv];tI: eKL:PiUm].Tqm]
tac];pQn]An]etl}:pgc],Kaw],Kn]w};n}.ekL:etmI;w}.miUn]kn]"
tUv];hUw]y}g:tI: kn] 24.1 El: lgk];piUc]eKL:mun];p}a;yU,lI (Health Information System)"
 lgk];Kgc]:hqc];yL (Drug doses tables) ekL:l}:lqk]:l}a:El:Kiun];Tt];Sac]w}.yw]." yLmac]siUw];ekL:
l}:SC],w}.pn] (tUw]yac], - Ceftriaxone tL,yC];hUm],Agk];eALkC]:El: tac];pQn]kQw],lUv]:lgc]:hUm]:kL,m'
Nitrofurantion tL, UTI)' yLmac]siUw];ekL:l}:l}a:w}.pn] (tUw]yac], - Gentamicin)"
 eKL:liun];Sut];Et. lm];nC];El:S}am}ahUw]eKL: nC];pp].piUc]nm];An]Kp];Kiuc]Ait],Agk],pgk]:km]; 4 n}.l}:

hQt];Sac]:w}. tL,hG]:hLkn]lik]:El: hUw]eKL:c}a:nn].yw]:"
pqk].Sm].wL:hUm]:hqc];hUm]:sC]kn] Kp];Kiuc]st];hQt];mL;n}eStL.ekL: nC];pp].n}. yc];etmI;lgc]:Pit];km]:
PWc]:yU," kgp]:n} Sc]wL:PU:lUPU:sC].tiuw];Kw] l}:hn]tac];Pit];/tI:Pit];n}ekL: Kqn];etL;pgc],lqc];mL;
pn]PU:tqm]:Kw]eSkm];" sum];PU:tqm]:hw];Kw]cin];lIhp].tgn]: eKL:pn]tac];hn]Tiuc] Am],nn] lgc]:K}:sC]
kU:siUw];KL:"
kp];Siup].mL;l}:tI:: burmeseborderguidelines@gmail.com
7
etsC].tiuw];pp].piUc]nm];n}.siUc].hiuw]?
2
pp].piUc]nm];n}.Am],Tuk],lIsC].tqn];nC];lWc]:tqp];tt];f}a,yUt];yL'
Aic],niUw]tac];hU.tI:SUmI;kQw],lUv]:tac];pQn] kUn];naw]eS etsac]:sC].tiuw];lWc]:s}W:mk];mn]:tac];pQn]l}:"
nc],hiuw]epL;etpQn]PWn];lI tL,sC].pp].n}.sWm];Sun] kUn];p}a:eP; hUc];yLAn]hac],k}wQc]; sWm];lqn]lin]miUc];
T};-man]:nn].l}:Aic]niUw]pp].kQw],lUv]:kan]yUt];yLAn]pWc],sC]c}a:eSTuk],mqn]:sWm];cw];l}a;El:tL,Aw]kCL,
sC].tac],tI:nn].etAm],Sac],Tuk],ekL:pQn]l}:" l}a;yUt];yL mI;tc];nm]nn]. l}a;yUt];yLnC];pp].n}.
etpQn]tac];liUk]:Tqc]:An]niuc]: tL,s}W:yUt];yLtac];pQn]An]pQn]haw].hqc];El:kUn];pQn]AL,yuEk," l}a;
yUt];yLnC];pp].n}.pQn]l}a;yUt];yLTqc]:tac];niuc]:kUv];" liUw]eSn}. l}a;yUt];yLyc];mI;tc];nm]n} etl}:
SC],sC]tgn]:n}.w}.tL,eS,"
1. lUtUv];tWn]:lWc]: tac];pQn]' tgn]:n}.etmWk],lat]:pn]fac]hac]:tac];pQn] El:lWc]:mk];
mn]:tac];pQn]' Tuk],l}:sC].l}a;kUt],tac];pQn]siUc].hiuw] Tuk],lIwUn].tUv];Tiuc] tac];pQn]An]pQn]l}:Tqc]:
siUc].hiuw]' eth}a.hqc];l}:siUc].hiuw]' etsC].tiuw];l}a;yUt];yLSc]El: eteh.kc]:tac];pQn]l}:siUc].hiuw]
siUw];n}.yw]:"
2. lUtUv];tWn]: lWk];tL,sC].tiuw];yLsWm];nc],AL,yuEl:nm].nk];kUn];pQn]hC];Tuk],mqn]:" tI:n}:
etl}: hn]Tiuc]Pac]hac]:tI:Am],Tuk],lIpn]yLEl: epL;pn]yLn}ekL: Tuk],lIfac].eKL:Sc]l}al}an}yw]."
eKL:kCam];tI:sC}.tiuw];tUw]pWt];w}.
mg = Milligram (mI,lI,krm],) g = Gram (krm],)
/ = Per (etL,pWk]:) Tab = Tablet (mQt].)
kg = Kilogram (kI,lUw],krm],) cc = Cubic centimetre(kiw];pik].Sqn],tI,mI,tiUw],)
ml = Mililitres(mI,lI,lI,tiUw],) SC = Subcutaneous (tC]:Piw]nc])
PR = per rectum(SC],tac];kUn]:) PV = Per vagina (pn]tac];hU;kiUt],luk]:)
STAT = Single dose (pn]pWk]:lQw]) PO = Per os (oral) (pn]tac];pak],)
IM = intramuscular (Sm];Kw]:kam]:niUw].) IV = intravenous (Sm];Kw]:SQn]:liUt]:lm])
d = Day (wn];) OD = one time a day (niuc]:wn];niuc]:pWk]:)
x = Time (pgk]:km];)
mn = Minute(minit].) BID = 2 times a day / 12 hourly (niuc]:wn];Sgc]pWk]:/Kqn]: 12sUw]:mUc];)
TID = 3 times a day / 8 hourly (niuc]:wn];Sam]pWk]:/Kqn]: 8 sUw]:mUc];)
QID = 4 times a day/6 hourly (niuc]:wn];SI,pWk]:/Kqn]: 6 sUw]:mUc];)
tL,tWc]; - 1 SI,SI, = 1 mI,lI,lI,tiUw],

tUw]yac], - 2 tabs Tid x 5 d pWc],wL: niuc]:pWk]:SWc]mQt]. niuc]:wn]; 3 pWk]: tL, 5 wn];' Kqn]: 8
sUw]:mUc];niuc]:pgk]:"
8
etsC].tuiw];pp].pUic]nm];n}.sUic].hbiw]? 2
AFB = Acid Fast Bacilli pqk].TI;rI;yL;hn]lUv]:kan]yWm].nm].AqS].

Sit].
AIDS = Acquired Immune Deficiency Syndrome Pac],hac]:tac];pQn] hqc];Kam],tUw]tUk];yWm];
ANC = Ante Natal Care lWc]:lUlWm]lum];lL; miUw]:p},kiUt],luk]:
ARI = Acute Respiratory Infection kiuc].kac].sp];siUw].mqc];tac];pQn]tI:lWt],lUm];
TUv]:sC]
BP = Blood Pressure hqc];liUt]:
CRP = Chronic Reactive Protein prUw],tin];An]tUw].tWp],Kaw];hiuc]
D5W = Dextrose 5% and Saline/ Water nm].kiUw] wan]/sQm];
ESR = Erythrocyte Sedimentation Rate hqc];mQt].liUt]:lqc]nWn];kWn];
Hb = Haemoglobin eh,mUw],klUw],pin],
Hct = Haematocrit kan]tqk]:niUc];mQt].liUt]:lqc]El:tac];
nqn]:nLliUt]:
HIV = Human Immuno-deficiency Virus siUw].mqc];w};rS].An]hQt];hC]:hqc];Kam],tUw]
tUk];yWm];
IPD = In-Patient Department f}a,kUn];pQn]nC];
LRTI = Lower Respiratory Tract Infection sp];siUw].mqc];tac];pQn]sWm];lWt],lUm];TUv]:
sC]pWt];tC]:
MS = Malaria Smear liUt]:tL,kUt],hLsiUw].mqc];naw]nUk].
NSS = Normal Saline Solution nm].kiUw]sQm];
OPD = Out-Patient Department f}a,kUn];pQn]nWk]:
ORS = Oral Rehydration Salts PWc]kiUw]Tat]:
PFG = Plasmodium Falciparum Gametocytes siUw].mqc];naw]nUk].PU:/Em:PL,SI,pL,rm],
PR = Pulse Rate hqc];liUt]:tWn]:
PFT = Plasmodium Falciparum Trophozoites siUw].mqc];naw]nUk].tUw]AWn],PL,SI,pL,rm],
PVG = Plasmodium Vivax Gametocytes siUw].mqc];naw]nUk].PU:/Em:w}a;wqk].
PVT = Plasmodium Vivax Trophozoites siUw].mqc];naw]nUk].tUw]AWn],w}a;wqk].
R/L = Ringers Lactate nm].ric];kiUw]<lqk].tQt]<
RR = Respiratory Rate hqc];TUv]:sC]
SFP = Supplementary Feeding Program Pqn]kan]lQc].lUtac];kin]An]Tqm]hqc];
TB = Tuberculosis tac];pQn]TI,pI,
TFP = Therapeutic feeding Program kan]yUt];yLlUv]:tac];kin]yqm].
URTI = Upper Respiratory Tract Infection lWt],lUm];TUv]:sC]pWt];niUw] sp];tit];
siUw].mqc];tac];pQn]
UTI = Urinary Tract Infection sp];siUw].mqc];tac];pQn]sWm];SQn]:tac];yQw]:
9
lm];nC];
3
kCam];nm]; 3
1 kQw],lUv]:lgc]:fim];Agk],pp]. pgk]:km]; (4) 6
2 etsC].tiuw];pp].piUc]nm];n}.siUc].hiuw] 8
3 lm];nC]; 10
4 hUp].TUp];kUn];pQn] 18
5 lgc]:Tuk],lIl}:fac]. An]sC].kn]tc];lum]:fL. 26
6 lWc]:eh.kc]: miUw]:tiUw].vL; 30
7 Pac]hac]:tac];pQn] An]pQn]kn]km]:nm] 35
7.1 t}alium]; (Coma) …………………………………………………………..….…….…………… 35
7.2 pQn]can]; (Convulsions) ………………………………………………………………...…… 40
7.3 hiUw].' AUn]:Agn],' nQt;] nL ………………………………………………………..………… 42
7.4 niUw].m}: (lUm];naw]) ………………………………………………………………….…………… 44
7.5 sQp]; ……………………………………………………………………………..…….……...……… 48
tWc].kiuc].kac].sQp];h}a.hqc]; …………………………………………………….………………….…. 51
sQp];lin].tWc]. ………………….…………………………………………………….……..……… 53
hUw]K}: ……………………………………………………………………….…………..……….……… 57
7.6 kiuc].kac].lium];tUw] (SHOCK) ………………………………………………………………….. 62
8 tac];pQn]kQw],lUv]: hUw]sC]El: SQn]:liUt]: 68

8.1 tac];pQn]liUt]:Suc] ………………….….………………………………….……………………… 68
8.2 hqc];hUw]sC]eA, ………………….………..…………………………………..……………....….… 75
8.3 t}aPak], ………………….………………………………………..……………………….……..…. 81
tac];pQn]K}eKL:sQp]; ……………………………………………………..…………....…......…. 83
10
lm];nC]; 3
9 pn],hLtac];pQn]KQw]: 87
9.1 tac];pQn]hiUk],El:KQw]: ………………..…………………………………..….….....……..…. 87
KQw]:mqc]; ………….………………………………………………..…….....……..…………..…..…. 87
tac];pQn]hiUk], ………….……………………………………………..………….……....……..…. 87
9.2 pQn]sQp];kC]:nC];pak], ………….……….………………………………..…………......……..…. 88
9.3 tiUw].vL;mat],sQp]; ………….…………………………………………………..…..…..…..…. 89
10 tac];pQn]kQw],lUv]:ehL,mUn];l] 90
10.1 tac];pQn]yQw]:wan] ……………………………………………………….………………..…..…. 90
Tat]:kiUw]wan]nC];liUt]:lUt];yWm]; ………………………………………...……………..……. 95
10.2 tac];pQn]mak],ln]T};rW}; ………….……………………………………………..…………..…. 96
ehL,mUn];l]T}W;r}W;eA, ………….………………………………………..……………………..…. 96
ehL,mUn];l]T}W;r}W;nm] …….…….……………………………………………….……....……..…. 97
tac];pQn]eKL;nQc] ………….………….……………………………………..………....……..…. 99
11 tac];pQn]tL 101
11.1 S}atLAUn]: (sut];Sun]cw];hac]: Am],Siuw]:) ………….………….…….………….…. 101
11.2 sp];tit];siUw].mqc]; (pQn]sQp];) ………….……………………………………….……..…. 102
tLsQp];El: sp];tit];sUiw].mqc];tac];pQn]kU:lWc]:lWc]:………………………….…… 102
tac];pQn]KWp],tLsQp];Sqp], ……………………………………..………………….…....……. 103
11.3 tiUw].vL;mat],sQp];tI:tL………….…………………………………….…...…….....……..… 105
11.4 tac];pQn]tL ………….………………………………………..………………….…....……..…. 106
tac];pQn]etL:mgk],………….……………………………………….……..…………..………..…. 106
tac];pQn]etL:niUw]. ………….…………………………….…………..……………....……..…. 107
tac];pQn]tLKqc] ………….……………………………………………..…………......……..…. 107
tLs}a./tLAUin]; .…………….……………………………………………...………....……..…. 108
11.5 tac];pQn]Piw]hUv],tLhqc]: (Xerophthalmia) ………………..…………..……....…. 109
12 tac];pQn]hUc];Kw]:El:lm];S}: 112
12.1 tWc].kCL, …………..……………………………………………………………………....……..…. 112
12.2 tac];pQn]tWc].kCL,kL,lL. …………..……..…………………………………...…..……....…. 120
12.3 tac];pQn]tp]; …………..…….………………………………………………...…..………..…. 122
11
3 lm];nC];
tp];kC]: (Hepatitis) …………..………………………………………..……...…....……..…. 122

tp];Kqc] …………..………………………………………………..…...…..………..……………. 123
pQn]ln
i C];TUc]lI …………..……………………………………………………...…..………..…. 124
TUc]lIkiuc].kac].sQp];kC];h}a.hqc]; …………..……………………………….…..……....……..…. 125
tp];sQp];pQn]ngc] …………..………………………………………………..………....……..…. 126
12.4 mqc];tiUk],nC];lm];S}: …………..………………………….………...…..………..……………. 128

mqc];tiUk],sp];sgm];lin]mL; …………..………………………………..……...…..………...…. 128
tiUk],tUw]Pqp]. …………..………………………………………………….…………....……..…. 129
13 tac];pQn]kQw],lUv]:SQn]:tac];yQw]:El:lgc]:eP:siUw].Pn]; 131
13.1 SQn]:tac];yQw]:sp];tit];siUw].mqc]; …………..……………………..……...…..……..…. 131
hUc];yQw]:kC]:sQp]; …………..…………………………….…………………….………....……..…. 132
tac];pQn]mak],kqw];kC]: …………..………………………………….…………..…….....……..…. 133
lWt],yQw]:kC]:sQp]; …………..…………………………..………………..……...…..………..…. 134
mak],ln]cam]:KL:kC]:sQp]; …………..……………………………………..……...…....……..…. 134
13.2 pQn]kWn]:lisgm];SQn]:tac];yQw]: …………..……………………..……...……….……..…. 135
13.3 mak],kqw];sQp];kC]:An]kiuc].kac].pQn]h}a.hqc]; ……………..……...……………....……….…. 137
13.4 tac];pQn]mak],kqw];An]hQt];hC]:kC]:tc];tUw] (Nephrotics Syndrome) ………..…. 138
13.5 sp];siUw].mqc];tac];pQn]tI:SQn]:tac];Ac],kL,eP:siUw].Pn]; …………………….…. 140
tac];pQn]l}al}aAn]pQn]sgm];Kgc]l}Agk],mL;tI:Ac],kL,eP:siUw].Pn]; …….……..…….. 140
tac];pQn]lup],kum]:kUn]:sQp];kC]: (PID) ………………………………..…………....……..…. 140
pQn]sqp];yQn];El:mI;hut];tI:KiUc]:Ac],kL,nac];yic]; ……………………..……………..…. 144
sp];tit];siUw].mqc];lUv]:lgc]:hUm]:kL,mAn]kUn];s}a;pQn] (STIs in men) …….…..…. 146
14 tac];pQn]kQw],lUv]:liUt]: 148
14.1 tac];pQn]liUt]:sac] ……………………………………………………….……..…………..…. 148
14.2 Thalassaemia …………………..………………………..……………….……..…………..…. 154
14.3 Kat],Tat]: G6PD …………………..………………………..……………….……..….…..…. 156
14.4 lWc]:SCac];liUt]: …………………..………………………..……………….……..…….…..…. 158
15 tac];pQn]An]sp];tit];l}: 162
15.1 tac];pQn]kgp]:siUw].mqc];pqk],TI;rI;yL; …………………..……………………..……………. 162
yC];hUm],Agk];eALkC]:kgp]:siUw].mqc];pqk],TI;rI;yL; …………………..………………………..…. 162
12
lm];nC]; 3
tac];pQn]yQw]:nU ( Leptospirosis) …………………..……………………….....……..…. 165

SKrp].S]t}.Pat].S] (Scrub typhus) …………………..……………………..……..…. 168
tac];pQn]kac];Kqc] ………………………………………….…………..………………………...…. 170
15.2 tac];pQn]An]pQn]kgp]:siUw].mqc];pL,rL,Sit]. (Parasitic Diseases) ……….……. 173
tac];pQn]tin]sac]. ……………………………….………..……………………….....……..…. 173
tac];pQn]naw]nUk]. ………………….……………………….………..…………….....……..….. 175
15.3 tac];pQn]An]pQn]kgp]:siUw].mqc];w};rt].S] (Viral Diseases) …………………………. 189
tac];pQn]naw]lUit]:Agk], …………………………………………..………..….....……..…….. 189
Agk];eALsQp];kC]:kgp]:siUw].mqc];w};rt].S] (Encephalitis) ……….…………..……………. 193
AQk].KY]A},wI,El:AQt],S] (HIV and AIDS) …………………….……………………....…. 194
mak],lqc] ……………………………………….…..………………………................……..…. 209
pUw],lIyUw], ………………………………………….………………..……………….....……..…. 211
tac];pQn]kWc].mLygc], ………………………………………….…………..………….....……..…. 212
16 tac];pQn]kam]:niUw].El:lup], 216
16.1 tac];pQn]lup],kp]; ………………………………………….……………….………….……..…. 216
lup],kp];sQp];kC]: kgp]:siUw].mqc];tac];pQn] ….………….……………………….…………...…. 216
lup],kp];sQp];kC]:An]Am],sC]:kgp]:siUw].mqc]; ……..…….……..………….………………..…. 218
16.2 tac];pQn]lup],El:kqn]lup],sQp];kC]: (OSTEOMYELITIS) ….…………………...…. 221
17 AL,hL,r 224
17.1 Kat],Tat]:AL,hL,r ………..……………………………………………..………………….…. 224
Kat],Tat]:AL,hL,rpan]kac] ………..…………………………………………….…………..…. 226
Kat],Tat]:AL,hL,rh}a.hqc]; ………..………………………………….………………..…..…..…. 227
17.2 tac];pQn]Kat],Tat]:wI,tL,min], ………..………………………………….……………….. 235
Kat],Tat]:wI,tL,min],eA, ………..………………………………………..….………...…. 235
Kat],Tat]:wI,tL,min],pI,niuc]: (beri beri) ………..……………………….…………..…. 237
17.3 lWc]:pI;pUn].tI: ………..………………………………….………………..………....……..…. 240
18 p}a;yU,lItac];pa};sC] 242
18.1 sC]Am],pk],ktI, ………..………………………………………..…….…………......……..…. 242
18.2 KIsC]m}:sC]pUn].tI: ………..……………..……………………………….…………....……..….. 244
18.3 tac];pQn]sC]tUk];tI:pQn]w}a;lc]mI;lgc]:tum].tiUw].sC]h}a.hqc]; …………….…………..…. 245
13
3 lm];nC];
18.4 sG]ygc],wUn]; ..…………….………………..………………………..….…………....……….…. 247

18.5 lgc]:pn]tac];K}:sC] ………..………………………………….…….……………....……..…… 248
19 pn],hLlgc]:kiUt],luk]: 252
19.1 liUt]:tUk];miUw]:Sn],ET,num],………..………………………………….…….……..…….... 252
tUk];luk]: ………..…………………………………………..…………………..…....……..…. 252
mI;Pac],hac]: An]Aap]:ettUk];luk]:……..…………………………….…..….….……..…. 252
tUk];luk]:mUt];SQc]: ………..……………………………………………….…..….………..…. 253
tUk];luk]:Am],mUt];SQc]: ………..……………………………………………..……..…..….. 253
Sn],eT,ta}nG];tgc]. ………..…………………………….………………..….…..……..…. 254
Sn],eT,t}anC];tgc].El:pQn]kgc]. …..…………………………………………..………….…. 254
et,Sn],eT,An]Am],pk],ktI, ………..……………………………..…….….……..…. 255
19.2 liUt]:tUk];miUw]:Sn],eT,yC],ek, ………..………………………………………..…..…..…. 256
19.3 liUt]:TWk], w}a;kiUt],luk]: ………..…………………………..…….……………..…..…..…. 257
19.4 Sn],eT,p},TUn]:liUn]eSkiUt], ………..………………………………….……..……..…. 259
19.5 liUt]:Suc]miUw]:pL;tgc].El:Agk],sgk];miUw]:pL;tgc]. ………..……………..…..…….…… 261
19.6 Sn],eT,mak],Ait], (Tuc]nm].tI:Sn],eT,lU.) ………………………………….… 265
20 hUw]eKL:tac],siUw]; 267
20.1 tac];pQn]lUm];mL:mU ………..……………………………….….…….……………..…..…..…. 267
20.2 kan]wac];Pqn]nL:hiUn]; ………..………………………………….……………….....……..…. 270
TUc]yac] ………..…………………………..………………………..…………..…....……..…. 270
yLkin]eh.ham]:Sn],eT, ………..…………………………………………..….…..……..…. 271
yLSm]; tI,pUw], ………..……………………………………………………..….…..……..…. 272
SC],KUv],(hBc],)nC];hUc];luk]: ………..………………………………………..….…..……….… 273
Pc]KQm]tC]:Piw]nc] (Norplant) ………..………………………………………………...…. 274
Tm];mn] ………………………..…………………………………………………….………..…. 275
20.3 lgc]:hQt];h}a. An]Aic]niUw]lgc]:pQn]s}a;/yic]; ………..……………………..…..…..…. 275
lWc]:hQt];Sac]:pn]kUn];pQn] GBV ………..………………………………....…....……..…. 276
20.4 lgk];l}a;yUt];yLhQt];hG]:tac];pQn]mw]SL,mL; ………..…………….……………..……. 281
14
lm];nC]; 3
21 tac];pQn]kQw],lUv]:SQn]:tac];TUv]:sC] 282
21.1 tac];pQn]lgt],lUm];TUv]:sC]pgt];niUw] ………..…………………………………..……..…. 282
tac];pQn]lgt],lUm];TUv]:sG]pgt];nUiw]sp];tit];tac];pQn]An]Am],haw].hqc];……..……… 282
lgt],lUm];TUv]:sG]pgt];nUiw]sp];tit];tac];pQn]pan]kac] ………..………….…..……..…. 283
K}:wt];nUk]. ………..………………………………………..…………..….……..…..………… 285
hUkC]: ………..………………………………………..……………………………….…..……..…. 289
21.2 tac];pQn]pgt],kI: ………..……………………………………..…….………….…....……..…. 291

tac];pQn]lgt],lUm];TUv]:sG]pgt];tC]:sp];tac];pQn] (LRTIs) ….….…………………….. 291
lWt],lUm];TUv]:sC]pWt];tC]:sp];tit];tac];pQn]An]lak],la}; …………………………… 295
lWt],lUm];Agn], nC];pWt],kC]: ………..………………………………………..….………..…. 296
ygn].hak]:El: pQn]tac];pQn]pgt],kI: ………..……………………………..….………..…. 296
pgt],kI:ygn].siUw].mqc];hQp]; ………..………….………………………………..….………..…. 296
pgt],kI:ygn].mQt].liUt]:Kaw]AI<rUw]SI<nUw]PI;l]lik]. ………………………….……..…. 296
pgt],kI:ygn].mqc];tiUk],Pqp]. ………..…………………………………………..….………..…. 296
21.3 tac];pQn]lgt],lUm];TUv]:sC] Kaw];hiuc] ………..…………………..…..……....……..…. 297
tac];pQn]lgt],lUm];pgc]; ………..………………………….…………………..….………..…. 298
tac];pQn]TUc]lUm];lQk]. nC];pgt], ………..…………………………………..….………...… 298
21.4 kiuc].kac].pQn]mgc]eKL: (TUv]:sC]kp].)………..………………………………………………… 300
21.5 tac];pQn]pgt],kC]:TI,pI, ………..…………………………….…….……………......……..…. 307
22 tac];pQn]Piw]nc] 318
22.1 sQp];yQn]; ….…..……………………………………………….…….……………..…..…..…. 318
22.2 sQp];AUm]ngc] ………..…………………………………….…….…………………...…..…..…. 319
22.3 eS;l]sQp];kC]: ………..……………….……………………….…….……………..…..….….…. 320
22.4 sQp];mat], ………..…………………………………………………………….…..……....…….. 321
22.5 sQp];f};m}: ………..……………………………………..….…….……………......……..…….. 323
22.6 pQn]KUm];pQn]hw]: ………..…………….……………………….…….……………..…….…..…. 325
22.7 tac];pQn]Piw]nc]An]pQn]kgp]:siUw].mqc];hQp]; ………….…….……………..…..……….. 326
22.8 Tat]:Am],mqn]:El:pQn]mun],man], ………..………………………..……...…..……..…. 328
22.9 tac];pQn]hw]: ………..………….……..……………………….…….……………....……..…. 328
22.10 tac];pQn]mak],hqc]; (lQk].) ………..………………………….…….……………....……..…. 329
15
3 lm];nC];
22.11 Varicella Zoster ………..………………………………..….…….……………......……..…. 331

tac];pQn]mak],lqc];Kaw] ………..……………………….…………………..…..….………..…. 331
mak],hqc]; (lUc]) ………..………………………………….……………..……..….………..…. 332
22.12 mqc];tiUk],Kw]:SWn].tC]:Piw]nc] ………..………….……………………………..…..…….…. 333
22.13 Larva Currens ………..……………….………………….…….………………...……..…. 333
22.14 tac];pQn]tut]: ………..……………..……………………….…….……………..…..…….…. 334
23 sC].KUw];Kgc] Pit];P}a, 339

23.1 pQn]kWc].ygn].lw]:El:yLmw];km] ………..……………………..……………..…..……... 339
lw]: ………..…………………………………………….………………………..….………..…. 340
yL:lm]' yL:PiUk],' emL,Pin]; ………..………………………………………..….…………... 341
yL:mL. (Aqp],Pqt]:tmin];) ………..…………….…………………………..…....……..…. 342
23.2 AUm]pU. ………..…………………………………………….….…….……………..…..…….…. 343
24 eKL:PiUm].Tqm] 345
24.1 lWc]:etl}:fac].tUv];tac];pQn]El: lWc]:sUiw].mqc];EP:tuin];haw].hqc]; (tac];pQn]kL,l) 345
24.2 HB (Lovibond) with HCT Equivalents …………….………….……………..…..…..…. 350
24.3 lWk];Kgc]: Peak Flow ………..……………………………….…….……………..……....… 351
24.4 lWk];Kgc]:l}a;pn]Knqn]; nm].nk];lUv]:SUn],Suc] ………..……………..…..……..... 352
24.5 lWk];KWc]:tac];yC],Suc]tUw]kUn]; ………..………………………………………….……..…… 357
24.6 nm].kiUw]tL,PiUm].Tqm]Tat]:nm].nC];tUw] ………..……………………………..…..…..…. 358
24.7 lWk];KWc]:Kaw];yam]; tL,yLeh.kc]: ………..………….………………..……....……..…. 359
24.8 lWk];Kgc]:lgc]:yUt];yL tac];pQn]naw]nUk]. ………..…………………...……..……..…. 361
yLkin] Artesunate ………..……………………………………………………....……..…. 361
yLkin] Chloroquine ………..…………………….………………………..….….……..…. 362
yLkin] Mefloquine …………………………………………………………..….………..…. 363
yLSm]; Artesunate IV ………..………………..………………………..….………….... 364
yLSm]; Quinine IV ………..…………………………..…….……………..….………..…. 366
yLSm]; Quinine IV infusion ………..………………….………………………………….. 367
yLSm]; Quinine IM ……………………………….……………………………......……..…. 368
yLSm]; Artemether IM ………..……………………….….………………..….………..…. 369
24.9 lWk];Kgc]: yL:yL ………..…………………………………….…….…….……....……..…… 370
24.10 yLtL,sC].tuiw]; miUw]:pL;tWc]. ………..………….………………….…….…………....……. 400
16
lm];nC]; 3
24.11 piUc]nm];tL,luk]:Agn],kiUt],mC],El:luk]:Agn],niuc]:KUp],lUc];tC]: ………..……...…… 402

luk]:Agn], Am],p},TUn]:liUn]eSkiUt], El:luk]:AWn],nm].nk];Am],tQm]TUn]: …… 402
lWc]:lum];lL;luk]:Agn], 2 lUin]lUc];tC]:pQn]kgc].liUt]:tqk],eP: ………..………… 404
lWc]:lum];lL;p}a;yU,lIluk]:Agn], AL,yu 2 lUin]lUc];tC]: ………..……….…..…… 405
pUic]nm];tL,lum];lL;luk]:AWn], 2 lUin]lUc];tC]:pQn]pWt],kI: ……………………………. 406
pUic]nm];tL,lum];lL;luk]:AWn], 2 lUin]lUc];tC]:pQn]kWc].lUit]:tqk],EP: ……………. 407
l}a;kan]yUt];yL tWc].kCL, ………..………………………………………..….………..…. 408
pUic]nm];hqc];yLptI<KYI<wn ………..……………………………..………………....……… 410
IV Fluids tL,Tic];Sim];Tat]:nm].nC];tUw]hG]:pQn]pkti ………..………………………… 410
lUm];m}:nC];tUw] tUk];ygm]; ………..………………………………………..….…..……..…. 411
lWc]:pgn]:tac];kin]pn]luk]:AWn], ………..……………………………………………….… 423
luk]:Agn],kiUt],mC], pQn]niUw].liUc] ………..……………………………..………….……..…. 414
luk]:AWn],kUit],pL;tac];pQn]naw]nUk]. ………..………………………..….………..……… 415
tac];pQn]naw]nUk]. An]luk]:Agn], 2 liUn]lUc];tC]:pQn] ………..…………………..… 415
PiUm]:Tqm]Tat]:wI,tL,min],El: AL,hL,r ………..…………………….……………………. 416
luk]:Agn],pQn]tac];pQn]kac];Kqc] ………..…………………………………..….………….... 417
25 Piun]Aic] ………..…………………………..……………….…….………..……..….…...…. 418
17
hUp].TUp];kUn];pQn]
4
kan]yUt];yLhG]:Kqm].lqp]:n}. lWc]:Aw]sC]mQt]:tL,eSSiUk]:Sm],El: lWc]:pn]tac];np].ym]etL, kUn];pQn]n}.
lm],lWc]:Et.Et." miUw]:hp].kUn];pQn]nC];hWc]:kUt],nn]. hQt];sWm];nc],pL:tC]:n}.tL"
1. tUc].tk].kUn];pQn]"
2. hQt];hG]:kUn];pQn]yU,ca}:lUm]sC]" hG]:kUn];pQn]nc]:tI:An]hac]:hqn];w}." epL;wL:Kw]pQn]hqc];nL,AL;lL;
n} hG]:Kw]nWn];lUc];tI:nWn];"
3. hG]:kUn];pQn]Aun],sC]l}:wL: Am],mI;PC]hU.sgm];lWc]:tac];pQn]Kw]nn].
 miUw]:PWc];kUt],kUn];pQn] etAm],pn]PC]l}:cin]; etAm],pn]PC]l}:hn]"
 liUw]eSkUn];pQn]An]kUt],yU,nn]. kUn];pQn]tac],ekL.Am],Tuk],lIhC]:yU,nC];hWc]:kUt],"
 emLyLniuc]:ekL. Tuk],lIsC].hWc]:kUt],niuc]:hWc]:eKLeKL"
 Am],Tuk],lIhC]:PC]l}:cin]; lWc]:tac];pQn]An]kUn];pQn]lat]:En"
 epL;kUt],lWc]:kUit],luk]:El:Ac],kL,eP:siUw].Pn]; Kqn];Tuk],lIhac]:hqn];lIlI"
4. kUt],tUv];Pac]hac]:An]pQn]eP;l}:"epL;Pac]hac]:kUn];pQn] Aap]:etpQn]eP;l}: hG]:nqt]:hp].
yLtUw]w};w};' tiUc],pac],tc];emLyLlUc]eS hp].w}.pQn]kUn];pQn]nC]; Am],nn] SUc],tUw]kCL,yL
tUw]tI:hUc];yLlUc] km];Siuw]:"
5. Tam]tUv];kUn];pQn] lWc]:tac];pQn]El:cw];l}a;kU:siUw];siUw];" tqm]:m}ahUw]y}W:lWc]:tac];pQn]hG]:sWt],
es;w}. tI:pp].m}atWc];kUn];pQn]" tWc]:Tam]tac];pQn]An]pQn]pUn].mL;p},hiuc]El: tUv];Kiun];piun];
lc]nC];pp].m}atWc];kUn];pQn] (lemma)" An]n}.pQn]Kk].tWn]:tI:lm],lWc]: kWp]:wL:tUw]yac],mn];
kL:pUn].mL;kUn];pQn] l}:hp].yLptI,KYI<wn (antibiotic) l}aSqn];w}.ekL:pQn]l}:" epL;kUn];pQn]
Am],mI;wC]hUc];yLkUn];pQn] Am],nn] mI;An]mC],suic] tWc]:Tam]tUv];wL:pp].An]kw],yU,lC] -
h}akCL,yw].hL.? Kiun];Tam]tUv];piun]; lWc]:tac];pQn]An]pUn].mL;eS tqm]:SC],w}.Kiun];mUt];mUt];"
6. kUt],tUv];kUn];pQn]hC]:sWt],es;" sqt]:eS;tUv];wL: nm].nk];El:lUm];m}:kUn];pQn]sgc],l}:tqm]:
w}.nC];wC]m}atWc];kUn];pQn] (lemma) yw].hiuw]"
7. Tt];Sac]lWc]:tac];pQn]wL:sWc],etl}: (k) hp].w}.pQn]kUn];pQn]nC];Am],nn] Suip],SUc],yUt];yL
km];Siuw]:hiuw] (K) hp].yUt];yLpQn]kUn];pQn]nWk]:eS pn]tac];hn]Tiuc] Am],nn] (c)
pn]tac]; hn]Tiuc] tL,lum];lL;tUw]sw]:kw],tI:hiUn]; (etAm],l}:pn]yL)"
8. tqm]:m}atWc];lWc]:tac];pQn] An]kUn];pQn]lat]:lUc];nC];wC]m}atWc];kUn];pQn] (lemma) lWc]:kUt],
18
hBp].TUp];kUn];pQn] 4
Tt];El: PWn];kUt],Tt];hgc]:lqp], (Lab)" tqm]:lUc];lgc]:mk];mn]:tac];pQn] (diagnosis)
El:lWc]:yUt];yL hG]:tqk],lqc];"
9. Sp];lqc];EnkUn];pQn] lWc]:tac];pQn]Kw]El: lWc]:yUt];yLAn]etyUt];yLpn]" epL;Am],hU.
wL: kUn];pQn]pQn]tac];pQn]Sc]n} hG]:lat]:Siuw]:Siuw]:wL:Am],hU. (tk];etl}:Siuw]:yUw];) eSEl:
Sp];lQc];EnwL: tk];etl}:kUt],sqt]:siUc].hiuw]sc],ethU.l}:"
10. epL;wL:tk];etl}:SUc],kUn];pQn]miUw];yLtUw]nC];wQc];' mUiw]:etSUc],kCL,nn]. pn]tac];yUt];yL
An]lm], lWc]:eSkWn],"
11. lWc]:eh.kc]: Am],nn] kUt],sqt]:tUv];wL: tac];pQn]mI;Am],mI;" tUw]yac],mn];luk]:AWn],
AL,yulQk].liUw] (5) KUp],nn]. etl}:kUt],Tt];tUv];lIlIwL: cw];l}a;kan]Sm];wk].Sin];mI;
w}.siUc].hiuw] lgc]:Kat],Tat]:AL,hL,r Sm].pQn]siUc].hiuw]"
12. epL;wL:ethp].yLkUn];pQn]nc],kUn];pQn]nWk]:El: etpn]tac];hn]Tiuc]kUn];pQn]siuc] hG]:kUn];pQn]
kin]yL An]ethC]:nn].tI:hUc];yLkm];lQw]eSEl: Sp];lqqc];EnlWc]:sC].yL An]etl}:kCL,
sC].tI:hiUn];" nc],hiuw]ethU.l}:wL: kUn];pQn]kin]yLyw].sgc],hak]:' Am],hak]:n}nn]. hG]:kUn];
pQn]yU,tI:hUc];yLmWk]:niuc]: sUw]:mUc];kWn]," miUw]:yc];Am],yU,lIn}. pn]tac];hn]Tiuc] lWc]:tac];
kin]El: mak],m}.mak],tgk], An]Tuk],lIkin]El:An]p},kin]l}:' lWc]:lum];lL; sQp];yQn];tI:
hiUn];ekL.lQw]sUiw];n}." lWc]:etl}:pC].tUv];sWm];hiuw]' Am],pC].sWm];hiuw]n}ekL: etl}:wUn].SWn],
pL;sWm];"
13. pn]lWc]:etl}:yUt];yLetL," lat]:EnkUn];pQn]wL: etl}:mL;sU;Kiun];tL,tUv];sWm]; cw];
l}a;tac]; pQn]epL;pQn]l}: hC]:lat]:wn];kCL,km];lQw]wL: etl}:mL;sU;Kiun];wn];lC]" lat];En
kUn];pQn] Am],nn] epL:Em:kUn];pQn] Pac]hac]:tI:pQn]eP;l}: (lat]:hG]:tqt]:etL; kCL,wL:
Pac]hac]:siUc].hiuw]) An]kQw],lUv]: tac];pQn]An]pQn]yU," epL;wL:hn]vL;Pac],hac]: An]pQn]
eP;l}:n}siuc] hG]:Aw]kUn];pQn]mL;hUc];yL km];Siuw]:"
tUw]yac],mn];-luk]:AWn],ekL.niuc]:pQn]K}:wt];Am],nn]lWt],lUm];kC]:n} lat];EnepL:Em:luk]:
AWn], lWc]:etl}:lUlWm]kUn];pQn]siUc].hiuw]' epL;luk]:AWn],TUv]:sC]yap],Am],nn] TUv]:sC]w};n}
hG]:Aw]kUn];pQn]mL;hUc];yLKiun];w};w};" epL;wL:luk]:AWn],tgc].kGL,pQn]nm].n}siuc] lat]:EnepL:Em:
luk]:AWn],wL:Pac]hac]:nm].nC];tUw]luk]:AWn],hqc]:n}.pQn]siUc].hiuw]El: epL;pQn]ekL:etl}:Aw]mL;
sU;hUc];yLkm];Siuw]:"
14. epL;kUn];pQn]pWk]:mL;sU;Kiun];tL,yUt];yLetL,n}siuc] tWc]:Tam]tUv];kUn];pQn]wL: lWc]:yUt];yL
sWc],Tuk],mqn]:hiuw] sWc],lImL;hiuw]" tUv];cw];l}a;kUn];pQn]eS Tuk],lIyLl}a;kw],ekL:yLkCL,
Am],nn] sC].tiuw];l}a; yUt];yLmC],tUv];"
19
hBp].TUp];kUn];pQn]
4
kn]tac];nL:nC];nL:lik]:tac];nL:nn]. etEnhUw]hup]: “Pac]hac]:tI:pQn]eP;l}:” “lWc]:eh.kc]:”
“lWc]:etl}:yUt];yLetL,” An]pQn]l}:nC];kUn];pQn]AL,yul}al}asiUw]; hUm]:tc];Aw]pUic]tqk]:eS Sp];lqc];
Enw}."
hUw]hup]:lWc]:hUp].TUp];kUn];pQn] pQn]Kk].pQn]tWn]:
hG]:Tt];Sac]Pac],hac]:An]pQn]eP;l}:El: lWc]:pQn]haw].hqc];" epL;hn]mqn]: tUv];tI:kn]nL: tL,
ekL:hG]:yUt];yLpn]km];lQw]" (tiUc],pac],tc];emLyLlUc]eSEl: hp].w}.pQn]kn
U ]; Pac]hac]:tI:pQn]eP;l}:
pQn]nC]; Am],nn] etl}:SUc],kCL,yLnC];wQc];)
hG]:Tt];Sac]tac];pQn]An]kUn];pQn]lat]:En Am],nn]tac];pQn]tI:haw].hqc];"
hG]:kUt],Tt];tUw]kUn];pQn] hG]:epL;sWt],es;El: Tt];tUv];tac];pQn]hG]:lI"
tqm]:lUc];tac];pQn] An]pQn]l}:l}al}aAn]eS liUk]:Aw]tac];pQn]An]etpQn]
l}:nm]liUw]piUn]:Sut];"
sqk],ePtac];pQn]kUn];pQn]wL:
1. hp].w}.pQn]kUn];pQn]nC]; Am],nn] etl}:SUc],kCL,yLnC];wQc];
2. hp].yLkUn];pQn]nc],kUn];pQn]nWk]:El:pn]tac];hn]Tiuc]
3. pn]tac];hU.tL,lum];lL;tUw]kw],tI:hiUn]; (Am],pn]yL)"
mk];mn]:wL:etsC].l}a;Sc]yUt];yLkUn];pQn]"
Sp];lqc];lWc]:tac];pQn]pn]kUn];pQn]"pn]lWk];l}a;lWc]:eh.kc]:El:kUt],Tt]; tUv];tI:kn]nL:tL,
yUt];yLpn]kUn];pQn]" lWk];l}a; lWc]:eh.kc]:
pn]lWc]:etl}:Suip],yUt];yL"lat]:EnkUn];pQn]wL: miUw]:lC]wn];lC]etl}:mL;sU; tUv];tI:kn]nL: tL,

tI:hUc];yLKiun];" Sp];lqc];EnkUn];pQn] lWc]:Pac]hac]: An]pQn]eP;l}:" lWc]:etl}: Suip],yUt];yL
Pac]hac]:An]pQn]eP;l}:
tL,AL,yutc];mUt];"
Pac],hac]:tac];pQn]pL:tC]:n}.tk];etl}:pn]tac];yUt];yLkm];Siuw]:"(tiUc],pac],tc];emLyLlUc]eSEl: hp].w}.
pQn]kUn];pQn]nC]; Am],nn] etl}:SUc],kCL,yLnC];wQc];)
20
AWn]tac];Sut];hC]:tUv];Tiuc]SQn]:tac];TUv]:sC]El:lWc]:TUv]:sC]
Puv],pn]SQn]:tac];TUv]:sC]"
SQn]:tac];TUv]:sC]pik].w}.yU,Am],nn]tI:pic],SUp];SWm], (pin],pak], pn]AWk],SI,kYin]," tUv];tI:
SWm],) Am],nn] TUv]:sC]Aap]:hiUw].nL, TUv]:sC]Aap]:yap],nL," kn] 7.1
(lWc]:ta}lium];) El:
kn] 21 (tac];pQn]kQw],lUv]:
SQn]:tac];TUv]:sC])
w}a;n}.ekL:mL;tUv];tI:hqc];liUt]: (pQn]Szk].)
hqc];ek, hqc];tWt],liUt]:Sm].w};' tL,hG]:liUt]:tQm]Kiun];nC];AQn]liUt]: Puv],pn]SQn]:liUt]:" Sm]; IV
pn]tI:SQn]:liUt]:" tUv];tI:
nn].sC].Kaw];yam];hiuc]liUw] 2 Sqk].kn]."
kn] 7.6 (pQn]Szk].)
ta}lium];' pQn]can];
pQn]can]; (pQn]etL:lQw] Am],nn] pQn]miUw]:k}:) Am],nn] tUv];tI: kn] 7.1, 7.2
t}alium]; (epL;pQn]n} sc],hLt}alium];kCL,hiuw]) (lWc]:ta}lium];El: pQn]can];)
lWc]:sQp];
epL;sQp];nL:AUk]; sQp];siUc].hiuw]
(kUt],tUv]; pn]hLhUw]sC]El:pWt],)
epL;sQp];tI:tWc]. sWc],nL:tWc].Kqc]w}.yU,hiuw] tUv];tI: kn] 7.5 (lWc]:sQp];)
(kUt],tUv];Kap]:yC];tWc].sQp];) El: kn] 8
epL;eKL;sQp]; Am],nn] hUw]K}:hqc];nL, sgc],l}:tiUw].vL;mat],sQp]; (tac];pQn]SQn]:liUt]:hUw]sC])
mL;hiuw] hqc];liUt]:Suc]hiuw] (kUt],tUv];lWc]:mat],sQp]; tqk]:tUv];
hqc];liUt]:)
lUm];m}:nC];tUw]Suc]pUn].tI: An]pQn]eP;Tuic]t}al}:
lUm];m}:nC];tUw]Suc]eSepL;pQn]sWm];-
eKL;Kqc] AUn]:AWn],nL,pUn].tI:' ta}lium];' pQn]can];' tUv];tI: kn] 7.4
tWc].sQp];haw].hqc]; hqc];TUv]:sC]eA,n}siuc] (lWc]:lUm];m}:nC];tUw]Suc])
21
hBp].TUp];kUn];pQn]
4
kUn];pQn]tac];sC] (yWc],) El: kUn];h}a.
tUv];tI: kn] 18 (p}a;yU,lIsC])
lgc]:mat],sQp];h}a.hqc];
Pac]hac]:tac],siUw]; An]pQn]eP;l}:tL,luk]:AWn],AL,yuyC],liUw] 2 KUp],
tUv];tI:tL,AL,yutc];mUt];" Pac]hac]:tac];tC]:n}.pQn]Pac]hac]: An]pQn]eP;l}:tL,luk]:AWn],

km];Siuw]:"
(Pac]hac]:pL:tC]:n}. tk];etl}:yUt];yLpn]km];lQw]" tiUc],pac],tc];emLyLlUc]eSEl: hp].w}.pQn]
kUn];pQn]nC]; Am],nn] SUc],kCL,yLtUw]tI:hUc];yLlUc])
Pac]hac]: An]pQn]eP;l}:km]:nm]
Am],kin]nUm];' Am],kin]nm].l}:' kin]Sc]ekL:hak]:AWk],Kiun];'
Am],K}:tUc].niuc]' t}alimu ];' pQn]can];
kQw],lUv]:SQn]:tac];TUv]:sC]eSEl: Pac]hac]:An]pQn]eP;l}:
TUv]:sC]w};" Puv],pn]SQn]:tac];TUv]:sC]"
TUv]:sC]yap]," pn]AWk],SI,kYin]," tUv];tI:
kam]:niUw].tI:nL:AUk];yup]:Kw]:kCL,' kn] 21 (tac];pQn]Sn Q ]:
SQc]TUv]: sC]hqc];eSEl: hqp], tac];TUv]:sC])
kQw],lUv]:pQn]tWc].eSEl: Pac],hac]:An]pQn]eP;l}:
- Tat]:nm].nC];tUw]hqc]: tUv];tI:
- P}a:pL;lit
U ]: kn] 12.1 (tac];pQn]tWc].kCL,)
- pQn]tWc].kCL,hiuc]liUw] 14 wn];
Pac]hac]:tac],siUw];An]pQn]eP;l}:tL,luk]:AWn],AL,yulQk].liUw] 2 KUp],
Pac],hac]:pL:tC]:n}. tk];etl}:yUt];yLpn]km];Siuw]:" (tiUc],pac],tc];KU;emLyLlUc]eSEl:
hp].w}.pQn] kUn];pQn]nC]; Am],nn] SUc],kCL,yLtUw]tI:hUc];yLlUc])
22
Pac]hac]:kUn];pQn]An]Aap]:etsp];vL;siUw].mqc];pqk],TI;rI;yL;siUw];n}.etpQn]
 kin]nUm];Em:Am],l}:'
tUv];tI: eKL:PiUm]:Tqm]
 lUm];naw](lUm];m}:Suc]liUw] 38 MC) Am],nn]tUw]yQn]nL,pUn]. lWc]:Entac];tL,luk]:
tI: (lUm];m}:tqm],liUw] 36 MC) pQn]can];' hUw]mw]; Am],nn] AWn],kiUt],mC],El:
ta}lium];' luk]:AWn],lqc]
 hqc];TUv]:sC] 20 pWk]:/minit]. Am],nn] 60 pWk]:/minit].'
 Kac];'
 kam]:niUw].tI:nL:AUk]; yup]:Kw]:kCL,h}a.hqc];'
 miUw]:TUv]:sC]KU;lc]etkI:Agk],tac];Kac]:'
 tI:SUp];SWm], (pin],pak],SWm],)'
 A}amQn]tI:S}alI' S}alIym];pQn]nm].'
 hUw]KI:mqp]:kC]:'
 tum],sQp];pQn]nWc]tI:Piw]nc]'
lWk];l}a;lWc]:eh.kc]:
kn]n}.etlat]:Tiuc] lWk];l}a;lWc]:eh.kc]:' lWc]:kUt],sqt]:El: tUw]yac],mac]:siUw];"
kU:lgc]:lgc]:
 pn]tac];hU.hC]:kUn];pQn]naw]nUk]. (kU:Sqn];) wL:naw]nUk].tit];sp];pQn]l}:siUc].hiuw]El: nc],huiw]et
Am],pQn]nn].eh.kc]:l}:siUc].hiuw]"
 pn]tac];hU.hC]:kUn];pQn] (km]:nm]kUn];pQn]lWt],liUt]:hUw]sC] Am],nn]kUn];pQn]yQw]:wan]) kQw],
lUv]:l}a;yU,Sw];Kw]kU:wn]; (tUv];tI: kn] 8 El: 10.1)"
 pn]tac];hU.hG]:kUn];pQn] (km]:nm]kUn];pQn]An]tit];sp];tac];pQn] siUw].mqc];sWm];Ac],kL, eP:siUw].
Pn];) kQw],lUv]:lWc]:tac];pQn]tI:tit];sp];kn]l}:kWp]:hUm]:kL,m" pn]tac];hU.lWc]:wac];Pqn]nL:
hiUn];El: SUc],kCL,kUt],tUv]; VCT tI:hUc];yLnC];wQc];"
 pn]tac];hU.kUn];pQn]kQw],lUv]:PWn];sL.lut],lqn];yL:' kin]lw]:' AUm]pU.Am],nn]kin]yL:mw];km]"
tL,Em:pL;tWc].
 Tam]tUv];lWc]:Sm];wk].Sin];tac];pQn]kac];Kqc]"
 kUt],tUv];Pac]hac]:liUt]:sac] (anaemia) El:pn]l}a;yUt];yLeh.kc]:tac];pQn]liUt]:sac]
(tUv];tI: kn] 14.1)"
23
hBp].TUp];kUn];pQn]
4
lWc]:Tuk],lIkUt],Tt]; tL,luk];AWn],AL,yulQk].liUw] 5 KUp],kU:pWk]: miUw]:Kw]mL;hUc];yL"
 Tam]tUv];wL: sWc],l}:Sm];yLeh.kc]: (wk].Sin];) yw].hiuw]" epL;p},l}:Sm];ekL: Sm];wk].

Sin];pn]Kw](Am],nn] lat]:EnEm:luk]:AWn],hG]:mL;Sm];yLwk].Sin];wa};lc]El: lat]:En
pL;wL: miUw]:lC])"
 Tam]tUv];wL:luk]:AWn],l}:kin] wI,tL,min], A km];liun];Sut];miUw]:lC]" epL;p},l}:kin]nC];Kaw];
tac]; 4 liUn]pUn].mL;n} yUt];yLpn]sWm];nc],An]Tuk],mqn]:"
 kUt],Tt];tUv];lWc]:tac];pQn]liUt]:sac]El: lat]:EnlWc]:lum];lL; sWm];nc],tI:Tuk],mqn]:"
 Tt];tUv];cw];l}a;Kat],Tat]:AL,hL,rL. (malnutrition) Tam]tUv];lWc]:lQc].Kw]:lQc].
nUm];El:Sp];lqc];EnlWc]:Ek:lit]:pn]hL lWc]:lQc].Kw]:lQc].nUm];wL:Tuk],lIhQt];siUc].hiuw]"
 tqm]:lUc]; nm].nk];El:SUn],Suc]nC];wC]SUn],Suc] (tUv];tI: kn]lik];eKL:PiUm].Tqm]tac];lc])"
lWc]:etl}:Suip],yUt];yL - eKL:Ennm];
kan]yUt];yLkUn];pQn]n}. yU,tI:kan]mk];mn]:tac];pQn] (diagnosis) tI:Tuk],mqn]:El:liUk]:lWk];
l}a;yUt];yLAn]Tuk],mqn]:nn].yw]." tL,kUn];pQn]nC]; hw];sac]:kum];km]lWc]:yUt];yLlIlI" tL,
kUn];pQn]nWk]: hw];Am],sac]:sWm];hU.l}:wL: sWc],kUn];pQn]yUt];yLtUw]kw],nc],hw];Sc],hiuw]"
nc],huiw]ettqt]:etL;wL:kUn];pQn]ethQt];sWm];nc],Sc],kCL,nn]. hC]:Kuk];sC]l}:piUc]siUw];n}."
1. (Am],mI;lWc]:sm]pQn]n}siuc]) yL,pn]yLnm]liUw] 2-3 mQw];

 kWp]:wL:mn];sac]:pQn]eP;l}: (yLmac]siUw]; epL;kin]sWm];kn]n} sac]:hQt];hC]:pQn]kWc].l}:)
 mn];sac]:pqt]:l}akCL,pqt]:kUv]; (yLmac]siUw]; epL;kin]sWm];kn]n}etAm],sac]:tiUw].Sc])
mn];sac]:etyap],tL,kUn];pQn]etl}:tWc]; l}a;kin]yL Kaw];yam];miUw]:lC]El: l}al}awn];Sm].
etl}:kin]yLAn]lC]PWc]: sQm]Aw]siUw];n}.kCL,"
2. tL,tac];pQn]tI:pQn]h}a.hqc];/ sQp];yQn];siUw];n}.tk];etl}:pn]hC]:tQm]KUS].(course)
Sc],kUn];pQn]wL:tk];etl}:kin]yLhC]:mUt];KUS]. (course) eSEl:epL;Am],lIKiun]: Am],nn]
mI; Pac],hac]:tI:pQn]l}:n}siuc] hC]:pWk]:mL;hUc];yLKiun];"
tL,tac];pQn]An]pQn]Kaw];yaw]; yU,tI:wL:kUn];pQn]etl}:mL;hUc];yLTI,mWk]:kL:hiuw] eSpn]sWm];
nc],tI: Tuk],l}:mL;"
 tL,kUn];pQn]An]pQn]tac];pQn]Kaw];yaw]; Tuk],lIhC]:mL;hUc];yLAm],eA,liUw] Sam]liUn]niuc]:pWk]:"
 Am],Tuk],lIpn]yLnm]liUw]tL,Sam]liUn]El: Tuk],lIhC]:mL;hUc];yLAgn]tac];yLp},mUt];"
24
3.lWc]:hac]:hqn];pn]yL
 epL;pQn]luk]:AWn], hC]:hk];yLmQt].pn]"
 tqm]:lUc];siuw]:yLEl:l}a;kin]/sC].yL niUw]TUc]yLhC]:sqc]:lqc];"
4. lat]:EnkUn];pQn] l}a;kin]/sC].yL tL,Kw]

 etl}:kin]yLmiUw]:lC] (Kqn]: 6 sUw]:mUc];' 8 sUw]:mUc];' 12 sUw]:mUc];)"
 etl}:kin]l}amQt]."
 etl}:kin]tL,l}awn];"
 ethQt];hiuw]sC].tiuw];l}a;yUt];yLnC];piun].tI:' l}a;hQt];nm].kiUw]Tat]: (ORS)"
 miUw]:lC]etl}:pWk]:mL;EntI:hUc];yLKiun];"
25
lWc]:Tuk],lIl}:fac].
5 An]sC].kn]tc];lum]:fL.
eKL:piut],tI:pWc],
lWc]:Tuk],lIl}:Pac].tI:sC].kn]tc];lum]:fL.An]wL:nn]. kWp]:piUw]:wL:PC]pQn]tac];pQn]Sc]yU,' PC]tit];siUw].
mqc];tac];pQn]Sc]yU,n}Am],hU.l}:El:nm].An]AWk],mL;sWm];tUw]kUn];/liUt]:kUn];Sm]. sac]:hQt];hG]:sp];tit];
siUw].mqc];tac];pQn]l}:El:nc],hiuw]epL;etAm],tit];sp];nn].tiun];Tuk],lIl}:Pac].w}.AWn]tac];" miUn]nc],
 luk].tI:kUn];pQn]eS sp];tit];PU:hap],kan]p}a;yU,lI
 luk].tI:kUn];pQn]eS sp];tit];kUn];pQn]tac],ekL.
 luk].tI:PU:hap],kan]p}a;yU,lIeS sp];tit];kUn];pQn]
tk];etl}:w}.sC]wL: nm]./liUt]: An]AWk],mL;sWm];tUw]kUn];pQn]kU:ekL. sp];tit];siUw].mqc];tac];pQn]l}:"

kgp]:n} PU:hap],kan]p}a;yU,lIkU:ekL. pQn]kUn];yU,nC];eP;nm]liUw]piUn]: tL,sp];tit];siUw].mqc];tac];pQn]' miUn]
nc], KQm]Sm];yLkUn];pQn]tm]vL;' nm].tUw]kUn];pQn]SQn]Kw]:SC],tL' pak], sQm]siUw];n}.yw]." pqk].Sm].wL:
lWc]:siUw];n}. hw];eh.kc]:l}:Pgc]:n}eStL. lWc]:hLl}a;ciUc].ew:El: mI;lgc]:Pac].w}.n}. lIliUw]piUn]:tL,
eh.kc]:eP;yw]."
l}a;hQt];Sac]:
 Am],wL:Agn]tac]; Am],nn]wa};lc] miUw]:tiUw].vL;kUn];pQn]yw].El: miUw]:Tgt],Tuc]miuw];kU:pgk]:
tk];etl}: Aw]Sp].pYL,eSSuk]:miuw];pn]kU:pgk]:"
 epL;wL:etl}:tuiw].vL;nm].tUw]/liUt]:kUn];pQn]n}siuc] hC]:SC],Tuc]miuw];tL,eS,"
 miUw]:hQt];kan]nn].epL;wL:Aap]:etvL;liUt]:/nm].tUw]kUn];pQn]SQn]vL;SC],n}siuc] nc],hiuw]epL;
etpQn]lgc]:eh.kc]:nn]. hC]:SC],man],tL' nL:kak],El: SiUw]:Kum];"
 lUt];ygn],Kk].tgn]:tI:Am],epL;lm],lgc]:" tUw]yac], ciUc].ew:lgc]:l}a:liUt]:' tiUm];liUt]:
Am],nn] yQp].h}g;sQp];pn]kUn];pQn]"
 Aw]kUn];pQn]An]Aap]:etmI;liUt]:/nm].tUw]y}g.SC],tI:ngn];Am],nn] yg}.SG],kUn];pQn]tac],ekL.
nn]. tk];etl}:Aw]w}.tI:niuc]:hac];eKL"
lgc]:lac].miuw];
 tI:hUc];yLtk];etl}:mI;nm].tL,lac].miuw];tL,eS," etl}:Aw]Sp].pYL, (KL:siUw].mqc];)Suk]:muiw];
yw].Suk]:nm].Tqc]:nm]nm]"
 pqk].Sm].wL:SC],Tuc]miuw];w}.eStL.w}a;yip];vL;liUt]:/nm].tUw]/nm].l}a;/niUw].nc]/nm].liUc]tUw]
kUn]nn]. hG]:Suk]:miuw];pqt]:km];lQw]"
26
lWc]:Tuk],lIl}:fac]. An]sC].kn]tc];lum]:fL. 5
 mUiw]:etkin]Am],nn] wa};kin]Kw]:yw]. Am],nn] miUw]:ethQt];Kw]:Pk]; hC];Suk]:miuw];kU:pgk]:"
 miUw]:kCL,Kw]:hgc]:nm].yw]. hC];Suk]:miuw];sgm];tL,eS,"
 w}a;sC].miuw];Sc],KI:muk]:' miUw]:A}Am],nn] sam]SC],miuw];nn]. hC];Suk]:miuw];tL,eS,"
 mUiw]:etSm];KQm]hC]:kUn];pQn]nn]. hC];Suk]:miuw];tL,eS,"
 miUw]:tUiw].niUw].tUw]kUn];pQn]yw]. hC];Suk]:miuw];tL,eS,"
TUc]miuw];
 miUw]:etl}:tuiw].vL;liUt]:' nm].tUw]' nm].l}a;' niUw].nc]' nm].liUc]tUw]kUn];pQn]nn]. tiuw];TUc]miuw];
An]mUt];SC]El:mac]tL,eS,"
 yUt];yLkUn];pQn]ekL.lQw]kUv];yU,eStL.ekL:yw]. epL;hQt];An]niuc]:yw].ethQt];Tqc]:An] niuc]:
nn]. hC]:l}a:TUc]miuw];mC],tL,eS,"
 kgn],etkCL,sU;kUn];pQn]Tqc]:ekL.mC],nn]. hG]:Tgt],TUc]miuw];AWk],yw]. Suk]:miuw];pqt]:AWn]tac];"
SiUw]:Kum];
 miUw]:Aap]:etmI;liUt]:' nm].tUw]kUn];pQn] SQn]tiUw].vL;SC],l}:nn]. hG]:nuc]:SiUw]:Kum];plat].Stik].
eS miUw]:sC].yw].nn].hC]:lac].pqt]:kU:pgk]:" tUw]yac],- miUw]:piUt],hU;kiUt],luk]:' miUw]:yL.PIhC]:tqk],"
 w}a;SC],hQt];kan]yw].Sk].' lac].SiUw]:Kum];kU:pgk]:"
man],tLEl: nL:kak],
 miUw]:Aap]:etmI;liUt]:' nm].tUw]kUn];pQn] SQn]tiUw].vL;SC],l}:nn]. hC]:tuiw];man],tLEl:nL:kak],
kU:pgk]:"
tUw]yac],- miUw]:piUt],hU;kiUt],luk]:El: miUw]:yL.PL,sQp];PIhG]:tqk],"
lgc]:Aw]w}.tI:lC]tI:niuc]:hac];eKL
 tL,lWc]:siUw].mqc]; An]sp];tit];kn]l}:sWm];lUm];
 Am],Tuk],lIAw]kUn];pQn]w}.hUm]:sgm];kUn];pQn]tac],ekL." hgc]:kUn];pQn]Tuk],lIpQn] hgc]:tI:hG]:lUm];
Kw]:lUm];Agk],lI" Pk];tUepL;sp];tit];tc];hUc];ehL;yC],ekL: Tuk],lIpik].w}.eSPuv],hU;lqc];
AWk],kCL, tac];ngk]:n}siuc] etsac]:hQt];hC]:lgc]:tit];sp];siUw].mqc];ek,lUc];l}:" epL;pQn]l}:hgc]:
tI:w}.kUn];pQn]nn]. Tuk],lImI;hU;lqc];yC],yC], hG]:hp].Sqc]lqt],El: lUm];l}:lInn].yw]."
 miUw]:etl}:tiUw].vL;tc];kUn];pQn]nn].hC]:SC],TUc]miuw];' man],tLEl: nL:kak],kU:pgk]:"
 lgc]:Aw]kUn];pQn]K}a.kCL,K}a.mL;nn]. tk];ethC]:l}:eA,lUc];"
27
lWc]:Tuk],lIl}:fac]. An]sC].kn]tc];lum]:fL.
5
 tL,tac];pQn] An]tit];sp];l}:lUv]:mun]Pgc]
 Am],Tuk],lIAw]kUn];pQn]w}.hUm]:sgm];kUn];pQn]tac],ekL."
 miUw]:etl}:tiUw].vL;tc];kUn];pQn]nn]. hG]:tiuw];Tuc]miuw];' man],tLEl: nL:kak],kU:pgk]:"
 tL,tac];pQn] An]tit];sp];l}:lgc]:lUv]:tiUw].vL;kn]
 Am],Tuk],lIAw]kUn];pQn]w}.hUm]:sgm];kUn];pQn]tac],ekL.El: hG]:kUn];Kw]:Agk],eA,"
 miUw]:etl}:tiUw].vL;tc];kUn];pQn]nn]. hG]:tuiw];Tuc]miuw];El: nL:kak],kU:pgk]:" miUw]:l}: tiUw].
vL;tc];kUn];pQn] (Am],nn]) nm].tUw]kUn];pQn]An]etsp];tit];tac];pQn]l}: Am],nn]
l}:tiUw].vL;' yip];vL;' KUw];kiUw],kUn];pQn]siUw];nn].n}siuc] hG]:Suk]:miuw];pqt]:km];lQw]"
 tL,eh.kc]:nn]. hG]:nuc]:SiUw]:Kum];Sgc]sn]."
 ciUc].ew: lgc]:sC].tiuw];KiUc]:miuw];hUm]:kn]tc];kUn];pQn]tac],ekL." (epL;mI;KiUc]:miuw];nm]yU,n}siuc])
hG]:sC]. KiUc]:miuw];tL,kUn];pQn]ekL.nn].eKLeKL" epL;wL:KiUc]:miuw];Am],nm]eSEl: kL:etl}:
sC].tiuw];hUm]:kn] n}siuc] mUiw]:p},sC].tL,kUn];pQn]tac],ekL.nn] hC]:lac].KiUc]:miuw];lIlIyw].
KL:siUw].mqc];pqt]:eSkgn],"
KWc]lqm] KWc]KUm];/Pa}
 tk];etAm],l}:sC].KQm]Sm];yLAn]sC].yw].lL;lL;" ciUc].ew:Aw]hUw]Sup]; Sup];SC],KQm]Kiun];"
 epL;sC].Kgc]lqm]'Kgc]mI;KUm];yw].hG]:Aw]pqt]:SC],nC];kgk];An]luc],El: nm].Am],Kw]:l}:nn]. tL,eS,"
 tI:w}.kgk];SC],Kgc]lqm]' Kgc]KUm];' Kgc]P}aAn]sC].yw].nn].ekL: lm],lgc]:nc],kn]" Tuk],lIAw]w}.
sm]kn] tc];tI:etsC]."
 tk];etl}:w}.StitL,eS,wL: KiUc]:miuw];An]sC].yw].siUw];nn]. miUw]:p},sC].Tqc]:km];niuc]:nn].
tk];etl}: lac].lIlIEl:KL:siUw].mqc];hG]:Tuk],mqn]:eSkgn],"
 miUw]:lac].KiUc]:miuw];KUm];' lqm]' P}a kU:pgk]:hG]:SC],Tuc]miuw];nLEl: etl}:w}.StieSlac]."
Kk].tWn]: lWc]:mUt];SC]
 tk];etl}:hQt];lgc]:mUt];SC] An]kUn];pQn]tiUw].vL; miUn]nc],kU,ngn];' haw];kU,ngn];' PiUn]An]
sC].kUt],Tt];kUn];pQn]' PiUn]wac];him];kU,ngn];siUw];n}.tL,eS," miUw]:hQt];lgc]:liUm]:SC]nn]. Tuk],lI
SC],TUc]miuw];tL,eS,El:sC].tiuw];nm].yLKL:siUw].mqc];mUin]nc],nm].yLSk].KUw];' EAl]kUw],ehL; Am],
nn] Aa},AUw],tin];"
 PL:An]kUw]:siUw];n}.ekL: Sk].hG]:liUm]:SC]yw]. Tuk],lIKL:siUw].mqc];sgm];" ciUc].Ew: An]ettiUw].vL;
KUw];Kgc]' SiUw]:KUw]; An]kUw]:liUt]:Am],nn]nm].tUw]kUn];pQn]"
28
lWc]:Tuk],lIl}:fac]. An]sC].kn]tc];lum]:fL. 5
PU:hap],kan]hgc]:lqp],
 tk];etl}:w}.sC]wL: (liUt]:/niUw].) An]Aw]tI:kUn];pQn]mL; tL,kU:siUw];nn]. sac]:mI;siUw].mqc];
tac];pQn] An]sp];tit];l}:"
 tk];etl}:SC],TUc]miuw];"
 epL;wL:Aap]:etmI;lgc]:SQn]SC],n}siuc]hC];SC],man],tL"
 miUw]:lac].KiUc]:miuw];KUw];lqp],kU:pgk]:Tuk],lISC],Tuc]miuw];"
 yL,kin]nC];hgc]:lqp],"
 miUw]:etkUt],Tt];siUw].mqc];An]sp];tit];lUv]:tac];lUm];l}: (miUn]nc], TB )nn]. hC]:SC],nL:
kak],kU:pgk]:"
epL;wL:PU:hap].kan]p}a;yU,lIekL.niuc]:kCL,tiUw].vL;nm].tUw]kUn];pQn]n}siuc] etl}:eh.kc]:siUc].hiuw]nn].
kCL,tUv];tI: “lgc]:eh.kc]: miUw]:tiUw].vL;yw].” tI:kn] 6"
29
lWc]:eh.kc]: mUiw]:tUiw].vL; (PEP)
6
eKL:piut],tI:pgc],
PEP An]wL:nn]. pQn]lgc]:eh.kc]:miUw]:tiUw].vL;nn].yw]." pgc],wL:miUw]:ekL.lC]ekL.niuc]: kCL,tiUw].vL; nm].
tUw]' liUt]:An]tit];sp];siUw].mqc];AQk].KY]A},wI,' Am],nn] tac];pQn]naw]niUw].liUc]' tac];pQn]tp];Kqc]
siUw];n}.l}:nn]. nc],hiuw]epL;eteh.kc]:yL,hG]:sp];tit];tac];pQn]AQk].KY]A},wI,n} kin]yLeh.kc]:l}:nn].
yw]:"tL,tac];pQn]tp];Kqc]pI,Et.Sm];yLeh.kc]: (wk].Sin];) eSAm],hG]:pQn]tac];pQn]l}: (tUv];pL:tC]:)"
PEP An]wL:nn]. epL;wL:kCL,tiUw].vL;siUw];An]etsp];tit];tac];pQn] HIV yw]. sC].l}a;kin]yL
antiretroviral (ARV) tL, 28 wn];eSEl: hQt];hC]:lgc]:etsp];tit];tac];pQn] HIV l}:nn].eA,
lUc];nn].yw]." PEP n}.pQn]l}a;yUt];yLAn]lm],lgc]: tL,sC].tiuw];miUw]:tiUw].vL;nm].tUw] An]sp];
tit];siUw].mqc];miUw]:Pgc];hQt];kan]El:miUw]:ekL.lC]ekL.niuc]:Tuk],kn].sn]nn].yw]:""lgc]:eh.kc]: miUw]:tiUw].vL;
yw].”n}.Am],sC]:tL,sC].tiuw]; tac]tqn]; lWc]:Tuk],lIl}:Pac].An]sC].kn]tc];lum]:fL. kUv];kL:liUw]eSKiUc]:
km].kqm]kQw],lUbv]:lgc]:eh.kc]: miUn]nc],Tuc]miuw];' kgk];SC],KiUc]:miuw];An]P}a/lqm] tI:kQp];Pc]tI:lIyw].
Tuk],lIsC].pQn]l}a;km].kqm]Tqc]:l}a;niuc]:"
piun];lc]
 AI:Sc]nC];tUw]kUn];pL;siUw].mqc];tac];pQn] HIVl}:
 liUt]:
 nm].can] (Sperm)' nm].miUk],KiUc]:Ac],kL,nac];yic];
 nm].Aap], (lm],lgc]:tL,Em:kQp];)
 tac];pQn]tgc].man];(Ascites)' ngc]yC]<hum]:pgt],pQn]sQp];' ngc]
 etAm],PUp].vL;siUw].mqc]; HIVl}:nC];
 hiUw],
 nm].l}a;
 tiUw].vL;nm].An]pL;siUw].mqc];tac];pQn]siUc].hiuw] sc],sac]:etsp];tit];tac];pQn]l}:
 KQm]lL:lI:tm]vL; (miUw]:Sm];pn]kUn];pQn] An]mI;siUw].mqc]; HIV Am],nn] miUw]:Sit],nm].
yLnC];lgt],KQm]Agk],pqt]:nn]. KQm]tm]vL;sw]:kw],Kiun];)"
 nm].tUw]kUn];pQn]An]mI;siUw].mqc];SQn]Kw]:pak],Am],nn]Kw]:tL"
 liUt]:Am],nn] nm].tUw]kUn]; An]mI;siUw].mqc];tUk];SC],niUw]Piw]nc]pQn]wUc];kCac]: Am],nn]
tUk];SC],niUw]sQp];sw]:kw],"
 vL;kn].sn]Am],nn] vL;hQt];h}a.kQw],lUv]:kan]hUm]:kL,m"
 miUw]:hUm]:kL,mtc];kUn];pQn]tac];pQn] HIV nn].Am],l}:eh.kc]:Sc] (epL;wL:P}a,lC]P}a,niuc]:
30
lWc]:eh.kc]: mUiw]:tUiw].vL; (PEP) 6
Sm].pQn] kUn];pQn] HIV eSEl: miUw]:hUm]:kL,mkn]nn]. Sm].Am],SC],TUc]yac]eh.kc]:)"
kgp]:yip];miuw];kn]' lat]:etL,kn]' sup],kn] Am],nn] sC].hgc]:nm].sgm];kn]eSyw].

Am],hQt];hG]:siUw].mqc]; HIV sp];tit];l}:"
miUw]:tiUw].vL;liUt]:' nm].tUw]kUn];pQn]yw].ethQt];siUc].hiuw]?
lgc]:yUt];yLAgn]tac];Sut];
 epL;wL:pQn]hU;kCL, (miUn]nc],hU;KQm]tm]SC],) n}siuc]yL,nqt]:pik].hG]:liUt]:kiut];l}" kUv];kL:Aw]Sp].pYL,
Suk].lac].tI:sQp];sgm];nm].nm]nm]"
 epL;wL:tiUw].vL;tI:Piw]nc] pqk].Sm].wL:tI:Piw]nc]Am],mI;sQp];eStL. hG]:Aw]Sp].pYL,Suk]:lac].sgm];
nm].nm]nm]"
 epL;wL:Kw]:tL Am],nn] Kw]:pak],n}siuc] hG]:Aw]nm].nm]nm]eSlac].tLlac].pak],pqt]:" tL,lgc]:
kn].sn] nn].hG]:kCL,tUv];tI: “l}a;yUt];yL lgc]:kn].sn]” (kn] 20.3)"
lgc]:Tt];Sac]eP;
lgc]:Tt];Sac]eP;n}. Tuk],lIhQt];sgm];kUn];An]mI;tUw]TUp];nm]" kgp]:wL:cw];l}a;mac]pgk]:etsac]:hQt];hG]:
eP;sp];tit];siUw].mqc]; HIV nm]liUw]ekL:pQn]l}:El:Sc]' kgp]:lgc]:etl}:tqp];tt];wL: etl}:yUt];
yLsiUc].hiuw]n}nn].Kiun]:yU,sgm];cw];l}a;sp];tit];siUw].mqc];nm]ek,nn].yw]:" tL,ethU.eKL:mun]; "lgc]:
Tt];Sac]eP;”nm]liUw]nn]. kCL,tUv];tI: "lgc]:Tt];Sac]eP;” Kgc]muk].sum];sw]:kw],"
epL;wL:KUw];Kgc]An]hw];tiUw].vL;nn]. Am],epL;hU.tqt]:etL;wL: kUn];pQn]ekL.nn].pQn] HIV hiuw]
Am],pQn]hiuw] n}nn]. Tuk],lITam]kac]sC]kUn];pQn]eSEl: kUt],Tt];liUt]:kUn];pQn]tUv];" lgc]:kUt],
sqt]:kUn];pQn]n}. w}a;pn] tac];hU.kQw],lUv]:lgc]:tac];pQn] HIV hG]:kUn];pQn]pgc],sC]tac];pQn]' lgc]:etyUt];
yLl}:siUc].huiw]' lgc]:etSUc],kUn];pQn]kCL,yLtUw]nC];wQc];siUc].hiuw]yw]. sc],Tuk],lIkUt],Tt];" lgc]:Am],
Tuk],lIhC]:PC]hU.lL;lL;n}.ekL: pQn]lgc]: lm],lgc]:" miUw]:kUn];pQn]Agk],hUc];yLkCL,yw].nn]. tk];et
l}:SC],sC]w}.kgn],wL: kUn];pQn]ekL.n}.n}. mI;siUw].mqc]; HIV "
lgc]:kqc].km]km]:nm] - miUw]:Am],En.ngn];(eS,KYL,)sC] hC]:sC].PEPw}.kgn]," kgp]:wL:epL;hU.tqt]:etL;

miUw]:lC]n}ekL: kiut];yut];kin]yLmiUw]:lC]ekL:l}:" Kaw];yam];lIliUw]piUn]:tL,etEt, PEP Et.nC];Kaw]; yam];
2 sUw]:mUc];w}a;tiUw].vL;yw]." kUv];kL:nC];Kaw];yam]; 72 sUw]:mUc];nn]. Et,miUw]:lC]ekL:l}:yU," (yic]:Et,
PEP w};l}:kL:hiuw]ekL: nuic]:Kqn];pQn]Pgn];lIkL:nn].yw]:")
mac]pgk]:mI;kUn];tiUw].vL;yw].Am],l}:Et, PEP n}siuc] Tuk],lIpn]hqc];sC]' sgm];lUv]:piUc]yUt];yLEl:

tgc]:Tam] sam];tUv];cw];l}a;Kw]n}. pQn]An]lm],lgc]:Et.Et."
31
6 lWc]:eh.kc]: mUiw]:tUiw].vL; (PEP)
l}a;yUt];yL PEP
l}a;yUt];yLn}. pQn]l}a;sC]. ARV hUm]:kn]tL, 4 wUc]:" lgc]:nm]ek,El:Sqn];yLAn]etsC].nn]. et
Kiun]:yU,sgm];yLAn]kin]kCL, (epL;hU.) El:hU.wL:kin]yLSc]kCL,yw]. Am],nn] yLAn]etkCL,hQt];hG]: yL
An]kin]kCL,nn]. Am],tiUw].eSEl: kin]sgm];nc],nn]nn].yw]." etKiun]:yU,sgm];lgc]:nm]ek, An]l}:
tiwU ].vL;Tqc]:km];niuc]:" epL;wL:sC].yL Zidovudine El: Lamivudine yw]. lgc]:Am],tiUw].yL Am],mI;
n}siuc] hG]:hUm]:yLpn]sgm];nc],
 Zidovudine niuc]:wn];niuc]:pgk]: niuc]:pgk]: 250 mI,lI,krm],
 Lamivudine niuc]:wn];Sgc]pgk]: niuc]:pgk]: 150 mI,lI,krm],
 epL;wL:Tuk],lIsC].yLAn]TI.Sam]Tqc]:n}siuc] hC]:pn]yL Indinavir niuc]:wn];Sam]pgk]: niuc]:pgk]:
800 mI,lI,krm], Am],nn] Efavirenz niuc]:wn];niuc]:pgk]: niuc]:pgk]: 600 mI,lI,krm], (yLn}.
Am],Tuk],lIpn]Em:pL;tgc].lL;lL;)"
lgc]:nm]eA,El: l}a;sC].yLhUm]:kn]n}. Tuk],lIsC].sgm];pk];piUc]l}a;sC].yLKgc]muk].sum];" epL;wL:kCL,tiUw].vL;
siUw].mqc]; HIV An]yLAm],tiUw].yw].n}siuc] tk];etl}:tiUc],pac],tc];PU:mI;tUw]TUp];nm]wL: Tuk],lIhQt];
siUc].hiuw]" An]lm],lgc]:Et. epL;wL:Et,sC].l}a;yUt];yL PEP yw].n}siuc]Tuk],lIsC].hG]:tQm]tL, 28 wn];"
Sun]kUn];p}a:eP;mac]tI: etmI;yLtL,liUm]:Et, PEP n}eStL. kgp]:Am],mI;tQmT ] Un]:El: km]:nm]Et.
tL,etSuip],yUt];yLkCL,Tqc]:nn]. etSUc],Kw]:hUc];yLlUc]"
Pac]hac]:Pgn];sL.yL
tk];etl}:Sp];lqc];EnkUn];pQn]wL: epL;kin]yLyw].etmI;Pac]hac]: K}:tUn].K}:hak]:' tgc].kCL,' sQp];
niUw].sQp]; tUw]El: hUw]K}:siUw];n}.n}siuc] etpQn]Am],l}awn];kUv];n}yw]." epL;Am],Sp];lqc];En kUn];
pQn]n}siuc] kUn];pQn]sac]:Am],SiUw];SL,sC]eSEl: etsac]:kiut];yuit];kin]yLekL:pQn]l}:" miUw]:kin]yL
pUn].kCL,mgk]: 10 wn];yw].et TUp];vL;Pac]hac]:hqc];liUt]:eA,El: K},mQt].liUt]:Kaw]eA,lUc];siUw];n}.El:
tk];etl}:hG]:hgc]:lqp], kUt],sqt]:liUt]:kCL,sgm];"
tac];pQn]tp];kC]: pI, El: SI,

lgc]:tiUw].vL;liUt]:El: nm].tUw]kUn];pQn]n}. sac]:hQt];hC]:sp];tit];tac];pQn]tp];kC]:pI,El: SI,l}:nc],
kn]" epL;sp];tit];tac];pQn]yw]. ethQt];hC]:tp];kC]:l}: (kn] 12.3)" etL,Tiuc]mUiw]:lQw]Et.yLeh.kc]:
(Vaccine)tac];pQn]tp];kC]:SI, p},mI;n}eStL. yLeh.kc]: (Vaccine) tac];pQn]tp];kC]:pI,Et.mI;yw].El:
epL;kUn];pQn] p},yam]:Sm];yLeh.kc]: (Vaccine) tac];pQn]tp];kG]:pI,n}siuc] hG]:Sm];pn]yLeh.kc]:
(Vaccine) tac];pQn] tp];kC]:pI,l}:"
Sm];yLeh.kc]:tac];pQn]tp];kC]:pI,pn]
 epL;wL:kUn];ekL.nn]. yam]:Sm];yLeh.kc]: (Vaccine) tac];pQn]tp];kC]:pI,pUn].mL; 10 pI<yw].n}
siuc] hG]:Sm];pn]yLtiUw];hqc];yLeh.kc]: (Vaccine) tac];pQn]tp];kC]:pI,"
32
lWc]:eh.kc]: mUiw]:tUiw].vL; (PEP) 6
 epL;wL:p},yam]:Sm];n}siuc] w}a;eStiUw].vL;yw].nC];Kaw];tac];niuc]:liUn] hC]:Sm];pn]pgk]:km];niuc]:
El: nC];Kaw];tac];liUn]TihUk];nn]. hC]:Sm];pn]Tqc]:pgk]:niuc]:"
lgc]:Siup],tUv];cw];l}a;kUn];pQn] (FOLLOW UP)

 Tuk],lIpn]hqc];sC]"
 Tuk],lIhUp].tc];kUn];pQn]eSEl: pn]tac];hn]Tiuc]wL:
 lgc]:sp];tit];tac];pQn] kWp]:lUv]:lL:lI:kCL,tiUw].vL;liUt]:siUc].n}n}.mI; 0.3% (3 nC]; 1000
ekL.) kUv];" cw];l}a;sp];tit];l}:n}. pQc];kn]tc];cw];l}a;sp];tit];tac];pQn]l}: lgc]:lUv]:
hUm]:kL,msgm];kUn];pQn] HIV eSEl: Am],sC].tiuw];lgc]:eh.kc]:Sc]"
 PEP n}.Am],sC]:eteh.kc]:lgc]:tit];sp];tac];pQn] HIV l}:hUw]pak],tQm]" kUv];kL:pQn]lgk];l}a;
hQt];hG]: lgc]:tit];sp];tac];pQn] HIV nn].eA,lUc];kUv]; Am],sC]:wL:eh.kc]:eP;l}:tQm]tQm]"
 Pgn];sL.yLkgp]: PEP Am],h}a.hqc];eStL. Tuk],lItUv];sgm];cw];l}a;kUn];pQn]yU,tL,eS,"
 w}a;eStiUw].vL;yw]. 8 wn]; Tuk],lIkUt],Tt];tUv];siUw].mqc]; HIV (hG]:hU.l}:lIwL:
lgc]:tiUw].vL; nn].sgc],hQt];hG]:sp];tit]; Am],sp];tit];tac];pQn])" mUiw]:p},kUt],El:
w}a;kUt],Tt];nn]. Tuk],lI pn]tac];hU.kQw],lUv]:tac];pQn] hG]:pgc],sC]lgc]:tac];pQn]lIlI"
 lgc]:kUt],Tt];nn]. Tuk],lIpQn]kac]sC]Kgc]kUn];pQn]tI:K}:kUt],Tt];" kUv];kL:kgp]:Am],l}:kUt],
Tt];eSEl: Am],Tuk],lItqp];tt];wL:etAm],sC]. PEP" pqk],Sm].wL:kUn];pQn] Am],K}:
kUt],sqt]: tac];pQn]n}ekL:pn] PEP l}:yU,"
 w}a;eSnn].Sam]liUn] Tuk],lIkUt],Tt];tac];pQn]" epL;lgc]:kUt],Tt];sI.wL:Am],pQn]n}
w}a;eSliUn] TihUk];yw]. Tuk],lIkUt],Tqc]:km];niuc]:" epL;kUt],Tt];miUw]:liUn]TihUk];yw].
yc];siwL:Am],pQn]n}siuc] pgc],wL:Am],l}:tit];sp];tac];pQn] HIV"
 kgn],p},hU.lIetL,Tiuc]liUn]TihUk];nn].kUn];pQn]Am],Tuk],lIhUm]:kL,mlUbv]:Am],l}:eh.kc]:El:
Am],Tuk], lIlU,liUt]:hG]:PC]"
 w}a;kUn];pQn]tiUw].vL;yw].nn]. Tuk],lItUv];sgm];Pac]hac]:tac];pQn]l}al}awUc]: miUn]nc],Pac]hac]:
kiuc].kac].naw]' lymphadenonpathy' pQn]mun],man],' eKL;sQp];' tac];pQn]naw]K}:liUt]:Agk],'
pQn]sQp]; nC];pak],An]Pac]hac]:An]l}:TUp];vL; nC];kUn];pQn]et,sp];tit];tac];pQn] HIV
Kw]nn].yw]." w}a;eStiUw].vL;yw]. 3-6 wUc]:epL;sp];tit];tac];pQn]n}siuc] km]:nm]etl}:
hn]Pac]hac]:siUw];n}. Agn]tac];yw]."
33
6 lWc]:eh.kc]: mUiw]:tUiw].vL; (PEP)
lgk];Kgc]:Kk].tgn]:
lL:lI:kCL,tiUw].vL;liUt]: Am],nn] nm].tUw]An]Aap]:etsp];tit];tac];pQn]l}:
yUt];yLpn]km];Siuw]:
l}a;can];pn]PU:Aw]pun]:Pgn]; PEP
PU:Aw]pun]:Pgn]; PEP etTt];Sac]Kk].tgn]:pQn]eP;l}:eS

ettqp];tt];wL:Tuk],lIEt,pn] PEP hiuw]Am],Tuk],lIEt,pn]
siwL:Tuk],lIsC]. PEP
wUn].Sgn],lgc]:Tuk],lIsC].
sC]. Am],sC]. yLeh.kc]:tac];pQn]tp];kC]:pI,
sC].tiuw]; PEP sgm];nc], tk];etl}:hQt];hC]:mn]:sC]wL:

piUc] PEP muk].sum]; l}:pn]lgc]:tiUc],pac],tI:Tuk],mqn]:
El:Siup],tUv];cw];l}a;kUn];pQn]
34
Pac]hac]:tac];pQn] An]pQn]kn]km]:nm]
7
7.1 ta}luim]; (Coma)
eKL:piut],tI:pgc],
pQn]lgc]:hU.tUw]ek,lUc];kCL,pqt]:" sn].tgn]:lgc]:hU.tUw]ek,lUc];kCL,n}. mI;l}asn].tgn]:nn]. lgc]:lium];tUw]
n}. pQn]sn].tgn]:An]h}a.hqc];liUw]piUn]:yw]."
 muin];mw]; (Drowsiness) sn].tgn]:n}.Aup],lat]:etL, Am],nn]tiUw].tUw]kUv];ekL: kUn];pQn]yc];
hU.tUw] l}:c}a:yU,"
 luim];tUw] (Stupor)sn].tgn]:n}.l}:Aup],lat]:hqc];hqc];Am],nn] tiUw].SC],tUw]hqc];hqc];yw]. kUn];pQn]
sc],hU.tUw]"
 ta}lium]; (Coma) sn].tgn]:n}. kUn];pQn]Am],hU.tUw]lL;lL;"
tI:pgc],l}a;tqk]:lgc]:lium];tUw]mI;l}aSqn];nn]. nC];pp].Entac];n}. etsC].l}a;tqk]:Sek;l]klat].S]kw];

(Glasgow Scale)kCL,"
lgc]:yUt];yL
1) hQt];pn]SQn]:tac];lUm];TUv]:s]Cpac], (Clear Airway)– l}a;Aw]kac];hqn]Kiun]:n}. pQn]l}a;hQt];hG]:
TUv]:sC]Kw]:Agk],l}:lIl}a;niuc]:yw]." kUv];kL:tk];etl}:Pac].El:w}.StilIlI miUw]:Aw]miuw]; hgc];yuk].
kgc],ekL:Kiun]:El: yiut]:eKL;Agk], kgp]:wL:etsac]:hQt];hG]:eKL;sQp];l}:" epL;mI;KiUc]:km].kqm]Tic];eKL;n}
ekL: sC].KiUc]:km].kqm]eSyUk].n}. etTuk],mqn]:lIliUw]" kUv];wL:nC];eKL;kUn];pQn] sgc],mI;Sc]Km]w}.hiuw]
epL;mI;n}ekL: Aw]niw].miuw];Kgk];Agk],mL; hG]:lUm];TUv]:sC]Kw]:AWk],l}:lI"
35
7 Pac]hac]:tac];pQn] An]pQn]kn]km]:nm]
2) l}a;wac];tUw]kUn];lium];tUw] (Coma position)– Aw]tUw]kUn];pQn] tm];wac];ngn];tac];Kac]:
sWm];nc],hac]:tac];tC]:n}." Aw]KLP}a,niuc]: ecL;Kw],w}." epL;wL:lgc]:lium];tUw]n}. pQn]mL;kgp]:vL;
mat],sQp];mL;n}siuc] miUw]:Aw]kUn];pQn]ngn];KI:kqc];nn]. hG]:lc]kUn];pQn]Siuw]:w}." kgp]:wL:l}a;Aw]tUw]wac];
siUc].n}n}. ethQt];hG]:kUn];pQn] Am],KUp];SC],lin].sw]:kw],El: hak]:ekL:etAm],tit];nC];eKL;
An]et hQt];hG]:TUv]:sC]Am],l}:nn].yw]:" epL;kUn];pQn]TUv]:sC]l}:lIhc];kUv]; sc],Tuk],lItm];wac];
siUc].nc],n}" etl}:pC].tUv];hqc];lUm];TUv]:sC]El: hqc];tgt],liUt]:yU,tL,eS," epL;kUn];pQn] kiut];
TUv]:sC] Am],nn] hUw]sC]kuit];tUc].kCL,n}siuc] etl}:Aw]kUn];pQn]ngn];c}aw};w};eSEl: sC].l}a;hQt];hG]:
hUw]sC]El:pgt],hQt];kan]Kiun]; (tUv];tI:nL:lik]: (427))km];Siuw]:"
3) kUt],tUv];Pac]hac]:lm],lgc]: (hqc];tgt],liUt]:' hqc];liUt]:' hqc];TUv]:sC]El:lUm];naw]kUn];pQn]) El:

Tat]:kiUw]wan]nC];liUt]:' Aw]liUt]:kUt],TUv];tac];pQn]naw]nUk].' tac];nqn]:nLKgc]mQt].liUt]:lqc]"
epL;wL: kUn];pQn]SWYk]. hG]:kCL,tUv]:tI: kn] 7.6 lgc]:pQn]SWYk]."
Pac]hac]:tac];pQn]
hG]:Tam]kUn];hiUn];kUn];pQn]sgm];nc],kCam];Tam]pL:tC]:n}.
 piun];lc]tac];pQn]kUn];pQn]mI;siUc].hiuw]Pgc]:
 Pac]hac]:tac];pQn]mUiw]:etlium];tUw](lUm];naw]Kiun]:Suc]' hUw]K}:' hak]:' pQn]can];)mI;Sc]Pgc]:
 pn]kin]yL:yLSc]kCL,yw].
 kUn];pQn]kCL,tum].tiUw].mL;hiuw]' epL;tum].tiUw].mL;n} tum].tiUw].mL;miUw]:lC]
 kUn];pQn]sgc],l}:kin]yLkgc].yL:yL Am],nn] lw]:w}.hiuw] sQm]Aw]siUw];n}.yw]."
kUt],sqt]:tUv];kUn];pQn]hC]:sgt],es;eSEl: yL,lium];kUt],tUv];
 sgc],eKL;kUn];pQn]AUn]:AWn],Am],nn]Kqc]yU,hiuw]?
 sgc],mI;h}g;sQp];tI:hUw]kUn];pQn] Am],nn] tC]:nc]hUw]kUn];pQn]nn].sgc],mI;kgn]:liUt]:yU,hiuw]?
 kUt],tUv];AWk];eAL
 Glasgow Coma Scale/Blantyre Coma Scale "
36
Pac]hac]:tac];pQn] An]pQn]kn]km]:nm] 7
 luk]:tLlm]kUn];pQn]tc];Sgc]P}a,nn]. epL;wL:yC],lQk].Am],miUn]kn]n}siuc] hG]:wUn].Sgn],wL:
liUt]:l} AWk],yU,nC];AWk];eALekL:pQn]l}:" epL;pQn]siUc].nn] Aw]kUn];pQn]SUc],lUc];yLtUw]
nC];wQc]; sWm];nc],epL,lSI,Kgc]muk].sum];" (tUv];tI: kn] 8.3 t}aPak],)"
 kUt],tUv];wL:hqc];hUt];tUw]Kgc]kam]:niUw].kUn];pQn]tUn]:Kqn]tUn]:KL Kqn]El:KLtc];P}a,S}a. El:
P}a,KCL sWc],pQc];kn]hiuw]? (t}aPak],' lup],Sn]lc]hk];)"
 miUw]:TUv]:sC]AWk],mL;l}:A}amak],m}. (tac];pQn]yQw]wan])' A}alw]:' A}ayQw]: (mak],kqw];Am],lI)"
 Piw]nc]SWm], (cyanosis)' niUw].liUc] (jaundice) El: PiUk],(pallor)"
Glasgow Coma Scale Score Blantyre Coma Scale Score

(Child < 5 year)
 tUc].niuc]tUw]l}:lIyU,  tUc].niuc]tUw]l}:lIyU,
- Tgm],kCam];Sc],l}:lIyU, 5 - siEntI:sQp];l}:yU, 2
- siEntI:sQp];l}:yU, 4 - epL;miUw]:sQp];n}Aw]tin]miuw];hUt];Kw]: 1
- ecL;l}:lIyU, 3 - Am],sC]:tac],siUw];(Am],nn])
- yiut]:l}:lIyU, 2 Am],mI;lgc]:tUc].niuc] 0
- Am],mI;lgc]:tUc].niuc] 1
 lat]:l}:lIyU,  lat]:l}:lIyU,
- lat]:l}:Tuk],mqn]: 5 - hgc].h}:l}:lIyU, 2
- lat]:l}:Suk].Suk].Sak].Sak]. 4 - Kac]; Am],nn] Am],hgc].h}:l}: 1
- lat]:eKL:kCam]; An]Am],Tuk],lIlat]: 3 lIlI 0
- Agk],SQc]An]Am],mI;tI:pgc], 2 - Am],mI;SQc]Sc]
- Am],mI;SQc]Sc] 1
 muin];tL  lgc]:tUc].niuc]tL
- muin];tLhc];kUv]; 4 - tUv];sgm];pw].m}a 1
- etmuin];tLmiUw]:lat]:kCam]; 3 - tUv];Am],mI;pw].m}a 0
- etmuin];tLmiUw]:sQp]; 2
- Am],muin];tLlL;lL; 1
Knqn];hUm]:kn]etyU,nC];wUc]: 3 Tiuc] 14' Knqn];hUm]:kn]etyU,nC];wUc]: 0 Tiuc] 5
- epL;hUm]:kn]yw].l}:eA,liUw] 5n} Aic]niUw] - epL;l}:Knqn];eA,liUw] 2 pgc],wL:lium];tUw]"

tac];pQn]Am],nn] pQn]lgc]:mat],sQp];mL;n}siuc]
pgc],wL:cw];l}a;Am],epL;lI"
- epL;l}:eA,liUw] 8 pgc],wL:lium];tUw]h}a.hqc];
nL,yw]."
37
lgc]:KUn].hLmk];mn]:tac];pQn] (Diagnosis)
hLtUv];lgc]:tac];An]etpQn]l}:eSyUt];yLsgm];nc],nn].
lgc]:An]pQn]l}:
- lium];tUw]El:mI;lUm]; naw]nUk].' tac];pQn]yC];hUm],Agk];eALkC]:' Agk];eALkC]:' tac];pQn] 15.2,
naw]Suc] tit];siUw].pqk],TI;rI;yL; Am],nn] sp];tit];siUw].mqc];tac]; 15.1,
pQn]An]h}a.hqc]; 15.3
-lium];tUw]El: mI;/Am],mI; Tat]:kiUw]wan]nC];liUt]:eA, (destrose < 30 mmol or 70mg/ 10.1
lUm];naw] 100 ml)' Tat]:nm].nC];tUw]eA,h}a.hqc];
- lium];tUw]El: Am],mI; tum].tiUw].kgk];hUw]h}a.hqc];(kCL,tiUw].vL;mL;)' kgc].' liUt]:Agk],nC]; 8.3
lUm];naw] Agk];eAL
lgc]:yUt];yL
 yUt];yLpn]sgm];nc],tac];pQn]"
 epL;Am],hU.tac];pQn] Am],nn] hU.tac];pQn]yU,eStL. Am],mI;yL:yLtL,yUt];yLkUn];pQn]n}siuc]
hG]:SUc], miUw];yLtUw] tI:hUc];yLlUc]w};w};"
lgc]:st];kan]kQw],lUv]:lium];tUw]Kaw];hiuc]
1. Sgc]sUw]:mUc];niuc]:pgk]: pin],w}a,tUw]kUn];pQn] hG]:ngn];lUc];kCL,Tqc]:P}a,niuc]:" hQt];Enl}a;pin],w}a,
kUn];pQn] hG]:kUn];hiUn];Kw]" etl}:pn]StikUn];hiUn];Kw]wL: yL,ephC]:kUn];pQn]ngn];c}alL;lL;
kgp]:wL:epL;ngn];c}an} ethQt];hG]:lin].kUn];pQn]sac]:kCL,Aiut];lgt],lUm]; Am],nn] hak]:sac]:Kw]:
kCL, nC];lgt],lUm];l}:"
2. SC], IV line El:S}ayQw]:pn]kUn];pQn]w}." nc],hiuw]etAm],hC]:nm].nC];tUw]kUn];pQn]hqc]:nn].
tk];etl}: pC].tUv];lgc]:nm].Kw]:El: nm].Agk],hG]:PQc],pQc];kn]"
3. epL;kUn];pQn]lium];tUw] kgp]:tiUw].vL;mat],sQp];tI:hUw]mL;n}siuc] nC];Kaw];tac]; 48 sUw]:mUc];Agn]
tac];nn].yL,pn] dextrose 5% kgp]:wL:Tat]:kiUw]wan]etsac]:hQt];hC]:sQp];tI:hUw]nn]. h}a.lUiw]
kw],l}:" kUv];kL: tL,kUn];pQn] tI:mI;Tat]:kiUw]wan]eA,nn]. pn] dextrose 5% l}:yU,"
4. etl}:kUt],Tt];pn]kUn];pQn]tL,eS," liUw]nn].2 sUw]:mUc];niuc]:pgk]:Tuk],lIkUt],Tt];tac];pQn]tI:
hQt];hG]:kUn];pQn]lium];tUw]"
5. miUw]:hp].kUn];pQn]Kw]:hUc];yLEl:w}a;nn].Tuk],lIkUt],Tt]; Coma score kU:wn];nuic]:wn]; 2 pgk]:"
6. epL;kUn];pQn] Am],kin]l}:n}siuc]Tuk],lIpn] dextrose niuc]:wn]; 2 pgk]:"
7. Tuk],lIlac].tUw]kUn];pQn]pn]kU:wn]; niuc]:wn];niuc]:pgk]:" miUw]:kUn];pQn]P}a:Am],nn]yQw]:yw].
Tuk],lIlac]. pn]km];Siuw]:" Am],Tuk],lIAw]es: Am],nn]KUw];hqc]:hqc]:sQt]. kUv];kL:Aw]nm].
38
lac].pn]kU:pgk]:eSEl: tk];etl}:s}g:hQt];pn]tc];pI:ngc].kUn];pQn]"
8. hC]:km];km];lac].pak],pn] Am],nn] yL,hG]:ek,liUw]niuc]:wn]; 4 pgk]:" epL;sC]. Vaseline
tL;pn]n}et hQt];hG]:pak],kUn];pQn]Am],hqc]:tqk],"
9. sC].nun];kuv]eSEl: Aw] NSS lac].tLpn]" nc],hiuw]etAm],hC]:pQn]yC];hUm],tLkC]: Am],nn]
pQn]tLsQp]; kgp]:piUk],luk]:tLhqc]:nn]. sC]. Terramycine eye oilment SC],pn]niuc]:wn]; 2
pgk]:" piUk],luk]:tL hqc]:n}. sac]:hQt]:hG]:tLmgt],l}:" epL;kUn];pQn]lp];tLAm],l}:n}siuc] Tuk],lI
sC].plat],StL,pik].pn]"
10. nc],hiuw]epL;etAm],hG]:kam]:niUw].tUc].niuc]yap],nn]. Tuk],lISgn]hG]:pI:ngc].kUn];pQn]nUt]:pn]El:
s}g:hQt]; hG]:kUn];pQn]tUc].niuc]pn] niuc]:wn]; Am],eA,liUw] 4 pgk]:"
11. tL,kUn];pQn]An]lium];tUw]Kaw];hiuc]nn]. tUv];sgm];nc],tac];pQn] An]hQt];hC]:lium];tUw]eSEl:
Tuk],lI wUn].Tiuc]lgc]:pn]tac];kin]sgm];S}ayac]SC],KU;lc](lgc]:Kat],Tat]:AL,hL,r kn] 17.1)"
lat]:EnpI:ngc]. kUn];pQn]wL: Am],Tuk],lIpg},kUn];pQn]yU,ekL.lQw]"
Aac]:Aic] - (hG]:tUv];pL:niUw])
7.2 pQn]can];] (Convulsions)

pQn]can];An]wL:nn]. pQn]lgc]:kiuc].kac].lium];tUw]kCL, hBm]:tc];tUw]Sgm],Am],nn] Am],Sgm],ekL:mI;El:
Aw]tin] Aw]miuw];tUc].niuc]haw].hqc];yU,siUc].nn] km]:nm]Et.ethiuc]Am],l}aminit]." kUn];pQn]mac]ekL.
yQw]:etln]Agk],mL; Am],nn] etKUp];lin].tUw]sw]:kw]," epL;kUn];pQn]kiuc].kac].hU.tUw]mL;yw]. hU.wL:pQn]
Sc]yU, Am],nn] miUw]:pQn]siUc].nn]yU,nn]. kUn];pQn]Am],l}:lium];tUw]kCL,n}siuc] Am],l}: pgc],wL:kUn];
pQn]can];" miUw]:lgc]:tUc].niuc]kUn];pQn] yQn]kCL,yw]. kUn];pQn]yc];etlium];tUw]yU,eSEl: etTUv]:sC]
hqc];hqc];mgk]:kiuc],sUw]:mUc];" w}a;nn].ekL:pqk].Sm].wL: kUn];pQn]hU.tUw]mL;l}g;l}g;eStL. yc];et Am],tgc];
Sc]l}:eSEl: etSm].kCam];Tam]kw],kw],yU,tik];tik]; (lgc]:wL:Kw]pQn]Sc]' Kw]yU,tI:lC]yU, sQm]Aw]
siUw];n}.kCL,)" Pac]hac]:Aw]tin]Aw]miuw];tUc].niuc]haw].hqc];n}. etAm],k}.hn]nC];luk]:Agn],lqc]El:hG]:w}.Sti
tUv]; lgc]:tUc].niuc]tLEl:pak],luk]:Agn],"
lgk];l}a;yUt];yLkUn];pQn]can];
1. Aw]ngn];sgm];nc],lgk];l}a;kUn];lium];tUw] (Aw]ngn];KI:kqc];) El:nc],hiuw]Am],hG]:kUn];pQn]tum].
tiUw].mat],sQp];l}:nn]. Aw]kUn];pQn]w}.tI:lgt]:eP;"
2. Sac];lac];pn] SQn]:tac];TUv]:sC]pgt];niUw] (AL:pak],eSEl:Kgk];hak]: Am],nn] KI:tiUw],An]
tit];yU, nC];pak],Agk],pqt]:)"
3. Sm];pn] IV 50% dextrose nm]nm] wQn].eSwL:kUn];pQn]Am],pQn]Tat]:kiUw]wan]ek,"
39
4. nc],hiuw]etkiut];yuit];lgc]:pQn]can];Am],nn] eh.kc]:eP;Tqc]:nn]. hG]:Sm];pn] Diazepam
(tUv];nC]; lgk];Kgc]:)" epL;kUn];pQn]tUc].niuc]mL;l}:yw].n}siuc] Kqn];c}a:tL,Sm];yL IM Am],nn]
PR pn]"
5. epL;mI;KiUc]:miuw];yU,n}siuc] pn]Agk],SI,kiYn],El:Aw]KiUc]:sup],KI:tiUw]:/nm].Agk],"
lgk];Kgc]:- Diazepam Injection 1 vial = 10 mg/2cc

nm].nk]; Dose IV (0.3mg/kg) 10mg/2cc
< 4 kg 1 mg 0.2 cc
4-8 kg 2 mg 0.4 cc
9-15 kg 4 mg 0.8 cc
16-35 kg 7.5 mg 1.5 cc
> 35 kg 10-12 mg 1-2 vial
hG]:Sm];pn] IV l}g;l}g; (w};Sut]; 0.5 cc etL, 30 Sqk].kan].)
Diazepam Rectally (PR) Am],nn] IM

AL,yu/nm].nk]; Dose PR 10mg/2cc pn] Diazepam tac];hU;kUn]:
(0.5mg/kg)
2 pat]:-2 liUn] 2.5 mg 0.3 cc  sC].Sric];eSsup].Aw]nm].yL Diazepam
< 4 kg 1 cc
2 - < 4 liUn] 2.5 mg 0.4 cc  epL;pQn]l}:tUv];nm].nk];luk]:Agn],eS
(4 - <6 kg) sup],Aw]yLAn]etsC].
4 - < 12 liUn] 5 mg 1 cc  Aw]KQm]Agk],tI:hUw]Sric];- Aw]Sric];
(6 - <10 kg) Sit],Kw]:nC];hU;kUn]:mgk]: 4-5 cm eS
1 - < 3 KUp], 6.25 mg 1.25 cc
yw].Sit],nm].yL
(10 - <14 kg)  sp];nip],kum]:kUn]:w}.pn]tc];Sgc]P}a,mgk]:
l}aminit].Ait];niuc]:
3 - < 5 KUp], 7.5 mg 1.5 cc
 sp];nip],kum]:kUn]:w}.pn]tc];Sgc]
(14 - <19 kg)
P}a,mgk]:l}aminit].Ait];niuc]:
> 5 pI< 10-12 mg 1-2 vial
epL;etSm];pn] Diazepam PR Am],nn] IM n}.yL,KUn];elL;hC]:hqc];yLAgn]," sC].l}:kU:wn];

nm]Sut];niuc]:wn]; 3 mg/ kg"
40
6. epL;Sm];yLpn]yw]. 10 minit].kUn];pQn]yc];pQn]can];yU,n}siuc] hG]:Sm];pn]Tqc]:km];niuc]:"
epL;Sm]; pn]Tqc]:km];niuc]:yw]. Tqc]: 10 minit]. yc];pQn]can];yU,n}siuc] hG]:Sm];pn] pgk]:km];
Sam]l}:"
7. epL;pgk]:km];Sam]yw].yc];pQn]can];yU,n},siuc] hG]:Sm];pn] Phenobarbital IV l}g;l}g;"
 1 ampoule: 200 mg / 2 ml KUn];elL;n]C; 20 cc ( 10 mg/ml)
 Dose: luk]:Agn], 15 mg/kg kUn];lUc] 10 mg/kg
 kgp]:yL Phenobarbital n}.sac]:hqc]:sp];sgm];nC];lgt],Sric];plat].Stik].El:
yL,pqt]:yL w}.nC];lgt],Sric];"
8. epL;Sm];yL Phenobarbital yw].kUn];pQn]yc];Siup],pQn]can];yU,n}siuc] Tuk],lISUc],kUn];pQn]
kCL,yLtUw] tI:hUc];yLlUc]"
yL,lium];wL:-
epL;Sm];yL Diazepam El: Phenobarbital l}al}apgk]:yw].n} ethQt];hG]:kUn];pQn]K}:ngn];nL,eS
etAm],tiun],c}a:c}a:mgk]:km];niuc]:"
lgc]:KUn].hLmk];mn]:tac];pQn](Diagnosis)
 kUt],Tt];tUv];Tat]:kiUw]wan]nC];liUt]: tL,tac];pQn]Tat]:kiUw]wan]nC];liUt]:eA,
 kUt],Tt];tUv];Pac],hac]:sp];tit];siUw].mqc]; (tac];pQn]yC];hUm],Agk];eALkC]:' naw]nUk].)
 Tam]tUv];lgc]:yUt];yLEl:lgc]:yam]:pQn]can];miUw]:pUn].mL;hUm]:tc];yLAn]yam]:kin]/yam]:Sm];mL;"
miUw]:kUt],Tt];tUv];tac];pQn]nn]. Tqc]:An]niuc]:Tuk],lIwUn].Tiuc]nn].piUc] AEIOU
A. lw]: E. man];pQn]kgc]. I. sp];tit];siUw].mqc]; O. KUc].nC];lU. U. mak],kqw];Am],lI
lgc]:An]pQn]l}: kn]
pQn]can];El:mI;lUm];naw] naw]nUk].' yC];hUm],Agk];eALkC]:' Pac]hac]:lUm];naw]Suc]pUn].tI:' 15.2, 15.1,
Pac]hac]:Agk];eALsQp];yQn]; kgp]:sp];tit];siUw].mqc];w};rt].S] 19, 15.3
pQn]can];El: mI;/Am],mI; Pac]hac]:Tat]:kiUw]wan]nC];liUt]:eA,' Tat]:nm].nC];tUw]eA, 10.1, 8.3,
lUm];naw] haw].hqc];' mat],sQp];tI:hUw]h}a.hqc];' yLygc],(yLmL.)' lw]:' 23.1
mak],kqw]; Am],lI'
Em:pL;tgc].pQn]can]; Agk],sgk];mUiw]:pL;tWc].(hqc];liUt]:Suc]+kC]:nm].+Tat]:prUw],tin]; 19.5,
nC];yQw]: mI;nm])' naw]nUk].' Pac]hac]:Tat]:kiUw]wan]nC]; 15.2,10.1
liUt]:eA,
km];km];pQn]can];El: niUw].cgk]:nC];Agk];eAL' mqc];tiUk],Kw]:nC];Agk];eAL 12.4
Sm].Am],mI;lUm];naw]
pQn]can];An]Am],hU. lUm];mL:mU 20.1
lgc]:tac];mn];tqt]:etL;
41
lgc]:yUt];yL
yiUc];m}algc]:yUt];yLetpQn]-
 hG]:kiut];yuit];lgc]:pQn]can];h}aw};w};"
 epL;mI;lUm];naw]Suc]n}ekL:yUt];yLpn] kgp]:wL:lgc]:n}. etpQn]lgc]:hQt];hG]:pQn]can];ekL:pQn]l}:"
km]:nm]Et. etpQn]luk]:AWn],lQk].liUw] 5 KUp],nn]. k}.mI;lUm];naw]Suc]Tiuc] 39 MC"
 tk];etl}:kUt],Tt];lgc]:tac];pQn]eSEl: yUt];yLpn]"
 nc],hiuw]kUn];pQn] epL;etAm],pQn]h}a.hqc];liUw]nn]. etAm],hC]:kUn];pQn]l}:mat],sQp];" yLhG]:kUn];
pQn]l}:lUm]." Aw]kUn];pQn]ngn];tI:lgt]:eP;" PQw]:KUw];hiUn];KUw];ey; Am],nn] Kgc]lqm]' Kgc]P}a
siUw];n}.hG]: hac],k}tc];kUn];pQn]"
Aac]:Aic] - hG]:tUv];pL:niUw]
7.3 hiUw].'AUn]:Agn],'nQt];nL(Fatigue/ tireness/ Numbness)

Pac]hac]:hiUw].' AUn]:Agn],El: nQt];nLsiUw];n}.pQn]Pac]hac]:hw];km]:nm] Am],pgk]:niuc]:ekL:pgk]:niuc]:
yam]:pQn] kn]kUv];kUv];nn].yw]." Pac],hac]:siUw];n}. Kqn];etk}.l}:hn]sgm];kUn];mI;AL,yunm] Am],nn]
miUw]:l}a;yU,Sw];' lgc]:hQt];kan]' nL:hiUn];tLey;hw]; yU,tC]:lgc]:mip],kin];kU:siUw];siUw];" sgm];nc],lgc]:ngn];'
lgc]:liuw]:hiUw].El: lgc]:y}g:Kgc]kin]hw];lIyU,eStL.epL;wL: lgc]:hiUw].' AUn]:Agn],El: nQt];nLsiUw];n}.
Am],h}an}siuc] etl}a:pQn] Pac]hac]:tac];pQn]mL;"
hQt]; SPIT: (STORY ) piun];tUw]' (PHYSICAL EXAM)kUt],Tt];tUw]kUn];pQn]' (INVESTIGATION AND
ASSESSMENT OF PSYCHOLOGICAL STATE ) sgp],Tam]El:Tt];Sac]cw];l}a;pa};sC]kUn];pQn]' (TREATMENT)
lgc]:yUt];yL"
(STORY ) piun];tUw]kUn];pQn] – AL,yu' A}' nm].nk];eA,lUc];' hUw]K}:' kUn].kUn].mUv]:mUv]:' TUv]:sC]
yap],' mI;lUm];naw]' tgc].pik].' tgc].kCL,' hak]:' piun];rL,SI, (kUt],Tt];tUv];lgc]:pL;tgc].)' tgc].Kiun]:
tgc].sQp]; miUw]:liUt]:nL:liUn]mL;' sQp];kam]:niUw].' eKL:etL,lup], Am],nn] hqc];eA,' tac];nm]eA,yQw]:
El: pgk]:km]; luk].yQw]:kac]Kiun];' tin]miuw];nQt];San]:" piun];nC];tUc],wUc];kUn]; hUm]:tc];piun];lut],
lqn];yL:El:kin]lw]:"
kUt],Tt];tUv];tac];pQn]P}a,sC]- tk];etl}:Tam]kUn];pQn]Siuw]:Siuw]: kQw],lUv]:lgc]:KIsC]' m}:sC]' kin];sC]'
Tat]:sC]tUk];' lgc]:pn],hLnL:hiUn];' lgc]:yU,Sw];hQt];Sac]:kU:wn];El: lgc]:sC]K}:kin]tac];kin]sQm]
sQm]siUw];n}.yw]."
(PHYSICAL EXAM)kUt],Tt];tUw]kUn];pQn]- kUt],Tt];tUv]; nm].nk];' tac];Suc]' Pac]hac]:lm],lgc]:
(hqc];tgt], liUt]:' hqc];liUt]:' lUm];m}:tUw]' hqc];TUv]:sC])' tUw]PUik],' mak],ln]' sC].KiUc]: Tgm],hUeSTgm],
tUv];pgt],El:hUw]sC] (SQc]hUw]sC]Am],man],mqn]:kgp]:lin].hUw]sC]Am],lI' tgm],T};r}W;' tp];El: pac]:
(sgc],yC],Am],yC],' Am],AUn]: Am],Kqc]' Kqc])' nC];tgc].sgc],mI;kgn]:Am],mI;kgn]:' lQp]:hQn];tUv];miUw]: kUn];
pQn] p}El:nc]:wL: sgc],pQn] (foot drop)"
42
INVESTIGATION (kUt],Tt];tUv];tac];pQn])
Tat]:kiUw]wan]nC];yQw]:' liUt]:tL,kUt],Tt];(lgc]:pqk],piUc]tac];nqn]:nLK},mQt].liUt]:lqc]El:K}, mQt].liUt]:
Kaw])' HB Am],nn] HCT' lgc]:sp];tac];pQn]siUw].mqc]; AFB ' lgc]:sp];Sn],eT, siUw];n}.Tuk],lItiUc],
pac]tc];emLyLEl:hn]Tiuc]wL:Tuk],lIkUt],Tt];kUv];sc],kUt],Tt];" lgc]:np].tUv];mQt].liUt]: eS;l]tQm]
tQm] FBC' yU,rI;yL;El: AI,lqk],TrUw],l}.T]' Tt];tUv];lgc]:hQt];kan]tp];' hqc];SUn];T};r}g; Sac]:
ehL,mUn];l] (TSH)' x-ray AUk]; (CXR)' liUt]:tL,kUt],Tt];naw]nUk]."
(TREATMENT) lgc]:yUt];yL
epL;wL:hU.tac];pQn]n}ekL: yUt];yLpn]sgm];nc],tac];pQn]" epL;Am],hU.wL:pQn]Sc]' lgc]:kUt],Tt];tUw]ekL:
Am],pQn]Sc]' pn],hLtac];sC]ekL:Am],mI;Sc]n}siuc] pn]hqc];sC]kUn];pQn]eSEl: mgk]:Tqc]: 2 wUc]: hG]:kUt],
Tt];tUv];Tqc]:km];niuc]:" lat]:EnkUn];pQn]wL: hG]:ngn];Aim],Aim],' liuw]:hiUw].tQm]TUn]:El: kin]tac];kin]
An]mI;AL,hL,r" epL;hn]Tuic]wL: kUn];pQn]Aap]:etpQn]kgp]:pn],hLtac];sC]n}siuc] hG]:Sp];lqc];EnwL: pn],hL
siUw];n}.sac]:hQt];hG]:hiUw].' AUn]:Agn],El: nQt];San]:l}:" (tUv];tI:tac];pQn]pa};sC] (mood disorders)
kn] 18.1)"
hLtUv];lgc]:tac]; tac];pQn]
lgc]:tac];An]sac]:pQn]l}: Pac],hac]:tac];pQn] kn]
sp];tit];siUw].mqc];(w};rt].S]' HIV' TB sQm]Aw] mak],ln]kC]:' sQp];' mI;lUm];naw] 15
siUw];n}.kCL,)
hqc];liUt]:eA, [Tat]:lQk];nC];liUt]:eA,' tUw]PiUk], (pac]:yC],pac]:kC]:) 14.1
(thalassaemia)liUt]:sac]{
tac];pQn]nm].kUt];hUc];Kw]:Agk],mL;eA, cw]cw]Sium];Sium];' tgc].pik].' niUw].tUw]KQc]:' nm]. 10.2
(Hypothyroidism) nk];tUw]Suc]Kiun]:mL;
sp];Sn],eT, hiUw].' K}:hak]:K}:tUn].' hUw]mw]; 19
pQn]tac];pQn]yQw]:wan] km];km];yQw]:' nm].nk];tUw]eA,lUc];' km];km]; 10.1
tgc].m}:nm].
tac];pQn]pgt], TUv]:sC]yap], 21
pn]hLkQw],lUv]:hUw]sC] (hUw]sC]Am],hQt];kan]l}:lI' TUv]:sC]yap],' hqc];tgt],liUt]:w}; Am],nn] TiUc];' 8
lin].hUw]sC]Am],lI' yC];hUm],hUw]sC]mac]' hqc];tQn]:hUw] kC]:
sC]Am],man],)
pn],hLkQw],lUv]:hUc];Kw]:El:S}: tgc].kCL,' hak]:' K}:tUn].K}:hak]:' sQp];tI: pL:niUw] 12
hUc];Kw]:
tac];pQn]kqn],SiUw], nm].nk];tUw]eA,lUc];'mak],ln]kC]:' PiUk], -
tac];pQn]Kat],Tat]:wI,tL,min],pI, tin]miuw];nQt];San]: 17.2
(km]:nm]Em:pL;tgc].)
tac];pQn]kQw],lUv]:sC] sC]tUk];' KIsC]m}:sC] 18.2
43
lgc]:eh.kc]:
lat]:EnkUn];pQn] hC]:ciUc].ew:lgc]:mip],kin];sC]' kin]tac];kin]tI:mI;AL,hL,rEl: liuw]:hiUw].hC]:tQm]TUn]:"
Aac]:Aic] - hG]:tUv];pL:niUw]
7.4 niUw].m}: (lUm];naw])

eKL:piut],tI:pgc],
lUm];naw]An]wL:nn]. pgc],wL:Pac]hac]:lUm];m}:nC];tUw]Suc]Kiun]:mL;nn].yw]:" epL;wL:lUm];m}: tC]:kic],Eh.
nm]liUw] 37.5 MC Am],nn] 38 MC nC];hU;kUn]:n}siuc] pgc],wL:mI;lUm];naw]yw]." lUm];naw]n}. pQn]Pac]hac]:
km]:nm]An] sp];tit];siUw].mqc];tac];pQn] miUn]nc],w};rt].S] pqk],TI;rI;yL;El: pL,rL,S}. (siUw].mqc];An]
mI;AL,yul}: kgp]:piuc]:Aic]yU,sgm];tUw]sC]piUn]:)"
Pac],hac]:tac];pQn]An]kQw],lUv]:mI;lUm];naw]
 kt]; - niUw].m}:yU,eStL.kUn];pQn]Sm].etwL:kt];"
 kt];Sn], - kt];haw].hqc]; KQw]:tac];niUw]tac];tC]:epL;elL,SC],kn]El: niUw].tUw]Sn],haw].hqc];"
Pac]hac]:tac];pQn]An]kiuc].kac].haw].hqc];
 tit];siUw].pqk],TI;rI;yL;El:pQn]SWYk]."
 sQp];naw]sgm];niUw].tUw] miUn]nc],kgc],ekL:Kqc]' pQn]can];' nL:tgc].Kqc]' tum],lqc]Agk],sgm];tUw] siUw];
n}.yw]."
 cw];l}a;liuk].lm],km]:nm] – kgp]:pL;tgc].' Kat],Tat]:AL,hL,r' hqc];Kam],tUw]tUk];ygm];' pQn]tac];
pQn] Kaw];yaw];' tt];mam].Agk],w}.' AL,yulQk].nL,Am],nn]yC],nL,(Tw]:)yw]."
tL,kUn];lUc]Tuk],lItqk]:lUm];m}:tI:kic],Eh.' pak],' hUEl: hU;kUn]:" epL;tqk]:tI:kic],Eh. Tuk],lIhiuc]mgk]: 5
minit].sc],etTuk],mqn]:"tL,luk]:Agn],lQk].liUw] 1 KUp],Tuk],lIsC].tL,mUw],mI,tL,tqk]:tI:hU;kUn]:nn].yw]."
(hG]:Aw]nm].El:Sp].pYL,El:Sc] Aw]Aql]kUw],ehL;El:Sc] Aw]nm].klUw],rin]; (Chlorine) El:Sc]
lac].pn]tL,mUw],mI,tL,)" epL;wL:mI;sC].yU,n} hC]:sC].tL,mUw],mI,tL,f};fL." epL;wL:sC].tqk]:tI:kic],eh.n} hG]:
mat]:m}alUm];m}:l}al}alUc];nC]; Chart (miUn]nc], 38 MC)" epL;wL:sC].tqk]:tac],tI: miUn]nc],hU;kUn]: Am],nn]
nC];pak],n}siuc] Tuk],lImat]:m}a (miUn]nc], 38 MC (rectal) ) n}yw]."
44
lgc]:yUt];yL
kUt],Tt];tUv];tac];pQn]An]h}a.hqc];l}:eS yUt];yLpn]An]Tuk],mqn]: (miUn]nc],
yLptI,KYI<wn (antibiotic) Am],nn] yLEk:naw]nUk].)"
epL;lUm];m}:luk]:Agn],nm]liUw] 37.5 MC' kUn];lUc]nm]liUw] 38 MC n}siuc] tk];etl}:yUt];yLlUm];naw]

pn]Agn]tac];"
 Tgt],SiUw]:KUw];kUn];pQn]Agk], (miUn]nc], yL,hG]:nuc]:SiUw]:nm]' yL,hG]:hUm],PL:)"
 Aw]PL:sup].nm].yQn]yQn] (Am],kt];) eSTUmqc],tc];tUw]"
 pn]yL Paracetamol tL,kUn];lUc] 500 mg – 1 gram QID (nm]Sut];wn];nuic]: 4 gram)
tL,luk]:Agn], 15 mg / kg (nm]Sut];wn];niuc]: 2 gram)
 hQt];hC]:kUn];pQn]l}:Tat]:nm].nm]nm] (hG]:kin]nm].nm]nm]' hC]:Siup],kin]nUm];Em:nm]nm])"
tL,tgc];-tL,kUn];pQn]An]yc];lium];tUw]yU, Am],nn]Aiun]Am],l}:nn].hC]:pn] Paracetamol
tac]; PR Am],nn] IM"
yL,pn]yL Aqt],S]pI,rin], (Aspirin) hG]:luk]:Agn],AL,yulQk].liUw] 12 KUp],lL;lL;"
Kt];s]ChLtac];pQn]An]hQt];hG]:mI;lUm];naw]eSyUt];yLkCL,
Pac]hac]:tac];pQn] tac];pQn]An]Aap]:etpQn]l}: kn]
kt];Sn],' hUw]K}:' hiUw],Agk],' hU.tUw]pQn]km]; naw]nUk]. 15.2
Am],hU.tUw]pQn]km];
hUw]K}:' mI;Pac]hac]:tac];pQn] kQw],lUv]:Agk];eAL' yC];hUm],Agk];eALkC]: 15.1
kgc]:ekL:KQc]
Pac]hac]:tac];pQn] kQw],lUv]:SQn]:tac];TUv]:sC] tac];pQn]kQw],lUv]:SQn]:tac];TUv]:sC] 21.1
Pac]hac]:tac];pQn] kQw],lUv]:SQn]:tac];yQw]: mak],kqw];kC]: 13.1
miUw]:tgc].kCL,nn].mI;liUt]:El:nm].muk].sgm]; pQn]tgc].kgp]:siUw].mqc];pqk],TI;rI;yL;/tgc].ngc], 12.1
sQp];yQn];' pQn]sQp];niUw]Piw]nc] sp];tit];siUw].mqc];tac];pQn]tI:Piw]nc]] 22.2
kiuc].kac].lium];tUw]' kt]; liUt]:pQn]kgc]. 7.6
tp];yC],El:sQp]; pQn]sQp];yQn];tI:tp]; 12.3
mI;lUm];naw]Suc]El:pQn]Kaw];hiuc] lUm];naw]t}.fg}. (Typhoid fever) 15.1
Piw]nc]tI:siUw].mqc];Kw]:nn].pQn]sQp];eShqc]:lgk]:' tac];pQn]K}:lak];Sat], (Scrub typhus) 15.1
mak],ln]kC]:' pQn]wUc];lqc]lqc]sgm];Piw]nc]
mI;lUm];naw]Kaw];hiuc]'A}El:nm].nk];tUw]eA,lUc]; tac];pQn]TI,pI, 21.5
mI;lUm];naw]'kUn].kUn].Kiun]:Kiun]:sgm];tUw]'KI:muk].l} l}:hp].siUw].mqc];w};rt].S]' pQn]wt]; 21.1
tac];pQn]tac],siUw]; kqn],SiUw],' AQk].KY]A}a,wI,/AQt],S] 15.3
45
epL;wL:Am],PUp].vL;tac];pQn] An]haw].hqc];eSEl: Am],sac]:mk];mn]:wL:pQn]Sc]n}siuc] Aw]yL
Paracetamol hG]:kUn];pQn]kCL,kin]tI:hiUn];eSlat]:EnwL: Tuk],lIkin]nm].mak],m}.pn]nm]nm]" lat]:En
kUn];pQn]pL;wL: epL;Am], lIKiun]:nC];Kaw];tac]; 48 sUw]:mUc];n}siuc] hG]:pgk]:mL;EnKiun];tI:hUc];yL" epL;hn]
Tiuc]wL:kUn];pQn]Aap]:etmL;yap], (miUn]nc],kCL,mL;yap],' lgc]:pgc],sC]tac];pQn]Am],epL;mI;) n}siuc] Tuk],lI
hp].w}.pQn]kUn];pQn]nC]; (IPD) tL,pC].tUv];wL: kUn];pQn] pQn]tac];pQn]Sc]"
yL,lium];kUt],Tt];Tqc]: miUw]:Pgn];liUt]:An]kUt],Tt];Agk],mL;' tI:liuk].lm],Et.epL;Pgn];kUt],liUt]:
Agk],mL; pQn] negative nn].yw]."
cw];l}a;An]liuk].lm],
1. Em:pL;tgc].mI;lUm];naw]
Em:pL;tgc].mI;lUm];naw]n}. sac]:pQn]lgc]:h}a.hqc];l}:tL,eS," kgp]:wL:lUm];naw]sac]:hQt];hC]:luk]:
Agn],tUk];l}: Am],nn]sac]:hQt];hC]:kiUt],mUiw]:p},Tiuc]Kaw];yam]; (tUv];tI: kn] 19.1)"
Tgm],tUv];hqc];tWn]:hUw]sC]luk]:Agn], nC];tgc]. epL;wL:luk]:Agn],Am],yU,lI [hqc];tQn]:hUw]sC]luk]:Agn],
nC];tgc].etSuc]liUw] 160 pgk]:etL,minit]. (FBH>160 beats per minute){ n}siuc]
Tuk],lIhG]:kin]yLpL,rL,SI,temL; (Paracetamol) El: hG]:kin]nm]. mak],m}.nm]nm]eSEl: yUt];yL
pn]sgm];nc],tac];pQn]" km]:nm]Et.mI;lUm];naw]kgp]:
 naw]nUk].-kUt],Tt];tUv];nC];liUt]:"
 sp];tit];siUw].mqc];sgm];SQn]:tac];yQw]:El:nC];lup],kum],kUn]:- kUt],sqt]:yQw]:tUv];' kUt],
sqt]:tUv];lgc]:kiUt],luk]:El: tac];pQn]kQw],lUv]:nac];yic];"
 sp];tit];siUw].mqc];sgm];SQn]:tac];TUv]:sC] – Tam]tUv];Pac]hac]:tac];pQn]' kUt],sqt]:tUv];
hqc];TUv]:sC]El: pgt],"
epL;wL:Am],TUp];vL;tac];pQn]eSEl: Pgn];kUt],sqt]:ekL:Am],pQn]Sc]- hG]:kin]yLpL,rL,SI,t
emL;eSEl: pC].tUv];cw];l}a;kUn];pQn]Tqc]:wn];niuc]:"
2. luk]:Agn],AL,yulQk].liUw] 1 KUp],mI;lUm];naw]
luk]:Agn],kiUt],mC],El:luk]:Agn],lQk].liUw] 2 liUn] (tUv];Pac]hac]:pQn]eP;tI: kn] 4
El:tgn]:PiUm]. Tqm]tac];lc] kn] 24)
luk]:Agn],kiUt],mC],El:luk]:Agn],AL,yulQk].liUw] 2 liUn]mI;lUm];naw]n}.sac]:pQn]lgc]:h}a.hqc];l}:tL,
eS,"
 yUt];yLnC];hgc]: IPD Tuk,] lIkUt],Tt];lUm];naw]tac];hU;kUn]:"
 epL;pQn]naw]nUk].n}ekL:etl}:pn]yLEk:naw]nUk].An]Tuk],mqn]:"
 epL;wL:pQn]lgc]:sp];tit];siUw].mqc];n}siuc] (miUn]nc], sp];tit];siUw].mqc];sgm];SQn]:tac];TUv]:
sC]' yC];hUm],Agk];eALkC]:) kgp]:siUw].mqc];etEP:w}; nC];tUw]luk]:Agn],kiUt],mC],l}:nC];Kaw];yam];
Am],l}a sUw]: mUc];El: hp].Kw]:yLnC]; IPD eSyUt];yLpn] sgm];nc],l}a;yUt];yLsiUw].mqc];
46
etEP:w};nC];tUw] nC];luk]:Agn],kiUt],mC], (tUv];tI:eKL:PiUm].Tqm] kn] 24.11)"
Pac]hac]:pQn]eP;nC];luk]:Agn],lqc]
 Am],kin]nUm];l}:  KI:mgm]:pgc];
 lUm];m}:tUw]tUk];(tqm],liUw] 36 MC )  miUw]:TUv]:sC]KU:lc]kI:Agk],Kac]:
 pQn]can];  Kac];
 hUw]mw]; Am],nn] lium];tUw]  S}alIyc];p},hqc]:eSmI;A}amQn]
 hqc];TUv]:sC]eA,liUw] 20 pgk]:/minit].Am],nn]  SUp];Sgm],
nm]liUw] 60 pgk]:/minit].  kam]:niUw].nL:AUk];lgk];Kw]:kCL,h}a.hqc];
 mI;tum],ngc]sgm];Piw]nc]
luk]:Agn],AL,yuyC],liUw] 2 liUn] (tUv];Pac],hac]:pQn]eP; tI:kn] 4)

epL;Am],mI;Pac]hac]:pQn]eP;Sc]n}yUt];yLpn]tI: OPD kUv];ekL:l}:" kUv];kL: Tuk],lIwUn].Sgn],
Tiuc]tL,eS,wL:-
 tac];pQn]naw]nUk].- kUt],Tt];liUt]:tUv];'
 tac];pQn]hUkC]: - kUt],Tt];kgc]hU'
 sp];tit];siUw].mqc];sgm];SQn]:tac];TUv]:sC] – hqc];TUv]:sC]w};' kam]:niUw].nL:AUk]; lgk];Kw]:'
miUw]:TUv]:sC]KU;lc]kI:Agk],Kac]:' TUv]:sC]SQc]hqc];' Sgm],' A}'
 yC];hUm],Agk];eALkC]: - hak]:' K}:ngn];' pQn]can];' kam]:niUw].nL:AUk];lgk];Kw]:' KI:mgm]:pgc];'
kgc],ekL: KQc]:pQn]mac]pgk]:'
 sp];tit];siUw].mqc];sgm];SQn]:tac];yQw]: - kUt],Tt];yQw]:tUv];' Aw]m},KrUw]SkUp].
(Microscope) kUt],sqt]: (epL;pQn]l}:)
 Pac]hac]:tgc].kCL,tgc].ngc],El:Tat];nm].nC];tUw]hqc]:'
 sp];tit];siUw].mqc];sgm];Piw]nc]–Tgt],KUw];luk]:Agn],pqt]:mUt];eShLtum],sQp];tUv]; tc];tUw]'
 sp];tit];siUw].mqc];sgm];lup],El:eKL:etL,- Aw]tin]Aw]miuw];tUc].niuc]tUv];" yip];tUv];eKL:
etL," kUt],Tt];tUv];lgc]:eKL:etL,kC]:El: eKL:etL,Aun],"
lgc]:tac];An]hQt];hC]:luk]:Agn],lQk].liUw] 5 KUp],k}.pQn]can];nn].Et.
pQn]kgp]:lUm];naw]nn].yw]:"
47
3. lUm];m}:nC];tUw]eA,
eKL:piut],tI:pgc],
hqc];lUm];m}:tqm],liUw] 35.5 MC "
lgc]:hqc];lUm];m}:tUk];n}.pQn]l}:kgp]:lgc]:tac];pL:tC]:n}."
 sp];tit];siUw].mqc];pqk],TI;rI;yL; (kn] 7.4)"
 luk]:Agn],kiUt],mC],' km]:nm]luk]:Agn],An]p},tQm]liUn]kiUt],eSEl:kiUt],mL;"
 Kat],Tat]:AL,hL,rhaw].hqc]; (kn] 17.1)"
 Tat]:kiUw]wan]nC];liUt]:eA, (kn] 10.1)"
 tac];pQn]yQw]:wan] (kn] 10.1)"
 lgc]:kin]lw]:nm]pUn].tI: (kn] 23.1)"
lgc]:yUt];yL
yUt];yLpn]sgm];nc],tac];pQn]" sC].tiuw];l}a;yUt];yLkqc],klU; (Kangroo method) (tUv];tI: kn]
25 nC];tgn]:PiUm]:Tqm])" nc],hiuw]epL;ethQt];hG]:luk]:Agn],Aun],nn]. tiuw];mak],hUw] (tL,luk]:Agn],
kiUt],mC],) El: hUm],PL:hUm],pn]"
7.5 sQp];
eKL:piut],tI:pgc],
sQp];An]wL:nn]. pQn]lgc]:Am],SiUw];SL,sC]El: pQn]Pac]hac]:mat],sQp];An]niuc]:nn].yw]:" sQp];pQn]
Pac]hac]:pQn]tac];pQn]An]niuc]:nc],kw]," kgp]:lgc]:sQp];nn].yw]. kUn];pQn]sc],mL;sU;tI:hUc];yL" kUn];
pQn] etKac];wL:sQp];- kUv];kL: sQp];n}.Am],sC]:tac];pQn] (Diagnosis)" Kt];sC]hLtUv];tac];pQn]
(piun];tac];pQn]' lgc]:kUt],Tt];f}a,yUt];yL) eSEl: yUt];yLpn]lgc]:sQp];nn]. tL,eS,"
hQt];hG]:lgc]:sQp];Sak]:SL,w}a;PL,tt];n}. pQn]lgc]:lm],lgc]:
tL,hG]:cw];l}a;kUn];pQn]lIKiun]:"
48
Aw]piun];lgc]:l}:sQp]; (Tam]tUv];kUn];pQn])
Kaw];yam]; Et,sQp];miUw]:lC] ?
Et,sQp]; Et,sQp];siUc].hiuw] ? (kiuc].kac].sQp]; Am],nn] sQp];Kiun]:mL;l}g;l}g;)
Kaw];tac]; sQp];hiuc]kL:hiuw]- sQp];h}a.hqc]; Am],nn] sQp];Kaw];yaw];"
Sqn];sQp]; pQn]sQp];Sqn]; (mQw];) siUc].hiuw] ? (km]:nm]kCam];wL:sQp];n}. etk}.sC].tiuw];sgm]; miUn]nc],
sQp];Sqp],' sQp];m}:' sQp];San]:' sQp];hqc];' sQp];kqn];' sQp];nL' sQp];l}al}a' sQp];Kiun]:
sQp];mUv]:' sQp];eP:kCac]:Agk],kCL,' sQp];miUn]vL;KQm]tqc];SC],' sQp];miUn]nc],vL;tQc]Tp].SC],
sQm]Aw]siUw];n}.kCL," kUn];pQn]K}:liUk]:lgc]:sQp];An] tI:wL:mL;pL:niUw]n}. An]niuc]:An]lC]
ekL:wL:l}:"
lgc]:kp];San] epL;hQt];Sc]yw]. hQt];hC]:sQp];Sak]:SL,mL;/ h}a.hqc];liUw]kw],? nC]; niuc]:wn];nn].
Kaw];lC]sQp];liUw]piUn]: ?
Agc]:tI: sQp];Et.Et.n}pQn]tI:lC]? luk].tI:nn]:eSsc],sQp];eP:kCac]:Agk],kCL,tac],tI:?
Pac]hac]: hUm]:sgm];sQp];nn].Sm].mI;Pac]hac]:tac];pQn]AI:Sc]? (mI;lUm];naw]' km];km];yQw]:' tgc].kCL,'
tac];pQn] tgc].pik].' hak]:)
lgc]:h}a.hqc]; sQp];h}a.hqc];kL:hiuw]? sC].tiuw];Kn]:tqk]:sQp]; (pain scale) (0 = Am],sQp]; El: 10 =
sQp];h}a.hqc];liUw]Sut];)" tL,luk]:Agn],Et. tUv];hac]:pL:tC]:eStqk]:tUv]; Kn]:sQp];"
0 1 2 3 4 5
Am],sQp]; sQp];Ait];Ait]; sQp];pan]kac] sQp];h}a.hqc]; sQp];h}a.hqc];nL, sQp];h}a.hqc];liUw]sC]
kUt],tUv];kUn];pQn]
kUn];pQn]An]h}a.hqc];nL,nn]. Tuk],lIpn]yLEk:sQp];eSyw].sc],kUt],tUv];" kUt],tUv];tI:Aap]:etpQn]
tI:sQp];Et.Et. – tUv];' Tgm,] tUv];' hU.Aw]
lgc];yUt];yL
 yUt];yLpn]epL;PUp].vL;lgc]:tac];pQn]"
 epL;Am],hU.wL:kUn];pQn] pQn]tac];pQn]Sc] kUn];pQn]Sm].sQp];h}a.hqc];yU,El: km];km];sQp];n}siuc]hp].
kUn];pQn] w}.pQn]kUn];pQn]nC];" pn]yLEk:sQp];El: k}.tUv];cw];l}a;kUn];pQn]yU,tL,eS,"
49
Kn]:Kk].l}a;pn]yLEk:sQp];
Kk].Ti 1 Kk].Ti 2 Kk].Ti 3 Kk].Ti 4
Paracetamol, ASA, Ibuprofen Codeine Pentazocine
Amitriptyline Indomethacin Tramadol (IM,SC,IV)
(tL,sQp];sgm];SQn]:AQn])
tL,hqc];yL (Doses) nn].kCL,tUv];tI:Kgc]:S}am}ayL tgn]:liun];Sut];pp].piUc]nm]; tI:kn] 24.9{

 epL;pQn]l}:hC]:pn]yLkin]kUv];
 Aw]yLEk:sQp];pn]hUm]:elL;sgm];kn]n}. etlIliUw]pn]yLSqn]; (mQw];) lQw]nm]nm]" tUw]yac],-
pn]yL Paracetamol Am],nn] NSAID hUm];tc];yLAn]hqc];liUw] (Tramadol Am],nn]
Codeine) n}.et hQt];hG]:h}asQp];l}:lIliUw] pn]yLSqn];niuc]:Sqn];lC]hac];kUv];"
 pn]yLEk:sQp];sgm];nc],Kaw];yam];mn];man],man],n}. lIliUw]pn]kgp]:kUn];pQn]ygn];kin]" kgp]:wL:
lgc]:n}. pQn]lgc]:lm],lgc]:Et.Et.tL,pn]tac];yUt];yLw}a;lc]PL,tt];kUn];pQn]"
tUw]yac],lgc]:yUt];yL
 hUw]K}:pan]kac]' sQp];tI:kam]:niUw]. eKL:etL,lup], Am],nn] lup], -(Paracetamol El:
Aspirin)" epL;wL:pn]yL Aspirin yw]. sQp];pan]kac]tI:kam]:niUw]. eKL:etL,lup],Am],lIKiun]:
El:Sc] yL:yLet Am],kCL,Kt];kn]El:Sc] hG]:Et,pn]yLEk:yQn]; miUn]nc], Ibuprofen
Am],nn] Indomethacin"
yL,pn]yL Aspirin hG]:luk]:Agn],AL,yulQk].liUw] 12 pI< kin]lL;lL;"
 (Amitriptyline low dose) pn]yLAmit].Trip]:T}lin];eA, (pn]yLnm]n}. sC].tiuw];tL,kUn];

pQn]sC]tUk];) n}.sC].tiuw];l}:tL,sQp];San]:tI:tin]' KL' Kqn] (km]:nm]Et.An]sQp]; kgp]:tac];
pQn]yQw]:wan] Am],nn] mat],sQp];) El:tL,eh.kc]:hUw]K}: kgp]:tac];pQn]m}a,krQn]; (Migraine
headache)"
 tL,sQp];pan]kac]- h}a.hqc];nn]. sC].tiuw];yL Codeine-paracetamol l}:" epL;wL:yLkUw],tQn];
(Codeine) Aap]:Am],epL;n} Et,pn]yL TrL,mL,etL; (tramadol) l}:"
 tL,sQp];h}a.hqc];kU:siUw];siUw];Et. pn]yL Pqn],tL,SUw],Sin],(pentazocine)" tL,kUn];pQn] An]
sQp];h}a.hqc];n}. tiun];etAm],l}:p}g,w}. lUv]:Am],l}:hLmk];mn]:tac];pQn]wL: pQn]Sc]" kgp]:wL:
pn]yLEk:sQp];hG]:h}asQp];kUv];n}.Am],pQc];epL;"
 Et,sQm] 2006 mL;n}.Sc],Siuw].yL Pqn],tL,SUw],Sin], (pentazocine) tI:miUc];T};Am],l}:yw]."
kgp]:n}kQw],lUv]:sQp];n}.sC].yLSc]l}:n}nn]. etl}:tiUc],pac],tc];emLyLlUc]"
50
tI:m}atgc];"
 kgp]:Pqn],tL,SUw],Sin], (pentazocine) n}.sac]:hQt];hC]:kCL,mip],SQn]:tac];TUv]:sC]l}:" epL;wL:
etsC].yLn}. hG]:kUn];pQn]An]pQn]tac];pQn]SQn]:tac];TUv]:sC]yU,yw]. Am],nn] kUn];pQn] An]
lU.Sum];Tat]:nm].nC];tUw]nm] (miUn]nc],kUn];yQp],vL;mak],) nn].tk];etl}:sC].sgm];Stinm]nm]"
 yL,pn]yLEk:sQp];nm]liUw] An]pn]l}:nm]Sut]; sgm];nc],siSc],w}.lL;lL;"
lgc]:yUt];yLAn]etl}:PiUm].Tqm]pn]
 lgc]:sQp];n}.etsac]:pQn]sgm];Pac],hac]:tac];pQn]miUn]nc], K}:tUn].K}:hak]: Am],nn] lgc]:m}:sC]"
lgc]:yUt];yLsQp];n}. etyUt];yLhUm]:pL;tac];pQn] kgp]:lgc]:lUv]:Pgn];sL.sQp];sgm];"
 yLtL,yUt];yL K}:tUn]:K}:hak]: - Metoclopramide and Chlorphenmine"
 yLtL,yUt];yL lgc]:m}:sC] - Diazepam"
 etAm],l}:pn]yL ASA, Ibuprofen Am],nn] Indomethacin siUw];n}. hG]:kUn];pQn]An]pQn]
hUc];Kw]: sQp];yU," kgp]:wL: yLsiUw];n}.etsac]:hQt];hG]: tac];pQn]hUc];Kw]:sQp];El: sQp];nC];
hUc];Kw]:h}a.kCL,l}: nn].yw]. (kn] 7.5)" epL;wL:tqp];tt];sC] etpn]yLsiUw];n}.hG]:kUn];pQn]
An]pQn]hUc];Kw]:sQp];n}ekL: nc],hiuw]etpQn]lgc]:eh.kc]:hUc];Kw]:nn]. pn]yLeh.kc]: H2 sgm];
(Cimetidine, ranitidine –donation) Am],nn] omeprazole"
 tL,kUn];pQn]An]pQn]tac];pQn]h}a.hqc];nL,El: tL,kUn];pQn]An]sm]t}ann]. yUt];yLpn]lgc]:sQp];
kUv];n}.km]:nm]Et.mn];Am],pQc];epL;" sgm];nc],PU:hap],kan]p}a;yU,lIekL.niuc]: sgm];nc],tI:pgc]pQn]
l}:nn].Tuk],lIw}. hG]:kUn];pQn]lUm]tUw]kUv];Am],kL; hG]:lUm]sC]liUw]piUn]:" tUv];tI:l}a;yUt];yL
hG]:mw]SL, (kn] 20.4)"
 Corticosteroids (tUw]yac],- prednisolone) n}.sac]:hQt];hG]:lgc]:sQp];yU,El: lgc]:Am],
K}:kin]K}:yqm].kUn];pQn]eA,lUc];l}:eStL. kUv];kL:Sm].mI;Pgn];sL.An]sgm];mL;ekL:nm]nc],kn]"
kgp]:n} epL;Am],l}:tiUc],pac],tc];emLyLlUc]eSEl: Am],Tuk],lIsC]. Corticosteroids"
tgc].kiuc].kac].sQp];h}a.hqc]; ( Acute abdominal pain)

eKL:piut],tI:pgc],
epL;wL;kUn];pQn]mI;Pac]hac]:tac];pQn] Am],nn] lk].KnL,miUn]nc],pL:tC]:n}. eSAn]An] miUn]nc], tgc].
sQp];' hak]:' mI;lUm];naw]' tgc].kCL, Am],nn] tgc].pik].' nL:tgc].Kqc] El: tgc].kC]:tgc].pgc]; siUw];n}yw]."
epL;kiuc].kac].pQn]tgc].sQp];h}a.hqc];n}siuc] lgc]:liUt]:tiun], (pQn]SWYk].) ekL:sac]:pQn]mL;sgm];" lgc]:tgc]:Tam]
piun];tac];pQn]kUn];pQn]El:kUt],Tt];n}.pQn]lgc]:Am],hQt];Am],pQn]El:lm],lgc]: tL,KUn].hLmk];mn]:tac];
pQn] An]Tuk],mqn]:"tac];pQn]mac]siUw]; tk];etl}:PL,tt];km];Siuw]:"Ac],kL,tac];nC];tqk], (miUn]nc], Et,
Sn],eT, ngk]:hUc];luk]:' AQn]liUt]:lUc]pgc];kC]:' pac]:tqk],)' yC];tgc].kC]:sQp]; (miUn]nc], hUc];Kw]:' S}:
Am],nn] hUc];lIpgc],)"
51
lgc]:tac];An]l}:pQn]km]:nm]
tp];AWn],sQp];kC]:' pac]:
mqc];tUik],' hBc];Kw]:kC]:'
S}:tn]' mam].kiuc].kac].kC]:' mI,
pQn]sQp];nC];hBc];Kw]:'
Sqn];Trik].' AQn]liUt]:Kiun];
SQn]:lWt],AL;han]pWc],
Aiut];tn]' AQn]liUt]:kCL,lUc]
hUc];lIkiuc].kac].kC]:' pQn]sQp];
pgc];kC]:' yC];kC]:' S}:kic],kC]:
tU,rUw],tU,En,l] nC;] hUc];Kw]:'
(miUw]:Et,pQn])
tp];kC]: tp];yC],' S}:kic],kC]:'
pgt],kC]:' lgt],hUc];luk]:kC]:' lgt],SUc],K},
El:hUc];K},pQn]sQp];yQn];mI;ngc]'
S}:kic],kC]:' lgt],hUc];luk]:kC]:' et,Sn],eT,ngk]:hUc];luk]:'
lgt],SUc],K},El:hUc];K},pQn]sQp]; S}: lUc];tI:SC],Kiun];Am], l}:
yQn];mI;ngc]' et,Sn],eT,ngk]: (Incarcered hernia)'
hUc];luk]:' pQn]kgn]:niw].tI:tC] tac];pQn]S}:
El: lgt],yQw]:' S}:lUc];' lUc]pQn]sQp];eSEl:kC]:'
pQn]litI: tC]El:lgt],yQw]:"
kam]:niUw].cw]:KLkC]:El:mI;ngc]'
miUw]:p},pn]lgc]:yUt];yLSc]nn]. Tuk],lIkUt],tUv];kUn];pQn]lIlI" siUc].hiuw]ekL:yw]. mac]pgk]: (kUn];pQn]

An]sQp];h}a.hqc];nn].) Tuk],lIpn]yLEk:sQp];Agn]tac];kgn], sc],etkUt],tUv];tac];pQn]" Tuk],lIkUt],
tUv];luk]:Agn],lQk]. miUw]:Kw]yQn]El: yU,nim]nim]"
tgc].sQp];n}.etpQn]l}:kgp]:pn]hLtI:l}:PL,tt];mL;El: Am],l}:PL,tt];mL;" sC].lgk];l}a;pL:tC]:n}.
pQn]piUc]En tac];yUt];yL-
1. nL:tgc].KQc]: hUm]:tc];sQp];pan]kac]etL,Tiuc]sQp];h}a.hqc];
An]pQn]siUc].n}km]:nm]n}. kgp]:l}:PL,tt];mL; lUv]:tac];pQn]yC];tgc].kC]:' S}:kic],kC]:' hUc];lIkC]:'

S}:pgc],/S}:tn]' et,Sn],eT, ngk]:hUc];luk]:siUw];n}.yw]." lgc]:pQn]li' S}:lUc];An]SC],Kiun];Am],l}:El:
lgt],hUc];lIkC]:siUw];n}. ekL:Tuk],lIl}:PL,tt];nc],kn]"
lgc]:yUt];yL
 SUc],kUn];pQn]kCL,hUc];yLlUc]
 yL,pn]kin]Sc]
 epL;wL:hLlUt].kL;Am],l}:El:etl}:pC].niuc]:Kiun]; Et,pn] IV El: antibiotics h]G:kUn];pQn]"
tac];liUk]:Ti 1: IV ampicillin + IV gentamicin + IV/PO metronidazole
tac];liUk]:Ti 2 : IV chloramphenicol + IV gentamicin
52
2. nL:tWc].AUn]: hUm]:tc];sQp];pan]kac]
An]pQn]siUc].n}km]:nm]n}. Am],kQw],lUv]:lgc]:PL,tt]; miUn]nc],mak],kqw];kC]:' mqc];tiUk],' tgc].sQp];miUw]:liUt]:

nL:liUn]mL; PID ' pQn]sQp];nC];hUc];Kw]: (Am],l}:pgc],)' pn]hLkQw],lUv]:lgc]:kiUt],luk]:El: tac];pQn]tp];kC]:"
lgc]:yUt];yL sgm];nc],tac];pQn]
Aac]:Aic]
mak],kqw];kC]: (tUv];tI: kn] 13.1)' mqc];tiUk], (tUv];tI: kn] 12.4)' tgc].sQp];miUw]:liUt]:nL:liUn]mL; PID
(tUv];tI: kn] 13.5)' pQn]sQp];nC];hUc];Kw]:(Am],l}:pgc],) (tUv];tI: kn] 7.5)' pn],hLkQw],lUv]:
lgc]:kiUt],luk]: (tUv];tI: kn] 19)' tac];pQn]tp];kC]: (tUv];tI: kn] 12.3)"
sQp];lin].tgc].(hUc];Kw]:sQp];)(Epigastric Pain)
lgc]:sQp];tI:lin].tgc].n}.k}.k}.l}:hn]nm]sgm];hUc];yLlqn]lin]T};-man]:"lgc]:tac];An]Aap]:etpQn]l}:
Et.
1. GASTRO-OESOPHAGEAL RELUX DISEASE
eKL:piut],tI:pgc],
tac];pQn]lgt],AL<han]kC]: Am],nn] tac];pQn]lUm];AiUw],hUc];Kw]:Kiun]:mL;Kiun];n}. pQn]kgp]:Kgc]kin]nC];hUc];
Kw]:Kiun]; pgk]:Kw]:mL;Kiun];nC];lgt],AL<han]lUv]:Pit];pktI.eSEl: yL.kw];h]G:eS;l]yC];S}:lU.lqw]nn].
yw]:" An]l}:pQn] siUc].n}n}. kgp]:lgc]:lqk]:l}a: An]Kqn]:wUc]:kac]lgt],AL<han]El:hUc];Kw]:nn].yw]."
eKL:pQn]eP;An]hQt];hG]:pQn]nn].etpQn]kgp]:kin]lw]:nm]nL,pUn].tI:'pI;nL,pUn].tI:' lut],lqn];yL:nL,pUn].
tI:' kin]tac];kin]PQt];nL,pUn].tI: siUw];n}.yw]:"
Pac]hac]:tac];pQn]
 sQp];m}:m}:El:pQn]hiuc]tI:lin].tgc]. Am],nn] tac];lc]lup],lin].tgc].'
 sQp];m}:m}:tI:lin].tgc].eSEl: nm].miUn]ArSL,nm].kUt].(Acid taste) Kw]:mL;nC];pak],'
 Aiun]yap],'
lgc]:KUn].hLmk];mn]:tac];pQn] mk];mn]:tac];pQn]sgm];nc],lgk];l}a;yUt];yL"
53
lgc]:yUt];yL
 lgc]:kin]ekL,PI,' nm].nQc]:sQm];' Kgc]kin]PQt];' lw]: El: lut],lqn];yL:siUw];n}. Kt];sC]hG]:
eA,lUc]; Am],nn] kuit];yc].pqt]:"
 epL;kUn];pQn]pI;nL,n} Tuk],lIlat]:EnhG]:kUn];pQn] lUt].nm].nk];sw]:kw],"
 pn] antacids: Aluminium hydroxide 500 mg TID nC];wUc]:kac]Kw]:Km]:El: mUiw]:etngn];
sgm];nc], Tuk],lIpn]"
 epL;wL: Aluminium Am],epL;n}siuc:] Omeprazole 20 mg OD kU:nC] tL, 4 wUc]: Am],nn]
Cimetidide 400 mg BD Am],nn] 800 mg OD Kaw];ngn]; tL, 4 wUc]:"
lgc]:eh.kc]:
lat]:EnkUn];pQn]wL: h]G:ew: ekL,PI,' lw]:' tac];kin]PQt];El: lut],lqn];yL:" kin]eA,eA,eS km];
km];kin]tac];kin]n}.ekL:sac]:hQt];h]G:tac];pQn]lUt];lUc];l}: kgp]:wL:tac];kin]etmI;nC];tgc].niuc]:Ait];niuc]:
Ait];w}.yU,tL,eS," mUiw]:p},Kw]:ngn];mgk]: 2 sUw]:mUc];nn]. ciUc].ew:yL,kin]tac];kin]" miUw]:kin]tac];kin]
yw]. Am],Tuk],lIngn];"
2. hUc];Kw]:sQp]; (GASTRITIS)
eKL:piUt],tI:pgc],
hUc];Kw]:sQp];An]wL:nn]. Piun].Piw]nC];hUc];Kw]:kC]:nn].yw]." lgc]:hQt];h]G:pQn]km]:nm]Et. kgp]:kin]lw]:nm]'
lut],lqn];yL:nm]El: kin]tac];kin]PQt];hqc];siUw];n}.yw]." yLmac]siUw]; (miUn]nc], ASA, Indomethacin,
Ibuprofen, high dose Ferrous Sulphate) siUw];n}.ekL: epL;kin]Kaw];hiuc]n} sac]:hQt];h]G:pQn] Am],nn]
h]G:tac];pQn]h}a.hqc];liUw],kw],l}:nc],kn]"
Pac]hac]:tac];pQn]
 sQp];m}:m}:tI:lin].tgc].
 tUn].' hak]:' lUm];nC];tgc].nm]' yU,yap],miUn]tgc].tQm]
 sQp];m}:m}:tI:lin].tgc].eS K}a.Kiun]:mL;nC];pak], hUm]:tc];nm].An]mI;ArSL,nm],kUt]."
lgc]:yUt];yL
 lgc]:kin]ekL,PI,' nm].nQc]:sQm];' Kgc]kin]PQt];' lw]:El: lut],lqn];yL:siUw];n}.hC]:Kt];sC]
eA,lUc]; Am],nn] kuit];yc].pqt]:"
 epL;kUn];pQn]pI;nL,n} Tuk],lIlat]:EnhG]:kUn];pQn] lUt];yWm];nm].nk];sw]:kw],"
54
 pn] antacids: Aluminium hydroxide 500 mg TID nC];wUc]:kac]Kw]:Km]:El:mUiw]:etngn];

sgm];nc], Tuk],lIpn]"
lgc]:pQn]hUc];Kw]:sQp];n}. Am],k}.l}:hn]luk]:Agn],pQn]"
3. tac];pQn] hUc];Kw]:sQp]; pqp].tiit].S] (PEPTIC ULCER DISEASE )
eKL:piut],tI:pgc],
tL,tac];pQn] pQn]sQp];nC];hUc];Kw]:pqp].tit].S]nn]. sQp];sQp];m}:m}:tI:lin].tgc].n}. etsac]:h}a.hqc];nm]
liUw]" epL;kUn];pQn] An]pQn]hUc];Kw]:kC]:Kaw];hiuc]nn]. pn]yL aluminium hydroxide yw].yc];p},lIKiun]:
mL;El:pn]yL mebendazole w}.yU,n}siuc] Tuk],lIEt,pn]yLtL,tac];pQn]hUc];Kw]:sQp];pqp].tit].S]"
tac];pQn]hUc];Kw]:sQp]; pqp].tit].S] km]:nm]pQn]kgp]:siUw].mqc];pqk],TI;rI;yL; (Helicobacter Pylori)
nn].yw]." siUw].mqc];Sqn];n}.n}.et sac]:Kam],l}:nm].kUt]; (Aqt].Sit].) El: mI;AL,yul}:nC];hUc];Kw]:
An]mI;nm].kUt];nm]nn].yw]." yL:yLAn] lUt];yWm];nm].kUt];nC];tgc].miUn]nc], aluminium ethQt];
h]G:lgc]:sQp];mw]mL;n}eStL. tac];sQp];n}.etpQn] Kiun];Tqc]:"
Pac]hac]:tac];pQn]
 sQp];m}:m}:tI:lin].tgc]. etk}.pQn]sQp];nm]liUw] nC];wUc]:kac]miuw].Kw]:miuw].niuc]:tc];miuw].niuc]:El: yam];
nC]sw]. (miUw]:nC];tgc].p},mI;Sc]) Sm].Kqn];etk}.sQp];liUw]hqc];" miUw]:kin]Kw]:tgc].An]sQp];yU, eth}a
kCL,km];niuc]:n}eStL. mgk]: 1-2 sUw]:mUc];ekL:etKiun];sQp];mL;Tqc]:"
 tUn].' hak]:' Am],K}:kin]Kw]:"
 hqc];eA,' hiUw].' AUn]:Agn],siUw];n}. kgp]:liUt]:Agk],Kaw];hiuc]nn].yw]."
lgc]:Suk].Sak].yap],yQn];kQw],lUv]:tac];pQn]kUn];pQn]mac]:ekL.etsac]:pQn]liUt]:Agk],h}a.hqc];l}:" kUn];pQn]
ethak]:Agk],mL;nm].km],km], (miUn]ekL,PI,) Am],nn] liUt]:lqc]lqc]yw]. tgc].etkCL,pQn]liUt]:lm]lm]
(P}a:SIlm]lm] nQw]nQw]mQn]mQn]) siUw];n}.yw]." (Tuk],lItgc];w}.wL: kUn];pQn]An]kin]yL mI;Tat]:lQk];
nn]. etP}a:pQn]SIlm])
mk];mn]:sgm];nc],p}a;yUt];yL – tI:Et.mn];km]:nm]Et. kUn];pQn]An]pQn]tac];pQn]hUc];Kw]:sQp];kU:ekL.
Tuk],lI kUt],Tt];tUv];siUw].mqc]; Helicobacter Pylori kgn],n}eStL. kgp]:kL:kUt],Tt];Suc]eS hQt];
yap],El: Tuk],lIyUt];yLpn]kUn];pQn] An]mI;liUt]:Agk], Am],nn] siUw];An]pQn]tac];pQn]Kaw];hiuc]eS
pn]yL aluminium hydroxide El: mebendazole ekL:Am],lIKiun]: siUw];nn].yw]."
55
lgc]:yUt];yL
tL,KL:siUw].mqc]; H. Pylori nn]. tk];etl}:sC].yLSam]mQw]; pn]hUm]:kn]yUt];yL"
Omeprazole 20 mg BID tL, 1 wUc]:
Metronidazole 400 mg TID tL, 1 wUc]:
Amoxicillin 500 mg TID tL, 1 wUc]:
sC].yLSam]mQw];pn]hUm]:kn]yw].nn]. etl}:Siup],pn] Cimetidine 400 mg PO BID
kCL,sgm];Tqc]:tL, 4 - 6 wUc]:"
epL;wL:pQn]kUn];pQn]liUt]:yc];Agk],yU,n}
 pn] IV line sgm]; RL Am],nn] NSS"
 pC].tUv];Tt];Sac]Pac]hac]:An]lm],lgc]:sgm];" hQt];h]G:hU. mU,liUt]:El: Hb/Hct kUn];pQn]w}."
 epL;kUn];pQn] kiuc].kac].t}alium];kCL,n}siuc] epL;pQn]l}: h]G:Tqm]liUt]:pn]"
 SC],S}ayac]pn]tac];KU;lc]"
 pn]yL Cimetidine"
 yL,pn]kUn];pQn]kin]Sc]tac];pak],lL;lL;"
 SUc],kUn];pQn]kCL,hUc];yLlUc]"
epL;wL:kUn];pQn]liUt]:Agk],kgp]:tac];pQn]hUc];Kw]:sQp];pqp].tit.]S]n}. pgc],wL:pQn]lgc]:lm],lgc]:"
w};l}:kL:hiuw]ekL:h]G:w};eS st];kan]lgc]:yUt];yLpn]"
lgc]:eh.kc]:
kgp]:yc];p},hU.wL:siUw].mqc]; H. Pylori luk]:tI:lG]mL;El: yc];p},hU.wL:nc],hiuw]etAm],sp];tit]; tac];pQn]
nn]. etl}:ciUc].ew:siUc].hiuw]" km]:nm]Et. Tuk],lIlac].miuw];hC];mUt];SC]' kin]tac];kin] An]hU.hn]wL:
mUt];SC]El: hac]:hqn];w}.Tuk],mqn]:' nm].An]yum],l}:wL:mUt];SC]siUw];n}. pQn]lgc]:kUn];kU:ekL. Tuk],lIhQt];
tL,eS,yU,yw]." tUv];tI: l}a;eh.kc]:tac];pQn]hUc];Kw]:sQp];"
4. mqc];tiUk],
mqc];tiUk],n}. k}.k}.hQt];hC]:luk]:Agn],' kUn];lUc]sQp];tI:lin].tgc].El:tgc].nn].yw]."(kn] 12.4)
tL,kUn];pQn]An]sQp];tI:lin].tgc].kU:ekL. hC]:yL mebendazole Am],nn] albendazole one course

eSEl:yUt];yLpn]"
(yL,pn]kUn];pQn]AL,yulQk].liUw] 1 KUp], Am],nn] Em:pL;tgc].Pgc];yU,nG]; first trimester)
56
5. lgc]:m}:sC] (Anxiety)
kUn];An]k}.m}:sC]km]:nm] sac]:Kac];sQp];tI:lin].tgc].l}:miUn]kn]" Tuk],lIsgp],Tam]piun];tac];pQn]lIlI El:
Tuk],lItUv];liuk].lm],kCL,tI: piun];Kw]:tUc],wUc];kUn];Kgc]kUn];pQn]sgm];" (kn] 20.4)
6. CARCICOMA OF THE STOMACH
kUn];pQn]An]sQp];tI:lin].tgc].eS nm].nk];tUw]eA,lUc];nn]. tk];etwUn].lgc]:pQn]tac];pQn]Kqn],SiUw]<

nn].yw]." km]:nm]Et.kUn];An]AL,yuEk,liUw] 60p}a Kqn];mI;Tac],hac]:pQn]l}:nm]" Pac]hac]:nm].nk];
eA,lUc]; (ygm]lUc];) Am],epL;kin]Kw]:wan]' hqc];eA,El: hiUw].AUn]:Agn],siUw];n}. Kqn];mI;Pac]hac]:pQn]l}:
nm]yw]." hgc]:yL (Klin];nik],) km]:nm]Et. Am],yUt];yLpn]h]G:h}al}:eStL.yUt]; yLh]G:Sak],SL,Et.
l}:yU,"
hUw]K}:
hUw]K}:n}. Am],sC]:tac];pQn] pQn]Pac]hac]:An]niuc]:kUv];" hLtUv];lgc]:tac]; An]hQt];h]G:hUw]K}:"

epL;hU.yw].wL: pQn]kgp]:Sc]n} sc],Tuk],lIpn]tac];yUt];yL"
lgc]:tac];hQt];h]G:hUw]K}:n}.mI;nm]nL,El:ethUm]:pL; -
 sC]Suk].Sak]. (Tension stress)  sp];tit];siUw].mqc];tac];pQn]
 sC]tUk]; ( depression)  tI:lQw] miUn]nc],yC];hUm],Agk];eALkC]:' tac];pQn]liuc],
 hUw]K}:P}a,lQw] (Migraine) KU;lc]pQn]sQp]; (sinusitis)
 kgp]:piUw]:tiUw].vL;mat],sQp];  KUc].nC];tUw]
 SQn]:liUt]:temporal arteritis - pqk],TI:rI:yL: miUn]nc],TI,pI,' tac];pQn]yQw]:nU
kC]: (leptospirosis)' tac];pQn]naw]S}:kC]: (typhoid)
 eKL:etL,lup],eKL:kC]: - w};rt].S]miUn]nc],naw]liUt]:Agk],(Dengue fever)
kQw],lUv]:Agk];eAL-niUw].cgk]: - pL,rL,S}. (parasitic) miUn]nc],naw]nUk].
t}aPak],liiUt]:l}nC];Agk];eAL  yL:mw];km] – kgp]:kiut];yc].kin]lw]:' kin]yL:' kin]
yL nifidipine El:kin]ekL,PI,"
Kk].tgn]:An]lm],lgc]:liUw]piUn]: tL,Tt];Sac]hUw]K}:nn]. pQn]l}a;Aw]piun];kUn];pQn]nn].yw]." Tam]kCam];

Tam] l}al}aAn]" kaCm];Tam]An]Tuk],lITam]Et.- hUw]K}:hqc];kL:hiuw]' hUw]K}:siUc].hiuw]' K}:tI:lC] (epL;pQn]l}:
h]G:kUn];pQn] sn]hac]:hUw]sw]:kw],eSsiEntI:K}:) siUw];n}.yw]." An]pQn]n}. sc],hLEt,pQn]hL.?
pQn]Kaw];hiuc]hL.? Et,K}: Kaw];lC]El: hiuc]kL:hiuw]? Tam]tUv];wL: AI:Sc]? siUc].hiuw]? Kqn];hQt];h]G:K}:hqc];
57
liUw]kw]," hC]:hLtUv]; lgc]:etpQn]l}: miUn]nc],-

 kiuc].kac].hUw]K}:h}a.hqc];
 pQn]mC],mC],
 pQn]hqc];mL;tik];tik]; (hqc];sQp];El:hqc];h}a.hqc]; Suc]Kiun]:tik];tik];)
 pQn]mL; miUw]:lQn]:Agk],hqc]; Am],nn] h}a.hqc];liUw]kw],mL;
 hUm]:sgm];Pac]hac]:tac];pQn]Agk];eALEl: SQn]:AL<yUc], -(tUw]yac],-mI;lgc]:sC]Suk].Sak].' lgc]:
tgc];kium];eA,lUc];' pQn]lUm];mL:mU' kan]tUc].niuc]tgp],Kiun];tI:lak],l}a;' Am],hU.niUw].hU.tUw]' hqc];kam]:
niUw].Am],mI;)
 hUm]:sgm];Pac]hac]:tac];pQn]Kc U ].nC];tUw]'
yUt];yLpn]tac];pQn] An]Sgn].yU, (miUn]nc],-sp];tit];siUw].mqc];) El: tL,hUw]K}:Et.pn]yL pL,rL,SI,
temL; ekL:ethQt];hG]:Sak]:SL,mL;"
lgc]:hUw]K}:An]siUw];hU.tqt]:etL; (Specific causes of headache)

1. hUw]K}: kgp]:sC]Suk].Sak].
hUw]K}:n}. km]:nm]etk}.pQn]tc];Sgc]P}a, (kgk];hUw]tc];Sgc]P}a,)' tI:eKL: Am],nn] tac];lc]kgk];hUw]n}.

etK}: h}a.hqc];eSEl: etAm],kQw],sgm];tac];pQn]Agk];eALEl: SQn]:AL<yUc],Sc]" km]:nm]Et. hUw]et
K}:kU:wn];eSEl: etlat]:EnwL:miUn]nc],Aw]siUk]:mt].hqc];hqc];w}." miUw]:lQn]:Agk],hqc]; hUw]K}:ekL: Am],h}a.
hqc];liUw]mL;"
lgc]:yUt];yL
Tuk],lISp];lqc];EnkUn];pQn]wL: hUw]K}:n}. kgp]:sC]Suk].Sak]. Am],nn] m}:sC]eSEl:hQt];hC]:kam]:niUw].
tI:kgk];hUw] El: eKL;siUw];n}.KQc]:hiuc]mL;yw]. sc],pQn]nn].yw]." kgp]:n} lgc]:ngn];hG]:Aim],Aim],' lgc]:
Suk].Sak].sC] Am],wL: tI:hiUn];' tI:hQt];kan] hG]:eA,lUc];El: hLKaw];yam];tL,lQn]:Agk],hqc];miUn]nc],
luv];nm].'mip],nUt]:tUw]El:/Am],nn] Aap],nm].Aun],pn]n}siuc]ethQt];hC]:kam]:niUw].KQc]:siUw];n}. eA,lUc];
kCL,l}:" tL,hUw]K}:nn].Et. kin]yLpL,rL,SI,temL; (paracetamol) ekL:l}:"
2. hUw]K}:P}a,lQw] (Migraine)
hUw]K}:P}a,lQw]km]:nm]Et. etKiun]:can]:can]:Am],nn] nLwiut].wiut].yU,P}a,lQw]nn].yw].' kgp]:lgc]: tUc].

niuc]eSEl: KQn];ethQt];h]G:h}a.hqc];liUw]" hUw]K}:P}a,lQw]n}. k}.pQn]hUm]:sgm]; K}:tUn].' hak]:' (kUw]Sqc]f};)'
Am],hn]sqc]:lqc];lIEl:P}a,tI:K}:nn].KU;lc]etk}.tn]w}.siUw];n}.yw]." tac];K}:n}. etsQp];Kiun]:mL;tik];
tik];l}al}asUw]:mUc];eSpQn]l}:Tiuc]l}al}awn];nn].yw]." etpQn]sgm];pL; miUn]nc],lgc]:muc]:hn]Tuk],yL.kw];
n}. k}.pQn] kn]km]:nm]El: Sqc]wqp].Agk],tL' Agk],hac]: Z nC];tLmL; Am],nn] lgc]:muc]:hn] yup]:ygm];
58
siUw];n}.yw]." miUn]nc], kQw],lUv]:Agk];eALEl: SQn]:AL<yUc],nn]. aphasia (lat]:kCam];Am],l}:)' nL'
nQt];San]: Am],nn] hqc];eA,siUw];n}.ekL: pQn]sgm];l}:" kUn];mac]:ekL. hHn]vL;Pac],hac]: (miUn]nc],
lqk]:l}a:sC]c}a:' hiUw].' haw]' kam]:niUw].KQc]:) mUiw]:etpQn]hUw]K}:mgk]:Am],l}asUw]:mUc]; Am],nn] Am],l}awn];
nn].yw]." km]:nm]Et.pQn]sgm];piun]; siUw].Pn];El: lgc]:Suk].Sak].sC]' lgc]:kin]lw]:' miUw]:nL:liUn]PU:
yic];mL;El: kin]yLKum];siUw];n}. etsac]:hQt];hC]:h}a.hqc];liUw]"
lgc]:yUt];yL
hC]:yU,nG];hgc]:lp];Sic],El: kt];yQn]n}.ekL: s}g:hC]:tac];pQn]Sak]:SL,mL;l}:" epL;pn]yLn}ekL: pn]
aspirin Am],nn] yLtI:c}a;nc],nn] miUn]nc], Ibuprofen, naprosyne Am],nn] diclofenac siUw];n}.
l}:" epL;wL:km];km];k}.pQn]n}ekL: SUc],sU;emLyL hC]:emLyLpn]lgc]:yUt];yLKaw];huic]" tL,eh.kc]:nn].
sC].yL amitriptyline, propanolol Am],nn] aspirin siUw];n}.l}:" kin]yLsgm];nm].An]mI; kL,EP;Ain]<
miUn]nc],nm].kUw],kL,kUw],lL,n}. ethQt];hC]:yLtiUw].liUw]"
3. Tat]:sC]tUk]; (Depression)
lgc]:hUw]K}:n}. k}.l}:TUp];vL;kUn];k}.Tat];sC]tUk];Kw] pQn]kn]nm]eSEl: ethUm]:pL;Pac]hac]:tac];pQn]

tac],siUw];sgm];" (kn] 18.1)
lgc]:yUt];yL
kCL,tUv];tI:lgc]:pn]tac];hn]Tiuc]l}a;yUt];yLkQw],lUv]:Tat]:sC]tUk];" (kn] 18.1)
4. w}a;tiUw].vL;mat],sQp];
Pac]hac]:tac];pQn]l}al}asiUw]; An]Am],tqt]:etL; hUm];pL;lgc]:hUw]K}:n}. w}a;tiUw].vL;mat],sQp];yw].

Am],yU,tI: lgc]:h}a.hqc];nm]eA,eSEl: sac]:pQn]l}:" hUw]K}:n}. km]:nm]etpQn] wn];tI:An]tiUw].vL;
nn].wn];lQw] Am],nn] w}a;tI:tiUw].vL;El:sac]:sQp];yU,siUc].nn]pQn]l}awUc]:eSEl: eth}akCL,l}g;l}g;"
hUw]K}:siUc].n}n}. etnLwiut];wiut];eSK}:w}. hUm]:tc];sQp];cqn];cqn];yU,tI:lQw]nn].yw]." mac]pgk]: tUn].hak]:'
lgc]:muc]:hn]yup]:ygm];siUw];n}. etsac]:pQn]hUm]:sgm];hUw]K}:siUc].n}yw]." lgc];tgc];kium];Am],lI tc]:SmL,Ti
yap],' sC]Am],nim]siUw];n}.ekL: k}.k}.pQn]nn].yw]."
lgc]:yUt];yL
Tuk],lIlQn]:Agk],hqc];pn]kam]:niUw].eKL;' kin]yLEk:K}:Ek:Kiun]:El: yL amitriptyline"
59
5. t}aPak],(Stroke)
etk}.pQn]hUm]:pL;sgm];hUw]K}:" t}aPak],n}. etmI;Pac]hac]:tac];pQn]eKLeKL (kn] 8.3)"
lgc]:yUt];yL
tUv];tI: (kn] 8.3)"
6. liUt]:Agk],nC];Agk];eAL (Subarachnoid haemorrage)
kiuc].kac].hUw]K}:h}a.hqc];tc];kgk];hUw]eSEl: Am],epL;hU.tUw]kCL,pqt]:eS mac]:pgk]:ekL: etmI;Pac]hac]: tac];

pQn]Agk];eALtc];SQn]:AL<yUc]," (kn] 8.3)
lgc]:yUt];yL epL;kUn];pQn]Et,hUw]K}:eA,liUw] 4 sUw]:mUc];pUn].mL;n}siuc] hC]:SUc],kCL,yLtUw]tI:hUc];yL

km];Siuw]: (tUv];tI: kn] 8.3)"
7. niUw].cgk]:
niUw].An]cgk]:nC];Agk];eAL sac]:hQt];hC]:hUw]K}:pan]kac]etL,epL;K}:h}a.hqc];El: sac]:hQt];hG]:pQn] Pac]hac]:

tac];pQn]Agk];eALtc];SQn]:AL<yUc]," lgc]:Agk],hqc];El: l}a;tm];wac];tUw]etsac]:hQt];hC]:tac];pQn]
h}a.hqc];liUw]El: hUm]:tc];tUn].tUn].hak]:hak]:sgm];" km]:nm]Et. Pac]hac]:siUw];n}. etpqk],piUc]:kn]tc];
lgc]:hUw]K}:tI:An]wL: pUn].mL;siUw]:nn]." tI:pQn]siUc].n}n}. etpQn]kgp]:Et,pQn]mC],mC],El: h}a.hqc];mL;tik];
tik];nn].yw]."
lgc]:yUt];yL
sgm];lqn]lin]T;} -man]:n}. yc];p},mI;lgc]:yUt];yLtac];pQn]niUw].cgk]:nC];Agk];eAL" tiUc],pac],tc];emLyLeS
nc],hiuw]lgc]:hUw]K}:etSak]:SL,nn].pn]kin]yLkCL,"
8. yC];hUm],Agk];eALkC]:/Agk];eALkC]: (Menigitis/encephalitis)
hUw]K}:h}a.hqc];Kiun]:mL; nC];Kaw];tac];Am],l}asUw]:mUc]; hUm]:tc];Am],epL;KG]:hU.tUw]El: mI;lUm];naw]sgm]; nn].

yw]." km]:nm]Et. etAm],mI;Pac]hac]:tac];pQn]Agk];eALEl:SQn]:AL<yUc], (kn] 15.1)" yC];hUm],Agk];
eALkC]: kgp]:siUw].mqc];TI,pI,n}. Am],epL;h}a.hqc];eStL. k}.hn]kUn];nC];Sun]kUn];pa}:eP;pQn]kn]"
60
lgc]:yUt];yL
yUt];yLpn]km];lQw] (Am],nn] epL;wL:tI:hUc];yLAm],yUt];yLtac];pQn]yC];hUm],Agk];eALkC]:l}: Suip],SUc],
kCL,yL)" epL;SUc],kUn];pQn]yC];hUm],Agk];eALkC]: wUn].Sgn],Sm];yL ceftriaxone (AL,yuyC],liUw] 2 liUn])
Am],nn] ampicillin El: gentamicin (lQk].liUw] 2 liUn]) pn]miUw]:mk];mn]:tac];pQn]El: miUw]:p},SUc],
kUn];pQn]" tac];pQn]yC];hUm],Agk];eALkC]: kgp]:siUw].mqc];w};rt].S]n}. Sm];yLKL:siUw].mqc];ekL:
etAm],tiUw].Sc]" epL;pQn]l}:mUiw]:p},yUt];yLpn]nn]. hQt];pn] LP " kUv];kL:kgp]:l}:pC].eSekL.ekL.
tL,hQt]; LP eSEl: Am],Tuk],lIhQt];hG]: lgc]:yUt];yLTiUc];kCL,pqt]:"
9. SQn]:liUt]:tI:KI:mqm].kC]: (Temporal arteritis)
kUn];pQn]AL,yuSuc] (50 Am],nn] Ek,liUw]) pQn]hUw]K}:P}a,lQw] (tc];Sgc]P}aekL:pQn]l}:) hUm]:tc];

Pac]hac]: Am],yU,lI mI;lUm];naw]' kam]:niUw].sQp];' kin]Kw]:Am],wan]' nm].nk];tUw]eA,lUc]; siUw];n}.yw]."
epL;yip];sam];tUv];hUw]n}siuc] ethU.mqn]:c}a:El: SQn]:liUt]:KI:mqm].etnLnLw}. hUm]:tc];liUt]:tgt],yU,
/Am],tgt],ekL:pQn] l}:" ESR ekL:etKiun]:yU,hn]hn]eS km]:nm]Et.etmI;mgk]: 50 p}a" tLmgt],n}.
pQn]Pgn];sL. lIl}:kUw]liUw]piUn]:nn].yw]."
lgc]:yUt];yL tiUc],pac],tc];KU;emLyLeSEl: pn]yL steroids"
10. tac];pQn]tac],siUw];- tac];pQn]KQw]:' tac];pQn]tL' tac];pQn]S};nt].' eKL:etL,lup],eKL:kC]: Am],nn]

A}' hUw]K}:
pn]hLkQw],lUv]:KQw]: (kn] 9)' tac];pQn]S};nt]. (kn] 21.1)' Am],nn] pn]hLtL (kn] 11) siUw];
n}. sac]:hQt];hC]:hUw]K}:" pn]hLkam]:niUw].Am],nn]lup],tI:eKL;ekL: km];km];k}.hQt];hC]:hUw]K}:l}:" kam]:niUw].tI:
nL:tgc].kiuc].kac].KQc]: (miUn]nc],miUw]:tgc].kCL,' miUw]:A}' miUw]:sam] Am],nn] miUw]:KUw]) siUw];n}.ekL:sac]:hQt];
hC]:hUw]K}:l}:miUn]kn]" kUv];kL:lgc]:sQp];K}:siUc].n}n}. etpQn]Am],l}aminit].eSeth}akCL," pqk].Sm].Am],hU.wL:
A}hUw]K}:n}.pQn] kgp]:Sc]n}eStL. mn];etmI;yU,siUc].nn]l}apIyU,yw]."
lgc]:yUt];yL hLlgc]:tac];An]hQt];hC]:pQn]eSEl: yUt];yLkCL," Ibuprofen, dicofenac Am],nn]

naprosyne siUw];n}. s}g:l}:yU,"
Aac]:Aic]
naw]liUt]:Agk],(15.3)' pn]hLKQw]:(9)' sC]tUk];(18.1)' pn]hLtL(11)' tac];pQn]yQw]:nU(15.1)' naw]nUk].
(15.2)' yC];hUm],Agk];eALkC]:(15.1)' SQn]:liUt]:tn](8.3)' tac];pQn]S};nt]. (12.1)' TI,pI, (21.5)'
naw]S}:kC]: (Typhoid) (15.1)
61
7.6 kuic].kac].luim];tUw] (SHOCK)

eKL:piut],tI:pgc], lgc]:kiuc].kac].lium];tUw]n}. kgp]:liUt]:An]l}yU, (tac];nm]eA,liUt]:)
Am],kum],TUn]: tL,et hQt];hC]:kUn];mI;S}asC]l}:nn].yw]." tL,hQt];kan]l}:nn]. Ac],kL,lm],lgc]:
(miUn]nc], Agk];eAL' hUw]sC]) etl}: hp].liUt]:El: Agk],SI,kYin],Am],kum],TUn]:"
lWc]:kiuc].kac].lium];tUw]n}.pQn]An]lm],lgc]:' lgc]:yUt];yLTiUc];n}.
sac]:hQt];hC]:Tiuc]t}al}:" mUiw]:etyUt];yLlgc]:kiuc].kac].lium];tUw]nn]. yL,pC].hC]:hqc];liUt]:tUk];"
lgc]:Tuk],lIhQt];pn]km];lQw] (Emergency management)

lgc]:yUt]yLkm]:nm] - tL,kUn];pQn]kU:ekL.
A = AIRWAY - Sac];lac];pn]SQn]:tac];lUm];Kw]: (pak],' eKL;' lgt],lUm];' l}a;wac];tUw] tL,kUn];
lium];tUw])
B = BREATHING - tc]:hqc];lqn]:Agk],SI,kiYn],pn]w}.w};w};
C = CIRCULATION - SC],pn] IV cannulas 2 An] (epL;pQn]l}:SC],An]yC],liUw]piUn]: 16G Am],nn]
18G)
 Et,pn]Slic];An]sC].km]:nm] (normal saline) pC].tUv];lgc]:PQc],KiUc]:Kgc]nm].(nm].Kw]:/nm].Agk],)
lgc]:yUt];yLtac],lgc]:ekL: etKiun]:yU,sgm];lgc]:An]l}:pQn]" lgc]:An]hQt];hC]:pQn]km]:nm]Et.
CLINICAL FEATURES
1. Hypovolemic shock (kiuc].kac].lium];tUw]kgp]:lU.Sum];nm].nC];tUw])
lgc]:l}:pQn]km]:nm]
 liUt]:Agk],h}a.hqc];Am],wL:tI:lC]nC];tUw]kUn]; (miUn]nc],mat],sQp];' et,Sn]eT,tac];ngk]:hUc];luk]:'
AQn] SQn]:p}g,liUt]:lUc] kC]:eSEl:liUt]:tqk],Agk],mL;)
 lU.Sum];nm].nC];tUw]h}a.hqc]; (miUn]nc], hak]:h}a.hqc];El:tgc].kCL,' vL;f};m}:' tac];pQn]tgc].man];
h}a.hqc];' pQn]naw]liUt]:Agk],h}a.hqc];)
62
2. Vasodilatory shock (kiuc].kac].lium];tUw]kgp]:SQn]:liUt]:kiuc].kac].kCac]:mL;)
lgc]:l}:pQn]km]:nm]
 sp];tit];siUw].mqc];pqk],TI;rI;yL;  tiUw].vL;tI:Agk];eALh}a.hqc];Am],nn]liUt]:Agk],
(kuic].kac].luim];tUw] kgp]:liUt]:pQn]kgc].) (kuic].kac].luim];tUw] An]kQw],lUv]: Agk];eAL)
 Tat]:Am],Tuk],mqn]:h}a.hqc];  kin]yL Am],nn] kgc].
(kuic].kac].luim];tUw]
kgp]:Tat]:Am],Tuk],mqn]:)
3. Cardiogenic shock (kuic].kac].luim];tUw] kgp]:hqc];hUw]sC]eA,' heart failure)
lgc]:l}:pQn]km]:nm]  hqc];tQn]:hUw]sC]Am],PQc],
 pQn]hqc];liUt]:eA,Kaw];hiuc] (kn] 14.1) (hqc];tQn]:hUw]sC]w};nL, Am],nn] TiUc];nL,)
 pI,tL,min], B1 eA, (kn] 17.2)  pgt],lU. (lUm];Kw]:nC];pgt],)
 lin].hUw]sC]lU.  hUw]sC]w}a; (Heart attack)
Pac]hac]:tac];pQn]
Pac]hac]:tac];pQn] kiuc].kac].lium];tUw]n}. etpqk],piUc]:kn] kgp]:Sqn];kiuc].kac].lium];tUw]pqk],piUc]:kn]" kUv];kL:
mac]Sqn];ekL: etTUp];vL; An]kUn];pQn] k}.pQn]kn]km]:nm]
 hqc];liUt]:tgn]:w};eSEl: hqc];eA, (niuc];minit].pUn].liUw] 110 nC];kUn];lUc])
 TUv]:sC]w};eSEl:tiun]: (niuc]:minit]. pUn].liUw] 30 nC];kUn];lUc])
 Piw]nc]Sm].kt];eS hiUw],Agk], (clammy)n}. k}.hn]kUn];pQn]SWYk].pQn]kn]km]:nm]" liUw]eSwL:
kUn]; kiuc].kac].lium];tUw] kgp]:SQn]:liUt]:kiuc].kac].kCac]:tam];sw].n}. Piw]etlqc]w}. (miUn]nc],liUt]:
pQn]kgc].)"
 hqc];liUt]:tUk]; (hqc];liUt]:pgt];niUw]eA,liUw]) 90 mmHg - kUn];kiuc].kac].lium];tUw] km]:nm]pQn]"
hqc];liUt]:eA,n}. pQn]Pac]hac]:An]pQn]Pa},lc] kiuc].kac].lium];tUw] ' kgp]:n} tL,yUt];yLkUn];
pQn] kiuc].kac].lium];tUw]nn]. Am],Tuk],lIpC].hG]:hqc];liUt]:eA,kgn],"
 yQw]:Agk],eA, (= oliguria)" hqc];yQw]:Agk],n}. eA,liUw] 30cc/sUw]:mUc];)"
 Tat]:sC]lqk]:l}a: - Agn]tac];Et. kUn];pQn]sC]Suk].Sak].eSkCc] w}a;nn]. hUw]mw];eSEl:
lium];tUw]kCL,pqt]:"
lgc]:pQn]SWYk].kgp]:liUt]:pQn]kgc]. (Septic shock) nn].etsac]:pQn]sgm];

 lUm]:m}:Suc]Am],nn]tqm],"
 mI;piun];wL: miUw]:p},mI;lUm];naw]nn]. sac]:kt];"
 Piw]nc]Aun],"
63
lgc]:kiuc].kac].lium];tUw]kgp]:Tat]:Am],mqn] (anaphylactic shock) nn].etsac]:pQn]sgm];

 mac]pgk]: puin];An]kin]yLAn]niuc]: (km]:nm]miUn]nc], yLpqn],En,Slin], El:yLEk:sQp];kC]:)'
mqc];KUp]; Am],nn] kin]Pit]; (km]:nm] tac];kin]pac],l}a,El: TUw],lin])" Pac]hac]:Tat]:
Am],mqn]:n}. etsac]:pQn]hiuc]mgk]: 5 minit].etL,Tiuc]l}asUw]:mUc];"
 pgc];kC]: (pak],El:kUc]eKL;)n}.ethQt];hC]:TUv]:sC]yap],"
 miUw]:TUv]:sC]etmI;SQc]"
 hqc];liUt]:n}. miUw]:p},lUc];nn]. etSuc]w}."
 mac]pgk]: etAgk],tum],KUm];eSEl:lam];kCL,w};w};tc];tUw]"
 mac]pgk]: hak]:El:tgc].kCL,"
lgc]:Tuk],lIhQt];pn]hG]:tqt]:nqt]:km];Siuw]:
lgc]:yUt];yLkm]:nm] - tL,kUn];pQn]SWYk].kU:ekL.
A = AIRWAY-Sac];lac];pn]SQn]:tac];lUm];Kw]: (pak],' eKL;' lgt],lUm];' l}a;wac];tUw]tL,kUn];lium];tUw])
B = BREATHING - tc]:hqc];lqn]:Agk],SI,kiYn],pn]w}.w};w};
C = CIRCULATION- SC],pn] IV cannulas 2 An] (epL;pQn]l}:SC],An]yC],liUw]piUn]: 16G Am],nn] 18G)
 Et,pn]Slic];An]pUin]:sC].km]:nm](normalsaline)pC].tUv];lgc]:PQc],Kiuc]:Kgc]nm].(nm].Kw]:/nm].Agk],)
lgc]:yUt];yLtac],lgc]:ekL: etKiun]:yU,sgm];lgc]:An]l}:pQn]" lgc]:An]hQt];hC]:pQn]km]:nm]Et.

1. HYPOVOLEMIC SHOCK: BLOOD/FLUID LOSS (pQn]SWYk].kgp]:lU.Sum]:nm].nC];tUw])
 kiut];yut];pn]liUt]:tI:Agk],yU,"
 pn] normal saline Am],nn] Ringer’s lactate niuc]:lI,tL,nC];Kaw];tac]; 15-20 minit].
Am],nn] 20cc/kg km];Siuw]:" sUw]:mUc];Agn]tac];nn].Tuk],lIpn]tI:eA,Sut]; 2 lI,tL,"
 epL;wL:liUt]:yc];l}yU, nm].An]sC].SC],Kw]:kCL,ekL: etl}:kCL,tqn];liUt]:tI:Agk],mL;l}:" pgc],wL:
nm]. 2 lI,tL, etL,niuc]:sUw]:mUc];"
 epL; kiuc].kac].lium];tUw]kgp]:Sum];liUt]:nn]. tk];etl}:SC],liUt]:pn] l}al}ayU,nit]."
etl}:hac]:hqn];liUt]:Pgm].w}.tL, 2 pun]: Am],nn] 3 pun]:Kgc]liUt]:tI:Agk],kCL," miUn]nc], -
epL;kUn];pQn] Sum];liUt]:kCL, 1000 cc n} kUn];pQn]etlUw], 2000-3000 cc w};w};"
2. SEPTIC SHOCK (kuic].kac].luim];tUw]kgp]:liUt]:pQn]kgc].)

 kgp]:liUt]:l}:Sum]; Agk],kCL,El:pn]nm]. IV"
 pn] ampiclllin El: gentamicin Am],nn] ceftriaxone, dose Suc] - IV etlIliUw]"
 Kt];sC]hLtUv];cw]:hak]:cw]:An]l}:sp];tit];siUw].mqc];"
64
3. ANAPHYLACTIC SHOCK (yL' Tat]:Am],mqn]:eSEl:kuic].kac].luim];tUw])
 kiut];yut];liUt]: Am],nn]yLAn]SCac];pn]yU,"
 tL,liUt]:/nm]. l}:Sum];Agk],kCL,nn].pn]nm]. IV "
 pn] adrenaline, chlopheniramine El: hydrocortisone (tL,hqc];yLtUv];tI:Tqc]:nL:niuc]:)
4. CARDIOGENIC SHOCK (kuic].kac].luim];tUw] kgp]:hqc];mip],liUt]:hUw]sC]eA,)

 yUt];yLpn]lgc]:tac];An]hQt];hC]:pQn]" (miUn]nc], - liUt]:sac]' beri beri)
 tL,yUt];yL lgc]:hqc];hUw]sC]eA,nn]. hC]:kCL,tUv];tI: (kn] 8.2)
eKL:m}atgc];kU:lgc]:lgc]:
SC],sC]pC].tUv];kUn];pQn]kU:ekL.miUn]nc],
 Pac]hac]:lm],lgc]:(hqc];liUt]:tgn]:' hqc];liUt]:' hqc];TUv];sC])siUw];n}.tUv];pn] 15 minit].niuc]:pgk]:"
 yQw]:An]Agk],mL;nn].(SC],S}ayac]w}.pn])tL,kUn];lUc]Tuk],lIAgk],mL;Am],eA,liUw] 30cc/sUw]:mUc];'
luk]:Agn], 2cc/kg/sUw]:mUc];"
 lgk];S}am}aPQc],Kiuc]:nm]. (Fluid balance chart)- m}atgc];nm].tI:SCac];Kw]:kCL,El: nm].An]l}:
lU.Sum]; kCL,w}." (yQw]:' liUt]:)
 epL;Aw]KiUc]:Tgm],hU Tgm],tUv];pgt],n} etl}:cin];SQc] miUn]nc],SQc]KUn]hUw]TUSC],kn]nn]. pgc],wL:
nm].Kw]:nC];tUw]nm]kCL,pqt]:"
epL;kUn];pQn]nim]kCL,yw].Tuk],lIKUn].hLmk];mn]:lgc]:An]hQt];hG]:kuic].kac].luim];tUw]" (Aac]:Aic]tI:Et,kn]n}.
Kiun];)
lgc]:yUt];yL Kt];sC]hLtUv];El:mk];mn]:lgc]:tac]; An]hQt];hG]:kuic].kac].luim];tUw]El:

yUt];yLnc],pL:niUw]"
lgc]:hQt];Sac]:Kaw];yaw]; (LONG-TERM MANAGEMENT)

lgc]:kuic].kac].luim];tUw]n}.pQn]cw];l}a;kiuc].kac].pQn] – epL;wL:Am],hQt];pn] hG]:Pac]hac]:An]lm],lgc]:siUw];
nn]. lIKiun]:mL;km];Siuw]:n}siuc] kUn];pQn]sac]:t}al}:" epL;wL:cw];l}a;lIKiun]: (hqc];tgn]:liUt]: <100bpm'
hqc];liUt]:pgt];niUw] > 90mmHG tac];nm]eA,yQw]: >30ml/sUw]:mUc];El:cw];l}a;sC]lIKiun]:mL;) l}a:hqc];
SCac];hC]:pQn] 1 lI,tL,nC]; 6 sUw]:mUc];"
65
lgc]:eh.kc]:
epL;wL:kUn];pQn]kuic].kac].luim];tUw]yw].yUt];yLl}:w};kL:hiuw]ekL: ethQt];hC]:lgc]:tum].tiUw].etL,KUc];nC];lm],
lgc]:kUn]; miUn]nc], mak],kqw];' tp];' Agk];eAL eA,kL:nn].yw]." lgc]:s}g:liUw]yUt];yLsQm]sw].El:
yUt];yL pn]w};w};n}. ets}g:kUn];pQn]lgt]:t}al}:"
kUn];siUw];yam]:Am],mqn]:eSsiUw];siUw]; miUn]nc],mqc];KUp];pQn]kgc]. Am],nn] yam]:Am],mqn]:yLsiUw];n}.

Tuk],lI lat]:EnwL: Tuk],lIpL;yLSm]; epinephrine El: yLkin] antihistamine w}.sp];tUw]tL,
eS," liUw]eSnn]. Kw]yc];Tuk],lItqm]: lgc]:tI:Kw]Am],mqn]:siUw];nn]. hQt];S}aeKL;h}g:w}.yw]."
Aac]:Aic]
hqc];liUt]:eA, (kn] 14.1)' Tat]:pI,tL,min], B1 eA, (kn] 17.2)"
l}a;pn]yLtL,yUt];yLkiuc].kac].lium];tUw]
Adrenaline (IM) 1 vial = 1cc = 1 mg
Adrenaline 1:1,000 n}.etmI; Adrenaline 1 mg etL, 1 mL solution nC]; 1 mL glass vial"
Dose for Anaphylactic shock, Severse Allergic Reaction
luk]:Agn], < 6 liUn] IM 0.05 mg 0.05 cc  Dose: 0.01/kg (pn]l}:nm]Sut]; 0.5 mg)
6 liUn] - 6 pI< IM 0.12 mg 0.12 cc  IM pQn]tUw]yac],tI:An]K}:hC]:Sm];

6 – 12 pI< IM 0.25 mg 0.25 cc  etL,Tiuc]hqc];liUt]:El: hqc];liUt]:tgn]:
nim]miUn]kw],nn]. 5 minit].niuc]:pgk]: etl}:
>12 pI< IM 0.5 mg 0.5 cc km];km];Sm];pn]"
kUn];lUc] IM 0.5 mg 0.5 cc  tL,luk]:Agn]lqc]- Aw] NSS KUn];elL;
hC]:sac]tL,luk]:Agn],yw].sc],Sm];pn]"
epL;wL:hqc];tgt],hUw]sC]kiut];yut]; Am],nn] kUn];pQn]Am],yU,lIh}a.hqc];nL,n}siuc]

etl}:Aw] adrenaline Sm];pn] IV l}g;l}g;"
IV Adrenaline (1:1000) hqc];tgt],hUw]sC]kiut];yut];
kUn];lUc] 1 mg
luk]:Agn], 0.01 ml/kg (= 10mcg/kg)
66
Chorpheniramine (IV) = 1cc = 10 mg
Chorpheniramine Maleate (IV/IM) – vial 10 mg/ml
luk]:Agn], 1 KUp],lUc];tC]: IV/IM 2 mg 0.2 cc  Dose:
AL,yu 1 – 5 pI< IV/IM 3 mg 0.3 cc
luk]:Agn], - 200 microgram / kg S TAT
kUn];lUc] – 10-20 mg over 1 minute STAT
AL,yu 6 – 12 pI< IV/IM 8 mg 0.8 cc
(pn]l}:nm]Sut]; 40 mg )
kUn];lUc] IV/IM 20 mg 2 cc  tc]; IV/IM n}.pQn]l}a;An]Tuk],lISm];
pn]
Am],nn]
Chorpheniramine Maleate (yLkin]) – tablet 4 mg
luk]:Agn], 1 KUp],lUc];tC]: yLkin] Am],K}:hC]:pn]kin]
AL,yu 1 – 2 pI< yLkin] ¼ tablet BD 1 mg BD
AL,yu 3 – 5 pI< yLkin] ¼ tablet QID 1 mg QID, nm]Sut];nuic]:wn]; 6 mg
AL,yu 6 – 12 pI< yLkin] ½ tablet QID 2 mg QID, nm]Sut];nuic]:wn]; 12 mg
kUn];lUc] yLkin] 1 tablet QID 4 mg QID, nm]Sut];nuic]:wn]; 24 mg
Hydrocortisone (IV/IM)
Hydrocortisone sodium succinate (IM/SlowIV) – 1 vial = 100 mg
luk]:Agn], 1KUp],lUc];tC]: IV/IM 25 mg/6 H  Dose:
AL,yu 1 – 5 pI< IV/IM 50 mg/6 H luk]:Agn], - 2 mg/kg (kU: 4-6 sUw]:mUc];)
AL,yu 6 – 12 pI< IV/IM 100 mg/6 H kUn];lUc] – 200 mg/kg (kU: 4-6 sUw]:mUc];)
kUn];lUc] IV/IM 200 mg/6 H  IM Am],nn] Slow IV n}.pQn]l}a;An]
Tuk],lISm];pn]
Am],nn]
Dexamethasone (IV/IM) – 1 vial = 1 cc = 4 mg
Dexamethasone Phosphate (IV/IM) – 1 vial = 1 cc = 4 mg
luk]:Agn], < 8 kg IV/IM 1 mg 0.25 cc  Dose:
8 kg – 15 kg IV/IM 3 mg 0.75 cc luk]:Agn], - 0.25 mg/kg STAT
15 kg – 30 kg IV/IM 5 mg 1.25 cc kUn];lUc] – 12 mg STAT
> 30 kg IV/IM 8 mg 2 cc
 IV/IM n}.pQn]l}a;An]Tuk],lISm];pn]
kUn];lUc] IV/IM 12 mg 3 cc
67
tac];pQn]kQw],lUv]: hBw]sC]El: SQn]:lUit]:
8
8.1 tac];pQn]liUt]:Suc]
eKL:piut],tI:pgc], tac];pQn]liUt]:Suc] (hqc];liUt]:Kiun]:Suc]) An]wL:nn]. hqc];liUt]:miUw]:hUw]sC]mip],
(hqc];liUt]:pgt];niUw]) El: hqc];liUt]:miUw]:hUw]sC]p}g, (hqc];liUt]:pgt];tC]:) Kiun]:Suc]liUw]kUn];km]: nm]nn].
yw]." km]:nm]Et. hqc];liUt]:miUw]:hUw]sC]mip], (hqc];liUt]:pgt];niUw])pQc];kn] Am],nn] Suc]liUw] 140 mm Hg
El: hqc];liUt]:miUw]: hUw]sC]p}g, (hqc];liUt]:pgt];tC]:)pQc];kn] Am],nn] Suc]liUw] 90 mm Hg n}.
pgc],wL:pQn]tac];pQn] liUt]:Suc]yw]." tac];pQn]liUt]:Suc]n}. pQn]lgc]:pQn]eP;t}aPak],l}: (kn] 8.3)'
hqc];hUw]sC]eA, (8.2)' hqc];hQt];kan]mak],kqw];Am],lI (kn] 8.2)"
kgp]:tac];pQn]liUt]:Suc]eSEl: etsac]:pQn]hUw]K}:' hUw]mw]; Am],nn] hiUw].AUn]:siUw];n}.yw]." epL;Am],mI;
Pac]hac]: tac];pQn]tac],siUw];sgm];mL;n}siuc] km]:nm]Et. etAm],En Pac]hac]:tac];pQn]Sc]" tqk]:sam];
pk],ktI,kUv];ekL:hU.l}:yU," kUn];lUc] An]mI;p}a;yU,lItI:lIn}. Tuk],lItqk]:tUv]; 3 pI<niuc]:pgk]:"
l}a;tqk]:hqc];liUt]:
 mUiw]:p},tqk]:pn]nn]. kUn];pQn]Tuk],lInc]:nim]nim] mgk]: 5 minit].eSkgn], (nc]:yU,)
 epL;tqk]:miUw]:lC]ekL: hC]:sC].Kqn]kUn];pQn]P}a,lQw]kUv]; (tqk],P}a,lC]n} m}atgc];w}.sgm];) km]:nm]Et.
etsC].Kqn]miuw];P}aKCLkn]"
 lUtUv];2 mmHg hC]:tqt]:nqt]:tL,eS,"yL,eplL:lI:lam];Aw] hC]:kCL,tUk];tI:tUw] 0 Am],nn] 5"
AL,yu' Kaw];yam];An]tqk]:El: kan]tUc].tUw]siUw];n}. ethQt];hC]:hqc];liUt]:pqk],piUc]kn]l}:" kgp]:sC] Am],
nim]' sQp];El:yU,tI:An]Am],yam]:miut]:ekL: sac]:hQt];hC]:hqc];liUt]:Kiun]:l}:nuic]:kqp].km]; nc],kw]," epL;
kUn];pQn] Am],mI;Pac]hac]:tac];pQn]Sc]n} tQk]:tUv];pgk]:lQw]kUv];eSEl:mk];mn]: tac];pQn]etAm],l}:"
tI:eA,Sut]; nC];Kaw];tac]; 3 liUn]l}:tqk]:tUv]; 3 pgk]:nn].epL;hqc];liUt]: miUw]:hUw]sC]mip], (hqc];liUt]:
pgt];niUw]) pQc];kn]Am],nn] Suc]liUw] 140 mm Hg El:hqc];liUt]:miUw]:hUw]sC]p}g, (hqc];liUt]: pgt];tC]:)
pQc];kn] Am],nn] Suc]liUw] 90 mm Hg n}. pgc],wL:pQn]tac];pQn]liUt]:Suc]yw]."
liUw]eSpQn]tac];pQn]liUt]:Suc]h}a.hqc]; (hqc];liUt]:pgt];niUw]nm]liUw] 180 Am],nn] hqc];liUt]:pgt];tC]:
nm]liUw] 120) Am],nn] epL;Am],mI;tac];pQn]Sc]sgm];eSEl: nC];Kaw];tac]; 3 liUn] tI:eA,Sut];
tqk];tUv]; 3 pgk]:yw]. hqc];liUt]:Am],nim]n}siuc] etpgc],l}:wL: pQn]tac];pQn]liUt]:Suc]"
lgc]:mk];mn]:tac];pQn]El:lgc]:yUt];yLtac];pQn]n}.pQn]An]lm],lgc]: kgp]:wL:sac]:pQn]eP;etL,tac];pQn]
hUw]sC]' SQn]:liUt]:tn]El: mak],kqw];Am],lIsiUw];n}.yw]." epL;wL: mI;lgc]:pQn]eP;l}:tac],siUw]; miUn]nc],
AL,yuyC],(60 p}a)' lic], (s}a;' yic];)' kin]Am],wan]' lut],lqn];yL:' K}mn];nC];liUt]:Suc]' pQn]yQw]:wan]
(kn] 10.1)
68
tac];pQn]kQw],lUv]: hBw]sC]El: SQn]:lUit]: 8
Am],nn] kUn];pQn]pQn]tac];pQn]hUw]sC] Am],nn] tac];pQn]mak],kqw];yU,yw].n}siuc] Kqn];ethQt];hC]:pQn]eP;
nm]liUw]yw]."
cw]:hak]: (Cause)
km]:nm]Et. 95% Am],hU.wL:liUt]:Suc]pQn]kgp]:Sc]" siUc].n}n}.Kw]hgc].wL: tac];pQn]liUt]:Suc] Am],hU.
cw]:hak]:" An]liUw] 5% Et.mI;cw]:hak]:" siUc].n}n}.Kw]hgc].wL: tac];pQn]liUt]:Suc]mI;cw]:hak]:"
lgc]:siUw];nn].Et.
 kin]lw]:' lut],lqn];yL:  yL:yLEl:yLmw];km] – prednisolone
 man];pQn]kgc].  yLeh.kc]:Sn],eT,' yLygc],mL:' yLEk:
 tac];pQn]mak],kqw]; kUn].Kiun]:An]Am],mI;steroid' SpU<temL;
 tac];pQn]mak],ln]him];mak],kqw];Am],nn]  sQp];El:sC]Am],nim]
mak],ln]tac],siUw];  tac];pQn]hUw]sC]An]kiUt],pL;mL;sgm];
 pI;pUn].tI:
*eKL:m}atgc];" "man];pQn]kgc].n}. pQn]cw];l}a;h}a.hqc];tL,Em:pL;tgc].eSEl: miUw]:sm]etkiUt],nn].etpQn]
liUt]:Suc]" pQn]siUc].n}n}.Am],miUn]tc];tac];pQn]liUt]:Suc]Am],hU.cw]:hak]:" l}a;yUt];yLekL: Am],miUn]kn]"
Pgn];sL.Pa},lc]tac];pQn]liUt]:Suc]
 SQn]:liUt]:- miUw]:p}tac]; kUn].Kiun]:' SQn]:liUt]:nC];hUw]sC]kqp]:"
 sum];SQn]:AQn]AL<yUc],kac] – t}aPak],n}. Pgn];sL.Pa},lc]tac];pQn]liUt]:Suc]An]niuc]: An]k}.
hn]pQn]nm]El:Aap]:etpQn]kgp]:SQn]:liUt]:nC];Agk];eALtqk],Am],nn]SQn]:liUt]:nC];Agk];eALtn]
kUn];pQn]liUt]:Suc]n}.etk}.pQn] SQn]:liUt]:tn]kqp].km];El: liUt]:l}tI: subarachnoid nm]"
kgp]:liUt]:Suc]eSEl: hQt];hC]:tum].tiUw].Agk];eALn}. etpQn]miUw]:hqc];liUt]:Suc]nL,kUv];El:
Am],SU:k}.pQn]" Pac]hac]:kQw],lUv]:SQn]:AL,yUc],n}ekL: ettum].tiUw].lgc]:lat]:kCam]; Am],nn]
lgc]:muc]:hn]kiut];yut]; kCL,sUw]:kqp]:' nL' kCc]' pQn]can];El:lium];tUw]siUw];n}.yw]:" epL;wL:kum];
Tic];hqc];liUt]:l}:lIn}ekL: Pac]hac]:siUw];n}.eth}akCL,"
 tL - sac]:hQt];hC]: rqt],tI,nL, (Retina) An]hp].AL<yUc],muc]:hn]lU.lqw]l}:" liUt]:Kiun]:Suc]
kL:hiuw]ekL: sac]:hQt];hC]:lU.lqw]kL:nn]." n}.etpQn]lgc]:tum].tiUw].AL<yUc],muc]:hn]" kUv];kL:
hG]:tL epL;mgt],kCL,n}ekL: eA,yU,yw]."
 hUw]sC] - hqc];liUt]:Suc]n}. etpQn]hUm]:pL;tc]; tac];pQn]hUw]sC]km]:nm] kgp]:piUw]:tac];pQn]SQn]:
liUt]: nC];hUw]sC]nn].yw]."kgp]:hqc];liUt]:Suc]eSEl: hUw]sC]etpQn]tam],kCL, kam]:niUw].hUw]sC]hgc]:P}a,
S}a.tac];tC]: etnLmL;" kgp]:liUt]:Suc]h}a.hqc];eSEl: ethQt];hC]:hqc];hUw]sC]P}a,S}a.eA,kCL,pqt]:"
kam]:niUw].hUw]sC]hgc]: P}a,S}a.tac];niUw] (eA,TrI,rn],) (Left Atrium) ettUc].niuc]w};mL;eSkw],"
 mak],kqw]; - kgp]:tac];pQn]mak],kqw];eSEl: sac]:pQn]hqc];liUt]:Suc]l}:" kUv];kL: kgp]:hqc];
liUt]:Suc]Kaw];hiuc]eSEl: etsac]:hQt];hC]: hqc];hQt];kan]mak],kqw];eA,Kaw];huic]kCL,l}:"
69
8 tac];pQn]kQw],lUv]: hBw]sC]El: SQn]:lUit]:
 hqc];liUt]:Suc]h}a.hqc];An]kum];Tic];Am],l}: - hUm]:tc];hqc];liUt]:etKiun]:Suc]nL,eSEl:
cw];l}a;pQn] Pgn];sL.sgm];lc]An]EnmL;miUn]nc],pL:niUw]w}. An]niuc]:nn].yw]."
lgc]:Tt];Sac]tac];pQn]liUt]:Suc]
Agn]tac];Sut]; Aw]piun];kUn];pQn]hC]:Kqm].lqp]:" kUt],Tt];tUv]; sgm];tUw]kUn];pQn] hC]:es;sgt]," w}a;nn].
hQt];lgc]:sqt]:eS;c}a:c}a:"
1. tqk],tUv];hqc];liUt]:kUn];pQn]hC]:tqt]:nqt]:" etl}:mk];mn]:tac];pQn]El: hqc];liUt]:Suc]h}a.hqc];
nm]eA, hC]:tqt]:nqt]:"
2. hLtUv];eKL:An]etsac]:pQn]eP;l}:etL,tac];pQn]hUw]sC]El:SQn]:liUt]:tac],siUw]; (tUv];pL:niUw])
El: tac];pQn]Pgn];sL.Pa},lc]"
3. mk];mn]:wL:sgc],mI;cw]:hak]:Sc] An]hQt];hC]:pQn]tac];pQn]hiuw]" tac];pQn]liUt]:Suc]mI;cw]:hak]:n}.
etpQn]nC];-
 kUn];pQn]An]mI;Pac]hac]:tac];pQn]tac],siUw];"  pQn]hqc];liUt]:Suc] An]h}a.hqc];"
 kUn];pQn] An]mI;lgc]:kUt],Tt];liUt]:El:  pQn]hqc];liUt]:Suc]An]yLAm],tiUw]."
yQw]:Am],pQn]pk],ktI,(puc],man],)"  kUn];pQn]An]mI;piun];km];km];pQn]tac];pQn]
 kUn];pQn]An]AL,yutuik].lQk].yU,(lQk].liUw]30pI<)" kQw],lUv]:SQn]:tac];yQw]: siUw];n}.yw]."
lgc]:sqt]:eS;nn]. ets}g:mk];mn]:l}:wL: lgc]:pQn]eP;etL,tac];pQn]hUw]sC]El: SQn]:liUt]:' mk];mn]:
tac];pQn]liUt]:Suc] mI;cw]:hak]:El: hC]:hn]tqk],lqc];lgc]:tac];pQn]Pgn];sL.Pa},lc]siUw];n}.yw]."
 Aw] urine dipstick eSkUt],Tt];tUv];kUn];pQn]kU:ekL. kUt],lgc]:tac];nm]eA,liUt]:'
prUw],tin];El: klU;kUt].S]nC];yQw]:" epL;wL:mI;n}ekL: Tuk],lItiUc],pac],tc];emLyL"
 epL;Tac],wL: Aap]:etmI;tac];pQn]Pgn];sL.sgm];lc] Am],nn] tac];pQn]liUt]:Suc] mI;cw]:hak]:n}
siuc]Aw]liUt]:tL,kUt],Tt]; plasma creatinine, BUN, electrolytes El: plasma cholesterol"
 epL;Tac],wL: Aap]:etmI;tac];pQn] hqc];liUt]:Suc]mI;cw]:hak]:n}siuc] tL,hLtUv];cw]:hak]:tac];pQn]
nn]. Tuk],lISUc],kUn];pQn]kCL, kUt],Tt];tI:hUc];yL"
tL,yUt];yLnn]. sC].piUc]nm]; (lgk];Kgc]: 1) eSs}g:tqp];tt];wL: Tuk],lIsC].lgk];l}a;An]lC] hC]:Tuk],mqn]:
tL,kUn];pQn]" mac]eKL:An]lm],lgc]: Am],Tuk],lIlium];wL: -
 Aw]hqc];liUt]:An]niuc]: w}.pQn]piUc]tL,kUn];kU:ekL.Am],l}:" kUn];pQn] An]mI;tac];pQn]yQw]:wan]
Am],nn] hqc];hUw]sC]eA, Am],nn] tac];pQn]mak],kqw];siUw];n}. Tuk],lIyiUc];w}.tI: BP <125/85"
 pqk].Sm].wL:hqc];liUt]:Suc]miUn]kn]eStL.kgp]:kUn];pQn]pqk],piUc]:kn]El:lgc]:tiUw].yLekL:etpqk],piUc]:kn]"
 kgp]:wL:epL;Tuk],lIlqk]:l}a:l}a;yUt];yLekL: etl}:lqk]:l}a:l}:nn]. Tuk],lItqk]:hqc];liUt]:
tL,eS,"
 Tuk],lIpn]tac];hn]Tiuc]kUn]:pQn]wL: Tuk],lIhQt];hG]:nm].nk];tUw]eA,lUc]; lQn]:Agk],hqc];pn] tL,
eS, hG]:ygm];kin]kiUw]sQm];El: kiut];yut];Am],nn] lgc]:tac],siUw];An]etpQn]eP;l}:nn].
hQt]:hC]:eA,lUc];"
70
l}a;yUt];yL(Therapy)
Tuk],lIlat]:EnkUn];pQn]kU:ekL.tL,hG]:lqk]:l}a:lgc]:yU,lgc]:Sw]; (tUv];tI:l}a;yUt];yLlUv]:lgc]:yU,Sw];)
hqc]; hqc]; lgc]:pQn]eP;etL,
liUt]: liUt]: tac];pQn]SQn]:liUt]: lgc]:yUt];yL
pgt]; pgt]; hUw]sC]El: Pgn];sL.
niUw] tC]: sgm];Pa},lc]
141 - 91-99 Am],mI; 1. l}a;yUt];yLlUv]:lgc]:yU,Sw];
159 2. Tt];Sac]tUv];Kiun];tI:eA,Sut]; 3 liUn]niuc:] pgk]:"
3. epL;wL:hqc];liUt]:nim]yU,El: Am],mI;Pgn];
sL.sgm];Pa},lc]Sc]n} Am],tap]:lUw], pn]yL
160 - 100-109 yQw]:wan]Am],mI; 1. 2 wUc]:niuc]:pgk]: tqk]:tUv];hqc];liUt]:tL, 12 wUc]:
179 Am],mI;tac];pQn]mak],kqw]; 2. epL;hn]wL: hqc];liUt]:Kiun]:Suc]mL;nm]liUw] 3 pgk]:n}
hqc];hUw]sC]eA,Am],mI; hC]:Et,pn]yL (lgk];Kgc]: 2 )
141 – 91 -109 pQn]yQw]:wan] Am],nn] 1. niuc]:wUc]:niuc]:pgk]: tqk]:tUv];hqc];liUt]:tL, 12 wUc]:
179 tac];pQn]mak],kqw]; 2. epL;hn]wL:hqc];liUt]:Kiun]:Suc]mL;nm]liUw] 3 pgk]: n}
Am],nn] hqc];hUw]sC]eA, hC]:Et,pn]yL (lgk];Kgc]: 2 )
180 – 110 -120 pQn]tc];mUt]; 1. hC]:kUn];pQn]ngn];tI:hUc];yL" nC];Kaw];tac]; 48 sUw]:
200 mUc];nn]. hC]:tqk]:pn]liUt]: niuc]:wn]; 4 pgk]:"
2. lQp]:hQn];tUv]; l}a;Kiun]:hqc];liUt]: (kU:Kaw];yam];'
kac]nC] kUv];' Am],wL:l}:' Kqn]tc];Sgc] P}a,'
ngn];/nc]:yU,)
3. epL;TUp].vL;Pac]hac]:tac];pQn]eSsiUw];siUw];
miUw]:hqc];liUt]:Kiun]:nn]. hC]:m}atgc];w}.
4. wUn].Sgn],lgc]:pQn]l}:tac];pQn]liUt]:Suc]An]mI;cw]:
hak]:
5. epL;liUt]:Kiun]:Suc]n}.yc];pQn]yU,tik];tik]; n}
hC]:Et,yUt];yLpn] (lgk];Kgc]: 2)
>200 >120 pQn]tc];mUt]; 1. hC]:kUn];pQn]ngn];tI:hUc];yLEl:liuw]:hiUw].tQm]tQm]"
Tuk],lIhC]:hqc];liUt]:lUc]; 2. pn]yL furosemide 20-80 mg PO
l}g;l}g;nC];Kaw];tac];pQn] STAT"epL;wL:Tuk],lIpn]n}ekL:hC]:pn]Tqc]:"
wn]; Am],sC]: nC];Kaw];
3. pC].tUv];sgm];Pac]hac]:tac];pQn]An]lm],lgc]: El:
tac];l}asUw]:mUc];" kgp]:
tac];nm]eA,yQw]:An]Agk],mL; kU:sUw]:mUc];"
wL:epL;hqc];liUt]:lUc];
w};n}. etsac]:hQt];hC]: 4. pn]yLhydrochlorothiazide, propranolol El:
enalapril PO nC];Kaw];tac]; 24 sUw]:mUc];
71
tLmgt],' mak],kqw];hqc];eA, hqc];liUt]:pgt];tC]:Tuk],lIlUc]mL; 120 mmHG pUn].kCL,
h}a.hqc];' t}aPak],El: 2 wn]; Tuk],lIlUc];mL; 110 mmHg pUn].kCL, 2-4
hUw]sC]kiut];yut];kCL,l}:" wn]; Tuk],lI lUc]; mL; 100 mmHg
5. epL;wL:hqc];liUt]:lUc];mL;Tiuc] 160/100mmHg Am],nn]
eA,liUw]nn]. tL, 2 wn]; hG]:pn]yLeS hC]:kUn];pQn]
lUc];hUc];yLl}:" hC]:kUn];pQn] mL;tqk]:tUv];hqc];liUt]:kU:
wn]; tL,niuc]:wUc]:"
6. tL,2 Tiuc] 3liUn]nn]. hC]:k}.mL;tqk]:hqc];liUt]:tUv];"
>200 >120 Pac],hac]: CNS El: 1. hC]:kUn];pQn]ngn];hUc];yLEl:tiUc],pac],tc];emLyL"
hUw]sC]hQt]; 2. pC].tUv];Pac]hac]:An]lm],lgc]: GCS El:yQw]:An]
kan]Am],pQn]tI:pQn]tac]; Agk],mL;"
(hqc];liUt]:Suc] 3. Kt]];sC]hC]:hqc];liUt]:pgt];tC]:lUc];mL;liUw] 110 mmHg
h}a.hqc];liUw]piUn]:) lUv]:pn]yL IV Furosemide 40-80 mg IV
 eAL.' hak]:
Hydralazine: 5 mg IV STAT tL,20-30
 hUw]K}:' sC]Suk].Sak]. minit].niuc]:pgk]: etL,Tiuc]hqc];liUt]:pgt];tC]: lUc];mL;
Tiuc] 110mmHg" pn]yLl}:nm] Sut]; 20 mg "
 yU,Am],nim] 4. epL;hqc];liUt]:pgt];tC]:lUc];mL;Tiuc] 110mmHg yw].n}
kuit];pn] IV El:pn]yLkin]"
 pQn]can];' lium];tUw]
5. epL;wL:kUn];pQn]kin]l}:miUw]:lC]n}ekL:Et,pn] yLkin]
 pn]hLAL<yUc],mgc];hn] Aw]"
6. epL;wL:hqc];liUt]:luc];mL;Tiuc] 160/100mmHg Am],nn]
 nm].TUm]:pgt], eA,liUw]nn]. tL, 2 wn];pn]yLeShC]:kUn];pQn]lUc];
hUc]; yLl}:"hC]:kUn];pQn]mL;tqk]:tUv];hqc];liUt]: kU:wn];
 hqc];mak],kqw];eA,h}a.hqc];
tL,niuc]:wUc]:"
7. tL, 2 Tiuc] 3 liUn] hC]:k}.mL;tqk]:hqc];liUt]:tUv];"
lgk];Kgc]: 2
epL;hqc];liUt]:yc];
**pn]yLyQw]: (miUn]nc], Suc]yU, l}a:pn]
hydrochlorothiazide)
Am],nn] Tqm]pn]
an ACE – inhibitor
Am],nn] Beta blocker (miUn]nc], enalapril) epL;wL:Am],mI;an
(miUn]nc], propanolol ACE – inhibitor
** epL;wL:kUn];pQn]mI;
Am],nn] atenolol) tac];pQn]hqc];hUw]sC] sC]. Methyldopa
epL;yLsiUw]; eA, Am],nn]
** yLyQw]:nn].lIpun]: ** epL;wL:kUn];pQn]
n}.Am],kum], yQw]:wan]n}siuc] liUk]:
tL,kUn];Tw]:eS beta- TUn]:n}siuc] pQn]Em:pL;tgc].n}
blocker Sm]. an ACE – inhibitor
Tqm]yLtac], Agn]tac];kgn], siuc] liUk]:
lItL,kUn];mI;tac]; siUw];pn] methyldopa
72 pQn]hUw]sC] Am],nn] Agn]tac];"
sQp];nL:AUk];
lgk];Kgc]: 3 yLhG]:hqc];liUt]:lUc];' tac];nm]eA,yL' tL,ew:El: Pgn];sL.yL
yLyQw]:
*Hydrocholorrothiazide 12.5 mg OD Angiotensin Converting Enzyme Inhibitor
(nm]Sut]; 50 mg OD) (ACE – I)
tL,ew: - tac];pQn]kw].' Em:pL;tgc].' hqc];hQt];kan]
U U
Enalapril 5 mg OD 3-4 wUc]:niuc]:pgk]:tiUw];pn] 2.5
tp];Am],nn] mak],kqw];Am],lIh}a.hqc]; mg OD (nm]Sut]; 40 mg OD )"
Pgn];sL.yL - hQt];hC]: Tat]:pUw],tqt],SI,yam], tL,ew: - Em:pL;tgc].
U U
nC];liUt]:eA,' Tat]:kiUw]wan] nC];liUt]:nm]' miUw]:lqk]: Pgn];sL.yL - hQt];hC]:hqc];liUt]:eA,lUc];'

l}a:kan]wac];tUw]nn]. hQt];hC]:hqc];liUt]:tUk]; hqc];hQt;] kan]tp];Am],lI' A}hqc]:
* Furosemide 40 mg OD (nm]Sut];Am],mI;) Central working Anti-hypertensive

tL,ew: - hqc];hQt];kan]tp];Am],lIh}a.hqc];
U U Methyldopa ( 250 mg BID-TID ' nm]Sut];
Pgn];sL.yL - hQt];hC]: Tat]:pUw],tqt],SI,yam], nC]; nuic]:wn]; 3 g ) (kUn];Tw]: 125 mg BID-TID '
liUt]:eA,(Tuk],lIpn]Tat]:kiUw]pUw],Tqt],SI,ym]sgm];) nm]Sut];nuic]:wn]; 2 g )"
tL,ew: - sC]tUk];' miUw]:tac];pQn]tp];TL.yU,
U U
Beta-blockers Pgn];sL.yL –tUn].' pQn]sQp];nC];pak],' pak],hqc]:'

*Propranolol 40 mg BD 3-4 wUc]:niuc]:pgk]: tiUw];pn]
kC]:
40 mg BD etL,Tiuc]hqc];liUt]:tWn]:lUc];mL;eA,liUw] 60
pgk]:/minit]. (nm]Sut]; 160 mg BD )" yLKCak]:SQn]:liUt]:
tL,ew: -mgc]eKL' tac];pQn]lgt],lUm];tn]Kaw];hiuc]' hqc];
* yLkin] Hydralazine 20 mg BD (nm]Sut]; 50 mg
U U
tgt],liUt]:eA,liUw] 50 pgk]:/minit].
BD)
Pgn];sL.yL - hQt];hC]:hqc];tgt],liUt]:eA,lUc];' p}a
tL,ew: - hqc];tQn]:hUw]sC]w};h}a.hqc];' tac];pQn]
tin]p}amiuw];kt];' Pn]Am],lI/ pan];et,
U U
mak],kqw];
Pgn];sL.yL - hUw]sC]tQn]:w}; (hqc];tgt],liUt]:
* Atenolol 25 - 50 mg OD "
w};)' hak]:"
tL,ew: - mgc]eKL' tac];pQn]lgt],lUm];tn]Kaw];hiuc]'
U U
hqc];tgt],liUt]:eA,liUw] 50 pgk]:/minit]. * yLSm]; Hydralazine IV tL,sC].miUw]:hqc];liUt]:Suc]

Pgn];sL.yL - hQt];hC]: hqc];tgt],liUt]:tqm],lUc];'
h}a.hqc]; 5 mg IV 20-30 minit].niuc]:pgk]: Sm];pn]
p}atin]p}amiuw];kt];' Pn]Am],lI/ pan];et,
l}g;l}g;etL,Tiuc] hqc];liUt]:pgt];tC]:lUc];mL;eA,liUw]
110 mm Hg (nm]Sut]; 20 mg)
tL,ew: - ham]:Sm];pn] kUn];t}aPak],
U U
Pgn];sL.yL – sgm];nc],pL:niUw]El: hQt];hC]:hqc];

liUt]:kiuc].kac].tUk];w};"
lgc]:yUt];yLtac];pQn]liUt]:Suc] (Management of HBP)

tac];pQn]liUt]:Suc] 5% n}.pQn]liUt]:Suc]mI;cw]:hak]:" tac];pQn]liUt]:Suc]siUc].n}n}. km]:Pgc]:ekL: yLhG]:
73
h}al}:" tac];pQn]liUt]:Suc] 95% n}.Sm]. pQn]liUt]:Suc]Am],hU.cw]:hak]:" tac];pQn]liUt]:Suc] siUc].n}.Sm].
yLAm],h}aKat],l}: yLTic];pn]w}.l}:kUv];n} Tuk],lISp];lqc];enkUn];pQn]" kgp]:Tic]; hqc];liUt]:Suc]pn]w}.
El: hQt];hC]:tac];pQn]Pgn];sL.sgm];lc]siUw];n}. eA,lUc];l}:" tk];etl}: Sp];lqc];Ensgm];wL: etl}:
yUt];yLtUw]kCL,etL,sUw]:" l}a;yUt];yLliUt]:Suc]nn]. mI; 2 tgn]:" tgn]:niuc]: l}a;yUt];yLlUv]:lgc]:
yU,Sw];kin]Sac]: El: sC].yL:yLyUt];yLnn].yw]."
1. l}a;yUt];yLlUv]:lgc]:yU,Sw];kin]Sac]: (Life style treatment)

epL;lqk]:l}a:l}:lgc]:hQt];lgc]:Sac]:An]Am],Tuk],mqn]:sgm];p}a;yU,lIn}siuc] Tuk],lIpn]hqc];hQt];Sac]:" Tuk],
lItiUw];hQt];nC];lgc]:lQn]:Agk],hqc];tL,eS,El: lgc]:hQt];lgc]:Sac]:An]Tuk],mqn]:sgm];p}a; yU,lIn}nn].
pn]tac];hn]Tiuc]hC]:kUn];pQn]tL,eS," l}a;yUt];yLlUv]:lgc]:yU,Sw]; An]lQw]kUv];ekL: sac]:hQt];hC]:hqc];
liUt]:lUt];ygm];lUc];mL;eSEl:pQn]miUn]kw],Kiun];" kUv];kL: tL,Tic];Sim]; l}a;hQt]; Sac]:mC],kGL,Kaw];hiuc]n}.
mn];yap],nL,El: tk];etl}:mI;lgc]:pn]hqc];kUn];pQn]nm]nm]" epL;wL: sC].l}a;yUt];yLlUv]:lgc]:yU,Sw];
kin]Sac]: An]lQw]kUv];eS hqc];liUt]:miUn]kw],mL;l}:n}siuc] etl}:pC].tUv]; cw];l}a;kUn];pQn]kCL,El: hC]:mL;
tqk]:hqc];liUt]: 3 liUn]niuc]:pgk]:"
miUw]:pn]tac];hn]Tiuc]kU:pgk]:nn]. Tuk],lIpn]hqc];l}a;yUt];yLlUv]:lgc]:yU,Sw]; hC]:kUn];pQn]kU:ekL.

 lgc]:m}:sC] -epL;kUn];pQn]Kac]; lgc]:m}:sC]' ngn];Am],lp];lI' eKL;KUm]' sC]lQk]. Am],nn]
sC]pit];sC]pgt];yU,n}siuc] s}g:Tqm]kum];Tic];lgc]:siUw];nn].pn]"
 yLmac]siUw]; - epL;kUn];pQn] sC].yLmac]siUw]; An]sac]:hQt];hC]:hqc];liUt]:Suc]nn]. epL;kUn]; pQn]
kiut];sC].Am],nn] l}a:sC].yLn}. etpQn]eP;l}:/Am],pQn]l}:hiuw]n} Tuk],lIAup],kum] tc];kUn];pQn]
El:emLyL"
 lw]: - pn]hqc];kUn];pQn] hG]:kiut];kin] Am],nn] hC]:kin]lw]:eA,lUc];"
 nm].nk];tUw]Suc] - epL;kUn];pQn] pI;nL, Am],nn] mI;nm].nk];nm]liUw]An]Tuk],lImI;n}siuc]
pn]hqc]; hC]:lUt]; (eKYL.) nm].nk];' hC]:Tic];lgc]:kin]lgc]:yqm]."
 lQn]:Agk],hqc]; - pn]hqc];hC]:kUn];pQn] lQn]:Agk],hqc];kU:wn];' hC]:kUn];pQn]p}tac];lQn]:tL,eS,
n}nn]. pn]tac];K}:sC]tL,kUn];pQn]kU:ekL.l}:"
 kiUw] – SC],kiUw]nC];tac];kin]eA,lUc];n}. etsac]:hQt];hC]:hQc];liUt]:eA,lUc];" sik];sgk];Pk];
An]hQt];hC]:Pk];wan]n}. km]:nm]mI;Tat]:kiUw]nm]yU,yw]." Tuk],lIygn];tac];hn]Tiuc]tI: emLyL
El: kUn];mI;p}a;hU.P}a,tac];kin]tac];yqm]."
2. yUt];yLlUv]:yL:yL (Treatment with medication)

tI:lgk];Kgc]: 2 nn].etpn]piUc]nm]; lgc]:liUk]:yLEl: sC].tiuw];yLw}." S}am}ayL tL,yUt];yL
tac];pQn]Sm]. yU,tI: lgk];Kgc]: 1 El: 3" epL;etAw]sC].l}a;yUt];yLlUv]:yL:yLn}siuc]
 kUn];pQn]tk];etl}:pgc],sC]wL: tac];pQn]liUt]:Suc]n}. yLAm],h}aKat],l}: kgp]:nn] yLn}. (hUm]:
74
tc];yUt];yLlUv]:l}a;yU,Sw];) tk];etl}:kin]kCL,tc];sUw]:" Kw]Tuk],lIlUlgm]tUv];sgm]; tac];pQn]
Kw]tL,eS,El: tqk]:hqc];liUt]:kCL,etL,sUw]:"
 tL,cw];l}a;An]Am],h}a.hqc];nn]. Et,Aw]tI:pn]yLmQw];lQw]kUv];' yL,pn]yLnm]El: yL,lium]; wL:
yLkm]:nm] etsC].Kaw];yam]; 4 - 8 wUc]:kgn], sc],ethn]Pgn];yL" 2-3 liUn]yw]. epL;hqc];liUt]:
yc];p},lUc];n} hC]:pn]yLnm]tiUw];Tqc]:"
 tUv];sgm];Pgn];sL.yLtL,eS," lat]:enkUn];pQn]wL: epL;mI;Pac]hac]:Pgn];sL.yLn} Am],sC]:wL:
kiut];kin]yLkUv]; kUv];kL:hC]:mL;EntI:hUc];yLKiun];"
 mUiw]:etlqk]:l}a:yLpn] Am],nn] ettiUw];yLtac],mQw];Tqc]:An]niuc]:nn]. epL;wL:Am],mI; Pac]hac]:
Pgn];sL.yLSc]n} hC]:tiUw];pn]yL nm]Sut];sgm];nc],tI:An]pn]l}:"
 epL;wL:kUn];pQn] kiuc].kac].kiut];kin]yLkm];lQw]n} sac]:etpQn]eP;l}: kgp]:n} epL;Kw]KG]:kiut];kin] yL
kgp]:mI;Pac]hac]:Pgn];sL.yLekL:yw]. Kw]Tuk],lIAup],AUw];tc];emLyLtI:hUc];yLeSkgn],"
lgc]:eh.kc]: tUv];tI: l}a;yUt];yLlUv]:lgc]:yU,Sw];kin]Sac]:
Aac]:Aic] hqc];hUw]sC]eA, (kn] 8.2)' t}aPak], (kn] 8.3)' AL<yUc],muc]:hn]Am],lI (11.1)
8.2 hqc];hUw]sC]eA,( Heart failure )

eKL:piut],tI:pgc], hqc];hUw]sC]eA,An]wL:n}. kgp]:hUw]sC]Am],mI;hqc];mip],liUt]:El: Agk],SI,kYin],
kCL,sU;Ac],kL,nC];tUw]Am],kum],TUn]:nn].yw]." epL;wL:mI;lgc]:kCc] tL,mk];mn]:tac];pQn]n} hC]:pn]yL
sam];tUv];eS tUv];tI:Pgn];tgp],yLyw]. sc],etsac]:mk];mn]:tac];pQn]tqt]:nqt]:l}:" hUw]sC]
tc];Sgc]P}a, (hgc]:hUw]sC]p}g,liUt]:P}a,S}a. El: hgc].hUw]sC]p}g,liUt]:P}a,KCL) pQn]l}:nc],kn]tc];Sgc]P}a,
(hqc];hUw]sC]P}a,S}a.El: hUw]sC]P}a,KCLeA,)" tc];Sgc]An] Pac]hac]:tac];pQn] etpqk],piUc]:kn]"
Pac]hac]:tac];pQn]
hqc];hUw]sC]P}a,S}a.eA, hqc];hUw]sC]P}a,KCLeA,
 miUw]:Et,Et. TUv]:sC]yap],miUw]:lQn]:Agk],hqc];  tgc].sQp];' Am],K}:kin]Kw]:' tUn].' tgc].pI'
kUv]; w}a;mL;eth}a.tUiw];mL;l}g;l}g;eS nc]:yU, tgc].pgc];
l}al}aekL: etTUv]:sC]yap],mL;"  SQn]:liUt]:yC], Jugular tI:eKL;PUk].Kiun]:mL;"
 TUv]:sC]yap], miUw]:ngn];c}a" tL,etngn];n}.  tp];yC],' mac]pgk]:etsQp];"
kUn];pQn] etsC].mgn]hUw]nm]mL;" (orthopnea)  KLpgt];tC]:kC]: Am],nn] epL;ngn];lUc];kCL,
 A}hqc]: km]:nm]A}kac]Kiun];kUv];" lc]pgt]:tC]: etkC]:"
 mI;SQc]KI:tiUw]," (l}:cin];SQc] tC]:kUn]:pgt],)
75
cw]:hak]:tac];pQn]hqc];hUw]sC]eA,  tit].SYO;kam]:niUw].hUw]sC] An]liUt]:kCL,Am],
 liUt]:Suc] tqk]:pn]hqc];liUt]:" Tiuc]nn].t}a (hUw]sC]w}a;) kUt],tUv]; ECG
 liUt]:eA, kUt],tUv]; Hct/Hb"  hUw]sC]tQn]:Am],PQc], kUt],tUv]; ECG"
 Beri Beri (pI,tL,min], B1 eA,)  tac];pQn]hUw]sC] kiUt],pL;mL;sgm];"
 ehL,mUn];T};r}W.nm] kUt],tUv]; TSH  tac];pQn]lin].hUw]sC] (lin].hUw]sC]
tI:hgc]:lqp]," kp].nL,pUn].tI: Am],nn] lUm]nL,pUn].tI:)"
 lw]:' sp];yL:mw]km]"
lgc]:st];kan]yUt];yL tac];pQn]hqc];hUw]sC]kiuc].kac].eA,h}a.hqc];
kUn];pQn]etmL;hUc];yL mUin]nc],Pac]hac]: nm].Kw]:pgt],h}a.hqc];" epL;pQn]siUc].n} kUn];pQn]
etkiuc].kac].TUv]:sC]Am],Aim],eS etsC]Am],nim]El: hC]:ngn];lUc];ekL:Am],K}:ngn];lUc];"
lgc]:etl}:kiuc].kac].yUt];yLpn]
 hC]:kUn];pQn]nc]:"
 (epL;mI;)SC],nL:kak], Et,pn]Agk],SI,kYin],nqn]:nqn]:nLnL' tI:eA,Sut];pn]hqc];w};tI: 1 minit].
6 lI,tL,"
 Sm];yLSQn]:AQn]pn] – (epL;cw];l}a;h}a.mL;n} ethn]l}:AQn]liUt]:Kiun];)" sC].eA,l}: kL:hiuw]
ekL: hC]:sC].eA,eA,"
 pn]yLyQw]: – furosemide kUn];lUc] 40-80 mg IV' luk]:Agn], 1 mg/kg"
 epL;pUn].kCL, 30 minit].yw]. kUn];pQn]yc];p},yQw]:Agk],mL;El: p},lIKiun]:n}siuc] pn]yLAn]miUn]
kn] Tqc]:km];niuc]:"
 wUn].Sgn],lgc]:Sm];yL wI,tL,min], B 1 100 mg IM sgm];"
 15 minit].nuic]:pgk]:mat]:ma}El: pC].tUv];Pac]hac]:lm],lgc]:kUn];pQn] etL,Tiuc] cw];l}a;epL; lI"
w}a;nn]. m}atgc];pn] niuc]:sUw]:mUc];niuc]:pgk]:"
 m}atgc];tac];nm]eA,yQw]:An]Agk],mL;hC]:tqt]:nqt]:' epL;wL:tk];etl}:sC].n}ekL: hC]:etL,S}a
yac]pn]"
 epL;wL:hqc];tQn]:hUw]sC]Am],PQc],' w};yU,n}siuc] (hqc]:tWn]:hUw]sC]Am],PQc],=> 120/minit].) hG]:pn]yL
digoxine"
epL;wL:kUn];pQn]lIKiun]:mL;yw].n}siuc] hLlgc]:tac];An]hQt];hC]:h}a.hqc];eS yUt];yLpn]"
76
lgc]:yUt];yL Kk].tgn]:Sgc]
 hC]:ngn];liuw]: nG];tI:ngn];  epL;wL:sC].yL furosemide Kaw];hiuc]n}siuc]
 hC]:kin]nm].eA,(niuc]:wn];nm]Sut];1.5lI,tL,) Tuk],lI Tqm]pn]] pUw],tqt],SI,yam], pL;sgm];
 pn]hqc];hC]:kUn];pQn] kiut];lut],lqn];yL:" (kgp]:wL:yL furosemide ethQt];hC]:kUn];pQn]
 Kaw];yam];yUt];yLyU,nn].sc]:nm].nk];pn] kU: lU.Sum];Tat]: pUw],Tqt],SI,yam],kCL,sgm];yQw]:)
wn];"  pn]hqc];hC]:kUn];pQn]kin]kUv]:Am],nn]
 Siup],pn] furosemide 20-40 mg PO kU:wn];" pn]yLmQt]. potassium chloride 1 mg BID"
nc],hiuw]etkum];Tic];nm].nk];kUn];pQn]mUin]kw],  epL;wL:pn] spironlactone (25 mg OD)
nn]. Sgc]wn];niuc]:pgk]: tiUw];yLpn] 20 mg sgm];yL furosemide yU,yw].n}siuc]
(epL;kUn];pQn]Am],mI;tac];pQn]mak],kqw];Am],lIn} Am],tap]: lUw],pn]pUw],tqt],SI,yam],)"
siuc] pn]yLl}:nm]Sut]; nuic]:wn]; 80 mg)"  epL;pQn]l}:Aw] enalapril eSEt,yUt];yL
pn]"
epL;wL:kUn];pQn] lIKiun]:mL;yw].n}siuc]
Tuk],lISiup],yUt];yLpn]nc],pUic]kw],kCL," yL,lUt];pn]yLeA,lUc];"
Suip],yUt];yL - lgc]:st];kan]yUt];yLhqc];hUw]sC]eA,Kaw];hiuc]
km]:nm]hqc];hUw]sC]eA,h}a.hqc];n}. pQn]Pgn];sL.cw];l}a;tac];pQn]Kaw];hiuc]An]niuc]:" Tuk],lItgc];w}.wL: miUw]:
Et,pQn]tac];pQn]nn]. km]:nm]kUn];pQn]etAm],hU.wL: sQp];pQn]kgp]:Sc]" epL;A}kac]Kiun];n}ekL: etwUn].
wL:pQn]Pac]hac]: pgt],kC]: Am],nn] tin]kC]:n}ekL: etwUn].Sgn],wL:Am],lm],lgc]:Sc]n}kUv];" epL;mk];
mn]:pn]yw].wL: pQn]tac]; pQn]hUw]sC]Kaw];hiuc]n}siuc] tk];etl}:pn]tac];yUt];yL (eA,Sut]; niuc]:liUn]
niuc]:pgk]:) kCL," kUn];pQn]ekL: tk];etl}:yUt];yLtUw]kCL,etL,sUw]:"
kUt],sqt]:tUw]hG]:TI,TUn]:
 kUt],tUv];SQc]hUw]sC] – miUw]:hUw]sC]tQn]:nn]. l}:cin];SQc] miUn]SQc]Kc];mC],mC], Am],nn] SQc]tin]
mL. El: SQc]An]pqk],piUc]:kn]tc];SQc]kw],kw],' tqk]:hqc];liUt]:' hqc];tgt],liUt]:El: nm].nk];"
 Pac]hac]:hqc];hUw]sC]P}a,S}a.eA, - l}:cin];SQc]nm].nC];pgt]," Pac]hac]:hqc];hUw]sC]P}a,S}a.eA, - kC]:
SQn]:liUt]: jugular tI:eKL;PUk].' tp];yC],El: sQp];"
 Pac]hac]:SQn]:liUt]:nC];Ac],kL,tUw]kqp]: - hUw]K}:' k}.lium];' mam].sQp];
 sn].tgn]: (ASac].) lgc]:TUv]:sC]hiUw]. An]muk].sum];kQw],lUv]:tac];pQn]hUw]sC]kU:siuc]:miUc];
Aem,rikan], Kw] mk];mn]:w}.
 sn].tgn]: 1 - Am],mI;Pac]hac]:tac];pQn]
 sn].tgn]: 2 - TUv]:sC]hiUw].miUw]:Agk],hqc]; (mk];mn]:wL: hQt];AI:Sc] sc],pQn])
77
 sn].tgn]: 3 - miUw]:Agk],hqc];hQt];kan]kU:wn]; (p}l}akI,lUw], Am],nn] mqk],l}akI,lUw],
kUn];pQn]sc],hiUw].)
 sn].tgn]: 4 - Pac]hac]:miUw]:liuw].hiUw]. (pqk].Sm].wL:Am],hQt];Sc]ekL: TUv]:sC]
Aap]:hiUw].kL:hiuw])"
pn]hqc];tL,etsC].l}a;yUt];yL lUv]:lWc]:yU,Sw];El: pn]tac];K}:sC]Tqc]:wL:

 hC]:kin]kiUw]eA,lUc];' hC]:lUt];ygm]; lgc]:lut],lqn];yL: lgc]:kin]lw]:El: yLmw];km] Am],nn]
hC]:kiut];yut];kin]"
 pn]tac];K}:sC] hC]:lQn]:Agk],hqc];El:lgc]:tUc].niuc]tUw]" epL;pI;nL,n}ekL: pn]hqc];hC]:kin]eA,lUc];"
lgc]:yUt];yLKaw];hiuc] (tUv];eKL:m}atgc];) epL;yc];mI;Pac]hac]:yU, -

1. pn]yLyQw]:eA,lUc]; tiUw;] yL ACE – I sn].tgn]: 2 Am],nn] 3:
miUn]nc],furosemide Am],nn] Tqm]Tqc]: epL;wL:Am],tap]:ew:yL dogoxin
tL,kum];Tic];nm].nC]; pn] Beta blocker hC]:Tqc]:yLAn]n}.pn]"
tUw] An]liUk]:tiUw].tI:
2. Tqm]Tqc]: ACE – I hUw]sC] (miUn]nc], sn].tgn]: 3 Am],nn] 4:
atenolol Am],nn] epL;wL:Am],tap]:ew:yL
(miUn]nc], enalapril)
metoprolol)" spironolactone
pn]" hC]:Tqc]:yLAn]n}.pn]"
eKL:m}atgc];
U
U Furosemide (PU,SI,m}.t]) * Metoprolol (mqt],tUw],prUw],elL<)

U
tL,yUt];yL tac];pQn]hqc];hUw]sC]eA,Kaw];hiuc]nn]. epL; U Dose: Et,pn] 25 mg BD" tiUw];yLpn] 4

U
wL:tac];pQn]kiuc].kac].TL.mL;n} etsC].yLAn] n}.km]: wUc]:niuc]:pgk]: niuc]:pgk]: 25 mg "

nm]" tL,yUt];yLKaw];hiuc]nn].etl}:lUt];yLpn] pn]yLl}:nm]Sut]; 100 mg lUv]:Am],tap]:Sgn],nm].
eA,eA,eS epL;wL:lgc]:nm].nC];tUw]nm]nn]. nk];tUw]"
lIKiun]:mL;yw].n} hC]:kiut];kin]yL Furosemide" U
tL,ew: - hqc];liUt]:tWn]:eA,liUw] 50 pgk]:/minit].

U U
Dose – 1mg/kg OD kUv];kL:pn]mgk]:Kaw];yam];

U
Ait];niuc]:yw]. lUt];lUc]; pn]pQn] 0.5mg/Kg " Pgn];sL.yL - hQt];hC]:hqc];tgt],liUt]:eA,lUc];' p}a

U
Pgn];sL.yL
U U - Tat];pUw],tqt],SI,ym],nC];liUt]: tin]p}amiuw];kt];' hqc];liUt]:tqm],' Pn]Am],lI' pan];
eA,lUc]; (tL,yUt];yLKaw];yaw];nn]. pn]yLmQt]. et,' hQt];hC]:tac];pQn]yQw]:wan]h}a.liUw]kw],' eh.Pac]
pUw],tqt],SI,ym],pL;sgm];) hac]:yQw]:wan] hQt];hC]:Am],hn]' (epL;Tiuc] 100 mg
78
Enalapril (Aqn]nLlL<pel;l]) etL,wn];yw]:n}siuc]yLetAm],tiUw].tac];pQn] kUv];
yLn}.pQn]yLtUw]lk];(pUic]lUc]) tL,yUT];yL hqc];hUw]sC] kL: ethQt];hC]:tac];pQn]mgc]eKL:El:yQw]:wan]h}a.sL.
eA,Kaw];hiuc]' kgp]:sC].tL,eh.kc]:lgc]:kam]:niUw].hUw]sC]lU. liUw]kw],kUv];" epL;wL:ettiUw];pn]yLn}tk];etl}: U
lqw]" Pac].Et.Et.wL:wL: " U
Dose – Et,pn] 2.5 mg OD tL,niuc]:wUc]:yw].

U U
w}a;nn]. hC]:pn]tiUw];mL;Sgc]pun]:kU:wUc]: etL,Tiuc]l}: U Spironolactone (Spin]nUw]lqk].tUn];)

Pgn];yLSuc]Sut]; km]nm]Et.etpQn] 20 mg OD' hQt];hC]: lgc]:l}:Kiun]:hUc];yL' lgc]:t}asiUw];n}.eA,
pn]yLl}:Suc]Sut]; nuic]:wn]; Am],pUn]. 40 mg " lUc];El: hQt];hC]:Pac]hac]:lIKiun]:
tL,ew: - hqc];liUt]:tqm], (hqc];liUt]:pgt];
U U
Dose: 25 mg kU:wn];(pC].Tt];Sac]lgc]:hQt];kan]
niUw]<90mm Hg) ' mak],kqw];Am],lI' Em:pL;tgc]." tp]; El: Tat]:pUw],tqt],SI,yam],nC];liUt]:)' Am],
pn]hUm]:yLPU,SI,m}.t] -tk];etl}:pC].tUv];lIlI kgp]: SU:pn]pUn].liUw] 25 mg"
wL:hqc];liUt]:sac]:kiuc].kac].tUk];w};" hC]:kUn];pQn]ngn];tI: tL,ew: - kUn];pQn]tI:hqc];hQt];kan]tp];Am],lI
U U
hUc];yLeSEt,pn]yLeA,Sut];" miUw]:Et,pn]pgk]:Agn] Pgn];sL.yL – tL,kUn];s}a; nUm];etsac]:yC],mL;'

U U
tac];Sut];nn].hC]:kUn];pQn]ngn];lUc];El:hG]:pn]hUw]Km]:" liUt]:hUw]liUn]Am],man],'hUw]mw];El:Agk],mun],man],'
Pgn];sL.yL – hqc];liUt]:tUk];' Tat];pUw],tqt],
U U
Tat]:pUw],tqt],SI,yam],nC];liUt]:nm]' epL;sC].hUm]:
SI,yam]nC];liUt]:Suc]' SQn]:liUt]:kC]:' A}hqc]:" tc]; Enalapril Tat]: pUw],tqt],SI,yam]nC];liUt]:
nm]nn]. Kqn];eth}a.hqc];)
Beta blockers An]liUk]:tiUw].tI:hUw]sC]
U
ep,tL, plgk],kiUw],n}. ethQt];hC]:lgc]:eth}a.hqc]; U Digoxin (t},kUw],Sin],)

tac];pQn]nn].TiUc];lUc];kCL,pqt]:' hQt]:hC]:lgc]:l}:Kiun]: kgp]:kam]:niUw].hUw]sC]pgt];niUw]Am],mip],l}:PQn],PQn],El:
hUc];yL' lgc]:t}asiUw];n}.eA,lUc];El:hQt];hC]:lgc]:tUc]. hQt];hC]:hUw]sC]tQn]:w}; Am],nn] pn]yLAn]Tuk],lI
niuch] Qt];Sac]:kU:wn];lIKiun]:" kUv];kL: miUw]:AQn]:Agk],hqc]; pn]yw]. Pac]hac]:yc];p},lIKiun]:siUw];n}. sc],et
nn]. Am],mI;Pgn];Sc]" lgc]:yUt];yLTuk],lIEt,pn] sC].yL t},kUw],Sin]," yLt},kUw],Sin], ethQt];hC]:
eA,eA," Pac]hac]:tac];pQn] lIKiun]:El: lgc]:tUc].niuc]hQt];
* Atenolol: Sac]: kU:wn];lIKiun]:"
U Dose: 25-50mg OD Aw]hUw]liUn]wL:Aw]eS Kiun]:yL
U Dose: kUn];lUc]pn] 0.25 mg PO TID wn];Agn]
U U
pn]l}g;l}g;" tac];' wa};nn]. 0.25 mg OD niuc]:wUc]:pn] 5wn];"

tL,ew: - hqc];liUt]:tWn]:nuic]:minit].eA,liUw] 50
U U
tL,kUn];Tw]:nn]. Et,pn] niuc]:wn]; Kiuc:] mQt].
pgk]: (0.125 mg OD)"
Pgn];sL.yL - hQt];hC]:hqc];liUt]:tgn]:eA,lUc];' p}a
U
tL,ew: - kUn];pQn]An]hqc];tgt]:hUw]sC]tqm],El:
U U
tin]p}amiuw];kt];' hqc];liUt]:tqm],' Pn]Am],lI' pan]; hqc];hQt];kan]tp];Am],lI

et,' hQt];hC]:tac];pQn]yQw]:wan]nL,liUw]kw],' eh.Pac] Pgn];sL.yL – Am],mqn]:tc]; yLt}kUw],Sin],
U U
hac]:yQw]:wan]w}.El: hQt];hC]:Am],hn]' (epL;Tiuc]niuc]: (hak]:' tUn].' sC]Am],nim]' hqc];tgt]:hUw]sC]tqm],

wn]; 100 mg yw].n}siuc]yLetAm],tiUw].tac];pQn] h}a.hqc];El:AL< yUc],muc]:hn]Am],lI)" epLpQn]siUc].
kUv];kL: ethQt]; hC]:tac];pQn]mgc]eKL:El:yQw]:wan] n}mL; hC]:lUt];yLlUc]; Am],nn] kiut];pn]yLpqt]:"
h}a.sL.liUw]kw],kUv];"epL;wL: ettiUw];pn]yLn} epL;pQn]Tat]:lqk];nC];liUt]:eA,El: ehL,mUn];T}.r}W.
tk];etl}: Pac].Et.Et.wL:wL: "
U U
eA,n}siuc] eP;Am],mqn]:yLn}. Kqn];eth}a.hqc];liUw]"
79
wI,tL,min], pI, 1 (Vitamin B 1)
lgc]:pQn]h}a.hqc];kU:eK.S] (case) Am],Aw]tac];pQn] Beri Beri Agk],pqt]:l}:n}siuc] Tuk],lIwUn].Sgn],
lgc]:pn]yLwI,tL,min] B 1 (100 mg IM)" nC];hgc]:yLhw];km]:nm]nn]. tac];pQn]Kat], Tat]:wI,tL,min],
B1 nn].pQn]kn]km]:nm]yU,yw]." Tuk],lIpn]tac];hn]Tiuc]wL: lgc]:yL,hC]:pQn] tac];pQn] Beri Beri nn].
Tuk],lIkin] siUc].hiuw]Am],nn] pn]yLwI,tL,min], B1" kUn];kin]lw]: nm]El: kUn];pQn]hqc];hUw]sC]eA,siUw];
n}. Kqn];Tuk],lIpn]yw]." (kn] 17.2)
Aqt],S]prin], (Aspirin)
tL,kUn];pQn]hqc];hUw]sC]eA,nn]. kgp]:pQn]SQn]:liUt]:nC];hUw]sC]kqp]:lUc];l}:El: epL;pn]yL Aqt],S]prin],
sgm];pL;Ait];Ait];n}siuc]eteh.kc]:Am],hG]:pQn]liUt]:Kqc]tUw]El:t}aPak],Am],nn]SQn]:liUt]:tn]siUw];n}."
tac];nm],eA,yL" " niuc]:wn]; 75 Tiuc] 100 mI,lI,krm],"
Tuk],lIlqk]:l}a:lgc]:yUt];yLmiUw]:lC] ?
 epL;nm].nk];Kiun]:mL;eSEl:mI;h}g;kC]:mL;n}siuc] Tuk],lItiUw];pn]yLAm],nn]Tqm]yLpn]Tqc]:niuc]:mQw];"
 epL;wL:TUv]:sC]yap],eSEl:hac]:hiUw].nm]mL;n}siuc]"
 epL;wL:hqc];liUt]:tqm],lUc]; (pgt];niUw] 90mmHg)' etl}:lUt];pn]yLyQw]: Am],nn] yL
enalapril"
 epL;hn]Pac]hac]:wL: Am],mqn]:yL t},kUw],Sin], - kiut];pn]yLmgk]:l}al}awn];eS epL;Pac]hac]:h}a
kCL,yw].n} Kiun];Et,pn]Kiun];Ait];Ait];"
 epL;hn]Pac]hac]:Tat]:pUw],tqt],SI,yam],nC];liUt]:nm] (tUn].' hqc];tgn]:hUw]sC]Am],PQc], epL;pQn]
siUc].n} ha}.hqc]; Am],nn] Kaw];hiuc]n}etl}:wL:pQn]cw];l}a;lm],lgc]:) hqc];liUt]:tWn]:w}; Am],nn]
TiUc];) n}siuc] lUt]; Am],nn] yL,pn]yL enalapril Am],nn] Spironolactone" epL;wL:pQn]
Pac]hac]:lm],lgc]:n}ekL: etl}:tiUc],pac],tc];emLyLkm];lQw]"
 epL;kUn];pQn]yU,lIKiun]:mL; Am],nn] cw];l}a;nim]mL;ekL: yL,lUt];yLtI:An]pn]yU,"
lgc]:eh.kc]:
pn]hqc];kUn];pQn] hC]:lqk]:l}a: l}a;yU,Sac]:kin]Sw];" epL;hn]wL:pQn]hUw]sC]w}a;(lU.) kgp]:SQn]:liUt]:
kqp]:n}siuc] hC]:pn]yLAqt],S]prin]," pn]tac];hn]Tiuc]lgc]:kin] Am],nn] pn]yLwItL,min], B1"
Aac]:Aic]
liUt]:Suc] (kn] 8.1)' hqc];liUt]:eA, (kn]14.1)' Beri Beri (Kat],Tat]:wI,tL,min], pI, 1)
(kn] 17.2)' ehL,l]mUn];T};r}W;nm] (kn] 10.2) kin]lw]:El:yLmw];km] (kn] 23.1 )"
80
8.3 t}aPak],(Stroke)
eKL:piut],tI:pgc],
t}aPak],Tqc]:An]niuc]:ekL: hgc].l}:wL:SQn]:liUt]:nC];Agk];eAL vL;lgc]:tum].tiUw].' pQn]lgc]:ES;l] eStI:
tI: nC];Agk];eAL l}:kiuc].kac].t}akCL, kgp]:liUt]:l}mL;Am],Tiuc]" kgp]:SQn]:liUt]:pgc],(SQn]:liUt]:nC]; Agk];
eALtqk],' liUt]:l}nC];Agk];eAL) Am],nn] SQn]:liUt]:tn] (liUt]:Kqc]tUw]pQn]kgn]:eS kCL,Aiut];w}.tI:
SQn]:liUt]: nC];Agk];eAL' SQn]:liUt]:tn]t}aPak],) eShQt];hC]:liUt]:l}sU;Agk];eAL kiut];kCL,El: sc],
l}:pQn]t}aPak],nn].yw]." 80% n}.kgp]:SQn]:liUt]:tn]eSEl: 20% n}.kgp]:SQn]:liUt]:pgc],eSsc],l}:
pQn]" tit].SYO;sgm]; SQn]:liUt]:kCL,nn]. l}:lU.lqw]t}akCL,nn].yw]." (tL,hC]:ES;l]nC];Agk];eAL l}:
hp].Agk],SI,kYin],' AL,hL,rEl: tL,Aw]Kgc]lU.siUw];n}.pqt]:nn]. etl}:mI;liUt]:l}Pan],mL;)" Aic]niUw]
Agc]:tI: tI:pQn]eS sc],l}:t}aPak],kCL, eStI:tI: miUn]nc],t}aPak],kCL,tc];tUw]' l}:lU.Sum];AL<yUc],
muc]:hn]kCL,' Am],lat]:kCam];l}:lIlI' tum].tiUw]. Agk];eAL An]m}atgc];' Stivan],eA,lUc];kCL,' lium];tUw]
Am],nn] t}asiUw];n}.yw]." lgc]:h}a.hqc];nn]. etAic]nUiw] tI:An]lU.lqw]kCL,kL:hiuw]El: ygm],lC]Kgc]Agk];
eAL An]tI:tum].tiUw].siUw];n}.yw]."
Pac]hac]:tac];pQn]
SQn]:liUt]:tn] SQn]:liUt]:nC];Agk];eALtqk],
 tLP}a,niuc]: Am],nn] tc];Sgc]P}a,' tLAm],  kiuc].kac].hUw]K}:El:h}a.hqc];
epL;hn]lI Am],nn] AL<yUc],muc]:hn]eA,  lium];tUw]' mI;lgc]:lqk]:l}a:tI:sC]
lUc];  pQn]can];
 hUw]K}:h}a.hqc];' km]:nm]etwL: hUw]K}:h}a.hqc];liUw]  hak]: Am],nn] tUn].h}a.hqc];
piUn]:nC];PwKw]" hqc];eA,nL, Am],nn]  hqc];liUt]:Kiun]:Suc]h}a.hqc];
Am],hU.niUw].hU.tUw]tI:nL: Am],nn] Kqn]  km]:nm]Et. tUw]P}a,lQw]Am],mI;hqc];' nL
Am],nn] KL' km]:nm]Et.etpQn] P}}a,niuc]: Am],nn] AQn]t}a
Kgc]tUw]kUn];"
 hUw]mw];' Tic];tUw]Am],l}: Am],nn] lgc]:
tUc]. niuc] Am],PQc],kn] km]:nm]Et. et
KUn];Kw]; tc]; Pac]hac]:tac],siUw];"
lgc]:mk];mn]:sgm];nc],l}a;yUt];yL – Aw]piun];tac];pQn]lIlI' km]:nm]Et. Tuk],lITam]Et,pQn]Pac]hac]:
siUc].hiuw]' Suip],lam];pQn]kCL,siUc].hiuw]El: An]etpQn]eP;l}: mI;eKL:Sc]l}al}asiUw];n}.yw]." etl}:kUt],
81
Tt]; kqw],lUv]:SQn]:AL<yUc]," epL;pQn]l}: epL;mI;etl}:Aw] ultrasound scan eSkUt],sqt]:SQn]:
liUt]: carotid tUv];"
eKL:siUw];An]etpQn]eP;l}:
AL,yuEl:lic], sgm];nc],AL,yueStac];pQn]t}aPak],ekL:etKiun]:Suc]mL;sgm];'
km]:nm]Et.epL;AL,yupUn]. 55" kUn];s}a;etpQn]l}:nm]liUw]nac];yic];"
pI:ngc].kUn];hiUn]; kUn];An]mI;pI:mI;ngc].yam]:pQn]t}aPak],nn]. lgc]:etpQn]t}aPak],l}:n}. etnm]liUw]"
tac];pQn] kUn];tI:An] pQn]yQw]:wan]' tac];pQn]hUw]sC]' liUt]:Suc'] AQk],KY]A},wI, Am],nn]
yam]:t}aPak],mL;siUw];n}. lgc]:etpQn]ta}Pak],l}:Kqn];Suc]"
l}a;yU,Sw];kin]Sac]: kUn];lut],lqn];yL:' kin]lw]:El: Aw]yLmw];km]Sm];Kw]:nC];SQn]:liUt]:siUw];n}.
sac]:pQn]tac];pQn]l}:Suc]"
lgc]:yUt];yLmiUw]:sw]. (pQn]mL;eA,liUw] 4 sUw]:mUc];)

 mk];mn]:lgc]:pQn]t}aPak],El: sqt]:eS;Kt].Agk], mUin]nc], Tat]:kiUw]wan] mI;nC];liUt]:eA,eS
El:lium];tUw]l}:siUw];n}." SUc],kCL,hUc];yL"
 miUw]:mI;lgc]:tum].tiUw].Agk];eALmC],mC],nn]. Tuk],lIl}:yUt];yL nC];Kaw];yam]; 4-6 sUw]:mUc];' kgp]:wL:
epL;w}a;eSnn].yw]. lgc]:lU.lqw]Agk];eALn}. etAm],pQn]miUn]kw],l}:Kiun];"
lgc]:yUt];yLKaw];hiuc] (w}a;lc] 4 sUw]:mUc];)

 kUn];pQn]t}aPak],n}. Tuk],lIw}.nC];hgc]:lp];Sic],El: Am],epL;mI;SQc]Sc]" yUt];yLpn]lgc]:sQp]; (kn]
7.5)"
 kUn];pQn]tI:An]yc];tuik].t}aluim];yU, (kn] 7.1)
 miUw]:pQn]mC],mC],nn].kgp]:kUn];pQn]An]Am],l}:kin]Sc]El: etk}.lIKiun]:mL;TiUc];eSTuk],lIpn]kUn];pQn]
kin]nC];Kaw];yam]; 24 sUw]:mUc];miUw]:Et,pQn]" mUiw]:ethC]:kin]nn]. Tuk],lIsqt]:eS; tUv];kgn],wL:
kUn];pQn]sgc],Aiun]l}:hiuw]" epL;kUn];pQn] Am],Aiun]l}: tk];etl}:SaCc];pn]yLhqc];"
 epL;wL:Am],l}:tUc].niuc]tUw]kUn];pQn]sQm]sw].n} Tuk],lISC],Tuc]tin]eSeh.kc]:Am],hC]:liUt]:Kqc]tUw]"
 lgc]:yUt];yLKaw];hiuc]" "epL;wL:Am],mI;lgc]:liUt]:l}tac];nC];n}siuc] Tuk],lIpn]yL Aqt],S]prin],
150 mg OD tL,nC];Kaw];tac]; 2 wUc]:Agn]tac];" w}a;nn].ekL: niuc]:wn]; 75 mg kCL,etL,sUw]:
tL,kUn];pQn]kU:siUw];"
82
lgc]:liUt]:Suc] miUw]:Et,t}aPak],mC],mC],
kgp]:mI;lgc]:tum].tiUw].SC],SQn]:liUt]:eSEl: nC];Kaw];yam];Am],l}asUw]:mUc]; Am],nn] Am],l}awn];nn].
hqc];liUt]: etKiun]:Suc]" An]pQn]siUc].n}n}. pQn]kgp]:Pgn];sgm];Pa},lc]t}aPak], Am],sC]:pQn]lgc]:piun].
Kam],An]l}:pQn]t}a Pak]," kgp]:tUw]hw]; Kt];sC]Tqm]liUt]:kCL,lQc].Agk];eALEl:sc],pQn]nn].yw]." epL;
pn]yLliUt]:Suc]nC];wUc]: et,pQn]nn].n}siuc] yLetsac]:hQt];hC]:Pac]hac]:tac];pQn] (SQn]:liUt]:tn]
Am],nn] SQn]:liUt]:tqk],) h}a.sL.liUw]kw],l}:" kgp]:n} epL;wL:nC];Kaw];tac]; 48 sUw]:mUc];mC],mC],nn].
hqc];liUt]:pgt];niUw]Kiun]:pUn]. 250-280 mmHg n}Tuk],lIpn]yL" km]:nm]Et. epL;pUn].Kaw];yam];n}.kCL,
yw]. mn];etmiUn]kw],kCL,hac];mn];kUv];" km];n}.epL;Tuk],lIyUt];yLSc]ekL: Et,pn]yLkGL,l}:"
lgc]:Piun].PU;tUw]hG]:lIKiun]; (Rehabilitation)
lgc]:Piun].PU;tUw]An]wL:nn]. pQn]Pqn]kan]hac]:hqn]; tL,hG]:kUn];pQn]Kiun];tUc].niuc]mL; l}:kL:hiuw]ekL: hG]:
tUc].niuc]hQt];Sac]:nc],kw],l}:kL:nn].El: hac]:hqn];tL,lgc]:tI:l}:lU.kCL,nn].yw]." lgc]:Piun].PU;tUw]n}.
etAic]niUw]pL; tac];hQt];Sac]:l}:PC]mn];" Tuk],lISUc],kUn];pQn] kCL,yLtUw]tI:muk].sum];tI:sm]kn] Am],
nn] kt].Kqn],P}a,lgc]: pUk];pgc]tUw]hG]:lIKiun];nn]." Pqn]kan]siUc].n}n}. Tuk],lImI;lgc]:yUt];yL p}a;tUw]
El:p}a;sC]" epL;pQn]Agk];eALP}a, S}a. tUw]etpQn]t}aPak],P}a,KCL' epL;pQn]Agk];eALP}a,KCLSm]. tUw]et
pQn]t}aPak],P}a,S}a." tL,kUn];tI:An]sC]. Agk];eALP}a,S}a.nm]eS Sm].tiUw].vL;P}a,S}a.n} lgc]:lat]:
kCam];etsac]:lU.lqw]l}:" epL;kUn];pQn] l}:lU.Sum]; lgc]:hp].hU.kCL,n} tL,ethQt];lgc]:pUk];pgc]tUw]hG]:lI
Kiun];nn]. etyap],Piut],Suk].Sak].nm] hUm]:tc];lgc]:pgc],sC]kn]El: lgc]:hQt];sgm];nc],tI:An]lat]:
nn]. etlUt];lUc];kCL," km]:nm] kUn];pQn]tI: An]Kat],lgc]:hp].hU.' AL<yUc],kU:siUw];' lgc]:kp];Siup],
lat]:etL,kn] Am],nn] lgc]:yiUn].kn]: KI:yQw]:siUw];n}.hiuc]n}siuc] Pgn];tI:et l}:Am],epL;Kqm]."
lgc]:eh.kc]:
kum];Tic];tac];pQn]liUt]:Suc]' pn]kin]yLAqt],S]prin],eSeh.kc]:" pn]tac];hn]Tiuc] hG]:kUn];pQn] kiut];
yc].lut],lqn];yL:' lQn]:Agk],hqc];tL,eS,El: ciUc].ew:lgc]:kin]lw]:nm]siUw];n}.yw]."
Aac]:Aic] liUt]:Suc] (kn] 8.1)
8.4 tac];pQn]K}eKL:sQp];(Rheumatic fever)

eKL:piut],tI:pgc],
tac];pQn]K}eKL:sQp];n}. pQn]tac];pQn]kC]:An]niuc]:eSEl: mac]pgk]: kum],eA,STrqt].tUw]kUw]kt].S] tI:
eKL; sp];tit];siUw].mqc];eSpQn]mL;nn].yw]." kUc]eKL;' lin].k},sQp];kC]:mgk]: 2 Tiuc] 6 wUc]: (Pt].PQc],
mgk]: 20 wn];) eSEl:pQn]mL;sgm];nn].yw]." km]:nm]Et. luk]:Agn], AL,yu nC];wUc]:kac] 5 pI:Tiuc]
15 pI: etk}. pQn]nm]" nC];An]kUn];pQn] eKL;sQp];tI:StrI,tUw]kUw]kt].S]n}. 2% kUv]; (Am],l}:
yUt];yL Am],nn] Am], l}:yUt];yLlIlI) etpQn]K}eKL:sQp];sgm];mL;"
83
Pac]hac]:tac];pQn]
tac];pQn]K}eKL:sQp]; ethQt];hC]:tum].tiUw].l}:yU, 4 tI: (eKL:etL,' hUw]sC]' sum];SQn]:AQn]AL<yUc],kac]
El: Piw]nc])" miUw]:tac];pQn]TL.nn]. etmI;Pac]hac]:nc],pL:tC]:n}.
 eKL:etL,lup],kC]:nm]liUw]niuc]:tI: (eKL:etL,kC]:)  tac];pQn]SQn]:AL<yUc],sk]. (km]:nm]et
km]:nm]Et. etpQn]EKL:etL,yC], (miUn]nc], pQn]tI: hUw]' nL:' tin] miuw]; Am],kum];
hUw]Kw],' tLtin]' eKL:Sgk],El: eKL:miuw];) Tic];l}:w};' lgc]: tUc].niuc] Am],PQc],kn]"
 lgc]:sQp];El:kC]:n}.etsac]:K}a.kCL,tI:niuc]:yw].tI: miUw]:ngn];Et. etAm],pQn]"
niuc]: (K}a.tI:kC]:eKL:etL,)' km]nm]Et. kUn];lUc]  tum],tC]:Piw]nc] – hUv],tum],lQk]. (lQk].
etpQn]kn]nm]" epL;pQn]siUc].n}n}. Am],l}amI,lI,lI,tL,Tiuc] 2 cm)' K}a.kCL,K}a.
etsac]:sQp]; mQw];lQw] Am],nn] mac]:pgk]:ekL: mL;eS Am],sQp];' km]:nm]Et.etpQn]niUw]
etkC]:' lqc]' epL;tiUw].vL;etsQp];siUw];n}.yw]." Piw]lup],El:SQn]: AQn] (miUn]nc],him]; eKL:
 mI;SQc]miUn]SQc]Kac];tI:hUw]sC] Sgk],' hUw]Kw],' eKL:miuw];' eKL:tin]' AQn]AL
 liUt]:kCL,kgc]Aiut];w}.tI:niuc]:eS hQt];hC]:hqc];hUw]sC] KI,liS].' eKL:etL,Sn]lc])
eA,' hUw]sC]y]C,"  pQn]Piun],lqc] Erythera sgm];Piw]nc]pQn]tI:
 l}:yin];SQc]yC];hUm], SISC],kn]" tI:- km]:nm]etpQn]Piun],lqc]eSAm],KUm];'
Am],sQp];' kac]etsqc]: lqc];eSEl:sgm];
him]; etpQn]Kgp],wUc];Suc]' tI:tUw]' KLlUc]El:
Kqn]" etk}.lqk]:l}a:"
etsac]:mI;lUm];naw]' pQn]tgc].sQp];' liUt]:l}Agk],tI:KU;lc] Am],nn] sQp];sgm];eKL:etL,siUw];n}.yw]."
Am],mI;Pac]hac]:An]lQw] Am],nn] lgc]:kUt],Tt];pgk]:lQw]n}. pQn]Pac]hac]:An]pqk],piUc]tac];pQn] K}eKL:
sQp];yU,yw]."
lgc]:mk];mn]:tac];pQn]sgm];nc], “lk];piUc]sUn];An]l}:Tt];yw]. (Revised Jone Criteria)etmI; 3 tgn]:"
1) lk];Tan]An]l}:sp];tit];siUw].mqc]; STrqt].tUw]kUw]kat].S] hqc];etL,SU:STrqt].tUw]kUw]
kat].S] (ASO) nm]Kiun]:mL;' epL;Aw]siUw].mqc];tI:eKL:etL, kUt],tUv];n} ethn]siUw].mqc];
STrqt].tUw]kUw]kat].S] tI:An]hQt];hC]:eS;l]liUt]: kum],eA,ep,tL,lU."
2) mk];mn]:Pac]hac]:lm],lgc]:" 3) mk];mn]:Pac]hac]:An]Am],epL;lm],lgc]:
 nc],Pac]hac]:pL:niUw]pQn]tI:hUw]sC] –  sQp];sQp];Kiun]:Kiun]:sgm];eKL:etL,
hUw]sC]kC]:' eKL:etL,kC]:l}atI:  mI;lUm];naw]
 tac];pQn]SQn]:AL<yUc],sk].  ERS/CPR Kiun]:mL; (kUt],Tt];tUv];liUt]:eS
 pQn]hUv],tum],tC]:Piw]nc] TUp];hn]Pac]hac]:sp];siUw].mqc];)
 pQn]Piun],lqc]tC]:Piw]nc]
84
tL,mk];mn]:tac];pQn]K}eKL:sQp];nn]. etl}:mI;
1) lk];Tan]An]l}:sp];tit];siUw].mqc];STrqt].tUw]kUw]kat].S]El:Pac]hac]:lm],lgc]: 2 An]
2) lk];Tan] An]l}:sp];tit];siUw].mqc];STrqt].tUw]kUw]kat].S]El: Pac]hac]:lm],lgc]: 1
An]El: Pac]hac]:Am],epL;lm],lgc]: 2 An]
Kk].tgn]:tac];pQn]
epL;pQn]tac];pQn]n}.ethiuc]mgk]: 3 liUn]" kUn];pQn]mgk]: 5% lUc];tC]:etpQn]tac];pQn]hiuc]liUw] 6 liUn]"
Pgn];sL.sgm];lc]
 pQn]tac];pQn] K}eKL:sQp];Kiun]; (5-50 %)
 tac];pQn]K}eKL:' sQp];hUw]sC]Kaw];hiuc] (lin].hUw]sC]niuc]:An] Am],nn] nm]liUw]nn]. hac]:Pac]
lU.lqw]kCL,)' An]n}. tac];pQn]K}eKL:sQp];An]lQw]kUv]; pQn]pn]hLKaw];hiuc]" epL;wL:pQn]h}a.hqc];n}
ethQt];hC]:hqc];hUw]sC]eA,Kaw];hiuc]l}:" km]:nm]Et. tac];pQn]K}eKL:sQp];hUw]sC]Kaw];hiuc]n}. miUw]:pQn]mC],
mC],l}al}apI< Am],nn] l}ahUw]Sip];pI< etAm],EnPac]hac]:Sc]"
 liUt]:kCL,kgc]Aiut];w}.tI:niuc]:eShQt];hC]:hqc];hUw]sC]eA, (kgp]:hUw]sC]hQt];kan]Am],l}:) eSEl:lU.t}a"
lgc]:yUt];yL
 hG]:ngn];liuw]:nC];tI:ngn]; 2 wUc]:"
 Sm];pn] Benzatine penicillin IM STAT 1.2 lan]. IU" luk]:Agn], 2,5000 – 50,000 IU/Kg
STAT (nm]Sut]; 1.2 lan]. IU )km];lQw]" epL;Am],mI; Benzatine penicillin Sm];pn] penicillin
tL, 10 wn];" epL;kUn];pQn]Am],mqn]:tc];yL penicillin hG]:Sm];pn]yL erythromycin tL, 10
wn];"
 pn]yLAqt],S]prin],nm]nm] etL,Tiuc]Pac]hac]:tac];pQn]epL;h}a" luk]:Agn],(>12 pI<) 20-25
mg/kg QID' kUn];lUc] 1-2 g QID" epL;wL:mI;Pgn];sL.yL miUn]nc], AL<yUc],l}:yin];lU.lqw]'
TUv]:sC]w};' pn]hLtgc].sQp]; Am],nn] epL;nC];tgc].mI;Tat]:nm].kUt]; nm]nL,n}siuc]
Tuk],lIygm];yLlUc];"
 prqt].nISUw]lUn]; (Prednisolone)
 epL;mI;Pac]hac]:tac];pQn]kQw],lUv]:hUw]sC] Am],nn] yLAqt],S]prin],n}. hQt];hC]:Am],kum];Tic];
lgc]:sQp];eKL:kC]: siUw];n}.n}siuc] hC]:sC].yLprqt].nISUw]lUn]; (Prednisolone)-
luk]:Agn],- 2 mg/kg OD tL, 2 wUc]: w}a;nn].ekL: ygm];lUc];l}g;l}g;tL, 2 wUc]:yw].
hC]:kiut];pqt]:"
85
kUn];lUc]- 60 -120 mg OD tL, 2 wUc]: w}a;n].ekL: ygm];lUc];l}g;l}g;tL, 2 wUc]:yw]. hC]:kiut];
pqt]:" w}a;eSyut];yLprqt].nISUw]lUn]; (Prednisolone) yw]. hC]:Siup],pn]yL Aqt],S]prin],
tL, 1 liUn]"
 tL,tac];pQn]AQn]sk].nn]. hC]:liuw]:hiUw].pn]" pn]t},yLSI,Pqp], (Diazepam)Am],nn] Pqn],
nUw],pL<pI<tL, (Phenobarbital)"
 epL;wL:pQn]hqc];hUw]sC]eA,Kiun]:mL;n}siuc] yUt];yLsgm];nc],l}a;yUt];yL tI:lgc]:hqc];hUw]sC]eA,
(kn] 8.2)"
lgc]:eh.kc]:
 lgc]:eh.kc]:Kk].tgn]:Tiniuc]: cw]:piun]. – tL,eh.kc]: tac];pQn]K}eKL:sQp];tI:kiuc].kac].pQn]
kUn];pQn] An]hw];wUn].Sgn],wL: pQn]tac];pQn]lin].k}kC]: kgp]:STrqt].tUw]kUw]kat].S]kU:ekL.
hC]:pn]yLkin] pqn],En,Slin], wI, (Penicillin V)tQm]tQm]tL, 10 wn]; Am],nn] Sm];pn]
Benzathine penicillin niuc]:KQm]"
 lgc]:eh.kc]:Kk].tgn]:TiSgc] – tL,eh.kc]:tac];pQn] An]km];km];pQn]"
kUn];pQn]kU:ekL.An]yam]:pQn]K}eKL:sQp];kU:ekL. Tuk],lIl}:Sm];yL Benzathine penicillin 1.2
lan]. IU tL, 4 wUc]:niuc]:pgk]:" lgc]:yUt];yLkQw],lUv]:KQw]:kU:pgk]:tk];etl}: KL:siUw].mqc];hC]:
lIeSkgn],"
Sm];yL Benzathine penicillin 4 wUc]:niuc]:pgk]:n}.Tuk],lISm];hiuc]kL:hiuw] ?

Am],mI;eKL:mk];mn]:Sc]w}.wL:Tuk],lIhQt];lgc]:eh,kc]:Kk].tgn]:TiSgc]hiuc]kL:hiuw]" piUc]nm];yUt]yLkm]:nm]wL:
Tuk],lI Sm];pn]Tiuc] kUn];pQn]AL,yuKUp]. 21 pI<el: mac]An]ekL:wL: Et,Aw]miUw]:kiuc].kac].pQn]K}eKL:
sQp];yw]. Tuk],lISm];pn]tI:eA,Sut];hiuc] 5 pI<" kUv]:kL:pp].mac]An]ekL:wL: epL;tac];pQn] kQw],lUv]:
hUw]sC]n}siuc] Tuk],lISm]; pn]etL,sUw]:n}yw]."
Aac]:Aic]
eKL;h}gsQp];/mak],ln]eKL;sQp]; (21.1)' hqc];hUw]sC]eA,(8.2)
86
pn]hLtac];pQn]KQw]:
9
9.1 tac];pQn]hiUk],El: KQw]:
An]k}.hn]pQn]nm]nn]. pn]hLKQw]:mqc];El:hBik],kC]:nn].yw]." kWp]:wL: Am],mI;lWc]:mUt];SC]nC];pak],yw].
sc],l}:pQn]tac];pQn]siUw];n}.eSEl: w}a;mL;sac]:hQt];hC]:lU.Sum];KQw]:l}:nn].yw]."
KQw]:mqc];
eKL:piut],tI:pgc],
kgp]:siUw].mqc]; Kw]:kCL,nC];KQw]:eS hQt];hC]:KQw]:pQn]hU;mL;nn].yw]." lgc]:pQn]siUc].n}km]:nm]Et. kin]tac];kin]
An]wan]nm]' KQw]:Am],lIsQm]piuc];El: Am],k}.SIKQw]:tL,eS, Am],nn] Am],SIKQw]:nn].yw]."
Pac]hac]:tac];pQn]
KQw]:etlm]eShk];w}." km]:nm]Et.mUiw]:kin] (Am],nn]) mUiw]:SUt].tac];kin]An]kt];nn]. KQw]:etkqn];"
lWc]:yUt];yL
 epL;KQw]:sQp];Kiun]:yU,kU:Kaw];yam];n} kUt],Tt];pn]tI:Kiun]: (KQw]:)"
 pn]yL Paracetamol Am],nn] Asprin tL,yUt];yLlWc]:sQp];Kuin]:"
 epL;wL:kC]:n}siuc] hG]:pn]yL Asprin El:yLKL:siUw].mqc]; Amoxicillin" epL;An]kC]: ygm];lUc];
yw].n}siuc] SUc],kCL,yUt];yLtI:sum];P}a,KQw]:"
 epL;wL:Sm].Am],kC]: kUv];kL:KQw]:Sm].sQp];Kiun]:yU,kU:Kaw];yam];n}siuc] SUc],kCL,yUt];yLtI: sum];
P}a,KQw]:"
 lgc]:yUt];yLAn]lIeSpiUn]:Et. Aut];pn]KQw]: (kup];KQw]:) Am],nn] TUv]:KQw]:nn].yw]."
SUc],kCL, yUt];yLtI:sum];hU.lgc]:P}a,KQw]:"
lWc]:eh.kc]: hQt];pn]lWc]:mUt];SC]KQw]:El: hiUk],kU:wn];"
tac];pQn]hBik], (Gums diseases)
tac];pQn]hBik],kC]:n}. etAm],sQp];' kWp]:n}El: kUn];km]:nm] etAm],hB.lWc]:Kw]pQn]Sc]yU,nn].yw]."
k) tac];pQn]hBik],kC]: (Gingivitis)
eKL:piut],tI:pgc],
hiUk],him];hgm];KQw]:kC]:nn].yw]." pQn]tac];pQn]nC];pak], An]k}.hn]pQn]nm]eSpUin]:nn].yw]."
87
9 pn]hLtac];pQn]KQw]:
Pac]hac]:tac];pQn] hBik],etlqc]eSkC]:' miUw]:SIKQw]:nn]. etmI;lUit]:AWk],mL;' A}apak],mQn]"
lWc]:yUt];yL
hQt];pn]lWc]:mUt];SC] nC];pak],kU:wn];" Aw]nm].yL Chlorhexidine 0.2% (Am],nn]) nm].kUiw] pUn]:pak],
pn]"
lWc]:eh.kc]:
hQt];pn]lWc]:mUt];SC]KQw]:El:hiUk],kU:wn];" hC]:emLyLP}a,KQw]:Kw]Kut],hin]Kan]:Agk],pn]"
K) kWp]:sUiw].mqc];tac];pQn]eS nUiw].hBik],lU.lqw] (Periodontitis)
eKL:piut],tI:pgc],
sUiw].mqc];pqk],TI;rI;yL; Kw]:kCL,nC];cw]:hak]: An]km].s}g:KQw]:yU,nn].eSEl: hUik],kC]:mL;"
Pac]hac]:tac];pQn]
epL;kCL,Kgn];' tiUw].vL;n} etmI;nm].nWc]AWk],mL; Am],nn] sQp];' Kuin]:' mI;lUm];naw]' hBik],kC]:siUw];n}.yw]."
lWc]:yUt];yL
hQt];pn]lWc]:mUt];SC]nC];SUp]; nG];pak],kU:wn];" hC]:P}a,KQw]:Kw] Kut],hin]Kan]:Agk],pn]"
9.2 pQn]sQp];kC]:nC];pak],
eKL:piut],tI:pgc],
kWp]:sp];tit];sUiw].mqc];w};rS].' pqk].TrI;yUiw]<El: fL: (fac];kat].) eSsac]:pQn]sQp];sgm];nC];pak],l}:"
tiUw].vL;mat],sQp];El: Ac],kL,nC];pak],sp];tac];pQn] Am],nn] Kat],Tat]:wI,tL,min],siUw];n}. eSpQn]
sQp];nC];pak],nn].yw]." luk]:Agn],Am],l}aliUn] luk]:Agn],Kat],Tat]:AL,hL,rEl: kUn];pQn]sp];siUw].mqc];
Aqk].KY]A},wI, siUw];n}.etk}.k}.pQn]tac];pQn]pak],sQp]; Candidiasis" pQn]sQp];nC];pak],n}.yUt];yLAm],nn]
Aw]An]tI:hQt];hC]:pQn]nn].Agk],pqt]:n} mgk]: 10 wn];ekL:eth}akCL," epL:wL: nC];Kaw];tac]; 2 wUc]: sQp];
nn]. Am],h}an} hC]:mL;sU;emLyLKiun];"
Pac]hac]:tac];pQn] sQp];' kin]yap],' hUw]mw];' hak]:"
88
pn]hLtac];pQn]KQw]: 9
lWc]:yUt];yL
 Siup],pn]kin]nm].El: tac];kin]" epL;Tuk],lIl}:sC].n}ekL: sC].S}ayac]eS lQc].tac];kin]"
 sC].nm].yL Chlorhexidine 0.2 % Am],nn] Aw]nm].kiUw]Aun],Aun], pUn]:pak],n} etyUt];
yLl}:lWc]:sUiw].mqc];w}a;rt].S]El: pqk].TI;rI;yL;" hC]:Aw] Gentian SI,Sgm], yUt];yLpn]"
epL;wL: mI;lgc]:sp];tit];siUw].mqc];pqk].TI;rI;yL; sgm];mL;Tqc]:n}siuc] pn]yLAmgk],SI,lin],
(Amoxicillin)"
 epL;pQn]fL: (fungal) n}w}a;kin]Kw]:yw]. tL; Gentian SI,Sgm],pn]" epL;wL:Am],tiUw].n} Aw]
yLmQt]. nit]:S]tqt],tin], (Nystatin) Ait],pQn]Pgc] Am],nn] yLAUm] (AUm]lut],Aw])
pn]kin]"
*epL;wL:luk]:Agn], yc];kin]nUm];Em:yU,n}siuc] pn]yLnit]:S]tqt],tin], (Aw]yLAit],pQn]Pgc]
yw]. Aw]miuw];Em:luk]:Agn],An]mUt];SC] tL;pn]nC];pak],hC]:sgt],) niuc]:wn]; 4 pgk]:" (tac];
pQn]Piw]nc]tUv];tI:kn] 22)"
*tL,kUn];pQn] AQk].KY]A}wI./ eA,A}tI,Aqt].S]nn]. hC]:tUv];tI: kn] 15.3"
9.3 tiUw].vL; mat],sQp];

Sc]wL:KQw]:kUn];lUc] l}:tum].tUiw].vL;eShUc]:AWk],mL;suic] Kiun];SC],pn]Kiun];w};w}; (Kuin];SC],tI:hU;mn];)" epL;
pQn]KQw]:luk]:AWn],hUc]:Et. Am],tap]:SC],pn]Kuin];"
lWc]:yUt];yL-
 tL,sQp];sQp];Kiun]:Kiun]:nn]. pn]yL Paracetamol Am],nn] Asprin"
 SC],pn]KQw]:kUn];lUc]Kuin];" tk];etl}:hQt];hC]:tqt]:etL;wL: kUn];pQn]hup],pak],l}:Kiun];miUn]kw]," epL;
Am],l}:Kiun];etl}:em;pn]KQw]:hC]:Kw]:kn]Kiun];"
 Sc],lat]:kUn];pQn] hG]:ciUc].ew: tac];kin]An]kqn],An]Kqc] tL,Kaw];tac]; 2 wUc]:"
miUw]:ethQt];hC]:lgc]:KQw]:pn]kUn];pQn]nn]. tk];etl}:mn]:sC]wL:
kUn];pQn]Am],mI;tac];pQn]hUw]sC]Sc]" epL;mI; tiUc],pac],tc];emLyLeS
pn]yLtL,eh.kc]: lgc]:sp];tit];siUw].mqc];"
89
tac];pQn]kQw],lUv]:ehL,mUn];l]
10
10.1 tac];pQn]yQw]:wan] (Diabetes Mellitus)
eKL:piut],tI:pgc],
tac];pQn]yQw]:wan] (Diabetes Mellitus) An]wL:n}. kgp]:tWm],mam]. Pancreas (tWm],An]Tuk]:AWk],pn]
nm].tL,yW}:AL,hL,rAqn],S}a;y]) Tuk]:AWk],Tat]:Ain],SU,lin];eA, (Am],nn]) hqc];Tat]:Ain],SU,lin];
lUt];yWm];kCL,El: pQn]Pac]hac]:tac];pQn]mL;An]niuc]:nn].yw]." An]n}.hQt];hG]:Tat]:kUiw]wan]nC];lUit]:
Suc]Kuin]:nn].yw]." tac];pQn]yQw]:wan]n}.mI;SWc]Sqn];-
Sqn];Ti 1 (lWc]:pQn]tac];pQn] 10%) km]:nm] etpQn]mL;sQm]lQk].eSsC].yLAin],SU,lin]; yUt];

yLpn]sc],l}:" (sC].yLkin] Am],tUiw].)
Sqn];Ti 2 km]:nm] kUn];lUc]An]AL,yuSuc] (40 pI<Kuin]:nUiw]) pQn]nn].yw]." sC].yLkin]eS yUt];

yLl}:" epL;wL:tac];pQn]h}a.hqc];n}siuc] Tuk],lIsC]. Ain],SU,lin];eSyUt];yLkCL,"
hUw]eKL:eP;An]hQt];hC]:pQn] - hUw]eKL:eP;An]hQt];hC]:pQn]tac];pQn] Sqn];Ti 2 Et. epL:Em: pI:ngc].

mI;piun];pQn]yQw]:wan]' BMI nm]liUw] 23 (lgk];Kgc]: BMI kCL,tUv];tI: eKL:PiUm].Tqm] kn] 24.4) El:
pI;pUn].tI: (kn] 17.3) miUw]:pL;tgc].yam]:pQn]yQw]:wan]' mI;piun]; pQn]Tat]:AL,hL,ryup]:ygm]; Am],nn]
kiUt],luk]:An]nm].nk];Am],tQm]"
Pac]hac]:tac];pQn]
 K}:kin]nm].  sUiw].mqc];tac];pQn] Kw]:mL;c}a: An]lm],lWc]: Sut];tac];pQn]
 km];km];yQw]: Piw]nc]' SQn]:tac];yQw]:' SQn]:tac];kUit],luk]: (fL:)
 hiUw]. (Candidiasis) El: tac];pQn]TI,pI,"
 nm].nk];tUk];lUc];  pn]hLAn]sWm];lc] tac];pQn]yQw]:wan]mL; (tUv];tI:pL:tC]:)
lgc]:etl}:kiuc].kac].yUt];yL
kUn];pQn]yQw]:wan]n}. sac]:kiuc].kac].lium];tUw]l}:"
 Aw] (dextrostick)kUt],Tt];tUv]; Tat]:kiUw]wan]nC];liUt]:kUn];pQn]kU:ekL. An]lium];tUw]
epL;wL:Tat]:kiUw]wan]nC];liUt]:nm] (>200 mg/dL)kUn];pQn]tI:An]lium];tUw]yU,nn].
 SC], IV cannula Et,SCac]; NSS pn]
 Aw]Ain],SU,lin];eSyUt];yLpn] (10 IE IV STAT yw].ekL: 0,1 IE/kg/h)
 kUt],Tt];tUv];Tat]:kiUw]wan]nC];liUt]:kU:sUw]:mUc];
 wUn].Sgn],pL;lgc]:SUc],kCL, yLtUw]tI:hUc];yL
90
tac];pQn]kQw],lUv]:ehL,mUn];l] 10
lWc]:KUn].hLmk];mn]:tac];pQn] (Diagnosis)
epL;kUn];pQn]ekL.nuic]: mI;Pac]hac]:tac];pQn] nc],tI:nUiw]nn].n}suic] Tuk],lIkUt],Tt];tUv]; tac];pQn]
yQw]:wan]" kUt],Tt];tUv]; Tat]:kUiw]wan]nC];yQw]:" tL,mk];mn]: tac];pQn]kUn];pQn] tI:An]kUt];Tt];
tUv];Tat]:kUiw]wan]nC];lUit]:eS TUp];vL;nn].' Tuk],lIsqt]:tUv]; sn].nm]eA,
Tat];kiUw]wan]nC];liUt]:"
lWc]:kUt],Tt]; epL;wL:kUn];pQn]mI;
tac];pQn]yQw]:wan]
Am],pn]fac].Kw]eS kUt], kUt],Tt]; tac];nm]eA,Tat]:kUiw]wan] > 11 mmol/L*
Tt]; Tat]:kUiw]wan] nC];lUit]: Kaw];lC]Kaw];niuc]:nC];niuc]:wn];" > 200 mg/dL
nC];lUit]: mn];Am],lm],lWc]:wL: kUn];pQn]kin]yw].hiuw]
p},l}:kin]"
Am],hC]:kin]Sc]eSEl: kUt],Tt];tac];nm]eA, Tat]:kUiw]wan]nC]; > 7 mmol/L
kUt],Tt];Tat]:kUiw]wan] lUit]: yam];kac]nC]' etl}:lat]:kUn]; > 126 mg/dL
nC];lUit]: pQn]wL: Et,Aw]tQc]:Kiun]; 12 mUc];kCL,
liUw]eSnm]. etAm],l}:kin] tac];kin]Sc]"
*lWc]:lqk]:l}a: 1mmol/L = 18mg/dL, 1 mg/dL = 0.055mmol/L
PWn];sL.sWm];lc]
Sc]wL:Am],l}:yUt];yL tac];pQn]yQw]:wan]siuc] epL;Kaw];hiuc]mL;nn]. sac]:tum].tUiw].tc];tUw]kUn]; hC]:lU.
lqw]l}: miUn]nc],
1. tac];pQn]SQn]:lUit]: - t}aPak],' tac];pQn]hBw]sC]' kuic].kac].pQn]tac];pQn]hBw]sC]' tac];pQn]SQn]:lUit]:
p}atin]p}amiuw]; (kWp]:pUiw]:liUt]:Am],l}lIEl: p}atin]etkt];Am],nn]etsQp];)
2. hqc];mak],kqw];Am],lI - Aw]An]kUt],yQw]:(Labstix) eSkUt],tUv];Tat]:prUw],tin];l}:"
3. tac];pQn]tL - lWc]:muc]:hn] An]mI;P}a,lc]nm].luik].' nm].tuin]:nn].lU.lqw] (tLkUn];pQn] et
mUw]; Am],hn]sqc]:lqc];lI)
4. tac];pQn]AL<yuc], - nQt];nLEl: mac]pWk]: tin]muiw];etkUn].kUn].Kiun]:Kiun]: (kac]Kuin];eth}a.hqc];
lUiw])"
5. pn]hLKL- kUn];pQn]yQw]:wan]n}. kgp]:liUt]:l}sU;KLAm],lI Sm].nQt];San]:El: hQt];hC]:sUiw].mqc];
tac];pQn] Kw]:sU;c}a:El: pQn]sQp];c}a:nn].yw]."
lWc]:yUt];yL
yiUc];Aan];lWc]:yUt];yL tac];pQn]yQw]:wan]n}. tL,hQt];hC]:Tat]:kUiw]wan]nC];lUit]:lUt];yWm];lUc];n}siuc]
kUn];pQn] etyU,lIKiun]:mL;eS etEh.kc]: lWc]:An]etmL;tum].tUiw].Kaw];yaw];l}:nn].yw]."
Am],pn]fac].eSkUt],Tt];Tat]:kiUw]wan]nC];liUt]:n}. Tuk],lIpQn]
70-140 mg dL (3,8 -7,8 mmol/L)
91
10 tac];pQn]kQw],lUv]:ehL,mUn];l]
1. lWc]:Sp];lqc];El: eKL:pn]tac];hB.
epL;mk];mn]:wL: pQn]tac];pQn]yQw]:wan]yw].n}suic] Sp];lqc];pn]kUn];pQn]wL: tac];pQn]yQw]:wan]An]wL:
nn]. pQn]AI:Sc]" lat]:EnkUn];pQn]wL: tac];pQn]An]n}. Am],yUt];yLhC]:h}aKat],l}:El: etsp];
tUw]kCL,etL,sUw]: (lUiw]eSpQn]yQw]:wan] mUiw]:tuik].man];yU, - Suip],tUv];tac];lc]) tac];pQn]yQw]:wan]n}.
kum];Tic];w}.l}:" lat]:EnkUn];pQn]wL: mI;yLAn]hQt];hC]: Tat]:kUiw]wan]nC];lUit]: lUt];yWm];lUc];El: mac]
siUw].mac]mQw]; kUn];pQn]hQt];Aw]hac];kUv]; hC]:Tat]:kUiw]wan] nC];lUit]:lUt];yWm]; lUc];l}:nc],kw]," pn]tac];
hn]Tiuc]wL: kUn];pQn]tk];etl}:tUv];tin]sw]:kw],kU:wn];wL: sgc],Kiun]:' sgc],mI;h}g;sQp];lqc] Am],nn] mI;
Pac]hac]:sp];tit];siUw].mqc];hiuw]"
2. yUt];yLlUv]:lWc]:yU,Sw];kin]Sac]:
 lWc]:tac];kin] * lUt];yWm];kUiw]wan] ( mUin]nc], mak],AUm]' Kw]:mun];' nm].mak],m}.' nm].wan]
nm].KUk].' nm].AW}:' nm].Piuc]:)" tL,tqn];tI:kUiw]wan]nn]. tL.kin]tac];kin] An]mI;Tat]:kSI,
(AL,lU;' Kw]:SW};' Kw]:mun];)" tac];kin]sUiw];n}. lqk]:l}a:pQn]Tat]: kUiw]wan]nC];tUw]l}:n}eStL.
mn];lqk]:l}a:TiUc]; kWp]:n} etAm],hQt];hC]:pQn] Tat]:kUiw]wan]nC];lUit]:Suc]w};"
 tk];etl}:fac].wL: Kw]:tc];Kw]:S}g;ekL: sac]:hQt];hC]:Tat]:kiUw]wan]Kiun]:l}:nc],kw],"
 ygm];kin]niUw].An]mn];El: nm].mn];pam];"
 kint ] ac];kin] tI:An]mI;kak],nm]Kiun]: (Pk];' mak],m}.)
 yL,kin]lw]:"
 epL;pI;nL,ekL: lUt];pn]nm].nk];n} Tat]:kUiw]wan]nC];lUit]:ekL: etlUt];lUc];kCL,sgm];"
 lWc]:lut],lqn];yL:- pn]tac];K}:sC]wL:kUn];pQn]yQw]:wan]nn]. Tuk],lIkiut];yc].lut],lqn];yL:"
 lWc]:lQn]:Agk],hqc];- pn]tac];hn]Tiuc]kUn];pQn] hG]:lQn]:Agk],hqc]; mUinn ] c], p}tac]; Am],nn]
pit].mak],nc]pn] kU:wn];"
tac];pQn]yQw]:wan]mac]An] sC].yUt];yLlUv]:lWc]:yU,Sw];kin]Sac]:kUv];ekL: hQt];hC]:Tat]:kiUw]wan]nC];liUt]:
pQn]miUn]kw],l}:Kiun];"
mUiw]:mk];mn]:tac];pQn]nn]. Sc]wL:TUp];vL; Dextrostix 140-200mg/dL (7.7-11mmol/L) sgm];nc],lgc]:
Am],pn]fac].eSkUt],Tt];mL;kgn],n}suic] Tuk],lIyUt];yLlUv]: lWc]:yU,Sw];kin]Sac]:kgn],"
epL;hbic]nuic]:lUin]yw].El: Am],lIKuin]:mL;n} sc],Tuk],lIAw]yLeSyUt];yLkCL,"
3. lWc]:yUt];yLlUv]:yL
mUiw]:Aw] Dextrostix eSkUt],Tt];yw]. nm]lUiw] 200mg/dl(11mmol/L) Am],nn] yUt];yLlUv]:
lWc]:yU,Sw];kin]Sac]:yw]. Am],lIKuin]:mL;suic] Tuk],lIhC]:emLyL Am],nn] PU:yUt];yLsn].Suc]Kw]]
(doctor or senior medic) et,pn]yLyQw]:wan]l}:"
92
yLyQw]:wan]mac]siUw];
suiw]:yL hqc];yLet,pn] hqc];yLSuc]Sut]; tL,tWc];
Metformin 500mg TID 1 g TID pn]kin]sWm];tL,Kw]:kU:tL,"
etmqn]:tL,kUn];mI;nm].nk]; nm]
Glibenclamide 5mg OD kUn];AL,yunm] 15 mg OD pn]kin]sWm];Kw]:nC]
2.5mg OD
 Et,pn] metformin hC]:pn]yLnm]Kiun]:mL;l}g;l}g;etL,Tiuc] 1 gram TID.
 Sc]wL:pn]yL metformine yw]. hqc];Tat]:kiUw]wan]yc];p},lUc];mL;n}siuc] hC]:pn] glibenclemide
sgm];Tqc]:"
 Sc]wL;kUn];pQn]kin]yL tL,yQw]:wan]eSEl: Sm].Am],kin]Kw]:kL:hiuw] Am],nn] Am],k}.kin]man],
man],n}siuc] etpQn]eP;tL,hqc];Tat]:kiUw]wan]nC];liUt]:eA,l}:" etl}:Sp];lqc];EnKw]lIlI kQw],
lUv]:lWc]:Pac]hac]:Tat]:kiUw]wan]nC];lUit]:eA,El:l}a;yUt];yL (kin]tac];kin] An]wan]' nm].wan])"
pqk].Sm].wL: pn]yLkum];Tic];tac];pQn]yQw]:wan]yw]. cw];l}a;yc];p},lIKiun]:kL:hiuw]n}siuc]pn] INSULIN NPH
70/30 retart (mI;hqc];yLKaw];hiuc]) Am],nn] INSULIN regular (mI;hqc];yLKaw];pgt];) tL,yUt];yL tac];
pQn]yQw]:wan]"
 hp].w}.pQn]kUn];pQn]nC]; tL,sC].Ain],SU,lin],yUt];yLAw]"
 Et,pn] 10 I.E Insulin NPS miUw]:kac]Km]: (sC].An]mI;hqc];yLKaw];pgt];miUw]:hUw]Km]:)"
 tL,etpn]yL Insulin tiUw];Kiun]:mL;nn]. hC]:tUv];lgk];Kgc]:pL:tC]:" Tuk],lIwUn].tUv];tL,
lgc]:pn]yL wn];Sgc]pgk]:El: tiUc],pac],lgc]:Pqn]kan]n}.tc];emLyL"
miUw]:kin]nn]. Tat]:kiUw]wan]nC];liUt]:mI; Pqn]kan]tL,yL Insulin
>180 mg/dL Add 4 IE
125 – 180 mg/dL Add 2 IE
80 – 125 mg/dL Siup],pn]sgm];nc]hqc];yLAn]pn]yU,
< 80 mg/dL lUt];ygm]; 2-4 IE
4. l}a;Siup],yUt];yotac];lc]
eKL:yUic];Aan];Et. tL,pn]tac];hB.El: kUn];pQn]mI;Tat]:kUiw]wan]nC];tUw]lI (km]:nm]etmI; 70 –
140mg/dL ) El:tL,kUt],sqt]:tUv];pn],hL An]mL;sWm];tac];lc] tI:An]yUt];yLl}:"
 mUiw]:Et,pn]yL etl}:kUt],sqt]:Kuin];kUn];pQn]kU:wUc]: etL,Tuic]Tat]:kUiw]wan]epL;nim]Sw];lI" Siup],
lat]:Encw];l}a;tac];pQn]yQw]:wan]pn]kUn];pQn]El: pn]tac];hB.lWc]:tac];kin]tc];lWc]: yUt];yL"
 mUiw]:Tat]:kUiw]wan]nC];lUt
i ]:nim]Sw];lIyw].nn]. kUt],sqt]:pn]kU:lUin]"
 lat]:EnkUn]pQn]wL: nc],huiw]Am],hC]:Tat]:kUiw]wan]nC];lUit]: yWm];lUc];pUn].tI:nn]. hC]:km];km];kin]
tac];kin]An]pQn]km]pQn]kgn]:"
 hC]:pn]tac];hB.kUn];pQn] An]kin]yLyQw]:wan]yU,kU:ekL. lWc]:Pac]hac]:Tat]:kUiw]wan]nC];lUit]:eA,El:
lWc]:Tuk],lIyUt];yLtI:hBin];siUc].hiuw]siUw];n}.yw]."
93
 Tuk],lIpn]tac];hB.kUn];pQn] kQw],lUv]:l}a;yUt];yLTat]:kiUw]wan]nC];liUt]:tUk];ygm];siUc].hiuw]" (kin]kiUw]
wan]niuc]:esL. esL.yC],)
Tam]wL:
 Pac]hac]:tac];pQn] - sWc],lI/Am],lIKuin]:mL;?
 pn]hLAn]mL;sWm];tac];lc]- tin]kt];' nQt];San]:' AL,yUc],muc]:hn]lUt];yWm]; (epL;pQn] -
hC]:kCL,sU;emLyL)"
 lWc]:Tat]:kUiw]wan]nC];lUit]:lUt];yWm];sgc],mI;hiuw]?' lat]:EnlWc]:Pac]hac]:mn]; (tUv];tI: pL:
tC]:)El:Sp];lqc];EnwL: An]n}.pQn]cw]:hak]:hQt];hC]:pQn] Tat]:kUiw]wan]nC];lUit]:eA,nn].yw]."
kUt],sqt]:
kU:lUin]
 hqc];liUt]:' etpn]yLtL,yUt];yLtac];pQn]liUt]:Suc] sgm];nc],lgk];Kgc]: kn] 8.1"
 sWm];KLnn]. sWc],mI;hg};sQp];' lWc]:sp];tit];sUiw].mqc];' nQt];San]:"
kU:pI<
 Labstix kUt],nC];yQw]:tUv];wL: sWc],mI;prUw],tin]; (lWc]:tC]Am],hQt];kan]l}:lI)"
 hBw]sC]- tUv];Pac]hac]:hqc];hBw]sC]eA,
 Sp];eS;tUv];tL tI:emLyLtL' lWc]:sgc],mI;/Am],mI;PL:
kUt],sqt]:tUv];Tat]:kUiw]wan]nC];lUit]:
lItWn]; lI tqm],nL, Suc]nL,
tac];nm] nm]lUiw] 70
eA,Tat]: El: eA,lUiw] eA,lUiw] 70mg/dL nm]lUiw] 180mg/dL
kUiw]wan] eA,lUiw] 180mg/dL
nC];lUit]: 140mg/dL eA,lUiw] 3.8mmol/L nm]lUiw] 10mmol/L
nm]lUiw] 3.8 eA,lUiw]
El: eA,lUiw] 10mmol/L
7.7mmol/L
etl}:hQt]; Siup],yUt];yLsgm];nc],tI:An]  kUt],sqt]:kUn];pQn]wL:  PiUm].pn]hqc];yL
yUt];yLyU, sWc],kin]tL,eS,yU,hiuw]"  kUt],sqt]:tUv];
epL;wL:kin]yU, hC]:lUt]; lgc]:sp];tit];siUw].
yLlUc];" epL;wL:Am], mqc];eSEl:yUt];yLp
kin] hC]:pn]tac];hU. n] (miUn]nc],siUw].mqc];
 yUt];yLpn] hC]:Pac]hac]: Kw]:tI:SQn]:tac];yQw]:)
Tat]:kUiw]wan]lUt];yWm];"  pn]tac];hU.lgc]:
(tUv];tI:pL:tC]:) kin]tac];kin]
tL,tWc];" lgc]:lqk]:l}a:hqc];yLnn]. Tuk],lIhC]:emLyLlUc]El: PU:st];yLsn].Suc]Kw]st];pn]kUv];"
94
Em:man];pQn]tac];pQn]yQw]:wan]
nac];yic];ekL.An]mI;tac];pQn]yQw]:wan] sQm]mUiw]:p},pL;tgc]. Am],nn] miUw]:pL;tgc].yU,nn]. sC].lWk];l}a;
lWc]:kin]yqm].eS Am],kum];Tic];Tat]:kUiw]wan]l}:n}suic] Tuk],lIAw]Ain,] SU<lin]; eSyUt];yLpn]"
miUw]:pL;tgc].n}. etsC].yLkin]Am],l}:" kgp]:n} Tuk],lISUc],kUn];pQn] kCL,hBc];yL Am],nn] tiUc],pac],tc];
emLyLeS hQt];Sac]:kCL,"
tL,Em:man];An]mI;tac];pQn]yQw]:wan]w}. etpQn] lWc]:etkiUt],luk]:tI:An]t}ayw].AWk],mL;'
lWc]:man];pQn]kWc].' lWc]:Am],p},tQm]lUin]mn];eSkUit],AWk],mL;' lWc]:luk]:AWn],etyC],pUn].tI:
sUiw];n}.pQn]l}:Suc]Et.Et." (tL,etkiUt],luk]:Agn],nm].nk];Am],tQm]nn].eA,)"
lgc]:eh.kc]: - tUv];tI:l}a;yUt];yLlUv]:lgc]:yU,Sac]:kin]Sw];"
Aac]:Aic] - tac];pQn]tL (kn] 11)' tac];pQn]SQn]:liUt]:hUw]sC] (kn] 8)' lgc]:pI;pUn].tI: (kn]

17.3)' lgk];Kgc]: BMI (kn] 24.5)
Tat]:kUiw]wan]nC];lUit]:lUt];yWm]; (Hypoglycaemia)
eKL:piut],tI:pgc], kWp]:wL:Tat]:kUiw]wan]nC];liUt]:eA,lUiw] 70 mg/dL (3.8 mmol/L) nn].yw]." lgc]:

pQn]naw]nUk].h}a.hqc];eSEl: Tat]:kiUw]wan]tUk];ygm];kCL,Tiuc] 40 mg/dL (2.2 mmol/L) n}.ekL: pgc],wL:
Tat]:kiUw]wan]nC];liUt]:eA,nn].yw]."
cw]:hak]:tac];pQn]mn];
1) pn]yLyQw]:wan] nm]nL,pUn].tI:
2) kUn];pQn]yQw]:wan] Am],kin]tac];kin]eSEl: kin]yLyQw]:wan]
3) pQn]naw]nUk]. (km]:nm]Et. Em:man]; Am],nn] yc];kin]yL kuv],nic];yU,)
4) kWp]:sUiw].mqc];tac];pQn]tac],sUiw];"
Pac]hac]:tac];pQn]
 hBiw],Agk],' tWc].m}:(KC]:kin])' sC]Sn],' hBw]mw];'
 Sc]wL:pQn]h}a.hqc]; - hBw]pn],' hBw]mw]; Am],nn] sC]pWt];sC]h}a. pQn]can]; luim];tUw]
 kUt],Tt];tUv]; Tat]:kiUw]wan]nC];liUt]: tL,mk];mn]:tac];pQn]"
 hLtUv];cw]:hak]:tac];pQn] (naw]nUk]. Am],nn] sp];tit];siUw].mqc];tac];pQn])
95
lWc]:yUt];yL
 epL;kUn];pQn]kin]l}: hG]:pn]kin]nm].kiUw]wan] Am],nn] nm].wan]n} ethQt];hC]:Tat]:kiUw]wan]
nC];liUt]:Kiun]:mL;km];niuc]:' lat]:EnkUn];pQn] hC]:kin]Kw]:"
 Sc]wL:kUn];pQn]lium];tUw]yU, Am],nn] Am],sac]:kin]Sc]l}: - hp].kUn];pQn]w}.tI: IPD pn]yL
50 ml 50% Dextrose IV STAT" miUw]:tiun],Kiun]:mL; hC]:kin]nm].kiUw]wan]"
 emLyL Am],nn] PU:yUt];yLsn].Suc]Kw] Tuk],lITt];Sac]hqc];yLKiun];"
Aac]:Aic] tac];pQn]yQw]:wan] (10.1)' tac];pQn]naw]nUk]. (15.2)"
10.2 tac];pQn]mak],ln]T};r}W; (Thyroid Disease)

eKL:piut],tI:pgc],
mak],ln]T};r}W;n}. pQn]tiuc],An]niuc]:yU,tC]:eKL;h}g tI:An]hQt];Sac]:ehL,l]mUn];Agk],mL;" tgm],T};r}W;n}.
ethQt];Sac]:ehL,l]mUn];Agk],mL;Sgc]Sqn]; (T};rUw],Sin]; El: F-T4) An]kCL,sgm];SQn]:liUt]:El: kum];
Tic]; lgc]:Pw]m}:AL,hL,rnC];tUw]kUn];" ehL,l]mUn];T};r}W; etkum];Tic];lgc]:hQt];kan] Ac],kL,nC];tUw]kUn];
km]:nm]" Kw]etSc],kan]KiUc]:Ac],kL,wL: Tuk],lIhQt];kan]w};kL:hiuw] TiUc];kL:hiuw]El: Sc],kan]wL: miUw]:lC]
Tuk],lIsC].AQn]hqc];kL:hiuw](miUn]nc], sC].Agk],SI,kYin],El: hQt];Tat]:m}:Agk],mL;) siUw];n}.yw]." An]ehL,
mUn];l]T};r}W;Tuk],lIhQt];Sac]:Agk],mL;kL:hiuw]nn]. Sm].pQn] Thyroid –Stimulating Hormone (THS)
kum];Tic];w}.nn].yw]."
sC].lgc]:tqk]:Tt]; THS El: F-T4 nC];liUt]:kUn];pQn]eSethn]l}:Tiuc]lgc]:Pit];pk],ktI,Kgc]ehL,mUn];l]
T};r}W;kUn];pQn]l}:" (pk],ktI, = puc],man],)
THS F – T4 eKL:tqp];tt];
pQn]pk],ktI, pQn]pk],ktI, T};rW};Am],mI;pn],hL
ehL,l]mUn];T}:r}W;eA,
pQn]pk],ktI, ehL,l]mUn];T}:r}W;eA, tI:Am],EnPac],hac]:Sc]
ehL,l]mUn];T}:r}W;nm]
pQn]pk],ktI, ehL,l]mUn];T}:r}W;nm] tI:Am],EnPac],hac]:Sc]
ehL,l]mUn];T};rW};eA,
eKL:piut],tI:pgc], lgc]:hQt];kan]mak],ln]T};rW};Am],lI"
Pac]hac]:tac];pQn]
 tgc].pik].  SQc]Am],Agk],
 hiUw]. AUn]:Agn],El:Tat]:sC]tUk];  KUn]hUw]hUc]:
 Piw]nc]hqc]: kt]; yQn]  nL:kC]: nL:ePL;
96
 lgc]:kUt],Tt]; - Aw]miuw];km]tUv];mak],ln]T};rW}; (mak],ln]kC]:' pQn]tum],)' tqk]:hqc];lUit]:
tgn]:tUv];"
 kUt],Tt];tUv];tI:hgc]:lqp], - TSH, F-T4
lgc]:yUt];yL
 ehL,l]mUn];T}:r}W;eA, tI:Am],EnPac],hac]:' (TSH Suc]' F-T4 pk],ktI,) – pC].tUv];kgn],"
 ehL,l]mUn];T}:r}W;eA, - pn]yLmQt]. thyroxin 0.1 mg"
eA,liUw] 65 pI< - nm]liUw] 65 pI< -
Et,pn]- 0.1 mg tL, 1 liUn] ( 1 OD)' Et,pn]- 0.025 mg tL, 1 liUn] ( 1/4 OD)
w}a;nn]. 0.15 mg tL, 1 liUn] (1.5 OD) kum];Tic]; TSH/ F-T4 tL,tUv];hn]Tiuc]wL:sc],pQn]
w}a;nn]. 2 liUn] kUt],Tt];tUv]; TSH/ F-T4 pk],ktI,hiuw]" lqk]:l}a:Kiun]:/lUc];pn]hqc];yLtL,
El: lqk]:l}a: Kiun]:/lUc];pn]hqc];yLtL, 0.05mg " 0.025mg" kum];Tic]; TSH/ F-T4 etL,epL;pQn]
kum];Tic];pn] TSH/ F-T4 kU:liUn]etL,epL;pQn] miUn]kw],Kiun];" epL; TSH/ F-T4 pQn]miUn]kw],Kiun];yw].
miUn]kw],Kiun];" epL; TSH/ F-T4 pQn]miUn]kw],Kiun];yw]. hC]: kUt],Tt];tUv]; TSH/ F-T4 6 liUn]niuc]:pgk]: El:
hC]:kUt],Tt];tUv]; TSH/ F-T4 6 liUn]niuc]:pgk]:El: lqk]:l}a:Kiun]:/lUc];pn]hqc];yL 0.025mg (1/4 OD)"
lqk]:l}a:Kiun]:/lUc];pn]hqc];yL 0.025mg (1/4 OD)"
lgc]:yUt];yLKaw];lc]
Kk].tgn]:yUt];yLmiUw]:mC],mC], - lat]:EnkUn];pQn]wL: etl}:mL;EnkU:liUn]nC];Kaw];tac]; 3 liUn]" 2 liUn]
niuc]:pgk]: etl}:kUt],Tt];tUv]; TSH El: F-T4 etL,epL;pQn]pUk],ktI,"
Kk].tgn]:yUt];yLw}a;liun]; - lat]:EnkUn];pQn]wL: etl}:mL;EnKiun]; 3 liUn]niuc]:pgk]:" 6 liUn]niuc]:
pgk]: etl}:kUt],Tt];tUv]; TSH El: F-T4"
ehL,l]mUn];T};rW};nm]
eKL:piut],tI:pgc], lgc]:hQt];kan]tgm],T};rW};nm]pUn].tI:"
Pac]hac]:tac];pQn]
 tgc].kCL,  hiUw],Agk],
 sC]Am],nim]  hUv],tLmqn];Agk],mL;
 nm].nk];tUw]lUt];ygm];  hqc];liUt]:tgn]:w};' sC]Sn]
 tUw]Aun],Aun],  miuw];Sn],
97
 lgc]:kUt],sqt]: - tqk]:hqc];liUt]:tWn]:' Aw]miuw];km]tUv];mak],ln]T};rW}; (mak],ln]kC]:'
pQn]tum],)"
 kUt],sqt]:tUv];tI:hgc]:lqp], - TSH, F-T4 (w}a;lc]niuc]:liUn] El: 6 liUn]niuc]:pgk]:)"
 Pac],hac]:Sn],eT,mak],Ait],n}. etmiUn]kn]tc];Pac]hac]:tac];pQn]ehL,l]mUn];T}:r}W;nm]"
lgc]:yUt];yL
 pn]yLmQt]. Propyl Thio Uracyl (PTU) 50 mg (yLn}.pQn]yLkum];Tic]; lgc]:T};rW};hQt];kan]
Am],Tuk],mqn]:)"
 pn]yL (PTU) 200 – 400 mg OD ( 4-8 mQt]. OD)"
 tL,kum];Tic];lgc]:hQt];kan]Kgc]T};rW}; - kUt],Tt];tUv]; (TSH, F-T4) w}a;niuc]:liUn]' w}a;nn]. 3
liUn]niuc]:pgk]:"
 miUw]:Pgn];kUt],Tt]; TSH, F-T4 El:Pac]hac]:tac];pQn] pQn]pk],ktI,mL; hC]:lUt];hqc];yLlUc]; 2
liUn]niuc]:pgk]: tL, 50 mg etL,Tiuc] 50-150 mg OD etL,wn];"
 yUt];yLSiup],kCL, tL, 12 Tiuc] 24 liUn] yw].ekL:kiut];yut];" tUv];sgm];Pac]hac]:tac];pQn]"
 tL,Pac]hac]:hUw]sC]tWn]:w};El:sC]Sn]lIKiun]:mL;km];Siuw]:nn]. hC]:pn]yL propranolol"
lgc]:yUt];yLKaw];lc]
Kk].tgn]:yUt];yLmiUw]:mC],mC], (3 liUn]) - etl}:mL;EnKiun];kU:liUn]"
Kk].tgn]:yUt];yLw}a;liun]; - etl}:mL;EnKiun]; 2 - 3liUn] niuc]:pgk]:"
m}atgc];" " nc],hiuw]etkum];Tic];lgc]:hQt];kan]Kgc]T};rW}; tL,Em:man];tI:pQn]ehL,mUn];l]T};rW};nm]nn].Tuk],

lI k}.k}.kUt],Tt];tUv]; (TSH, F-T4)" Am],Tuk],lIpn]kiUt],luk]:tI:hiUn];ekL.lQw]El: epL;kiUt],luk]:mL;
ekL: Tuk],lIkUt],Tt];luk]:tUv];wL: luk]:sc],mI;Pac]hac]:tac];pQn]T};rW};hiuw]"
lgc]:eh.kc]:
 kUn];pQn]Tuk],lIkin]yLEl:mL;EnemLyLKw]tL,eS,"
 kUn];pQn]Tuk],lIhU.Pac],hac]:tac];pQn] ehL,mUn];l]T};rW};nm] Am],nn] eA,nL,pUn].tI:"
 kUn];pQn]Tuk],lIhU.wL:yLmac]:siUw];etsac]:mL;yL.kw];lgc]:yUt];yLtac];pQn]ehL,l]mUn];T};rW};l}:"
 epL;etEt,kin]yLAn]mC],mC],miUw]:lC]Am],wL: kUn];pQn]Tuk],lItiUc],pac],tc];emLyLAgn]tac];kgn],"
Aac]:Aic] Sn],eT,mak],Ait], (kn] 19.6)"
98
tac];pQn]eKL;nQc]
eKL:piut],tI:pgc],
tac];pQn]eKL;nQc]n}.pQn]kgp]:tgm],(mak],ln])T};rW};yC],Kiun]:mL;nn].yw]:" km]:nm]kUn];nC];piun].tI:An]Am],k}.
l}:kin] tac];kin]An]mI;Tat]:A},AUw],tin];eA,n}.etpQn]kn]nm]" epL;k}.kin] mn];kqw]' Pk];kat],luc];
Am],nn] mn];lqc]n}. etsac]:pQn]eKL;pWm];l}:" Tat]:A},AUw],tin];n}. pQn]Tat]:Am],mI;Am],pQn] tL,
hQt];Sac]:ehL,mUn];l]T};rW};Agk],mL;El: kgp]:Kat],Tat]:A},AUw],tin];n}. ethQt];hG]:lgc]:hQt];Sac]:ehL,
mUn];l]T};rW;} Agk],mL; Am],PQc],eSsc],pQn]tac];pQn]ehL,l]mUn];T};rW};nm] Am],nn] eA,nn].yw]:" tL,
tqn];Kiun];lgc]:hQt];Sac]: Am],PQc],nn].tgm], (mak],ln]) T};rW};sc],l}:yC],Kiun]:mL;" lgc]:lut],lqn];yL
El: miUw]:pL;tgc].siUw];n}. yuic]:Kqn];ethQt];hG]:tac];pQn]h}a.liUw]l}:"
Pac]hac]:tac];pQn]
 mak]ln]T}:rW};yC],Kiun]:mL;"
 ehL,l]mUn];T};rW};nm] Am],nn] eA,"
 miUw]:pL;tgc].yU,nn].ethQt];hC]:Tat]:A},AUw],tin];eA,- etsac];hQt];hC]: lgc]:p},tQm]liUn]eS
El: kiUt],lgc]:luk]:Agn],nC];tgc].t}akgn],kiUt],siUw];n}. Suc]Kiun]:nn].yw]."
 luk]:Agn], - tac];Kiun]:yC],tUw]El:sC] (lgc]:hQn];hU.) TiUc];"
p}a;yUt];yL (sgm],nc], WHO mk];mn]:w}.)
kum], 0" " T};rW};Aap]:Am],pQn]Sc]' kUt],Tt];Am],vL;Sc]' eKL;Am],yC],"
kum], 1" " tgm],(mak],ln])T};rW};yC],nn]. Aw]miuw];sp];hU.l}:eStL. Am],hn]eKL;yC],"
kum], 2" " eKL;yC],eKL;pum];yU,nn]. hn]l}:tqk],lqc];lI"
kUt],sqt]:tI:hgc]:lqp]," " Sc]wL:mI;Pac]hac]:tac];pQn]T}:rW};n} kUt],Tt];tUv]; TSH El: F-T4"
lgc]:PWn];sL. (pn],hLsgm];lc])
etsQp];tI:eKL;Am],nn]kp]." epL;wL:yC],nL,pUn].tI:eSEl:mip],vL;lgt],lUm];Am],nn] lgt],eKL;
eSEl: tUv]:sC]yap], Am],nn] Aiun]tac];kin]yap],n}siuc] Tuk],lIPL,Agk],pqt]:"
lgc]:yUt];yL
Sm];nm].mn];A},AUw],tin];pn] tL, 1 dose' w}a;nn].niuc]:pI<Sm];pn]Tqc]:km];niuc]:"
yLmQt].nm].mn];A},AUw],tin]; - 200 mg pQn]yLmQt].tL,pn]kin] niuc]:pI<niuc]:pgk]:
luk]:Agn],lQk].liUw] 1 KUp], 1 mQt].
luk]:Agn], 1 - 5 KUp], 2 mQt].
luk]:Agn], 5 - 15 pI< 3 - 4 mQt].
Em:man]; 2 mQt].
kUn];lUc]' km]:nm]Et. nac];yic];tI:mI;AL,yusp];Sn],eT,l}:yw]. 3 - 4 mQt].
99
10 tac];pQn] kQw],lUv]:ehL,mUn];l]
 tL,luk]:Agn],Et. w}a;eSkin]yLyw]. eKL;pum];etyup]:h}akCL,l}g;l}g;" tL,kUn];lUc]nn]. eth}akCL,
TiUc];liUw] Am],nn] pqk].Sm].wL:tgm], (mak],ln]) T};rW};hQt];kan]l}:lIyw].eStL. eKL;pum];Et.
etAm],h}a"
 kUn];pQn]km]:eA, etsac]:pQn] ehL,l]mUn];T};rW};nm]Kiun]:mL;' epL;pQn]siUc].nn] Tuk],lIyUt];yL
sgm];cw];l}a;kCL,"
 kUn];pQn]An]eKL;pum];yC],nL,pUn].tI:eSEl:mip],vL;lgt],lUm]; Am],nn] lgt],eKL;eSEl:TUv]:
sC]yap], Am],nn] Aiun]tac];kin]yap],kUv]; sc],Tuk],lIPL,Agk],pqt]:"
lgc]:eh.kc]:
l}a;eh.kc]:tac];pQn]eKL;pum]; Am],nn] Kat],Tat]:A},AUw],tin]; An]lIliUw]piUn]:Et. pn]tac];hU.kQw],
lUv]: lgc]:kin]kiUw]A},AUw],tin]; (m}atgc]; - An]muk].sum]; TBBC s}g:Tqm]pn])" Sc]wL: piun].tI:nn].
Am],mI;kiUw]A},AUw],tin];lL;lL;n} Tuk],lIpn]yLmQt].nm].mn];A},AUw],tin];hC]:kUn];nC];piun].tI:nn]."
Aac]:Aic] tac];pQn]ehL,l]mUn];nm] Am],nn] eA, (kn] 10.2)"
100
tac];pQn]tL
11
tL,tWc]; - tL,eKL:mun];hUw]y}g:nn]. hC]:kCL,tUv];Aw]tI:pp].“Burma Border Eye Care Manual”"
11.1 S}atLAUn]:(sut];Sun]cw];hac]: Am],Siuw]:)

Sc]wL:tUv];pgc],hU;KQm] hn]l}:lIliUw]n}siuc] pgc],wL:kUn];ekL.nn].
Tuk],lIsC].tiuw];man],tLyw]."
(k) S}atLAUn]: kU:Kaw];yam];

lWc]:S}atLAUn]:n}. pQn]lgc]:pQn]kn]km]:nm]" kUn];pQn]S}atLAUn]:n}. etpQn]kWp]:lUv]:tac];pQn]tL Am],
nn] etl}:sC].tuiw];man],tLnn].yw]." cw]:hak]:An]hQt];hC]:pQn]S}atLAUn]:km].nm]Et. epL;kUt],Tt];
tUv];hUv],tLlIlIn}siuc] sac]:TUp].hn]l}:yU, (kqw]:tLSC]mI;hg};sQp]; tLpQn]PL:n} tqk],lqc];lIwL: sp];
tit];siUw].mqc];)"
(K) hqc];tUv];sm]AUn]: (S}atLyaw];)

km]:nm]ethU.kn]wL: S}atLyaw];" lgc]:n}.ethQt];hC]:tUv];Kgc]sm]sm] Am],epL;hn]lIEl: yiuc]:AL,yu
yG], yuic]:Sm].Kqn];h}a.hqc];mL;l}:"
S}atLyaw];n}. sgm];nc],AL,yueS etmqc],l}:pQn] 2 kum],"

 kUn];lUc] AL,yU. 40 pI<lUc];tC]: An]pQn]S}atLyaw];nn]. etmk];mn]:tac];pQn]wL:
Hyperopia" pQn]siUc].n}n}. sC].tiuw];man],tLpL,wL,m}aelL;pn]ekL: etEk:lit]:pn],hLl}:"
 kUn];lUc] AL,yU. 40 pI<Kuin]:nUiw]kU:ekL. k}.pQn]S}atLyaw];yU,yw]." lgc]:lUlik]:El: lgc]:yQp].
KUw]; sUiw];n}. etyap],mL; (Am],nn]) tiun];Am],hQt];Sac]:l}:nn].yw]." lWc]:hqc]; tUv];sm]
AUn]:n}. pQn]SPL,wkUn];hw]; sgm];lUv]:AL,yuEl: Pac]hac]:siUc].n}n}.ethgc].wL: Presbyopia"
 sC].tiuw]; man],tLlUlik]:n}. etsW}:pn]l}:yU,yw].(man],tLpL,wL,m}aelL;)"
(c) hqc];tUv];k}AUn]: (S}atLpgt];)

kUn];siUw];S}atLpgt];km]:nm] ettUv];k}Am],epL;hn]lI" (miUn]nc],luk]:hQn]; Am],lUtUw]lik]:niUw]
pqn]:lm]l}:' epL;lUpp].n}ekL: l}:Aw]pp].mL;sm]sm]tLsc],lUl}:siUw];n}.yw].)" Pac]hac]:siUc].n}n}.
ethgc].wL: Myopia"
 sC].tiuw]; man],tLpL,wL,m}aTgn]n} etsW}:pn]l}:yU,yw]."
101
11 tac];pQn]tL
(s) hqc];tUv];AUn]: miUw]:hBw]Km]:El: kac]Kuin];

lWc]:Am],hn]miUw]:kac]Kuin];n}. pQn]Pac]hac]:Kat],Tat]:wI,tL,min],eA, miUw]:Et,pQn]An]nuic]:yU,
yw]." sWm];lqn]lin]n}. Kw]hgc].wL: tLPac];k},n}yU,yw]." luk]:AWn],etk}.pQn]nm]n}eStL. kUn];lUc]
ekL:sac]:pQn]l}:" kUn];pQn]tLPac];k},Kw]n}. epL;hBw]Km]:mL;kUv];ekL: ethn]yap],yU,yw]."
tL,yUt];yLnn]. tUv];Aw]tI: lWc]:Kat],Tat]:wI,tL,min],eA, (kn] 17.2)"
11.2 sp];tit];siUw].mqc]; (pQn]sQp];)

tLsQp];El: sp];tit];sUiw].mqc];tac];pQn]kU;lgc]:lgc]:
eKL:piut],tI:pgc],
tLP}a,nuic]: Am],nn] tc];Sgc]P}a, l}:sQp];kC]: kWp]:pUiw]:pqk],TI:rI;yL;' w};rt].S] Am],nn] Am],mqn]:
tc];lUit]:lUm];siUw];n}.yw]." mac]pgk]:mac]lC] tLsQp];kC]:nn]. kgp]:Am],hU.l}:wL:pQn]mL;kWp]:Sc] (pqk],TI;rI;
yL;' w};rt].S]) Am],mqn]:tc];lUit]:lUm]; Am],nn] cw]:hak]:tac],siUw];n}nn]. mk];mn]:yap],w}.yU,"
Pac]hac]:tac];pQn]
 tLlqc]
 epL;pQn]kgp]:sUiw].mqc]; pqk],TI;rI;yL;n} etpQn]ngc]w}." epL;sC].yL TL,rL,m},Sin], Terramycin
Eye Oilment (TEO)n} ethQt];hC]:Kqn];l}:yU,"
 epL;pQn]kgp]:sUiw].mqc];w};rt].S]Sm]. etmI;nm].tLl}Agk],mL;" sC].yLTL,rL,m},Sin], Terramycin
Eye Oilment (TEO)nn]. etAm],h}al}:n}eStL. epL;Am],mI;lWc]:h}a.hqc]; Sc]sWm];lc]Et.
nC];Kaw];tac];nuic]:wUc]:nn]. etsac]:h}akCL,hc];kUv];yU," nC];Kaw];PBn]etk}.pQn]tLsQp]; kgp]:sUiw].
mqc;] w};rt].S] nC];Sun]p}a:eP;El: hUw]kUn];etpQn]kn]Tiuc] 20-30% yU,yw]."
 tLsQp];kgp]:Am],mqn]:tc];lUit]:lUm];nn]. Aw]yL (TEO)eSyLAm],lIKiun]:l}:" Aw]nm]. An]
mUt];SC], km];km];k}.Suk]:lac].pn]n} ethQt];hC]:tac];pQn]lImL;l}:yU," pQn]tLsQp]; kgp]:Am],mqn]:
tc];lUit]:lUm]; n}.tL,ettqp];tt];wL:pQn]kgp]:Sc]Et.Et.n}.yap],"
Aw] TEO eSyUt];yLtLsQp]; yWn].kgp]:sUiw].mqc];w};rt].S]El: Am],mqn]:tc];lUit]:lUm];

siUw];n}.Am],Kqn];mL;l}:n}eStL. etsac]:hQt];hC]:Pac],hac]:tac];pQn]lIKiun]:l}:eS
eteh.kc]:lgc]:sp];tit];siUw].mqc];pqk],TI;rI;yL;An]sgm];lc]mL;l}:nn].yw]."
102
tac];pQn]tL 11
lgc]:KUn].hLmk];mn]:tac];pQn](Diagnosis) - lgc]:kUt],Tt];"
lWc]:yUt];yL
sWm];lqn]lin]tac];mUt];Et. yLtL,tac];pQn]tLsQp];n}. etpQn]yLtL; Terramycin Eye Ointment
(TEO) An]lQw]kUv];" nC]; TEO n}.mI;yL Tetracyclline n}eStL. etAm],pQn]eP; tL,luk]:AWn],'
Em:man];El: Em:An]lQc].nUm];luk]:AWn],Kw]sUiw];n}.sC].lL;lL;"
 Aw]yLtL;(TEO) SC],pn] nuic]:wn]; 4 pWk]: etL,Tiuc]hC]:yLepL;SQc]:kCL, 2 lgt],"
 Sc]sC].yw].Am],tiUw].n}siuc] hC]:sC].yLygt],tL chloramphenicol"
 sC].nm].Aun],Suk]:eS tQk];pn]n}siuc] ethQt];hC]:lWc]:kC]:sQp]; lUt];yWm];kCL,l}:"
 Enpn]l}a;SC],yLnC];tL" Em:luk]:AWn], tk];etl}:s}g:SC],yLpn]luk]:AWn]," lat]:EnkUn];
pQn]Kw]wL: mUiw]:etSC],yLnn]. hC]:lac].nL:El: Suk]:muiw];lIlIyw]. sc],SC],yLpn] kUn];pQn]"
 epL;yUt];yLyw]. Am],p},Kqn];n}suic] lat]:hC]:kUn];pQn]mL;sU;Kiun];"
 yL,Aw]Sc]puk].pik].tLtI:An]sQp];w}.lL;lL;"
pQn]tLsQp];h}a.hqc];yWn].kgp]:sUiw].mqc];' hUm]:tc];sp];tit];sUiw].mqc];tac];pQn]nC];kqw]:tL El:yUt];yLyw].

Am],Kqn];mL;n}suic] hC]:SUc],kCL,hBc];yo"
lgc]:eh.kc]: lgc]:mUt];SC]tUw]sw]:kw],' Suk]:miuw];tL,eS,"
Aac]:Aic] pp].kqm]miuw]; Burma Border Primary Eye Care Manual"
tac];pQn] KWp],tLsQp];Sqp], (Trachoma)

eKL:piut],tI:pgc],
tac];pQn] KWp],tLsQp];Sqp],n}. pQn]yWn].lUv]:sUiw].mqc];pqk],TI;rI;yL; Chlamydia organism nn].yw]."
pqk].Sm].wL: sWm];lqn]lin] Am],hn]pQn]yw].eStL. mac]pgk]: luk]:AWn],El:kUn];lQc]. luk]:AWn],Kw]ekL:
yc];sac]:sp];pQn]kn]l}:yU," km]:nm] kUn];An]pQn]tac];pQn]n}. etAm].k}. hB.tUw]wL:pQn]yU,"
tac];pQn]KWp],tLsQp];Sqp],n}. tI:lC]Am],mI;lWc]:mUt];SC]him];hgm];tI:yU,El:tUw]n}suic] etKqn];k}.pQn]kn]nm]"
lWc]:pn]tac];hB.El:lWc]:Eh.kc]:n}. pQn]pUic]lm],lgc]: tL,kum];Tic];tac];pQn]sQp];Sqp],him];KWp],tLnn].yw]."
Sc]km];km];k}.pQn]tac];pQn] Kgp],tLsQp];Sqp],n}.n}siuc] etsac]:hQt];hC]:pQn]Tiuc]

tLmgt],l}:"
103
11 tac];pQn]tL
Pac]hac]:tac];pQn]
kan]kUt],Tt];tac];pQn] Kgp],tLsQp];Sqp], etmI; 5 Kn].tgn]:"
1. tac];pQn]Kgp],tLsQp];Sqp], tI:An]mI;tum],lQk]. (Trachoma with Follicle (TF))

Pac]hac]:tac];pQn]Agn]tac];Sut];Et. etmI;tum],lQk].tC]:Kgp],tLpL:niUw]" tum],siUw];n}. etpQn]tum],SIKaw]
Am],nn] SIliUc]" epL;wL:mI;tum],siUc].n} 5 An] Am],nn] nm]liUw]nn].n}siuc] An]n}.pgc],wL: Pac]hac]:
sn].tgn]:Agn]tac];Sut];tac];pQn] Kgp],tLsQp];Sqp],nn].yw]."
2. tac];pQn]Kgp],tLsQp];Sqp], tI:An]sQp];kC]: (Trachoma with Inflammation (TI))

tC]:Kgp],tLpL:niUw]etlqc]w}." mac]:pgk]:ethn]tum]lqc]El:sQp];kC]:yU,sgm];kn]" kgp]:sQp];kC]:El: ethQt];hC]:
hn]SQn]:liUt]:tC]:Kgp],tLpL:niUw]l}:yap],"
3. tac];pQn]Kgp],tLsQp];Sqp], tI:An]mI;h}g;sQp]; (Trachoma with Scarring (TS))

epL;kUn];ekL.niuc]:k}.pQn]tLsQp];n} sQp];nn]. etsac];yQn];pQn]h}g;sQp];l}:" ethn]pQn]h}g;Kaw]tC]:Kgp],tLpL:
niUw]El: etAm],hn]SQn]:liUt]:l}:" tL,etpin]:KWp],tLeS kUt],Tt];tUv];nn]. etyap],Pgc]:"
4. tac];pQn] Kgp],tLsQp];Sqp], kgp]:KUn]tLTim]:tqc];SC], (Trachoma with Trichiasis (TF))

kgp]:pQn]h}g;sQp];h}a.hqc];tI:Kgp],tLpL;niUw]El: KUn]tLpL;niUw]etpk];lUc];mL;SC],hUv],tLl}:nn].yw]." pQn]siUc].
n}n}. hgc].wL:pQn] Trichasis n}yw]."
5. kqw]:tLSC] ekL,nIrL, mgt], (Corneal Opacity (CO))

miUw]:KUn]tLtqc];Kw]:tI:hUv],tL' KUn]tLetkCL,pt];SC],kqw]:tLSC]yU,tL,eS,eSEl: etsac]:hQt];hC]:pQn]h}g;
sQp];niUw]kqw]:tLSC]" siUw].mqc];pqk],TI;rI;yL; Am],nn] w};rt].S]ekL:Kw]:sU;h}g;sQp];l}:c}a:eS El:sp];
tit];tac];pQn]l}:c}a:"
kUt],Tt];tUv];P}a,ngk]:El: tgc]:Tam]tUv];piun];yUt];yLkUn];pQn]ekL: ethU.El:mk];mn]:l}:yU," tUv];
tI:tLP}a,nUiw]wL: sgc],mI;tum],lQk].' Pac]hac]:kC]:pWc];' KUn]tLsgc],Tim]:tqc];SC],tLyU,sUiw];n}.yw]." mk];mn]:
suiw]:tac];pQn]n}. Tuk],lIpQn]PU:yUt];yL An]l}:lQp]:hQn];lWc]:p}a;tLKw]kUv];"
104
tac];pQn]tL 11
lWc]:yUt];yL (sn].tgn]:Kiuk].Kk].) sn].tgn]: 1 El: 2
 Suk]:nL:Suk]:tL niuc]:wn]; 4 pgk]:" (mUiw]:p},SC],yLtL; TEO kU:pgk]:)
 SC],yLtL; TEO pn] wn];niuc]: 4 pWk]: etL,yLepL;SQc]: 4 lgt],El:
 epL;wL:AL,yulQk].liUw] 8 KUp], hG]:pn]yL Azithromycin (luk]:Agn], 20 mg/kg' kUn];lUc] 1
gram) Am],nn] Doxycycline (100 mg niuc]:wn];Sgc]pgk]:' tL, 2-3 wUc]:)"
 Tam]tUv];kUn];pQn]wL: sgc],mI;kUn];nC];hiUn];pQn]siUc].nc],n}Pgc]:hiuw]"
 lat]:EnkUn];pQn]wL: epL;tL;yLmUt];eSh}ayw].ekL: tL,Tt];Sac]tac];pQn]nn]. hC]:mL;hBc];yL
Tqc]:km];niuc]: kgp]:wL:mac]pWk]:etsac]:l}:yUt];yLTqc]:km];TI. 2 "
Sc]wL:mI;yL TEO pQc];epL;yU,n}ekL: pn]yL TEO kCL, tL,kUn];hiUn];kUn];pQn]kU:ekL."
lWc]:yUt];yL (sn].tgn]:w}a;lc]) sn].tgn]: 3-5

sn].tgn]:yUt];yLtac];pQn] KWp],tLsQp];Sqp],nn]. lgc]:sQp];Sqp],h}akCL,yw].n}eStL. hg};sQp];tC]:nc]tL
tI:An]lU.lqw]El: KUn]tLAn]tqc];Kw]:mL;tac];nC]; (Trichiasis) El: hQt];hC]:kqw]:tLSC]lU.lqw] (hQt];hC]:
kqw]:tLSC]mWt],- Cornea Opacity) siUw];n}.yc];etsac]:pQn]w}.yU,"
 tL,eh.kc]:kqw]:tLSC]lU.lqw]El: tLmgt],kCL,nn]. etl}:Aw]kim];kqt];pqt]: KUn]tLAn]ecL; Kw]:sU;
nC];tL Am],nn] epL;Tuk],lITUv]:ekL: etl}:TUv]:pqt]:"
 tL,kUn];pQn]mac]ekL. tk];etl}:PL,tt];pn]El: hC]:SUc],tUw]kCL,yUt];yL tI:An]mI;emLyL An]l}:
hQn];P}a,tLmL;"
lgc]:eh.kc]: pn]tac];hU.lgc]:mUt];SC]tUw]sw]:kw],El:him];hgm];"
Aac]:Aic] pp].kqm]miuw]; Burma Border Primary Eye Care Manual (kn] 14)' STI (kn] 13.5)"
11.3 tiUw].vL;mat],sQp];tI:tL
lgc]:mat],sQp]; Am],nn] hg};sQp];tI:tLsUiw];n}. sac]:hQt];hC]:tLmWt], Am],nn] lU.Sum];tLl}:"
miUw]:lC]l}:tiUw].vL;mat],sQp];tI:tLn}suic] tk];etl}:eh.kc]: yL,hC]:sp];tit]; sUiw].mqc];tac];pQn]Tqc]:
nn].yw]."
lWc]:yUt];yL
 Aw]nm].yL Normal Saline Am],nn] nm].mUt];SC]eS lac].pn]tLlIlI"
 Aw]KWcA
] n]sp];w}.tI:tLsiUw];nn].AWk],pqt]:"
105
11 tac];pQn]tL
 SC],pn]yLtL; TEO nm]nm]"

 Sc]sUiw].wL: kqw]:tLSC] Kut],mqn]:vL;n}suic] hC]:sC].PL:kWt]. An]yuit]:l}:hBt];l}:nn]. pUk].w}.pn]"
kac]nC]sw].Tqc]:wn];niuc]: Aw]PL:An]pUk].w}.Agk],yw]. Tt];Sac]tUv];cw];l}a;tac];pQn]"
 Siup],yUt];yLlUv]: TEO El: epL;etl}:pUk].pn]ekL:etl}:pUk].pn]w}."
 lgc]:pUk].hBm],w}.nn]. etAm],l}:w}.pUn].lUiw]nuic]:Kuin];"
Sc]sQp];yQn]; hG]:kiut];yut];lgc]:pUk].hUm]," kgp]:wL:tLAn]pUk].hUm],w}.nn].

etpQn]tI:pqk],TI;rI;yL;eP:Agk],l}:c}a:" yL,pUk].hUm],tLAn]sQp];yQn];(sp];tit];siUw].mqc];)lL;lL;"
 sQp];h}a.hqc]; An]hBv],tL l}:lU.lqw]w}.nn]. Tuk],lISUc],kCL,hBc];yo" Sc]wL:kUn];pQn]ekL.nn].

vL;mat],sQp];Tuic]tI:hBv],tLln]AWk],mL;El: etl}:SUc],kUn];pQn]kCL,tac],tI:n}suic] hC]:Aw]Pqn],
Eh.tLw}.pn] (Am],sC]:sC].PL:kWt].hBm],tL)" epL;mat],sQp]; tiUw].vL;h}a.hqc];siUc].n}n}. km]:nm]
tLetmgt], Am],nn] l}:lU.Sum];tLyU,yw]."
11.4 tac];pQn]tL
m}atgc];" " hC]:kQp];S}am}aAn]hB.w}.wL: nC];tLpQn]PL:El: kUn];pQn]An]yam]:l}:PL,tt];tL' mat]:m}aw}.
lWc]:kUn];pQn]ekL.lC]ekL.nn]. suiw]:' AL,yu' s}a;' yic];' m}ahUin];' lWc]:mk];mn]:tac];pQn]El: lWc]:tUbv];
hn]KWc]tLhBv],lC]hBv],nn]." mat]:m}algc]:tLlm]tUw].tgp],Sqc]f};w}.sgm];" lWc]:mat]:m}a S}am}akUn];pQn]
tL,PL,tt];tLn}. pQn]lWc]:hac]:hqn];tI:lI tL,mL;PL,tt];tLnn].yw]." Aic]nUiw]S}am}an}.eS ethL
kUn];pQn]l}: Kn]Kn]w};w};El: sg}:hG]:lWc]:SQc]:Kaw];yam]; emLyLtL,PL,tt];eA,lUc];nn].yw]."
tac];pQn]etL:mgk], (Cataract)
eKL:piut],tI:pgc],
hBv],tLpQn]etL:mgk],n}. sac]:hQt];hC]: tLAm],hn]lInn].yw]." etpQn]PL:kCL,tc];hUv],tL Am],nn]
lQn];tL (lens -SUn],tI:hQt];hC]:hw];tUbv];hn]l}:) kUv];ekL:mI;" tL,mk];mn]:tac];pQn]nn]. tUv];tI:
luk]:tLlm]kUv];ekL: ethn]miUn]nc],mgk],kum]:Kaw]hUm],lQn];tLw}.yU,yw]." tac];pQn]nC];hBv],tLmI;PL:n}.
pQn]cw]:hak]:hQt];hC]:kUn];tL mgt],sgm];lqn]lin]yU,yw]."
tLpQn]etL:mgk],n}. liUw]eSPL,tt]; Am],mI;yLSc]etyUt];yLpn]l}:"
106
tac];pQn]tL 11
tac];pQn]etL:niUw]. (Ptergium)
tac];pQn]etL:niUw].n}. pQn]etL:niUw].PUw],Agk],mL;tI:hUv],tLnn].yw]." km]:nm]Et. etpQn]hac]:Sam]sQc],
eSEl: p}alqm]Sm].etlam];yC],kCL,sU;luk]:tLlm]nn].yw]." km]:nm]Et. etL:niUw].n}. etPUw],Agk],mL;
tac];KU;lc]eSEl: yC],lam];kCL,tI:hUv],tLlm]" etL:niUw].n}. etpQn]SIKaw]' Am],nn] etmiUn]niUw].tL'
kgn]:niUw].siUw];n}.yw]." kgp]:Sc]kUn];hw];l}:pQn]etL:niUw].mL;n}.Et. ekL:yc];p},hU.kn]" lgc]:l}:yU,nC];
lqt],hiuc]hiuc]n}. Aap]:etpQn]eP;l}:An]niuc]:El: lgc]:pI:ngc]. siUw].KiUw];yam]:pQn] (sgm];S}aliUt]:)
siUw];n}.yw]." epL;etL:niUw]. PUw],Agk],mL;yw]. mn];etAm],h}al}:eSpgk]:"
lgc]:pQn]etL:niUw].n}. Am],sC]:kgp]:sp];tit];siUw].mqc];" kgp]:n}Am],tap]:Aw]yL TEO eSyUt];yLpn]"
lgc]:yUt];yLtL,etL:niUw].Et. etl}:PL,tt];An]lQw]kUv];" etL:niUw].An]lQk].Et. Am],tap]:Aw]

Agk], kgp]:wL:PL,tt];Aw]Agk],yw].eStL. mn];etpQn]mL;mC],kUv]; (lgc]:PL,tt];n}. Kqn];ethQt];hG]:
cgk]:Agk],mL;w}; liUw]kw],)" tL,lgc]:yUt];yLetL:niUw].lQk].nn].Et. etl}:lat]:EnkUn];pQn]wL:
mn];Am],sC]:sp];tit]; siUw].mqc];tac];pQn] Am],nn] Am],sC]:pn]hLyC],(pQn]niUw].cgk]:l}al}akUv];)"
kUv];kL: tL,etL:niUw].An]yC],Et. kgp]:wL:epL;p}g,w}.n} etsac]:yC],kCL,Tiuc]hUv],tLlm]eS sac]:hQt];hC]:
tUbv];Am],hn]El: tk];etl}:PL,tt];Agk],pqt]:" Sc]wL:etL:niUw]. yC],Kw]:nC];hUv],tLlm] mgk]: 2
Am],nn] 3 mI,lI,lI,tL,n}siuc] Tuk],lISC],siuw]:kUn];pQn]w}.nC];S}am}apC].PL,tt];l}:yw]."
tac];pQn]tLKqc] (Glaucoma)
tac];pQn]tLKqc]n}. pQn]kgp]:hqc];At];S}atLSuc]nL,eSEl: yL.kw];SQn]:AL<yUc],tUbv];hn] hC]:epL;lU.lqw]
kCL,tik];tik];nn].yw]." kgp]:SQn]:AL<yUc],lU.lqw]El: kUn];pQn]ekL:etAm],sac]:tUv];hn]l}:" lgc]:lU.
lqw] siUc].n}n}. etAm],sac]:lIKiun];l}:eSpgk]:yw]."
Pac]hac]:tac];pQn]
 hqc];At];S}atLSuc]Kiun]:mL; (IOP pk],ktI,etpQn] 10mm – 22 mmHg)
 Pqn],hp].AL<yUc],tUbv];hn] etlgk];w}." (sC]. Fundoscopy eStUv];nC];tLAw])
 tLtUv];Am],hn] (Am],lIl}:Kiun];)
 kUn];pQn]tLKqc]n}. kgp]:SQn]:AL<yUc],lU.lqw]kCL,yw].El: lgc]:tLlm] tgp],ygn].Sqc]f};ekL:
eth}akCL, pqt]:" km]:nm]Et. tac];pQn]tLKqc]n}. etAm],sQp];eSEl: tac];pQn]eth}a.hqc];mL;
l}g;l}g;" hqc];At]; etSuc]pUn].liUw] 22 mmHg' etpQn] (30 - 60 mmHg)"
107
11 tac];pQn]tL
ethQt];hiuw]mk];mn]:tac];pQn]tLKqc]
 tqk]:hqc]; IOP (KiUc]:miuw];hqc];At];tL)  kUt],sqt],tUv];lgc]:tgp],hp].Sqc]f};
 tUv];tac];liuk].Kgc]Kgc]:tLtac];nC];  kUt],sqt]:tUv];lgc]:tgp],hp].Kgc]hUv],tLlm]
 kUt],Tt]; lgc]:tUv];hn]tL
(yU,P}a,nL: eSkUt],sqt]:tUbv];)
Sc]wUn].hn]Tiuc]wL: kUn];pQn]Aap]:etpQn]tLKqc]n}siuc] hC]:SUc],kCL,yLtUw]tI:emLyLf}a,tL"
lgc]:yUt];yL
 yUt];yLlUv]:kan]PL,tt]; (Trabeculectomy or Irredetomy)
 w}a;lc]PL,tt];yw].ekL:tk];etl}:tqk]:hqc];At];tLpn]tL,eSEl:kin]yLTic];hqc];At];tL,eS,"
tLsa}./tLAUin];
tLsa}./ tLAUin];n}. pQn]tLP}a,niuc]:El:P}a,niuc]:Am],tUv];kCL,tac];lQw]kn]nn].yw]." Am],wL:luk]:Agn],
hiuw]kUn];lUc] Sc]wL:kiuc].kac].tLs}a.Kiun]:mL;n} tk];etl}:SUc],kCL,sU;emLyLkm];Siuw]:" tk];etl}:Tgm],
tUv]; epL:' Em: An]w}.StitUv];hn]lgc]:tLs}a.Kgc]luk]:"
cw]:hak]:An]hQt];hC]:tLs}a./tLAUin];
 kgp]:kiUt],pL;mL;sgm];El:lgc]:Kiun]:yC],tiUw];tgn];TiUc];"
 epL:Em:An]yam]:SC],man],tLpL,wL,Suc]Suc]"
 yam]:tiUw].vL;mat];sQp];tI:tL"
Tt];sam];lgc]:tLs}a./tLAUin];
1. yU,hac],mgk]: 1 mI,tLeSAw]f};S}aTgc],tUv];tI:tL" hC]:tUv]; lgc]:tgp],ygn].Sqc]kqw]:tL' cw];f};
tc];Sgc],f}a, Tuk],lIpQn]tI:lQw]kn]" Sc]wL:pQn]s}a.Agk],n} cw];f};etsm]kCL, tac];KU:lc]eS
s}a.Kw]:Sm]. cw];f};ethac],Agk],KU;lc]kCL,"
2. yU,hac],mgk]: 1 mI,tLeSAw]f};S}aTgc],tUv];tI:tL" hC]:tUv]; lgc]:tgp],ygn].Sqc]kqw]:tL' cw];f};
tc];Sgc],f}a, Tuk],lIpQn]tI:lQw]kn]" Sc]wL:pQn]s}a.Agk],n} cw];f};etsm]kCL, tac];KU:lc]eS
s}a.Kw]:Sm]. cw];f};ethac],Agk],KU;lc]kCL,"
3. epL;pQn]luk]:Agn],n}siuc] hC]:Kw]tUv]KU;lc]Kw]eSyw]. Aw]f};Sgc],tUv];" Aw]miuw];pik].hUv],tL
An]hw];Tac],wL:lIeS tUv];tLhUv],An]hw];Tac],wL:s}a.nn].wL: sgc],mI;lgc]:tUc].niuc] tUv];
eS tI:tI:hiuw]' epL;Am],tUc].niuc] pgc],wL:Am],s}a. Am],nn] Am],mI;lgc]:tUv];hn]n}yw]."
4. luk]:Agn],An]tI:yC],epL; tL,hUm]:miuw];lgc]:Tt];sam];tUv];tLnn]. Tuk],lITt];sam];pn]"
108
tac];pQn]tL 11
lgc]:Tuk],lIhQt];Sac]:
Sc]kUt],sqt]:vL;wL: tLs}a.n} kgp]:wL:epL;Am],yUt];yLpn]nC];Kaw];tac]; 7 pI<n} etsac]:hQt];hC]:
tLmgt],kCL, l}:etL,sUw]:El: hC]:SUc],tUw]luk]:Agn],kCL,yLtUw]tI:emLyLP}a,tLkm];Siuw]:" epL;wL:Am],mI;
emLyLP}a,tLsiuc] Tuk],lIAw]PL:hUm],pUk].tLw}." Aw]PL:hUm],pUk].tLw}.P}a,tI:lIn}. ethQt];hC]:tL
P}a,An]Am],lI hQt];kan] tiUw];nm]liUw]" Tuk],lIhUm],pUk];w}. etL,Tuic]epL;Am],mI;lgc]:Kiup]:nL:Sc]Tqc]:
(etsC].Kaw];yam];mgk]: 2 Tiuc] 3 liUn])"
11.5 tac];pQn]Piw]hUv],tLhqc]: (Xerophthalmia)

lWc]:Kat],Tat]:wI,tL,min],eA,n}. sWm];lqn]lin] pQn]pn]hLyC],lUc]An]nuic]: pun]:tL,tac];pQn] kQw],lUv]:
tLeSAm],kL; tL,tac];pQn]luk]:AWn],El: luk]:AWn],l}:t}aPat],sUiw];n}.yw]." tac];pQn]tL An]k}.
hUm]:pQn]sgm]; lWc]:Kat],Tat]:wI,tL,min],eA,nn].Et. pQn]Piw]tLpQn]sQp];nn].yw]."
Pac]hac]:tac];pQn]yC];hUm],tLpQn]sQp]; An]kUt],sqt]:tUv];l}:nn].Et.
1. tLmgt],kac]Kiun]; - Kat],Tat]:wI,tL,min],eA,n}. etsac]:hQt];hC]:tUv];kac]Kiun];Am],hn]lI"
km]nm] Et.ethU.sk];wL: tLPac];Km]: Am],nn] tLPac];k},El: pQn]Pac]hac]:Et,pQn]
tac];pQn]Piw]tL pQn]sQp];nn].yw]."
2. sn].Piw]tLhqc]: - kgp]:Kat],Tat]:wI,tL,min],eA,El: hQt];hC]:sn].Piw]nm].(tL)hqc]:"
kgp]:nn]El: sn].Piw]tLn}. ethqc]:El:sL;" pqk].Sm].wL:Pqp].tLeStL. sn].Piw]tLekL:
yc];ethqc]:yU,"
3. tum],pI,tgt]. (Bitot’s spot) – tum],pI,tgt].n}.etpQn]Tuc]lUm];lQk].lQk]. Am],nn] pQn]Pgc];
pgc];Agk],mL;tI:hUv],tLlm]sm]sm]tc];kqw]:tLSC]nn].yw]." km]:nm]Et. etpQn]SIKaw] Am],nn]
SImUn],"
4. sn].Piw]kqw]:tLhqc]: - Sc]Piw]kqw]:tLhqc]:n}siuc] etAm],sac]:ygn].tgp],Sqc]l}:Kiun];lIlI"
kgp]:Am],liun]:yw].El: ethn]Piw]kqw]:tLl}:c}a:"
sn].Piw]kqw]:tLpQn]sQp];' Piw]kqw]:tLpgc], - epL;sn].Piw]kqw]:tL hqc]:yU,tL,eS,n} ethQt];hC]:
pQn]eP;tL,siUw].mqc];pqk],TI;rI;yL; Am],nn] w};rt].S]Kw]:mL;l}:El: etpQn]sQp]; An]hgc].wL:
corneal ulcers An]sac]:hQt];hC]:sn].Piw]kqw]:tLpgc],(Keratomalacia)l}:" epL;kUn];pQn] pQn]
corneal ulcers n}siuc] etsac]:hQt];hC]: tLmgt],l}:tc];sUw]:pan]nn].yw]."
5. pQn]h}g;sQp]:tI:sn].Piw]kqw]:tL – w}a;eSpQn]sQp];yw]. etmI;h}g;sQp];kiut];w}. tI:sn].Piw]kqw]:
tLeS kqw]:tLetAm],SC]nc],kw],yw].El: etAm],tUv];hn]l}:" h}g;sQp]:niUw]Piw]kqw]:tLn}.
etsp];kGL,etL,sUw]:"
109
11 tac];pQn]tL
m}atgc]; - Am],sC]:wL:kUn];pQn] tI:An]Kat],Tat]:wI,tL,min],eA,kU:ekL. etmI;pn],hLtac];pQn]tLsgm];mL;
(Am],nn] tLethqc]:Ait];Agt];kUv];) n}eStL. kgp]:sp];tit];siUw].mqc]; tac];pQn]mac]siUw];kUv]; et
hQt];hC]:tac];pQn]h}a.hqc];eSEl: etsac]:hQt];hC]:tLmgt],l}:nC];Kaw];tac];Am],l}awn];kUv];kgn],yw]."
lgc]:Kat],wI,tL,min],eA,n}.pQn]l}:kU:ekL.eStL. luk]:Agn],AL,yuniuc]:KUp],Tiuc] hUk];KUp], etpQn]km]:nm]"
luk]:Agn],kin]nUm];Em:km]:nm]Et. Am],k}.Kat],Tat]:wI,tL,min],eA,kn]"
kUt],sqt]:tUv];tLtac];ngk]:El: sgp],Tam]tUv];piun];yLtUw]kUn];pQn]ekL: etsac]:mk];mn]:tac];pQn]
l}:" sqt]:Tt];tUv]; tac];pQn]Piw]hUm],tLpQn]sQp];lIlI sqt]:tLtc];Sgc]P}a," lgc]:mk];mn]:tac];pQn]
liun];Sut];n}. Tuk],lIpQn]PU:yUt];yL tI:An]yam]:lQp]:hQn];P}a,tLmL;kUv];"
lgc]:yUt];yL
 tL,eh.kc]:Am],hC]:siUw].mqc];tac];pQn]Kw]:nn].pn]yL TEO, 2 lgt], hC]:kUn];pQn]Piw]kqw]:tLhqc]:kU;ekL."
 kUn];pQn]Piw]kqw]:tLpQn]sQp];El: pgc],kU:ekL. Tuk],hUp].TUp];tc];emLyLP}a,tL"
 lgc]:yUt];yLTat]:wI,tL,min],eA, (tUv];tI: lgc]:Kat],Tat]:wI,tL,min],eA, kn] 17.2)
 luk]:Agn],lQk].liUw] 6 liUn]  luk]:Agn], 1 KUp],El: yC],liUw] (> 8kg)

wn];tI:mk];mn]:tac];pQn] (D 1)50,000 IU wn];tI:mk];mn]:tac];pQn] (D 1) 200,000 IU
wn];lc] (D 2)50,000 IU wn];lc] (D 2) 200,000 IU
w}a;eSniuc]:wUc]: (D 8)50,000 IU w}a;eSniuc]:wUc]: (D 8) 200,000 IU
 luk]:Agn], 6 - 11 liUn] (< 8kg)  nac];yic];An]mI;AL,yueP:siUw].Pn];l}:
wn];tI:mk];mn]:tac];pQn](D 1)100,000 IU 10,000 IU niuc]:wn];niuc]:pgk]:tL,Sgc]wUc]:
wn];lc] (D 2) 100,000 IU Am],nn]25,000 IU niuc]:wUc]:niuc]:pgk]: tL, 8 wUc]:
w}a;eSniuc]:wUc]: (D 8) 100,000 IU
yLmQt]. wI,tL,min],eA, etmI; 2 Sqn];" 200,000 IU (International unit) El: 25,000 IU"
hqc];yL ettqm]:w}.tI:Aqp],yL:yL" m}atgc];wn];TI.An]mk];mn]:tac];pQn]El: hqc];yLAn]pn]kCL,lIlI"
110
tac];pQn]tL 11
 lgc]:yUt];yLtL,Em:man]; -
* epL;pQn]tLmgt],kac]Kiun];El: mI;tum],pI,tgt].n}siuc] wI,tL,min],eA, 10,000 IU
niuc]:wn];niuc]:pgk]:tL, 2 wUc]: Am],nn] wI,tL,min],eA, 25,000 IU niuc]:wUc]:niuc]:pgk]:tL, 8 wUc]:"
* epL;pQn]Piw]kqw]:tLpQn]sQp];El: pgc],n}siuc]-
wn];tI:mk];mn]:tac];pQn] (wn];Ti 1) 100,000 IU
wn];lc] (wn];Ti 2) 100,000 IU
w}a;eSniuc]:wUc]: (wn];Ti 8) 100,000 IU
(l}a;kan]n}. hC]:pQn]emLyLkUv]; pQn]PU:st];pn])
lgc]:eh.kc]:tac];pQn]sn].Piw]tLhqc]:
tUv];tI: lgc]:Kat],Tat]:wI,tL,min],eA," epL;sqk],pn] yLTat]:wI,tL,min],eA,hC]: luk]:Agn],kU:ekL. 6
liUn]niuc]:pgk]:n}siuc] eteh.kc]:tac];pQn]Kat],Tat]:wI,tL,min],eA,l}:" liUw]nn].luk]:Agn],An]Agk],mak],
lqc]' pQn]tgc].kCL,h}a.hqc]; Am],nn] tac];pQn]SQn]:tac];TUv]:sC]h}a.hqc]; siUw];n}.Kqn];Tuk],lIsC]. wI,tL,
min],eA,eS yUt];yLpn]yw]."
tac];pQn]sn].Piw]tLpQn]sQp];El: lgc]:eh.kc]:Kat],Tat]:wI,tL,min],eA,
kiUt],mC], wI,tL,min],eA, 50,000 IU miUw]:kiUt],Agk],mL;"
luk]:Agn],lQk].liUw] 6 liUn] (epL;Am],l}:pn] wI,tL,min],eA, 50,000 IU"
miUw]:kiUt],)
luk]:Agn], 6 liUn] Tiuc] 1 KUp], wI,tL,min],eA, 100,000 IU kU: 4-6 wUc]:"
luk]:Agn], 1 KUp], Kiun]:niUw] wI,tL,min],eA, 200,000 IU kU: 4-6 wUc]:"
nac];yic];tI:An]mI;AL,yueP:siUw].Pn];l}: wI,tL,min],eA, 200,000 IU (w}a;kiUt],luk]: nC];
Kaw];tac];niuc]:liUn])"
Aac]:Aic] lgc]:Kat],Tat]:wI,tL,min],eA, kn] (17.2)"
111
tac];pQn]hBc];Kw]:El:lm];S}:
12
12.1 tgc].kCL,
lgc]:etl}:fac].tUv];sgm];
(tUv];tI:eKL:PiUm].Tqm])
eKL:piut],tI:pgc],
tWc].kCL,n}. pQn]Pac]hac]:tac];pQn]kUv]; Am],sC]:tac];pQn"] pQn]tgc].kCL, hiuc]liUw] 2 wUc]:n}.hgc].wL:
tgc]. kCL,Kaw];hiuc] (m}atgc]; - cw]:hak]:An]hQt];hC]:pQn]El: l}a;yUt];yLtgc].kCL,Kaw];hiuc]n}. etpiUc]:kn]
tc];tgc].kCL,h}a.hqc];w};)"
tWc].kCL,h}a.hqc];w};n}. P}a:wn];niuc]:nm]lUiw] 3 pWk]:El: nuic]:wn]; 300 g eShiuc]liUw] 14
wn];nn].yw]." tgc].kCL,h}a.hqc];w};n}. sac]:pQn]l}:kWp]:l}al}algc]:yU,yw]." (tac];kin]pQn]kWc].' sp];siUw].
mqc];tac];pQn] tI:hUc];Kw]:El: lm];S}: pn]hLkQw],lUv]:lWc]:PL,tt]; Am],nn] tac];pQn]tac],siUw];)"
Ek:lit]:yUt];yLlgc]:tgc].kCL, (Management of Diarrhoea)

 Pac]hac]:tac];pQn]tI:An]pQn]hUm]:kn]–tgc].kCL,Am],pL;liUt]: Am],nn] pL;liUt]: (tgc].ngc],)
 Tt];Sac]:lgc]:Tat]:nm].hqc]:nC];tUw]
 liUk]:lgc]:yUt];yL Am],nn] lat]:hC]:mL;EnKiun];
tgc].kCL,h}a.hqc];mI; 2 Sqn];El: etEnw}.sgm];nc],pL:tC]:n}. (etpQn]hUm]:kn]ekL:pQn]l}:)
tgc].kCL,Am],pL;liUt]:
Pa}:etlqw]pQn]nm].' etPa}:nm]El: SIetsac] (SIkm],' SIliUc])" etmI;Pac]hac]:tgc].sQp]; El:
lUm];naw] n}eStL. Pa}:etAm],mI;liUt]:El: nm].muk].Agk],mL;sgm];" Pac]hac]:tac];pQn] tI:An]hU.
hn]l}:sgm];nc], p}a;yUt];yLnn]. lgc]:Tat]:nm].nC];tUw]hqc]: etKgp]:cm];w}." cw]:hak]: An]hQt];hC]:
pQn]nn]. etpQn]w};rt].S]' pqk],TI:rI;yL; (Cholera El: Escherichia )El: pL,rL,S}. (Giardia )"
(m}atgc]; - tgc].kCL,h}a.hqc];Am],pL; liUt]:n}. kUn];pQn]naw]nUk].ekL:pQn]l}:)"
tgc].ngc], - tgc].kCL,pL;liUt]:
P}a:etpUiw].pUiw].nm]liUw]pQn]nm]. hUm];tc];pL;liUt]:Agk],mL;sgm];" etmI;Pac]hac]:tgc].sQp];El: lUm];naw]
etSuc]l}:" cw]:hak]:An]hQt];hC]:pQn]km]:nm]Et. kgp]:siUw].mqc]; Shigella El: Campylobacter siUw].mqc];
pL,rL,S}. miUn]nc], amoeba ekL: sac]:hQt];hC]:pQn]tgc].ngc],l}:nc],kn]"
112
tac];pQn]hBc];Kw]:El:lm];S}: 12
Pac]hac]:tac];pQn]
 kUn];pQn]tgc].kCL,l}awn];yw]. ?
 pQn]nm].hiuw] pL;liUt]:sgm]; ?
 tgc].sgc],sQp];' miUw]:P}a:yw]. hU;kUn];sgc],sQp];' sgc],mI;lUm];naw] Am],nn] hak]: ?
lgk];Kgc]: 1; tgc].kCL,h}a.hqc];
tgc].kCL,Am],pL;liUt]: tgc].ngc],
Pac]hac]: mac]:pgk]:etmI;lUm];naw] lUm];naw]Suc]
tgc].sQp];Ait];Ait]; tgc].sQp];
hak]: hak]:
P}a: pQn]nm].sac]sac] pL;liUt]:
lgc]:pQn]EP;Tiuc]t}al}: Tat]:nm].nC];tUw]hqc]: liUt]:vL;kgc].
lgc]:lm],lgc]:Et. Tt];Sac]lgc]:Tat]:nm]. nC];tUw]hqc]:El: yUt];yLpn]nn].yw]." lgc]:mk];
mn]:tac];pQn]n}. etsC].tiuw];p}a;yUt];yLkUv]; (miUw]:tgc].kCL,pL;liUt]: Am],nn] Am],pL;liUt]:)"
tL,ethU.l}:wL: pQn]kgp]:w};rt].S]' pqk],TI:rI;yL; Am],nn] AmI;pL; (siUw].mqc];tgc].ngc],) hiuw]n}nn].
etl}:kUt],sqt]:P}a: tUv];Tqc]:hac];eKL" etl}:wUn].kCL,tUv];Tqc]:wL:
 tgc].kCL,kU:siUw];siUw];nn]. etl}:wUn].Tiuc]lgc]:Tat]:nm].nC];tUw]hqc]: Agn]tac];kgn],"
(tUv];tI:pL:tC]:)
 epL;wL:mI;lUm];naw] etl}:wUn].tUv];tac];pQn] An]hUm]:pQn]l}:sgm]; miUn]nc], tac];pQn]naw]
nUk]. (kn] 15.2 )' kqn]kac]hUpQn]sQp];yQn]; (kn] 21.1)' pgt],kC]: (kn] 21.2)' yC];hUm],
Agk];eALkC]: (kn] 15.1)' Am],nn] SQn]:tac];yQw]:sp];tit];siUw].mqc];tac];pQn] (kn] 13.1)
siUw];n}.hUm];pL;sgm];wL: mI;/ Am],mI;n}yw]."
 P}a:pQn]nm].sac]sac]El: lUc];w};' tUv];wL:sgc],hak]:sgm];hiuw]" epL;mI;n} etl}:wUn].tUv];
lgc]:pQn] tac];pQn]tgc].kCL,kL,l (12.2)"
 epL;kUn];pQn]mI;Pac]hac]:kQw],lUv]:tgc]. miUn]nc], tgc].sQp];h}a.hqc];w}; Am],nn] nL:tgc].KQc]:n}siuc]
wUn].lgc]:etpQn]l}:kgp]:PL,tt];mL; (S}:tn]' Am],nn] S}:tqk],)siUw];n}."
 epL;luk]:Agn],ekL.niuc]:pQn]tgc].kCL,Kaw];hiuc]eS hiuc]liUw] 2 wUc]:n} etl}:wUn].Sgn],
lgc]:Kat],Tat]: AL,hL,r (kn] 17.1)"
 tL,luk]:Agn],lQk]. – wUn].tL,etlqk]:l}a:pn]kin]tac];kin]" kgp]:wL:luk]:Agn],tgc].kCL,
km]:nm]n}. etpQn]miUw]:Em:luk]:Agn], Et,lqk]:l}a:pn]kin]nUm];tw]: (cw]:hak]:tac],siUw];
tI:etpQn]l}: - nm]. Am],l}:tUm]: Am],nn] tw]:nm].hc]:wUv],)"
113
12
Tt];Sac]lgc]:Tat]:nm].nC];tUw]hqc]: (Evaluation of Dehydration)
tgc].kCL, (km]:nm]Et.tgc].kCL,An]Am],pL;liUt]:) n}. sac]:hQt];hC]:Tat]:nm].nC];tUw]hqc]:h}a.hqc];"
Agn]tac];Sut]; tk];etl}:Tt];Sac] Pac]hac]:Tat]:nm].nC];tUw]hqc]:- tUv]; lgk];Kgc]: 2"
lgk];Kgc]: 2" lgc]:Tt];Sac]Pac]hac]:Tat]:nm].nC];tUw]hqc]: sgm];nc],p}a;yUt];yL

(WHO - muk].sum];p}a;yU,lIlum]:fL.)
Pqn]kan] k Pqn]kan] K Pqn]kan] c
Tat]:nm].nC];tUw] Tat]:nm].nC];tUw]hqc]: Tat]:nm].nC];tUw]hqc]:
Am],hqc]: pan]kac] h}a.hqc];
2 An] Am],nn]nm]liUw]) 2 An] Am],nn]nm]liUw]
cw];l}a;km]:nm] pk],ktI, Aap]:m}:sC]
tL pk],ktI, lgk];Kw]:kCL,Ait];niuc]:
nm].tL mI; Am],mI;nm].tLAgk],mL; Am],mI;nm].tLAgk],mL;
pak],El:lin]. ym];yU, hqc]: hqc]:h}a.hqc];
kin]nm]. Am],pQn] lm],lgc]: kin]nm].Am],l}:
nc],tgc].m}:nL,
yip];Piw]nc]eS miUn]kw],Kiun]; miUn]kw],Kiun];TiUc]; miUn]kw],Kiun];TiUc];nL,
p}g,tUv];Kiun];
lgc]:yUt];yLTat]:nm].nC];tUw]hqc]: (Treatment of Dehydration)

sgm];nc],Pqn]kan] k Kgc] WHO tL,yUt];yLtgc].kCL,tI:hiUn];
 kUn];pQn] Am],mI;Pac]hac],Tat]:nm].nC];tUw]hqc]:" Am],tap]:yUt];yLtI:hUc];yL nC]; IPD "
 lat]:EnEm:luk]:Agn], hC]:pn]kin]nUm];Em:mn];liUw]kw],El: hiuc]liUw]kw]," epL;luk]:Agn],Am],kin]
nUm];Em:n}siuc] pn]nm].kiUw] ORS (tUv];tI: eKL:PiUm].Tqm]) Am],nn] miUn]nc], (nm].Kw]:'
nm].Pk];) tUv];tI: eKL:PiUm].Tqm] 24.6 sC].l}a;kin]tac];kin]eS
hQt];hC]:Tat]:nm].nC];tUw]lIKiun]; - pn]kin]nUm];SUm]: (yUw];kiUt],) etL,tgc].kCL,epL;h}a"
 tL,eh.kc]: luk]:Agn],Kat],Tat]:AL,hL,rnn]. pn]luk]:Agn],kin]nm]nm]" Sc]luk]:Agn],
kin]tac]; kin]An]Kqc]l}: hC]:pn]kin]tac];kin] An]pQn]Kw]:' mak],m}.' Pk];yiUw]:nac];KQw]El:
SC],nm].mn];kin]pn] nC];tac];kin] 1-2 esL.tL,Sgc]wUc]:"
 Sp];lqc];EnEm:luk]:Agn], l}a;sap]:' la};hQt];nm].kiUw] ORS Am],nn] nm].Kw]:tUm]:" (tUv];
eKL:PiUm].Tqm])
114
pn]kin]nm].nm]liUw]An]kin]yU,kU;pgk]:" lat]:EnEm:luk]:Agn],wL:hC]:pn]
lQk].liUw] 2 KUp], nm].kiUw] ORS 50-100 ml w}a;lc]tgc].kCL,kU:km];
yC],liUw] 2 KUp], nm].kiUw] ORS 100-200 ml w}a;lc]tgc].kCL,kU:km];
 Tam]tUv];Em:luk]:Agn],wL: wn];niuc]:luk]:Agn],kin]nm].nm]kL:hiuw]El: hC]:mL;EntI:hUc];yLKiun];

niuc]:wUc]: Sgc]pgk]:"
PiUm].Tqm] Tat]:Sc],kSI (Zinc) pn]luk]:Agn],

tac];nm]eA,An]Tuk],lIpn]luk]:Agn],
lQk].liUw] 6 liUn] – niuc]:wn]; pn]yLmQt]. 20 mI,lI,krm],Kuic]:niuc]: tL, 14 wn];"
yC],liUw] 6 liUn] – niuc]:wn]; pn]yLmQt]. 20 mI,lI,krm],niuc]:mQt]. tL, 14 wn];" Enpn]
Em:luk]:Agn], lgk];l}a;pn]Tat]:Sc],kSI"
luk]:Agn],lqc] – Aw]yLKUn];elL;tc];nm].nUm];Em:mC],mC],' nm].kiUw] ORS Am],nn] nm].An]
mUt];SC] nC];esL."
luk]:Agn],yC],liUw] – hC]:luk]:Agn],kQw].kin] Am],nn] KUn];elL;pn]tc];nm].An]mUt];SC]
nC];kqw]: Am],nn] nC];esL."
pn]fac].Em:luk]:Agn],wL: hC]:pn]kin]yLTat]:Sc],kSI hC]:KUp]; 14 wn];tQm]tQm]"
 pn]tac];hn]Tiuc]Em:luk]:Agn],wL: epL;luk]:Agn],pQn] Tuk],lIAw]luk]:Agn],mL;EnKiun];-

 P}a:Agk],mL;nm]  pUn].mL;Sam]wn];eSyw].Aap]:etp},h}a
 tgc].m}:nm].nL,  mI;lUm];naw]
 tLlgk];Kw]:kCL,tac];nC];  Am],kin]Am],yqm].miUn]kw],
(Pac]hac]: 3 An]pL:niUw]n}.pgc],wL: luk]:Agn],
pQn]Tat]:nm].nC];tUw]hqc]:)
piUc] 4 piUc] tL,yUt];yLtI:hiUn];

pn]kin]tac];kin] An]pQn]nm].nm]liUw]kw],(tUv]; Pqn]kan] k
tL,kin]An]pQn]nm].)
PiUm].Tqm]pn]Tat]:Sc],kSI (Zinc)
hC]:pn]kin]nc],kw],kCL,tik];tik];
nt].tc];emLyL tL,hUp].TUp];EnKiun];Kaw];nL:
115
12
sgm];nc],Pqn]kan] K Kgc] WHO tL,yUt];yLlum];lL;lgc]:Tat]:nm].nC];tUw]hqc]:
 hp].w}.yLtI:hUc];yL
 4 sUw]:mUc];Agn]tac];nn]. pn]nm].kiUw]sgm];nc],lgk];Kgc]: 3
 Sc]wL:luk]:Agn],nn]. Tuk],l}:pn]nm]liUw]n}ekL: tk];etl}:pn]nm]liUw]
 hC]:luk]:Agn], kin]nUm];Em:nc],kw],
 w}a;eS 4 sUw]:mUc];yw]. hC]:Tt];Sac]pn]lgc]:Tat]:nm]. (tUv];lgk];Kgc]: 2 ) Kiun];eSyw].
hQt];sgm];nc],piUc]An]wL:w}.Kiun]; (hQt];Sac]:sgm];lgk];Kgc]: 2 Tqc]:km];niuc]:tL 4 sUw]:mUc];)"
lgk];Kgc]: 3" tac];nm]eA,nm].kiUw], ORS An]tan],lIpn] nC];Kaw];tac]; 4 sUw]:mUc];Agn]tac];
AL,yu lQk].liUw] 4 – 12 12 liUn] – 2 - 5KUp], 5-14 pI< yC],liUw] 14
4 liUn] liUn] 2 KUp], pI<
nm].nk]; eA,liUw] 6 Tiuc] 10 10 Tiuc] 12 12 Tiuc] 19 19 Tiuc] 29.9 30 kI,lUw],
6 kI,lUw], kI,lUw], kI,lUw], kI,lUw], kI,lUw], Kiun]:niUw]
krm], lUc];tC]: lUc];tC]: lUc];tC]: lUc];tC]:
ORS(ml) 200-400 400-700 700-900 900-1400 1400-2200 2200-4000
 w}a;eS 4 sUw]:mUc];yw]. Tt];Sac]Kiun];Tat]:nm].nC];tUw]"

 w}a;eSyUt];yLlum];lL; lgc]:Tat]:nm].nC];tUw]yw]. hQt];sgm];nc], Pqn]kan] k
 Sc]wL:Tat]:nm].nC];tUw]yc];hqc]:yU, hQt];Pqn]kan] K Kiun];Tqc]:"
sgm];nc],Pqn]kan] K Kgc] WHO tL,yUt];yLlum];lL; lgc]:Tat]:nm].nC];tUw]hqc]:h}a.hqc];

 hp].kUn];pQn]yLtUw]w}.tI: IPD: SCac];pn]nm].yL Ringer lactate sgm];nc], (lgk];Kgc]: 4) tI:
SQn]:liUt]:"
 15 minit]. niuc]:pgk]: hC]:Tt];Sac]Kiun]; cw];l}a;luk]:Agn],"
 Sc]wL:pn]yLtQm]tI:yw].( 6 sUw]:mUc];tL, luk]:Agn],lqc] El: 3 sUw]:mUc];tL,kUn];lUc])
hC]:Kiun];em;Tt];Sac] Tat]:nm].nC];tUw]yw]. Et,Pqn]kan] k' K Am],nn] c Kiun];"
 Sc]wL:Am],mI; IV hC]:pn]nm].kiUw] ORS tac];S}ayac]Kw]:KU;lc]" hC]:pn]nuic]:sUw]:mUc]; 20 ml/kg/ tL,
6 sUw]:mUc];" Tt];Sac]cw];l}a;miUn]nc],pn]yL IV "
 yUt];yLkUn];pQn]tI: IPD tI:eA,Sut]; tL, 24 sUw]:mUc];El: Aw]w}.yLtUw]Tqc]: etL,Tiuc]
hLtac];pQn]An]hQt];hC]:pQn]epL;l}:"
 Sc]wUn].Tiuc]wL: pQn]tgc].kCL,kL,ln}siuc] hC]:pn]yLptI,KYI<wn (yLKL:siUw].mqc];tac];pQn]) (kn]
12.2)"
 w}a;eSyUt];yLpn]luk]:Agn], lgc]:Tat]:nm].nC];tUw]hqc]:yw]. hC]:hQt];sgm];nc],Pqn]kan] k"
116
lgk];Kgc]: 4" l}a;sC]. Ringer lactate eS pn]nm].yLtac];SQn]:liUt]:tL,yUt];yLTat]:nm].nC];tUw]
Agn]tac];Sut]; hC]:pn] w}a;nn]. hC]:pn]

30 ml/ kg 70 ml/kg
lQk].liUw] 12 liUn] 1 sUw]:mUc]; 5 sUw]:mUc];
yC],liUw] 12 liUn] 30 minit]. 2.5 sUw]:mUc];
Tuk],lItgc];w}.wL: hUm]:ygt],/etL, 1 minit]. = ccx x hUm]:ygt],An]mI;nC]; 1 cc

Hr 60
tUw]yac], - Sc]wL:K}:pn] 500 SI,SI, nC];Kaw];yam]; 5 sUw]:mUc];n}siuc] etl}:Sgn],nc],pL:tC]:n}."

1 SI,SI, etmI; 20 ygt]," kgp]:n} hUm]:ygt],nC];niuc]:minit]. =500/5 x 20/60 = 33 ygt],/minit].
(niuc]:minit]. 33 ygt],)
lgc]:yUt];yL
piUc]An]hQt];km]:nm]
 eh.ham]:Am],nn]yUt];yLlgc]:Tat]:nm].nC];tUw]hqc]: (l}a;yUt];yLPqn]kan] k' K Am],nn] c)
 eh.ham]:lgc]:Kat],Tat]:AL<hL,r (l}a;yUt];yL Pqn]kan] k)
 PiUm]:Tqm]pn] Tat]:Sc],kSI ( Zinc)
 sC].yLptI,KYI<wn miUw]:l}:hU.wL:pQn]kgp]:Sc]kUv]; (tUv];pL:tC]:)
 Am],Tuk],lIpn]yL tL,hC]:lgc]:tgc].kCL,kiut];yut]; (miUn]nc], yL loperamide)
 luk]:Agn],AL,yulQk].liUw] 12 KUp], An]Tuk],lIhp].w}.yUt];yLtI:nC]; IPD hC]:pn]wI,tL,min],eA,
pL;sgm];"
tL,kUn];pQn]An]P}a:pQn]nm].nn]. Am],tap]:pn]yLptI,KYI<wn"
etl}:yUt];yLpn]lgc]:Tat]:nm].nC];tUw]hqc]:kUv];"
tgc].kCL,Am],pL;liUt]:
tgc].lU.' tWc].eh:Am],pL;liUt]:
tgc].kCL,h}a.hqc];Am],mI;liUt]:pL;sgm];km]:nm]n}.Am],tap]:pn]yLptI,KYI<wn" kUv];kL:P}a:pQn]nm].nn]. et
mI;yU, Sgc]Sqn]; An]tk];etl}:pn]yLptI,KYI<wn"
117
12
tgc].kCL,kL,l (Cholera) – tgc].kCL,pQn]nm]. (miUn]nm].Suk]:Kw]:) An]kiuc].kac].pQn]El: h}a.hqc];nn].

Tuk],lI wUn].Tiuc] lgc]:tgc].kCL,kL,l (kn] 12.2 )" kUn];pQn]An]yC],liUw] 5 KUp], Am],nn] kUn];lUc]
An]kiuc]. kac].tgc].kCL, pQn]nm].h}a.hqc];eS Tat]:nm].nC];tUw]hqc]:w}; (km]:nm]ethak]:sgm];) Am],nn]
luk]:Agn],yC],liUw] 2 KUp], yU,nC];piun].tI:tac];pQn]eP:yU,eS Sm].kiuc].kac].tgc].kCL,pQn]nm].h}a.hqc];n}siuc]
Tuk],lIwUn].Tac],w}.wL: pQn]tgc].kCL,kL,ll}:nn].yw]." luk]:Agn],lQk].ekL: sac]:pQn]tgc].kCL,kL,ln}
eStL. kgp]:miUn]c}a;kn] tc];tgc].kCL,pQn]nm].An]pQn]kgp]: w};rt].S]rUw],tL, ( rotavirus ) El: pQn]Sc]
Et.Et.nn]. etsqk],EPyap], yw]." kgp]:wL: pn]yLptI,KYI<wnn}. ethQt];hC]:tgc].kCL,eA,lUc];eS
Kaw];yam];tgc].kCL,pgt];lUc];l}:El:Tuk],lIpn]yLptI,KYI<wn hG]:kUn];pQn]tgc].kCL,kL,l h}a.hqc]; kU:ekL.yw]."
tgc].lU. (Giardia )- tgc].lU.n}.kgp]:siUw].mqc];pL,rL,S}.pQn] nn].yw]."

giardia intestinalis
km]:nm]Et. epL;ettUv];P}a,p}a;yUt];yLn} liUw]eShak]:' tgc].sQp];' nm].nk];tUw]lUt];ygm];El:
tgc].kCL,pQn]nm]. etAm],k}.mI;Pac]hac]:AI:Sc]" epL;tgc].lU.Kaw];hiuc] (pQn]hiuc]liUw] 14 wn];) n}siuc]
hC]:pn] metronidazole (luk]:Agn],lqc] pn]hqc];yL 15 mI,lI,krm],/kI,lUw] mqc],pQn] 3 doses tL, 5
wn];' kUn];lUc] 2g/wn]; OD tL, 3 wn];)"
tgc].ngc], - tgc],kCL,tI:An]pL;liUt]:sgm];
Sc]pQn]l}: PU:yUt];yLTuk],lIl}:hn]tUw]yac],P}a:kUn];pQn]"
tgc].ngc],etmI;Sgc]Sqn];
pQn]kgp]:pqk],TI;rI;yL;" siUw].mqc];pqk],TI;rI;yL;l}aSqn]; etsac]:hQt];hC]:pQn]tgc].ngc],l}:eS An]tI:h}a.
hqc];liUw]piUn]Et. pQn]SYI,Ekl];lL, (Shigella)" Pac]hac]:etmI;pL; - lUm];
naw]' w}a;P}a:yw].hU;kUn]:etsQp];' yU,Am],lI"
pQn]kgp]:AmI;pL;" km]:nm]Et. etAm],pQn]h}a.hqc];eSEl: kUn];pQn] 30% etmI;lUm];naw]pL;
sgm];" mac]pgk]:siUw].mqc];AmI;pL; etKw]:mL;tac];SQn]:liUt]:eS ethQt];hC]:ngk]:
liUw]eSSQn]:liUt]:(miUn]nc],tp];)pQn]sQp];yQn];pQn]ngc]nn].yw]. (kn] 12.3)"
tgc].kCL, An]pQn]kgp]:pqk],TI;rI;yL;El: AmI;pL;n}. epL;Am],l}:kUt],sqt]:P}a:tUv]; tI:hgc]:lqp],n}siuc]

etAm],sac]:hU. lgc]:pqk],piUc]:kn]l}:" kgp]:n} tk];etl}:liUk]:l}a;yUt];yL sgm];nc],Pac]hac]:tac];pQn]
(km]:nm]Et. epL;mI;lUm];naw]El: epL;kUn];pQn]An]Tac],hac]:pQn]eP;l}:)"
118
kUn];pQn]tI:An]pQn]eP;l}:
1. luk]:Agn],An]lQk].liUw] 2 KUp],"
2. kUn];lUc]AL,yuSuc]liUw] 50 pI<"
3. luk]:Agn],An]Kat],Tat]:AL,hL,r (median Z SCORE eA,liUw] 80%)"
4. lUm];naw]Suc]liUw] 39 CM "
5. Pac]hac]:Tat]:nm].nC];tUw]hqc]:h}a.hqc];"
6. Pac]hac]:sC]sL.' can];Kiun]: Am],nn] ta}lium];"
1. Am],mI;lUm];naw]
 yUt];yLlgc]:Tat]:nm].nC];tUw]hqc]: sgm];nc],piUc]pL:niUw]tI:An]Enw}."
 Sc]cw];l}a;kUn];pQn]lIKiun]:mL; yUt];yLtI: OPD ekL:l}:"
 Sc]hn]Tiuc]wL: kUn];pQn]Aap]:etpQn]eP;l}: hp].yUt];yLtI: IPD " tL,eh.kc]:lgc]:
eP:siUw]. nn]. hC]:yUt];yLtI:niuc]:eKLeKL"
 pn]yL Metronidazole luk]:Agn], - 10mg/kg TID tL, 7 wn];"
kUn];lUc] – 750 – 800mg TID tL, 7 wn];"
hqc];yL Metronidazole pn]tL,AmI;pL;n}. Tuk],lInm]liUw]tI:An]pn]yU,tL,eS," pn]sgm];nc], An]
tI:Enw}.tI:n}:"
 pn]yLwI,tL,min],eA, hC]:luk]:Agn],lQk].liUw] 12 KUp],El: An]p},l}:kin]nC];Kaw];tac]; 4
liUn]pUn].mL; (kn] 17.2)"
2. mI;lUm];naw]
 yUt];yLlgc]:Tat]:nm].nC];tUw]hqc]: sgm];nc],piUc]pL:niUw]tI:An]Enw}."
 Sc]cw];l}a;kUn];pQn]lIKiun]:mL; yUt];yLtI: OPD ekL:l}:"
 Sc]hn]Tiuc]wL:kUn];pQn]Aap]:etpQn]eP;l}:hp].yUt];yLtI: IPD" tL,eh.kc]:lgc]:eP:siUw].
hC]:yUt];yLtI:niuc]:eKLeKL"
 yUt];yLlgc]:lUm];naw] (kn] 7.4 )"
 pn]yL Ciprofloxacin luk]:Agn], - 10mg/kg BD tL, 5 wn];
kUn];lUc] – 500mg BD tL, 5 wn];
El:yL Metronidazole luk]:Agn], - 10mg/kg TID tL, 7 wn];
kUn];lUc] – 750 – 800mg TID tL, 7 wn];
 pn]wI,tL,min],eA, hC]:luk]:Agn],lQk].liUw] 12 KUp],El: An]p},l}:kin]nC];Kaw];tac]; 4
liUn]pUn].mL; (kn] 17.2)"
 etl}:pn]kin]tac];kin] An]Tuk],lIkin] miUn]nc],tL,luk]:Agn], hC]:pn]kin]nUm];El:
tL,luk]:Agn],yC],tc];kUn];lUc] hC]:kin]nc],tI:kin]yU,kU;wn];"
119
12
 pC].tUv];lgc]:lak],l}a;Suk].Sak]. miUn]nc], tgc].kC]:KQc]:' S}:pgc],pQn]hU;El: liUt]:pQn]kgc]."
m}atgc];" " epL;mI;hgc]:lqp], tL,kUt],sqt]:P}a:tUv];n}siuc] ethQt];hC]:sqk],yqk]: pQn]tgc].kCL, kgp]:pqk],TI;
rI;yL;El:AmI;pL;l}:" epL;kUn];pQn]tgc].kCL,nm]mL;n}siuc] Tuk],lIkUt],sqt]:P}a:tUv]; tI:hgc]:lqp], tL,
sqk],yqk]:tgc].kCL,wL: pQn]kgp]:Sc] (lQc].tUw]siUw].mqc];yw]. sam];tUv];lgc]: ygn].tgp],yLKgc]siUw].mqc];)'
pgc],lqc];pn]emLyLlgc]:tgc].ngc], l}:eP:kCac]: tL,hac]:hqn];lgc]:eP:kCac]:siUw].mqc];"
lgc]:eh.kc]:
pn]tac];hU.hG]:kUn];pQn]El: Em:luk]:Agn],kUn];pQn] tL,eh.kc]:tgc].kCL,sgm];nc],pL:tC]:n}.-
 mUiw]:etkin]Kw]:' miUw]:hQt];Kw]:Pk];El: miUw]:kCL,Tac]mL;nn]. Aw]Sp].pYL,eSSuk]:miuw];pn]tL,eS,"
 lQc].nUm];Em:pn]luk]:Agn],"
 Sc]wL:nm].kin]nn]. p},l}:SC],KlUw],rin];n}siuc] hC]:tUm]:Aw]"
 tUm]:huc]Kw]:Pk];hC]:Suk];lIlIEl: hUm],w}.lIlI"
 sC].tiuw];Tac]Pa}:' w}a;luk]:Agn],P}a:yw]. hQt];lgc]:mUt];SC]pn]lIlI"
 yL,sC].yLKp];lUm]; (miUn]nc], aluminium) Kaw];hiuc] kgp]:wL:nm].kUt]. (nm].y}g:tac];kin])n}.
ettiuk];etL; eh.kc]:siUw].mqc];pqk],TI;rI;yL;hac];kUv];mn];yU,yw]."
yLehkc]: (wk].Sin];)
tL,tgc].kCL,kL,lnn]. yLeh.kc]:Kaw];pgt]; (tL,sC].miUw]:siUw].mqc];eP:kCac]:nn].lI)mI;yU,"
Aac]:Aic] naw]nUk].(15.2)' kqn]kac]hUpQn]sQp];yQn]; (21.1)' pgt],kC]:( 21.2)' yC];hUm],Agk];eALkC]:

(15.1)' sp];tit];siUw].mqc];tac];pQn] sgm];SQn]:tac];yQw]: (13.1)' tac];pQn]tgc].kCL,kL,l (12.2)"
12.2 tac];pQn]tgc].kCL,kL,lL. (Cholera)
lgc]:etl}:pgc],Kaw],Kn]w};
tUv];tI: eKL:PiUm].Tqm]
eKL:piut],tI:pgc],
tac];pQn]tgc].kCL,kL,ln}. pQn]kgp]:sp];tit];siUw].mqc];pqk],TI;rI;yL;p}<prI,AUw],(Vibrio cholerae)
sgm];lm];S}: nn].yw]:" siUw].mqc];n}.ethQt];Sac]:kgc]. Cholera Toxin (CT) Agk],mL;eS kgc].n}.Sm].
ethQt];hC]:Tat]:nm]. El:Tat]:kiUw]nC];tUw] (nm].kiUw]El:) Tc],lUc];mL;nC];lm];S}:" siUw].mqc];tgc].kCL,
kL,lL.n}. eteP:tiun];l}:sgm]; nm].An]hc]:wUv],El: Kgc]kin]An]hc]:wUv],"
120
luk]:Agn],yC],liUw] 5 KUp], Am],nn] kUn];lUc] tI:An]kiuc].kac].tgc].kCL,pQn]nm].h}a.hqc];eS Tat]:nm].

nC];tUw]hqc]:w}; (km]:nm]ethak]:sgm];) Am],nn] luk]:Agn],yC],liUw] 2 KUp], yU,nC];piun].tI: An]tac];
pQn]eP:yU,eS Sm].kiuc].kac].tgc].kCL,pQn]nm].h}a.hqc];n}siuc] Tuk],lIwUn].Tac],w}.wL: pQn]tgc].kCL,kL,lL.l}:"
Pac]hac]:tac];pQn]
Pac]hac]:tac];pQn]n}. etAm],mI;Sc]hC]:hn] etL,Tiuc]tgc].kCL,pQn]nm].(miUn]nm].Suk]:Kw]:)h}a.hqc];nn].yw]."
kUn]; pQn]mac]:ekL. An]pQn]h}a.hqc];nn]. ethQt];hC]:kUn];pQn]lU.Sum];nm].nk];l}: 10% w};w}; hUm]:tc];
kiuc].kac].lium]; tUw] kgp]:lU.Sum];Tat]:nm].nm] (hypovolemic shock)' liUt]:l}a:pQn]nm].kUt].kgc].
(metabolic acidosis)' lU.Sum];Tat]:pUw],tqt],SI,yam],nm] siUw];An]etsac]:hQt];hC]:kUn];pQn] Tiuc]t}a
l}:nn].yw]." w}a;eStgc].kCL,yw]. etEt,hak]:" kgp]:lUv]:tac];nm]eA,siUw].mqc]; tI:An]sp];tit];
El: kUn];An]sp];tit];siUw].mqc]; 75% Am],nn]nm]liUw]n}. etAm],EnPac]hac]: tac];pQn]Sc]" kUn];
tI:mI;kum],liUt]:AUw],n}.etsac]:pQn]tac];pQn]tgc].kCL,kL,lL.h}a.hqc];n}.nm]liUw]kUn];An]mI;kum],liUt]:tac],siUw];"
miUw]:mI;lgc]:eP:tiun];sgm];nc],p}a;yUt];yL' miUw]:Am],mI;cw];l}a;eP:tiun];nn]. kUt],sqt]:tUv]; siUw].mqc];
pqk],TI;rI;yL; p}<prI,AUw], (Vibrio cholerae) nC];tUw]yac],P}a:"
lgc]:yUt];yL
 Am],wL:pn]kin]tac];pak], Am],nn] SCac];SC],sgm];SQn]:liUt]: Tuk],lIyUt];yL hQt];hC]:Tat]:nm].
tI: An]lU.Sum];kCL,nn].lIKiun];" wn];Agn]tac];nn]. kUn];pQn]etlUw],nm]. 10-15 lI,tL,"
 miUw]:SCac];pn] Ringers lactate tL,hC]:Tat]:nm].lIKiun];mL;nn]. w}a;eSSCac];pn] 24 sUw]:mUc];
yw].Tuk],lIw}.StiPiUm].Tqm]pn] Tat];pUw],tqt],SI,yam],Tqc]:" epL;pQn]l}: hG]:kUt],sqt]:tUv];
Tat]:pUw], tqt],SI,yam]," Sc]wL:Tat]:pUw],tqt],SI,yam],eA,yU,n}siuc] nC];nm].kiUw] Ringer
lactate 1 lI,tL,nn]. hG]:PiUm].Tqm]pn]pUw],tqt],SI,yam], 10ml 10% 1-2 lgt],sgm];"
 pqk].Sm].wL: yLptI,KYI<wnn}. ethQt];hG]:tac];pQn]mw]lUc];' hQt];hG]:P}a:eA,lUc];El:
siUw].mqc];tac];pQn] Pan],Kw]:nC];P}a:eA,lUc];l}:n}eStL. Am],tap]:sC].ekL:l}:"
yLptI,KYI<wn An]muk].sum];p}a;yU,lIlum]:fL.km].Tqm]pn] mI;yU,tc];nm] miUn]nc], (Doxycycline,
Tetracycline, Trimethoprim-sulfamethoxazole,Erythromycin, Chloramphenicol Am],nn]
Ciprofloxacin)" miUw]:Am],p},hiuc]n}. l}:Kaw],tI:hUc];yLEm:Sgt], kQw],lUv]:siUw].mqc];tiuw]etL,yL
ptI<KYI<wnwL: yLmiUn]nc], Tetracycline El: Trimethoprim-sulfamethoxazole siUw];n}." lgc]:yL
Am],tiUw].n}. Suc]mL;Et.Et.n}yw]." kgp]:n} sgm];nc],eKL:mun];n}.eS yLAn]Tuk],lIK}:hG]:sC].Et.
etpQn] Ciprofloxacin 1 gram STAT dose tqn];" m}atgc]; - mUiw]:p},pn]yLnn].
Tuk],lIsqt]:eS;tUv]; lgc]:tiuw]yL tI:hgc]:yLeSyw]. sc],sC].tiuw];"
121
12
lgc]:eh,kc]:
 sC].nm].mUt];SC]tL,Suk]:miuw];El: huc]Kw]:Pk];"
 yL,kin]tac];kin]pac],l}a, An]p},l}:tUm]:huc]"
 ciUc].ew:kin]Kw]:liUw] kgp]:wL:Kw]:liUw]n}. pQn]tI:eP:tiun];siUw].mqc];tac];pQn]l}:lI"
yLeh.kc]: (wk].Sin];)
yLeh.kc]:n}.eteh.kc]:l}:Kaw];pgt]; (hUk];liUn]) kUv];" Tuk],lIsC].tiuw]; miUw]:Kaw];siUw].mqc];eP:tiun];h}a.
hqc]; nC];piun].tI:"
Aac]:Aic] tgc].kCL, (kn] 12.1)
12.3 tac];pQn]tp];
tp];kC]:(Hepatitis)
eKL:piut],tI:pgc],
tac];pQn]tp];kC]:n}. kgp]:tp];sQp];kC]:Kiun]:mL;nn].yw]." etmI;w};rt].S]tp];kC]: l}aSqn];An]hU.sk];
kn]nm] – tac];pQn]tp];kC]:h}a.hqc];w};n}. pQn]kgp]: Hepatitis A eSetsp];mL;tac];SQn]:tac];kin]-SQn]:
tac];P}a:" tac];pQn]yQw]:nUn}. etsac]:hQt];hC]:pQn]tp];kC]:h}a.hqc];w};mL;l}:nc],kw]," tac];pQn]tp];kC]:tI:
An]pQn]kgp]: Hepatitis B km]:nm]Et. Am],h}a.hqc];w};kL:hiuw]eS etsp];tit];mL;tac];liUt]:' nm].tUw]
kUn];El:lUv]:lgc]: hUm]:kL,m"pQn]tp];kC]:kgp]: Hepatitis B n}.Sm].etsac]:hQt];hC]:pQn]tp];Kqn],SiUw]<l}:"
tac];pQn]n}. etpQn]kCL, sgm];tc];tUw]n}eStL. An]luik].lm]:Et. etpQn]tI:tp];nm]liUw]piUn]:"
Pac]hac]:tac];pQn]
 niUw].liUc] (h}a.hqc];nC];Kaw];tac]; 2  sQp];tI:tgc].tac];niUw]P}a,KCL
wUc]:eSlIKiun];mL;l}g;l}g;)  Piw]tp];etliUm]:eS etsQp];miUw]:tiUw].vL;
 yU,Am],lI' mI;lUm];naw]' El: etyC],
Am],K}:kin]K}:yqm].'hak]:  SIyQw]:Ek,' SIP}a:Am],sac]
lgc]:KUn].hLmk];mn]:tac];pQn] (Diagnosis) Liver function test, specific antibodies
122
lgc]:yUt];yL
 yUt];yLs}g:hC]:Sak]:SL,kUv]; - Sc]wL:Tat]:nm].nC];tUw]kUn];pQn]hqc]:nL, Am],nn] kin]Am],l}:
hp].w}.yUt];yLtI:hgc]: IPD"
 tiuk];SUn]; hC]:kUn];pQn]kin]nm]. Am],nn] pn]nm].kiUw] dextrose 5% IV"
 Am],Tuk],lIkin]lw]:"
 yUt];yLtac];pQn] tI:An]hQt];hC]:pQn]Agn]tac];kgn], (miUn]nc], tac];pQn]yQw]:nU)"
 Sc]wL:kUn];pQn] kin]yLtI:An]tum].tiUw].tp];l}:yU,n}siuc] hC]:kiut];kin]yLsiUw];nn].eS SUc],kUn];
pQn] kCL,sU;emLyL"
lgc]:eh.kc]:
tp];kC]: eA, - Tuk],lIhQt];lgc]:liUm]:l},hC]:lIKiun]:"
tp];kC]: pI, - lgc]:eh.kc]:tL,PU:hap],kan]p}a;yU,lIEl: Sm];pn]yLeh.kc]:"
yLeh.kc]: (wk].Sin];)-Sm];pn]wk].Sin];tp];kC]:pI, miUw]:kiUt],mL;' AL,yu 6 liUn]El:wUc]:TI. 14"
Aac]:Aic-] lgk];Kgc]:Sm];pn]yLwk].Sin];(eKL:PiUm].Tqm])' lgc]:eh.kc]:tL,PU:hap],kan]p}a;yU,lI (kn] 5)"
tp];Kqc] (Liver Cirrhosis)

eKL:piut],tI:pgc],
tp];Kqc]n}. pQn]tac];pQn]Kaw];hiuc]eS yL.hC]:eS;l]nC];tp];lU.lqw]yw]. Aw]niUw].yiUw]. (tissue) tI:
An]pQn]h}g;sQp]; mL;tqn];tI:w}.nn].yw]." An]hn]pQn]km]:nm]Et. pQn]kgp]: yam];sp];sUiw].mqc];tp];kC]:pI,
(Am],nn]) SI, mL;" epLkin]lw]:nm]nm]Kaw];hiuc]siuc] ethQt];hC]:yQn];pQn] tp];Kqc]l}:" kgp]:piUw]:tac];pQn]
liUt]:eSEl: k}.k}.hak]:Agk],liUt]:n}.ekL: sac]:hQt];hC]:pQn]tp];Kqc] l}:nc],kw]," w}a;liun];Sut];
ethQt];hC]: tp];ta}eS etpQn]Agk];eALAm],lI' Tat]:kiUw]wan]tUk];' liUt]:Agk],'
tac];pQn]tgc].man];El: sp];tit]; tac];pQn]tac],siUw];c}a:siUw];n}.yw]."
Pac]hac]:tac];pQn]
 niUw].liUc]  mam].yC],' liUt]:Agk],sgm];hUc];Kw]:El:
 yU,Am],lI' hqc];eA,' KUm];tc];tUw] lm];S}:
 PL,miuw];lqc]  kam]:niUw].lQk].lUc];
 miuw];etSn]l}g;l}g;  SQn]:liUt]:etPUw],Agk],mL;tI:Piw]nc]
 tac];pQn]tgc].man];' tin]El:tac];lc]kC]: mUin]nc],yC];kuc],kaw]
123
12
lgc]:KUn].hLmk];mn]:tac];pQn](Diagnosis) - Liver function test (AST/ALT)' epLpQn]l}:hC]:

epL.Tat]:man], ultrasound sgm];"
lgc]:yUt];yL
Am],yUt];yLtp];Kqc]hC]:h}al}:' etl}:yUt];yLkum];Tic]; Pac]hac]:tac];pQn]El: tp];ta}TiUc];lUc];kUv];"
 tac];kin] – kin]tac];kin]An]mI;Tat]:prUw],tin];nm]nm]' kin]kiUw]eA,eA,"
 Sc]mI;liUt]:Agk],sgm];hUc];Kw]:El:lm];S}:n} tiUm];(SCac];)liUt]:pn]El: pn]yLwI,tL,min]eK, 1
mg IM"
 tL,eh.kc]:liUt]:Agk],sgm];hUc];Kw]:El: lm];S}:nn]. pn]yL omeprazole (kn] 7.5)"
 kgp]:wL;liUt]:Suc]n}. etsac]:hQt];hC]:liUt]:Agk],l}:El: hC]:k}.tqk]:pn]hqc];liUt]:"
 Sc]wL:pQn]tac];pQn]tgc].man];' tin]El:tac];lc]kC]:n} hC]:pn]yL Spironolactone Am],nn]
Furosemide"
lgc]:eh.kc]: kiut];pqt]:lgc]:kin]lw]:El:yL: An]hQt];hC]:tum].tiUw].tp];l}: (miUn]nc], yLTI,pI,

El:yLtac];pQn]tut]:"
Aac]:Aic] liUt]:Agk],sgm];hUc];Kw]:El:lm];S}: (kn] 7.5)
pQn]lI.nC];TUc]lI (Biliary colic)

eKL:piut],tI:pgc],
pQn]lI.nG];TUc]lIAn]wL:nn]. kgp]:kgn]:lI. Pan],mL;tac];SQn]:lgt],TUc]lIeS hQt];hC]:tgc].sQp]; h}a.h}a.
hqc];hqc];nn].yw]." miUw]:kgn]:lI.kCL,Aiut];SQn]:lgt],TUc]lIEl: sc],hQt];hC]:niUw].liUc]Kiun]:mL;" km]:nm]
An]kCL,Aiut]; SQn]:lgt],TUc]lIEt. etpQn]kgn]:lI. Am],nn] mqc];tiUk], (km]:nm] etpQn]tiUk],mUn];)
siUw];n}.yw]." pQn]lI.tI:TUc]lIn}. miUw];Kaw];nac];yic];pL;tgc].yU,nn]. Kqn];etk}.pQn]l}:"
Pac]hac]:tac];pQn]
 etsQp];h}a.hqc];Kiun]:mL;pQn]km];pQn]km];eS etsQp];kCL,Tiuc]tac];lc]El: hUw]mL,P}a,KCL"
 tac];niUw]tgc]. Pa},KGLetKQc]:Kiun]:mL;eS etsQp];etL,epL;tiUw].Am],l}:"
 tI:kac]tgc].ekL: etsQp];eS tac];sQp];nn].etKiun]:mL;P}a,niUw]tgc].Pa},KCL"
124
 hak]:"
 Am],mI;lUm];naw] Am],pQn]niUw].liUc]"
sgm];nc],pa};yUt];yL – Aw] ultrasound (epL;pQn]l}:) eSkUt],sqt]:tUv];Tuc]lIyw]. hLtUv];
tI:yU, kgn]:lI."
lgc]:yUt];yL
 pn]yL Buscopan IM Am],nn] IV
 pn]yL Pentazocine IM Am],nn] IV
 Sc]wL:pn]yL Buscopan Am],nn] Pentazocine 2 pgk]:yw]. Am],lIKiun]:mL;n}siuc] Tuk],lIhUp].
TUp];El: tiUc],pac],tc];emLyL"
 lgc]:yUt];yLmqc];tiUk], (kn] 12.4)"
lgc]:eh.kc]: KYL;mqc];tgc].pn]man],man],(miUn]nc],Em:man];)' kin]tac];kin] An]mI;Pgn];lIetL,p}a;yU,lI'

kin]nm].mn];eA,eA,"
Aac]:Aic] lgc]:yUt];yLmqc];tiUk], (kn] 12.4 )' sQp]; (7.5)
TUcl
] Ikiuc].kac].sQp];kC]:h}a.hqc]; (Acute cholecystitis)
eKL:piut],tI:pgc],
TUc]lIkiuc].kac].sQp];kC]:h}a.hqc];n}. pQn]kgp]:SQn]:lgt],lI Tuk],Aiut];tn]eS sp];tit];siUw].mqc];pqk],TI;
rI;yL;El: hQt];hC]:sQp];kC]:nn].yw]." tac];pQn]n}.etpQn]l}: w}a;lgt],TUc]lI Tuk],Aiut];tn]nn].yw]."
kgp]:Kat],Tat]:AL<hL,rEl: tac];pQn]naw]S}:kC]:siUw];n}.ekL: hQt];hC]:pQn]l}:nc],kw],"
Pac]hac]:tac];pQn]
 sQp];' epL;kCL,tiUw].vL;tgc].n} etsQp];nL,eS pgt];niUw]tgc].etKQc]:w}."
 hak]:
 mI;lUm];naw]' kt];Sn],
 niUw].liUc]
125
12
sgm];nc],pa};yUt];yL – Pac]hac]:An]hn]l}:tqk],lqc];nn].Et. epL;hC]:TUv]:sC]Kw]:hqc];hqc];yw].
tiUw].tUv];tI: pgt];niUw]Pa},KCLtgc].n} etsQp];eStL. P}a,S}a.Sm].Am],pQn]Sc]" epL;pQn]l}:hC]:Aw]
ultrasound eSepL. Tat]:man], tUv];cw];l}a;lIEl:kgn]:lI."
tac];pQn]An]pQn]sgm];mL;Pa},lc] TUc]lIsQp];kC]:pQn]ngc]' Kap]:yC];tgc].sQp];kC]:

lgc]:yUt];yL
 ngn];liuw]:hiUw].'pn]yLEk:sQp];Kiun]:(Buscopan IM Am],nn] IV ' codeine Am],nn] tramadol)"
 etAm],l}:pn]kin]Sc]tac];pak],"
 pn]nm].kiUw]El: yLtac];SQn]:liUt]:"
 SCac];pn]yL Ceftriaxone 1 gram IV OD El: Metronidazole 500 mg IV TID"
Sc]wL:lUm];naw]lUc];mL;n}siuc]pn]yLkin] Ceftriaxone El:Metronidazole TID tL, 10 wn];"
 kgp]:wL:epL;Am],PL,TUc]lIAgk],pqt]:n}siuc] kUn];pQn] 25 % n}. etk}.pQn]Kiun];El: hC]:wUn].
Sgn],lgc]:tL,PL,TUc]lIAgk],"
lgc]:eh.kc]: kan]PL,tt];TUc]lIAgk],n}. eteh.kc]:TUc]lIkiuc].kac].sQp];kC]:h}a.hqc];nn].l}:"
Aac]:Aic] tp];sQp];pQn]ngc]' tac];pQn]naw]S}:kC]: (kn] 15.1)' Kat],Tat]:AL,hL,r (kn] 17.1)
tp];sQp];pQn]ngc]
eKL:piut],tI:pgc],
tp];sQp];pQn]ngc]n}. pgc],wL:pQn]ngc]tI:niuc]:Am],nn] nm]liUw]nn].nn].yw]." tp];sQp];pQn]ngc]
etmI;Sgc]Sqn];
 Amoebic (pQn]kgp]:AmI;pL;) 1. Bacterial (pQn]kgp]:pqk],TI;rI;yL;)
 etpQn]nm]liUw]pQn]kgp]:pqk],TI;rI;yL;Sam]pun]:"  km]:nm]pQn]kgp]:siUw].mqc];pqk],TI;rI;yL;Kw]:kCL,
 kUn];pQn]etlat]:EnwL: pQn]tgc].ngc], sgm];SQn]:lgt],TUc]lI"
Am],p},hiuc]n}.kUv];"  kUn];pQn]etk}.Am],yU,lI/liUt]:pQn]kgc].liUw]"
 lgc]:yam]:Aw]yL Metronidazole yUt];yL  lgc]:yam]:Aw]yL ptI,KYI<w yUt];yLmL;
mL;mI;/Am],mI; mI;/Am],mI;
126
Pac]hac]:tac];pQn]
 mI;lUm];naw]' kt];Sn],' Am],K}:kin]Sc]' hak]:
 tp];sQp];El:yC], - epL;Aw]miuw];yip];tUv]; Am],nn] t}g,tUv];n}ethU.l}: (kUn];pQn] 50%)"
 mac]:pgk]: sQp];nL:AUk];eS nm].etsac]:Kw]:pgt],P}a,KCLsgm];"
 km]:nm] niUw].etAm],liUc]' mam].etAm],yC],' tac];pQn]tgc].man];Am],mI; (epL;mI;n} Tuk],lIwUn].
Sgn],KUn].hLmk];mn]:tac];pQn]tac],siUw];)
lgc]:KUn].hLmk];mn]:tac];pQn] sgm];nc],p}a;yUt];yL - Aw] ultrasound eSepL.Tat]:man],tUv];n}.
ets}g:lgc]:KUn].hLmk];mn]:tac];pQn] tp];pQn]ngc]l}:nm]" kUt],sqt]:tUv];P}a:tL, hLlgc]:tac];An] hQt];
hC]:pQn]"
lgc]:yUt];yL
epL;cw];l}a;kUn];pQn]nim]yU, (Am],yU,lI/liUt]:pQn]kgc]. Am],kL:hiuw]) n}siuc]
 pn]yL Metronidazole PO tL,luk]:Agn], 7.5 – 10 mg/kg TID
tL,kUn];lUc] 750 – 800 mg TID
 Sc]wL:cw];l}a;kUn];pQn] lIKiun]:mL;yU,n}siuc] Tuk],lIpn]kCL,Tqc]:tL, 14 wn];"
 Sc]wL:pn]yL 3 Tiuc] 5 wn];yw].eStL. cw];l}a;kUn];pQn] Am],lIKiun]:mL;n}siuc] hC]:yUt];yL
sgm];nc], lgk];l}a;yUt];yL Am],yU,lI/liUt]:pQn]kgc]."
Sc]kUn];pQn] Am],yU,lI/liUt]:pQn]kgc].n}siuc]-
 Et,pn] IV ampicillin ' Gentamicin El: Metronidazole PO/IV (miUn]hqc];yL
sgm];nc],pL:niUw])" Siup],pn]kCL,Tqc]: 14 wn]; (kiut];pn] Gentamicin w}a;lc]pn]yw]. 8
wn];)"
Aic]niUw]tac];yC],Kgc]sQp];ngc] (yC],liUw] 6 Sin],tI,mI,tL,)El:Sc]

tUv];lgc]:tgp],ygn].Kiun];yLptI,KYI<wEl:Sc] tk];etl}:PL,tt]; Aw]ngc]Agk],
lgc]:eh.kc]:
Sc]yUt];yL tac];pQn]tgc].ngc],An]pQn]kgp]:AmI;pL;mL;sQm]sw].n}siuc] eteh.kc]: lgc]:pQn]tp];sQp];
pQn]ngc]l}:"
Aac]:Aic] tgc].ngc], (kn] 12.1)"
127
12
12.4 mqc];tiUk],sgm];lm];S}:
mqc];tiUk],An]yU,sgm];lm];S}:An]hU.sk];kn]km]:nm]Et. etmI;tiUk],tUw]mUn]; (ascaris)' tiUk],pak],mQt];
(hookworm)' tiUk],siUk]:mL.(trichuris)' tiUk],tUw]tiut],(taenia)" kUn];pQn]km]:nm] etsp];tit];mL;
kgp]:pUiw]:Am],Suk]:miuw];eSEl: kin]tac];kin]' Am],tuiw];Kqp];tin]eSEl:p}kCL,mL; Am],nn] kin]niUw].lip];'
Pk];lip];"
Tuk],lIyUt];yLmqc];tiUk], kgp]:wL: (k) tL,eh.kc]:tac];pQn]liUt]:sac]El: Kat],Tat]:AL<hL,r (K)
tL,eh.kc]:Pgn];sL.sgm];mL;Pa},lc] miUn]nc],-
 S}:tn]' kgp]:S}:tn]El:niUw].liUc]
 Cystcercosis (Taenia solium ) – hQt];hC]:tum].tiUw].Agk];eAL' Piw]nc]El: lU.lqw]"
Sc]tk];etl}:Aw] yLStI;rW};eS (miUn]nc], yL Prenisolone) yUt];yLkUn];pQn]

ekL.nn].tL,tac];pQn]tac],An]n}siuc] tk];etl}:KYL;mqc];tiUk],pn]sgm];tL,eS,"
mqc];tiUk],sp];sgm];lin]mL;
eKL:piut],tI:pgc],
mqc];tiUk],sp];sgm];lin]mL;n}. etmI;miUn]nc], tiUk],tUw]mUn]; (ascaris)' tiUk],pak],mQt]; (hookworm)'
tiUk],siUk]: mL. (trichuris) siUw];n}.yw]." Pwpn],tUc],mqc];pL,rL,S}.(tiUk],) siUw];n}. liUw]eSnC];tUw]kUn];
yw]. Et. etpQn] nC];lin]yw]." lgc]:sp];tit];km];Siuw]:km]:nm]Et. kgp]:K},mqc];tiUk],sp];tit];mL;
sgm];miuw];tI:Am],Suk].eSEl: hQt];Kw]:Pk];' kin]tac];kin]siUw];n}.El: Kw]:kCL,tac];pak], etL,epL;Kiun];
Agk],kCL, tac];hU;kUn]:Kiun]; Am],nn] kgp]:Am],tiuw];Kqp];tin]eSp}niUw]lin]El: sI;Kw]:sgm];Piw]nc]eS
Kw]:mL;nC];tUw]kUn];" mqc];tiUk],n}. pqk].Sm].wL: etyU,nC];S}:kUn]; An]sp];tit];vL;mL;n}eStL. Et
sac]:kCL,nC];tUw]l}:kU:tI:" luk]:Agn], An]mI;mqc];tiUk],n}. etsac]:hQt];hC]:tum].tiUw].lgc]:tUw]yC],Kiun]: El:
lgc]:Kiun]:yC],Kgc]Agk];eAL lgc]:hQn];hU.Kw]siUw];n}.yw]."
Pac]hac]:tac];pQn]
 hn]tUw]tiUk],nC];P}a: Am],nn] hak]:  hU;kUn]:KUm];
 tgc].Kiun]:tgc].sQp];  liUt]:sac]Kaw];hiuc]
 km]:nm] etsQp];tI:lin].tgc]." km]:nm]Et.  Kat],Tat]:AL,hL,r
pQn]kgp]:sp];tit];tiUk],hUw] mQt];"  tac];pQn]An]pQn]sgm];mL;l}:Et.
 tgc].etyC],kC]:pgc];Kiun]:mL;" pgt],kC]:kgp]:tiUk],' S}:tn]' niUw].liUc]
m}atgc];" " kUn];pQn]An]mI;mqc];tiUk],n}. etAm],k}.mI;lUm];naw]" epL;mI;n}siuc] Tuk],lIhLtac];pQn]tac],siUw];
An]pQn]sgm];l}:"
128
tL,hLtUv];tiUk], Am],nn] K},tiUk],nn]. Aw] microscope eSkUt],sqt]:tUv];P}a:" kUt],
sqt]:liUt]:tUv];eS;l]mQt].liUt]:Kaw] eosinophil nm]n}ekL: ethU.l}:nc],kw],"
lgc]:yUt];yL
tL,kUn];lUc]El: luk]:Agn],yC],liUw] 1 KUp], (tL,tgc]; - tL,nac];yic]; tI:An]sc],hLpL;tgc]. l}:
Sam]liUn]Agn],tac];nn]. etAm],l}:pn]kin])
 pn]yL Mebendazole 100 mg BID tL, 3 wn]; Am],nn]
 pn]yL Albendazole 400 mg STAT (tL,luk]:Agn],AL,yu 12-24 liUn] 200 mg STAT )
epL;pQn]liUt]:sac]n}ekL: hC]:yUt];yLpL;sgm]; (km]:nm] pQn]kgp]:tiUk],hUw]mQt];)(kn] 14.1)
Tuk],lIKYL;mqc];tiUk],pn]kUn];mU,nm]pQn]km]; miUn]nc],tI:hUc];hQn];El:
piun].tI:An]mI;kUn];mI;mqc];tiUk],kn]nm] hC]:nac];yic];pL;tgc].yU,nC];Kaw];yam]; second and third
trimester siUw];n}."
lgc]:eh.kc]: lat]:EnhC]:sC].Tac]P}a:kn]' w}a;eSP}a:yw].El: miUw]:ethQt];Kw]:Pk];nn].

Suk]:miuw];tL,eS,' mUiw]:etkin]tac];kin]ekL: hG]:Suk]:muiw];' hG]:tiuw];Kqp];tin]"
Aac]:Aic] liUt]:sac] (14.1) ' tac];pQn]tp]; (12.3)"
tiUk],tUw]Pqp.] (Taenia )
eKL:piut],tI:pgc],
tiUk],tUw]Pqp].n}. etPqp].Pqp].yaw];yaw];eS mI;pgc]:yaw];kCL,tc];tUw]El: sac]:yaw];l}:Tiuc] 10 mI,tL,
kgn],yw]." km]:nm]Et. kgp]:kin]niUw].lip];El: nUiw].Am],Suk];Am],lip];eS sp];tit];mL;nn].yw]."
K},mqc];tiUk],siUc].n}n}. etAgk],kCL,sgm];Pa}:kUn];eS sac]:sp];tit];kCL,tI:tUw]St];l}:" sc],wL: epL;kin]
niUw].St]; (miUn]nc], wUw];' k}Ca;' mU)siUw];n}. huc]Am],p},Suk];eSkin]n}. sac]:sp];tit];l}:nn].yw]."
Pac]hac]:tac];pQn]
 ethn]tUw]tiUk],nC];P}a:Am],nn] hak]:kUn];pQn]
 tgc].Kiun]:tgc].mUv]:' sQp];tI:lin].tgc].' tUn].
 kUn];pQn] kin]nm]yU,n}eStL. Sm].ygm]
 Sc]sp];tit];mqc];tiUk],Sqn]; (T.solium) n}siuc] ethn]pQn]hUv],hUv],tC]:Piw]nc]El:kam]:niUw]."
Sc]mqc];K},nC];Agk];eALkUn];pQn]n}siuc] kUn];pQn]etpQn]can]; Am],nn] pQn]lUm];mL:mUl}:"
129
12
lgc]:KUn].hLmk];mn]:tac];pQn] Aw]m},klUw],SkUp].eS kUt],sqt]:tUv];P}a:kUn];pQn]"
lgc]:yUt];yL
 Praziquantel tL,luk]:Agn],yC],liUw]4 KUp],El: kUn];lUc] 20 mg/kg STAT Am],nn] 1g STAT
 Niclosamide tL,luk]:Agn],nm].nk];eA,liUw] 10 kI,lUw], 500 mg STAT
luk]:Agn],nm].nk];nC];wUc]:kac] 11-35 kI,lUw], 1 gram STAT
tL,kUn];lUc] 2 gram STAT
miUw]:p},Aiun]lUc];nn].hC]:yqm].yLAgn]tac];kgn],"
lgc]:eh.kc]:
Tuk],lIpn]tac];hU.wL:
 tUm]:tac];kin]hC]:Suk]; ciUc].ew:lgc]:kin]niUw].mUEl: niUw].St];lip]; Am],nn]
Am],Suk];Am],lip];"
 hC]:sC].Tac]P}a:' w}a;kCL,Tac]f}a:mL;yw]. hC]:Suk]:miuw]:kU;pgk]: Am],nn] mUiw]:etyip];tac];kin]kU:pgk]:"
 Tuk],lItUv];wL:niUw].St];nn]. sgc],mI; Am],mI;K},tiUk], Sc]wUn].wL: niUw].mUnn].
Aap]:etmI; K},mqc];tiUk],n} yL,epkin]lL;lL;"
Aac]:Aic] tac];pQn]liUt]:sac] (kn] 14.1 )' pQn]lUm];mL:mU (kn] 20.1)
130
tac];pQn]kQw],lUv]:SQn]:tac];yQw]:
El:lgc]:EP:siUw].Pn]; 13
13.1 SQn]:tac];yQw]:sp];tit];siUw].mqc];
eKL:piut],tI:pgc],
 sp];tit];siUw].mqc];sgm];SQn]:tac];lgt],yQw]: An]wL:nn]. kiuc].kac]. Am],nn]
pQn]sQp];yQn];Kaw];hiuc] sgm];eStI:tI: Am],nn] l}al}atI:sgm];SQn];tac];lgt],yQw]:nn].yw]."
 Cystitis - hUc];yQw]:kC]:sQp];"
 Urethritis – lgt],yQw]:kC]:sQp];"
 Prostatitis – mak],ln]cam]:KLkC]:sQp];"
 Pyelonephritis – mak],kqw];kC]:sQp];kUv];n}eStL. sac]:tum].tiUw].kCL, sgm];SQn]:tac];yQw]:l}:"
tac];pQn]yQw]:wan]n}. pQn]eKL:pQn]eP;l}:An]niuc]:nc],kw]," tI:hgc]:yLhw];km]:nm]nn]. l}:hUp].vL;wL:
siUw].mqc];pqk],TI;rI;yL;mac]tUw] ettiuw]/mI;hqc];Kam],tc];yLptI,KYI,wnEl: nm]Kiun]:mL;" kgp]:n}
epL;etyUt];yL tac];pQn]sp];tit];siUw].mqc];sgm];SQn];tac];yQw]:n}. etl}:tUv]; lgc]: siUw].mqc];tiuw]yL
nC];piun].tI:nn].eS pn]yLkCL,"
cw]:hak]:siUw].mqc];An]l}:sp];tit];sgm];SQn]:tac];yQw]: (Causes of urinary tract infection)

 pqk],TI;rI;yL;' km]:nm]Et. pQn] E.Coli  kgn]:lI. Am],nn] mI;Sic],Kgc] Aiut];SQn]:
etsac]:hQt];hC]:pQn] UTIhaw].hqc]; Am],nn] tac];yQw]:w}. Am],nn] kiUt],pL;mL;sgm];"
Kaw];huiuc]  hUm]:kL,m"
 siUw].mqc];tI,pI,ekL: etsac]:hQt];hC]: sp];  Pgc];yam];pL;tgc].yU,"
tit];siUw].mqc];l}:"  nac];yic];mac]ekL. Am],mI;lgc]:tac];Sc]eS
 siUw];mqc];tac];pQn] An]sp];tit];l}:sgm]; El: pQn]mL;hc];kUv];"
Ac],kL,eP:siUw].Pn];
 l}:SC],S}ayac] tI:lgt],yQw]:w}."
tac];pQn]sp];tit];siUw].mqc]; sgm];SQn]:tac];yQw]:n}. tL,PU:s}a;etpQn]yap],n}eStL. kgp]:miUw]:AL,yu
Suc]mL;eS pQn]mak],ln]kC]:sQp];' tac];pQn] An]sp];tit];kgp]:hUm]:kL,m' mI;kgn]:lI. nC];mak],kqw];siUw];n}.
etsac]:hQt];hC]: sp];tit];siUw].mqc];tac];pQn]l}:" siUw].mqc];sp];tit]; SQn]:tac];yQw]:luk]:Agn],n}. kgp]:
sac]:hQt];hC]:mak],kqw];t}al}:El: Tuk],lIyUt];yLKn]w};sQm]sw]." Sc]km];km];k}.pQn] sp];tit];siUw].mqc];
sgm];SQn]:tac];yQw]:n}siuc] etsac]:hQt];hC]:pQn] kgn]:hin]sgm];lgt],yQw]:' kgp]:h}g;sQp];etkCL,Aiut]; SQn];
tac];yQw]: (Am],nn]) mak],kqw];ta}Kaw];hiuc]siUw];n}.yw]."
luk]:Agn],An]k}.sp];tit];siUw].mqc];tac];pQn]SQn]:tac];yQw]:nn]. Tuk],lISUc],kCL,kUt],tUv];tI:hUc];yL"
sp];tit];siUw].mqc]; An]Am],Sp];lqc];Enlgc]:tac];mn];l}:n}.
etpQn]l}:kgp]:pQn]kgn]:lI.sgm];SQn];tac];yQw]:' pQn]tum], Am],nn]
pQn]tac];pQn]An]sp];tit];lgc]:lUv]:hUm]:kL,m" Tuk],lIwUn].Sgn],Tiuc] tL,SUc],kCL,hUc];yL"
131
13 tac];pQn]kQw],lUv]:SQn]:tac];yQw]:El: lgc]:EP:sUiw].Pn];
hUc];yQw]:kC]:sQp]; (Cystitis)
eKL:piut],tI:pgc],
sp];tit];siUw].mqc];tI:hUc];yQw]:' nac];yic];etpQn]tac];pQn]n}.nm]"
Pac]hac]:tac];pQn]
 miUw]:yQw]:nn].etSqp],m}: (Dysuria)  yQw]:Agk],liUt]: (Haematuria)
 Am],mI;lUm];naw]  km];km];yQw]: (Frequent urination)
 yQw]:Kun]Kun] (Cloudy urine)  sQp];tI:hUw]nw], (Pain and tenderness in
the lower abdomen)
 kUt],sqt]:yQw]:tUv]; - Kun], Am],nn] mI;liUt]:nC];yQw]:"
 Aw] dipstick eS kUt],sqt]:yQw]:tUv]; - mI;K},mQt].liUt]:Kaw]El: n},TrUw],kYqn], pL;mL;sgm];"
 Sc]wL: Aw]yQw]:w}.hC]:ngn];hgn];yw]. Aw]m},klUw],SkUp].sqt]:tUv];n}siuc] etTUp].vL;
niUw].eS;l]Kaw] niUw].eS;l]lqc]El: siUw].mqc];pqk],TI;rI;yL;"
Sc]wL:kUn];pQn]k}.pQn]hUc];yQw]:sQp];n}siuc] wUn].Sgn],Tiuc]lgc]:pQn]lI. Am],nn] sp];tit];

tac];pQn]lgc]:lUv]:kL,m" tL,kUn];s}a;km]:nm]Et. etAm],k}.pQn]hUc];yQw]:kC]:kn]" Sc]siUw].mqc];
Kw]:SQn]:tac]; yQw]:kUn];s}a;pQn]n}siuc] Tuk],lIwUn].Sgn], lgc]:tac];pQn] An]sp];tit];lUv]:
lgc]:hUm]:kL,m (kn] 13.5)" Sc]wL:siUw].mqc];sp];tit];SQn]:tac];yQw]: luk]:Agn],n}siuc]
nc],hiuw]mak],kqw];etAm],w}a;nn]. Tuk],lIyUt];yLKn]Kn]w};w};"
lWc]:yUt];yL
 yUt];yLtI:hgc]: OPD – hC]:kUn];pQn]kin]nm].nm]nm] (tL,kUn];lUc] niuc]:wn];lC] 3-4 tw]:)"
 tk];etl}:liUk]:yLptI,KYI<wnsgm];nc],piun].tI:
 l}a;pn]yL pn]yL Cotrimoxazole 960 mg BID (mac]:tI:nn].lgc]:tiuw]yLn}.etSuc])
Am],nn] pn]yL Nitrofurantoin 100 mg QID (An]lIliUw]piUn]:Et. Tuk],lIkin]sgm];
tac];kin]) (tL,tgc]; - Am],Tuk],lIpn]Em:man];tgc].Ek,) Am],nn] pn]yLkin]
Cephalosporin (tUw]yac], - Cephalexin 500 mg BID tL, 3 wn];)"
Kaw];tac];yUt];yL
pun]:tL,kUn];pQn]nac];yic];Kw]nn]. pn]yLptI,KYI<wn tL, 3 wn];Agn]tac];kgn],"
pun]:tL,kUn];pQn]kUn];s}a;' Em:man]; El:luk]:Agn],Kw]nn]. hC]:pn]yLptI,KYI<wn tL, 7 wn];"
132
tac];pQn]kQw],lUv]:SQn]:tac];yQw]:El:lgc]:EP:sUiw].Pn]; 13
Sc]wL:yLAm],tiUw]. Am],nn] Sc]pQn]tac];pQn]Kiun];nC];Kaw];tac]; 8 wUc]:
Tuk],lISUc],yQw]: kCL,lQc].siUw].tI:hgc]:lqp],eSkUt],sqt]:tUv];" w}a;nn].yw]. Tuk],lIEt,pn]yLKiun];mC],"
lat]:EnkUn];pQn]wL: w}a;eS 5 wn]; Am],nn] epL;mI;lUm];naw]n} Tuk],lImL;EnKiun];" Sc]siUw].mqc];
tiuw]yLn}ekL: etl}:kUt],sqt]:tUv];eSyUt];yLsgm];nc],Pgn];kUt],sqt]:"
tL,tgc];" " tL,Em:man];nn].epL;wL:yLpti,KYI<wnmac]siUw];Am],tiUw].n}siuc] sC].tiuw];yL Ciprofloxacin

l}:"
tL,kUn];pQn] Tat]: G6PD eA,nn].yL Nitrofurantoin El: Ciprofloxacin n}.

etsac]:hQt];hC]: lU.Sum];mQt].liUt]:lqc]l}:" (kn] 14.3) lat]:EnkUn];pQn]wL:
epL;yQw]:Agk],SIkm],km], Am],nn] niUw].liUc]mL;n}siuc] Tuk],lIyut];kin]yLeSEl:
mL;Enhgc]:yLKiun];"
lgc]:eh.kc]:tL,tac];pQn]hUc];yQw]:El:lgt],yQw]:kC]:sQp];
hG]:kin]nm]. niuc]:wn]; 2 lI,tL, (2tw]:)" mUiw]:etngn];El: miUw]:hUm]:kL,myw].nn]. kCL,yQw]:pqt]:km];
lQw]" kgp]:wL:epL;tgc].pik].n}. etsac]:hQt];hC]:yQw]: tI:nG];hUc];yQw]:Am],Agk],mUt];El: yL,hC]:tgc].pik]."
tac];pQn]mak],kqw];kC]:
tac];pQn]mak],kqw];kC]:n}. pQn]kWp]:sUiw].mqc];tac];pQn]Kw]:kCL,nC];mn];eS sQp];kC]:n}eStL. Sm].kCL,tum].tiUw].
sgm]; lgt],yQw]:l}:nn].yw]."
Pac]hac]:tac];pQn]
 mI;lUm];naw]hqc];' kt];  miUw]:yQw]:nn].sQp];Sqp],m}:
 tac];lc] Am],nn]  km];km];yQw]:
Aqw]sQp];Siuw]:tI:mak],kqw];  liUt]:pQn]kgc].
 yQw]:Kun],' yQw]:pL;liUt]:( Haematuria )
lgc]:KUn].hLmk];mn]:tac];pQn]
 kUt],sqt]:yQw]:tUv]; - Kun], Am],nn] mI;liUt]:nC];yQw]:"
 Aw] dipstick eSEl: kUt],sqt]:yQw]:tUv];- mI;K},mQt].liUt]:Kaw]El:n},TrUw],kYqn],pL;mL;sgm];"
 Sc]wL:Aw]yQw]: w}.hC]:ngn];hgn];yw]. Aw]m},klUw],SkUp].sqt]:tUv];n}siuc] etTUp].vL; niUw].
eS;l]Kaw] niUw].eS;l]lqc]El: siUw].mqc];pqk],TI;rI;yL;"
 Sc]mI;KiUc]: Ultrasound n} kUt],sqt]:hLtUv];lgc]:pqk],piUc]:Kgc]mak],kqw];"
133
tac];pQn]kQw],lUv]:SQn]:tac];yQw]:El:lgc]:EP:sUiw].Pn];
13
lWc]:yUt];yL
 Aw]hQt];kUn];naw]nC];eS yUt];yLpn] etL,lUm];naw]epL;h}a"
 tL,eh.kc]: lgc]:Kat],Tat]:nm].nn]. Sc]kUn];pQn]kin]nm].Am],l}:n} hC]:Sm];pn] IV eS
pC].sqt]:tUv]; tac];nm]eA,yQw]: An]Agk],mL;sgm];"
 hC]:kin]nm].nm]nm] (tL,kUn];lUc]nn]. niuc]:wn]; 3-4 lI,tL,)" pun]:tL,sQp];El: naw]nn].
pn]yLsgm];nc],cw];l}a; (kn] 7.4 ' 7.5)
 pn]yLkin] Ciprofloxacin 500 mg BD* tL, 14 wn]; (tL,Em:man];nn].
epL;wL:yLpti,KYI<wnmac]siUw]; Am],tiUw].n}siuc] sC].tiuw];yL Ciprofloxacin l}:)
Am],nn] pn]yLkin] Cephalosporin (tUw]yac], - Cephalexin 1 gm TID tL, 14 wn];)"
Am],nn]
 Sc]kUn];pQn]Am],kin]yLl}:n}siuc] hG]:pn] Ceftriaxone 1 gram OD IV/IM etL,Tiuc]kUn];pQn]
epL;kin]yLl}:"
lgc]:eh.kc]:tac];pQn]hUc];yQw]:El: mak],kqw];kC]:sQp];
hG]:kin]nm].wn];niuc]: 2 lI,tL, (2 tw]:)" mUiw]:etngn];El: miUw]:hUm]:kL,myw].nn]. kCL,yQw]:pqt]:km];
lQw]" kgp]:wL:epL;tgc].pik].n}. etsac]:hQt];hC]:yQw]: tI:nG];hUc];yQw]:Am],Agk],mUt];El: yL,yU,hC]:tgc].pik]."
Aac]:Aic] tac];pQn]sp];tit];l}:lUv]:lgc]:hUm]:kL,m (kn] 13.5 )"
lgt],yQw]:kC]:sQp]; (Urethritis)
(tUv];tI:kn] 13.5 )
mak],ln]cam]:KLkC]:sQp]; (Prostatitis)
eKL:piut],tI:pgc], mak],ln]cam]:KLkC]:sQp];"
Pac]hac]:tac];pQn]
 mI;lUm];naw]  yQw]:pL;liUt]:
 sQp];tI:hUw]nw],  miUw]:yQw]:nn].sQp];Sqp],m}:
 Sc]kUt],sqt]:tUv];hU;kUn]:n} etsQp];h}a. hqc];  km];km];yQw]:
 yQw]:ngn];kgn];
134
 kUt],sqt]:tUv];hU;kUn]:
 kUt],sqt]:yQw]: - etmI;liUt]:Am],nn] yQw]:Kun],
 Aw] dipstick eS kUt],sqt]:yQw]:tUv]; - mI;K},mQt].liUt]:Kaw]El: n},TrUw],kYqn],pL;mL; sgm];"
 Sc]wL: Aw]yQw]:w}.hC]:ngn];hgn];yw]. Aw]m},klUw],SkUp].sqt]:tUv];n}siuc] etTUp].vL;
niUw].eS;l]Kaw] niUw].eS;l]lqc]El: siUw].mqc];pqk],TI;rI;yL;"
lWc]:yUt];yL
 Aw]hQt];kUn];naw]nC];eS yUt];yLpn] etL,lUm];naw]epL;ha}"
 tL,eh.kc]:lgc]:Kat],Tat]:nm].nn]. Sc]kUn];pQn]Am],kin]nm].l}:n} hC]:Sm];pn] IV El:
pC].sqt]:tUv]; tac];nm]eA,yQw]:An]Agk],mL;sgm];"
 hC]:kin]nm].nm]nm] (tL,kUn];lUc]nn]. niuc]:wn]; 3-4 lI,tL,)"
 pun]:tL,sQp];El: naw]nn].pn]yL sgm];nc],cw];l}a; (kn] 7.4 ' 7.5)
 pn]yLkin] Ciprofloxacin 500 mg BD* tL, 14 wn]; Am],nn]
 Sc]kUn];pQn]Am],kin]yLl}:n}siuc] hC]:pn] Ceftriaxone 1 gram OD IV/IM etL,Tiuc]kUn];pQn]
epL;kin]yLl}:"
13.2 pQn]kgn]:lI.sgm];SQn]:tac];yQw]:
eKL:piut],tI:pgc],
sgm];nC];SQn]:tac];yQw]:nn]. mI;kgn]:lI. (nC];hBc];yQw]: Am],nn] nC];mak],kqw];) Auit];tn]w}. nC];SQn]:tac];
yQw]:eStI:tI: Am],nn] tc];mUt];" kgn:] lI. An]pQn]nC];mak],kqw];n}. etsac]:lUc];mL;sWm];lWt],yQw]:
eS Auit];tn]w}.sgm];lgt],yQw]:"
kUn];pQn]tI:An]k}.pQn]tac];pQn] U.T.I nn]. Tuk],lIkUt],sqt]:lgc]:pQn]lI.

nC];mak],kqw];"
Pac]hac]:tac];pQn]
 sQp];haw].hqc]; An]km];nuic]:pQn] km];nuic]:h}a' hBw]nw],sQp]; (sQp];mUiw]:K}:yQw]:) Am],nn]
sQp];yU,tL, eS,"
 yQw]:Agk],pL;lUit]:
 yQw]:pL;kgn]:lI.mL;sgm];
 mI;Pac]hac]:sUiw].mqc];tac];pQn]Kw]:-mI;lUm];naw]' kt];
135
13
lWc]:KUn].hLmk];mn]:tac];pQn]
 sC]. Dipstix eSkUt],yQw]:-lUit]:' Sc]sUiw].wL:TUp];vL;pL; Leucocytes El: Nitrites sUiw];n}.suic]
sac]:pQn]pL;sWm]; sUiw].mqc];tac];pQn]tac],siUw];yU,yw]."
 sC].l}a;Aw]yQw]:ngn];kgn];eS kUt],sqt]:tUv];siUw].mqc];tac],siUw];Tqc]:"
lWc]:yUt];yL
Aw]hQt];kUn];pQn]nC];w}."
sC].kin]nm].nm]nm] (pun]:tL,kUn];lUc] 3-4 lit].)" epL;Am],kin]l}: hC]:pn]nm].tac]; IV "
Sc]mI;lUm];naw]eS kt];n}siuc] (sp];siUw].mqc];tac];pQn]tac],siUw];) hC]:yUt];yLpn]sgm];nc],l}a;
yUt];yLmak],kqw];kC]:sQp];" (kn] 13.1)
 yUt];yLpn] sgm];nc],lgc]:h}a.hqc];nm]eA,tac];pQn]"
1. Aspirin, Ibuprofen, Indomethacin Am],nn] Diclofenac yLkin]/ yLSm]; sUiw];nn].pn],
tUc],pn] An]niuc]:yw].An]nuic]:" (kn] 7.5 )
2. Buscopan (Hyoscine butylbromide ) yLkin]/yLSm];n}.pn]sgm];nc],lgc]:h}a.hqc];nm]eA,tac];pQn]
luk]:Agn],lQk].liUw] 6 KUp], 0.5 mg/kg
kUn];lUc] 20 mg
Sc]wL:pn]yLyw]. 30 minit].El: sQp];yc];p},h}an}siuc] pn]sgm];nc],hqc];yLnc],kw],Tqc]:
(niuc]:wn];pn]l}: Am],pUn]. 100 mg) yL,pn]luk]:Agn],lQk].liUw] 6 KUp],El:Em:man];
Sc]sQp];yc];p},h}an}
1. pn]yL Pantazocine 30mg/1cc (IM/IV)
luk]:Agn], (IM ) 1mg/kg
( IV ) 0.5mg/kg
kUn];lUc] (IM/IV) 30 – 60 mg
 Sc]wL:pn]yLEk:sQp]; lUv]:yLAn]hqc];Sut];yw]. sQp];yc];Am],Kqn];n}suic] hC]:SUc],kCL,hBc];yL"
 Sc]wL:mI;Pac]hac]: lWt],yQw]:tn] (hBw]nw],sQp];eSAm],yQw]:l}:) n}suic] hC]:SUc],kCL,hBc];yL"
 mUiw]:SUc],kUn];pQn] An]SQn]:tac];yQw]:Auit];tn]nn]. kCL,hBc];yLsuic] etl}:wUn]. lWc]:Eh.kc]:
lWc]:hUc];yQw]:KQc]:pWc];nL,eS hQt];hC]:KUic]:Ac],kL,tac],An]hBt];El: mak],kqw];lU.lqw]siUw];n}.yw]."
lgc]:eh.kc]:
kgp]:wL:lgc]:Kat],Tat]:nm].n}. pQn]eP;An]niuc]:El: hG]:kin]nm].mak],m}.pn]nm]nm]" ciUc].ew:tac];kin]
An]sac]:hQt];hG]:pQn]lI.Kiun]:mL; (miUn]nc], mak],Pit].pgm]:' mQt].mak],mUc]:SI,hUw],' kUw],kUw];' nm].mak],
Ait],/nm].mak],sgk];' nm].nQc]:sQm];' KUw],kL,KUw],lL,)"
Aac]:Aic] tac];pQn]mak],kqw];kC]:sQp]; (kn] 13.1)
136
13.3 mak],kqw];sQp];kC]: An]kuic].kac].pQn]h}a.hqc]; (AGN)

eKL:piut],tI:pgc],
mak],kqw];sQp];kC]:An]kiuc].kac].pQn]h}a.hqc];n}. pQn]kWp]:sUiw].mqc];tac];pQn] Kw]:kCL,tI:TUc]sqt]:lQk].lQk].
(ketL.) tI:An]yU,nC];mak],kqw];nn].yw]." cw]:cL, An]hQt];hC]:pQn] Pac]hac]:hBw]hup]: mI;yU,l}alWc]:nn].
An]hn]pQn] km]:nm]eS yUt];yLh]G:h}al}:Et. tI:pQn]kgp]: Post-Streptococcal Glomerrulo
nephritis nn].yw]." tac];pQn]n}. sac]:Kw]:mL;sgm];tac];pQn]Piw]nc] (miUn]nc], impetigo' kn] 22.1)
Am],nn] eKL;sQp]; ( tonsillitis' kn] 21.1) sUiw];n}.yw]." sac]:Kw]:mL;sgm]; tac];pQn]tac],siUw];
mUin]nc],pWt],kC]:' naw]S}:kC]:' tac];pQn]yQw]:nU (Leptospirosis) naw]nUk].' tp];kC]: A El: C '
mak],lqc]sUiw];n}.ekL:sac]:pQn]l}: yU,nc],kw]," tI:An]pQn]km]:nm]Et. luk]:AWn], AL,yU. 3
KUp],Kuin]:nUiw]"
Pac]hac]:tac];pQn]
kUn];pQn] 50% tI:pQn] AGN etAm],mI;Pac]hac]:h}a.hqc];El: Am],K}:mL;yUt];yLkn]" liUw]nn].Et.
kUn];pQn]etmI;Pac]hac]:
 SIyQw]:mUin]kCn];f};' SIlQk];Kiun]:Kan]:km],
 nm].tum]kn]El:pQn]kC]: km]:nm]Et.etkC]:sWm];nL: kUv];sac]:kC]:tac];tUw]yU,nc],kw],yw]."
 yQw]:eA,El:KUn].(Oliguria)
 hqc];lUit]:Suc]' sac]:Kuin]:Ait];AWt];kUv];n}eStL. kUn];pQn] 5-10% sUiw];n}.Et.sac]:pQn]h}a.hqc];"
 Sc]wL:kC]:tac];tUw]suic] sac]:pQn]lUv]: nm].Kw]:pWt],eSkC]:nn].yw]." etTUv]:sC]yap], etl}:
cin];SQc]nm].l}a;pWt],pWt];tC]:"
 Aw] dipstick eS kUt],sqt]:yQw]:tUv]; - mI;K},mQt].liUt]:Kaw]El: n},TrUw],kYqn], pL;mL;sgm];"
 Sc]wL:Aw]yQw]: w}.hC]:ngn];hgn];yw]. Aw]m},klUw],SkUp].sqt]:tUv];n}siuc] etTUp].vL;
niUw].eS;l]Kaw] niUw].eS;l]lqc] hyaline, granular and red blood cell casts"
Tam]tUv];lgc]:kL:pUn].mL; sgc],yam]:pQn]sQp];sgm];Piw]nc] Am],nn]

nC];eKL;" tUv];h}g;sQp];kw],sgm];Piw]nc]"
lWc]:yUt];yL
 Aw]hQt];kUn];pQn]naw]nC];w}.eS hC]:ngn];liuw]:"
 yL,hC]:kin]nm].kiUw]nm]"
 kum];Tic];pn]lgc]:nm]. An]pn]tL,kUn];lUc] nuic]:wn]; 500 ml - 1lit].El:tL,luk]:Agn], niuc]:
137
13
wn]; 50ml/kg (nm]Sut]; 1lit].)"
 Sc]lgc]:sQp];kC]: (lin].k},nC];eKL;El: tI:Piw]nc]) yc];mI;yU,n}siuc] Tuk],lIpn]yLptI<KYI<wn
miUn]nc], Amoxicillin Am],nn] Cloxacillin siUw];n}.yw]."
 kUn];pQn] An]kC]:h}a.hqc];nn]. hC]:pn]yLkin] Furosemide 1 mg/kg/day "
 yUt];yLtI:mI;lgc]:Suk].yuc]: - liUt]:Suc] (kn] 8.1)' pgt],kiuc].kac].kC]:h}a.hqc]; (kn] 8.2)'
pQn]can]; (kn] 7.2)"
lgc]:eh.kc]:
tL,tac];pQn] lin].k},nC];eKL;El:Piw]nc]sQp];kC]: (kn] 21.1 El: kn] 22.1)n}. Tuk],lI yUt];yLhC]:
lI" eh.kc]:lgc]:sQp];kC]: An]etsac]:hQt];hC]:yQn];pQn]mak],kqw];kiuc].kac].kC]:h}a.hqc];" tL,kUn];pQn]yQw]:wan]
nn].Tuk],lIkum];Tic]; Tat]:kiUw]wan]nC];liUt]:pn]El: tL,kUn];pQn]liUt]:Suc]nn]. kum];Tic];hqc];liUt]:pn]]"
Aac]:Aic] yQw]:wan] (kn] 10.1)' liUt]:Suc] (kn] 8.1)' pgt],kiuc].kac].sQp];kC]:h}a.hqc]; (kn] 8.2)
13.4 tac];pQn]mak],kqw];An]hQt];hC]:kC]:tc];tUw] (Nephrotics

Syndrome)
eKL:piut],tI:pgc],
tac];pQn]mak],kqw]; An]hQt];hC]:kC]:tc];tUw]nn]. etTUp].vL;Tat]:prUw],tin];nm] n}eStL.
nC];liUt]: Sm].ygm];lUc];nn].yw]." tI:l}:pQn]siUc].n}n}. kgp]:mak],kqw];sQp];kC]: ( Primary glomerular
disease)Am],nn] tac];pQn]An]sgm];P}a,lc]yQw]:wan]mL; Am],nn] kgp]:mak],kqw]; sQp];kC]: ( Secondary
glomerular disease)" Sc]K]G:hU.tqt]:etL;wL: pQn]kgp]:Sc]nn]. Aw]niUw].tI:mak],kqw];mL;kUt],sqt]:n}
ethU.l}:yU,yw]."
Pac]hac]:tac];pQn]
 kC]:tc];tUw] (kUn];pQn]km]:nm]nn].  Tat]:prUw],tin];nC];yQw]:nm]
kgp]:nm].Kw]:pgt],eSsQp];kC]:)  Tat]: Albumin nC];liUt]:eA,
 yQw]:eA,
lgc]:yUt];yL
 hLcw]:hak]:An]lm],lgc]:eS yUt];yLpn]" (miUn]nc],- tac];pQn]yQw]:wan]' sp];tit];siUw].mqc];)
 kUn];pQn]siUc].n}tc];mUt]; Tuk],lIyUt];yLpn] tI:hgc]:kUn];pQn]nC];" yLAn]sC].yUt];yLtac];pQn]
km]:nm] etpQn]yL steroids (miUn]nc], Prednisolone) El:yLyQw]:"
138
1. Prednisolone mac]:pgk]:yL Prednisolone yUt];yLtac];pQn]mak],kqw];An]hQt];hG]:
An]kC]:tc];tUw]h}al}:"
hqc];yL– yLkin]tL,luk]:Agn], PO 1 mg/kg BID" yLkin]tL,kUn];lUc] PO 1-1.5 mg/kg OD
w}a;eSpn] yLkin] Prednisolone wUc]:nuic]:yw]. etl}:Tt];Sac]cw];l}a;kUn];pQn] –
kUn];pQn]lIKiun]:" Siup],pn]yL tL,kUn];lUc]El:luk]:Agn], -

Prednisolone 1.5 mg/kg OD pn]wQn].wn]; tL, 8 wUc]:"
nm].nk];ygm];lUc]; kU:Sgc]wUc]: hC]:lUt];hqc];yL 0.5 mg/kg eS
El:kiut];yut];pn]yL"
kUn];pQn]Am],lI pgc],wL:yLsteroids tL,kUn];lUc]El:luk]:Agn], -

Kiun]:" Am],tiUw]." kU:Sgc]wUc]: hC]:lUt];hqc];yL 0.5 mg/kg
hC]:kiut];yut];pn] eS El:kiut];yut];pn]yL"
nm].nk];Am], yL Prednisolone Siup],pn]yLyQw]: (tUv];tI: - 2 )
ygm];lUc];
2. yLyQw]:
yLyQw]:n}.pqk].Sm].wL: hQt];hG]:An]kC]:nn]. h}al}:n}eStL. Am],yUt];yLtac];pQn]l}:" kgp]:n}Tuk],lI
pn]kuik];sgm]; yLtac],siUw]; Furosemide - tc];luk]:Agn],El:kUn];lUc] PO: 1 mg/kg OD El:
Spironolactone - tc];luk]:Agn],El:kUn];lUc] PO: 3 mg/kg OD Sc]kUn];pQn]lIKiun]:mL;yw].
n}siuc]Tuk],lIlUt];ygm];hqc];yLpn]" miUw]:yc];sC].yLyQw]:yU,nn]. Tuk],lIw}.StitUv];Pac]hac]:
nm].nC];tUw] tI:An]lUt];ygm];kCL,"
3. yUt];yLtac];pQn]tac],siUw];
Tuk],lIw}.StiwL:Tat]:prUw],tin]; An]hQt];Sac]:pn]hqc];Kam],tUw] lUt];ygm]; El: kin]yL steroids
n}. sac]:hQt];hC]:pQn]eP;tL,kUn];pQn]" kgp]:n} yUt];yLpn]lgc]:sp]; tit];siUw].mqc];tac],siUw];
miUn]nc],
 tL,eh.kc]:mqc];tiUk],eP:tiun];nn].pn]yL (kn] 12.4)"
 tk];etl}:hU.tqt]:etL;wL: kUn];pQn]Am],pQn]tac];pQn] TB Am],nn]tac];pQn] Amoebic yU,
kgp]:wL: yL steroids n}. etsac]:hQt];hC];tac];pQn]siUw];n}. nL,liUw]nn].yw]."
4. An]lm],lgc]:tac],siUw]; An]etl}:st];kan]
 yL,hC]:kUn];pQn]ngn];eSAm],tUc].niuc]Sc] (kgp]:wL:kUw]pQn]tac];pQn]liUt]:tc]eS Aiut];SQn]:liUt]:)
 kum];Tic];lgc]:kin]nm].' hC]:kin]tac];kin]An]mI;Tat]: EK<lUw],rI,El:prUw],tin];"
 yUt];yLpn] tI:hUc];yLetL,epL;Kqn];" w}a;eSKqn];yw].ekL: etl}:hC]:mL;EntI:hUc];yL kU:wUc]:
139
13
tL,eS, (tL,sc]:nm].nk];El:Aw] dipstick eSkUt],sqt]:tUv];yQw]:)
 lgc]:yUt];yLtc];mUt];n}. ethiuc]mgk]: 4-5 liUn]"
kUn];pQn]tI:An]h}aygn].yLn}. etsac]:pQn]tac];pQn]Kiun];" kgp]:n}lat]:EnkUn];pQn]wL:

Sc]kC]:mL;Tqc];Ait];Agt];n} hC]:mL;EntI:hUc];yLKiun];" Et,pn]lgc]:yUt];yLKiun];mC],"
lgc]:eh.kc]:
kgp]:wL:miUw]:Pgc];kC]:yU,tc];tUw]nn].siUw].mqc];tac];pQn]tac],siUw]; sac]:Kw]:mL;l}:El: tL,hG]:pQn]lgc]:eh.kc]:
nn]. Tuk],lIwUn].Sgn],pn]yL Penicillin V (500 mg PO BD) "
Aac]:Aic] tac];pQn]yQw]:wan] (kn] 10.1)' mqc];tiUk], (kn] 12.4)
13.5 sp];siUw].mqc];tac];pQn]tI:SQn]:tac];Ac],kL,eP:siUw].
Pn]; (Reproductive track infections)
lgc]:etl}:fac].tUv];sgm];
eKL:lm],lgc]: - tac];pQn]nC];kn]n}. km]:nm] etkQw],lUv]:tac];pQn] An]sp];tit];l}:sgm];lUv]:lgc]:
kL,m (STI)" Sc]wUn].Tac],wL: kUn];pQn]Aap]:etpQn]tac];pQn] tI:Ac],kL,eP:siUw].Pn];n}siuc] Tuk],lI
kUt],sqt]:tUv]; tI:nC];hgc]:tL,kUt],sqt]:tUv]; lk]:KnL,El: Pac]hac]:tac];pQn] miUn]nc], - Kgc]l}
Agk],mL;tI: Ac],kL, EP:siUw].Pn];' sQp];' tum],hut];' pak],hUc];luk]:sQp];kC]:El: sQp];miUw]:yip];
tiuw].vL;siUw];n}.yw]." tL,tac];pQn] kQw],lUv]:Ac],kL,eP:siUw].Pn];n}. Tuk],lIkUt],sqt]: ekL.hUm]:
ngn];Tqc]:f}a,niuc]:pL;eSyUt];yLpn]" kgp]:wL: tac];pQn]An]pQn]lUv]: lgc]:hUm]:kL,mn}. etsac]:hQt];hC]:
lgc]:sp];tit];siUw].mqc]; HIV c}a:liUw]El: lgc]:kum]; Tic];tac];pQn] STI n}. pQn]An]lm],lgc]:Et.Et."
Sc]wUn].Tac],wL:pQn] STI n}siuc] Tuk],lIwUn].Sgn], lgc]:pQn]l}:tac];pQn] HIV sgm]; (kn] 15.3) El:
tiUc],pac],pn]tac];hU. kQw],lUv]:tac];pQn]eS kUt],sqt]:tUv]; siUw].mqc]; (VCT)"
tac];pQn]l}al}asiUw]; An]pQn]sgm];Kgc]l}Agk],mL;tI:Ac],kL,eP:siUw].Pn];
hU;kiUt],luk]:sQp];kC]:El: pak],hUc];luk]:sQp];kC]:
eKL:piut],tI:pgc],
hU;kiUt],luk]:El: pak],hUc];luk]:pQn]sQp];yQn];kC]:nn].yw]." tac];pQn]tc];Sgc]An]n}. pQn]kgp]:sp];tit];
siUw].mqc]; lQk].lQk].miUn]nc], (protozoal, bacterial or fungal) siUw];n}.yw]." Pac]hac]:tac];pQn]
Sgc]An]n}. etc}a;mUin]kn]w}.n}eStL. hU;kiUt],luk]:sQp];kC]:n}.etAm],sQp];" kgp]:wL:tac];pQn]pak],hUc];
luk]:sQp];kC]:n}. h}a.hqc];El: lgc]:yUt];yLekL: etAm],miUn]kn]"
140
Pac]hac]:tac];pQn]
 mI;Kgc]lak],l}a;l}Agk],mL;  hU;kiUt],luk]:sQp];kC]: An]pQn]kgp]:siUw].mqc];n}.
 pak],hU;kiUt],luk]: KUm];/m}: ethQt];hC]:pak],hU;kiUt],luk]:kC]:El: etmI;Kap]:
 miUw]:hUm]:kL,mnn]. sQp]; PiUk],PiUk],Agk],mL;'ethn]h}g;y}a;lqc]lqc]pL;sgm];
 miUw]:yQw]:nn]. sQp];  Sc]wL:pak],hUc];luk]: lqc]kC]:yU,eS Sm].mI;ngc]
Agk],mL; sgm];n}siuc] Tuk],lIwUn].Sgn],lgc]:
pak],hUc];luk]:sQp];kC]:"
eKL:An]pQn]eP; tI:An]pQn]sgm];pak],hUc];luk]:sQp];kC]:
 mI;Kgc]Agk],mL;tI: hU;kiUt],luk]:
 ekL.hUm]:kL,msgm];nn].ekL: mI;Kgc]Agk],mL;sgm];hU;yQw]:
nC];Kaw];tac];Sam]liUn]pUn].mL; kUn];pQn] mI;kU:ngn];hUm]:kL,msgm];nm]liUw]niuc]:ekL."
Sc]kUn];pQn]mI;eKL:An]etpQn]eP;l}:nc],wL:mL;pL:niUw]suic] Tuk],lImk];mn]:yUt];yLnc],tac];pQn]pak],hUc];
luk]:sQp];kC]:"
lgc]:yUt];yLtac];pQn] hU;kiUt],luk]:sQp];kC]:
Pac]hac]:An]lm],lgc]:Et. mI;Kgc]Pit];pk],ktI, Agk],mL;sgm];hU;kiUt],luk]:nn].yw]." siUw].mqc];lQk].lQk].
An]pqk],piUc]:kn]nn].ekL: ethQt];hC]:Kgc]tI:Agk],mL;pqk],piUc]:kn]kCL,"
Sqn];Kgc]tI:Agk],mL; siUw].mqc];tI:pQn]kgp]: lgc]:yUt];yL

k. Kgc]SIKaw]El:pQn]pUk], k. km]:nm]pQn]kgp]: siUw].mqc]; k. Metronidazole(PO) 2 g
Trichomonas (protozoal infection) STAT
K.Kgc]SIKQw]Kun],Kun],El: K. km]:nm]pQn]kgp]:siUw]. mqc]; K. Metronidazole(PO) 2 g
mQn]miUn]A}apL Gardnerella (bacerial vaginosis = STAT
superficial bacterial infection)
c. Kgc]SIKaw]El:KUm]; c. pQn]kgp]:siUw].mqc]; Candida c. mUiw]:etngn];nn]. Aw]yL
(fungal infection) Nystatin 100000 units OD
SC],Kw]:w}.nC];hU;kiUt],luk]:liuk].liuk].
tL, 14 wn];"
 pQn]kgp]:tac];pQn]l}al}aSqn]; miUn]nc], (Trichomonas, Gardnerella and Candida )

ekL:pQn]l}:" epL;pQn]siUc].nn]siuc] hC]:yUt];yLpn]tc];Sgc]siUw];"
 lat]:enkUn];pQn]wL:w}a;kin]yLyw]. 7 wn]; Tuk],lImL;En tI:hUc];yLKiun];"
 Sc]wL:kin]yLyw]. 7 wn]; yc];p},Kqn];mL;n}siuc] Tuk],lIyUt];yLsgm];nc],tac];pQn]
pak],hUc];luk]:sQp];"
141
13
lgc]:yUt];yLtac];pQn]pak],hUc];kiUt],luk]:sQp];kC]:
Sc]eKL:pQn]eP; An]wL:mL;pL;niUw]mI;yU, Am],nn] Sc]pak],hUc];luk]:lqc]eSkC]:El: Sm].mI;nm].
miUn]ngc]Agk],mL;sgm];n}siuc] Tuk],lIyUt];yL sgm];nc],tac];pQn] pak],hUc];luk]:sQp];kC]:nn].yw]."
tac];pQn]ngc]nC]; (klac],) Gonorrhoea El: Chamydia n}. pQn]tac];pQn]lm],lgc]:
An]hQt];hC]: sQp];kC]:nn].yw]."
 tL,tac];pQn]pak],hUc];luk]:sQp];nn]. tk];etl}:yUt];yLtac];pQn] Gonorrhoea El:
Chamydia tc];Sgc]An]nC];Kaw];yam];lQw]kn]"
tL, Sm];pn] Ceftriaxone IM 250 mg km];lQw]
Gonorrhoea Am],nn] hG]:kin]yL Azithromycin 1 g km];Siuw]:
l}a;yUt];yLtac];pQn]pak],hUc]; hUm]:tc];
luk]:sQp];kC]:hUm]:kn] Doxycycline PO 100 mg BD/ 200 mg OD tL,
El: 7 wn]; Am],nn] hC]:kin]yL Azithromycin 1 g
km];Siuw]:
tL, Chamydia
 tL,Em:man]; Am],nn] kUn];pQn]tI:An]Am],Tuk],tc];yL Doxycycline nn]. hC]:pn]yL

Azithromycin Am],nn] Erythromycin PO 500 mg QID tL, 14 wn];"
lgc]:eh.kc]:tac];pQn] An]sp];tit];lUv]:hUm]:kL,m
Tuk],lIpn]tac];hU. kQw],lUv]:lgc]:sp];tit];tac];pQn] kgp]:hUm]:kL,mpn]kUn];pQn]' miUw]:hUm]:kL,mnn].
hG]:sC].tiuw]; TUc]yac]El: kU:hUm]:kL,mnn].Tuk],lImI;ekL.lQw]kUv];"
tac];pQn]lup],kum],kUn]:sQp];kC]: (PID)
eKL:piut],tI:pgc], pQn]sQp];kC]:tac];niUw]hUc];luk]: (endometritis, salpingitis, turbo – ovarian
abscess, pelvic peritonitis) n}. km]:nm]pQn]kgp]:tac];pQn] Gonorrhoea Chamydia El: Anaerobic
bactria siUw];n}.yw]." PID n}.etpQn]h}a.hqc];liUw] tac];pQn]hU;kiUt],luk]:El: pak],hUc];
luk]:sQp];kC]:nn].yw]."
Pac]hac]:tac];pQn]
 sQp];tI:tac];tC]:tgc].  miUw]:liUt]:nL:liUn]mL;nn]. etsQp];pqk],piUc]:
 mac]pgk]:mI;lUm];naw]  sQp];miUw]:hUm]:kL,m (dyspareunia )
 miUw]:kUt],sqt];tUv];nn]. hUc];luk]:/adnexa  mI;Kgc]Pit];pk],ktI,Agk],mL;tI:hU;kiUt],luk]:
etsQp];  sQp]; miUw]:yQw]: (dysuria )
(mac]pgk]:etkUt],tiUw].vL;kgn]:tI:An]sQp];)
142
 sgm];nc],p}a;yUt];yL – miUw]:kUt],sqt]:tUv];hU;kiUt],luk]:nn]. pak],hUc];luk]: Am],nn] adnex
etsQp]; Am],nn] etyip];vL;luk]: pelvic n}siuc] lgc]:etpQn]tac];pQn] PID n}.nm]yw]."
 kUn];pQn]tac];pQn]ngc]nC];nn]. Kgc]tI:Agk],mL;nC];hU;kiUt],luk]:/pak],hUc];luk]:nn]. epL;Aw]m},klUw],
SkUp].tUv];n}siuc] ethn] gram-negactive diplococci" pqk].Sm].wL: Aw]m},klUw]SkUp].tUv];
Am],hn]siUw].mqc]; Chlamydia n}eStL. miUw]:yUt];yLtac];pQn] ngc]nC];nn]. tk];etl}:yUt];
yLpn]sgm];"
lgc]:yUt];yL
tac];pQn]ngc]nC];(klac],)' Chlamydia El: pqk],TI:rI;yL; anaerobic n}. pQn]tUw]lm],lgc]: An]hQt];
hC]:pQn] PID El: miUw]:yUt];yL PID nn]. tk];etl}:yUt];yL tc];Sam]Sqn]; miUw]:lQw]kn]kCL,"
tL,tac];pQn]ngc]nC];(Gonorrhoea) Ceftriaxone IM 250 mg
El: STAT
tL,tac];pQn] Chlamydia hUm]:tc];
l}a;yUt];yLhUm]:kn]tc];tac];pQn] El: *Doxycycline PO 100 mg
PID (hgc]: OPD) tL,tac];pQn] pqk],TI:rI;yL; BID / 200mg OD tL, 14 wn];
anaerobic hUm]:tc];
Metronidazole PO 500 mg
TID tL, 14 wn];
*etAm],l}:pn]kUn];pQn]Em:man];" " tL,kUn];pQn]Em:man];nn]. Aw]yL Erthromycin (PO 500
mg QID tL, 14 wn];)tqn];yL Doxycycline"
eKL:mk];m}atL,kUn];pQn] Tuk],lIhp].w}.yLtI:hgc]: IPD

 kUn];pQn]pL;tgc].yU,  Am],yU,lIh}a.hqc];
 kiUt],luk]:mC],mC],/tUk];luk]:  kUn];pQn] Am],sac]:hQt];sgm];l}a;yUt];yL
 mI;ngc]tI: pelvic OPD hG]:tUw]:l}:
 w}a;eS sC].l}a;yUt];yLtI: OPD yw]. 3
wn];eStL. kUn];pQn]Am],lIKiun]:mL;"
yUt];yLpn]tI:hgc]: IPD
 Ceftriaxone IM 250 mg OD* El:
 Doxycycline PO 100 mg BID / 200 mg OD Am],nn] Tetracycline PO 500mg QID El:
 Metronidazole PO/IV 500 mg TID
pn]siUc].nc],n}etL,kUn];pQn]lIKiun]:mL;" w}a;lIKiun]:mL;ekL:Suip],pn]
 Doxycycline PO 100 mg BID / 200 mg OD El:
 Metronidazole PO/IV 500 mg TID tc];mUt];tL, 14 wn];"
143
13
yLtL,pn]Em:luk]:Agn],kiUt],mC],An]sp];tit];siUw].mqc]; - Tuk],lIwUn].lgc]:hUk].luk]:
etkiut];w}.nC];hUc];luk]:El: Tuk],lIwUn].Sgn], tL,Aw]Agk],nn].SUc],kCL,sU;hUc];yLlUc]"
lqk]:l}a:yLptI<KYI<wnpn] (Ampicillin, Gentamicin, Metronidazole)
m}atgc];" " Sc]kUn];pQn] mI;Pac]hac]:tgc].sQp]; (kn] 7.5) Am],nn] yUt];yLyw]. 3 wn];

Am],lIKiun]:mL;n}siuc] hC]:SUc],kCL,yLtUw]tI:hUc];yLlUc]" mUiw]:etSUc],tUw]kCL,nn]. hC]:SGac];pn] IV El:
SC],pn]yLptI,KYI<wnC];nm].yLpL;sgm];"
lgc]:eh.kc];
Tuk],lIpn]tac];hU. kQw],lUv]:lgc]:sp];tit];tac];pQn] kgp]:hUm]:kL,mpn]kUn];pQn]' miUw]:hUm]:kL,mnn].
hG]:tiuw]; Tuc]yac]El: kU:hUm]:kL,mn}.Tuk],lImI;ekL.lQw]kUv];"
Aac]:Aic] Sepsis (kn] 7.6)' tgc].kiuc].kac].sQp];h}a.hqc]; (kn] 7.5)"

*nC];piun].tI:hw];yU,n}. (eA;SYL;sQc],san];wn];Agk],) yam];mI;l}a;can];mL;w}.wL: siUw].mqc];ngc]nC];
(Gonorrhoea) ettiuw]etL,yL Ceftriaxone El: yL Azithromycinn}yw]." Sc]wL:pn]yLyw].
Am],mI;lgc]:tiUw].yLn}siuc] kgp]:wL:etl}:lQc]. yw].hLsiUw].mqc];El: hC]:kCL,sU;emLyLlUc]"
pQn]sQp];yQn];El:mI;hut]; tI:KiUc]:Ac],kL,nac];yic];
eKL:piut],tI:pgc],
Genital ulcers mI;lgc]:pQn]sQp];sgm];Piw]nc] Am],nn] mucosa tI:Ac],kL,nac];yic];nn].yw]."
Genital wart Et.pQn]hut];sgm];Ac],kL,nac];yic];eSetmI:lk]:KnL,Pqp].Pqp]. Am],nn] pgc];Kiun]:mL;yaw];
yaw];nn].yw]." tc];Sgc]siUw];n}. pQn]kgp]:siUw].mqc];tac];pQn]An]sp];tit];l}:kgp]:lgc]:hUm]:kL,mnn].yw]."
Pac]hac]:tac];pQn]
 Anal / genital pQn]sQp];him];hU;kUn]:El: Ac],kL,nac];yic];
 Herpes primary infection miUw]:Et,pQn]sQp];mC],mC],nn]. etmI;lUm];naw]" tI:him];hgm];Ac],kL,nn].
etmI;tum],tqk],pQn]nm].El:sQp];Sqp],"
 Inguinal mak],ln]tI:cam]:KLsQp];kC]:"
144
lgc]:KUn].hLmk];mn]:tac];pQn]El:lgc]:yUt];yL
lgc]:KUn].hLmk];mn]:tac];pQn]El: lgc]:yUt];yLn}.etAic]nUiw]lgc]:h}a.hqc];tac];pQn] (sQp];' h}g;sQp];' hut];)
Sqn];tac];pQn] yUt];yLtL, tac];liUk]:TI.niuc]: tac];liUk]:TI.Sgc]

tac];pQn]
Syphilis Benzathine Penicillin IM Procain Penicillin IM 1.2
2.4 MIU STATⁱ MIU OD tL, 10 wn];
hUm]:tc]; Am],nn]
Ciprofloxacin PO 500 mg * Doxycycline PO 100 mg
El: QID tL, 3 wn]; (Am],nn] BID / 200 mg OD tL, 14
Genital ulcers Erythromycin PO 500 mg wn];
tum],sQp];yQn]; QID tL, 7 wn]; Am],nn] _________________
Chancroid Azithromycin PO 1 g STAT) Ceftriaxone IM 250 mg
STAT
Genital ulcers** Aw]Sp].pYL,El:nm].Suk]:pn]
tum],sQp];yQn]; tL;yL Gentian Violet tL,
(tum],sQp];pgc];lQk].lQk]. 5 wn];"
miUn]tbm],f};m}:)
Herpes Paracetamol 1 g QID tL,
5 wn];
Aciclovir 200 mg
1wn];hL:pgk]: tL, 7 wn];
Genital papule Molluscum Aw]Sp].pYL,El:nm].Suk]:pn]
(yU,hac],kn]eSEl:kac] Contagiosum mgk]: 8 wUc]:eth}akCL,hc];kUv];"
tum],sQp];etlgk];w}.)
pQn]hut];sgm];KUic]:Ac],kL, Aw]Sp].pYL,El:nm].Suk]:pn]
(etsU.tbm]kn]w}.el:miUn] Condyloma yL Paracetamol PO 1 g
nc],Pac]hac]:Pk];kat], Acuminata QID tL, 5 wn];"
luc];) Aap]:etl}:PL,Agk],pqt]:"
*etAm],l}:pn]kUn];pQn]Em:man];" "sC].yL Erthromycin tqn];yL Doxycycline "

kgp]:yLmn];nm]El: Benzathine Penicillin n}.Tuk],lIEPhQt];Sgc]pgk]:eS Sm];pn]Sgc]tI:"
** miUw]:kiUt],luk]:nn]. nc],hiuw]epL;eh.kc]:tac];pQn] An]hQt];hC]:luk]:Agn],tLmgt],nn]. Tuk],lIpn]yL

acyclovir " miUw]:etkiUt],luk]:nn]. Sc]hn]wL:tac];pQn]n}. pQn]yU,n}siuc] Tuk],lIPL,kiUt],luk]:Agn],pn]"
SUc],kUn];pQn]kCL,sU;emLyL"
145
13
lgc]:eh.kc]:
Tuk],lIpn]tac];hU. kQw],lUv]:lgc]:sp];tit];tac];pQn]kgp]:hUm]:kL,mpn]kUn];pQn]' miUw]:hUm]:kL,mnn]. hC]:sC].
tiuw];Tuc]yac]El: kU:hUm]:kL,mn}.Tuk],lImI;ekL.lQw]kUv];" yUt];yLpn]kUn];pQn]El: kU:hUm]:ngn];"
Aac]:Aic] tac];pQn]Piw]nc] (kn] 22)"
sp];tit];siUw].mqc]; kgp]:lgc]:hUm]:kL,mAn]kUn];s}a;pQn] (STIs in men)

eKL:piut],tI:pgc],
tac];pQn]tI:An]sp];tit];pQn]mL; kgp]:lUv]:lgc]:hUm]:kL,m"
Pac]hac]:tac];pQn]
 tI:KUic]:Ac],kL,El: him];hU;kUn]:nn]. etmI;sQp];Am],nn] h}g;sQp];"
 Herpes primary infection miUw]:Et,pQn]sQp]; tum],mC],mC],nn].etmI;lUm];naw]"
tI:him];hgm];Ac],kL,nn]. etmI;tum],tqk],pQn]nm].El:sQp];Sqp],"
 Inguinal mak],ln]tI:cam]:KLsQp];kC]:"
 mI;hut];niuc]:tum], Am],nn] nm]liUw]nn]. tI:Ac],kL,/him];hU;kUn]:"
 tac];pQn]ngc]nC];nn].etmI; Urethral discharge Agk],mL;El:etsQp];miUw]:yQw]:"
kUn];pQn]tac];pQn]ngc]nC];nn]. Kgc]tI:Agk],mL;sgm];hU;yQw]:nn]. epL;Aw]m},klUw]SkUp]. tUv];n}siuc]
ethn] gram-negactive diplococci" pqk].Sm].wL: Aw]m},klUw]SkUp].tUv]; Am],hn]siUw].mqc];
Chlamydia n}eStL. miUw]:yUt];yLtac];pQn]ngc]nC];nn]. tk];etl}:yUt];yLpn]sgm];"
Sqn];tac];pQn] yUt];yLtL, tac];liUk]:TI.niuc]: tac];liUk]:TI.Sgc]

tac];pQn]
Syphilis Benzathine Penicillin IM 2.4 Procain Penicillin IM 1.2
1
MIU STAT MIU OD tL, 10 wn];
hUm]:tc]; Am],nn]
Genital ulcers
(open sores)
El: Ciprofloxacin PO 500 mg BD (Doxycycline PO 100 mg
tum],sQp];yQn];pQn]tI: tL, 3 wn]; (Am],nn] BID / 200 mg OD tL, 14
Erythromycin PO 500 mg QID wn];)
KUic]:Ac],kL,kUn];s}a; tL, 7 wn]; Am],nn] _______________
Chancroid Azithromycin PO 1 g STAT) Ceftriaxone IM 250 mg
STAT
146
Ceftriaxone IM 250 mg STAT

Penile or urethral (Am],nn] Azithromycin PO
discharge Gonorrhoea 1 g STAT )
pQn]ngc]niUw]KUic]:Ac],kL,
kUn];s}a; Am],nn] El: hUm]:tc];
nC];hU;yqw]: __________________
Doxycycline PO 100 mg BID / Erythromycin PO 500 mg
200 mg OD tL, 7 wn]; QID tL, 7 wn];
urethral Chlamydia
KUm];sgm];nC];hU;yQw]: (Am],nn] Azithromycin PO (Am],nn] Tetracycline
1 g STAT ) PO 500 mg QID tL, 7
miUw]:yQw]:nn].etm}:
wn];)
Inguinal Doxycycline PO 100 mg BID /
(mak],ln]cam]:KLkC]:) 200 mg OD tL, 7 wn];
Chlamydia
(Lymphogranuloma (Am],nn] Azithromycin PO
Venereum)Painful bubo 1 g STAT )
Genital ulcers** Aw]Sp].pYL,El:nm].Suk]:pn]"
tum],sQp];yQn]; tL;yL Gentian Violet tL, 5
(tum],sQp];pgc]; lQk].lQk]. wn];"
miUn]tbm],f};m}:) Paracetamol 1 g QID tL, 5
Herpes wn];
Aciclovir 200 mg nuic]:wn]; 5
pgk]: tL, 7 wn];
Genital papule Aw]Sp].pYL,El:nm].Suk]:pn]"
(yU,hac],kn]eSEl:kac] Molluscum mgk]: 8 wUc]:eth}akCL,hc];kUv];"
tum],sQp];etlgk];w}.) Contagiosum
pQn]hut];sgm];KUic]:Ac],kL, Aw]Sp].pYL,El:nm].Suk]:pn]"
(etsU.tbm]kn]w}.el:miUn] Condyloma yL Paracetamol PO 1 g QID
nc],Pac]hac]:Pk];kat], Acuminata tL, 5 wn];"
luc];) Aap]:etl}:PL,Agk],pqt]:"
lgc]:eh.kc];
Tuk],lIpn]tac];hU. kQw],lUv]:lgc]:sp];tit];tac];pQn]lUv]:hUm]:kL,mpn]kUn];pQn]' miUw]:hUm]:kL,mnn].
hC]:sC].tiuw]; Tuc]yac]El: kU:hUm]:kL,mn}.Tuk],lImI;ekL.lQw]kUv];" yUt];yLpn]kUn];pQn]El: kU:hUm]:ngn];"
Aac]:Aic] tac];pQn]Piw]nc] (kn] 22)"
147
tac];pQn]kQw],lUv]:liUt]:
14
14.1 tac];pQn]liUt]:sac]
eKL:piut],tI:pgc],
tac];pQn]liUt]:sac]n}.liUt]:An]l}pn],yU,nC];tUw]kUn];nn].Tat]:An]ygm].hG]:liUt]:lqc] An]hgc].
wL: Haematocrit (Hct) Am],nn] Haemoglobin (Hb) siUw];n}. eA,liUw]pk],ktI,nn].yw]."
lgc]:siUw];n}.n}. yU,tI: AL,yu' s}a;/yic]; (lic],)El: Kaw];yam]; pL;tgc].eS pqk],piUc]kn]kCL,"
eKL:An]et pQn]eP;l}:Et. mqt].liUt]:lqc] Am],sac]:Aw]Tat]:
Agk],SI,kYin],kCL,sU;tit].SYO;nC];tUw]kUn];nn].yw]." tac];pQn]liUt]:sac]n}. etpQn]l}:lUv]: k)
lU.Sum];mQt].liUt]:lqc] (tUw]yac], - haemolysis El: haemorrhage )' Am],nn] K)lgc]:hQt];
Agk],mQt].liUt]:lqc]eA,lUc]; (tUw]yac], Kat],Tat]:AL,hL,rEl: K}Sn]lc]Tuk],mip],)siUw];n}.yw]."
tI:pgc],tac];pQn]liUt]:sac]
Hb (g/dl) Hct %
luk]:Agn],kiUt],mC], < 14 < 42
luk]:Agn], 1 – 14 pI< < 12 < 36
kUn];lUc] (s}a;) < 13 < 39
kUn];lUc] (yic];) (Am],pL;tgc].) < 12 < 36
kUn];lUc] (yic];) (pL;tgc].yU,)* < 10 <
*m}atgc];" " Tat]: Hb tUk]; miUw]:pL;tgc].n}.pQn]SPL,wyU,yw]."

tac];pQn]liUt]:sac]n}. pQn]pn],hLp}a;yU,lIyC],lUc]An]niuc]: nG];pgt];piun].tI:m}:
sgm];nc], An]pQn]PU:hap],kan]p}a;yU,lIekL.niuc]:eS etsac]:s}g:eh.kc]:l}:
1. pn]tac];hU.kQw],lUv]:lgc]:kin]yqm].
2. sqk],pn]yLTat]:lQk];El: Tat]:ePL;lQt]. (Am],sC]:tL,yUt];yL Thalassemia )
3. KYL;mqc];tgc].pn]tL,eS,
lgc]:tac];An]l}:pQn]km]:nm]
m}atgc];" " lgc]:tac];An]l}:pQn]liUt]:sac]km]:nm]nn]. etnQn]. pQn]SInLw}."
kiuc].kac].pQn]h}a.hqc];
 naw]nUk]. (mQt].liUt]:lqc]kiuc].kac].Tuk],yL.lU.lqw]) (kn] 15.2)
 liUt]:kiuc].kac].Agk],nm] (kgp]:l}:tiUw].vL;mat],sQp];El: SQn]:liUt]:kCL,nC];hUc];Kw]:' SQn]:tac];
148
tac];pQn]kQw],lUv]:lUit]: 14
Ac],kL,EP:siUw].Pn]; lU.lqw]' liUt]:Agk],kgp]:lUbv]:pL;tgc]. miUn]nc], - kiUt],luk]:yw].
liUt]:Tgk],nm])
 Tat]: G6PD eA, (tUv];pL:tC:] n}.Tqc]:)
lgc]:pQn]Kaw];yaw];
 Kat],Tat]:AL,hL,r (kn] 17.1)  tac];pQn] Thalassaemia (tUv];pL:tC]:)
 (nC];tac];kin]nn]. Kat],Tat]: ferrous, folate  liUt]:Agk],Kaw];hiuc]
Am],nn] vitamin B12 )  Kqn],SiUw]<
 sp];tit];mqc];tiUk],pak],hUw]mQt];El: mqc];tiUk],tUw]  tit];siUw].mqc];tac];pQn]Kaw];hiuc] (HIV, TB)
mUn]; (kn] 12.4 ) (kn] 15.3, 21.5)
 km];km];sp];Sn],eT,pL;tgc]. (Em:man];liUt]:  tac];pQn]tp];El: mak],kqw];
sac])  tac];pQn]mam].kC]:yWn].lWc]:m}:
 hG]:kin]nUm];Em:hiuc]eS Am],pn]kin]tac];kin]  tac];pQn]lUit]:sac] aplastic
tac],siUw];tqn];nUm];Em: (luk]:Agn],pQn] liUt]:
sac])
 pQn]sQp];tI:hUc];Kw]:
km];nm]Et.tac];pQn]liUt]:n}. etpQn]kgp]:lgc]:tac];An]wL:mL;pL:niUw]n}. nm]liUw]niuc]:An]" Sc]wL:pn]yL

Tat]: Ferrous Sulphate (FS), Folic Acid (FA) El: KYL;mqc];tgc].pn]n}siuc] etsac]:hQt];hG]:kUn];pQn]
lIKiun]:mL;l}:yU,yw]."
Pac]hac]:tac];pQn]
tac];pQn]liUt]:sac]n}. sac]:pQn]l}:kU:ekL.n}eStL. An]tI:pQn]c}a:eSpiUn]:Et. nac];yic];An]pL;tgc].
El: luk]:Agn],lQk].nn].yw]." Pac]hac]:tac];pQn]n}. etAic]niUw]lgc]:h}a.hqc];tac];pQn]wL: pQn]Kaw];hiuc]
Am],nn] kiuc].kac].pQn]h}a.hqc];hiuw]nn].yw]." An]Am],pQn]h}a.hqc];nn]. etAm],EnPac]hac]:Sc]" kUv];kL:
Sc]wL:Am],mI; lgc]:yUt];yLSc]n}siuc] tac];pQn]An]Am],h}a.hqc];n}. eth}a.hqc];mL;l}g;l}g;eS hQt];hG]:pQn]
tac];pQn]Kaw];hiuc]kCL, (miUn]nc], miUw]:pL;tgc].nn]. ethQt];hG]:tum].tiUw]. tac];yC],luk]:Agn],nC];tgc].'
luk]:Agn],kiUt],mL;ekL:nan];yC], El: sp];tit];tac];pQn]l}:c}a:siUw];n}.yw]."
tac];pQn]liUt]:sac]Kaw];hiuc]
 hiUw].c}a:  miUw]:hQt];kan]El:p}kCL,p}mL;nn]. TUv]:sC]yap],'
 tum].tiUw].lgc]:hQt];kan]can]; (kgp]:n} hiUw].c}a: sC]Sn],(Am],sC]:miUw]:liuw]:yU,)
l}a;l}:eA,' Am],tUv];Tiuc]luk]:l}:lI)  PiUk],AQn];tQn]; (Kgp],tL' PL,miuw];' nQp].miuw];)
 tL,luk]:Agn],Sm]. nan];yC],' lgc]:Kiun]:  miUw]:Am],hQt];Sc]nn]. hqc];tWt],hUw]sC]El: hqc];
yC],TiUc];' Am],hQn];Kuit];pUin]:tI:hUc];hQn]; tWt],liUt]:pQn]pk],ktI,
149
14 tac];pQn]kQw],lUv]:lUit]:
tac];pQn]liUt]:sac]Kaw];hiuc]h}a.hqc];
mac]pgk]: hqc];tWt],liUt]:El: hqc];tWt],hUw]sC]kUn];pQn] tI:An]pQn]liUt]:sac]h}a.hqc]; ( Hb < 6 ) n}. et
pQn]pk],ktI,kUv];" An]pQn]siUc].n}n}. kgp]:wL:tac];pQn]liUt]:n}. pQn]h}a.hqc];mL;l}g;l}g; (mI;mqc];tiUk],hUw]mQt];
Kaw];hiuc]'km];km];pQn]naw]nUk].) Am],nn]mI;Tat]: haemoglobin eA,mL;sQm]mUiw]:kiUt], (Thalassaemia)"
 hiUw].AUn]:El: Am],mI;hqc];h}a.hqc];  PiUk],liUc]h}a.hqc];

 tUc].niuc]Ait];Ait];Agt];Agt];kUv];ekL:  mI;SQc]Agk],mL;tI:hUw]sC]
hiUw].AUn]:' sC]Sn],  miUw]:Am],hQt];Sc]nn].hqc];tWt],hUw]sC]El:
hqc];tWt],liUt]:pQn]pk],ktI,
tac];pQn]liUt]:sac] An]kiuc].kac].EnPac]hac]: ACUTE SYSPTOMATIC ANAEMIA - HB Tat]:

haemoglobin kiuc].kac].tUk]; ( tUw]yac] – liUt]:Agk],nm]' pQn]naw]nUk].h}a.hqc];)
 AUn]:Agn],' hiUw].AUn]:  miUw]:Am],hQt];Sc]nn]. hqc];tgt],hUw]sC]w};yU,
 miUw]:Am],tUc].niuc]Sc]ekL: hiUw].yU, (kUn];lUc] >120 )
 miUw]:Am],tUc].niuc]Sc]ekL: sC]Sn],  miUw]:Am],hQt];Sc]nn]. hqc];TUv]:sC]w};
 PiUk],liUc] (Kgp],tL' PL,miuw];' nQp].miuw];) (kUn];lUc] >40/m )
 hqc];liUt]:tUk]; (pL:niUw] <100mmHG )
(tUw]yac], - miUw]:kiUt],luk]:yw].nn].
lUit]:Tgk],)
 km];km];mI;SQc]Agk],mL;tI:hUw]sC]
kgp]:liUt]:sac]eSEl: hUw]sC]w}a; ANAEMIA HEART FAILURE

 miUw]:nc]:liuw]:hiuw].yU,ekL:TUv]:sC]yap],  pgt],kiuc].kac].kC]:h}a.hqc];
 hqc];eA,h}a.hqc];  tp];kC]: (Hepatomegaly)
 mac]:ekL. nL:AUk]; etsQp];  Jugular SQn]:liUt]:Kw]:tI:eKL;kC]:
 PiUk],liUc]h}a.hqc];  Peripheral oedema El: pac]:kI: (tgc].yG],)
lgc]:KUn].hLmk];mn]:tac];pQn] sgm];nc],p}a;yUt];yLEl:tI:hgc]:lqp],-Hb Am],nn] Hct, CBC
lgc]:yUt];yL
lgc]:yUt];yLtac];pQn]liUt]:sac]
 hqc];yL ferrous sulphate El: folic acid tL,sC].yUt];yLkm]:nm]Et. pn]yLkin] tL,mgk]:
Sgc]wUc]: kUv];ekL: tac];pQn]etlIKiun]:mL; (kU: 7-10 wn];nn].Tat]: Hb Tuk],lIKiun]:mL;
150
1 g/dl)" w}a;eS Tat]:lQk];Kiun];lIKiun]:mL;nc],kw],nn]. nc],hiuw]epL;etTic];Sim]; Tat]:lQk];
nC];tUw]l}:nn]. Tuk],lI pn]yLTat]:lQk];kCL,Tqc]:tL, 3-6 liUn]" nc],hiuw]tUw]kUn];pQn] epL;
etmI;hqc];lut],Tat]:lQk];l}:lI nn]. Tuk],lIpn]yL vitamin c kCL,sgm];"
 Sc]wL: Hb <6/ Hct <18 yU,n}siuc] Tuk],lItiUc],pac],tc];emLyL tL,etSGac];liUt]:eS
yUt];yLpn]"
 tL,tac];pQn]kiuc].kac].EnPac]hac]:liUt]:sac]w};nn].Et. Tuk],lIhQt];hC]:liUt]:kiut];yut];yw].SCac];
pn] liUt]:Kiun];w};w};"
 tL,yUt];yLtac];pQn]hUw]sC]w}a; An]pQn]kgp]:tac];pQn]liUt]:sac]hG]:h}an}. Am],SU:mI;El: nc],hiuw]
epL;etAm],Tiuc]Kk].tgn]:nn].n}.Tuk],lIyUt];yLeh.kc]:pn]"yUt];yLpn]lgc]:pgt],kC]:(kn] 8.2)"
 kUn];pQn]liUt]:sac]kU:ekL. Tuk],lIKYL;mqc];tgc].pn] (kn] 12.4)"
hqc];yLtL,yUt];yL (Treatment dose)

Ferrous kUn];lUc] 200 mg TID Folic acid kUn];lUc] 5 mg OD
sulphate luk]:Agn], < 5 Kg 50 mg BD luk]:Agn], 2.5 mg
OD
> 5 Kg 100 mg -200mg
BD
w}a;eSkin]yLyw]. 6 liUn]nn]. hG]:lqk]:l}a: Treatment dose pQn] Prophylactic dose

eSyUt];yLpn] kCL,Tqc]:tL, 3 liUn] (Sc] Hb / Hct pQn]miUn]kw],Kiun];yw].)"
hqc];yLeh.kc]: (Prophylactic dose)

Ferrous kUn];lUc] 200 mg OD Folic acid kUn];lUc] 5 mg/wUc]:
sulphate luk]:Agn], < 5 Kg 50 mg OD luk]:Agn], 2.5 mg/wUc]:
> 5 Kg 100 mg -200mg
OD
yLkin] Ferrous sulphate (200 mg) niuc]:mQt].n}. etmI;Tat]:lQk]; 65 mg "
hqc];yLtL,yUt];yL - tL,luk]:Agn], Tat]:lQk]; 3 - 6 mg/kg (Tat]:lQk];nm]Sut]; 200 mg =

Ferrous sulphate niuc]:wn]; 3 mQt].)"
hqc];yLtL,eh.kc]: - Tat]:lQk];tL,luk]:Agn], nuic]:wn]; 1 - 2 mg/kg (nm]Sut]; 15 m)"
151
yUt];yLlgc]:tac];tI:An]hQt];hC]:pQn]
1. naw]nUk].
 pn]yLsgm];nc],l}a;yUt];yLnaw]nUk]. (kn] 15.2)

 miUw]:Am],mI;lUm];naw]yw]. Am],nn] kUt],sqt]:Am],hn]siUw].mqc];naw]nUk].yw]. sc],pn]yL
Ferrous sulphate El: Folic acid"
 Sc]hn]wL: kUn];pQn]kiuc].kac].liUt]:sac] Am],nn] kgp]:liUt]:sac]eSEl: mI;Pac]hac]:hUw]sC]
etw}a; Am],nn] pQn]naw]nUk]. PF n}siuc] Tuk],lISUc],tUw]kCL,yUt];yLtI:hUc];yL"
km]:nm] luk]:Agn],An]pQn]naw]nUk].n}. sac]:kiuc].kac].liUt]:sac]w};"

lgc]:n}.yw].pQn]lgc]:hQt];hC]: luk]:Agn],t}akgp]: tac];pQn]naw]nUk].TI.niuc]:"
 Sc]wL:siUw].mqc];naw]nUk]. nC];liUt]:kUn];pQn]nm]nL,' pQn]naw]nUk].h}.hqc];yU,' Tat]: Hb nC];
liUt]: tqm],liUw] 7 Tat]: Hct tqm],liUw] 20 n}siuc] etl}:SCac];liUt]:eS yUt];yLpn]"
(siUw].mqc];naw] nUk].ekL:etyL.mQt].liUt]:lqc]yU,tik];tik];)"
2. liUt]:l}Agk],h}a.hqc]; hUm]:tc];mI;Pac]hac]:Sgzk].
 hQt];hC]:liUt]:An]Agk],yU,nn].kiut];yut];"(mip],SQn]:Agk],kCL,w}.' Sc]tUk];luk]:n} hC]:SUc],kCL,
yUt];yL tI:hgc]:Em:El:luk]:Agn],)
 Aw]KQm]yC], cannulas 2 mak]:Sm];SC],pn]tI:SQn]:liUt]:Kw]:" SCac]; Ringer Am],nn] NSS
Sm];pn]w};w}; etL,Tiuc] hqc];liUt]:epL;Kiun]:pUn]. 90mm Hg"
 Sc]pQn]l}: hC]:SUc],tUw] kCL,yLtUw]tI:hUc];yLlUc]" (Sc]liUt]:Agk],sgm];nC];lgt],tac];kin])
 Sc]pQn]l}:kUt],sqt]:kum],liUt]:pn]w};w};eSSCac];liUt]:pn]" kgp]:l}:pC].liUt]:tL,et SaCc];pn]
eS yL,SUc],tUw]kUn];pQn]tUk];liun];"
 w}a;l}:SCac];liUt]:yw]. sc],pn]yL Ferrous sulphate El: Folic acid"
3. mqc];tiUk],hUw]mQt];' El:TUp];vL;mqc];tiUk],tUw]mUn];nC];P}a:lUc] (Am],nn]) tI:Am],hU.lgc]:tac];

 KYL;mqc];tgc].pn] (kn] 12.4 )
 pn]yL Ferrous sulphate El: Folic acid sgm];nc],hqc];yLtL,yUt];yL"
4. mqc];tiUk],hUw]mQt];' El:TUp];vL;mqc];tiUk],tUw]mUn];nC];P}a:lUc] (Am],nn]) tI:Am],hU.lgc]:tac];

 KYL;mqc];tgc].pn] (kn] 12.4 )
 pn]yL Ferrous sulphate El: Folic acid sgm];nc],hqc];yLtL,yUt];yL"
152
5. Kat],Tat]:AL,hL,r' pL;tgc].El: lQc].nUm];luk]:yU,
 pn]tac];hU.kQw],lUv]:lgc]:kin]yqm].tI:An]mI;AL,hL,r
 miUw]:pL;tgc].yU,nn].pn]yL Ferrous sulphate El: Folic acid sgm];nc],hqc];yLtL,eh.kc]:"
Sc]pQn] Hct<30% siuc]hG]:kUt],hLtUv];Pac]hac]:tac];pQn] Thalassaemia Am],nn] mqc];tiUk],
n}siuc] hG]:pn]yL Ferrous sulphate El: Folic acid sgm];nc],hqc];yL tL,yUt];yL"
6. lgc]:tac];tac],siUw]; ( tUw]yac],- pqk].Sm].wL:yUt];yLpn]yw].eStL. liUt]:yc];sac]yU,)

 kUn];pQn]mac]ekL.n}. tL,etkin]yL Ferrous sulphate nn].yap],yQn];nL," kUn];pQn]siUw];n}.
ekL: etSiup],pQn]liUt]:sac]yU, kgp]:wL:Am],Kam],Pgn];sL.yL Ferrous sulphate miUn]nc],
hak]:' tgc].Kiun]: Am],nn] tgc].kCL,siUw];n}." tL,ethLl}a;yUt];yLtac],siUw]; tL,kUn];pQn]
siUc].n}n}. tiUc],pac], Aup],AUw];tc];emLyL"
 Kat],Tat]:wI,tL,min], 12 ekL:pQn]liUt]:sac]l}:nc],kw]," kUt],Tt];tUv]; sgc],kUn];pQn]
kin]lw]:" tL,kUn];lUc].lqn],P}a,hgc]:lqp],Kw]nn]. Aw]liUt]: mUin]nc], tL,kUt],sqt]:siUw].
mqc];naw]nUk]. (multisegmented neutrophils (>5 lobes) nC]; thin smear) n}ekL:
sac]:kUt],sqt]:mQt].liUt]: lqc]yC],l}:" tL,kUn];pQn]Kat],Tat]:wI,tL,min], 12 siUc].n}n}.
Sm]; Vitamin B 12 (1 mg) nuic]:wUc]: 3 pgk]: tL, 2 wUc]:n}ekL:ethn]Pac]hac]:lIKiun]:mL;nm]"
 Haemolytic anaemia (kgp]:mQt].liUt]:lqc] l}:lU.lqw]eSEl: l}:pQn]liUt]:sac]) n}.
Haemolysis (kgp]:mQt].liUt]:lqc]Tuk],yL.kw];lU.lqw] Am],nn] l}:lU.lqw]) eSEl: sc],
pQn]nn].yw]." tac];pQn]An]hQt];hC];pQn]siUc].n} nC];piun].tI:pgt];siUw];n}.Et. kgp]:tac]; pQn]
Thalassaemia El: Kat],Tat]: G6PD (lUtUv];Tqc]:nL:lik]:tac];nL:) siUw];n}.yw]."
tac];pQn]An]hQt];hC]:Em:luk]:Agn],l}:t}a Kuic]:niuc]:nC];piun].tI:pgt];m}:n}. kgp]:liUt]:sac]n}.yw]."
kUn];km]:nm] An]yU,him];hgm];lqn]lin] sgm];wan]:ngk]:km]:nm] etpQn]tac];pQn] liUt]:sac]
kn] kgp]:wL:Kat],Tat]:AL,hL,r' km];km];pQn]naw]nUk].' kUit],luk]:nm]' l}:lQc].nUm];luk]:El:
mI;mqc];tiUk],siUw];n}.yw]." kgp]:lgc]:tac]; An]hQt];hC]:pQn] liUt]:sac]n}.yUt];yLc}a:El: Am],epL;
l}:SQc]:ciun];nm]"
lgc]:eh.kc]:
pn]yLTat]:lQk];El: folic acid sgm];nc],hqc];yLeh.kc]: pn]Em:pL;tgc].kU:ekL.El: pn]tac];hU. kQw],
lUv]:lgc]:kin]yqm].hG]:Kw]" eh.kc]:tac];pQn]An] sp];tit];l}: (tac];pQn]naw]nUk].) El: yUt];yLpn]
sQm]sw]." KYL;mqc];tgc].pn]Em:pL;tgc]. (1st trimester yw].) El: luk]:Agn],lQk]. pan]Kiun]:hUc];hQn];
l}:yw].kU:ekL."
Aac]:Aic] tac];pQn]naw]nUk]. (kn] 15.2)' mqc];tiUk], (kn]12.4)' Kat],Tat]:AL,hL,r (kn]17.1)
153
14.2 Thalassaemia
eKL:piut],tI:pgc],
tac];pQn] Thalassaemia n}. pQn]mL;kgp]:l}:sp];tI:epL;Em:mL; (tac];pQn]kQw],lUv]:S}aSiup],siUw].KiUw];)eS
hQt];hC]:Am],hQt];Agk],Tat]: Haemoglobin (puc],man],)pk],ktI,nn].yw]." Tat]: Haemoglobin n}.
etyU,nG];mQt].liUt];lqc] An]Aw] two alpha (α) two beta chains (β) eShQt];Sac]:w}." tac];pQn]
Thalassaemia Sm].mI; Haemoglobin chains eA, Am],nn] Am],mI;lL;lL;nn].yw]." tac];pQn] α
Thalassaemia nn].etpQn]ygn].lUv]:lgc]:tum].tiUw]. α chains El: tac];pQn] β Thalassaemia Sm].
etpQn]ygn].lgc]:tum]. tiUw]. β chains"
tac];pQn]An]n}.n}. Et,Aw] Am],mI; chains lL;lL;El: Aic]niUw]lgc]:lqk]:l}a: kQw],lUv]:tac];nm]
eA, chains eSetpqk],piUc]:kn]kCL," kgp]:n}tac];pQn]n}. etAm],mI;Pac]hac]:Sc]lL;lL;El: Am],hU.l}:
wL:mI;tac];pQn]etL,Tiuc]mI;Pac]hac]:h}a.hqc];nn].yw]." sgm];him];hgm];lqn]lin]miUc];T};-miUc]:man]:Et. An]pQn]
tac];pQn] α / or β Thalassaemia n}.mI;hUw]pak],kUn];mgk]: 10% kUv];"
(1) β Thalassaemia minor - mI;lgc]:tum].tiUw].Tat]: Hb Ait];Agt];kUv];"
Pac]hac]:tac];pQn] tac];pQn]Am],h}a.hqc];'
kUn];pQn]yiUn].kn]:l}:etL,liUt]:sac]'
miUw]:pL;tgc].nn].km];km];fac].tUv];vL;"
lgc]:KUn].hLmk];mn]:tac];pQn] CBC, Thalassaemia test
lgc]:yUt];yL pn]yL Folic acid El:pI,tL,min] pI,tc]; SI,'

miUw]:pn]Tat]:lQk];nn]. yL,hC]:pn]mqn]:nm]"
(2) β Thalassaemia Intermedia - mI;lgc]:tum].tiUw].Tat]: Hb km]:Pgc]:"
Pac]hac]:tac];pQn] kUn];pQn]yiUn].kn]:l}:etL,liUt]:sac]yU,eStL. h}a.hqc];mL;

sgm];AL,yu' mam].yC],"
lgc]:KUn].hLmk];mn]:tac];pQn] CBC, Thalassaemia test
lgc]:yUt];yL kUt],sqt]:Tat]: Hb pn]tL,eS,"pn]yL Folic acid El:

pI,tL,min],pI,hUm]:pL; Am],nn]pI,tL,min],pI, 12' miUw]:pn]
Tat]:lQk];nn]. yL,hC]:pn] mqn]:nm]" mac]:pgk]:l}a;yUt];
yLPL,tt];Aw]mam].Agk],n}.ekL: hQt];hC]:tac];pQn]Kqn];
l}:yU,"
154
Sc]pn]yLTat]:lQk]; Am],nn] tL,kUn];pQn]An]pQn]liUt]:sac]Am],ha}.hqc];nn]. Am],lI

Kiun]:mL;n}siuc] Tuk],lIwUn].Sgn],lgc]:pQn] β Thalassaemia minor El: Intermedia"
(3) β Thalassaemia Major - Tat]: Hb km]:nm]Am],lI"
Pac]hac]:tac];pQn] liUt]:sac]h}a.hqc];n}. etEt,pQn]nC];AL,yuniuc]:KUp],"

luk]:Agn],etAm],yC],l}:lIEl: Am],mI;lgc]:Kiup]:nL:"
luk]:Agn],k}.sp];tit];tac];pQn]nm]"
lup],Am],yC]:Kiun]:mL;nc],pk],ktI,' km]:nm]etpQn]tI:nL:"
tp];El:mam].yC],( Hepato - Splenomegaly)"
Sc]Am],l}:SCac];liUt]:pn] km]:nm]t}anC];Kaw];tac];niuc]:pI<
Sc]SCac];liUt]:pn]l}:tQm] lgc]:tUw]yC],ekL:etKqm].lqp]:eS etkCL,hUc];hQn];l}:lI"
tQm]TUn]:TUn]: lgc]:sp];tit];tac];pQn]ekL:eteA,lUc];eS p}a;yU,lIekL: etlIKiun]:
mL; lgc]:lup],yC],ekL:etlIKiun]:mL;"
w}a;lc] 10 pI<yw]. etmI;Pac]hac]: Tat]:lQk];sU.tum]El: tac];pQn]
tp];' etpQn] Cardiac toxicity mL;" km]:nm]Et. kgp]:Tat]:lQk];
sU.tum]nC];hUw]sC]eS ethQt];hC]:t}al}:"
Sc]SCac];liUt]:pn]l}:Am], liUt]:sac]' tUw]nan];yC],' lup],Am],pQn]pk],ktI,"
tQm]TUn]: mam].yC],'
lUm];m}:nC];tUw] etKiun]:Kiun]:lUc];lUc];
liUt]:Agk],
km]:nm]Et. miUw]:AL,yul}: 20-30 pI<nn]. kgp]:mI;Tat]:lQk];
sU.tum]nC];hUw]sC]nm]eSEl:t}a"
lgc]:KUn].hLmk];mn]:tac];pQn] CBC, film (target cells),Thalassaemia test"
lgc]:yUt];yL
 wUn].Sgn],lgc]:SCac];liUt]:pn]tL,eS, tL,kum];Tic]; Hb >8 El: Hct >24"
 kUn];pQn] tI:An]etl}:SCac];liUt]:l}al}apgk]:El: nm]nm]nn]. Tuk],lISCac];pn]tI:hUc];yL"
 SCac];liUt]:lgc]:lQw]kUv];pQn]l}a;yUt];yL An]tiUw].liUw]piUn]:n}eStL. lgc]:k}.l}:SCac];liUt]:
pn]n}.Sm]. hQt];hG]:Tat]:lQk];sU.tum]El: sac]:hQt];hC]:tum].tiUw].Ac],kL,nC];tUw]mac]An]eS
155
hQt];hG]: t}al}: (mUiw]:SCac];liUt]:kU:km];nn]. pn]yL 1-2 gm kU:pgk]:n} ets}g:hQt];hG]:
lgc]:sU.tum]Tat]: lQk];eA,lUc];l}:)"
 pn]yL Folic acid 10mg OD El:pI,tL,min], C "
 Sc]mI;lgc]:mam].yC],n}wUn].Sgn],lgc]:PL,tt];Aw]mam].Agk], (m}atgc]; - Pgn];lIn}.etpQn]tL,
kqp].km];kUv];)
m}atgc]; - lgc]:pL;tgc].n}. ethQt];hC]:tac];pQn]liUt]:sac]kgp]: Thalassaemia n}.

h}a.hqc];liUw]kw],El: lgc]:n}.kUv];ethQt];hC]:kUn];pQn]mI;Pac]hac]:kiuc].kac].h}a.hqc];
Am],nn]Kaw];yaw];pgk]:AWn]tac];Sut];"
14.3 Kat],Tat]: G6PD

(=GLUCOSE - 6 – PHOSPHATE DEHYDROGENASE DEFICIENCY )
eKL:piut],tI:pgc], tac];pQn]An]n}.n}. pQn]kgp]:Tat]:prUw],tin]; An]hgc].wL: G6PD nC];mQt].

liUt]:lqc] Am],mI;nn].yw]." tac];pQn]An]n}. etpQn]kgp]:S}aSiup],siUw].KiUw];An]niuc]:eS etpQn]mL;sQm]
kiUt],El: An]pQn] km]:nm]n}. etpQn]kUn];s}a;yw]." kUn];pQn]An]mI;tac];pQn] An]n}.n}. km]:nm]et
Am],mI;Pac]hac]:tac];pQn]Sc]" km]:Pgc]:Et.etpQn]liUt]:sac]Kaw];hiuc]"
tL,kUn];pQn]mac]ekL.nn]. Am],wL:kgp]:sp];tit];siUw].mqc];tac];pQn] Am],nn] kin]yLmac]siUw];eSEl:

sac]:kiuc].kac].pQn] haemolytic anaemia (mQt].liUt]:lqc] Tuk],yL.lU.lqw]) l}:"
lgc]:An]pQn]siUc].n}n}. yU,tI:lgc]:lUt];ygm];eS etpqk],piUc]:kn]kCL,tc];nm]" kUn];pQn]mac]ekL. kin]yL

Sqn];lQw]eS Am],mI;Pac]hac]:n}eStL. tL,kUn];pQn]mac]ekL.Sm]. pn]Sqn];yLhqc];yLmiUn]kn] ekL:sac]:
mI;Pac]hac]: tac];pQn]mL;"
Pac]hac]:tac];pQn]
kUn];pQn]km]:nm] etAm],EnPac]hac]:tac];pQn]Sc]" kUn];pQn]mac]ekL.Sm]. pQn]liUt]:sac]Kaw];hiuc]" Sc]
kin]yL eSAn]An]eS etsac]:kiuc].kac].pQn] haemolytic anaemia h}a.hqc];(tUv];pL:tC]:) Am],nn]
sp];tit]; siUw].mqc]; Am],nn] Am],yU,lIh}.hqc];kCL,pqt]:"
 niUw].liUc]' PiUk],' yQw]:SIEk,' mac]:pgk]:tgc].etKiun]:El: sQp];tac];lc]
 tL,luk]:Agn],lqc]An]sc],hLkiUt], pQn]niUw].liUc]nn]. etpQn]l}:tc];liUt]:sac] Am],nn]
Am],pQn]liUt]:sac]ekL:pQn]l}:"
156
wa};eSkin]yLsgm];nc],pL:tC]:n}.eS Sc]kUn];pQn] mI;tac];pQn]liUt]:sac]Kaw];hiuc] Am],nn] Et,PiUk],mL;'

niUw].liUc] Am],nn] SIyQw]:km],mL;n}siuc] Tuk],lIwUn].Sgn],lgc]:tac];pQn]Kat],Tat]: G6PD "
kUt],sqt],liUt]:tUv];ekL: ethU.l}:wL: kUn];pQn]sgc],Kat],Tat]:G6PDn}.hiuw]" Sc]kUn];pQn]
kiuc].kac].pQn]liUt]: sac] nC];Kaw];tac];Sgc]liUn]nn]. yL,kUt],sqt]:tac];pQn]Kat],Tat]:n}kgn],"
Am],mI;la};kUt],sqt]:wL: hG]:kUn];pQn] kin]yLeSAn]An]eS hU.l}:wL: mI;Am],mI; haemolytic crisis"
lgc]:yUt];yL
 hG]:kiut];yut];kin]yL An]ethQt];hC]:mQt].liUt]:lqc]lU.lqw]
 yUt];yLpn]tac];pQn] An]sp];tit];l}:
 km]:nm]Et. lgc]:mQt].liUt]:lqc]lU.lqw]n}. mn];eth}akCL,hc];mn];El: Am],yUt];yLekL:l}:"
 tL,etsg}:ASak]:kUn];pQn] An]pQn]ha}.hqc];nL,nn]. sG].la};SGac];lUit]:pn]"
 kUt],Tt];tUv];lgc]:kUn];pQn]yQw]:' hC]:kUn];pQn]kin]nm].mak],m}.nm]nm]"
yLEl:San]eK;mI; An]hQt];hC]:mQt].liUt]:lqc]kUn];Kat],Tat]: G6PD lU.lqw]
Dapsone and sulphones

Methylene Blue
Niridazole
Nitrofurantoin
Primaquine
Quinolones ( hUm]:tc]; ciprofloxacin, norfloxacin, ofloxacin, nalidixin acid )
Sulphonamides ( hUm]:tc]; co-trimoxazole )
m}atgc]; - mothballs n}.kgp]:mI; naphthalene El: ethQt];hC]:mQt].liUt]:lqc]lU.lqw]l}:"
 Sc]tk];etl}:pn]yLsiUw];An]lat]:mL;n}.n}siuc] lat]:EnkUn];pQn]wL: epL;kin]yLyw].eS

Sc]pQn] niUw].liUc] Am],nn] yQw]:SIkm]lm]n}siuc] hC]:mL;EnKiun];tI:hUc];yLkm];lQw]"
yLAn]pQn]EP;l}:tgn]:tL,kUn];Kat],Tat]: G6PD
Aspirin
Chloroquine (pn]l}:tL,tac];pQn]naw]nUk].An]kiuc].kac].pQn])
Vitamin K analogue (menadiol sodium phosphate )
Quinine (pn]l}:tL,tac];pQn]naw]nUk].An]kiuc].kac].pQn])
157
lgc]:eh.kc]:
tL,kUn];pQn] An]hU.wL:Kat],Tat]: G6PD nn]. Tuk],lIciUc].ew:lgc]:kin]yLEl:
San]eK;mI;An]et hQt];hG]:mQt],liUt]:lqc]lU.lqw]l}:"
Sc]kUn];pQn] pQn]kUn];Kat],Tat]: G6PD n}siuc] lgc]:m}atgc];w}.nC]; lemma kUn];pQn]

tqk],tqk],lqc];lqc];n}. ethQt];hC]:PU:pn]lgc]:yUt];yLmiUw];nL: Am],mI;pn]hL"
Aac]:Aic] tac];pQn]liUt]:sac] (kn] 14.1)
14.4 lgc]:SCac];liUt]:
eKL:An]EnwL: etl}:SCac];liUt]:
kgp]:pk];piUc]SCac];liUt]: l}amU,l}asum]; An]hQt];Sac]: lgc]:s}g:liUw]yU,sgm];lqn]lin] pqk],piUc]:kn]El:
pL:tC]:n}. etpQn]piUc]nm];lgc]:SCac];liUt]:kUv];" Sc]kUt],sqt]:kum],liUt]: tac];pQn]naw]nUk].' tac];pQn]
tp];Kqc]pI,El: AQt].KY]A},wI,kUv]; sc],Tuk],lISCac];liUt]:pn]" Tuk],lIkUt],sqt]: tL,tac];pQn]
tp];Kqc]SI,El: Sit].Pilit]. pL;sgm];"
mUiw]:lG]etl}:tqp];tt];wL: etl}:SCac];liUt]:
 sc]:tUv];Pgn];lIAn]etl}:hp].El:
EP;An]Aap]:etsp];tit];tac];pQn]miUn]nc],tp];Kqc]'AQt].KY]A},wI,"
 SCac];liUt]:pn]miUw]:lUw],Et.Et.kUv]; - tk];etl}:wUn].Sgn], lgc]:cw];l}a;kUn];pQn]
Agn]tac];Sut];"
kiuc].kac].l}:SCac];liUt]: (hC]:SCac];pn]w};w};) Am],SCac];pn]liUt]:

 liUt]:sac] An]kiuc].kac].EnPac]hac]:  Pac]hac]:tac];pQn]liUt]:sac]Kaw];hiuc]An]
tac];pQn] Am],nn] kgp]:tac];pQn]liUt]: Am],h}a.hqc]; (kn] 14.1)
sac]eSEl: mI;Pac]hac]:hUw]s]Cw}a;El:
 kiuc].kac].liUt]:Agk],h}a.hqc]; Am],nn]
 kUt],Tt];vL;siUw].mqc];naw]nUk].An]h}.hqc];Am],
nn] mI;yU,nC];liUt]:nm]El: Tat]: Hb <7 –
Hct <20
158
lgc]:wUn].Sgn],SCac];liUt]:pn]
 hUm]:lUv]:Pac]hac]:tac];pQn]liUt]:sac]Kaw];hiuc] * tL,kUn];pQn]liUt]:sac]h}a.hqc];nn].
pqk].Sm].wL: Am],hn]PiUm]:Tqm]pn]Sc]n}
El:Tat]: Hb <6 – Hct <18 eStL. Hb etl}:mI;kL:hiuw] sgc],et
SCac];l}:n}nn]. Am],mI;eKL:tUk];lUc];w}.
 Tuk],lItiUc],pac],lgc]:n}.tc];emLyL"* nC];siuc]:miUc];tI:lC]" emLyLmac]ekL.
ettqp];tt];SCac];liUt]:pn] miUw]: Hb yU,tI:
6g/dl n}eStL. emLyLmac]ekL.Sm]. Tat]:
Hb epL;Tiuc] 4 yw].ekL:
yc];Am],SCac];lUit]:pn]ekL:mI;" lgc]:n}.
Tuk],lIpQn]lgc]:tqp];tt];emLyL
An]ettUv];Tiuc]AL,yu' cw];l}a;p}a;yU,lI'
cw];l}a;tUc],wUc];El: lgc]:tac];An]
hQt];hC]:kUn];pQn]liUt]:sac]siUw];n}.yw]."
tL,kUn];pQn] An]l}:SCac];pn]liUt]:yw].nn]. Tuk],lIpn]yL Ferrous Sulphate El: Folic Acid

sgm];nc],hqc];yLyUt];yLEl:KYL;mqc];tgc].pn]" tL,kUn];pQn] Thalassaemia Et. hC]:pn] Folic Acid
Sqn];lQw]kUv];El: KYL;mqc];tgc].pn]"
 tL,ettqp];tt];lgc]:kiuc].kac].SCac];liUt]:pn]Kn]w};n}. Am],Tuk],lItUv];eKL:tgp],tI:hgc]:lqp],kUv];
Tuk],lItUv];Tiuc]cw];l}a;kUn];pQn]n}.pQn]An]lm],lgc]:yw]."sgc],kUn];pQn]PiUk],liUc]' hqc];eA,siUw];n}.
sgc],mI;Am],mI;' kUt],Tt];tUv];hqc];tgt],liUt]:' hqc];TUv]:sC]El: hqc];liUt]:siUw];n}.yw]."
 tL,tqp];tt];SCac];liUt]:pn]nn]. cw];l}a;kUn];pQn]n}. lm],lgc]:liUw]eSeKL:tgp], Hb"
Kp].Kn] = km];Siuw]: - Sc]pC]. kUn];pQn]sac]:t}al}:"

Sm]; IV cannula An]yC],liUw]piUn]:pn] El:pn]nm]. IV eS hLkUn];etlU,pn]liUt]:w};w};"
Kk].tgn]: An]etl}:hQt]; tL,SCac];liUt]:pn]kUn];pQn]
tL,kUn];pQn] –
1. kUt],sqt],kum],liUt]:El: kum], rhesus(+ Am],nn] -)kUn];pQn]"
2. Sm]; IV cannula An]yC],liUw]piUn]:pn]tI:SQn]:liUt]:yC], - kgp]:wL:Sc] cannulae lQk]. liUt]:ekL:
et l}Kw]:l}:eA,El: TiUc];"
3. nc],hiuw]ethC]:AQn]liUt]:Kw]: epL;etpiut],w}.nn].SCac];SC], normal saline w}.pn] Am],nn]SCac];
liUt]: hG]:Kw]:kCL,km];Siuw]:"
4. hLkUn]; An]mI;kum],liUt]:lQw]kn]tc];kUn];pQn]"
5. Sc]Kp].Kn]nL,pUn].tI:El:hLkUn];etlU,liUt]:pn]Am],mI;n}siuc] hG]:hQt];sgm];nc],piUc]kum],liUt]:An]
Kw]:kn]l}:"
159
kum],liUt]:kUn];pQn] kum],liUt]:tI:hp].l}:
O O kum],liUt]: O = SG],pn]l}:kum],liUt]:kU:siUw];
A A,O
B B.O
AB AB,A,B,O kum],liUt]: AB = hp].l}:kum],liUt]:kU:siUw];
Kk].tgn]:An]etl}:hQt]; kQw],lUv]:kUn];An]etlU,liUt]:pn]
1. kUt],Tt];tUv]; Pac]hac]:cw];l}a;kUn];An]etlU,liUt]: -
 Am],Aw]Em:pL;tgc].' Am],Aw]kUn];  nC];Kaw];tac]; 3 liUn]pUn].mL;n}.Am],l}:lU,
AL,yu lQk].liUw] 17 Am],nn] liUt]:
yC],liUw] 65 pI<  hqc];liUt]:pk],ktI,
 Am],mI;lUm];naw]  epL;tUv];sgm];nc],p}a;yUt];yLsiuc] Am],mI;
 miUw]: 6 liUn]pUn].mL;nn]. tac];pQn]liUt]:sac]
Am],pQn]niUw].liUc]  Am],mI;tac];yam]: hQt];lgc]:pQn]eP;
An]etsp];tit];siUw].mqc];tac];pQn]
kgp]:lgc]:hUm]:kL,m Am],nn] AQt].KY]A},wI,
2. Aw]liUt]:tI:kUn];etlU,liUt]: Sc]wL: -
 Am],mI;siUw].mqc];tac];pQn]naw]nUk].  Am],mI;siUw].mqc];AQt].KY]A},wI,El:tp];kC]:pI,
 Hb > 11g/dl*  (Sc]kUt],sqt]:tUv];n} etAm],l}:mI;
 miUw]:Aw]liUt]:Kw]:kn]tUv];nn]. siUw].mqc];tac];pQn] SI, El: VDRL test
Am],mI; lgc]:liUt]:tc] n}. etl}:pQn] negative )"
3. Aw]liUt]:tI:kUn];etlU,liUt]:-
pn]ekL.etlU,liUt]:nn].kin]nm].eS lat]:EnhC]:Kw]ngn];c}aliuw]:w}.mgk]: 10 minit]."
 pn]yL Ferrous Sulphate El: Folic Acid tL,hqc];yLeh.kc]:hC]:kUn];lU,liUt]: tL,2 wUc]:"
* mac]pgk]:tL,ethLkUn];etlU,liUt]:n}. hLyap]," pI:ngc].kUn];pQn] An]K}:lU,pn]liUt]:ekL:etmI;"
Sc]Tat]: Hb Kw]Tuk],lIpQn] < 11 g/dl n}eStL. kUv];kL:Sm].mI; > 9g/dl kUv];ekL:
Sc]cw];l}a;kUn];pQn]mI;eP;Tiuc]t}al}: kgp]:tac];pQn]liUt]:sac]n}siuc] pqk].Sm].wL:Tat]: Hb
Kw]Am],Kqm].lqp]:lIeStL. Tuk],lItqp];tt]; Aw]liUt]:Kw]SCac];pn]l}: (pn]yL Ferrous Sulphate El:
Folic Acid tL,hqc];yLyUt];yL hC]:ekL.lU,liUt]:)"
tL,kUt],sqt]:tUv];wL: kum],liUt]:Kw]:kn]l}: Am],Kw];kn]l}:nn]. hC]:Aw]liUt]:kUn];etlU,El:kUn];pQn]
ekL.ygt],ygt],eSmL;KUn];tUv];niUw]man],SC]" Sc]liUt]:tc]kCL,pqt]:n}siuc] yLAw]liUt]:ekL.nn].SCac];pn]"
160
SCac];liUt]:pn]kUn];pQn]
1. np].Sgn],tUv];liUt]:tI:An]etl}:SCac];pn] ( 1 Tuc] = 350 – 450 cc )
luk]:Agn],lQk].liUw] 1 KUp], 15 cc/kg

luk]:Agn],yC],liUw] 1 KUp], 15 cc/kg
luk]:Agn],An]Kat],AL,hL,rh}a.hqc]; 15 cc/kg
kUn];lUc] 1-2 Tuc]
yU,tI:tac];pQn]liUt]:sac]h}a.hqc];nm]eA,eS sC].l}:Kiun]; tac];nm]nc],pL:niUw]n}."

2. tk];etl}:mn]:sC]wL: SCac];liUt]:pn]kUn];pQn]n}. pQn]An]Tuk],mqn]:"
3. hqc];l}liUt]:tI:An]SCac];pn]
lgc]:SCac];liUt]:n}. Tuk],lIhiuc]mgk]: 3 sUw]:mUc];" kUv];kL:wL:-
 tL,kUn];pQn]tI:mI;hqc];liUt]:tUk];El:liUt]:kiuc].kac].l}Agk],h}a.hqc];nn].
(etL,Tuic]hqc];liUt]:tac];niUw] epL;pQn] > 90mm Hg ) nn]. SCac];pn]mgk]: 10 minit]."
 tL,kUn];pQn] tI:An]mI;EP;pQn]hUw]sC]w}a;l}: (luk]:Agn], An]Kat],AL,hL,rh}a.hqc];' kUn];lUc]
An]AL,yuy]G,' mI;tac];pQn]kQw],lUv]:hUw]sC] Am],nn] mak],kqw];' tac];pQn]
liUt]:sac]Kaw];hiuc]) n}. hC]:SCac];pn]nC]; Kaw];tac]; 4 sUw]:mUc];" liUw]nn]. miUw]:SCac];pn]kCL,
Kiuc]:nuic]:nn]. hC]:SC],yL Furosemide PO/IV (luk]:Agn], 1 mg/kg' kUn];lUc] 20 mg )
pn]sgm];"
4. miUw]:etl}:kUt],sqt]:tUv]; VITAL SIGNS:
 miUw]:p},Et,
 w}a;eSEt,yw]. 5 minit].El: 15 minit]."
 w}a;eSnn].ekL: sqt]:kU:sUw]:mUc]; etL,Tiuc]epL;SCac];liUt]:pn]yw].kCL, niuc]:sUw]:mUc];"
5. yL,Aw] D5W (kgp]:wL:ethQt];hC]:kCL,yL.kw];mQt].liUt]:lqc]lU.lqw]) Am],nn] Aw] RINGER

(ethQt];hC]:liUt]:tc]) KUn];elL;pn]nC];liUt]:lL;lL;" tc]; NORMAL SALINE Et.
KUn];elL;l}: yU,"
6. yL,Aw]yLSc]SC],nC];liUt]:lL;lL;"
7. yL,Kw],Kgn];tw]:liUt]:"
 miUw]:SCac];eS;l]liUt]:lqc]kCL,yw]. (SUn],tI:lqc]Kgc]liUt]:) hG]:kiut];yut];SCac];liUt]:pn] kgp]:wL:
tL,hC]: Tat]: Hb Kiun]:mL;nn]. kUn];pQn]etl}:mI;eS;l]liUt]:lqc]kUv];"
 nm].SC]liUt]: (SUn],nm].SC]Kgc]liUt]:)nn]. sC].tiuw];l}:tL,kUn];pQn]eA,eSEl:
etsac]:hQt];hC]:pgt], kC]:l}:kUv];"
 tL,kUn];pQn] An]kiuc].kac].liUt]:Agk],nn].Et. Tuk],lISCac];pn]SUn],nm].SC]liUt]:yU,"
161
tac];pQn]An]sp];tit];l}:
15
15.1 tac];pQn]kgp]:siUw].mqc];pqk],TI;rI;yL;
yC];hUm],Agk];eALkC]:kgp]:siUw].mqc];pqk],TI;rI;yL;
Meningococcal Meningitis
lgc]:etl}:SUc],Kaw], Kn]w};
eKL:piut],tI:pgc],
tac];pQn]An]n}.n}. pQn]kgp]:siUw].mqc];pqk],TI;rI;yL; (km]:nm]Et. etpQn] Streptococcus pneumonia,
Neisseria mengingitides Am],nn] Haemophilus influenza) eSEl: yC];hUm],Agk];eALl}:kC]:nn].
yw]." siUw].mqc];pqk],TI;rI;yL;n}. luk].tI:kUn];ekL.niuc]:El:ekL.niuc]: etsp];tit];kn]l}:tac];nm].l}a;
El: KI:tUiw],Kw]siUw];n}.yw]." lgc]:tac]; An]hQt];hC]:yC];hUm],Agk];eALkC]:l}:Et.– miUn]nc], kgp]:siUw].mqc];
w};rt].S]eS Agk];eALEl:yC];hUm],Agk];eALkC]: (kn] 21.5)' kgp]:siUw].mqc];TI,pI,eSEl: yC];hUm],Agk];
eALkC]: (kn] 15.3)' kgp]:siUw].mqc];Krit].S]tUw],eS El:yC];hUm],Agk];eALkC]: (kn] 15.3 )"
Pac]hac]:tac];pQn]
luk]:Agn],lQk].liUw] 1 KUp], luk]:Agn],yC],liUw] 1 KUp],El:kUn];lUc]
 mI;lUm];naw] (38.5 M El:Suc] liUw]  mI;lUm];naw] (38.5 M El:Suc]liUw]nn].)'
nn].)' kUn].kUn].Kuin]:Kuin]:' mw];' Am], hUw]K}:' hak]:"
kin]nUm];lIlI' hak]:' pQn]can];'lium];tUw]"  Am],tUv];Sqc]lqt],l}: (kUw]Sqc]lqt],)
 h}:hqc];nL, Am],nn] Am],tUc].Am],niuc]  kgc],ekL:Kqc]
Sc]eSAit];El: yQn]hqc];nL,pUn].tI:  mI;Pac]hac]:tac];pQn]yC];hUm],Agk];eALkC]:
 kgk];hUw]tac];nL:etsac]:kC]: (mI;Pac]hac]: Kernig El:/Am],nn]
 km]:nm]Et. kgc],ekL:etAm],Kqc] Brudzinksi)
 liUt]:pQn]kgc]. – liUt]:sium];l}Agk],mL;  pQn]can];' lium];tUw]"
eS pQn]h}g;sm].tI:Piw]nc]"  liUt]:pQn]kgc]. – liUt]:sium];l}Agk],mL;eS
pQn]h}g;sm].tI:Piw]nc]"
Sc]mI;lUm];naw]El: hUw]K}:h}a.hqc]; Am],nn] mI;lUm];naw]El: lium];tUw]n}siuc] Tuk],lIwUn].Sgn],
lgc]:tac];pQn] yC];hUm],Agk];eALkC]:" kUt],sqt],tUv];lgc]:kgc],ekL:Kqc]Am],Kqc]"
kgc],ekL:Kqc] – hG]:kUn];pQn]kUm]:lUc]; hC]:kac];mL;tiUw].vL;tI:nL:AUk];" Sc]kUn];pQn]Kac];wL: kgc],ekL:KQc]:Kqc]

yU,n}siuc] wUn].Sgn],l}:wL: yC];hUm],Agk];eALkUn];pQn]etsac]:kC]:yU,"
162
tac];pQn]An]sp];tit];l}: 15
Pac]hac]: kL;nit]. Kernig’s sign – hG]:kUn];pQn]ecL;KLlUc]eS hC]:Aw]KLyQt],Agk],kCL," Sc]kUn];pQn]
Kac];kgc]:ekL:Kiun]: Am],nn] KQc]:Kqc]yU,n}siuc] wUn].Sgn],l}:wL: yC];hUm],Agk];eALkUn];pQn] etsac]:kC]:yU,"
Pac]hac]:prut].Sin];S]kI Brudzinski sign –yUk].kac];kUn];pQn] hG]:c}anL:Kiun]:n}siuc]ethn]KLlUc] kUn];pQn]
ecL;Kiun]:mL;"
Pac]hac]:An]hn]l}: sgm];nc],p}a;yUt];yLEl: Pgk]:(esL,)Aw]K}mn];tI:Aqw] (tI:cw];l}a;pQn]l}:kUv];)
 kUt],sqt]:siUw].mqc];naw]nUk].pn]tL,eS,"tac];pQn]naw]nUk].El: yC];hUm],Agk];eALn}. sac]:pQn]mUiw]:lQw]
kn]l}:"
 Pgk]:(esL,)Aw]K}mn];tI;Aqw] - Pac]hac]:K}mn];tI:Aqw]' tc];nm]eA, K},mQt].liUt]:Kaw]' tac];
nm]eA, Tat]:kiUw]wan]' tac];nm]eA,Tat]:prUw],tin];El: sC].m},klUw],SkUp].eS hLtUv];siUw].mqc];
nC];hgc]:lqp],' kUt],sqt]:tUv]; (gram stain, Ziehl Neelsen stain, India Ink stain)sgm];"
lgc]:tac];An]hQt]; K}mn];Aqw] pqk],TI:rI;yL; w};rt].S] TI,pI, Krit],StUw],

hC]:pQn] pk],ktI, ekL.kt].S]
Pac]hac]:K} SC] Kun], SC] Kun],Ait];Ait]; Kun],Ait];Ait];
mn];Aqw]
mQt].liUt]:Kaw] < 5/ mm³ > 200/ mm³ >10 mm³ >10mm³ >10 mm³
Tat]:kiUw]wan] Mmol/L tqm], pk],ktI, tqm], tqm],
Tat]:prUw],tin]; 0.15 – 0.4 Suc] Suc] Suc] Suc]
g/L
kUt],sqt]:siUw]. Am],mI; mI;siUw].mqc];ngc] Am],mI; nC];SI,Enl] nC];Ain],tI;yL;
mqc];nC];hgc]:lqp], StQn];nn].mI; Aic].StQn];nn].
siUw].mqc];TI,pI, mI;siwU ].mqc];
Sc]mI;Pac]hac]: hqc];mip],nC];Agk];eAL (miUn]nc], hUv],tLlm] Am],yC],tan],kn]' miUw]:Aw]Sqc]f};

Tgc],tUv];tL lm]nn]. Am],mI;lgc]:tUc].niuc]Kiun];Sc]' hqc];tgt],hUw]sC]TiUc];pUn].tI:' nG];kUn];lUc]
hqc];TUv]:sC] niuc]:minit]. tqm],liUw] 50 pgk]:El: hqc];TUv]:sC]Am],PQc],kn]) n}siuc] Am],Tuk],lI
esL,(Pgk]:) K}mn];Aqw]" pqk].Sm].wL: Am],sac]:esL,(Pgk]:) K}mn];Aqw]n}eStL. Sc]wUn].Tiuc]wL:
pQn]tac];pQn]yC];hUm],Agk],eALkC]:n}siuc] Tuk],lIpn] yLptI,KYI<wnkCL,"
miUw]:pC].tL,esL.(PWk]:)K}mn];Aqw]nn]. tL,pn]yLptI,KYI<wnn}. yLepTiUc]; "
kgp]:wL: Sc]pn]yLTiUc];kCL,n}siuc] etsac]:pQn]EP; etL,kUn];pQn]Tiuc]t}al}:"
Sc]Am],p},sac]:esL.(PWk]:)K}mn];Aqw]n}ekL: hC]:pn]yLptI,KYI<wnw}.AWn]tac];kgn],"
lgc]:yUt];yL
 hp].kUn];pQn]w}.tI:hgc]:kUn];pQn]nC];
 pn]yLptI,KYI<wn
163
15 tac];pQn]An]sp];tit];l}:
First choice
luk]:Agn],yC],liUw] Ceftriaxone IV/IM 50 mg/kg/day BD Am],nn] 100mg/kg/day OD* 10 wn];

2 liUn]tc];mUt]; (tUw]yac], - luk]:Agn], 50/kg BD El: kUn];lUc] 2 g BID )
luk]:Agn],lQk].liUw] Ampicillin IV/IM 50 mg/kg QID El:

2 liUn]tc];mUt]; Cefotaxime IV/IM 50 mg/kg BID - QID El:
Gentamicin IV/IM 4 mg/kg OD
* 14 - 21 wn]; (w}a;eS 7 wn]; kiut];yut]; Gentamicinl}:)
tac];liUk]:l}a;yUt];yLtac],siUw]; Sc]Am],mI;yL Ceftriaxone
luk]:Agn],yC],liUw] 2 Chloramphenicol IV/IM 25 mg/kg QID

liUn]El:kUn];lUc]
Sc]cw];l}a;kUn];pQn] lIKiun]:El: lUm];naw]lUt];ygm];mL;n} lqk]:l}a:pn]yLkin]El:
hqc];yL hC]:liUw]Kiuc]:niuc]: (12.5 mg/kg QID ) tL,tc];mUt]; 10 wn];"
Em:pL;tgc]. Ampicillin IV 2 g QID tL, 10 wn];"
 Dexamethasone – IV 0.15 mg/kg QID tL, 4 wn]; Sc]pn] (miUw]:p},l}:pn]yLptI,KYI,w Am],nn]

pn]hUm]:kn]) n}siuc] ethQt];hC]:cw];l}a;luk]:Agn],El: kUn];lUc]lIKiun]:"
 nc],hiuw]eth]G:pQn]lgc]:s}g:liUw] tL,yUt];yLnn]. hC]:pn]tI:An]pQn]nm].El: Agk],SI,kYin],"
 tL,hC]:lUm];naw]lUt];ygm];lUc];nn]. pn]yL paracetamol"
 tLcan];Kiun]:nn]. hC]:pn] diazepam (0.5 mg/kg tac];kUn]:' nm]Sut]; 10 mg) Am],nn] 0.3
mg/kg IM (kn] 7.2)"
 Sc]kUn];pQn]ta}lium];n} Kqn];Tuk],lIlum];lL;pn]kUn];pQn]lIlI" (kn] 7.2)
lgc]:eh.kc]:
yLeh.kc]:n}. pn]l}:tL, kUn];etAap]:yU,nC];eP:sp];tit];tac];pQn]l}: ( miUn]nc],- kUn];An] yam]:
PL, tt];Aw]mam].Agk],w}.) El:kUn];An]yU,sm]tc];kUn];pQn] (kUn];nC];hiUn];lQw]kn])nn]." nc],hiuw]et
eh.kc]: Am],hC]:Kw]tit];sp];tac];pQn]l}:n}. Tuk],lIpn]yLtLeh.kc]:km];Siuw]: (yLkin] Ciprofloxacin
15 mg/kg STAT tL,luk]:Agn], El: 500 mg STAT tL,kUn];lUc])"
yLeh.kc]:
yLeh.kc]: tL,tac];pQn]yC];hUm],Agk];eALkC]:km]:nm]nn]. Pgn];sL.yLAm],epL;SU:mI;El: tm];sC]eSsC].
tiuw];l}:n}eStL. pgt];tac];hw];yU,n}. yLeh.kc]:An]k}.pn]km]:nm]Et.p},mI;"
164
tL,tgc];
→ tac];pQn]yC];hUm],Agk];eAL An]pQn]kgp]:siUw].mqc];TI,pI,n}. tL,kUn];lUc] etAm],k}.mI;lUm];naw]Suc]
El: lUm];naw]etk}.Kiun]:Kiun]:lUc];lUc];" tL,luk]:Agn],Sm]. Sc]mI;Pac]hac]:tac];pQn]SQn]: AL,
yUc], (miUn]nc], t}aPak],Pak],tUw]' t}aPak],Kuic]:tUw]) siUw];n}.n}siuc] Tuk],lIwUn].Sgn], lgc]:
tac];pQn]yC];hUm],Agk];eALkC]:" tac];pQn]siUc].n}n}.km]:nm] etsac]:et,pQn]mL;l}g;l}g;eSkgp]:lqk]:
l}a: lgc]:yU,Sw];El: etsac]:EnPac]hac]:mL;"
→ tac];pQn]yG];hUm],Agk];eAL An]pQn]kgp]:siUw].mqc];n}. km]:nm]kUn];An]mI;hqc];Kam],tUw]eA,kUv]; et
pQn] eS miUw]:Et,pQn]nn]. kgp]:etpQn]mL;mL;l}W;l}W;El: etAm],k}.hU.tUw]" lUm];m}:tUw]et
pQn]pk],ktI, (puc],man],) Am],nn] etSuc]Ait];Ait];" kUv];kL:tac];pQn]n}. etsac]:hQt];hC]:
hUw]K}:Kaw];hiuc]El: h}a.hqc];" (lgc]:yUt];yLnn]. kCL,tUv];tI: AQk].KY]A}wI, kn] 15.3)
Aac]:Aic]
siUw].mqc];naw]nUk]. Kw]:Agk];eAL (15.2)' yC];hUm],Agk];eALkC]: (15.3)' yC];hUm],Agk];eALkC]:
kgp]:siUw].mqc];TI,pI, (21.5)' yC];hUm],Agk];eALkC]:kgp]:siUw].mqc]; Cryptococcal (15.3)' tac];pQn]yQw]:nU
(15.1)"
tac];pQn]yQw]:nU (Leptospirosis)
lWc]:etl}:fac].tUv];sgm];
eKL:piut],tI:pgc],
tac];pQn]yQw]:nUn}. pQn]kgp]:siUw].mqc];pqk],TI;rI;yL; An]hgc].wL: lqp].tUw]Sp};rnn].yw]." siUw].mqc];n}.
etyU,nC];tUw]St]; (km]:nm]nC];tUw]nU' mL' mqw];El: wUw];kC}a;)eSEl: etAgk],mL;tac];ngk]: sgm];yQw]:
St];nn].yw]." w}a;eSAgk],mL;sgm];yQw]:St];yw]. siUw].mqc];siUw];n}.Kw]etyU,l}: tac];ngk]:l}aliUn]yU,
yw]." siUw].mqc]; etKw]:nC];tUw]kUn];l}:sgm];sQp];' Piw]nc]tI:An]pUv],nm].' kqw]:tLSC] kgp]:miUw]:l}:tiUw].
vL;nm]. An]mI;siUw].mqc]; (tUw]yac],-yQw]:tUw]St];) Am],nn] l}:yU,sm]tUw]St]; An]mI;siUw].mqc];yU,
tL,eS,siUw];n}.yw]."
kUn];An]mI;Pac]hac]:sp];tit];tac];pQn]l}:Et. etpQn] kUn];hQt];h}:nL;El: yU,nC];miUc]'
kUn];Am],k}.tiuw];Kqp];tin]eSp}nC];nm].' eK;nm].' hgc]:nm].El:kUn];k}.w}a:nm].siUw];n}.yw]."
Pac]hac]:tac];pQn]
 kiuc].kac].kt];Sn],El: mI;lUm];naw]"
 tL' kqw]:tLetlqc]Kgc], (tLetlqc]Kgc]eS Am],mI;ngc])
 tI:kam]:niUw]. kUn].Kiun]: (km]:nm]Et.etpQn]tI:tgc],ngc]:)
 hUw]K}:
165
mac]pgk]:tgc].etmUv]:' mw];El: K}:hak]:' tgc].lU.' A}El:eKL;sQp];' kp].nL:AUk];' eKL:etkUn].Kiun]:
siUw];n}.yw]." etpQn]siUc].n}mgk]: 5 Tiuc] 9 wn];eSEl: Am],pQn]h}a.hqc]; Am],nn] etL,epL;h}a.hqc];
nn].yw]." km]:nm]Et. etpQn]Tiuc]Kk].tgn]:n}.yw]. liUw]eSpQn]Kaw];hiuc]Am],kL; sac]:pQn]Pgn];sL.
tI:An]h}a.hqc];mL;nn].yw]."
 tac];pQn]yC];hUm],Agk],eALkC]: - hUw]K}:h}a.hqc];El:etmip],tI:nL:Pak], Am],nn]KI:mqp]:mL;tc];Sgc]P}a,"
 tp];El:mak],kqw];lU.lqw] – (tac];pQn]ew;l])lUm];naw]Suc]pUn]. 40 M' niUw].liUc]' yQw]:eA,'Am],yQw]:
lL;lL;siUw];n}. (etsac]:pQn]hUm]:tc];liUt]:tUk];tac];nC];' pWt],kC]:' hUw]sC]tgt],Am],PQc],El: liUt]:
yut];l}siUw];n}.yw]." kUn];pQn]mac]ekL.nn]. etpQn]mam].yC],' tp];yC],siUw];n}.yw]."
 etsac]:pQn] liUt]:tUk];tac];nC];eS pgt],kC]:El: TUv]:sC]yap],hUm]:kn]" tac];pQn]siUc].n}n}. tp];'
mam].Am],lU.eStL.ekL: sac]:pQn]l}:yU,yw]." liUw]eSnn]. kUn];pQn]etsac]:A} eSpL;liUt]:mL;
sgm];n}eStL. Sc]Tgm],tUv];hUw]sC]kUn];pQn] etl}:cin];SQc]tgt],hUw]sC] pk],ktI,(puc],man],)kUv];"
 kqw]:tLSC]kC]:"
 tp];lU.n}. etsac]:lIKiun];mL;l}:n}eStL. mak],kqw];lU.El: lgc]:TUv]:sC]lU.n}. pQn]Pgn];sL.sgm];
Pa},lc] An]pQn]eP;yC],lUc]Et.yw]."
sgm];nc],la};yUt];yL' kUv];kL:lgc]:kUt],Tt];mac]siUw]; etsac]:s}g:hC]:mk];mn]:l}:yU,
 Dipstick – ethn]liUt]:El:prUw]tin];nC];yQw]:"
 kUt],sqt]:tUv];nG]:hgc]:lqp], - mI;Tat]: CK El: pI,lI,lU,pin],nm]"
 Aw]KiUc]:miuw];lIkUt],sqt]:liUt]: - (Serology ) l}a;kUt],sqt]:n}. ettqt]:etL;Sut];n}eStL.
KiUc]:siUc].n}Sm]. Am],mI;kU:hgc]:yLEl: tL,lUPgn];kUt],mn];ekL:yap],nn].yw]."
Sc]pQn]l}: hC]:yUt];yLsQm]sw]." kUv];kL:tUk];liun];kCL,n}eStL.ekL: l}a;yUt];yL tI:An]Tuk],mqn]:ekL:

yc];mI;yU,"
 pn]kin]yL paracetamol tL,yUt];yLpn]lgc]:kUn].Kiun]:El:lUm];naw]"
 pn]nm]. IV"
(k) pQn]Am],h}a.hqc];
 PO doxycycline 200 mg OD tL, 7 wn];"
 tL,luk]:Agn],El:Em:pL;tgc]. PO amoxicillin (luk]:Agn], 10 – 25 mg/kg TID ' kUn];lUc] 500
mg TID) tL, 7 wn];"
(K) pQn]h}a.hqc];
 IV ampicillin (luk]:Agn], 10 – 25 mg/kg TID ' kUn];lUc] 500mg – 1 g QID) tL, 7
wn];Am],nn]
 Ceftriaxone IV (luk]:Agn], 25 – 50 mg/kg OD ' kUn];lUc] 1- 2 gm OD) * tL, 7 wn];"
166
lgc]:eh.kc]:
nc],hiuw]hG]:nUeteA,lUc];nn]. hC]:kQp];yup];yak];sgm];him];hiUn];ey;' pn]tac];hU. kUn];siUw];An]lqp]:etpQn]
eP;sp];tit];tac];pQn]l}:El:tL,eh.kc]:nn].hC]:kin]yL doxycycline(200 mg niuc]:wUc]:niuc]:pgk]:kU:wUc]:)"
yLeh.kc]:
mI;yLeh.kc]:tL,tUw]St];n}eStL. yLettiUw].Am],l}aliUn]kUv];" yLeh.kc]:tL,kUn];Sm]. kgp]:Pgn];lI
mn];yc];eA,El: nC];pgt];piun].tI:hw];yc];p},sC].kn]l}:"
Aac]:Aic]
naw]nUk].(15.2)' yC];hUm],Agk];eALkC]: (15.1)' lUm];naw]t}.P}g. (15.1)' Scrub typhus (15.1)' tp];kC]:
(12.3)"
SKrp].S]t}.Pat].S] (Scrub typhus)
lWc]:etl}:pk];tLpC].tUv];sgm];
tUv];tI: eKL:PiUm]:Tqm]
eKL:piut],tI:pgc],
SKrp].S]t}.Pat].S] (Scrub typhus)n}. pQn]kgp]:siUw].mqc];pqk],TI;rI;yL; tI:hgc].wL: (rickettsia)
eSEl: kgp]:h};An]yU,sgm];yiUw]:yL:El: yU,nC];TiUn]nC];pL,KUp];eS sp];tit];mL;nn].yw]." km]:nm]ekL:
etpQn] nUk].wic],El: nUsiUw];n}.pQn]tUw]St]; An]pL;siUw].mqc];siUw];n}.mL;nn].yw]."
tac];pQn]An]n}.n}. k}.pQn]tac];pgt];m}: tI:hw];yU,n}.km]:nm]eS mI;lUm];naw]An]Am],hU.wL:
pQn]kgp]:Sc]nn]. ekL: pQn]kgp]:siUw].mqc];n}.yw]." km]:nm]Et. Am],yUt];yLeS h}akCL,hc];mn];n}eStL.
km]:Pgc]:Sm]. Tiuc]t}a l}:nn].yw]."
Pac]hac]:tac];pQn]
 mI;lUm];naw] naw]eSAm],hiuc]l}awn]; etmI;tum],lqc]pqk],
 hUw]K}:h}a.hqc]; pqk],Agk],mL;sgm];tUw]" tum],lqc]siUw];n}.
 mak],ln]sQp];Kiun]:Et,Aw]tI:mqc];KUp]; El: etEt,Agk],tI:tUw]eSEl:etsac]:lam];
mak],ln]sQp];Kuin]:tc];tUw] kCL,tc];tUw]
 tI:mqc];KUp];nn]. etpQn]Piun],lqc]Kiun]:mL;eS  mac]:pgk]:etmI;Pac]hac]: Agk];eALEl:
nC];kac]Sm].etpQn]nc], Kap]:sQp];hqc]:lm] yC];hUm],Agk];eALkC]:
(ESCHAR)" km]:nm]Et.etpQn]tI:lc]'  Pac]hac]:lgt],lUm];kC]:' tp];kC]:' yC];hUm],
cam]:KLEl: mak],hm]siUw];n}.yw]." mak],hUw]sC]kC]:' lgc]:hQt];Sac]:pqk],piUc]:
(lk]:KnL,kQw],lUv]:tac];pQn]p}a;sC])
El:mak],kqw];lU."
167
kUn];An]yU,nC];piun].tI: An]mI;tac];pQn]SKrp].S]t}.Pat].S]
km]:nm]etAm],k}.pQn] Am],yU,lIh}a.hqc];El: km]:nm]Am],mI;Piun],lqc]El:
Kap]:sQp];hqc]:"
lgc]:KUn].hLmk];mn]:tac];pQn]sgm];nc],p}a;yUt];yL – Et,Aw]sgp],Tam]piun];lc]tac];pQn]El: Am],hn]mI;
siUw].mqc];naw]nUk].nC];liUt]:eSEl: KuUn].hLtac];pQn]l}:" KUn].hLtac];pQn]l}al}apgk]:El: tUv];piun];tac];
pQn] l}al}apgk]:eStL. etAm],hn]Pac]hac]:tac];pQn]Sc]" kUv];kL: Sc]wL:kUt],sqt]:tUv];liUt]:ekL:
Am],hn] siUw].mqc];tac];pQn]naw]nUk].El: tUv];piun];tac];pQn]ekL: Am],hn]Sc] tqt]:etL;siuc] hC]:wUn].
Sgn],lgc]: tac];pQn] SKrp].S]t}.Pat].S]"
sgm];lqn]lin]miUc];T};-miUc];man]:n}. etmI;mU,rin];t}.Pat].S] (Murine Typhus) An]pQn]Pac]hac]:
hc];kUv];mn];Tqc]:Sqn];niuc]:" pQn]tac];pQn] An]sp];tit];l}:h}a.hqc];eS etmI;lUm];naw]' hUw]K}:El:
Piun],lqc]' km]:nm]etmiUn] SKrp].S]t}.Pat].S]' kUv];kL:etAm],epL;h}a.hqc];" mU,rin];t}.Pat].S]
(Murine Typhus )n}. etpQn]kgp]:siUw].mqc]; lik].Kit].SYL;t}.PI, (rickettsia typhi) El: etsp];
tit];SC],kUn];mL;sgm];mt];nUnn].yw]." tUw]St];An] mI;siUw].mqc];tac];pQn]Et.pQn]nUEl: tUw]St];An]
miUn]nUnn].yw]." l}a;yUt];yL Et.etmiUn]tc];l}a;yUt];yL SKrp].S]t}.Pat].S]nn].yw]."
lgc]:yUt];yL
 yUt];yLpn]lUm];naw]El:sQp];Kiun]:"
 pn]yLptI,KYI<wn
(k)yLtL,Kk].tgn]:niuc]:
Doxycycline luk]:Agn], ** 4.5 mg/kg OD tL, 7 wn];
kUn];lUc] 200 mg PO tL, 7 wn];
(K)yLtL,Kk].tgn]:Sgc]
Chloramphenicol 500 mg PO QID tL, 7
wn];
** Pgn];lIyL Doxycycline An]pn]kin]Kaw];pgt];
pun]:tL,luk]:Agn],El: Em:pL;tgc].n}.Am],kiuc],
tan],tc];Pgn];sL.yL An]Aap]:etpQn]l}:nn].El: Am],pn]kin]yLSc] yc];etlIliUw]nn].yw]."
Sc]pQn]l}: pn]yL azithromycin 500 mg tL,wn];Tiniuc]:El: 250 mg Et,Aw]wn];Ti 2-5"
(hqc];yLtL,luk]:Agn], 10mg /kg OD tL, 3 wn];)" yL Azithromycin n}.pQn]yL An]Am],mI;eP;tL,
Em:pL;tgc]."
yL Cotrimoxazole, erythromycin, gentamicin El: amoxicillin siUw];n}. pun]:tL,tac];pQn]
SKrp].S]t}.Pat].S]nn]. yLAm],tiUw].Sc]"
Sc]yUt];yLpn] 48 sUw]:mUc];yw]. lUm];naw]Am],ygm];lUc];n}siuc] – pgc],wL: kUn];pQn] Aap]:etAm],

l}:pQn]tac];pQn]SKrp].S]t}.Pat].S]" wUn].Sgn],tUv];tac];pQn]tac],siUw]; (naw]K}:liUt]:Agk],'
tac];pQn]yQw]:nU' naw]S}:kC]:)"
168
lgc]:eh.kc]:
lgc]:lUlgm]lum];lL;p}a;yU,lItUw]sw]:kw],El: PQw]:mUv].tUw]St]; An]EP:siUw].mqc];l}:n}. pQn]An]lm],
lgc]:Et.Et.yw]." pn]tac];hn]Tiuc]kUn];tc];nm] yL,k}.kCL,tI:mqc];h};nm]' epL;etkCL,ekL: hC]:tL;yLeh.
kc]:' nuc]:SiUw]:KUw];nL siUw];n}.yw]." kUn];pQn]ekL: Tuk],lIPac].tUw]sw]:kw],hc];kUv];El: Sk].KUw];lQc];
nC];nm].m}: Am],nn] SC],nm].yLKL:siUw].mqc]; Permethrin 1% sgm];" tL,kUn];An]etl}:kCL,nC];piun].tI:
mI;EP;nm]nn]. pn]tac];hn]Tiuc] hC]:kin]yL Doxycycline tL,eh.kc]: (200 mg niuc]:wUc]:niuc]:pgk]:)"
emLyL' PU:hap],kan]p}a;yU,lI An]hQt];kan]nC];piun].tI:tac];pQn]EP:lam];nn].ekL: Tuk],lIkin]yLtL,eh.
kc]:yU,tL,eS,"
wk].Sin]; (yLeh.kc]:) yc];p},mI;wk].Sin]; (yLeh.kc]:)"
Aac]:Aic] tac];pQn]K}:liUt]:Agk], (kn] 15.3)' tac];pQn]yQw]:nU (kn] 15.3)' tac];pQn]naw]S}:kC]:

(kn] 15.3)'
tac];pQn]kac];Kqc]
eKL:piut],tI:pgc],
tac];pQn]kac];Kqc]n}. pQn]tac];pQn]An]niuc]: An]hQt];hC]:t}al}:eS An]mI;Pac]hac]:lm],lgc]:nn].Et.
kgp]:kgc]. An]siUw].mqc];pqk],TI:rI;yL;hQt];Agk],mL;nn]. ethQt];hC]:SQn]:AQn]KQc]:' SQn]:AQn]sk].siUw];n}.
yw]." kgp]:siUw].mqc];Kw]:kCL,sgm];h}g;sQp];' hU;sQp];liuk].El: pQn]mL;nn].yw]." sgm];nc],cw];l}a;tac];pQn] h}a.
hqc];mL;' kam]:niUw]. sgm];kac];ekL: etKQc]:Kqc]mL;eS SQn]:AQn]ekL:etsk].mL;" kgp]:sUic].n} sc],hgc].wL:
tac];pQn]kac];Kqc]nn].yw]." w}a;nn].ekL: etkin]yap],' Aiun]yap],' kam]:niUw].sgm];tUw]ekL:
etKQc]:Kqc]mL;eS etpQn] SQn]:AQn]KQc]:' SQn]:AQn]sk].siUw];n}.yw]." kgc].siUw];n}.n}.
etsac]:yU,nC];KI:tUw]St];siUw];n}.yw]."
tac];pQn]kac];Kqc]An]luk]:Agn],lqc]pQn]n}. pQn]tac];pQn]An]niuc]: tI:An]luk]:Agn],lqc] k}.pQn]kn]nn].
yw]." luk]:Agn],lqc] An]Em:mn]; Am],yam]:Sm];KQm]eh.kc]:tac];pQn]kac];Kqc]eSEl: l}:pQn]kn]nn].
yw]." km]:nm]Et.siUw].mqc];Kw]:kCL,sgm];S}alI tI:kqt];pQn]sQp];El:An]liuk].lm],Et. kgp]:sC].tiuw];KUw];Kgc]
An]Am],l}:KL:siUw].mqc];nn].yw]."
Pac]hac]:tac];pQn]
 pQn]sQp];tI:Am],mUt];SC]  kam]:niUw].KQc]:' pQn]can]; (tUw]yac], -
 mI;lUm];naw]Ait];Ait]; kac];Kqc])
 hiUw],Agk],  Aiun]kin]yap],"
 kam]:niUw].tc];tUw]KQc]:Kqc]"
sC].hgc]:lqp],eS Am],sac]:KUn].hLtac];pQn]l}:" tUv];Pac]hac]:tac];pQn]kUv]; sc],sac]:mk];mn]:tac];pQn]
lgc]:KUn].hLsiUw].mqc];pqk],TI;rI;yL;l}:n}.ekL: Am],lm],lgc]:tL,mk];mn]:tac];pQn]kL:hiuw]"
169
lgc]:yUt];yL
Suk]:sQp];pn]tc];mUt];" Aw]ngc]' Pun],' S}a;' pgt];lQk];lQk].siUw];n}.Agk],eS Suk]:pn]hC]:mUt];SC] (kn]
22.4)" Sc]kUn];pQn]kac];Kqc]eSEl: pQn]can];n}siuc] yUt];yLpn]sgm];nc],l}a;yUt];yLeS nc],huiw]
Am],hC]:SQn]:tac];TUv]:sC]pik].kCL,n}. pQn]An]lm],lgc]:Et.yw]."
lgc]:eh.kc]:El: Sm];yLeh.kc]: (wk].Sin];)

kUn];pQn]yam]:Sm];yLeh.kc]:tQm]TUn]:yw]. kUn];pQn]Am],l}:Sm];yLeh.kc]:
eP;An]etsp]; – yLTqm]hqc];yLliun];Sut]; tQm]TUn]:
tit];tac];pQn]l}: (3 pgk]:lUc];tC]:)
5 pI<lUc];tC]: 5 pI<Kiun]:niUw] 10 pI<Kiun]:niUw]
Et,Sm];pn]yLeh.kc]:
Am],tap]:Sm]; Am],tap]:Sm]; Sm] ; pn] y LTq m ] Am],nn] Sm];pn]tQm]:TUn]:
mI;eP;eA,* hqc];
(5 pgk]:tQm]tQm])
yLptI,KYI<wn'
yLptI,KYI<wn ptI<KYI<wnEl: yLptI,KYI<wn' ptI<KYI<wn
mI;eP;Suc]** yLptI,KYI<wn El:yLTqm]
hqc]; yLTqm]hqc];liun]; El: yLTqm]hqc];liun];Sut];
Sut];
*sQp];An]sp];tit];tac];pQn]l}:eA, - sQp];lQk].' y}a;vL;

** sQp];An]hQt];hC]:sp];tit];tac];pQn]l}:c}a: - mat],sQp];liuk].' tam],p}g;tiuk];' h}g;sQp];lup],hk];' h}g;sQp];
f};m}:' mI;Kgc]Km]yU,nC];tUw]' mat],sQp];An]hiuc]liUw] 6 sUw]:mUc];"
yLptI,KYI<wn Cloxacillin tL, 5 wn]; (tL,hqc];yLnn]. tUv]:tI:eKL:PiUm].Tqm])

yLPUim].hqc];yL Tetanus toxoid vaccine 0.5 ml IM Sm];pn]tI:Kqn]' kum],kUn]:
Sm];ptI,KYI<wnpn] tL,kUn];lUc] Sm];pn]ptI,KYI<wn 250 units Tetanus IM STAT hgp]:him];sQp];"
Sc]pUn]. 24 sUw]:mUc];yw]. Am],nn] h}a.hqc];mL; Am],nn] miUn]f};m}:mL;n}siuc]
pn]ptI,KYI<wn 500 units Tetanus"
tL,luk]:Agn], Am],wL:yC],lQk].kL:hiuw] Sm];pn]ptI,KYI<wn 250 units Tetanus IM
STAT
Aac]:Aic] (kn] 22.4)
170
naw]S}:kC]: (Typhoid fever)
lWc]:etfac].tUv];sgm];
eKL:piut],tI:pgc],
naw]S}:kC]:n}. pQn]tac];pQn] An]pQn]kgp]:siUw].mqc];pqk],TI;rI;yL; hgc].wL: (Salmonella typhi)" tac];pQn]
n}. etsp];tit];l}:sgm];tac];kin]El: miuw];An]Am],mUt];SC]nn].yw]." Kaw];tac];tI:wac];K}, EP:siwU ].
Et. 10-15 wn];nn].yw]."
Pac]hac]:tac];pQn]
kUn];pQn] An]lqp]:wL:pQn]n}. etmI;Pac]hac]:
 mI;lUm];naw] 38.5 Mc Am],nm]liUw]nn]. hiuc]liUw] 7 wn];"
 nC];liUt]: Am],hn]siUw].mqc];naw]nUk].' mI;lUm];naw]eS Am],hn]lgc]:tac];wL: naw]kgp]:Sc]El:
mI;Pac]hac]: sgm];nc],pL:tC]:n}.eSAn]An]
 tgc].Kiun]:
 tgc].kCL, Am],nn] tgc].pik].
 hqc];tgn]:hUw]sC]TiUc]; (mI;lUm]naw]yU,n}eStL. hqc];liUt]:tgn];Am],w};)
Pac]hac]:tac];pQn]n}. kgp]:Et,pQn]mgk]:wUc]:Agn]tac];Sut];nn]. etAm],hU.hn]lIEl: tL,KUn].hLmk];mn]:
tac];pQn]n}. etsac]:yap],w}."
Pac]hac]:tac];pQn]tac],siUw];Et. - hiUw].AUn]:' hUw]K}:' A}hqc]:' Am],KG]:kin]Kw]:"
wUc]:TiSgc] wUc]:TI.Sam]El: SI,
 Agk],tum],lqc]sgm];pum]El:nL:AUk];  Pgn];sL.tac];pQn] etsgm];lc]mL; (siUc].n}
 hqc];tgt],hUw]sC]TiUc]; (hqc];liUt]:tWn]: n}. pqk].Sm].wUn].Sgn],wL: kUn];pQn]Kqn];lI
 hqc];tgt],hUw]sC]TiUc]; (hqc];liUt]:tWn]: yw].n}eStL. Kuin];pQn]Kiun]:mL;l}:)"
Am],w};Kiun]:mL; sgm];nc],mI;lUm];naw])  S}:pgc],' liUt]:tUk];tac];nC];El: yC];hUc];Kw]:
 tp];El:mam].yC], tac];nC];kC]:"
 liUt]:pQn]kgc].
 pgt],kC]:
 mI;Pac]hac]:yC];hUm],Agk];eALkC]:El:sC]Suk].Sak].
lgc]:KUn].hLmk];mn]:tac];pQn] tac];pQn]naw]S}:kC]:n}. Aw]siUw].mqc];tI:liUt]: Am],nn]

K}Sn]lc] mL;lQc].kUv]; sc],etmk];mn]:tac];pQn]l}:"
171
lgc]:yUt];yL
 hp].w}.yUt];yLtI:kUn];pQn]nC];" pn]nm].yL IV" ORS Am],nn] IV (NSS Am],nn] RL)"
 Aw] Paracetamol yUt];yLpn] lgc]:lUm];naw]"
 yLptI,KYI<wn –
tac];liUk]:TI. 1
Ciprofloxacin luk]:Agn], 7.5 mg /kg BID tL, 5-7 wn];
kUn];lUc] < 40 kg 250 mg BID tL, 5-7 wn];
kUn];lUc] > 40 kg 500 mg BID tL, 5-7 wn];
tL,tac];pQn]An]h}a.hqc];/ kUn];pQn]An]Am],Aiun]l}:
Ceftriaxone IV/IM 50 mg/kg OD tL,7 wn];
tL,tgc];" " TUp];wL:yL ciprofloxacin n}. yUt];yLAm],tiUw].siUw].mqc]; ( Salmonella )

nC];piun].tI:pgt];hw]; yU,n}yw]." Sc]pn]yL ciprofloxacin yw]. cw];l}a;tac];pQn] Am],lI Kiun]:n}siuc]
hC]:Siup],pn]kCL,Tqc]: 10-14 wn];" Am],nn]ekL: l}a:pn]yL azithromycin Am],nn] ceftriaxone
tqn];"
 Sc]mI;Pac]hac]: yC];hUm],hUc];Kw]:kC]:n}siuc] hC]:SUc],kUn];pQn]kCL,yUt];yLtI:hUc];yL" (kn] 7.5)
 Sc]mI;Pac]hac]:An]h}a.hqc]; ( Sgzk].' lium];tUw]) – dexamethasone 3 mg/kg IV
nC];Kaw];tac]; 30 minit]." w}a;nn]. 1 mg/kg kU: 6 sUw]:mUc]; tL, 2 wn];"
lgc]:tum].tgp],etL,yLn}.etTiUc];" w}a;lc] 4-5 wn]; kUn];pQn]yc];etmI;lUm];naw]"

hC]:yiUn].kn]:pC].tUv];kgn]," kUv];kL:Sc]wL:Tiuc]wn];TI. 7 yw]. yc];mI;lUm];naw]yU,siuc]
hC]:Kiun];mk];mn]:tac];pQn]tac],siUw]; Am],,nn] siUw].mqc];tiuw]yLptI,KYI<wn
lgc]:eh.kc]:
tac];pQn]An]n}. pQn]tac];pQn]An]sp];tit];l}:c}a:" kin]tac];kin]El: nm].An]mUt];SC]n}. pQn]An]
lm],lgc]:liUw]piUn]:" pn]tac];hn]Tiuc] hC]:kUn];nC];hiUn];El: kUn];sgm];him];hgm];hiUn]; sC].Tac]P}a: An]Auit];
hUm]:w}.lIEl: w}a;eSkCL,P}a:mL;El: mUiw]:etkin]tac];kin]nn]. Tuk],lISuk]:miuw];kU:pgk]:" Sc]fac].tUv];hn]
Tiuc]wL:tac];pQn]EP:tiun];El: kUn];pQn]nm]siuc] tL,eh.kc]:Am],hC]:tac];pQn]eP:h}a.hqc]; (pQn]hL:) Agk],
kCL,nm]nn]. Tuk],lIpgc],lqc];Tiuc]emLyL"
yLeh.kc]: (wk].Sin];)
mI;yLeh.kc]: An]pQn]yLkin]" kUv];kL:nC];piun].tI:pgt];hw];yU,n}.Et. Am],mI;yLeh.kc]:naw]S}:kC]:"
Aac]:Aic] tac];pQn]naw]nUk]. (kn] 15.2)' SKrp].St}.Pt].S]](kn] 15.1)' tac];pQn]yQw]:nU

(kn] 15.1)' TI,pI, (kn] 21.5)
172
15.2 tac];pQn]An]pQn]kgp]:siUw].mqc];pL,rL,S}. (Parasitic

Diseases)
tac];pQn]tin]sac]. (Lymphatic Parasitic Diseases)
eKL:piiut],tI:pgc],
tac];pQn]An]n}.n}. pQn]kgp]:siUw].mqc];An]sac]:kgp]:kin]yU,sgm];piUn]: (pL,rLS}.) Sqn];niuc]:nn].yw]."
Pac]hac]:tac];pQn]n}. yU,tI:siUw].mqc];tI:pqk],piUc]:kn]El:Sc]' lgc]:tum].tgp],tUw]kUn]; Am],miUn]kn] El:
Sc] etpqk],piUc]:kn]kCL," luk].tI:yuc];KUp];eSEl: tac];pQn]sac]:sp];tit]; kUn];ekL.niuc]:kCL,sU;ekL.niuc]:
nn].yw]." pL,rL,S}.(siUw].mqc];) n}.etKw]:kCL,nC];tUw]kUn];hw]; sgm];Piw]nc]yw].etKw]:kCL,sgm];nm].liUc]
kUn];eS etkCL,yU,Sw];nC];mak],ln]nm].liUc]" tac];pQn]tin]sac]. An]l}:hn]pqk],piUc]:kn]Et.etpQn]
wU;KYI;rI;yL; pn]KrWp].tI< (Wucheria bancrofti) El:prUkI;yL;mlL,yI<(Brugia malayi) nn].yw]."
Pac]hac]:tac];pQn]
 etsac]:Am],mI;Pac]hac]:tac];pQn]Sc]" Sc]pQn]tac];pQn]Kaw];hiuc]mL;
 naw]eShUw]K}:' mak],ln]kC]:' KUm];sgm];Piw]nc]'  etpQn]tin]sac].mL;
mac]:pgk]:etsac]:mI; siUw].mqc];pqk],TI;rI;yL;  tac];pQn]tgc].man];Ait],
Kw]:mL;PiUm].sgm];Tqc]:"  mak],kqw];kC]:' yQw]:pL;liUt]:"
 km]:nm]Et. mak],ln]tI:cam]:KLkC]:"  yQw]:pL;ngc] (yQw]:Kun],' yQw]:etmiUn]
 kgp]:nm].liUc]etkCL,Aiut];w}.El: etkC]:sgm]; nm].nUm];' kgp]:nm].liUc]pgc],El: etmI;
tin]' miuw];' nL:AUk];' K},lm]siUw];n}.yw]." nm].liUc] pL;mL;sgm];nC];yQw]:)
Pgn];sL.Pa},lc]tac];pQn] kgp]:Tat]:AI,nUw],Sin]nUw]eP;l]nC];liUt]:El: etsac]:hQt];hG]:pgt],kC]:" sgm];

piun].tI: pgt];m}:hw];yU,n}. kUn];pQn] An]mI;Tat]:AI,nUw],Sin]nUw]eP;l]nC];liUt]:n}. (km]:nm] kac]Kiun];)
etA}hqc]:' epL;TUv]:sC]etmI;SQc]hiut].hat].' TUv];sC]kp].' mI;lUm];naw]' mac]pgk]: sac]:A}Agk],liUt]:
siUw]; n}.yw]."
 epL;kUt],sqt]:tUv];liUt]: (kac]Kiun]; Kqn];lI) ethn]vL; m},KrUw],PI<lL<Er;y]"
 Sc]Aw]kgn]:niUw].lQk]. tI:mak],ln]mL;kUt],tUv];n} ethn]vL;siUw].mqc];m},KrUw],PI<lL<Er;y]
Am],nn] kUt],sqt]:tUv];Tat]:prUw],tin];nC];liUt]: An]tiuk];etL;siUw].mqc];ekL:l}:"
 kUt],sqt]:Tat]:prUw]tin];nC];yQw]:"
173
lgc]:yUt];yL
 Albendazole PO 400 mg STAT*
El:
 Doxycycline 200 mg OD tL, 6 wUc]: **"
Am],nn]
 Diethylcarbamazine (DEC) 1 mg/kg tL,wn];Agn]tac];Sut];El: Kiun]:mL;tik];tik]; etL,Tiuc]
2 mg/kg TID (wn];TI. 4-21)" Siup],pn]sgm];hqc];yLn}.tL, 21 wn];" (etl}:fac].Pgn];sL.yL
miUn]nc], - lUm];naw]' hUw]K}:' kam]:niUw].sQp]; ' Am],K}:kin]Kw]:' tgc].KUn].) siUw];n}.yw]." yL
DEC n}. etlItgn]:tL, yUt];yLKL:siUw].mqc]; m},KrUw],PI;lL<Er;y]El: mqc];tiUk],kUn];lUc]
miUn]nc],wU;KYI;rI;yL; pn]KrWp].tI< (Wucheria bancrofti) El: prUkI;yL;mlL,yI< (Brugia
malayi) siUw];n}.yw]:" kin]yLpgk]:lQw]kUv]; etlac].siUw].mqc];l}: 50% yw]."
*tL,tgc];" " Sc]kUn];pQn]pL;tgc]. yU,nC];Kaw];tac];Sam]liUn]Agn]tac];yU,n}siuc] yL,pn]yL
albendazole"
**tL,tgc];" " Sc]kUn];pQn]pL;tgc].yU,n}siuc] yL,pn]yL doxycyline"
piUc]piun].cw]:lum];lL;tUw]kw], tL,kUn];pQn] An]pQn]tin]sac]. –
 Aw]Sp].pYL,El:nm].yQn]An]mUt];SC] Suk]:tI:pQn]tac];pQn]nn].pn]El: sQt].pn]lIlIhC]:hqc]:"
 miUw]:ngn];kac]Kiun];nn]. hC]:Aw]KLP}a,tI:pQn]nn]. yUk].w}."
 lQn]:hqc];pn]KLAn]pQn]tL,eS,"
 hQt];hC]:nQp].tin]nQp].miuw];mUt];SC]"
 tuiw];Kqp];tin] An]Sac],etL,"
 yUt];yLh}g;sQp]; Am],nn] h}g;lgk]: (kn] 22.4)"
lgc]:eh.kc]:
 eh.kc]:yL,hC]:yuc];KUp]; - ngn];nC];Sut]; Am],nn] tL;yLeh.kc]:yuc];"
 nC];piun].tI:An]k}.pQn] tac];pQn]tin]sac].nm]nn]. Aw]yL Diethylcarbamazine (DEC) El:
albendazole yUt];yLeh.kc]:pn]kUn];tc];nm] pQn]pgk]:pQn]pgk]: sgm];nc],Kaw];yam];"
 PQw]:mUv].yuc];"
yLeh.kc]: p},mI;yLeh.kc]:" tL,hC]:mI;yLeh.kc]:nn]. p},pQn]l}:"
Aac]:Aic] lgc]:lum];lL;yUt];yLsQp];(kn] 22.4)"
174
tac];pQn]naw]nUk].
lWc]:etl}:fac].tUv];sgm];tac];pQn]
tL,hUw]y}g:nn]. hC]:kCL,lUtUv];tI:pp]. SMRU"
eKL:piut],tI:pgc],
tac];pQn]naw]nUk].n}. pQn]kgp]:siUw].mqc];pL,rL,S}.Sqn];niuc]: An]luk].tI:yuc]; AenL,PrI,tUw]Em:eS hQt];
hG]:sp];tit];Tiuc]kUn];nn].yw]." An]hn]vL;sgm];lqn]lin] miUc];T};-mUic];man]:n}. etmI;siUw].mqc];naw]nUk].
plat],SmUw]tI,yam],tc]; 4 Sqn]; tI:An]hgc].wL:plat],SmUw]tI,yiUw]<l] ePLSI,prm] (PF)'plat],S
mUw]tI,yiUw]<l] wI,pqk].(PV)' plat],SmUw]tI,yiUw]<l] mL,lL,lI,yL,l](PM) El:plat],SmUw]tI,yiUw]<l]
AUw],Epl] (PO) - An]n}.pQn]eA," An]pQn]naw]nUk].eS t}akm]:nm]Et. pQn]kgp]:siUw].mqc];plat],S
mUw]tI,yiUw]<l] ePLSI,prm] (PF) nn].yw]." nC];piun].tI: An]hw];yU,n}.siUw].mqc];plat],SmUw]tI,yiUw]<l]
ePLSI,prm] (PF) n}.pQn]siUw].mqc]; An]mI;lgc]:tiuw]yL Suc]liUw]piUn]:yw]."
Pac]hac]:tac];pQn]
 mI;lUm];naw] hUm]:tc];Pac]hac]:eSAn]An] miUn]nc], hUw]K}:' kt];Sn],' hiUw],Agk],' kUn].Kiun]:
sgm]; kam]:niUw].El: eKL:etL,lup],' Am],K}:kin]KG]:yqm].' hUw]mw];' hak]:' tgc].Kiun]:' tgc].kCL,)
 mac]pgk]: kUn];pQn]etlium];tUw] Am],nn] pQn]can];eSEl: mL;Tiuc]tI:hgc]:yL"
 mac]pgk]: miUw]:kUn];pQn]mL;Ennn]. Am],mI;lUm];naw]"
 km]:nm]etpQn]liUt]:sac]El: tp];yC],"
kUn];pQn]kU:ekL. An]mI;lUm];naw]nn]. hC]:wUn].Sgn],lgc]:naw]nUk].w}.

Agn]tac];kgn],
kUt],sqt]:siUw].mqc];nC];liUt]: (Am],nn]) Aw]nm].SC]liUt]:eS kUt],sqt]:ekL: KUn].hLmk];mn]:tac];pQn]
l}:yU,yw]."
 Sc]nC];liUt]: mI;Tat]:TrUw],pUw]r}. (T) n}siuc]pgc],wL:pQn]tac];pQn]naw]nUk]."
 eKL:tgp],tI:Agk],mL;ethUm]: (PF + PV) ekL;pQn]l}:"
 Sc]wL:hn]vL;siUw].mqc];kmI,tUw],S}.nC];liUt];kUv];n}siuc] pQn]kUn];mI;siUw].mqc];kUv]; Am],sC]:kUn];An]
Am],yU,lIEl:Am],tap]:yUt];yLpn]ekL:l}:" Am],p},l}:hp].yLnaw]nUk].mL;tQm]tQm]eS Sm].kUt],
sqt]: vL;siUw].mqc];kmI,tUw],S}.nC];liUt];n}siuc]hC]:Aw] (MAS3, AS7D7, Q7D7) eSyUt];yLpn]"
175
tL,tgc];
 miUw]:p},pn]lgc]:yUt];yLnaw]nUk].nn]. hC]:kUt],sqt]:tUv];siUw].mqc];kU:km];" kac]Kiun]; Am],nn]
miUw]:cw]; l}a;kp].kin]; tgn]:tL,kUt],sqt]:liUt]:Am],l}:nn]. tL,KUn].hLmk];mn]:tac];pQn]El:
yqk]:Sqn]; siUw].mqc];wn];lc]nn]. hG]:Aw]liUt]:tL,kUt],sqt]:w}.tL,eS," kgp]:l}:pC].eKL;tgp],liUt]:
hC]:Agk],mL;Tqc]: wn];niuc]:eSEl; yL,hC]:l}:Et,yUt];yLTiUc];"
 Sc]lgc]:kUt],sqt]:liUt]:pQn] (Negative) n}hC]:kUt],sqt]:Tqc]:km];niuc]:"
yL,lium]; - tL,mk];mn]:tac];pQn]n}.etl}:kUt],sqt]:liUt]:kUv];n}eStL.
lgc]:h}a.hqc];tac];pQn]nn]. hC]:tUv];Pac]hac]:kUn];pQn]Aw]"
tL,tUv];Tiuc]tac];nm]eA,siUw].mqc];nn]. tUv];tI:lgc]:kUt],sqt]:liUt]:"
tL,lgc]:h}a.hqc];nm]eA,nn]. hC]:tUv];Pac]hac]:kUn];pQn]eS tqp];tt];"
lgc]:eh.kc]:
yuc];AenL,PrI,tUw]Em: tI:An]KUp];miUw]:hUw]Km]:El: kac]Kiun];n}.yw].An]sac]:hQt];hG]: sp];tit];siUw].
mqc];" ngn];nC];Sut]; (An]lIliUw]piUn]:Et. Sut];Es:yLAn]sC].tiuw];l}:hiuc])' nuc]:kUn]yaw];SiUw]:Kqn]yaw];
mUiw]:kac]Kiun];' tL;yLeh.kc]:yuc];' t}:f};liup]:yuc];siUw];n}. eteh.kc]:l}:tL,ekL.lC]ekL.niuc]:" l}a;kin]yL
naw]nUk].tL,eh.kc]:n}. Am],epL;lIsC].tiuw];tL,pgt];tgn]:hw];yU," KUc];kan]eh.kc]:tac];pQn]naw]nUk].nn].
ethUm]:pL; pn]tac];hU.kQw],lUv]:tac];pQn] kUt],sqt]:tac];pQn]sQm]sw].El: KUn].hLmk];mn]:yUt];yL
tac];pQn] (km]:nm] tL,kUn];An]mI;Pac]hac]:sp];tit];l}:c}a: miUn]nc],luk]:Agn],El: Em:pL;tgc].)
Sit],yLyuc];El: sC].tiuw];Sut];Es: yLsiUw];n}.yw]."
yLeh.kc]:
etL,Tiuc]etL:lQw]Et. p},mI;yLeh.kc]:"
Aac]:Aic]
yC];hUm],AWk];eALkC]: (kn] 15.1)' naw]S}:kC]:(kn] 15.1)' naw]t}.f}. (kn] 15.3)' ta}luim]; (kn]
7.1)' pQn]can];(kn] 7.2)' liUt]:sac] (14.1)"
KUn].hLmk];mn]:lgc]:h}a.hqc]; - sgc],kUn];pQn] pQn]naw]nUk].An]h}a.hqc];hiuw]?

miUw]:kUt],sqt]:El: mk];mn]:tac];pQn]naw]nUk].yw]. mUiw]:etyUt];yLpn]nn]. etl};tqp];tt];wL:
naw]nUk].An]pQn]nn]. sgc],h}a.hqc];huiw] Am],h}a.hqc];" mUiw]:etyUt];yLnn]. hC]:kUt],sqt]:nac];yic]; AL,yu
(15-50) pI< kU:ekL.wL: sgc],pL;tgc]. Am],pL;tgc]."
176
piUc]mk];mn]:tac];pQn]naw]nUk].An]h}a.hqc];
 siUw].mqc];naw]nUk].Kw]:Agk];eAL kUn];pQn]etlium];tUw]w}."
 liUt]:sac]h}a.hqc]; Hb< = 6g/dl (Hct <18 %) Am],,nn] Pac]hac]:liUt]:sac]h}a.hqc];
 mak],kqw];lU. yQw]:Am],mI; Am],nn] yQw]:Ait];Ait]; ( niuc]:wn];eA,liUw]
400cc)
 nm].Kw]:pgt], TUv]:sC]PC];El: l}:cin];SQc]TUv]:sC]tC]:kUn]:pgt],
 Tat]:kiUw]wan]nC];liUt]:tUk]; hiUw],Agk],' PiUk],liUc]' sm]etlium];tUw]'Dextro
<2.5mMol(<45mg/dl)
 pQn]Sgzk]. hqc];tgt],liUt]: > 130El: <80/50 p}atin]p}amiuw];kt];
 liUt]:sium];Agk], liUt]:sium];Agk],tI:hiUk],' yQw]:pL;liUt]:' hak]:Agk],liUt]:'
Agk],Piun],lqc] sm].sgm];Piw]nc]
 Pac]hac]:kQw],lUv]:Agk];eAL lium];tUw]' sC]pit];sC]pgt]; sC]Suk].Sak].' pQn]can];
 Tat]:nm].kUt];nC];liUt]:nm] TUv]:sC]hqc];
 mI;Tat]:eh,mUw],klUw],pin],nC];yQw]: yQw]:lqc] Am],nn] km],lqc]
tL,tgc];" " Sc]mI;Pac]hac]:eSAn]An]ekL: pgc],wL:pQn]naw]nUk].h}a.hqc];yw]." kUv];kL:kUn];pQn]km]:nm]

etmI;Pac]hac]:nm]liUw] 2 Tiuc] 3 An]"
Pac]hac]:naw]nUk].h}a.hqc];tac],siUw];
 hqc];eA,nL,eSEl: Am],kin]Am],yqm].l}:ekL.lQw]
 mI;siUw].mqc];naw]nUk].nC];liUt]:nm] (nC];mQt].liUt]:lqc]niuc]:luk]:n}. mI;siUw].mqc];nm]liUw] 4 tUw])
 lUm];naw]Suc]pUn].tI: ( Suc]liUw] 40.5 cM )
 niUw].liUc]
 hak]:h}a.hqc];
177
Pac]hac]:naw]nUk].h}a.hqc];
(mI;/Am],mI;)
pQn]naw]nUk].h}a.hqc]; naw]nUk].Am],h}a.hqc];
yUt];yLsgm];nc], eKL:tgp], MS
pQn]naw]nUk].h}a.hqc];
(D)
yUt];yLsgm];nc],
MS = nm]liUw] 4 %
Am],mI;Pgn];sL.sgm];lc]kgp]:
tac];pQn]naw]nUk]. (C)
yUt];yLpn]sgm];nc], naw]
MS = nm]liUw] 4 % nUk].pk],ktI,(puc],man],)
(A,B)
lgc]:yUt];yL
A. lgc]:yUt];yLwI,pqk].(PV)pk],ktI, (yUw];yUw];)' AUw],Epl](PO)Am],nn] mL,lL,lI,yL,l](PM)
Sc]siUw].mqc]; (wI,pqk].' AUw],Epl]' mL,lL,lI,yL,l]) mI;nC];liUt]:siuc] (Am],sC]: EP,l]SI,prm],)

 tL,lUm];naw]nn]. pn]yL Paracetamol"
 yUt];yLtac];pQn]naw]nUk]. ( tUv];tI:lgk];Kgc]:yUt];yLTqw]niuc]:)
 kUt],sqt]:tUv];kUn];pQn] An]pQn]h}a.hqc];l}:nm](Em:pL;tgc].El:luk]:Agn],lQk].liUw] 2 KUp],)
El: tqp];tt];wL:sgc],Tuk],lI hp].w}.yUt];yLtI:hgc]:kUn];pQn]nC];hiuw]"
kUn];pQn]naw]nUk]. PV Am],nn] PO eS Aw]yL Chloroquine

Sqn];lQw]yUt];yLn}.w};eSh}ayw].Kuic]:niuc]: Kiun];etpQn]Kiun]; An]pQn]Kiun];n}.
kgp]:wL:siUw].mqc];kCL,liuw]:Sw];w}. tI:nC];tp];nc], hypnozoites nn].yw]." mI;yL Primaquine
Sqn];lQw]kUv]; An]etyUt];yLhC]:siUw].mqc]; tI:An]Sgn].p}a:yU,nC];tp]; hG]:t}al}:"
178
kUv];kL: yL Primaquine n}. sac]:hQt];hC]:mQt].liUt]:lqc] tL,kUn];Kat],Tat]: G6PD Kw]lU.lqw]l}:nn].
yw]." nc],hiuw]etyUt];yL Am],hC]:l}:pQn]eP;nn]. Tuk],lIpn]yL Primaquine 15mg OD tL, 14
wn];" pn]yL Primaquine niuc]:wUc]:niuc]:pgk]: tL,kUn];pQn]Kat],Tat]: G6PD n}.pQn]lgc]:tm];sC]l}:yU,"
Sc]Am],mI;KiUc]:km].kqm] tL,kUt],sqt]:Tat]: G6PD n}siuc] tL,kUn];pQn] naw]nUk]. PV El: PO
nn].Tuk],lIpn]yL Primaquine niuc]:wUc]:niuc]:pgk]:kUv];"
Primaquine dose kUn];lUc] 15mg (base) PO OD x 14 wn]; ( etAm],l}:pn]Em:pL;tgc]. )

luk]:Agn], 0.25 – 0.5 mg/kg PO OD x 14 wn];
Am],nn] (Kat],Tat]: G6PD Am],nn] Am],sac]:kUt],sqt]: G6PD l}:)
kUn];lUc] 45 mg niuc]:wUc]:niuc]:pgk]: x 6 wUc]: / 30 mg niuc]:wUc]:niuc]:pgk]: x 8
wUc]:
luk]:Agn], 0.75 mg/kg niuc]:wUc]:niuc]:pgk]: x 8 wUc]:
nC];pp]. SMRU pn]tac];hn]Tiuc]w}.wL: kgp]:kUw]mI;Pgn];sL.yLsgm];lc]mL;El: Tuk],lIlUlgm]tUv]; kUn];

pQn]lIlI kU:wn];eS yUt];yLpn]tL, kUn];An]km];km];pQn]Kiun];kUv];" tI:hgc]:yLnC];miUc];T};Et. tL,
kUn];pQn]naw]nUk].n}. pn]yL Primaquine tL, 14 wn];kUv];" nc],hiuw]etlUt];ygm]; lgc]:Pgn];sL.yL
sgm];hUc];Kw]:El:lm];S}:nn]. Tuk],lIkin]yL Primaquine sgm];tac];kin] eSAn]An]" hgc]:yLpgt];
sQc],san];wn];Agk],AL,SYL.n}.Et. kgp]:yLAm],epL;tiUw].El: ethn]pn]yL Primaquine nm]liUw]tac],
tI:" tL,tI:hgc]:yL Tuk],lIpn]kL:hiuw]nn]. Tuk],lIAup],AUw]; tiUc],pac],tc];emLyL (hqc];yLAn]pn]l}:
nm]Sut];tL,kUn;] lUc] 30 mg PO OD x 14 wn];)"
tL,tgc];" " tL,kUn];pQn] An]mI;Pac],hac]:naw]nUk]. PV h}a.hqc];nn]. hC]:yUt];yLsgm];nc],
l}a;yUt];yL naw]nUk].h}a.hqc]; (miUn]nc], PF h}a.hqc]; - tUv];tI: l}a;yUt];yL D)
kUn];pQn]An]Am],sC]:Em:pL;tgc].pQn]naw]nUk]. (PF + PV ) hUm]:kn]

kUt].sqt]:liUt]: tUv];siUw].mqc];naw]nUk]. – PFT, PFGT, PVT, PFT
tL,kUn];pQn] An]mI;siUw].mqc];naw]nUk].nm]liUw]niuc]:Sqn];nn]. kgp]:naw]nUk]. PF n}. pQn]naw]nUk].An]

h}a.hqc];liUw]piUn]:El: Tuk],lIyUt];yL sgm];nc],l}a;yUt];yLnaw]nUk]. PF"
kgp]:n} tac];liUk]:lgc]:yUt];yLEt.etpQn] artesunate – mefloquine (MAS 3)' kUv];kL: tL,

Aw]yLsiUw];n}. yUt];yLnn]. mI;cw];l}a;An]Am],Tuk],lIsC]. sgm];nc],pL:tC]:n}."
miUw]:Am],p},yUt];yLEl: miUw]:yUt];yLyU,nn]. Tuk],lIkUt],sqt]:sgm];nc],pL:tC]:n}.
(k) sgc],naw]nUk].h}a.hqc];hiuw]
(K) Sc]pQn]nac];yic];n} hG]:kUt],sqt]:tUv];wL: sgc],pL;tgc]./Am],pL;tgc].
(c) nC];Sgc]liUn]pUn].mL;n}. sgc],kUn];pQn]l}:hp].yL Mefloquine mL;hiuw]?
(s) AL,yuEl:nm].nk];kUn];pQn]
(S) kUt],sqt]:tac];nm]eA,siUw].mqc];naw]nUk]. (Sc]wL:mI; 4% siuc] pgc],wL:mI;siUw].mqc];nC];liUt]:nm])
(v) miUw]:yUt];yLyU,nn]. hC]:kUn];pQn]l}:kin]Kw]:kin]nm]."
179
yLlium];yUt];yL Pac]hac]:tac];pQn]tac],siUw]; miUn]nc],lUm];naw]' hak]:' Tat]:nm].nC];tUw]eA,El:Tat]:
kiUw]wan]nC];liUt]:eA,siUw];n}.yw]."
B. naw]nUk]. PF (An]Am],Suk].yuc]:) Tm],mtL, - Am],mI;Pac]hac]:h}a.hqc];

 mI;EP,SI,prm], nC];liUt]:eA,liUw] 4%"
 kUn];pQn]Am],l}:pL;tgc].
 yUt];yLlum];lL; tI:hgc]:kUn];pQn]ngk]: - tUv];tI:lgk];Kgc]:yUt];yL – Tqw] 2, 3, 4

 tL,luk]:Agn],lQk].liUw] 2 KUp],nn].Sc]pQn]l}:hp].w}.tI:hgc]:kUn];pQn]nC];"
kgp]:wL:sac]:lqk]:l}a:pQn]naw]nUk]. h}a.hqc];mL;" Sc]Am],pQn]l}: nC];Kaw];tac]; 24
sUw]:mUc];An]Et,pQn]nn]. hG]:kUn];hiUn];Kw]lum];lL;pn] lIlI"
C. mI;siUw].mqc];naw]nUk].EP,SI,prm]
nC];liUt]:nm]n} - Am],mI;Pac]hac]:h}a.hqc];Sc]
eStL. Am],mI;Pgn];sL.sgm];lc]Suk].yuc]:Sc] - mI;EP,SI,prm], nC];liUt]:eA,liUw] 4%"
- kUn];pQn]Am],l}:pL;tgc].
 hp].kUn];pQn]w}.tI:hgc]:kUn];pQn]nC];" tUv];Tiuc]lum];lL;kUn];pQn]lIlI" hC]:kin]Kw]:El:nm].l}:"

 yUt];yLsgm];nc],l}a;yUt];yLnaw]nUk],pk],ktI,
 pn]yLtL,tac];pQn]naw]nUk]. (sgm];nc],lgk];Kgc]:yUt];yL Tqw] 5 -6 )"
 Sc]cw];l}a;kUn];pQn]h}a.hqc];mL;n} hC]:sC].l}a;yUt];yLtac];pQn]naw]nUk].h}a.hqc];"
 lgc]:etpQn]liUt]:sac]n}. km]:nm]Et. luk]:Agn],etpQn]l}:nm]" kUt],sqt]: miUw]:hp].Kw]:yL'
miUw]:tQm] 24 sUw]:mUc];El: mUiw]:etlUc];hgc]:yL"
D. naw]nUk].h}a.hqc];El: siUw].mqc];naw]nUk].Kw]:Agk];eAL
 hp].kUn];pQn]w}.tI:hgc]:kUn];pQn]nC];"
 pn]yLtL,tac];pQn]naw]nUk]. (sgm];nc],lgk];Kgc]:yUt];yL Tqw] 7 )"
 tUv];Tiuc]lum];lL;kUn];pQn]lIlI"
 yUt];yLsgm];nc],l}a;yUt];yLnaw]nUk].pk],ktI,
 nC];Kaw];tac];sUw]:mUc];Agn]tac];nn]. hG]:sqt]:tUv]; lum];m}:/hqc];tgt],liUt]:/hqc];liUt]: El:sgc],
kUn];pQn]lium];tUw]/Am],lium];tUw] siUw];n}.kU:sUw]:mUc];" w}a;nn].Kqn]: 2 sUw]:mUc]; Am],nn] 4
sUw]:mUc];yw]. kUt],sqt]:pn]niuc]:pgk]:"
 mUiw]:p},pn]yL Quinine Am],nn] w}a;eSpn]yw]. Am],nn] Sc]cw];l}a;kUn];pQn] h}a.hqc];mL;n}
hC]:kUt],sqt]:Tat]:kiUw]wan]tUv];" tL,kUn];pQn] Em:pL;tgc].El: luk]:Agn], (miUw]:SCac];pn]yL
180
Quinine IV)nn]. hC]:Aw] dextrostick kUt],sqt]:Tat]:kiUw]wan]pn] niuc]:wn]; 4 pgk]:"
 Sc]mI;Pac]hac]:liUt]:sac]El:Sc] Tat]:eh,mUw]klUw],pin],pQn] <7.3 (Hct <22)El:Sc] hC]:kUt],
sqt]:pn] Tat]:eh,mUw]klUw],pin],kU:wn];"
 Sc]kUn];pQn]wL:yQw]:eA, Am],nn] Sc]kUn];pQn]lium];tUw]siuc] hG]:kUt],sqt]:tac];nm]eA,yQw]:pn]"
 hC]:kUt],sqt]:siUw].mqc];naw]nUk].kU:wn];"
 yUt];yLpn]lgc]:Pgn];sL.sgm];lc]naw]nUk].
lgc]:Pgn];sL.sgm];lc]naw]nUk]. An]pQn]km]:nm]
lUm];naw] pn] paracetamol' Aw]PL:ym];nm].sQt].tUw]pn]' pn]yL Asprin (kn] 7.4
)"
(yL,pn]yL Asprin hC]:luk]:Agn],El:kUn];An]mI;klQt].liUt]: (platelet)
eA,)
lium];tUw] hC]:yUt];yL sgm];nc],l}a;yUt];yLsiUw].mqc];naw]nUk].Kw]:Agk];eAL (kn] 7.1 )"
pQn]can]; l}a;yUt];yL - miUw]:Et,pQn]can];nn].hC]:pn] Diazepam IV/IM/PR (kn] 7.2)"
Tat]:kiUw]wan] Sc] Dextro <2.5 mMol <45mg/dl n}siuc] Aw] D50 IV 1ml/kg eS
nC];liUt]:eA, yUt];yLpn]" (kn] 10.1)
liUt]:sac]h}a.hqc]; Sc]hn]wL:Tuk],lISCac];liUt]:siuc] hC]:SCac];liUt]:pn] (kn] 14.3 )
nm].Kw]:pgt], hG]:kUn];pQn]nc]:" lUt];ygm];lgc]:SCac];liUt]:pn]" pn]yL furosemide"(kn] 8.2 )
Sc]Am],yQw]: Sc]Tat]:nm].kUn];pQn]eA,siuc] hG]:pn] Ringers/NSS " Sc]lium];tUw]siuc]
hG]:SC],S}ayQw]:pn]"
siUw].mqc];tac],siUw];Kw]: tL,kUn];pQn]naw]nUk].h}a.hqc];n}. lgc]:etsp];tit];siUw].mqc];tac],siUw];l}:n}. c}a:"
miUw]:yUt];yLnaw]nUk].yU,nn]. Sc]kUn];pQn] mI;lUm];naw]Kaw];hiuc]El:
lium];tUw]siuc] hG]:pn] IV ceftriaxone, ampicillin, gentamicin"
kuic].kac].luim];tUw] hG]:pn] NSS RL w};w};" hG]:pn]etL,Tiuc] Bp > 90mmHg (kn] 7.6)"
Sc]mI;Pac]hac]: Aap]:etpQn]SWYk]. hC]:pn] IV ceftriaxone, ampicillin,
gentamicin hUm];tc];yLnaw]nUk]."
 miUw]:kUn];pQn]mI;hqc];Kam],mL;yw].n}ekL: hC]:kiut];yut];yL IV/IM eS Et,pn]yLkin]km];lQw]" tUv];tI:
lgk];Kgc]:l}a;yUt];yL – Tqw] 7"
E. naw]nUk]. An]Aw]lgc]:Aap]:etpQn]l}:eSyUt];yL
kUn];pQn] mI;Pac]hac]:naw]nUk].tqt]:tqt]:etL;etL;eS Sc]Am],kUt],sqt]:liUt]:l}: (Am],mI;hgc]:lqp],)
Am],nn] nC];liUt]:Am],mI;siUw].mqc];naw]nUk]. Am],nn] kUn];pQn] l}:kin]yLnaw]nUk].tI:hiUn];mL;n}siuc]
hC]:yUt];yLpn] sgm];nc],lgc]:Aap]:etpQn]l}:eSEl: yUt];yLnaw]nUk].pn]"
 kUt],sqt]:siUw].mqc];naw]nUk].pn]Tqc]:km];niuc]:"
 hC]:kUt],sqt]:tUv];lgc]:h}a.hqc];tac];pQn]eS
 hC]:yUt];yLsgm];nc],naw]nUk].pk],ktI,(puc],man],)" tUv];tI:lgk];Kgc]:l}a;yUt];yL – Tqw] 8
181
15 tac];pQn]An]sp];tit];l}:
lgc]:yUt];yLnaw]nUk]. An]Aw]lgc]:Aap]:etpQn]l}:eSyUt];yL
 hG]:hp].kUn];pQn] w}.yUt];yLtI:hgc]:kUn];pQn]nC];"
 hG]:yUt];yL sgm];nc],l}a;yUt];yLnaw]nUk].An]h}a.hqc];" tUv];tI:lgk];Kgc]:l}a;yUt];yL – Tqw] 7
F. Em:man]; pQn]tac];pQn]naw]nUk].
 kgp]:wL:kUn];pQn]siUc].n}n}. sac]:kiuc].kac].lqk]:l}a:pQn]naw]nUk].An]h}a.hqc];El: Sc]pQn]l}: hG]:hp].

kUn];pQn]yUt];yLtI:hgc]:kUn];pQn]nC];"
 tUv];tI: lgk];Kgc]:l}a;yUt];yL – Tqw] 9,10,11,12,13 "
kUn];pQn] tI:An]Am],Tuk],lIpn]yLnaw]nUk].
pn]yLnc],pL:tC]:n}.Am],l}: -
MEFLOQUINE: Am],mqn]:tc];yL' pL;tgc].yU,' luk]:Agn],mw]liUw] 5kg' miUw]:pUn].mL; 63
wn];nn].yam]:kin]yL mefloquine' kUn];An]mI;lUm];mL:mU' kUn];ygc],'
kUn];sac]:pQn]can];' hUw]mw];yU,' kUn];An]lium];tUw]yU,El: pQn]niUw].liUc]h}a.hqc];
siUw];n}. yL,pn]yL mefloquine"
DOXYCYCLINE: Am],mqn]:tc];yL' pL;tgc].yU,' luk]:Agn],lQk].liUw] 8 KUp],"
ARTESUNATE: Am],mqn]:tc];yL"
PRIMAQUINE: Am],mqn]:tc];yL' pL;tgc].yU,"
DAILY PRIMAQUINE: kUn];pQn]An]Kat],Tat]: G6PD yU, (pn] primaquine pQn]wUc]:l}:)"
tL,tgc]; kQw],lUv]:lgc]:yUt];yL
1. siUw].mqc];naw]nUk]. sgm];lqn]lin] ettiuw]yL (yLAm],tiUw].) naw]nUk].An]sC].yU,km]:nm]" Sc]Am],
sC].tiuw];yLAn]liUw]yU,n}.lIlIn}siuc] Am],hiuc]Am],nan];yLAn]etyUt];yLtac];pQn]naw]nUk].ekL:
etAm],liUw]Sc]yw]."
2. lgc]:yUt];yLtI:An]lI Am],nn] An]kum],TUn]:An]wL:nn]. hG]:kUn];pQn]kU:ekL. l}:hp].yLhqc];yL
(Dose) An]Tuk],mqn]:El: l}:hp].yLkum],kum],TUn]:TUn]:nn].yw]."
3. mac]pgk]: miUw]:yUt];yLpn]nn]. kgp]:kUn];pQn]hak]:El: ethQt];hG]:Siup],yUt];yLyap]," (km]:nm]Et.
yL mefloquine)"
 miUw]:p},pn]yLnaw]nUk].nn]. hC]:pn]yL paracetamol Am],nn] Asprin Am],nn] Aw]PL:
sup].nm].sQt].tUw]pn]Agn]tac];kgn],"
 w}a;kin]yLyw]. 30 minit].nn]. Sc]kUn];pQn]hak]:pqt]:n}siuc] hG]:Sm]; Metoclopramide IM
182
pn]El: w}a;nn]. 10 minit]. hC]:pn]kin]yLKiun]; dose tQm]tQm]"
 w}a;kin]yLyw]. 1 sUw]:mUc]; Sc]kUn];pQn]hak]:pqt]:n}siuc] hG]:Sm]; Metoclopramide IM pn]eS
w}a;nn]. 10 minit]. hG]:pn]kin]yLKiun]; dose Kiuc]:niuc]:"
 w}a;pn]kin]yLpgk]:km];Sgc]yw].nC];Kaw];tac];niuc]:sUw]:mUc]; Sc]kUn];pQn]yc];hak]:yU,n}siuc] pqk].Sm].
wL: Sm]; Metoclopramide IM El: lUm];naw]Am],mI;eStL. hG]:yUt];yLsgm];nc],naw]nUk].
An]h}a.hqc];"
 w}a;kin]yL MFQ kCL,yw]. 1 sUw]:mUc]; Sc]kUn];pQn]hak]:n}siuc] Am],tap]:pn]yLTqc]:km];niuc]:"
 pqk].Sm].wL: pn]yL Metoclopramide IM eStL. Sc]kUn];pQn]hak]:h}a.hqc];nL, etL,epL;
Am],kiny ] Ll}:n}siuc] hp].kUn];pQn]w}.tI:hgc]:kUn];pQn]nC];eSh]G:Sm];pn]yL Quinine/ artesunate/
artemether etL,epL;kiut];hak]:"
4. Sc]pn]yLkin]yw]. cw];l}a;kUn];pQn]h}a.hqc];mL;n}siuc] –
 hG]:lqk]:l}a:la};yUt];yLsC].yLnaw]nUk].An]hqc];Suc]eSyUt];yL" mUin]nc],sC].(Quinine Am],nn]
Artemisinin)
 Sc]kUn];pQn] kin]yL Quinine yw]. 2 dose nC];Kaw];tac]; 24 sUw]:mUc];pUn].mL;n}siuc] yL,pn]
yL PiUm].hqc];yL Quinine lL;lL;"
5. kgp]:yLptI,KYI<wneS pQn]S}:kC]:n}. pQn]Pgn];tum].tUiw].h}a.hqc];liUw]piUn]: Kgc]yL clindamycin El:
sac]:hQt];hG]:Tiuc]t}al}:" kgp]:n} mUiw]:etpn]yLnn]. Tuk],lISp];lqc];EnkUn];pQn]wL: kgp]:yLeS
tgc].sac]:lU.l}:" Sc]tgc].lU.n} hC]:kiut];kin]yLkm];Siuw]:" Aic],niUw]cw];l}a;tgc].kCL,eS hG]:yUt];yL
pn]sgm];nc],cw];l}a;" (Tqm]Tat]:nm].pn])" miUw]:cw];l}a;h}a.hqc];nn]. Tuk],lISm];pn]nm].yL IV El:
metronidazole "
tL,tgc]; -
kUn];pQn]tI:An]mam].Am],lI (mam].Am],hQt];kan]l}:lIlI) Am],nn]Am],mI;mam].nn].tL,etyUt];yLhG]:
siUw].mqc];naw]nUk].h}akCL,pqt]:mUt];n}. etTiUc];nL,eSSc]yUt];yLh}ayw].eStL. yc];ethn]siUw].mqc];naw]
nUk].tuik].mI;nC];liUt]:yU,"
cw];l}a;An]Kuik].Km]
 Am],mqn]:tc];yL Quinine El: Chloroquine:
sC].tiuw];yLAn]l}:mL;tI: artemisnin" Am],nn]ekL: pn]yL dexamethasone' pC].tUv]; 10
minit]. yw]. sc],pn]yLnaw]nUk].El: hC]:lUlgm]tUv];lIlI" Sc]mI;Pac]hac]:Am],mqn]:yL (miUn]nc],
- mI;tum], Agk],mL;sgm];tUw]' nL:kiuc].kac].kC]:mL;' TUv]:sC]yap],mL;) n}siuc]hC]:pn]yL dexamethasone
PiUm].Tqc]:eS kum];Tic];pn]hqc];liUt]:El: Agk],SI,kYin], (tUv];tI: kn] 7.6 lgc]:kuic].kac].luim];tUw]
kgp]:Am],mqn]:tc];yL)"
 Am],mqn]:tc];yL Artesunate:
pn]yL Quinine hUm]:tc]; Tetracycline , doxycycline Am],nn] clindamycin
183
 tL,luk]:Agn],lqc]
tL,Sm];yL IV nn]. Sc]hLSQn]:AQn]yap],n}siuc] hG]:Sm];pn]yL IM quinine Am],nn]
artemether" tL,lgc]:hac]:hqn];yLSm]; Quinine nn]. hC]:tUv];tI:eKL:PiUm].Tqm])"
kUn];pQn] An]mI;Pac]hac]:Am],mqn]:yL Am],epL;h}a.hqc];nn]. pn]yL pL,mI,tgn],yw].kUv];ekL: pn]yLnaw]

nUk].niuc]:KYot].l}:yU," Sc]wL:etAan];hQt];siUc].n}n}siuc]tL,eteh.kc]:lgc]:Am],mqn]:yLh}a.hqc]; Am],nn]
Am],hG]:pQn]Sc]nn].Tuk],lIhp].kUn];pQn]w}.yUt];yLtI:hgc]: IPD" Sc]kUn];pQn]lat]:wL: Am],mqn]:tc];yLeS
An]An]n}tk];etAm],l}:pn]yLnn].lL;lL;" yUt];yLlgc]:Am],mqn]:tc];yLnaw]nUk]. (Am],mqn]:yL
Ait];Agt];El:Am],mqn]:yLh}a.hqc];' kn] 7.6 )"
Tqw] kUn];lUc](An]Am],sC]:Em:pL;tgc].) luk]:Agn],lQk].liUw] 8KUp],
(A) lgc]:yUt];yLnaw]nUk]. PV,PF,PO Sm],mtL, (yUw];yUw];)
1 CQ3
Sc]km];km];pQn]Kiun]; - hG]:wUn].Sgn],pn] primaquine
(B) naw]nUk].Sm],mtL, (Am],mI;Pac]hac]:h}a.hqc];' EP,SI,prm]nC];liUt]: eA,liUw] 4% )
2 nC];Kaw];tac]; 2 liUn]pUn].mL;nn]. MAS 3 MAS 3
Am],l}:kin]yL MFQ
3 nC];Kaw];tac]; 2 liUn]pUn].mL;nn]. AS 7 D7 AS 7
l}:kin]yL MFQ Am],nn]
MAS 3
4 nC];Kaw];tac];42 wn];pUn].mL;nn]. AS 7 D7 AS 7
l}:kin]yL AS7D7 Am],nn]
AS 7
(C) nC];liUt]: mI;siUw].mqc];naw]nUk]. EP,SI,prm]nm]eStL.Am],mI;Pgn];sL.sgm];lc]An]Suk].yuc]:Sc]
5 nC];Kaw];tac]; 2 liUn]pUn].mL;nn]. MAS 7 MAS 7
Am],l}:kin]yL MFQ
6 nC];Kaw];tac]; 2 liUn]pUn].mL;nn]. Hyper AS 7 D7 Hyper AS 7
l}:kin]yL MFQ Am],nn]
MAS 3
(D) naw]nUk].h}a.hqc]; (PV,PF)El: lgc]:yUt];yLnaw]nUk]. An]Aap]:eth}a.hqc];
7 lium];tUw]' hUw]mw];' kCc]' AS IVyw]. AS El: D7 sgm];lc] AS IVyw]. AS 7 sgm];lc]
mak],kqw];lU.' liUt]:sac]h}a.hqc]; Am],nn] Am],nn]
Hb <6' kuic].kac]. luim];tUw]' AM IMyw]. ASEl: D7sgm];lc] AM IMyw]. AS sgm];lc]
nm].Kw]:pgt],' Tat]:kiUw]wan]nC]; Am],nn] Am],nn]
liUt]:eA,' liUt]:tUk];tac];nC];' QIV yw]. Q7 D7 sgm];lc] QIV yw]. Q sgm];lc]
yQw]:pL;liUt]:' nC];yQw]: mI;Tat]: Sc]kUn];pQn]Et,kin]l}:
nm].kUt];nm] Sc]kUn];pQn]Et,kin]l}:hc];kUv]; hc];kUv];yw].n} hC]:kiut];
yw].n} hG]:kiut];yut];pn]yLSm]; yut];pn]yLSm];km];lQw]"
km];lQw]"
184
(E) lgc]:yUt];yLnaw]nUk]. An]Aap]:etpQn]

8 l}a;yUt];yLnaw]nUk]. Sm],mtL, Q 7 D7 Q 7 D7
(F) lgc]:yUt];yLnaw]nUk]. An]Aap]:etpQn]
Case pL;tgc]. yU,nC];Kaw];tac]; pL;tgc]. yU,nC];Kaw];tac];
Sam]liUn]Agn]tac];yU, hUk];liUn]/kw]:liUn]
9 naw]nUk].PF Sm],mtL, CQ 3 CQ 3
10 naw]nUk]. PF Sm],mtL,Am],nn] 1st attack: Q7D7 supervised 1st attack: Q7D7
hUm]:kn] 2nd attack: AS7 C7 supervised
3rd attack: AS7 C7 2nd attack: AS7 C7
3rd attack: AS7 C7
11 naw]nUk]. Sm],mtL, (Am]mI;Pac]hac]:
h}a.hqc];' EP,SI,prm],nG];liUt]: nm] Hyper AS7 C7
liUw] 4%)
12 naw]nUk].h}a.hqc]; (PF El: PV)
El: lgc]:yUt];yLnaw]nUk]. pn] AS IVyw].' pn] AS El: C7 sgm];lc]
An]Aap]:etpQn]h}a.hqc];l}:
13 lgc]:yUt];yLAn]Aap]:etpQn]
Q7 C7
naw]nUk].l}:
eKL:kCam];pgt]; - tUv];tI:Tqc]:nL:lik]:niuc]:
hqc];yL (Dose) - tUv];tI: eKL:PiUm].Tqm]
tL,tgc]; - Sc]mI;n} sC].tiuw]; KUw],AL,tam], (Artemeter + Lumefantrine sC].hUm]:kn]) eSyUt];yL

naw]nUk]. Sm],mtL, (An]Am],Suk].yuc]:) l}:"
185
kak],eSL;tL,lgk];Kgc]:yUt];yLnaw]nUk].
186
*SCac];pn]yL Quinine IV hC]:lUc];l}g;l}g;miUn]nc],SCac]; IV" KUn];elL;hC]:hqc];yL eA,lUc];Am],nn] "

**Sc]tqk]:kn]tUv];tc]; Quinine IV n}siuc] Artesunate IV n}.ethQt];hC]:lgc]:t}aeA,lUc]; 30%"
***Sc]wL:Am],mI;hqc];yL clindamycin mk];mn]:w}.tL,luk]:Agn],n}siuc] hC]:sC]. A7"
KiUc]:miuw];kUt],sqt]:naw]nUk].l}a;Kn]w}; (Paracheck)
tac];pQn]naw]nUk].n}. hn]Pac]hac]:kUv];eS Am],sac]:mk];mn]:tac];pQn]l}:" nC];piun].tI: An]mI;siUw].mqc];
naw]nUk].tiuw]yLl}al}aSqn];nn]. sC].kUt],nG];hgc]:lqp],eS KUn].hLmk];mn]:tac];pQn]n}. etTuk],mqn]:liUw]
piUn]:"kUv];kL: tgn]:tL,mac]tI:tI:Am],mI;m},klUw]SkUp]. Am],nn] mI;Kaw];yam];eA,nn]. sC].KiUc]:miuw];kUt],
sqt]:naw]nUk].Kn]w}; (RDT) n}.etlIliUw]piUn]:"
pk];piUc]
lgk];l}a;An]n}.n}. etkUt],sqt]:KUn].hL prUw],tin];Sqn];niuc]: (siuw]:Aqn],tI,kYqn],)" Sc]Pgn];tgp],En
wL: prUw],tin];An]wL:nn].mI;nC];liUt]:hw]; (positive) n}siuc] pgc],wL: mI;siUw].mqc];naw]nUk].nC];liUt]:n}
yw]." (ethn]SQn]:SIEl: SQn]:kum];Tic];)" KiUc]:kUt],sqt]: An]KUn].hLl}:Et.-
1. HRP – 2 (prUw]tin]; 2 An]mI;hqt].S]tI,tin];nm])- km]:nm]Et.etsC]. Paracheck-Pf test
nC];piun].tI:n}." siUw].mqc];EP,SI,prm], Sqn];lQw]kUv]; An]hQt];prUw]tin]; HRP – 2 Agk],mL;"
 Sc]wL:mI;siUw].mqc]; EP,SI,prm],n}siuc] KiUc]:kUt],sqt]:etEn positive (PUp].vL;tac];pQn])
 Sc]mI;siUw].mqc];naw]nUk]. PV,PM Am],nn] PO n}siuc]KiUc]:etEn negative"
An]lm],lgc]: tL,tgc];
 Pgn];tgp], tI:An]Pit]; ( tUw]yac], - lgc]:kUt],sqt]:En negative kUv];kL: kUn];pQn]
Sm].mI;siUw].mqc]; PF) Pgn];tgp],siUc].n}n}. etpQn]l}: miUw]:kUn];pQn] mI;Pac]hac]:tac];pQn]h}a.hqc];
El: mI;siUw].mqc];tac];pQn]nm]pUn].tI: (Sc]siUw].mqc];Kw]:yU, nC];mQt].liUt]:lqc]tc];mUt]; 20%)"
lgc]:pQn]siUc].n}n}. Am],k}.l}:hn]eStL. kgp]:Pgn];tgp],EnwL: negative n}ekL: Am],Tuk],lI
mk];mn]:wL: naw]nUk].h}a.hqc];" Tuk],lItqp];tt]; sgm];nc],Pac]hac]:tac];pQn]tac],siUw];sgm];"
 w}a;eSsiUw].mqc];naw]nUk]. Kw]:hQt];tI:kUn];pQn]pUn].kCL, 1 liUn]yw]. Pgn];tgp],yc];etEnyU,"
kgp]:n} An]kUn];pQn] sc],hLpQn]naw]nUk]. pUn].mL;niuc]:liUn]eSEl: yUt];yLh}alIkCL,yw].nn].
Pgn];tgp], etPit];yU, (EnwL: positive eStL.Am],pQn]naw]nUk].)"
2. pLDH (parasite Lactate Dehydrogenase )- optiMAL (Diamed, Switzerland)

KiUc]:kUt],sqt]:An]n}. etkUt],sqt]:tL,siUw].mqc];tac];pQn] PF tc];An]Am],sC]: PF l}:" kUv];kL:
Am],sac]:kUt],sqt]: tI:mI;siUw].mqc]; naw]nUk].hUm]:kn]l}:El: Am],sac]:sqk],EP siUw].mqc];naw]nUk].
PV,PO, PM siUw]:n}.l}:"
187
lgc]:Epl]Pgn];tgp],KiUc]:kUt],sqt]: pL,rL,KYqk].
Pac]hac]:tac];pQn]naw]nUk].
Pgn];tgp],pQn] Pgn];tgp],pQn]
positive
negative
Sc]wUn].Sgn],wL:pQn]naw]nUk].
wUn].Sgn],wL:pQn]
naw]nUk]." h}a.hqc];(*) hC]:kUt],sqt]:
pn]yL Tqc]:km];niuc]: Am],nn]
yUt];yLpn] sgm];nc],l}a;
Chloroquine
yUt];yLnaw]nUk].h}a.hqc];"
Sc]Pgn];tgp],pQn]
positive(**)n}
Aic]niUw]cw];l}a;siUw].mqc];
Sc]Am],l}:yUt];yLnaw]nUk]. Sc]l}:yUt];yLnaw]nUk].mL; naw]nUk].nm]eA,eS
mL; nC];Kaw];tac]; 2 liUn] nC];Kaw];tac]; 2 liUn] yut];yLpn]sgm];nc],
cw];l}a;
Aw]l}a; MAS3 Sc]kin]w}.nC];Kaw]; Sc]kin]w}.nC];Kaw];tac];

eSyUt];yLpn] tac]; 3 wUc]: 3 wUc]:pUn].mL;
Sc]kUn];pQn]l}:kin]yLtQm]tQm] Sc]kUn];pQn]Am],l}:kin]yLtQm]
TUn]:TUn]:El:Tuk],lUlgm] tQm]TUn]:TUn]:El:Am],l}:
tUv];sgm];lIlIn}siuc](***) Tuk],lUlgm]tUv];sgm];mL;
lIlIn}siuc]
pC].tUv];" Siup],yUt];yLpn]" yUt];yLpn]

kUt],sqt]:tUv]; sgm];nc],Am],yw].tUw]:
Tqc]:km];niuc]:"
188
tL,tgc];
(*) yLlium];wL:pqk].Sm].wL:Pgn];tgp],pQn] negative n}eStL.Am],wL:l}:wL:Am],pQn]naw]nUk].h}a.hqc];"
(**) Pgn];kUt],sqt]:tI:tqk],lqc];lIAn]wL:nn]. liUt]:tL,kUt],sqt]: kCL,tiUw].vL;KiUc]:kUt],sqt]:
miUw]:lC]ekL: EnTqw]lqc]tI:SQn]:yC],tqk],lqc];lInn].yw]."
(***)l}a;yUt];yLkum],TUn]:n}. l}:kin]yL MAS3 Am],nn] A7 T 7(D7) Am],nn] Q7 T7 (D7)
tQm]tQm]TUn]:TUn]:El: Tuk],lUlgm]tUv];sgm];lIlI" (tUv];Kiun];tI:pp]. SMRU)"
15.3 tac];pQn]An]pQn]kgp]:siUw].mqc];w};rt].S](Viral
Diseases)
tac];pQn]naw]liUt]:Agk], (Dengue Fever)
eKL:piut],tI:pgc],
tac];pQn]An]n}.n}.pQn]kgp]:siUw].mqc];w};rt].Sqn];niuc]:eS kgp]:yuc];eA.tI;S]KUp];El:l}:sp];tit];mL;nn].
yw]." yuc];siUc].n}n}. Kw]etKUp];miUw]:kac]wn];eS km]:nm]Et.etpQn]Kaw];PUn]" tac];pQn]naw]liUt]:Agk],
sac]:pQn]l}: 2 Sqn];"
1. tac];pQn]naw]liUt]:Agk],Sm],mtL,El:
2. kgp]:naw]liUt]:Agk],El:liUt]:tUk],tac];nC];eSpQn]kuic].kac].luim];tUw] Am],nn] kgp]:naw]liUt]:Agk],
El: liUt]:tUk];tac];nC];eS mI;lUm];naw]"
Pac]hac]:tac];pQn]
Sc]kUn];pQn]mI;Pac]hac]: nc],pL:tC]:n}.siuc] Pac]hac]:tac];pQn]An]etmI;l}:
hG]:wUn].Sgn],lgc]:pQn]naw]liUt]:Agk],  hUw]K}:h}a.hqc];
 mI;lUm];naw] 2 Tiuc] 7 wn];eSAm],hn]mI;  pQn]Piun],lqc]sgm];Piw] - km]:nm]Et.et
siUw].mqc];naw]nUk].nC];liUt]:El: Am],hn] pQn]sgm];nL:' eKL;El: nL:AUk];"
lgc]:An]hQt];hG]:mI;lUm];naw]Sc]eS mI;eS
 mak],ln]kC]:
eKL:eKL: sgm];nc],pL:tC]:n}.
 tp];yC],El:sQp];
 mI;Pac]hac]:liUt]:tUk];tac];nC];' (tourniquet
 km]:nm]Et. mam].etAm],yC],"
test positive*)
 kUn].Kiun]:sWm];niUw].sgm];tUw]h}a.hqc];
 pQn]tum],lqc]nc],tac];pQn]naw]liUt]:Agk],
(etmI;sgm];KLsgm];miuw];)"
 kQt],liUt]:ygm];lUc]; (thrombocytopenia)
189
15
*tourniquet test positive – Aw]PL:pat]:Kqn]tL,tqk]:hqc];liUt]:nn]. pat]:Kqn]kUn];pQn]eS
miUw]:tqk]:tUv];hqc];liUt]:pL:tC]:' pL:niUw]nn]. hC]:kiut];yut];w}. 5 minit]." w}a;nn].ekL: mL;np].tUv];
mQt].lqc]tI:wUc];w}. (2.5 Sin],tI,mI,tL,)niUw]PL,miuw];" Sc]mI;mQt].lqc]nm]liUw] 20 n}siuc] An]n}. pgc],wL:
pQn]tac];pQn]liUt]:Agk],yw]." kUv];kL: An]Tuk],lIw}.StiEt. nC];kUn];pQn]hUw]pak], 20 n}. pqk].Sm].wL:
Am],sC]:pQn]kgp]:naw]liUt]:Agk],eS pQn]kgp]:siUw].mqc];w};rt].S]tac],siUw];ekL: sac]:Enl}:siUc].n}miUn]kn]"
ygn].liUt]:Agk],kgp]:tac];pQn]naw]liUt]:Agk],El:
naw]ygn].liUt]:Agk],kgp]:tac];pQn]naw]liUt]:Agk], El: kiuc].kac].lium];tUw]
 Pac]hac]:tac];pQn]Et. etmiUn]nc],Pac]hac]:tac];pQn]naw]liUt]:Agk],El: liUw]nn].
 w}a;eSlUm];naw]lUc];yw]. 3 Am],nn] 4 wn];yw].kiuc].kac].lium];tUw]Kiun]:mL;
 mI;Pac]hac]:liUt]:Agk], - liUt]:Agk],sgm];KU;lc]' hiUk],' mac]pgk]:sgm];hU;kUn]:
 etmI;tum],lqc]Agk],mL;tc];tUw] km]:nm]Et. sgm];tin]' sgm];miuw];' nL:AUk];' nL:
 niUw].Am],liUc]
km]:nm] lgc]:mk];mn]:tac];pQn]n}.Et. ettUv];Pac]hac]:Aw]kUv];" kUv];kL:sC].hgc]:lqp]:eS kUt],sqt]:
Aw]ekL: KUn.] hLmk];mn]:tac];pQn]l}:yU,"
lgc]:yUt];yL
1. naw]liUt]:Agk],
Am],mI;yLtL,yUt];yLtac];pQn]An]n}. lgc]:yUt];yLEt. pQn]tL,eh.kc]:lgc]:Suk].yuc]:kUv];"
 Aw] Paratacemol eS yUt];yLlUm];naw]pn]"
 yL,pn] Asprin lL;lL; - kgp]:wL: sac]:hQt];hG]:pn]hLkQt];liUt]: lU.h}a.hqc];liUw]kw],eS et
hQt];hG]:liUt]:Agk],hqc];liUw]kw],l}:"
 Tat]:nm].nC];tUw]hqc]:- pn]nm].kiUw] ORS " Sc]kUn;] pQn]Am],kin]nm].l}:n}siuc] hG]:Sm]; RL Am],
nn] NSS pn] (tUv];tI:lgk];Kgc]:pL:tC]:) tL,l}a;hac]:hqn];nm].kiUw]nn]. hG]:tUv];tI:
eKL:PiUm].Tqm]tac];lc]"
 pC].tUv];sgm]; Pac]hac]:lm],lgc]:El: tac];nm]eA,yQw]:An]yQw]:Agk],mL;El: hC]:fac].tUv];
Pac]hac]: An]etkuic].kac].luim];tUw]l}: km]:nm]Et. nC];wUc]:kac] 3-7 wn]; Am],nn] miUw]:lUm];
naw]ygm];lUc];"
190
2. kuic].kac].luim];tUw]ygn].liUt]:Agk], kgp]:tac];pQn]naw]liUt]:Agk],El: naw]ygn].liUt]:
Agk], kgp]:tac];pQn]naw]liUt]:Agk],
 tUv];tI:Pqn],lgk];Kgc]:pL:tC]:
kgp]:wL: nc],hiuw]ettm];wac]; l}a;hQt];Sac]:eh.kc]: pQn]Kk].pQn]tgn]: tL,Am],hC]:tac];pQn] EP:tiun];
w};nn]. Sc]fac].Stihn]wL: kUn];pQn] pQn]tac];pQn]n}.nm]mL;n}siuc] hG]:pgc],sU;Tiuc]emLyL"
lgc]:eh.kc]:tac];pQn]
yuc];eA,tI;S] An]sac]:hQt];hG]:EP:tiun]; sp];tit];l}:n}. etk}.KUp];kac]wn];" kgp]:n} tL,eh.kc]:n}.
Sc]ngn];kac]wn];ekL: Tuk],lIngn];nC];Sut];' nuc]:SiUw]:Kqn]yaw];' kUn]KLyaw];' tL;yLeh.kc]:yuc];KUp];
Am],nn] t}:yLhiup]:yuc];"
yLeh.kc]:
yc];p},mI;yLeh.kc]:"
Aac]:Aic] naw]nUk].(15.2)' SKrap]. t}.Pat].S] (15.1)' tac];pQn]yQw]:nU (15.2)'

naw]liUt]:Agk],(15.2)"
191
15
naw]liUt]:Agk],
Pac]hac]:liUt]:Agk],' EnwL:pQn]tac];pQn]' kQt];liUt]:tUk];' mQt].liUt]:lqc]nm]Kiun]: "
Sc]wL:kUn];pQn]Am],kin]nm].l}: Am],nn] eA,n}siuc] Sm];pn]yLnG];AQn]" w}a;eS niuc]:sUw]:mUc];yw].
Kiun];Tt];Sac]tac];pQn]Kiun];"
Sc]wL:lIKiun]:mL; Sc]wL:Am],lIKiun]:mL;
hqc];TUv]:sC]lIKiun]:' hqc];liUt]:tgn]:lIKiun]:El: hqc];TUv]:sC]lI' hqc];liUt]:tgn]:El:
yQw]:lImL;n}siuc] tac];nm]mQt].liUt]:lqc]Am]],lIKiun]:mL;n}siuc]
yWm];pn]hqc];yL hC]:liUw] 1-3 mls/kg/hr" tiUw];PiUm].pn] hqc];yLhC]:Tiuc] 10ml/kg/hr"
w}a; 1 sUw]:mUc];yw]. Kiun];Tt];Sac]Kiun];"
Sc]Siup],lIKiun]:mL;tik];tik];
miUw]:tQm] 24 sUw]:mUc];nn]. Sc]wL:lIKiun]:mL;
hC]:kiut];yut];pn] yL IV" Am],lIKiun]: yWm];pn]hqc];yL hG]:liUw] 1-3 mls/kg/hr"
pQn]Sgzk].El: naw]ygn].liUt]:Agk], kgp]:tac]; Sc]Siup],lIKiun]:mL;tik];tik];

pQn]naw]liUt]:Agk], miUw]:tQm] 36sUw]:mUc];nn].hG]:kiut];yut];pn]yL
tiUw];PiUm].pn]hqc];yL hG]:Tiuc] 10ml/kg/hr" IV"
w}a; 1 sUw]:mUc]; 1 pgk]: hG]:sqt]:hqc];liUt]:tgn]:El:
hqc];TUv]:sC]" 2 sUw]:mUc]; 1 pgk]: hG]:kUt], sqt]: Sc]wL:Am],lIKiun]:mL;
tac];nm]eA,mQt].liUt]:lqc] hqc];TUv]:sC]lI' hqc];liUt]:tgn]:El: tac];
nm]mQt].liUt]:lqc] Am]],lIKiun]:mL;n}siuc]
hG]:wUn].Sgn], SUc],kUn];pQn] kGL,yLtUw]nC];wQc];"
Sc]wL:lIKiun]:mL; SCac];pn] nm].SC]liUt]: 10ml/kg/hr" w}a; 1
hqc];liUt]: hqc];liUt]:tgn]:lIKiun]:mL;eS sUw]:mUc];yw]. Kiun];Tt];Sac]Kiun];"
tac];nm]mQt].liUt]:lqc]ekL:etlImL;
nC];Kaw];tac]; 6 sUw]:mUc]; hC]:pn]hqc];yL 10
mls/kg/hr yw].yWm];lUc];mL; 5 yw]. 3 "
Sc]wL:lIKiun]:mL;
Sc]Am],lIKiun]:mL; nC];Kaw];tac]; 2-4 sUw]:mUc];
pn]Agk],SI,kYin]," SCac];liUt]: hC]:lUt].ygm]; nm].SC]liUt]:pn] 3-6
pn]" SUc],kCL,yLtUw]tI:hUc]; mls/kg/hr "
Sc]Siup],lIKiun]:mL;tik];tik]; yLAn]tUv];tac];pQn]l}:lI "
 Siup],pn]yL IV kCL,"
Sc]Siup],lIKiun]:mL;tik];tik];
 Sc]tQm] 48 sUw]:mUc];yw].
 Siup],SCac];pn]yL IV 3-6mls/kg/hr
hG]:kiut];yut];pn]yL IV"
 Siup],pn]yL IV kCL,"
 Sc]tQm] 48 sUw]:mUc];yw].
kiut];pn]yLIV
 miUw]:lIKiun]:mL;nn]. Aic]niUw]nm].An]mI;
nC];tUw]eS Tuk],lIpn]yLyQw]:kCL,"
192
Agk];eALsQp];kC]:kgp]:siUw].mqc];w};rt].S](Encephalitis)
eKL:piut],tI:pgc],
kgp]:siUw].mqc];w};rt].S]Sqn];niuc]: Kw]:kCL,nG];Agk];eALeS hQt];hG]:Agk];eAL l}:kiuc].kac].sQp];kC]:h}a.hqc];nn].
yw]. (miUn]nc], herpes simplex)" mac]:pgk]:tac];pQn]Agk];eALsQp];kC]:h}a.hqc];n}. pQn]kgp]:Pgn];sL.
tac];pQn]tac],siUw]; miUn]nc], tac];pQn]kgc].mLygc],' tac];pQn]mak],lqc];' Sit].Plit].S] Am],nn]
tUw],mUw]plat].S]mUw]<Sit].S] siUw];n}.yw]."
tac];pQn]Agk];eAL An]lm],lgc]:Sqn];niuc]:Et. pQn]tac];pQn]Agk];eALsQp];kC]:kYpan],nn].yw]." tac];
pQn]An]n}.n}. pgt];sQc],san];wn];Agk],AL,SYL. miUc];Ain];tI;yL;El: pSiPik].pgt];san];siUw];n}. et
pQn]nm]eS pQn]An]lm],lgc]:Et.Et.yw]." tac];pQn]An]n}.n}. etpQn]l}:kgp]:yuc];Sqn];niuc]:
An]kiUt],mL;sgm];nL; tI:An]mI;nm].TUm]:yU,tL,eS," siUw].mqc];w};rt].S] An]hQt];hG]:pQn]Et. pQn]
w};rt].S]PelL,wI, An]km]:nm] etyU,nC];mUEl: nUk].siUw];n}.yw]."
nC];pI<niuc]:n}. kUn];etpQn]mgk]: 30,000-50,000 ekL.eSEl: kUn];pQn] 30% l}:t}akgp]:tac];pQn]n}."
tL,siUw];Am],t}ann] 30% etmI;Pac]hac]:tum].tiUw].SQn]:AL,yUc],Agk];eALh}a.hqc];" Sc]yam]:pQn]pgk]:niuc]:
yw].nn]. miUn]l}:hqc];eh.kc]:tL,etAm],pQn]Tqc]:tc];sUw]:"
Pac]hac]:tac];pQn]
kUn];An]vL;siUw].mqc];Kw]:km]:nm]n}. etAm],mI;Pac]hac]:tac];pQn]Sc]" etk}.pQn]hUw]K}:El: mI;lUm];
naw]tL, 1 Tiuc] 6 wn];kUv];" lk]:KnL,tac],siUw];Et. Am],tUv];Sqc]SC]l}:' hqc];AUn]:' kgc]ekL:Kiun]:
El: pQn]can]; siUw];n}.yw]." tac];pQn]n}. ethQt];hG]:h}a.hqc];l}:liUw] Tiuc]t}apgt];tC]:' ta}Kuic]:tUw]'
pQn]can];' ta}luim];El: Tiuc]t}al}:nn].yw]." w}a;pQn]tac];pQn]eS An]sac]:kiut];w}.Et. t}aPak],'
hUnUk],' lgc]:Kiun]:yC],p}a;sC] p}a;hU.TiUc];El: sC]Am],man],siUw];n}.yw]."
Aw]K}Sn]lc] mL;kUt],sqt]:" kUt],sqt]:ptI<KYI,wnSqn];niuc]: An]mI;nC];K}Sn]lc]eS mk];mn]:
tac];pQn]l}: (tk];etl}: sC].hgc]:lqp],An]Kuik].tgn];)" kUt],sqt]:tUv]; Tat]:kiUw]wan]nC];liUt]:'
siUw].mqc];naw]nUk]. (tL,hG]:yqk]:kn]l}:tc]; naw]nUk].Kw]:Agk];eAL)" Sc]mI;Pac]hac]: hqc];mip],nC];Agk];eAL
(miUn]nc] hU;tLlm] Am],PQc],kn] Aw]Sqc]f};Sgc],tUv];yw]. Am],mI;lgc]:tUc].niuc] hUw]sC]tgn]:TiUc];hqc];
(50 pgk]:lUc];tC]: tL,kUn];lUc])El: TUv]:sC]Am],PQc],n}siuc] Am],Tuk],lIAw]K}Sn]lc]yw]." pqk].Sm].
wL: Am],sac]:Aw] K}Sn]lc]n}eStL. Sc]wUn].Sgn],wL: pQn]yC];hUm],Agk];eALkC]:n}siuc] hG]:pn]yLptI<
KYIwn tL,siUw].mqc];pqk],TI;rI;yL;w}.Agn]tac];kgn],"
lgc]:yUt];yL
 Sc]pQn]l}: hG]:pn]yL acyclovir" yUt];yLpn] sgm];nc],Pac]hac]:tac];pQn]"
 yUt];yLlgc]:sQp];/kUn].Kiun]:" (kn] 7.5)
 tL,lgc]:pQn]can]; (kn] 7.2)"
193
15
 tL,kUn];pQn]tI:An]lium];tUw] (kn] 7.1)"
 sC].l}a;Aw] KYI<wnC];tUw]yUt];yLKiun]; - nUt]:tUw]pn]' tUc].niuc]tin]miuw];pn]" (hG]:kam]:niUw]. pQn]
nc],kw],Kiun];El: eh.kc]:Am],hG]:kam]:niUw].Kqc]tUw])
 Sc]p},sac]:lat]:l}:wL:Am],sC]:yC];hUm],Agk];eALkC]:kgp]:siUw].mqc];pqk],TI;rI;yL;n}siuc] yUt];yLpn]sgm];
nc],tac];pQn]yC];hUm],Agk];eALkC]: kgp]:siUw].mqc];pqk],TI;rI;yL; etL,epL;mk];mn]:tac]; pQn]l}:tqk],lqc];
(kn] 15.1)"
lgc]:eh.kc]:
kgp]:pgt];tgn]:tI:hw];yU,n}. tI:kiUt],yuc]; (nm].nC];tUc]:nL;) nm]nL,El: mac]:pgk]:mac]lC] lgc]:kum];Tic];
yuc];n}. Am],epL;mI;Pgn];Sc]kL:hiuw]" lgc]:Aw]nm].kw],Agk], SC],nm].mC],pn]n}. tL,mac]tI:Et. etpQn]
lgc]:hQt];Sac]:An]Tuk],mqn]:yU,"
tL,lgc]:eh.kc]:etL,ekL.Et. – tUw]yac], - sC].tiuw];Sut];' yLeh.kc]:yuc];siUw];n}. etsac]:eh.kc]:
Am],hG]:sp];tit];siUw].mqc];tac];pQn]l}:" tL,lgc]:EP:pQn]ha}.hqc];Et. hG]:lQc].mUtI:hiUn];eA,lUc];nn].yw]."
yLeh.kc]: pqk].Sm].wL: mI;yLeh.kc]:yw].eStL. Am],p},mI;sC].nC];pgt];tgn]:n}."
Aac]:Aic] kgp]:siUw].mqc];pqk],TI;rI;yL;eSEl: yC];hUm],Agk];eALkC]: (15.1)' ta}luim]; (7.1)'

pQn]can]; (7.2)' lgc]:hQt];hG]:sQp];h}a (7.5)"
AQk].KY]A}wI,El:AQt].S] (HIV and AIDS)

eKL:piut],tI:pgc],
tac];pQn]AQt].S]n}. pQn]tac];pQn]An]hUm]:kn]pQn] kum],niuc]:eS pQn]kgp]:siUw].mqc];w};rt].S]AQk],KY]A}wI,
(siUw].mqc];w};rt].S] An]hQt];hG]:hqc];Kam],tUw]tUk];ygm];) nn].yw]." siUw].mqc];w};rt].S]AQk],KY]A}wI,n}.
etyL.kw];hG]:SI,tI, 4- tI,ES;l]Am],nn] mQt].liUt]:Kaw]lU.lqw]nn].yw]." mQt].liUt]:Kaw]siUw];n}.
pQn]An]lm],lgc]: SUn],niuc]:Kgc] hqc];Kam],tUw]kUn];nn].yw]." miUw]:kUn];An]Tuk],siUw].mqc];AQk],KY]A},wI,
yL.lqw]mQt].liUt]:Kaw]Kw]nn]. kgp]:hqc];Kam], tUw]ygm];lUc];kCL,El: hQt];hG]:Am],Kam],l}: siUw].mqc];tac],siUw];
An]Kw]:mL;nC];tUw]El: tac];pQn]Kqn],SiUw]< siUw];nn].l}:"
siUw].mqc];tac];pQn]mac]siUw];n}. etpQn]tI:kUn];mI;hqc];Kam],tUw]eA,El: ethgc].siUw];n}.wL: tac];pQn]An]
sac]:him]Aw]tiuw].tac];n}yw]." AQt].S]n}. pQn]Kk].tgn]:liun];Sut]; An]siUw].mqc];AQk].KY]A},wI, Kw]:yL.
kw];El: etpQn]mL;tac];pQn] An]sac]:him]Aw]tiuw].tac];eS sac]:pQn]Kqn],SiUw]<mL;l}:siUw];nn].yw]."
etyU,l}:pI<yaw];Kaw];hiuc] mUin]nc],kUn];mI;sat]:pan]tQm]:TUn]:ekL.niuc]:yU,yw]." kgp]:n}El: kUn];siUw];n}.
n}. hw];hgc].wL: (kUn];mI;AL,yuAn]yU,sgm]; siUw].mqc];AQk].KY]A},wI,) n}yw]." Sc]kin]yLAn]Tuk],
mqn]:n}siuc]etsac]:eh.kc]:tac];pQn]An]sac]:him]Aw]tiuw].tac];l}:" yLeA,AL,r]tI,n}. etsac]:eh.kc]:
cw];l}a;tac];pQn] An]eth}a.hqc];nn]. TiUc];lUc];eSEl: hQt];hG]:yU,lIyU,n}eStL. yLn}.Am],sac]:KL:
siUw].mqc];AQk].KY]A},wI,l}:"
194
lgc]:sp];tit];tac];pQn]El: lgc]:eh.kc]:
lgk];l}a;An]sp];tit];siUw].mqc];tac];pQn] lgc]:eh.kc]:
sp];tit];tac];Ac],kL,eP:siUw].Pn];  ciUc].ew:lgc]:hUm]:kL,m Am],nn]
 mI;Sqt].sL,eS
hUm]:kL,mtc];kUn];tI:Am],mI;siUw].mqc];ekL.lQw] Am],nn]
 sC].tiuw];TUc]yac]yic]; TUc]yac]s}a;El:
 yUt];yLtac];pQn] An]sp];tit];mL; kgp]:lgc]:hUm]:kL,m
nn].sQm]sw]."
 miUw]:l}:tiUw].vL;siUw].mqc]; Am],nn] miUw]:hU.tUw]wL: sp];
tit];siUw].mqc];nn]. hG]:kin]yLeh.kc]:km];lQw]" miUn]nc],
lgc]:Tuk],kn].sn]nn]. sC].tiuw];l}a;n}.l}:" (kn] 6)
sp];tit];siUw].mqc];AQk],KY]A},wI, kgp]:KQm] El:  ciUc].ew: lgc]:sC].KQm]Sm];yLmw];km]"
lgt],yLAn]mI;siUw].mqc]; (tUw]yac],kUn];Sm];
yL:mw];km]' PU:hap],kan]p}a;yU,lI' kUn];Sm]; 
ciUc].ew:lgc]:sG].tiuw];KQm]El: lgt],yLhUm]:kn]sC].tiuw];
l}a;) lgt],yLEl: KQm]An]mUt];SC]tL,eS,"
 yL,sC].tiuw];Kgc]mI;KUm];hUm]:kn] (tUw]yac], - KQm]Sm];
l}a;' KQm]sI;hU' mit]:TLnUt],)"
 tL,PU:hap],kan]p}a;yU,lISm].hQt];sgm];nc],pk];piUc]eh.kc]:"
 Sc]lL:lItiUw].vL;
nC];piun].tI:hQt];kan]siuc]tL,eh.kc]:lgc]:sp];tit];siUw].
mqc];AQk].KY]A},wI,nn].h]G:sC].tiuw];lgk];piUc] kin]yLkm];Siuw]:"
sp];tit];siUw].mqc];kgp]:liUt]:El: nm].liUt]:  hG]:sC].tiuw]; piUc]nm];l}a;SCac];liUt]:"
(tUw]yac], - SCac];vL;liUt]:
 nc],hiuw]eteh.kc]: lgc]:sp];tit];siUw].mqc]; AQk].KY]A},wI,
An]mI;siUw].mqc];AQk].KY]A},wI,)
nn]. sC].kCam];Tam]eS Kt].kgc];kUn];lU,liUt]:"
 mUiw]:etSCac];liUt]:nn]. hG]:kUt],sqt]:siUw].mqc];AQk].KY]
A},wI, kUn];An]etlU,liUt]: (mUiw]:et kUt],sqt]:nn].
Tuk],lItiUc],pac], pn]tac];hU. kQw],lUv]:tac];pQn])"
Sc]Am],pQn]l}:n}ekL: kUt],sqt]:liUt]:eS yL,pn]kUn];
lU,liUt]:hU. Pgn];tgp],liUt]:"
luk].tI:Em:eSsp];tit];sU;luk]:  hG]:tUv];tI: lgc]:luk]:nC];tgc].
sp];tit];siUw].mqc];AQk].KY]A},wI, mL;tI:Em:El:
lgc]:eh.kc]:"
195
15
lgc]:KUn].hLmk];mn]:tac];pQn] kUt],sqt]:tUv];siUw].mqc];AQk].KY]A},wI,"
kgp]:Sc]El: Tuk],lIkUt],sqt]:siUw].mqc];AQk].KY]A},wI,?
(k) kUt],sqt]: Kt].kgc];tL,SCac];liUt]: (Screening for Blood transfusion)

kgp]:wL: siUw].mqc];AQk].KY]A},wI,n}. sac]:sp];tit];kn]l}:sgm];liUt]:El: lgc]:kUt],sqt]:liUt]: An]etlU,
mL;n}. pQn]An]lm],lgc]:Et.Et." kUv];kL:eKL:lm],lgc]:An]niuc]:Sm]. kgp]:wL:tL,l}:liUt]: An]Am],mI;
siUw].mqc];kUv];El: Am],sC]:tL,kUt],sqt]:kUn];pQn]" (tUv];tI: lgc]:lU,liUt]: - kn] 14.1)
liUw]eSwL:pn]lgc]:tiUc],pac],El: kUt],sqt]: (VCT) hG]:sw]:tL,nL.An]etlU,liUt]:El: sw]:tL,nL.

ygm];hp].lgc]:tiUc],pac],kQw],lUv]:tac];pQn] lgc]:kUt],sqt]:Kt].kgc];liUt]:n}. Am],Tuk],lIAw]mL;
sC].tL,mk];mn]:tac];pQn]" yiUc];An];An]Kt].kgc];liUt]:n}. tL,hG]:tqt]:etL;wL:
liUt]:An]etSCac];pn]nn]. mUt];SC]eSAm],mI;siUw].mqc];kUv];"
(K) mk];mn]:tac];pQn]AQk],KY]A},wI, (Diagnosis of HIV infection)

mUiw]:etkUt],sqt]:pn]nn]. tI:hgc]:yL Tuk],lIpn]kUn];pQn]l}: sgm];nc],pL:tC]:n}. –
1. lgc]:Tic];Sim];pn]eKL:mun];kUn];pQn] (Confidentiality)
eKL:mun];kUn];pQn] (Am],wL:pQn]hiuw]Am],pQn])n}. Am],l}:KCac].sw]:Kgc]mn];eS tk];etAm],hG]:l}:hUw]:l}kCL,
sU;PC]lL;lL;" kgp]:wL: Sc]kUn];hw];mn]:sC]wL: ekL.etpn]lgc]:tiUc],pac],El: tac];hU.n}.Am],l}:KCac].
Kw]eS etAm],mgk],lat]:PC]lL;lL;n} etht];Aup],AUw]; lat]:Enlgc]:kCam];nC];sC]Kw]"
2. lgc]:tiUc],pac],pn]tac];hU. mUiw]:etkUt],sqt]: (Pre test counseling)

An]n}.ethUm]:pL;eKL:mun];El: pQn]lgc]:km].s}g: tL,Kw]ettqp];tt];l}:wL: Tuk],lIkUt],sqt]: hiuw]
Am],Tuk],lIkUt],sqt]:"
3. Sp];lqc];hG]:lIyw].sc],ygn];KCac]. (Informed consent)

mUiw]:etkUt],sqt]:nn]. kgp]:wL:l}:tiUc],pac],pn]tac];hU.yw].El: Kw]ekL:ethU.lgc]:tac];pQn] AQk].KY]A},wI,
El: hU.tUw]sw]:kw],wL: lgc]:yU,Sw];hQt];Sac]:kL:pUn].mL; An]etsp];tit];tac];pQn]n}. mI;Am],mI;"
4. lgc]:tiUc],pac],pn]tac];hU. w}a;kUt],sqt]: (Post- test counseling)

tL,pn]lgc]:tiUc],pac],pn]tac];hU.kQw],lUv]:tac];pQn]" An]n}. etlm],lgc]:tgn]:tL, kUn];tI:An]kUt],
sqt]:vL; wL:mI;siUw].mqc]; tL,hG]:ep.sC]l}:lgc]:Kw]pQn]' tL,emLyU,yiun];yaw];kCL,' tL,l}:lgc]:yUt];yLAn]
Tuk],mqn]:' tL,emLkin]tac];kin]An]mI;AL,hL,r' tL,hG]:mI;hqc];sC]siUw];n}.yw]."
5. lgc]:kUt],sqt]:nC];hgc]:lqp], (Laboratory testing)

Aw]KiUc]:miuw]; kUt],sqt]:l}a;w};nC];Sun]p}a:eP; Am],nn] Aw]l}a;AI,lI,SL Am],nn] western Blot
196
nC];hUc];yL eSkUt],sqt]:tUv];l}:" Tuk],lIsC].tiuw]; l}a;kUt],sqt]:An]Am],miUn]kn] tI:eA,Sut];
2pgk]:" tL,mk];mn]: tac];pQn]An]Tuk],mqn]:nn]. Tuk],lIhQt];sgm];piUc]nm]; tqt]:tqt]:etL;etL;El:
mI;lgc]:Kqm].lqp]:lI"
6. tL,l}:hp].lgc]:yUt];yLAn]Tuk],mqn]:' lgc]:km].s}g:AL,hL,r' lgc]:km].Tqm]hqc];sC]El:

lgc]:s}g:Tqm]nn]. SUc],kCL,pn]tI:An]Tuk],mqn]: (Referral for appropriate Clinical
Psycological and social support services)
lgc]:lm],lgc]:liUw]piUn]: tL,kUn];pQn]An]sp];tit];siUw].mqc];AQk].KY]A},wI,Et. nc],hiuw]etl}:hp].tac];s}g:
Tqm] lgc]:yUt];yLEl:hqc];sC]nn].yw]." eKL:An]ethQt];pn]l}: mI;tc];nm]nn]. km]:nm]Et. hQt];
Sac]:pn] tI:Sun]p}a:eP;ekL:l}:" hUm];miuw];kn]eS tc]:Kiun];mL;pn]lgc]:tiUc],pac],pn]tac];hU.El: lgc]:
yUt];yL' lgc]:lUlgm]lum];lL;El: lgc]:km].Tqm]"
Pac]hac]:tac];pQn]
miUw]:Et,sp];tit];siUw].mqc];AQk],KY]A},wI,
 pQn]sn].tgn]:Agn]tac];Sut]; An]kUn];ekL.niuc]: Et,l}:sp];tit];siUw].mqc];"
 pqk].Sm].wL:lgc]:kUt],sqt]: (Am],vL;) n}eStL. kUn];ekL.n}.ekL: yc];sac]:eP:tac];pQn]
sU;tac], ekL.l}:yU,"
 miUw]:tUw]kUn]; Et,Tuk]:Agk],lgc]:eh.kc]:tac];pQn]nn]. lgc]:kUt],sqt]:etEnwL: (pQn]tac];pQn])
(w}a;eSsp];tit];yw]. nC];Kaw];tac]; 2-3 liUn])"
 kUn];pQn] etEt,mI;Pac]hac]: hqc];Kam],tUw]kiuc].kac].tUk];ygm];l}asiUw]; miUn]nc], (mI;lUm];naw]'
Piun],lqc]Agk],sgm];tUw]' mak],ln]kC]:) nG];Kaw];tac];Am],l}awn]; etL,Tiuc]l}al}awUc]:nn].yw]."
lgc]:mk];mn]:sn].tgn]: tac];pQn]Kgc]muk].sum];p}a;yU,lIlum]:fL. (Clinical staging according to

WHO)
sn].tgn]: (1)
 Am],mI;Pac]hac]:tac];pQn]"
 mak],ln]sgm];tUw] k}.sQp];kC]:hiuc]"
sn].tgn]: (2) tac];pQn]An]Am],h}a.hqc];

 nm].nk];tUk];ygm]; 5% Tiuc] 10%"
 km];km];k}.pQn]tac];pQn] kQw],lUv]:SQn];tac];TUv]:sC]" miUn]nc], pQn]S};nt].' lin].k},sQp];kC]:'
pQn]sQp]; nC];pak],' Am],nn] km];km];pQn]hUAgk],ngc] siUw];n}.yw]."
 pQn]tac];pQn]lQk].lgk].sgm];Piw]nc]'sgm];nQp].miuw];El:nC];pak],"miUn]nc],nQp].miuw];SL;'pQn]sQp];nC];pak],"
 pQn]sQp];mak],lqc]; Am],nn] yam]:pQn]sQp];mak],lqc]; mUiw]:pUn].mL;Kaw];tac]; 5 pI<"
197
15
sn].tgn]: (3) tac];pQn] An]h}a.hqc];mL;Ait];Ait]; (sn].tgn]:n}. eS;l]SI,tI,PUw];
et eA,liUw] 350 lUc];tC]:)
 nm].nk];tUw]tUk];ygm];h}a.hqc];' nm].nk];tUw]etlUt];ygm];nm]liUw] 10% "
 pQn]fL:sgm];nC];pak],"
 tac];pQn]pqk],TI;rI;yL;An]h}a.hqc];" miUn]nc], pgt],kC]:' pQn]sQp];yQn];sgm];kam]:niUw]."
 pQn]tac];pQn]TI,pI, Am],nn] yam]:pQn]miUw]:pUn].mL;pI<k}a"
 tgc].kCL,tgc].lU. hiuc]liUw]niuc]:liUn]"
 Am],mI;lgc]:Sc]eSEl: mI;lUm];naw]hiuc]liUw]niuc]:liUn]"
sn].tgn]: (4) tac];pQn]An]h}a.hqc];mL; (sn].tgn]:n}. eS;l]SI,tI,PUw];eteA,liUw]

200 lUc];tC]:)
 Pac]hac]:l}asiUw]; An]ygm]lUc];kgp]:siUw].mqc];AQk].KY]A},wI, (Kat],San]AL,hL,rh}a.hqc];)
 pQn]tac];pQn]TI,pI,EP:Agk],ngk]:pgt],h}a.hqc];"
 siUw].mqc];tac];pQn]h}a.hqc];Kw]: (miUn]nc], - yC];hUm],Agk];eALkC]:kgp]:siUw].mqc];Krip].tUw]KUw]Kt].S]'
lgt],Kw]: pQn]SL;' pneumocystis carinii' pgt],kC]:h}a.hqc];El: tac];pQn]h}a.hqc];l}al}asiUw];"
 Kqn],SL<(Kqn],SL<pak],hUc];luk]:' pQn]Kqn],SL<sgm];mak],ln]nm].liUc]El: Kaposi’s sarcoma)"
l}a;yUt];yL (eA,AL,r]tI,) etL:lQw]n}.Et. etsC].yLyU,Sam]kum],"

1. NRTI’s (Nucleoside Reverse Transcriptase Inhibitors); 3TC, D4T, ddl,AZT
2. NNRTI’s (Non - Nucleoside Reverse Transcriptase Inhibitors); Nevirapine (NVP),Efavirenz
3. PI’s (Protease Inhibitors): Ritonavir, Indinavir and Nelfinavir
4. Sc]sC].tiuw];yL Sam] Am],nn] SI,Sqn];elL;kn]n} sac]:l}:yLAn]lIliUw]piUn]:l}:" (kn]:nm]Et.
2 NRTI’s El: NNRTI Am],nn] PI)"
5. lgc]:yUt];yLAn]pn]yLsiUc].nn]n}. kgp]:wL:sac]:mI;Pgn];sL.yLnm]El: Tuk],lIlum];lL;
him];sm]lIlI"
6. tI:nC];miUc];T};n}.Et. etmI;yLSam]Sqn]; An]hUm]:kn]w}. nC];mQt].lQw] (GPO-vir)" nG];yLniuc]:mQt].
n}. etmI; 3TC' D4T El: NVP eS etl}:kin]nuic]:wn];Sgc]pgk]:" yLAn]n}.n}. nC];miUc];T};
sC].pQn]yLsn].niuc]:yw]."
kgp]:yLsiUw];n}. Am],sac]:yLtac];pQn]hG]:h}aKat],l}:El: tk];etl}: kin]yLkCL,etL,
sUw]:" kiut];yut];kin]yLmiUw]:lC] ekL:siUw].mqc];AQk].KY]A},wI, etKiun];nm]mL;miUw]:nn].
yw]."
tL,tUv];Tiuc]wL: yLAn]kin]kCL,nn]. mI;Pgn];lIkL:hiuw]' mI;lgc]:tgp],ygn].siUc].hiuw]mL;El: Pgn];sL.yL

siUc].hiuw]n}nn]. Tuk],lIlUlgm]lum];lL;tUv];sgm];tL,eS,"
198
yLeh.kc]:
etL,Tiuc]etL:lQw] yc];p},mI;yLeh.kc]:siUw].mqc];tac];pQn]AQk].KY]A},wI,"
Tqc]:nL:lik]:tac];nL:nn].etmI; “l}a;lum];lL;l}ala}siUw]; tL,kUn];pQn]AQk].KY]A},wI,” El:lgc]:eh.kc]:

tac];pQn] him]Aw]tiuw].tac];tc];l}a;yUt];yL"
l}a;lum];lL;l}ala}siUw];
lgc]:lum];lL;kUn];tI:An]pQn] HIV mC],mC],n}. Am],sC]:wL:Tuk],lIl:} pn]yLkUv];Am],kL: Tuk],lIs}g:Tqm]pn]
l}al}asiUw];" tL,pn]tac];s}g:Tqm]pn]l}al}asiUw];nn]. Tuk],lImI;kUn]; (pn]tac];hU.El: lgc]:tiUc],pac],'
emLyL' PU:hap],kan]p}a;yU,lI) siUw];n}.yw]." cw];l}a;kUn];pQn]nn]. Sc]Am],l}:KCac].kUn];pQn]eS
etAm],l}:hG]: kUn];tac];ngk]:hU.lL;lL;El: Sc]miUw]:lC] Am],lat]:Am],l}: lL;lL:kUv];
lgc]:Tuk],lIhG]:kUn];lum];lL;kUn];pQn] hU.w}.n}. pQn]An]lm],lgc]:Et.Et." Aic]niUw]cw];l}a;sC]kUn];pQn]El:
tac];pQn]eS Tuk],lIhQt];sgm];nc], eKL:pL:tC]:sUiw];n}."
(1) SUc],kUn];pQn]kCL,pn]tI:An]mI;tac];s}g:liUw]Pa},tac];sC]
(miUn]nc],muk].suk];An]s}g:liUw]kUn];sp];siUw];mqc]; AQk].KY]A},wI,yU,' tI:An]pn]lgc]:tac];hU.
hG]:kUn];pQn]El: pI:ngc].kUn];pQn] kCL,tik];tik];' SUc],kCL,pn] muk].sum]; miUn]nc], COERR "
(2) mk];mn]:pn] sn].tgn]:cw];l}a;kUn];pQn] sgm];nc],muk].sum];lUc]p}a;yU,lIlum]:fL." hG]:Tam]tUv];

kUn];pQn]El: kUt],sqt]:tUv];Pac]hac]:El:piun];tac];pQn]"
(3) hLEl:yUt];yLpn]tac];pQn] tI:An]k}.pQn]sgm];tac];pQn]AQk].KY]A},wI,"
(4) kUt],sqt]:tac];pQn]TI,pI,"
 kUt],sqt]:tUv];Pac]hac]:tac];pQn]AQk].KY]A},wI," (kn] 21.5 )
 Sc]pQn]TI,pI,n}siuc] hG]:kUt],sqt]:KI:tUiw], (Aac]:Aak],) pn] Sam]pgk]:"
 Sc]wL: nC];Aac]:Aak],nn]. Am],mI;siUw].mqc];n}eStL. Sm].mI;Pac]hac]:tac];pQn]yU,n}siuc]
hC]:SUc],kCL,epL.AQk].S]er<tUv];"
(5) lgc]:kUt],sqt]:tac];pQn]tac],siUw]; (FBC, ALT, CD4 El: tac];pQn]ngc]nC]; )
tac];nm]eA, SI,tI, 4
miUw]:lum];lL;yUt];yLpn] kUn];pQn]AQk].KY]A},wI,nn]. lgc]:np].tac];nm]eA, SI,tI, 4 n}.pQn]An]
lm],lgc]:Et.Et." lgc]:np].tac];nm]eA, SI,tI,4 n}.lm],lgc]: kgp]:pUiw]:wL: -
 tL,lam];tUv];hqc];Kam],tUw]kUn];pQn]' tL,lam];tUv];cw];l}a;kUn];pQn]El:hqc];tUk];Kgc]hqc];Kam],tUw]
kUn];pQn]siUw];n}.n}. pQn]An]sC].tiuw];l}:Et.Et."
 lgc]:pn]yLeA,AL,r]tI,El: lgc]:eh.kc]:tac];pQn] sac]:Aw]tiuw].tac];n}. etAic],niUw]hqc];tUk];
Kgc]hqc];Kam],tUw]kUn];pQn]" SI,tI,4 kUn];An]Am],mI;siUw].mqc];n}. km]:nm]Et.nG];nuic]: kYO.pik].mI,lI,
mI,tL,nn].etmI; 500 Tiuc] 1400"
199
15
(6) tUv];tI:cw];l}a; sn].tgn]:tac];pQn]El: Aic]niUw]tac];nm]eA, SI,tI,4 eS etl}:tqp];tt];wL:
Tuk],lIpn]/Am],pn]lgc]:eh.kc]:tac];pQn] An]sac]:Aw]tiuw].tac];El: yLeA,AL,r]tI,
(7) AL,hL,r
(k) sg}:lgc]:kin]yqm].tgn]:tL,kUn];pQn]tac];pQn]Kaw];hiuc] hUm]:tc];kUn];pQn]AQk].KY]A},wI,' AQt].S]"
(K) pn]tac];hU.kQw],lUv]:lgc]:kin]yqm].An]mI;AL,hL,r"
(8) tL,kUn];pQn]nac];yic];El: tI:An]mI;kU:nn]. Tuk],lIpn]tac];hU. kQw],lUv]:tac];pQn]
AQk],KY]A},wI,El: lgc]:pL;tgc]." nc],hiuw]etAm],mI;lgc]:pL;tgc]. An]Am],l}:tc]:sC] Am],nn]
An]Am],l}:wac];Pqn]Sc] w}.nn]. pn]tac];hU.lgc]:wac];Pqn]nL:hiUn];An]liUk]:l}:"
(9) sgm];SQn]:tac];yQw]:nn]. sgc],mI;ngc]Agk],mL;/Am],Agk],mL; - Tam]tUv];Pac]hac]:El: Aw]l}a;
RPR eS kUt],sqt]:tUv];tac];pQn]kL,lac],"
(10) pn]tac];hU. kQw],lUv]:lgc]:nm].An]mUt];SC]' hac]:hqn];lgc]:kin]yqm].hG]:mUt];SC]' lgc]:yip];tiUw].vL;
kn]El: lgc]:Suk]:miuw]; hUm]:tc];lgc]:mUt];SC]tUw]sw]:kw],El:lgc]:sC].tiuw];nm]. An]mUt];SC]siUw];
n}.yw]."
(11) pn]tac];hU. kQw],lUv]:lgc]:siUw].mqc];AQk],KY]A},wI, sp];tit];kn]l}:kgp]:hUm]:kL,mtc]; kU:ngn];sgm];'
hG]:sC].TUc]yac]' pn]TUc]yac]El: mgk],lat]:EnwL: TUc]yac] etsac]:l}:tI:lC]Pgc]:"
(12) lat]:kUn];pQn]tL,hG]:mL;EnKiun]; - nc],hiuw]epL;ethU.l}:tqt]:etL;wL: kUn];pQn]yU,Sw];Tuk],mqn]:
yU,nn].k}.hUp].TUp];tc];kUn];pQn] An]Et,pQn]mC],mC], tL,l}al}aliUn]n}. etsac]:mI;tiuw].tac];Tam]
kCam];Tam] El: kUn];pQn]l}:hp].tac];s}g:Tqm]An]Tuk],lIl}:"
lgc]:KUn].hLmk];mn]:El: lgc]:yUt];yLtac];pQn] kQw],lUv]:AQk].KY]A},wI, tc];tac];pQn]tI:An]sac]:Aw]

tiuw].tac]; (Diagnosis & Treatment of common Hiv related illness and opportunistic infections)
1. lgc]:tgc].kCL,' tgc].lU.Kaw];hiuc] (Chronic Diarrhoea) (kn] 12.1)
Pac]hac]:tac];pQn]
tgc].kCL,hiuc]liUw] 2 wUc]:El:tc];hak]:' nm].nk];tUw]lUt];ygm];' tgc].Kiun]:El:
Tat]:nm].eA,lUc];siUw];n}.yw]." lgc]:tgc].kCL,n}. etpQn]pQn]h}ah}aeS etAm],mI;liUt]:tc];nm].muk].eS
etpQn] nm].km]:nm]" tgc].kCL, 50% nn]. etAm],mI;cw]:hak]:Et,pQn]Sc]"
lgc]:yUt];yL
nc],hiuw]hG]:kUn];pQn]l}:hp].tac];kin]An]mI;AL,hL,rnn]. Tqm]Tat]:nm].nC];tUw]pn] (pn]nm].kiUw]El:
Sm];pn]yL Kw]:AQn])" lgc]:mUt];SC]tUw]sw]:kw],n}. hG]:w}.pQn]An]lgc]:lm],lgc]: (Suk]:miuw];hG]:mUt];SC]'
kin]nm].An]tUm]:w}.yw].' kin]niUw].El: Pk];An]huc]tUm]:w}.Kqm].lqp]:lI)" hG]:kUt],sqt]:cw]:hak]:tgc].kCL,
tI:hgc]:lqp],eS pn]lgc]:yUt];yL" Sc]Am],hLvL;cw];hak]:tac];pQn]n}siuc] –
 Sc]tgc].kCL,mI;liUt]:pL;sgm];n}siuc] - pn]yL metronidazole " Sc]wL:Am],lIKiun]:mL;El: mI;
200
lUm];naw] pL;n}siuc] hG]:pn]yL ciprofloxacin " hG]:tiUc],pac],tc];emLyL kQw],lUv]:Kaw];tac];
An]etl}:pn]yL"
 tgc].kCL,An]Am],pL;liUt]: - Sc]hn]Tiuc]wL: pQn]kgp]:mqc];tgc].n}siuc] hG]:pn]yL mebendazole
Am],nn] albendazole" tgc].kCL,An]Am],pL;liUt]:km]:nm] Am],tap]:pn]yLKL:siUw].mqc];"
tL,kUn];pQn]AQk].KY]A},wI, km]:nm]hG]:wUn].Sgn],pn]yL cotrimoxazole tL, 5 wn]; Am],nn]
metronidazole tL, 10 wn];" Sc]Am],mI;lgc]:Kiup]:nL:Sc] hG]:SUc],kCL,sU;emLyL"
2. mI;lUm];naw]Kaw];hiuc]
Pac]hac]:tac];pQn]
mI;lUm];naw]Suc]liUw] 37.5 M C hiuc]liUw] 2 wUc]:El: mI;Pac]hac]:tac];pQn]tac],siUw]; hUm]:pL;sgm];Ait];
Ait]; Am],nn] Am],mI;' naw]nUk].' tac];pQn]kQw],lUv]:siUw].mqc];pqk],TI;rI;yL; (pgt],kC]:' siUw].mqc];
Kw]:SQn]:tac];yQw]:' pQn]sQp];yQn];ngc]tI:kam]:niUw].' mI;siUw].mqc];pqk],TI;rI;yL;nC];liUt]:nm]) TI,pI,' siUw].
mqc];TI,pI, An]kUn];km]:nm] Am],SU:pQn]' tac];pQn]kgp]:siUw].mqc];w};rt].S] (tac];pQn]tI:SQn]: tac];
TUv]:sC]' SI,Aqm],wI,' w};rt].S] Aqp].p]StQn];-pL;) Am],nn] niUw].h}a. miUn]nc], Kqn],SiUw]<mak],ln]
nm].liUc]"
lgc]:yUt];yL
Sc]Am],hU.lgc]:tac]; An]hQt];hG]:mI;lUm];naw] (FOU = Fever of unknown origin)n}siuc] hG]:Aw]
amoxicillin Am],nn] cotrimoxazole eSyUt];yLpn]tL, 7 wn];" Sc]Am],mI;lgc]:Kiup]:nL:Sc]
Am],nn] cw];l}a;h}a.hqc]; mL;liUw]kw],n}siuc] hG]:SUc],kCL,kUt],sqt]:lIlIcam];cam];"
3. A}El: (Am],nn]) TUv]:sC]pgt]; (cough and shortness of breath)
Pac]hac]:tac];pQn]
A}El:TUv]:sC]pgt];Kaw];hiuc] Am],nn] A}h}a.hqc];mL;tik];tik];' TUv]:sC]w};' nL:AUk];sQp];' TUv]:sC]kp]."
1. Sc]wL:kiuc].kac].A}Kiun]:mL; h}a.hqc];El:mI;lUm];naw]Suc]' A}El:mI;KI:tUiw],n}siuc]
➔ hG]:yUt];yL sgm];nc],l}a;yUt];yLpgt],kC]: kgp]:siUw].mqc];pqk],TI;rI;yL; (kn] 21.1) Sc]mI;
Pac]hac]:h}a.hqc]; hp].w}.yUt];yLtI:hgc]:kUn];pQn]nC];" yUt];yLsgm];nc],l}a;yUt];yLpgt],kC]:"
2. mI;lUm];naw]' hiUw].AUn]:' nm].nk];tUw]tUk];siUw];n}. pQn]Agn]tac]; etmI;Pac]hac]:tac];pQn]
SQn]:tac]; TUv]:sC]" w}a;nn].ekL: A}hqc]: (Am],mI;KI:tUiw],)' TUv]:sC]w};mL;El: Am],mI;Pac]hac]:
tac];pQn]pgt],tc]; Pac]hac]:tac],siUw]; Am],nn] mI;eA,n}siuc]
➔ yUt];yLpn] sgm];nc],pgt],kC]:kgp]:siUw].mqc];KLrInI<pL<mUw]nI;yL; (PCP)" hp].w}.tI:
hgc]:kUn];pQn]nC]; -
pn]yL Cotrimoxazole 1600/320mg (sulphamethoxazole/trimethoprim component) TID
PO tL, 21 wn];"
201
15
Sc]pQn]pgt],kC]:h}a.hqc];n}siuc]-
Prednisolone : tL,luk]:Agn], 2 mg/kg/day then decrease gradually"
tL,kUn];lUc] 40 mg BID x 5 days then 40 mg OD x 5 days,then
20 mg OD x 5 days etL,epL;yw].lgc]:yUt];yL"
3. Sc]wL: A}hiuc]liUw] 5 wUc]:' pn]yLKL:siUw].mqc];yU,ekL: tac];pQn]Am],lIKiun]:mL;' KI:tUik],nm].l}a;
pL;liUt]:mL;Ait];Ait];' hiUw],Agk],kac]Km]: Am],nn] mI;lUm];naw]hUw]Km]:"
➔ wUn].Sgn],tL,yUt];yLwL: pQn]tac];pQn]TI,pI,w}.kgn]," (kn] 21.5)
4. pgt],kC]: (TI,pI,) (Tuberculosis)

Pac]hac]:tac];pQn]
lk]:KnL,El: Pac]hac]:tac];pQn]n}. etmiUn]kn]tc]; kUn];An]Am],pQn]tac];pQn]AQk].KY]A},wI," kUv];kL:
AFT test km]:nm]n}. pqk].Sm].wL:pQn]TI,pI,eStL.ekL: etEn negative km]:nm]" pQn]TI,pI,ngk]:pgt],n}.
Kqn];etpQn]kn]km]:nm]"
lgc]:yUt];yL
Sqn];yL' hqc];yL' Kaw];tac];yUt];yLEl: Pgn];sL.yLn}. etmiUn]kn]tc]; kUn];An]Am],mI;siUw].mqc];
TI,pI," (tUv];tI: tac];pQn]TI,pI,)
tL,kUn];pQn]AQk].KY]Aa},wI, An]kUt],sqt]:vL;wL: pQn]TI,pI,nn].
Am],wUn].Sgn],tac];nm]eA, SI,tI, 4 eS Aw]yL cotrimoxazole yUt];yLpn]
sgm];nc],hqc];yL l}a;yUt];yL eh.kc]:"
5. pQn]fL:sgm];nC];pak], (Oral Candiasis (thrush))

Pac]hac]:tac];pQn]
pQn]mQt].Kaw]Kaw]Agk],mL;sgm];lin].' kUc]eKL;' sgm];tac];nC];kqm]:El: hiUk],siUw];n}.eS Kut],Agk],pqt]:l}:"
miUw]:kin]tac];kin]nn]. etm}:wiut]:wiut]:yU,nC];pak],"
lgc]:yUt];yL
Gentian Violet 1% w}a;eSkin]Kw]yw]. tL; Gentian Violet pn]"
Am],nn] Nystatin Tablet 500,000 IU QID x 10 wn]; Am],nn] 200,000 IU oral
suspension (yLAUm] 5 pgk]:tL, 7 wn];)
Sc]Am],lIKiun]:mL;
Ketoconazole luk]:Agn],lQk].liUw] 2 KUp], 3-6 mg/kg/day tL, 7 wn];
kUn];lUc] 200 mg OD PO tL, 7 wn];
Am],nn] Fluconazole luk]:Agn], 2-4 mg/kg/day tL, 7 wn];
kUn];lUc] 100 mg OD PO tL, 7 wn];
202
6. pQn]fL:sgm];lgt],eKL; (Oesophageal Candidiasis)

Pac]hac]:tac];pQn]
km]:nm]Et. etpQn]fL:sgm];nC];pak],El: etsQp];eSAiun]tac];kin]yap]," tac];pQn]An]n}.yw]. pQn]
cw]:hak]:An]lm],lgc]:lUiw]pUin]:An]hQt];hG]:kUn];pQn]AQk].KY]A},wI, Am],mI;hqc];El: nm].nk];tUw]tUk];ygm];"
lgc]:yUt];yL
Fluconazole 200 – 400 mg OD x 14 - 21 wn];" tL,tgc];- yL,yUt];yLhiuc]pUn].liUw] 21 wn];"
7. yC];hUm],Agk];eALkC]: kgp]:siUw].mqc];Krip].tUw]KUw]Kt].S] (Cytococcal Menigitis)
Pac]hac]:tac];pQn]
hUw]K}:An]ha}.hqc];Kaw];hiuc]El: yLAm],h}a' Am],yU,lI' sC]Suk].Sak].' pQn]can];' Pac]hac]:yC];hUm], Agk];eAL
kC]: kgp]:siUw].mqc];pqk],TI;rI;yL; (miUn]nc], mI;lUm];naw]' kgc],ekL:KQc]:' tUv];Sqc]lqc];Am],l}:' hUw]mw];El:
K}:hak]:) siUw];n}.etAm],mI;"
lgc]:KUn].hLmk];mn]:tac];pQn] tI:hgc]:lqp],
Aw]K}Sn]lc] mL;kUt],sqt]:tUv];" SUc], CSF tL, India ink test Am],nn] lQc].siUw].mqc];
tL,kUt],sqt]:" tL,hLsiUw].mqc];Krip].tUw]KUw]Kt].S]nn]. SUc],liUt]: Am],nn] K}Sn]lc]kCL,tI:hgc]:lqp],"
Sc]KUn].hLtac];pQn] Am],l}:n}siuc] hG]:SUc],kUn];pQn]kCL,hUc];yL"
lgc]:yUt];yL
Amphotericin B 0.7 – 1.0 mg/kg/day IV 2 wUc]: w}a;nn].ekL: Siup],pn] fluconazole tL, 8
wUc]:"
Am],nn]
Fluconazole luk]:Agn], 4-6 mg/kg/day tL, 8 wUc]:
kUn];lUc] 400 – 800 mg OD tL, 8 wUc]:
lgc]:eh.kc]:sn].tgn]:Sgc] - w}a;lIKiun]:mL;yw]. tL,eh.kc]:nn]. hG]:pn]yL
Fluconazole"
8. pQn] Penicillium marneffei infection

tac];pQn]n}. pQn]cw]:hak]:lm],lgc]:Kgc] tac];pQn]tI:kQw],lUv]:AQk].KY]A},wI,nC];miUc];T};"
Pac]hac]:tac];pQn]
mI;lUm];naw]' liUt]:sac]' mak],ln]El:tp];kC]:' nm].nk];lUt];lUc];' mI;tum],miUn]mQt].TUw], (nC];kac]lgk];
w}.) Agk],sgm];tUw]" Sc]pQn]siUc].n}mL; kUn];pQn]etsac]:t}aw};'
203
15
lgc]:KUn].hLmk];mn]:tac];pQn]tI:hgc]:lqp],
SUc],liUt]:Am],nn] pgt];niUw].Piw]nc]kCL,sU;hgc]:lqp],tL,lQc].siUw].mqc];"
lgc]:yUt];yL
Amphotericin B 0.5 – 0.7 mg/kg/kU:wn]; tL, 2 wUc]: Am],nn]
Itraconazole 200 mg kU:wn]; tL, 2 wUc]:
lgc]:eh.kc]:sn].tgn]:Sgc] pn]yL Itraconazole 200 mg tL,kU:wn];
lgc]:eh.kc]:tac];pQn] An]sac]:Aw]tiuw].tac];w}.Agn]tac]; (Prophylaxis (prevention) of

Opportunist infections)
tac];pQn]siUw];n}.n}. ethQt];hG]:kUn];pQn]AQk].KY]A},wI, hqc];eA,lUc];eS ethQt];hC]:ES<l]SI,tI, 4 ygm];
lUc];tik];tik];" w}a;nn].hqc];Kam],tUw]kUn];pQn] ettUk];lUc];tik];tik];eS Kqn];hQt];hG]:siUw].mqc];tac],siUw];
Kw]:mL;c}a:" kgp]:n}tL,yUt];yLtac];pQn]tI:sac]:Aw]tiuw].tac]; hQt];tI:kUn];pQn]n}. lm],lgc]:Et.Et."
lgc]:lIAn]niuc]:Et. kgp]:wL:tL,tac];pQn]mac]An]n}. kin]yLeSekL: sac]:eh.kc]:l}:nn].yw]."
An]n}.hgc].wL: lgc]:eh.kc]:tac];pQn] w}.Agn]tac];"
l}a;eh.kc]:etmI;Sgc]Sqn];
lgc]:eh.kc]:sn].tgn]:Agn]tac]; Eh.kc]:w}. miUw]:yc];p},pQn]tac];pQn]" yam]:pQn]tac];pQn]niuc]:Sqn];
lgc]:eh.kc]:sn].tgn]:Sgc] Am],nn]l}al}aSqn];yw]. yLtUw]Kqn];yw].eS nc],hiuw]etAm],pQn]
Tqc]:nn]. Eh.kc]:w}.Agn]tac];
1. lgc]:eh.kc]:w}.Agn]tac];lUv]:yL Cotrimoxazole
lgc]:eh.kc]:n}.km]:nm]etsC].tiuw]; tL,eh.kc]:tac];pQn]fL:nC];pak],El:naw]Tgk],SUw]plat].S]mUw];Sit].S]
(toxoplasmosis)" tac];pQn]pgt],El:lm];S}: An]pQn]kgp]:siUw].mqc];pqk],TI;rI;yL;siUw];n}.ekL:eh.kc]:l}:"
kUn];pQn] An]mI;tac];pQn]cam],sgm];nc],pL:tC]:n}.nn]. Tuk],lIpn]yL cotrimoxazole "

 sp];tit];siUw].mqc];AQk].KY]A},wI,mL;l}: 15 pI<p}ayw]. etL:lQw]Sm].Am],mI;Pac]hac]:tac];pQn]kQw],
lUv]:pgt],El: ES<l]SI,tI,4 eA,liUw] 350 (Sc]wL:etL:lQw] mI;Pac]hac]:tac];pQn]TI,pI, yU,n}
siuc] kUn];pQn]siUw];nn]. Tuk],lIkin]yLsgm];nc],hqc];yLAn]pn]kCL," tUv];tI: l}a;yUt];yL
tac];pQn]tI:sac]:Aw]tiuw].tac];)"
 sgm];nc],lgc]:mk];mn]:sn].tgn]:tac];pQn]AQk].KY]A},wI, Kgc]muk].sum];lUc]p}a;yU,lIlum]:fL.nn]. kUn];
pQn] An]yU,nC];sn].tgn]: 3 Am],nn] 4" (lgc]:mk];mn]: sn].tgn]:tac];pQn] AQk].KY]A},wI,'
kn] 15.3)
 kUn];pQn]AQk].KY]A},wI, An]mk];mn]:wL: mI;tac];pQn]TI,pI,w}.sgm];"
204
 kUn];pQn] An]yam]:pQn]pgt],kC]: kgp]:siUw].mqc];KLrInI< pL<mUw]nI;yL; (PCP) Am],nn] An]yam]:
yUt];yLnaw]Tgk],SUw]plat].S]mUw];Sit].S] (toxoplasmosis) miUw]:p},hiuc]nn]. (lgc]:eh.kc]:sn].
tgn]:Sgc])"
hqc];yL(Dose)-(hqc];yLtL,sn].tgn]:eh.kc]:Agn]tac];El:sn].tgn]:eh.kc]:Sgc]nn]. etmiUn]kn]kUv];)
cotrimoxazole – single strength ( TMP 80 mg – SMX 400 mg)
tL,tgc];" " tL,kUn];pQn] An]Am],mqn]:tc];yL cotrimoxazole nn]. hG]:pn]yL Dapsone 100 mg

OD" tL,kUn];pQn]AQk].KY]A},wI,tI:pL;tgc].yU,nn]. hG]:pn]hqc];yLeh.kc]: cotrimoxazole l}: miUn]nc],
hqc];yLtL,kUn];lUc]"
miUw]:lC]etl}:kiut]; - w}a;eSl}:kin]yL ARV tL, 6 liUn]yw]. SI,tI,4 nm]liUw] 350 mL;"

Sc]wL: Am],mI;eA,AL,r]wI,pn]n}siuc] etl};kin]yLeh.kc]:kCL,etL.sUw]:"
luk]:Agn],
luk]:Agn],kU:ekL.An]Em:pQn]AQk].KY]A},wI,eSEl:kiUt],mL;siUw];nn].Tuk],lIpn]kin]yLEt,Aw]wUc]:TI. 4-6"
 pn] TMP-SMX 6-8 mg/kg/day x pn]niuc]:pgk]:"
 Sc]wL: luk]:Agn],Am],ep.hqc];yL Cotrimoxazole l}:n}siuc] pn]yL Dapsone 2 mg/kg/day
niuc]:wn];niuc]:pgk]: kUv];kL:kgn],etpn]kin]nn]. hG]:Tam]tUv];wL: luk]:Agn],sgc],Kat],Tat]:
G6PD hiuw]" Sc]wL: luk]:Agn],Kat],Tat]: G6PD siuc] tL,hqc];yLetpn]nn]. hG]:tiUc],pac],
tc];emLyL"
 Sc]hU.tqt]:etL;wL: luk]:Agn],Am],mI;siUw].mqc];AQk].KY]A},wI, Am],nn] w}a;eSpn] ARV yw].
SI,tI,4 Kiun]:mL; 20% n}siuc] kiut];pn]yL cotrimoxazole l}:"
2. lgc]:eh.kc]:w}.Agn]tac]; lUv]:yL Fluconazole
lgc]:eh.kc]:lUv]:yL Fluconazole n}. etsC].tiuw];tL,eh.kc]:tac];pQn] yC];hUm],Agk];eALkC]: kgp]:siUw].mqc];

Krip].S]tUw]KUw]Kt].S]" kgp]:tac];pQn]An]n}.n}. Am],SU:hn]luk]:Agn]pQn]El: Am],tap]:pn]luk]:Agn],
ekL:l}:"
(k) lgc]:eh.kc]:sn].tgn]:Agn]tac];
kUn];pQn] An]mI;tac];pQn]cam],sgm];nc],pL:tC]:n}.nn]. Tuk],lIpn]yL fluconazole" (tL,Em:pL;tgc].Et.
miUw]:kiUt],luk]:yw].sc],Tuk],lIpn])"
 SI,tI,4 eA,liUw] 100
 sgm];nc],Pac]hac]:tac];pQn]Am],sC]:tac];pQn]Krip].S]tUw]KUw]Kt].S]El:sgm];nc],lgc]:kUt],sqt]:Am],
hn]mI; siUw].mqc];Krip].S]tUw]KUw]Kt].S]nC];liUt]: (Sc]wL:mI;n}siuc] Tuk],lIPiUm].Tqm]hqc];yLpn]'
hG]:tUv];lgc]: yUt];yLtac];pQn] An]sac]:Aw]tiuw].tac]; sgm];nc],pL:tC]:)"
205
15
hqc];yL (Dose) - fluconazole 400 mg/week (nC];niuc]:wUc]:nn]. hC]:pn]wn];An]miUn]kn])"
miUw]:lC]etl}:kiut]; - w}a;eSl}:kin]yL ARV yw].tL, 6 liUn]El: SI,tI,4 nm]liUw] 100"

Sc]wL: Am],mI;eA,AL,r]wI,pn]n}siuc] etl};kin]yLeh.kc]:kCL,etL.sUw]:"
(K) lgc]:eh.kc]:sn].tgn]:Sgc]
w}a;kUn];pQn] An]yam]:pQn]tac];pQn]Krip].S]tUw]KUw]Kt].S]eSyLh}ayw].nn]. Tuk],lIpn]yLeh.kc]:
sn].tgn]:Sgc] tL, 10-12 wUc]:"
hqc];yL (Dose) - fluconazole 200 mg PO kU:wn];"

miUw]:lC]etl}:kiut]; - w}a;eSl}:kin]yL ARV yw].tL, 6 liUn]El: SI,tI,4 nm]liUw] 100"
Sc]wL: Am],mI;eA,AL,r]wI,hG]:n}siuc] etl};kin]yLeh.kc]:kCL,etL.sUw]:"
lgc]:eh.kc]: Am],hC]:siUw].mqc];AQk].KY]A},wI,tI:Em:mI;yU,nn]. sp];tit];kCL,sU;luk]:nC];tgc].

(PMTCT AND HIV IN PREGNANCY )
eKL:piut],tI:pgc],
tL,Em:pL;tgc].nn].eh.kc]:pn]Am],hG]:siUw].mqc];AQk].KY]A},wI,tI:Em:mI;yU,nn].sp];tit];kCL,sU;luk]:nC];tgc]."
tL,Em:pL;tgc]. An]mI;siUw].mqc];AQk].KY]A},wI,nn]. sp];tit];kCL,sU;luk]:nC];tgc].l}: 15% Tiuc] 45%

yU,yw]." An]pQn]siUc].n}n}. hgc].wL: wL,tI,kiUw]< Tran],Smit].SYin]; (vertical transmission)
El:siUw].mqc]; etKw]:kCL,sU;luk]:nC];tgc].l}:l}al}atac];"
 mUiw]:p},kiUt],' miUw]:luk]:Agn],yc];yU,nC];hUc];luk]:El:Sc]
 miUw]:kiUt],nn]. luk]:Agn],l}:tiUw].vL;liUt]:An]mI;siUw].mqc];' nm].tUw]El:Sc]
 w}a;kiUt],yw]. kin]nm].nUm];Em:El:Sc] sac]:sp];tit];l}:" (siUw].mqc];AQk].KY]A},wI,n}. mI;pL;nC];
nm].nUm];Em:)"
Pqn]kan] PMTCT Et. tL,eh.kc]: Am],hG]:siUw].mqc];AQk].KY]A},wI,tI:Em:mI;yU,nn]. sp];tit];kCL, sU;
luk]:Agn],Kw]nn].yw]."
etmI;l}a;hQt];Sac]:yU,Sam]tac];-
(1) miUw]:pL;tgc].yU,nn]. pn]kin]yLeA,AL,tI,"
(2) miUw]:kiUt],luk]:nn]. ciUc].ew:lgc]:tiUw].vL;El: l}a;An]etsp];tit];tac];pQn]l}:"
(3) pn]tac];hU.kQw],lUv]: lgc]:lQc].nUm];luk]:Agn],"
206
tL,Em:pL;tgc].n}. liUw]eSlgc]:yUt];yLyw]. yc];Tuk],lIl}:hp].lgc]:lum];lL;tI:lIpL;sgm];" kgp]:wL:miUw]:

l}:hU.Kaw],wL: tUw]sw]:kw],sp];siUw].mqc];AQk],KY]A],wI,n}. ethQt];hG]:tUk];sC]' Tat]:sC]tUk];El: m}:sC]KI
sC]l}:nn].yw]." Kw]etEt,m}:sC] lgc]:p}a;yU,lIKw]' lgc]:pL;tgc].Kw]' p}a;yU,lIluk]:Agn],' lgc]:kUn];hUin];
Kw]ethn]Tiuc]SiUk]:Sm],Kw]siUw];n}. etEt,mI;mL;" kgp]:n}lgc]:km].s}g:tac];sC]El: tUc],wUc];hG]:pgc],sC]Kw]n}.
pQn]An]lm],lgc]:Et.Et." Tuk],lIpn]tac];hU. kQw],lUv]:tac];pQn]AQk],KY]A},wI,El: l}a;yU,Sw];sgm];
siUw].mqc];AQk].KY]A},wI," Kw]Tuk],lIl}: hp].tac];kin]An]mI;AL,hL,r PiUm].Tqm]sgm];"
lgc]:km].s}g:siUw];n}.n}. Tuk],lIhG]:PU:hap],kan]p}a;yU,lI An]l}:Piuk];lgc]:Pa},n}.mL;km];Siuw]:' An]mI;

tUw]TUp]; lgc]:lum];lL;Em:pL;tgc].An]mI;siUw].mqc];AQk].KY]A},wI,Kw] hQt];Sac]:pn]kCL,"
1. lgc]:pn]yL ARV miUw]:pL;tgc].
Sc]pn]yL ARV miUw]:pL;tgc].yU,El: miUw]:kiUt],luk]:nn]. ethQt];hG]:lgc]:sp];tit]; siUw].mqc];AQk].KY]A},wI,

Em:sU;luk]:eA,lUc];l}:" l}a;sC].yLAn]Am],miUn]kn]ekL: mI;tc];nm]" An]tI:sC].kn] km]:nm]Et.
sC].yL zidovudine, iamividune El:/Am],nn] nevirapine Sgc]Sam]Sqn]; pn]hUm]:kn]miUw]:pL;tgc].yU,'
miUw]:kiUt],El: w}a;kiUt],luk]:yw]. pn]Em:El:luk]:An]sc],hLkiUt],mL;"
Em:pL;tgc].mac]ekL.n}. Aic]niUw]sn].tgn]:tac];pQn] An]Kw]pQn]yU,El: tac];nm]eA, SI,tI,4 eS

Aap]:etl}:sC].yL ART tL,tac];pQn]AQk].KY]A},wI,Kw]" lgc]:n}.n}. ethQt];hG]: EP;An]siUw].mqc];
etsp];tit]; luk]:Agn],n}.ekL: etlUt];ygm];kCL,sgm];"
tUv];Kiun];tI:l}a;sC].tiuw];yL ARV nC];hgc]:yLtL,eKL:mun];lgc]:yL' hqc];yLAn]etl}:sC].El:Pgn];sL.yL"
2. ciUc].ew: lgc]:hQt];hC]:hU;kiUt],luk]:kCac]:Kiun]: miUn]nc],s}g:puit],hUc];luk]:pn]El: kqt];pak],hU;

kiUt],pn]siUw];n}.
An]lm],lgc]: miUw]:kiUt],luk]:Agn],pn]nn]. tL,hG]:luk]:Agn], tiUw].vL;liUt]:El: nm].tUw]Em:
eA,liUw]piUn]: nn].Tuk],lIhQt];sgm];nc],eKL:pL:tC]:n}. -
 yL,piut],hUc];luk]:pn] – lgc]:pC].hG]:hUc];luk]:piut]:hc];kUv];n}. pQn]An]lm],lgc]:" kUv];kL: lgc]:p}g,hG]:
hUc];luk]:piut],hc];kUv];hiuc]hiuc]n}.ekL: pQn]lgc]:An] hQt];hG]:sp];tit];siUw].mqc];nm]l}:nc],kw],"
 ciUc].ew:lgc]:sC].tiuw]; KiUc]:km].kqm] An]ethQt];hG]:Piw]luk]:Agn],pQn]h}g;l}: miUn]nc],Aw]KiUc]:s}g:
sn]luk]:Agn],Agk],mL; Am],nn] lgc]:sC].kim];h}; (liUw]eScw];l}a;luk]:Agn],Am],lI)
 epL;Am],mI;lgc]:tac]; An]lInL,n} hG]:ciUc].ew:piUt],hU;kiUt],luk]:pn]"
 miUw]:luk]:Agn]kiUt],mL;nn]. tL,etAw]liUt]: An]sp];tI:tUw]luk]:Agn],Agk],pqt]:nn]. tk];etl}:
Suk]:tUw]luk]:Agn],pn]lIlI"
 tL,eh.kc]:tUw]sw]:kw],nn]. Em:kQp];luk]:ekL:tk];etl}:sC].tiuw];Tuc]miuw];' SiUw]:eh.kc]:tUw]El:
man],tL"
207
15
3. lgc]:pn]tac];kin] hG]:luk]:Agn],lqc]
l}a;Sgn],AL,hL,rtac];kin] hG]:Em:pL;tgc]. An]mI;siUw].mqc];AQk].KY]A},wI,n}. pQn]lgc]:lIliUw]piUn]:" kUv];kL:
tk];etl}:pn]lgc]:tac];hU. l}a;hac]:hqn];tac];kin]An]lgt]:eP;El: sC].tiuw];siUw];n}.yw]." eP;lUc]
tL,sC].tiuw]; l}a;Sgn],AL,hL,rtac];kin]Et. pQn]l}a;Am],hac]:hqn];tac];kin] hG]:lgt]:eP;El: sC].tiuw];
nn].yw]." l}a;Sgn],AL,hL,rtac];kin]n}. lgc]:hac]:hqn];El: lgc]:sC].tiuw];kU;Kk].tgn]:nn].
Tuk],lIkum];Tic];pn] sgm];lIlIEl: hQt];Sac]:sgm]; -
 hQt];Enl}a;hac]:hqn];El: sC].wan],pak],piut],eS pgn]:pn]hG]:lgt]:eP;"
 pn]emL:El:wan],pak],piut], An]Sac],Tuk], tL,hac]:hqn];sC].l}a;Sgn],AL,hL,rtac];kin]"
 tL,km];km];huc]tac];kin]tI:Sgn],np].w}.nn]. pn]nm].mUt];SC]El: f};Puin];hG]:kum],TUn]:"
 lat]:EneP;Kgc]l}a;hac]:hqn];tac];kin] An]Am],mUt];SC]El: Am],Sac],Tuk],"
Em:luk]:Agn], tk];etl}:pn]tac];kin] An]Sgn],np].AL,hL,rw}.Sqn];lQw]kUv];" Sc]k}.k}.pn]kin]nUm];
mac]pgk]:mac]lC]n} lgc]:etsp];tit];siUw].mqc];tac];pQn]ekL: etSuc]Kiun]:l}:miUn]kn]n}nn]. Em;luk]:Agn],
Tuk],lIpgc],sC]w}." Em:luk]:Agn], Tuk],lIhU.pgc],eKL:n}.lIlI"
Sc]wL:Am],pn]lgc]:p}a;hU.' Am],mI;nm].mUt];SC]pn]El: f};Puin];kum],TUn]:n}siuc] lgc]:hG]:kin]nm].nUm];
Em:n}.etSac],Tuk],liUw]" Sc]Am],sC]:siUc].nn]n} tL,luk]:Agn],etsp];tit];tac];pQn]AQk].KY]A},wI,ekL:
etSuc]Kiun]:mL;' lgc]:sac]:pQn]tgc].lU.tgc].kCL,ekL: etSuc]Kiun]:eS sac]:hQt];hG]: Tiuc]lU.t}akgn],yw]."
Sc]wL:Em:luk]:Agn], etliUk]:lQc].nUm];Em:l}a;lQw]kUv];n}siuc] Tuk],lIpn]lgc]:K}:sC]sgm];nc],pL:tC]:n}.wL:-
 hG]:kin]nUm];Em:An]lQw] – liUw]eSnUm];Em: Am],pn]kin]Sc] (nm].ekL:Am],pn]) etL,Tiuc]AL,yu
luk]:Agn],l}:hUk];liUn]yw]. hG]:lqk]:l}a:kin]tac],siUw]; tqn];nUm];Em:w};w};"
 lum];lL;tw]:nUm]; - yUt];yLhUw]nUm];sQp];kG]:sQm]sw].El: ciUc].ew:yL,hG]:Piw]hUw]nUm];tqk],"
 yUt];yL fL:nC];pak],luk]:Agn],sQm]sw]."
4. lgc]:lUlgm]sgm];tUv];Em:El:luk]:Agn],
tL,Em:pL;tgc]. -
 lum];lL;sgm];nc],lgc]:lum];lL;Em:pL;tgc]."
 miUw]:lum];lL;Em:pL;tgc].siUc].nn]n}. miUw]:kUn];pQn]mL;sU;kU:pgk]: hG]:kUt],sqt]:tUv]; lgc]:Pgn];sL.
yL mI;/Am],mI;' lUm];naw]mI;/Am],mI;El: A}/Am],A}siUw];n}."
 lgc]:kUt],sqt]:tUw]nn]. sc]:nm].nk];tUv];' tUv];lgc]:mI;fL:Am],mI;fL:nC];pak],' Tgm]tUv];
pgt],lI/Am],lI' mak],ln]kC]:/Am],kC]:' sgc],mI;tum],/Am],mI;"
 pn]yLTat]:lQk];El: Folic acid tL,eh.kc]:tac];pQn]liUt]:sac]El: kUt],sqt]:pn]kU:liUn]wL:
liUn]sac]/Am],sac]"
208
 miUw]:kUn];pQn]mL;sU;kU:pgk]:nn]. hG]:pn]lgc]:kin]yqm].tI:mI;AL,hL,rsgm];kU:pgk]:"
 hG]:kiUt],luk]:tI:hgc]:yL"
tL,luk]:Agn], -
 tL,eh.kc]:tac];pQn]TI,pI,nn]. hG]:kin]yL cotrimoxazole etL,TiucA ] L,yul}: 18 liUn]" (kn]
15.3)
 pn]yLeh.kc]: (wk].Sin];) luk]:Agn],An]Em:mI;siUw].mqc];AQk].KY]A},wI,kU:ekL. mUin]nc],luk]:Agn],
tac],siUw];" liUw]eSwL: -
 hC]:pn]yLeh.kc]:pI,SI,sI, luk]:Agn],tI:Em:mI;siUw].mqc];AQk].KY]A},wI,kiUt],mL;nn].kU:ekL.
miUw]:kiUt],mL;km]; lQw]" kUv];kL:sgm];nc],Pac]hac]:tac];pQn]El: wUn].Sgn],wL:luk]:Agn],Aap]:pQn]
AQk].KY]A},wI,El:An]hU. tqt]:etL;wL:pQn]AQk].KY]A},wI,nn]. etAm],l}:pn]yLeh.kc]:pI,SI,sI,"
 kUt],sqt]:siUw].mqc];AQk].KY]A},wI,pn] miUw]:AL,yu 12 El: 18 liUn]"
tac];pQn]mak],lqc] (Measles)
lWc]:etl}:SUc],Kaw],Kn]w};
eKL:piut],tI:pgc],
tac];pQn]mak],lqc]n}. pQn]kgp]:siUw].mqc];w};rt].Sqn];niuc]:eS sac]:sp];tit];l}:kgp]: lUm];An]kUn];pQn]
tac];pQn]nn].TUv]:s]GAgk],mL;' Pgc]nm].l}a;' Pgc]KI:tUiw],kUn];pQn]siUw];n}.yw]." tac];pQn]An]n}.n}.
pQn]tac];pQn]An] sp];tit];l}:w};An]niuc]:yw]." km]:nm]Et. luk]:Agn],etk}.pQn]nm]eS etsac]:
mI;Pgn];sL.sgm];lc]mL;" lgc]:t}akgp]:mak],lqc]n}. miUw]:tac];pQn]eP:nm]nn]. etSuc]l}:Tiuc] 30%
eSEl: km]:nm]Et.ett}akgp]: pQn]pgt],kC]:nn].yw]."
Am],mI;yLtL,etyUt];yLtac];pQn]mak],lqc]" yiUc];Aan];An]yUt];yL An]lm],lgc]:Et. tL,eh.kc]:
Pgn];sL.sgm];lc] hG]:t}akgp]:tac];pQn]eA,lUc];nn].kUv];" tL,luk]:Agn], An]Kat],Tat]:AL,hL,rnn].
Kqn];sac]:pQn]Pgn];sL.sgm];lc]l}:c}a:nn].yw]."
Pac]hac]:tac];pQn]
 mI;lUm];naw]Suc]liUw] 38.5 M C eShiuc]liUw] 3 wn]; El:
 Kgp],tLSC]etlqc]eS kC]:' mI;nm].muk].l}' A}
 mac]pgk]:mac]lC] etmI;tum],Kaw] ekL,plit].S]epL. Agk],mL;tI:yC];miUk],nC];pak],"
 w}a;eSSgc]Sam]wn]; etmI;tum],lqc]Agk],mL;tc];tUw]eS (Piun],lqc]) etEt,tI:eKL;' nL:AUk];'
tgc].El: lUc];kCL,tI:KL"
209
15
Pgn];sL.sgm];lc]
 pgt],kC]:
 hUAgk],ngc]
 kgp]:tgc].kCL,tgc].lU.eS Tat]:nm].eA,kCL,El: Kat],Tat]:AL,hL,r
 kgp]:Kgp],tLpQn]sQp];El:tLsac]:mgt],l}: (kUn];An]Kat],Tat]:pI,tL,min]eA,Kqn];pQn]l}:nm]liUw])
 Agk];eALkC]:
 t}a
tUv];Pac]hac]:tac];pQn]eS mk];mn]:tac];pQn]l}:" siUw].mqc];tac];pQn]n}. etyU,sgm];liUt]:' yQw]:El:
nm].l}a;"
lgc]:yUt];yL
lgc]:yUt];yLn}. tL,yUt];yLeh.kc]:Pgn];sL.sgm];lc]nn].yw]."
 tL,lUm];naw]nn].pn]nm].kiUw]El:yL paracetamol' tgc].kCL,tgc].lU.El:Tat]:nm].nC];tUw]eA,
 nc],hiuw]hG]:n]G;pak],mUt];SC]nn]. pUn]:pak],pn]" Aw]yL 1% gentian violet tL;sQp];nC];pak],"
 pn]yLwI,tL,min],eA, sgm];nc],hqc];yLyUt];yL (kn] 17.2)" Tqc]:wn];niuc]: pn]Tqc]:km];niuc]:"
 lac].tLpn]kU:wn];" tL,Kgp],tLlqc]nn]. Aw]yL Terramycin Eye Ointment ygt],tL;pn]"
 tac];pQn]An]Kw]:mL;Tqc]: - pgt],kC]: (kn] 21.2) pn]yL amoxicillin"
hUAgk],ngc] (kn] 21.1) pn]yL amoxicillin"
 pn]tac];hn]Tiuc]Em:luk]:Agn], hG]:pn]kin]nUm];Em:kCL,eS lQc].tac];kin]tac],siUw]; tgn]:tL,
luk]:Agn],An]ekL.yC],liUw]"
 Sc]kUn];pQn]nC];hgc]: IPD pQn]mak],lqc]n} Sm];yLeh.kc]:pn]luk]:Agn], An]yC],liUw] 6 liUn] nC];
hUc];yLtc];mUt];"
lgc]:eh.kc]: = yLeh.kc]:
tL,eh.kc]:tac];pQn]nn].Et. Sm];yLeh.kc]:nn].yw]." Sm];yLeh.kc]: (0.5 cc yLeh.kc]:mak],lqc])
pn]luk]:Agn],tI:mI;AL,yul}: 9 liUn]kU:ekL. niuc]:pgk]:" (tUv];tI:eKL:PiUm].Tqm] 24)
Aac]:Aic] pgt],kC]: (kn] 21.2 )' hUAgk],ngc] (kn] 21.1)"
km]:nm]Et. nC];piun].tI:An]sac]:pQn]tac];pQn]nm]nn]. kgp]:sac]:eP:pQn]hL<kCL,l}:El:

mat]:m}atac];pQn]kU:An]eS SUc],Kaw],pn]kCL,"
210
pUw],lI,yUw], (Poliomyelitis)
tUv];tI:eKL:PiUm].Tqm]
eKL:piut],tI:pgc],
tac];pQn]An]n}.n}. pQn]kgp]:siUw].mqc];w};rt].S]pUw],lI,yUw],eS hQt];hG]:kiuc].kac].pQn]mL;nn].yw]." kgp]:
siUw].mqc];pUw],lI,yUw],n}. etkCL,yL.kw];eS<l]AL,yUc], tI:lup],Sn]El: kUn];pQn]sac]:t}aPak],l}:nn].
yw]." tac];pQn] An]n}.n}. luk].tI:kUn];ekL.niuc]: kCL,sU;kUn];ekL.niuc]: (P}a:lUc] – luk].tI:miuw]; Kw]:
sU;pak],) sp];tit];kCL, km];Siuw]:El:Sc]' sp];tit];tac];Agm]: (tac];kin] An]mI;P}a:lUc]tit];yU,'
nm].An]kin]Kw]:kCL,)" pn]kin]yLeh.kc]:eSEl: eh.kc]:tac];pQn]pUw],lI,yUw],n}.l}:"
Pac]hac]:tac];pQn]
 kUn];An]sp];tit];siUw].mqc];kCL,n}. etAm],EnPac]hac]:tac];pQn]Sc]"
 hac]:Pac]An]Am],pQn] t}apgt];tUw] – mI;lUm];naw]' kUn].Kiun]:sgm];kam]:niUw].' hUw]K}:' hak]:'
sQp];sgm]; Sn]lc]"
 hac]:Pac]An]t}apgt];tUw] – l}a;tI:SQn]:AQn]t}akCL,siUc].n}n}. kiuc].kac].AUn]:Agn], Am],PQc],
kn]eS etEt,luk].tI:tin] pQn]Kiun]:mL;tac];kgk];hUw]n}.yw]." kUv];kL: lgc]:hU.niUw].hU.tUw]
sgm];Piw]nc]n}. yc];etmiUn]kw]," lgc]:AUn]:Agn],n}. Sc]mL;Tiuc]tI: pgt];kam]:niUw].TUv]:sC]n}
kUn];pQn]sac]:Tiuc]tI:t}al}:"
kUn];pQn]An]kiuc].kac].t}apgt];tUw]kU:ekL. sgm];nc],p}a;yLn} wUn].Sgn],wL: pQn]kgp]:pUw],lIyUw],w}.kgn],"
Aw]tUw]yac],P}a:lUc]eS kUt],sqt]:siUw].mqc];l}:"
lgc]:yUt];yL
 kUn];pQn] An]t}apgt];tC]:kCL,nn]. hp].w}.tI:hgc]:kUn];pQn]nC];eS hG]:liuw]:w}.kgn],"
 pn]yLtL,lgc]:kUn].Kiun]:sQp];mUv]:"
 kgp]:kUn];pQn] l}:ngn];yaw];hiuc]nL,El: nc],hiuw]sgm];lc]etAm],pQn]sQp];Kiun]:mL;nn].
hG]:eh.kc]:pn]"
 nc],hiuw]etAm],hG]:kam]:niUw].lQk].lUc];kCL,' Kqc]KQc]:mL;nn]. hG]:tUc].niuc]pn]yU,tL,eS,"
kgp]:wL: lgc]:Sm];yLn}. etsac]:hQt];hG]:tac];pQn]pUw],lI,yUw],h}a.hqc];l}:El:

kUn];pQn]An]hw];wUn].Sgn],wL: pQn]pUw],lI,yUw],nn]. yL,Sm];KQm]pn]lL;lL;"
211
15
lgc:] eh.kc]:El: yLeh.kc]:
 miUw]:luk]:Agn],kiUt],mC],nn]. pn]yLeh.kc]:' miUw]:l}: 6 wUc]:' miUw]:l}: 10 wUc]:' 14 wUc]:El:
niuc]:KUp], w}a;pn]yLliun];Sut];yw]."
 Sc]wUn].Sgn],wL:nC];piun].tI:nn].mI;kUn];pQn]pUw],lI,yUw],n}siuc] hG]:pn]yLeh.kc]:pUw],lI,yUw], tL,
luk]:Agn],AL,yulQk].liUw] 5 KUp],nC];piun].tI:nn].kU:ekL.pqk].Sm].wL:yam]:pn]yw].eStL.ekL:yw]."
 Sc]hU.tqt]:etL; kgp]:l}:hU.tI:hgc]:lqp],wL: pQn]pUw],lI,yUw],Et.n}siuc] hG]:pn]yLeh.kc]: pUw],lI,
yUw], tL,luk]:Agn],pQn]kum],pQn]mU,Aw]"
Aac]:Aic] (lgk];Kgc]:yLeh.kc]: - tI:nL:lik]:eKL:PiUm].Tqm])
tac];pQn]kgc].mLygc], (Rabies)
lWc]:etl}:SUc],Kaw], Kn]w};
eKL:piut],tI:pgc],
tac];pQn]kgc].mLygc],n}. pQn]kgp]:w};rt].S]Sqn];niuc]: An]sac]:hQt];hG]:t}al}:eS etpQn]tI:St];lQc].
sgm];hiUn]; (miUn]nc], mqw];' mL)' St];pL, (miUn],nc], - nUk].wic],) Agn]tac];" tac];pQn]An]n}.
etsp];tit]; St];sU;St]; Am],nn] St];sU;kUn]; kgp]:lUbv]:kCL,tiUw].vL;nm].l}a; An]mI;siUw].mqc];
(miUn]nc], - KUp];vL;' Kut],vL;' el;vL;Piw]nc]tI:mI;h}g;yU,' tiUw].vL;nm].KI:muk]:)" miUw]:lC] mI;Pac]hac]:
tac];pQn]Agk],mL; kUn]; Am],nn] St]; An]sp];tit];siUw].mqc];mL;nn]. sac]:t}al}:" kUv];kL: w}a;eS
sp];tit];siUw].mqc];yw]. miUw]:p},mI;Pac]hac]:tac];pQn]nn]. Sc]Sm];yLeh.kc]: Kuit];Kaw];yam];n}siuc]
sac]:eh.kc]:ASak]:kUn];pQn]l}:"
Pac]hac]:tac];pQn]
 w}a;eSvL;KUp];yw]. 20 Tiuc] 90 wn]; etKUm];' sQp];' nL (him];tI:vL;KUp];)"
 mI;lUm];naw]' kt];Sn],' hqc];eA,' hUw]K}:
 tac];pQn]kgc].mLygc],An]lIkUw] – Pac]hac]:tac];pQn] An]Am],nim]' sC]h}a.' sC]Am],man],'
kam]:niUw].KQc]:' kUw]nm]. Am],nn]
 tac];pQn]kgc].mLygc],SQn]:AQn]t}a – SQn]:AQn]tI:vL;KUp]; etEt,t}aeSeP:Agk],kCL,"
 Sc]pQn]tac];pQn]kgc].mLygc],tc];Sgc]Sqn]; An]wL:mL;pL:niUw]n}.n}siuc] SQn]:AQn]kUn];pQn] ett}a
kCL,l}g;l}g;eSetlium];tUw]El:Tiuc]t}al}:" kUn];pQn]An]t}akgp]:tac];pQn]n}.tc];mUt]; etpQn]kgp]:
212
SQn]:AQn]kam]:niUw].sgm];SQn]:tac];TUv]:sC]t}aeS Am],TUv]:sG]l}:El: sc],l}:t}akn]nn].yw]."
Sc]Am],lum];lL;lIlIsiuc] kUn];pQn]sac]:t}al}:nC];Kaw];tac];sQt];wn];tI:An]Et,pQn]tac];pQn]
nn].yw]."
vL;mLKUp];' vL;nUk].wic],KUp];' Sc]kUn];pQn] An]mI;h}g;mat],sQp];El: mI;Pac]hac]:tac];pQn] SQn]:AL,yUc],
yup]:ygm];n}siuc] mk];mn]:l}:wL: pQn]tac];pQn]kgc].mLygc],"
Em:pL;tgc].El: luk]:Agn],AL,yulQk].liUw]niuc]:KUp],nn]. Sm];yLeh.kc]:

tac];pQn]kgc].mLygc],l}:"
lgc]:yUt];yL
tL,kUn];pQn] An]EnPac]hac]:tac];pQn]yw].nn]. Am],mI;yLlC] etyLhG]:tiUw].l}:lI" cw];l}a;siUc].n}
nn]. nc],hiuw]ethQt];hG]:tac];pQn]lIKiun]:nn]. tk];l}:yUt];yLsgm];Pac]hac]:tac];pQn]kCL,kUv];" (miUn]nc],
- pn]yLhG]: lgc]:sQp];hG]:eA,lUc]; (kn] 7.5)' pn]yLngn];lp]; (kn] 7.2)"
eh.kc]:tac];pQn]kgc].mLygc],l}: sgm];nc],pL:tC]:n}.
1. yUt];yLpn] h}g;KUp];
2. w}a;eSvL;mLygc],KUp];yw].nn]. * Sm];yLeh.kc]:km];lQw] *(yLeh.kc]: El:/Am],nn] yLEk:
tac];pQn]kgc].mLygc],)"
1. yUt];yLpn] h}g;KUp];
 Aw]nm].El: Sp].pYL,Suk]:h}g;tI:vL;KUp];hG]:mUt];SC]"
 Aw]yLAI,tenL; Am],nn] yLAa}.AUw],tin];SC],pn]"
 Sc]wL:sQp];nn].pQn]h}g;KUp];' hG]:Aw]ngc]liUt]:nw]:Agk],pqt]:" nC];Kaw];tac]; 24 sUw]:mUc];nn].
yL,nqt]: yQp].El: pik].h}g;sQp];" Sc]sm]pQn]nL,n} Sm];yLptI<KYI<wnpn]Agn]tac];"
 nc],hiuw]eteh.kc]: Am],hG]:sp];tit];siUw].mqc];tac],siUw]; (miUn]nc], siUw].mqc];kac];Kqc]) nn].
Tuk],lISm];pn]yLeh.kc]:kac];Kqc]El: yLKL:siUw].mqc]; hUm]:tc];yLeh.kc]:tac];pQn]kgc].mLygc],"
(lgc]:yUt];yL lum];lL;h}g;sQp];El: tac];pQn]kac];Kqc]' kn] 21.4)"
213
15
2. w}a;eSvL;mLygc],KUp]; Sm];yLeh.kc]:pn]
Aic]niUw]l}a;tiUw].vL;eS mqc],kum], (sgm];nc],muk].sum];lUc]p}a;yU,lIlum]:fL.)
kum], (1) Sc]piun];tac];pQn]tqt]:etL;n} Am],tap]:pn]lgc]:

tiUw].vL;l}al}a' lQc].tac];kin] Am],nn] yUt];yL"
el;SC],Piw]tI:mI;h}g;sQp];
kum], (2) Sm];pn]yLeh.kc]:km];lQw]"
tiUw].vL; kUbv];liUt]:Am],Agk],' KUp];vL; eStL. kUv];kL: Sc]wL: nC];Kaw];tac]; 10 wn];pUn].mL;El:
Am],mI;h}g;sQp];' el;vL;Piw]nc] tI:mI;sQp];' mLAn]KUp];nn].Am],pQn]Sc]' Am],mI;Pac]hac]:tac];
y}a;vL;Piw]nc] tI:Am],mI;Sc] eh.kc]:w}. pQn]Sc]n}siuc] kiut];yut];pn]yLeh.kc]:l}:"
kum], (3) Sm];pn]yLeh.kc]:El:yLEk:tac];pQn]kgc].mLygc],
KUp];vL;h}a.hqc]; mI;h}g;KUp];niuc];h}g;Am],nn] tc]; 2 Sqn];km];lQw]"
nm]liUw]nn]. Am],nn] yC];hUm],mac]kUn]; miUn]nc], kUv];kL: Sc]wL:nC];Kaw];tac]; 10 wn];pUn].mL;El:
sn].tLSC] kCL,tiUw].vL; tc];nm].l}a;tUw]St]; mLAn]KUp];nn]. Am],pQn]Sc]'
Am],mI;Pac]hac]:tac];pQn]Sc]n}siuc] kiut];yut];
pn]yLeh.kc]:l}:"
 Sm];pn] yLEk:tac];pQn]kgc].mLygc], hG]:kum], (2) El: (3) Kn]w};l}:kL:hiuw]ekL: hG]:pn]w};w};

km];lQw]"
 yLEk:tac];pQn]kgc].mLygc], (Anti-rabies immunoglobulin) n}. Tuk],lIpn]kum], ( 3) El:
kum], (2) An]mI;hqc];Kam],tUw]eA," Tuk],lIpn]yLn}. hiuc] 7 wn];"
kgp]:pC].tUv]; mLetpQn]Am],pQn]tac];pQn]eS yL,hG]:l}:Sm];pn]yLeh.kc]:

TiUc];kCL,pqt]:"
lgc]:Sm];yLEk: tac];pQn]kgc].mLygc],
 Sm];Kw]:kCL,nC];h}g;KUp];liuk].liuk].El: him];hgm];h}g;KUp];" Sc]pQn]l}: sgm];nc],p}a;tUw]nn]. hG]:Sm];pn]
him];hgm];h}g;sqp];nm]nm]" Sc]wL: yLyc];liUw]yU,n}siuc] hG]:Sm];pn]Tqc]:tI:niuc]: tI:kam]:niUw].
(miUn]nc], - kam]:niuw].KLlUc]nL:) hG]:hac],kn]tc]; An]etSm];yLeh.kc]: tac];pQn]kgc].mLygc],"
 etAm],l}:Sm];nm]liUw] tI:mk];mn]:w}. – nm].yLAn]Sgn],np].w}.nn]. Tuk],lISm];pn]
h}g;sQp];kU:tI: - Sc]Am],epL;n}siuc] Aw]nm].kn],mL;elL; 2 – 3 pun]:eS Sm];pn] him];hgm];h}g;
sQp];mUt];mUt];" Volume of RIG: 20IU/kg for human RIG or 40IU/kg of Equine RIG"
Kp].m}asqn],tL,Sm];yLeh.kc]:
 Kp].m}asqn],tL,Sm];yLeh.kc]: Kw]:nC];kam]:niUw].
 miUw]:Sm];yLeh.kc]:nn]. yL,Sm];tI:kum],kUn]:" hG]:Sm];tI:kam]:niUw].Kqn]"
214
 *Classical 5 dose:
 Et.Aw]wn];An]vL;KUp];' wn];TI. (3)' wn];TI. (4)' wn];TI. (7) El: wn];TI.(28)
siUw];nn]. hG]:Sm];pn]yLeh.kc]: tI:kam]:niUw].Kqn] Am],nn] kam]:niUw].tI:KLlUc]Pa},nL: tL,niuc]:
pgk]:niuc]:KQm] (1 mI,lI,mI,tL,)"
 * tac];liUk]:Tqc]:An]niuc]: - sC].l}a;Sm];yLeh.kc]: 2-1-1 pn]"
 miUw]:wn];An]vL;KUp];nn]. hG]:Sm];pn]tI:kam]:niUw].Kqn]S}a.El:KCL niuc]:P}a,niuc]:KQm]" Sm];pn]Tqc]:
KQm]niuc]: miUw]:wn];TI. (7) El:wn];TI. (21)"
 Kp].m}asqn],tL,Sm];yLeh.kc]: tI:Piw]nc]
 lgc]:sC].l}a;Sm];yLeh.kc]: tC]:Piw]nc]n}. etlUt];ygm]; tac];nm]yLeh.kc]:eA,lUc];eS
kL:sC].s}a,ekL: eteA,lUc];Tiuc] 60% -80%"
la};Sm];pn] (2) tI: (2-2-2-0-1-1)

wn];TI.(0)(3)El:(7) - 0.1 Am],nn] 0.2 ml ID in 2 sites tI:kam]:niUw].Kqn]Sgc]P}a,
wn];TI. (28)El:(90) - 0.1 Am],nn] 0.2 ml ID in 1 site tI:kam]:niUw].Kqn] P}a,lQw]
la};Sm];pn] (8)tI:
wn];TI.(0) - 0.1 ml ID into 8 sites 2x tI:kam]:niUw].Kqn]Sgc]P}a,'
kam]:niUw].tI:mL,' tgc].n}g.' KLlUc]
wn];TI. (7) - 0.1 ml ID into 4 sites 2 x tI:kam]:niUw].Kqn]Sgc]P}a,'KLlUc]
wn];TI. (28) - 0.1 ml ID into 1 site
wn];TI. (28)El:(90) - 0.1 ml ID into 1 site
l}a;Sm];pn] (8) tI:n}. sC].tiuw]; mUiw]:cw];l}a;Kuik].Kk]. miUw]:Am],mI;yLEk:tac];pQn]kgc].mLygc],l}:"
Sc]wL:etsC].tiuw]; l}a;Sm];yLtC]:Piw]nc]n}siuc] Tuk],lISgn]pn]PU:hap],kan]p}a;yU,lI lgk];l}a;Sm];

pn]lIlI" Tuk],lImI;tI:kQp];Sim]; yLeh.kc]:El: tqp];tt];wL: w}a;eSpiut],sC].yw]. tL,sC].hG]:mUt];nn].
etw}.hiuc]Sut];l}awn]; " etl}:hG]:tqt]:etL;wL: mI;lgt],El:KQm]pgt]; tL,Sm];tC]:Piw]nc]"
lgc]:eh.kc]:El: yLeh.kc]:
ciUc].ew: yLhG]:St];An]sp];siUw].mqc];KUp];vL;" pqk].Sm].wL: Am],p},mI;mLygc],KUp];vL;ekL:yw]. lgc]:Sm];yL
eh.kc]:n}.etlItgn]:tL, kUn];An]sac]:vL;tUw]St];KUp];l}:nm] (miUn]nc], emLyLSt];' kUn;] An]l}:
tiUw].vL;tUw]St];yU,tL,eS, Am],nn] PU:hap],kan]pL,m}.)"
tac];pQn]kgc].mLygc],n}.Sc]l}:Sm];yLeh.kc]:Kiut];tn];n}siuc] pQn]tac];pQn]An]eh.kc]:Am],hG]:Tiuc]t}al}:"
Aac]:Aic] l}a;lum];lL;sQp]; ( kn] 22.4)
215
tac];pQn]kam]:niUw].El:lup],
16
16.1 tac];pQn]lup],kp]; (Disorder of the Joints)
tac];pQn]lup],kp];n}.pQn]kgp]:siUw].mqc];Kw]:kCL,nC];lup],kp]; (kgp]:siUw].mqc];Kw]:El:lup],kp];kC]:) Am],nn] lup],
kp]; kC]:An]Am],mI;siUw].mqc];Kw]: (tac];pQn]kC]:Sm],mtL,) Am],nn]kgp]:tiUw].vL; (eKL:Kt];) siUw];n}.yw]."
lup],kp];sQp];kC]: kgp]:siUw].mqc];tac];pQn] (Septic Arthritis)
eKL:piut],tI:pgc], - lup],kp];kC]: kgp]:siUw].mqc];tac];pQn]n}. lup],kp];An]niuc]: Am],nn] nm]liUw]nn].

kC]:eS km]:nm]Et. etAm],pQn]PQc],kn] etsac]:pQn] P}a,S}a. Am],nn] P}a,KCLP}a,lQw]kUv];" lgc]:
siUw].mqc];Kw]:lup],kp];eStI:tI:eSsQp];kC]:n}. luk]:Agn],etpQn]kn]km]:nm]El: etpQn]kgp]:siUw].mqc];
Stqp]:P}lUw]<kUw]<kt].S] (Staphylococcus) nn].yw]." kUv];kL: luk]:Agn], An]Am],l}:Sm];
yLeh.kc]:n}. etsac]:pQn]kgp]:siUw].mqc]; eh,mUw]PI<lat].S] Ain],PlU<SL< (Haemophilus influenza)
km]:nm]" lgc]:siUw].mqc];Kw]:lup],kp];l}al}atI:eSkC]:n}. kUn];lUc]etpQn]km]:nm]El: etpQn]kgp]:siUw].mqc];
kUw],nUw],ekL.kt].S] (Gonococcus)" kgp]:l}:tiUw].vL; mat],sQp];miUw]:Am],hiuc]El: K}lup],kp];sQp];yQn];
kC]:n}.ekL: pQn]tac];pQn]An]l}:hn]pQn]kn]km]:nm]"
Pac]hac]:tac];pQn]
luk]:Agn],kiUt],mC], Am],nn] luk]:Agn]lqc] luk]:Agn], Am],nn] kUn];lUc]
 kgp]:siUw].mqc];Kw]:lup],kp];El: tin]/miuw];  lup],kp];sQp];h}a.hqc];"
Am],tUc].niuc]l}:"  lup],kp];etL,kC]:El: lqc]"
 eth}: miUw]:tUc].niuc]lup],kp];tI:kC]:"  kgp]:siUw].mqc];Kw]:lup],kp];El: tin]/miuw];
 sC]pit];sC]pgt];c}a:" Am],tUc].niuc]l}:"
 mI;lUm];naw]"  mI;lUm];naw]Ait];Agt];"
lgc]:KUn].hLmk];mn]:tac];pQn] – Aw]ngc]tI:eKL:kC]:Agk],mL;lQc].eSkUt],sqt]:tUv];tL,yUt];yL"
Sc]kUn];pQn]mI;Pac]hac]:sgm];nc],pL:tC]:n}.siuc]hG]:wUn].Sgn],wL: eKL:etL,kC]:kgp]:siUw].mqc]; kUw],nUw],ekL.kt].S]
(Gonococcus)"
 lup],kp];sQp];kC]: lup],kp];niuc]:yw].  Piw]nc]pQn]tum],pQn]hUv],- pQn]tum],pQn]hUv],siUw];n}.

lup].kp];niuc]: tL, 1 Tiuc] 4 wn];" etpQn]SIKgc],Tiuc]SIlqc]El: etsac]:pQn]tum],
 kgp]:lup],kp];kC]:El: sQp];tI:miuw];Am],nn] AUm]ngc] Am],nn] sm].man].mL;"
eKL:miuw];"  mI;nm].Kaw]Agk],mL; tI:SQn]:tac];yQw]:Am],nn]
216
tac];pQn]kam]:niUw].El:lup], 16
 sQp];tI:lup],kp];lQw]kUv];" hU;kiUt],luk]:"
 mI;lUm];naw]"  mUiw]:yQw]:nn]. sQp]; Am],nn] m}:"
 tgc].n}g.sQp];"
tL,yUt];yLnn]. tk];etAw]ngc]Agk],tI:eKL:etL,mL;El: KUn];hLmk];mn]:tac];pQn]n}.
lgc]:yUt];yL
luk]:Agn], 5 KUp],lUc];tC]:
 hp].w}.yUt];yLtI:hgc]:kUn];pQn]nC];"
 Sm];pn]yL Cloxacillin IV El: gentamicin yw]. pn]yLkin]sgm];tL, 21 wn];"
 Sc]wL:wn];TI. 3 yw].yc];p},lIKiun]:mL;n}siuc]PiUm].Tqm]yL ceftriaxone IM/IV pn]tL, 21 wn];"
 Sc]wL:pQn]tI:lup],kp]; tI:l}:hp].nm].nk];nm] miUn]nc], lup],kp];tI:kum],kUn]: Am],nn] hUw]Kw],
n}siuc] hG]:pn]liuw]:l}al}awn];Ait];niuc]:"
luk]:Agn],yC],liUw] 5 KUp],
 Sm];pn]yL Cloxacillin IV tL, 3 wn];yw]. pn]yLkin]sgm];tL, 21 wn];"
 Sc]wL:wn];TI. 3 yw]. yc];p},lIKiun]:mL;n}siuc]PiUm].Tqm]yL gentamicin IM/IV pn]tL, 5 wn];"
 Sc]wL:pQn]tI: lup],kp];tI:l}:hp].nm].nk];nm] miUn]nc], lup],kp];tI:kum],kUn]: Am],nn] hUw]Kw],
n}siuc]hG]:pn]liuw]:l}al}awn];Ait];niuc]:"
kUn];lUc]
(k) Sc]Am],mI;Pac]hac]:siUw].mqc];Kw]:n}siuc] yUt];yLpn]hgc]:kUn];pQn]ngk]:"
 pn]yL Cloxacillin 500mg PO QID eA,Sut];tL, 21 wn];"
(K) Sc]lUm];naw]Suc]El: cw];l}a;kUn];pQn]Am],epL;lI Am],nn] w}a;eSyUt];yL 2 wn];yw].
Am],lIKiun]:mL;n}siuc]-
 pn]yL Cloxacillin IM/IV etL,epL;lIKiun]:mL; (Siup],pn]yLkin] tI:eA,Sut];tL, 21 wn];)
El: wUn].Sgn],wL: pQn]eKL:kC]:kgp]:siUw].mqc];kUw],nUw],ekL.kt].S] (Gonococcus)"
Sc]mI;Pac]hac]:siUw].mqc];kUw],nUw],ekL.kt].S] (Gonococcus) Kw]:n}siuc]
 PiUm].Tqm]yL Ceftriaxone IV/IM pn]tL, 21 wn];"
lgc:] eh.kc]:
pn]yLKL:siUw].mqc]; eh.kc]:tgn]:tL,kUn];An]lqp]:etmI;eP; (miUn]nc],kUn];yQp],vL;mak],mL; An]Am],
p},hiuc]) n}. etpQn]lgc]:km].s}g:Am],hG]:pQn]tac];pQn]l}:"
Aac]:Aic] siUw].mqc];An]sp];tit];kn]l}:lUv]:lgc]:hUm]:kL,m (kn] 13.5)
217
tac];pQn]kam]:nUiw].El:lup],
16
lup],kp];sQp];kC]: An]Am],sG]:siUw].mqc];
mI;lgc]:tac];tc];nm] hQt];hG]:lup],kp];kC]: An]Am],sG]:kgp]:sUiw].mqc];" km]:nm] etpQn]kgp]:lup],kC]:El:
lup],kp]; ekL:kC]:pL;mL;sgm];' K}lup],kp];sQp];kC]:El:kw]. (gout)"
tL,tqp];tt];wL: eKL:tI:kC]:n}. pQn]kgp]:siUw].mqc];Kw]:hiuw] Am],nn] kC]:Sm],mtL,hiuw]n}nn].
pQn]lgc]:yap],yU," kgp]:n} tL,kQp];Aw]eKL:mun];piun];lc]tI:sqc]:lqc];n}. pQn]An]lm],lgc]:Et."
Sc]Am],hU.tqt]:etL;wL: pQn]kgp]:Sc]n}siuc] hG]:yUt];yLpn]tac];pQn] tc];Sgc]Sqn];"
(k) lup],El: lup],kp];kC]:

eKL:piut],tI:pgc],
lup],El:lup],kp];kC]:An]wL:nn]. tI:lup],kp];nn]. etkG]:Ait];Agt];kUv];" lgc]:tac];An]l}:pQn] siUc].
n}nn]. lup],Agn],An]eh.kc]:lup],kp];w}.siUw];n}. l}:hk];lqw]kCL, Am],nn] kgp]:l}:sC].kan]nm]el: pQn]
nn].yw]." kgp]:wL:lup],Agn], An]eh.kc]:yU,l}:lU.lqw]kCL,eS lup],Kqc] An]yU,tC]:lup],Agn],nn]. kgp]:
Am],mI;Sc]eh.kc]:yw].El:sc],hU.tUw]sQp];mL;nn].yw]." km]:nm]Et. miUw]:tUc].niuc]tI:lup],kp]; An]hp].
nm].nk];nm](p}tac];' suk]; niUw]lup],kp];An]l}:hp].nm].nk];nm]) nn].ethU.sQp];" lup],kp]; tI:k}.pQn]
nm]Et.lup],kp];kum],kUn]:' huw]Kw],'sgm];lup],kp];Sn]lc]' lup],kp];tin]El:lup],kp];miuw];siUw];n}.yw]."
Pac]hac]:tac];pQn]
 sQp];kC]:Kaw];hiuc] – ethQt];hG]:lgc]:tUc].niuc]eKL:etL,eA,lUc];El: KQc]Kiun]:mL;"
 eKL:etL, etkm];km];k}.kC]:El: miUw]:tUc].niuc]nn].etl}:yin];SQc]tI:eKL:etL,"
 kam];niUw].him];hgm];lup],kp];tI:An]pQn]nn]. etlQk].El:AUn]:"
 Sc]l}:sC].tiuw];lup],kp]; tI:pQn]nn]. tc];wn];n}siuc] Pac]hac]:tac];pQn]Kqn];eth}a.hqc];mL;"
lgc]:epL.AQk].S]er; tI:lup],kp];An]pQn]sQp];n}siuc] etsac]:mk];mn]:tac];pQn]hG]:Tuk].mqn]:l}:"
lgc]:yUt];yL
 Paracetamol
 pn]yLEk:sQp];kC]: miUn]nc], indomthacin, ASA, ibuprofen ( kn] 7.5 )"
km]:nm]Et. yLEk:sQp];/Kiun]:n}. tk];etl}:pn]Kaw];yaw];El: etl}:fac].lgc]:Pgn];sL.yL
tL,kUn];pQn] sUiw];mI;AL,yuSuc]"
218
lgc]:eh.kc]:
lQn]:Agk],hqc];pn]tL,eS,' epL;pQn]l}:Et. hG]:p}tac]; Am],nn] luv];nm]." Aw]Tuc]nm].Aun],Tp].pn]
mUiw]:etlQn]:Agk],hqc];El: Aw]Tuc]nm].kt];Tp].pn]tI:lup],kp];tI;kC]:n}. ethQt];hG]:miUn]nc],yiut]:SQn]:
yiut]: AQn]El: ets}g:hQt];hG]:sQp];kC]:nn]. mw]lUc];mL;l}:"
Aac]:Aic] sQp]; (kn] 7.5)"
(K) K}lup],kp];sQp];kC]:
eKL:piut],tI:pgc],
etsQp];kC]:hgp]:him];hgm];lup],kp];Kaw];hiuc]El: Pgn];sL.tac],siUw]; ethUm]:pQn]l}atI:tc];tUw]" Pac]hac]:tac];
pQn]n}. etpQn]pQn]h}ah}aeS nC];Kaw];hiuc]nn]. lup],kp];etlU.lqw]kCL,yw]. hac]:Pac]lup],kp];ekL: etsac]:
lqk]:l}a:kCL,pqt]:" Pac]hac]:siUc].n}n}. km]:nm]Et.etEt,pQn] w}a;AL,yul}: 40 pI<Kiun]:kCL," (kUv];kL:
tac];pQn]K}lup],kp];sQp];kC]:n}. miUw]:lQk].ekL:sac]:pQn]l}: - miUn]nc],tac];pQn] StI<l] (still disease)'
lup],kp];sQp];kC]:hUm]:tc]; lgc]:lqk]:l}a:Kgc]Piw]nc]El: mam].yC],)" km]:nm]Et. etpQn]nm]liUw]lup],kp];
niuc]:tI:El: etpQn]PQc],kn] (tc];Sgc],f}a,Kgc]tUw]kUn];)" tI:pQn]nm]Et. pQn]lup],kp];niw].miuw];"
Pac]hac]:tac];pQn]
 Sc]tiUw].vL;lup],kp]; (km]:nm] pQn]lup],kp];niw].miuw];' lup],kp];Kqn]' hUw]Kw],) siUw];n}.etsQp];"
liUw]eSnn]. tI:lup],kp];nn]. etm}:El:kC]:"
 Am],wL:tUc].niuc]ekL.lQw]El: piUn]:tUc].niuc]pn]n} lup],kp];nn]. etsQp];eS tUc].niuc]l}:eA,"
 kUn];pQn]km]:nm] etk}.lat]:EnEt. “kac]nC]sw].luk].mL; lup],kp];etKQc]w}. epL:kac]wn];ekL:
eth}a kCL,hc];mn];” n}yw]."
Pgn];sL.sgm];lc]
 kgp]:lup],kp];lU.kCL,El: hac]:Pac]etlU.kCL,sgm];"
 hqc];liUt]:eA,' etmI;tum],pQn]hUv], Agk],mL;sgm];Piw]nc]' yC];hUm],hUw]sC]kC]:' pgt],etKqc]eS pQn]
kgn]:kCL,pqt]:"
lgc]:epL.AQk].S]er;tI:lup],kp];tI:pQn]sQp];n}siuc] etmk];mn]:tac];pQn]l}:" Aw]liUt]:mL;kUt],sqt]:tUv];
wL: mI;liUt]:sac]hiuw]/Am]mI;liUt]:sac] (mQt].liUt]:lqc]' tac];nLnqn]:Kgc]liUt]:)"
lgc]:yUt];yL
 pn]yLEk:sQp];Kiun]: - Asprin ' ibuprofen ' indomethacin (kn] 7.5)"
 pn]yLeh.kc]: yL,hG]:tac];pQn]h}a.hqc];Kiun]:mL; - miUn]nc], Km];' penicilliamine' yLnaw]nUk].
219
16
(chloroquine) Am],nn] methotrexate" tL,etsC].yLsiUw];n}.yUt];yLEl: hqc];yL
An]etl}:pn]n}. tiUc],pac],tc];emLyLtL,eS,"
 pn]hqc];yLStiUw]<r}W;tI:Am],Suc] tL,yUt];yLKaw];hiuc] - Prednisolone PO 7.5 mg OD "
 yUt];yLpn]tac];pQn]liUt]:sac] (kn] 14.1)"
tL,tgc]; -
* Sc]wL:pn]yLStiUw]<r}W;n} pn]hqc];yLAn]tqm],liUw]piUn]: tI:nc],pQn]l}:" yLkiuc].kac].kiut];pn]yL
StiUw]<r}W;lL;lL;' lat]:EnkUn];pQn] lgc]:Pgn];sL. An]l}:kin]yLStiUw]<r}W;Kaw];yaw]; (miUn]nc],
hUc];Kw]: pQn]sQp];' hqc];lup],AUn]:' tac];pQn]etL:hin]' pQn]sQp];yQn];c}a:liUw]mL;)"
* Sc]wL:etl}:pn]yLStiUw]<r}W;hUm];tc]; ibuprofen Am],nn] indomethacin n}siuc] tL,eh.kc]:
liUt]:Agk],nC];huc];Kw]:nn]. hG]:PiUm].Tqm]pn]yL omeprazole " (kn] 7.5 )
lgc]:eh.kc]:
lQn]:Agk],hqc];pn]tL,eS,' epL;pQn]l}:Et. hG]:p}tac]; Am],nn] luv];nm]." Aw]m}. Am],nn] es:Kqc]
An]nLpat]:w}.pn]lup],kp];kqn],kqn],n}siuc] ethQt];hG]:Pac]hac]:tac];pQn]lIKiun]:mL;eS ethQt];hG]:lup],kp];
tUc].niuc]l}:lIliUw]kw],"
Aac]:Aic] sQp]; (kn] 7.5)' tac];pQn]liUt]:sac] (kn] 14.1)"
(c) tac];pQn]kw]. (Gout)
eKL:piut],tI:pgc],
lup],kp];sQp];kC]: kgp]:kgn]:Krit],S]tiUw]<yUrI;yL<kgn]:lQk].lQk]." Tat]:yUrI;yL<nm]Kiun];mL;n}. kgp]:kin]
tac];kin] An]mI;Tat];yUrI;yL<El:Sc]' kgp]:kin]yLmac]An]El:Sc] sc],pQn]mL;nn].yw]." km]:nm]
Et. etpQn]tI:hUw]Kw]:El: lup],kp];hUw]Em:tin]km]:nm]"
Pac]hac]:tac];pQn]
 lup],kp];kiuc].kac].sQp];Kiun]:h}a.hqc];"
 lup],kp]; (km]:nm]Et. eKL:niw].Em:tin]) m}:' kC]:El: lqc]"
Pgn];sL.sgm];lc]
hac]:Pac]lup],kp]; An]pQn]tac];pQn]lU.kCL,' pQn]lI.nC];mak],kqw];' mak].kqw];lU."
lgc]:KUn].hLmk];mn]:tac];pQn] tUv];tI:hac]:Pac]El:kUt],sqt]:tI:hgc]:lqp], - kUt],sqt]:liUt]:'

kUt],sqt]:AI;Aqt].S]AL<' kUt],sqt]:nm].kUt];yU,rin];nC];yQw]:"
220
lgc]:yUt];yL
kiuc].kac].pQn]h}a.hqc]; Kaw];hiuc]
 yLEk:sQp];Kiun]: miUn]nc], ibuprofen Am],nn]  Allopurinol (w}a;eSkiuc].kac].pQn]h}a.hqc]; 3
Indomethacin (yL,sC]. aspirin lL;lL;) wUc]:yw].Et,pn] 100-300 mg OD)
 Sc]Am],lIKiun]:' wUn].Sgn],tL,sC].yLStiUw]<r}W;
w}a;eStiUc],pac],tc];emLyLyw]."
tL,tgc]; -
* Sc]wL:pn]yLStiUw]<r}W;n} pn]hqc];yLAn]tqm],liUw]piUn]: tI:nc],pQn]l}:" yLkiuc].kac].kiut];pn]yL
StiUw]<r}W;lL;lL;' lat]:EnkUn];pQn] lgc]:Pgn];sL.yLStiUw]<r}W; An]l}:kin]Kaw];yaw]; (miUn]nc],
hUc];Kw]: pQn]sQp];' hqc];lup],AUn]:' tac];pQn]etL:hin]' pQn]sQp];yQn];c}a:liUw]mL;)"
* Sc]wL:etl}:pn]yLStiUw]<r}W;hUm];tc]; ibuprofen Am],nn] indomethacin siuc]
tL,eh.kc]:liUt]:Agk], nC];huc];Kw]:nn]. hG]:PiUm].Tqm]pn]yL omeprazole " (kn] 7.5 )
lgc]:eh.kc]: lqk]:l}a:lgc]:kin]yqm].' yL,kin]lw]:' ciUc].ew:kin]niUw].' kin]Pk];yiUw]:nac];KQw]nm]nm]"
16.2 tac];pQn]lup],El:kqn]lup],sQp];kC]:(OSTEOMYELITIS)
eKL:piut],tI:pgc],
tac];pQn]lup],El:kqn]lup],sQp];kC]:n}.pQn]kgp]:siUw].mqc];Kw]:kCL,nC];lup],' km]:nm]Et.pQn]siUw].mqc];pqk],TI;rI;yL;
El: luk]:Agn], etpQn]km]:nm]" luk].tI:SQn]:liUt]:nC];lup],eS etsac]:eP:tiun];kCL,tac],tI:sgm];
liUt]: (miUn]nc], hUpQn]ngc]' pgt],kC]:) l}:" mac]pgk]: siUw].mqc];tac];pQn]n}. luk].tI:sQp];An]pQn]yU,
(tiUw].vL;mat],sQp]; Am],nn] eS;l]niUw].tC]:Piw]nc]sQp];kC]:) nn].eS eP:tuin];Kw]:nG];lup],l}:"
kgp]:siUw].mqc];Kw]:El: etpQn] ngc]mL;eS ngc]siUw];n}.Sm]. etkCL,tit];SQn]:tac];liUt]:El: etpQn]
lup],nw]:' lup],P}g:eSEl: liun];Sut]; lup],ethk];l}:c}a:nn].yw]." siUw].mqc]; An]hQt];hG]: pQn]
km]:nm]Et. pQn]siUw].mqc];Stqp]:P}lUw]<kUw]<kt].S] (Staphylococcus) nn].yw]." Sc]Am],l}: yUt];
yLlIlIn}siuc] tac];pQn]lup],sQp];kC]:n}. etsac]:pQn] Kaw];hiuc]mL;eS etsac]:hQt];hG]:pQn] lup],hqc]:El:
hac]:Pac]lup],etsac]:lU.kCL,pqt]:"
km]:nm]Et.etk}.pQn]tI:lup],nL:Kqc]:' lup],kp];KLlUc]' lup],kp];lc]miuw];El: lup],kp];Sn]lc]" An]pQn]
tI:lup],Sn]lc]n}. etpQn]kgp]:siUw].mqc]; Stqp]:P}lUw]<kUw]<kt].S] (Staphylococcus) Kiuc]:niuc]:eS
pQn]kgp]:siUw].mqc];tac];pQn]TI,pI,Kiuc]:niuc]:nn].yw]."
221
16
Pac]hac]:tac];pQn]
 sQp];nC];lup],"  Am],yU,lI' hiUw].AUn]:"
 him];hgm];pQn]tac];pQn]nn].etm}:' lqc]El: kC]:"  Am],l}:tum].tiUw].vL;Sc]eStL. lup],hk];"
 mI;lUm];naw]"  mI;ngc]suim];Agk],mL;tI:niUw].
 tUn].hak]: (tI:An]pQn]Kaw];hiuc]kUv];)"
 Sc]kUt],sqt]:liUt]:n} mQt].liUt]:Kaw]etnm]w}."
 Sc]Aw]liUt]: miUw]:lUm];naw]Kiun]:nn].mL;lQc].eSkUt],sqt]:siUw].mqc];nC];liUt]:n}siuc]etpQn]lgc]:km].Tqm]
hG]:hU.siUw].mqc];An]tqt]:etL;l}:"
 Aw]KQm]sup],Aw]ngc]nC];lup], tI:pQn]sQp];nn].mL;lQc].eS kUt],sqt]:tUv];"
 lgc]:epL.AQk].S]er;n}. Am],sac]:mk];mn]:tac];pQn]tL,kUn];pQn] An]Et,pQn]nn]. tqt]:etL;l}:"
lgc]:yUt];yL
tac];pQn]lup],sQp];kC]:n}. tk];etl}:Aw] yLptI,KYI<wnyUt];yLpn]Kaw];hiuc]El: ethiuc]l}:Tiuc]l}al}awUc]:
Am],nn] l}al}aliUn] El:mac]pgk]:tk];etl}:PL,tt];yUt];yLsgm];" yL,lium];yUt];yLpn] lgc]:sQp];
Kiun]:" Sc]tac];pQn]h}a.hqc];n} etsac]:pQn]Tiuc]tI:lU.Sum]; miuw];' tin]l}:nn].yw]." Aic]niUw] piun];tac];
pQn]kUn];pQn]' An]pQn]tac];pQn]El: AL,yU.kUn];pQn]eSetl}:tqp];tt];wL: Tuk],lIpn] yLptI,KYI<wn
Sqn];lC]n}yw]."
222
pn]yLptI,KYI<wn - miUw]:pn]yLptI,KYI<wnnn]. Tuk],lIpn]Am],eA,liUw] 6 wUc]:"
1. luk]:Agn],(4 liUn]lUc];tC]:) IV -4 wUc]: Cloxacillin IV El: Ceftriaxone IV
Sc]wL:Sm];pn]yL 4 wUc]:yw]. cw];l}a;tac];pQn]lIKiun]:mL; Am],mI;lUm];naw]' tac];pQn] Am],pQn]tiUw];mL;

n}siuc]hG]:lqk]:l}a:pn]yLkin] Cloxacillin" kUt],sqt]:tUv]; AI;Aqt].S]AL,eSEl: hG]:Siup],pn]kin]yL
etL,AI;Aqt].S]AL,epL;pQn] miUn]pk],ktI,Kiun];"
2. luk]:Agn],(4liUn]Kiun]:niUw]) IV- 4 wUc]: Cloxacillin IV
El:kUn];lUc]
Sc]wL:Sm];pn]yL 4 wUc]:yw]. cw];l}a;tac];pQn]lIKiun]:mL; Am],mI;lUm];naw]' tac];pQn]Am],pQn]tiUw]; mL;
n}siuc] hG]:lqk]:l}a:pn]yLkin] Cloxacillin" kUt],sqt]:tUv]; AI;Aqt].S]AL,eSEl: hG]:Siup],pn]kin]yL
etL,AI;Aqt].S]AL,epL;pQn]miUn]pk],ktI,Kiun];"
Sc]wL:mI;sQp];'tac];pQn]yQw]:wan] mat],sQp];" Cloxacillin El: Ceftriaxone
Am],nn]
Cloxacillin El: Ceftriaxone El: Metronidazole"
kUt],sqt]:tUv];AI;Aqt].S]AL,eSEl:hG]:Siup],pn]
kin]yL etL,AI;Aqt].S]AL,epL;pQn]miUn]pk],ktI,Kiun];"
lgc]:PL,tt];yUt];yL
tk];etl}:Tt];Sac]tac];pQn]wL: sgc],Tuk],lIl}:PL,tt]; Aw]ngc]/lup],Pw]:Agk],pqt]:hiuw]Am],Aw] Agk],
pqt]:" Sc]wL: Am],sC]:eP:mL;sgm];liUt]:siuc] Tuk],lIwUn].lgc]:PL,tt]; Aw]ngc]Agk],pqt]: tL,eS," tL,
yUt];yLnn]. Sc]wL:tk];etl}:sU;PU:lUc].lqn],P}a,lup],n} hC]:SUc],kUn];pQn]kCL,sU;PU:lUc].lqn],P}a,lup],"
lgc]:eh.kc]:
Sc]wL:KG]:eh.kc]: tac];pQn]lup],sQp];kC]: An]eP:mL;sgm];liUt]:n}siuc] eh.kc]:Am],hG]:siUw].mqc];tac],tI:
Kw]:sU;nC];lup]," tL,ethQt];siUc].n}nn]. tk];etl}:KUn].hLmk];mn]:siUw].mqc];tac];pQn] hG]:tqt]:etL;El:
tk];etl}:yUt];yL tac];pQn]tac],tI: tI:An]pQn]kgp]:siUw].mqc];pqk],TI;rI;yL<siUw];nn].tk];etl}:yUt];
yL hG]:Kiut];tn];" lgc]:eh.kc]:An]lIliUw]piUn]:Et. hG]:lum];lL;yUt];yLpn]mat],sQp]; miUw]:pQn]mC],mC],hG]:lI
El: pn]yLptI,KYI<wnsQm]sw].nn].yw]."
223
AL,hL,r
17
17.1 Kat],Tat]:AL,hL,r (Malnutrition)
eKL:piut],tI:pgc],
lgc]:Kat],Tat]:AL,hL,rn}. kgp]:Am],l}:kin]tac];kin]kum],TUn]:El:Sc] Am],nn] Am],l}:kin]tac];kin]
An]mI;AL,hL,rTuk],mqn]:El:Sc] Am],nn] kgp]:tac];pQn]eSsiUw];siUw];El:tUw]Am],l}:hp].AL,hL,rEl:
Sc] Am],nn] lgc]:lqk]:l}a:sC].tiuw];AL,hL,rnC];tUw]El: sc],l}:pQn]nn].yw]."
Sc]wL:luk]:Agn],ekL.niuc]: Am],l}:kin]tac];kin] An]mI;AL,hL,r' Am],l}:kin]AL,hL,r

An]Tuk],l}:kin]nn].kum],TUn]:n}siuc] lgc]:tUw]yC],etTiUc];kCL,pqt]: Am],nn] kiut];
kCL," luk]:Agn], An]Kat],Tat]:AL,hL,rn}. etsac]:pQn]tac];pQn]c}a:liUw] luk]:Agn],
tac],ekL.eS sac]:pQn]Tiuc]t}al}:"
luk]:Agn],lQk].liUw] 5 KUp],n}. Sc]Am],k}.l}:pn]kin] tac];kin]An]mI;AL,hL,rAit];Agt];tL,eS,siuc]

etsac]: Kat],Tat]:AL,hL,rl}:c}a:El: An]lm],lgc]:eSnn].Et. miUw]:Kw]Et,kin]tac];kin] An]pQn]
km]pQn]kgn]:El: kiut];kin]nm].nUm];Em:" luk]:Agn],AL,yupan]<n}.yw]. An]Kat],AL,hL,rl}:c}a:' Am],yU,
lIl}:c}a:El: l}:t}akgp]: tac];pQn]" kgp]:n} tL,hLyUt];yLpn]luk]:Agn],An]Kat], Tat]:AL,hL,rn}.
pQn]An]lm],lgc]:"
Tuk],lIkUt],sqt]:nm].nk];tL,SUn],Suc] (Weight for Height Z Score) pn]kUn];pQn]luk]:Agn],

An]AL,yu lQk].liUw] 5 KUp], An]mL;tI: hgc]:kUn];pQn]nC];El: kUn];pQn]ngk]:kU:ekL."
 Aw]KiUc]:sc]:nm].nk];luk]:Agn],eS sc]:nm].nk];pn]"
 Kiun];mL;tI: An]mat]:m}aw}.nC];pp].piun];Sm];yLeh.kc]: (yLwk].Sin];) luk]:Agn],eS Aw]mL;
niUc];kn]tUv];"
 Aic]niUw]tac];Suc]luk]:Agn],eS l}a;Sgn],np].nm].nk];Tuk],lImI; (Weight for Height Z Score)
nn]. hG]:tUv];tI:lgk];Kgc]: (nC];eKL:PiUm].Tqm]tac];lc])"
Pac]hac]:tac];pQn]/lgc]:KUn].hLmk];mn]:tac];pQn] (luk]:Agn],)
Kat],Tat]:AL,hL,rh}a.hqc];etmI; 3 Sqn];
(k) Kat],Tat]:AL,hL,r mL<rt].S]mat].S] (K) Kat],Tat]:AL,hL,r kCL<SYI<yUw]<ekL;
 mI;nc]El:lup],kUv];' ygm]hqc];nL, mI;K}mn];  tin]kC]:' Kqn]lQk]."
El:kam]:niUw].Ait];Agt];"  Piw]hqc]:El: etpQn]miUn]kQt];pL"
 luk]:Agn],tUv];miUn]kUn];Tw]:"  nL:luk]:Agn],etmUn];miUn]liUn]w}."
 Am],K}:kin]' hiUw].AUn]:eSAm],SUn]sC]him];hgm];  Am],K}:kin]' hiUw].AUn]:eSAm],SUn]sC]him];hgm];
224
AL,hL,r 17
 sgm];nc],lgk];Kgc]: l}:eKL:tgp], ma}Tgn] 2  sgm];nc],lgk];Kgc]: l}:eKL:tgp],m}Tgn]

lUc];tC]:" Suc]liUw] 2 (tI:l}:nm]liUw] 2 nn].kgp]:
ePL;kC]:yU,)
(c)Kat],Tat]:AL,hL,r mL<rt].S]mat].S] kCL<SYI<yUw]<ekL;

tac];pQn]An]n}.n}. etpQn]tac];pQn]tc];Sgc]An] nc],pL:niUw]n}.eS Pac]hac]:tac];pQn]ekL:
ethn]hUm]:kn]tc];Sgc]An]"
lgc]:yUt];yL (Management)
tL,luk]:Agn], An]Tat]:Kat],Tat]:AL,hL,rpan]kac]nn]. sC].l}a;kan]lQc].lU PiUm].Tqm]AL,hL,reS

yUt];yL" lQc].lUpn]tI: hgc]:kUn];pQn]ngk]:"
tL,luk]:Agn], An]Kat],Tat]:AL,hL,rh}a.hqc];nn]. sC].l}a;kan]lQc].lU PiUm].Tqm]AL,hL,reSyUt];yL
lQc].lUpn]tI:hgc]:kUn];pQn]nC];"
tk];etl}:tqt]:etL;lgc]:hQt];Sac]: sgm];nc],piUc]yUt];yLhG]:Tuk],mqn]:" Pgn];lIAn]etAgk],mL;n}.

etAic]niUw] hqc];sC]El: lgc]:hQt];lgc]:Sac]:PU:yUt];yLlum];lL;Et.Et."
miUw]:l}:hp].yUt];yLlum];lL;w}. tI:hgc]:kUn];pQn]nG];nn]. Tuk],lIhG]:lUc];hUc];yLmiUw]:lC]

 mat]:m}anm].nk];' SUn],Suc]El: eKL:tgp], W/H Z score Kgc]luk]:Agn],miUw]:hp].yUt];yL"
 mat]:m}aniUw]Pqn],KYat].nm].nk];luk]:Agn],An]yiUc];Aan];K}:hG]:Tiuc]nn].eSyUt];yLpn]
etL,luk]:Agn], epL;Tiuc]nc],tI:mat]:m}aw}.yw]. sc],hG]:lUc];hUc];yL"
 tL,luk]:Agn],An]Kat],Tat]:AL,hL,rpan]kac] (sC].l}a;kan]lQc].lUPiUm].Tqm]AL,hL,r - SFP)

 Sc]nm].nk];Kiun]:mL;Tiuc] > -1.5 Z score El: nm].nk];Am],lUc];Kuin]; nC];Kaw];tac]; 2
wUc]:Tp];kn]n}siuc] pn]lUc];hUc];yLl}:
 tL,luk]:Agn], An]Kat],Tat]:AL,hL,rh}a.hqc]; (sC].l}a;kan]lQc].lUyUt];yLPiUm].Tqm]AL,hL,r -
TFP)
 Sc]nm].nk];Kiun]:mL;Tiuc] > -2 Z score eS nm].nk];Am],lUc];Kuin]; nC];Kaw];tac]; 2 wUc]:Tt];
kn]n}siuc] pn]lUc];hUc];yLl}:" Suip],SUc],yUt];yLsgm];nc],Pqn]kan] SFP "
tL,tgc];" " yL,lium];tqk]:tUv];SUn],Suc]luk]:Agn],kU:liUn]El:Sgn],np].nm].nk];luk]:Agn],tI:yiUc];m}aw}."
225
AL,hL,r
17
Kat],Tat]:AL,hL,rpan]kac] (Moderate Malnutrition)
(-3 etL,Tiuc] <-2 Z Score W/H)
SUc],luk]:Agn], kCL,lum];lL;sgm];nc], l}a;kan]lQc].lUPiUm].Tqm]AL,hL,r (SFP)" hG]:yUt];yLlum];lL;luk]:
Agn], tI:hiUn];ekL:l}:" miUw]:luk]:Agn],mL;sU;tI:hgc]: OPD nn]. Tuk],lIyUt];yL hQt];Sac]:sgm];nc],
pL:tC]:n}. -
1. lUlWm]Tt];Sac]luk]:Agn], (Evaluate the Child)

tUv];wL:luk]:Agn],sgc],kC]:/Am],kC]:' cw];l}a;tac];pQn]h}a.hqc];tI:pQn]yU,El: lgc]:l}:Sm];yLeh.kc]:"
Kt];sC]Tam]tUv];epL:Em:luk]:Agn],wL: kgp]:Sc]luk]:Agn],Am],yC]," lgc]:tac];An]etpQn]l}:etmI; -
 miUw]:tuit];nUm];Em:nn].Am],l}:pn]kin]tac];kin] An]Tuk],lIpn]kin]El:Am],pn]kin]nm]pQc];epL;"
 kgp]:kUn];hiUn];ekL: Am],epL;mI;tL,kin]El: luk]:Agn],ekL:Am],l}:hp].AL,hL,rtQm]TUn]:"
 Am],k}.km];km];Sgm]pn]luk]:Agn], km];Ait];Ait];"
 Am],yU,lIEl: Am],kin]l}:"
 kgp]:Em:l}:kCL,hQt];kan] Am],nn] kgp]:mI;luk]:Tqc]:ekL.niuc]:El: Am],l}:tUv];luk]:ekL.yC],nn].
tQm]TUn]:"
kCL,yQm]:sC];tI:hiUn];eS Aup],lat]:pn]tac];hU.n}. etsac]:km].s}g:l}:yU,yw]."
2. Et,yUt];yLpn] pQn]Kk].tgn]:El: yUt];yLtac];pQn]tac];siUw];An]mI;sgm]; - tUv];lgc]: tgc].kCL,'

liUt]:sac]El: tac];pQn]Kaw];hiuc]tac],siUw];
3. pn]hqc];hG]:luk]:Agn],kin]tac];kin]pk],ktI,
Sp];lqc];EnwL: luk]:Agn],Tuk],lIkin]tac];kin] An]pn]kin] (tac];kin]tL,Tqm]AL,hLr' tac];kin]
An]mI;mn];' K},' TUw],El: tac];kin]tac],siUw];) n}eStL. Am],Tuk],lImip],AI;hG]:kin]" liUw]nn]. Tuk],
lIpn]hqc];h]G:luk]:Agn], kin]tac];kin]pk],ktI, (miUn]nc], Kw]:' pL' Pk];yiUw]:nac];KQw]' kUv]:) El:kin]
tac];kin]An]Tqm]hqc];nC];wUc]:kac]miuw].Kw]: - lgc]:n}.pQn]lgc]:lm],lgc]:Et.Et.)"
4. mgk],lat]:pn]Em:luk]:Agn],hG]:mL;hp].tac];kin] An]etsqk],pn]kU:wUc]:
5. sc]:nm].nk];luk]:Agn],kU:wUc]:El: mat]:m}atI:Pqn],KYat].w}.
 Sc]nm].nk];luk]:Agn], Am],tiUw];Kiun]:mL;nC];Kaw];tac]; 6 wUc]:n}siuc] hG]:hp].yUt];yL tI:hgc]:kUn];
pQn]nC]; tWn]:tL,kum];Tic];lgc]:kin]yqm].El: hQt];sgm];nc],piUc]nm];lQc].lU tL,hG]:l}:lqk]:l}a:luk]:
Agn], Kw]:sU;l}a;kan]lQc].lUPiUm].Tqm]AL,hL,r"
 mUiw]:ethG]:luk]:Agn],lUc];hUc];yLnn]. Sc]wL:luk]:Agn], pQn]kUn];nC];nL:hiUn]; An]yU,nC];Sun]p}aeP;
n}siuc] Tuk],lITam]hG]:hU.tqt]:etL;wL: tL,l}:hp].tac];kin] El:l}:hp].tac];kin] kum],TUn]:yU,nn].
l}:pn]S}am}a kUn];hiUn];w}.kU:ekL."
226
AL,hL,r 17
6. Sp];lqc];pn]Em:luk]:Agn],
Sp];lqc];EnEm:luk]:Agn],wL: nc],hiuw]epL;ethG]:luk]: mI;p}a;yU,lItI:lIEl: tUw]yC],Kiun]:mL; sgm];nc],
An]Tuk],lIpQn]n}. miUw]:tt];nUm];Em:nn]. luk]:Agn],tk];etl}:kin] tac];kin]l}al}asiUw]; miUn]nc],Kw]:'
TUw],' mak],m}.' Pk];yiUw]:nac];KQw]' niUw].' K},El: pL"
7. tL,hG]:kUn];hiUn];kU:ekL. hU.lgc]:p}a;yU,lIEl: lgc]:AL,hL,rn}. PU:hap],kan]p}a;yU,lI Tuk],lIAqw],

yQm]:hiUn];kUn];wan]:yU,tL,eS,"
yUt];yLsgm];Kk].tgn];
KYL;mqc];tgc].pn] 1 – 2 KUp], Albendazole 200 mg OD tL, 3 wn];
2 KUp],Kiun]:niUw] Mebendazole 100 mg BID tL, 3 wn];
Vitamin A lQk].liUw] 6 liUn] pn] 50,000 IU miUw]:wn];TI. 1' 2 El:
6 -11 liUn] (eA,liUw] 8 kI,lUw],) 8
1 KUp],Kiun]:niUw] (nm]liUw] 8 pn] 100,000 IU miUw]:wn];TI. 1' 2
kI,lUw],) El:8
pn] 200,000 IU miUw]:wn];TI. 1' 2
El:8
Vitamin B1 10mg kU:wn]; tL, 6 wUc]:
Folic Acid 5 mg wn];TI. 1' w}a;nn]. 5 mg/
niuc]:wUc]: tL, 3 liUn]
Ferrous Sulphate nm].nk];eA,liUw] 5 kI,lUw], 50 mg OD tL, 3 liUn]
nm].nk]; 5 -9 kI,lUw], 100 mg OD tL, 3 liUn]
nm].nk];nm]liUw] 10 kI,lUw], 200 mg OD tL, 3 liUn]
Sc]mI;n} hG]:pn]Tat]: Zine supplements El: minerals (magnesium, copper) sgm];"
tL,tgc];" " Tuk],lIpn] wI,tL,min],eA, hqc];yLtL,eh.kc]:El: hqc];yLtL,yUt];yL Kqn]:kn]
niuc]:liUn]" kgp]:n} mUiw]:ethG]:wI,tL,min]eA,pn]luk]:Agn],nn]. Tuk],lItUv];wC]Kqp];liUc]luk]:Agn],kgn],"
Sc]wL:luk]:Agn],n}. pQn]kUn];pQn] luk].tI:hgc]:kan] yUt];yLlQc].lUPiUm].Tqm]AL,hL,rSUc],mL;n}siuc] Am],
tap]:pn]yLKYL;mqc];tgc].El: wI,tL,min],eA,' liUw]Sgc]An]n}.nn]. lgc]:yUt];yLmiUn]kn]mUt];"
Kat],Tat]:AL,hL,rh}a.hqc]; (Severe Malnutrition)

(<-3 Z Score W/H Am],nn] tUw]Kic];tc];Sgc]Pa}, kC]:PQc],kn]eS Sc]tQk];n}etlgk];lUc];Kw]:kCL,)
lgc]:Kat],Tat]:AL,hL,rh}a.hqc];n}. pQn]cw];la};tac];pQn] An]lm],lgc]:Kiuk].Kk].El: pQn]cw];l}a;An]et
l}:hp].yUt];yLw}. tI:hgc]:kUn];pQn]nC]; kgp]:wL:etl}:pC].tUv];lum];lL;kUn];pQn] kU:Kaw];yam];" lgc]:yUt];
yLn}. etmqc],l}:pQn] 2 Kn].tgn]:"
Kn].tgn]:niuc]: km]:nm]Et.etAw]yLeS yUt];yLpn]"
pqk].Sm].wL:Et,pn]kin]tac];kin]An]Kiuk].Kqm].yw].eStL. nm].nk];et Am],kiuc].kac].
Kiun]:mL;km];lQw]"
227
AL,hL,r
17
Kn].tgn]:Sgc] l}a;yUt];yLAn]sC].tiuw];tac];kin]An]mI;AL,hL,r (Piun].PU;Pac]hac]:kUn];pQn] - kn]
17.1)"
Kn].tgn]:niuc]:
km]:nm]" " kgp]:wL:Kw]etAUn]:Agn],hqc];nL,El:Sc] lgc]:y}g:tac];kin]Kw]Am],epL;lIEl:Sc] tL,
lQc].luk]:Agn],tI:pQn]siUc].nc],n}n}. etl}:sC].Kaw];yam];hiuc]" Sp];lqc];Enpn]kUn];hiUn];Kw]wL: tL,lQc].
pn]luk]:Agn], lUv]:hG]:emLyLKw]s}g:kum];Tic];lum];lL;pn]nn]. tk];etl}:sC].Kaw];yam];nm]"
tUv];tI:lgk];Kgc]: 1 l}a;hac]:hqn];nUm]; An]mI;Tat]:AL,hL,rSuc] High Energy Milk (HEM)

tL,Kn].tgn]:niuc]: An]Tuk],lIpn]tac];nm]hG]:Tuk],mqn]:El: km];km];pn]"
Sc]luk]:Agn], Am],kin]nUm];l}:tac];pak],lL;lL;kgn], sc],etsC].tiuw];Sa}yac]eSpn]kin];tac];KU;lc]"
p]C.tUv];tac];nm]eA,tac];kin]An]luk]:Agn],kin]kCL, hG]:Tuk],mqn]:sgm];nc],tUw]yac],lgk];Kgc]: 2"
tL,eh.kc]:Tat]:wan]nC];liUt]:eA,lUc]; - km];km];pn]kin]El: pn]kin]Ait];Ait];" pn]kin] tc];kac]
wn];kac]Kiun];" tL,luk]:Agn],An]hqc];eA,nL,pUn].tI:nn]. hG]:pn]kin] niuc]:sUw]:mUc];niuc]:pgk]:"
tL,eh.kc]:Am],hG]:luk]:Agn],kt]; - mgk],lat]:pn]hqc]; hG]:Em:luk]:Agn], Aum]:luk]:w}.kU:yam];El:
wn];Agn]tac];nn]. yLAap],nm].pn]luk]:Agn],kgn],"
tL,yUt];yLlgc]:Tat]:nm].nC];tUw]eA, - tL,lam];Kat]:lgc]:Tat]:nm].nC];tUw]eA,Kgc]luk]:Agn],n}.
pQn]lgc]:yap], kgp]:wL:Piw]nc]luk]:Agn], ethU,yan];El: tLetlgk];Kw]:tac];nC];yU,yw]." kgp]:n}
hG]:tUv];tI:pak],El:nC];tLwL: sgc],mI;Tat]:nm].hiuw]Am],mI;" Tam]wL: luk]:Agn],sgc],yQw]:/Am],yQw]:
nc],pk],ktI," Sc]pQn]l}: tL,Tqm]Tat]:nm].nC];tUw]nn]. hG]:ciUc].Ew: Sm]; IV pn]"
 KUn];elL;nm].kiUw]Tat]:sac]sac] eSpn]kin] (kgp]:wL: Am],K}:hG]:luk]:Agn],kin]sQm];pUn].tI:)
Am],nn] pn]kin]nm]. ReSoMal (tUv];tI:lgk];Kgc]: 3)"
 Siup],pn]kin]nUm];Em:" (Sc]Em:luk]:Agn], Am],yU,lIn} yUt];yLlgc]:Am],yU,lIpn]'
KYL;mqc];tgc].' hG]:Kw]kin]Kw]:/kin]nm].nm]nm]" nc],hiuw]Em:luk]:Agn], epL;etSac]:nUm]; An]mI;
Tat]:AL,hL,rEl: Tat]:lQk];pn]luk]:Agn],nn]. hG]:pn]yL Vitamin A, Ferrous sulphate,
Folic acid, Vitamin B1"
 pn]kin]nm].kin]An]mUt];SC]"
yUt];yLpn]sgm];nc],Kk].tgn]:yUt];yL (tUv];tI:lgk];Kgc]: 4) El: pn]yLKL:siUw];mqc]; tL,yUt];yL
lgc]:tit];siUw].mqc];" luk]:Agn], An]Kat],Tat]:AL,hL,rh}a.hqc];km]:nm] etsac]: sp];tit];siUw].mqc];
h}a.hqc];El:Am],mI;Pac]hac]:lUm];naw]" lgc]:kiuc].kac].lium];tUw]kgp]:liUt]:pQn]kgc].n}. pQn]Pgn];sL.An]h}a.hqc];
lm],lgc]:An]niuc]:yw]."tL,eh.kc]: lgc]:kiuc].kac].lium];tUw]kgp]:liUt]:pQn]kgc].n}. Tuk],lIpn] yLptI,KYI<wn
kU:ekL."Am],mI;Pac]hac]:n}eStL.Tuk],lIkUt],sqt]:siUw].mqc];naw]nUk].pn]"pC].tUv];hqc];liUt]:tgn]:' hqc];TUv]:
sC]El:tac];nm]eA,yQw]:An]Agk],mL;yU,tL,eS," sc]:nm].nk];luk]:Agn],pn]kU:wn];eS hG]:mat]:m}anC];
Pqn],KYat].w}."
228
AL,hL,r 17
lgk];Kgc]: 1
sn].tgn]:niuc]: - nUm];An]mI;Tat]:AL,hL,rSuc]
miuw].pgk]:km];An]Tuk],lIpn]kin] 8-12 miuw]. nC];Kaw];tac]; 24 sUw]:mUc];
Kaw];tac];An]Tuk],lIKqn]:pn] 8 miuw]. = Kqn]:pn] 3 sUw]:mUc];niuc]:pgk]:
12 miuw]. = Kqn]:pn] 2 sUw]:mUc];niuc]:pgk]:
tac];nm]eA,etL,miuw]. = 135 SI,SI, x nm].nk]; (kI,lUw],krm],)

miuw].pgk]:km];nC];Kaw];tac]; 24 sUw]:mUc];
l}a;KUn];elL;tL,sn].tgn]: 1 – nUm];An]mI;Tat]:AL,hL,rSuc] (H.E.M)

SUn],KUw];Kgc]Kn
U ];elL;El:tac];nm]eA, - l}a;hQt];Sac]: -
nUm];Pgc] 25 g tc]:nm].hG]:liUt],yw]. Siup],tc]:hG]:liUt],Tqc]: 5-7
kiUw]wan] 100 g minit]."
nm].mn];kin] 27 g Aw]KUw];Kgc] An]etl}:KUn];elL;nn]. KUn];elL;
w}a;eSSC],KUw];Kgc]sgm];nc],pL:niUw]n}.yw]. hG]:Aw] pn]nC];nm].Aun],"
nm].tUm]:Suk]; SC],hG]:tQm]niuc]:lI,tL," Aw]w}.hG]:yQn]yw]. sc],tk];SC],w}.nC];kgk];"
Sc]wL:mI;Tuc]Tat]:lQk];tI: UNICEF pn]n}
hG]:PiUm].Tqm] KUn];elL;pn]"
yL,kQp];w}.eSsC].Kiun];nUm]; An]tI:KUn];elL;yw].eS kin]Am],mUt];nn].

lL;lL;" kgp]:wL:etsac]:hQt];hG]:tgc].kCL,l}:"
lgk];Kgc]: 2
mat]:m}atac];nm]eA, tI:An]luk]:Agn],kin] sgm];nc],lgk];l}a;pL:tC]:n}.-
tUw]yac], - Sc]wL:pn]luk]:Agn],kin] 8 miuw].nC];Kaw];tac]; 24 sUw]:mUc];n}siuc] tqm];hac]:wUc];mUn]; 8
An]eSEl:mat]:m}alUc];nC];wUc];mUn];tI:luk]:kin]kCL," tc];mUt];' kiuc],niuc]:' niuc]:km]; sL.kCL,siUw];n}.
sgm];nc],pL:tC]:n}.
nm]liUw]Kiuc]:Ait];niuc]:
tc];mUt];
229
AL,hL,r
17
lgk];Kgc]: 3
l}a;KUn];elL;nm].kiUw] ORS
(tUv];tI: l}a;hac]:hqn];nm].kiUw] ORS - kn] 24.6)
Pgc]kiUw] ORS 1 TUc] (tL,nm]. 750 SI,SI,) + nm].mUt];SC] 1500 SI,SI, + kiUw]wan]
30 krm], + pUw],tqt],SI,yam], 1.5 krm],
Am],nn]
Pgc]kiUw] ORS 1 TUc] (tL,nm]. 1000 SI,SI,) + nm].mUt];SC] 2000 SI,SI, + kiUw]wan]
40 krm], + pUw],tqt],SI,yam], 2.5 krm],
lgk];Kgc]: 4
l}a;yUt];yLsgm];Kk].tgn]; (systemtic treatment)
1. tk];etl}:pn]yLKL:siUw].mqc];hG]:luk]:Agn],An]Kat],AL,hL,rha}.hqc];kU:ekL.
 luk]:Agn],An]mI;cw];l}a;nim] yLkin] amoxicillin
 kCL<SYI<yUw]<ekL; Am],nn] IM* penicillin/ampicillin and IM gentamicin

Sc]wL:Am],yU,lIh}a.hqc];
 miUw]:lIKiun]:mL; lqk]:l}a:pn]yLkin] amoxicillin
 Sc]wL:Am],lIKiun]:nC];Kaw];tac]; 3 wn]; Am],nn] IM* ceftriaxone tL, 5 wn]; w}a;nn].ekL: pn]

wUn].Sgn],wL:pQn]yC];hUm],Agk];eALkC]: yLkin] amoxicillin
(*ciUc]:ew:Sm];yL IV pn] )
2. Vitamin A lQk].liUw] 6 liUn] pn] 50,000 IU miUw]:wn];TI. 1' 2 El: 8
6 -11 liUn] (<8 kg) pn] 100,000 IU miUw]:wn];TI. 1' 2 El: 8
1 KUp],Kiun]:niUw](>8 kg) pn] 200,000 IU miUw]:wn];TI. 1' 2 El: 8
3. Vitamin B1 10mg kU:wn]; tL, 6 wUc]:
4. Folic Acid 5 mg wn];TI. 1' w}a;nn]. 5 mg/ niuc]:wUc]: tL, 3 liUn]
5. Zine supplement lQk].liUw] 6 liUn] 20 milligram nuic]:wn]; kiuc],mQt]. tL, 14 wn];
yC],liUw] 6 liUn] 20 milligram niuc]:wn];nuic]:mQt]. tL, 14 wn];
El: Sc]wL:mI;ekL:pn]Tat]:El<(magnesium,
copper)sgm];
6. mUiw]:p},Tiuc] sn].tgn]:Sgc]nn]. yL,pn]Tat]:lQk];El: yLKYL;mqc];tgc]."
7. kUt],sqt]:tUv];lgc]:l}:Sm];yLeh.kc]: (wk].Sin];) wL:sgc],l}:Sm];KUp];/Am],KUp]; Sc]p},KUp].n}ekL:hC]:Sm];
pn]"
230
AL,hL,r 17
Kn].tgn]:Sgc]
Sc]wL:lgc]:y}g:tac];kin]luk]:Agn],lIKiun]:mL;yw]. kin]l}:mL;n}siuc] mk];mn]:l}:wL:
mL;Tiuc]Kn].tgn]:Piun].PU;kUn];pQn] An]pQn]sn].tgn]:Sgc]yw]." luk]:Agn], An]p},l}:Aw]
S}ayac]lQc].tac];kin]tI:KU;lc]Agk],nn]. p},mk];mn]:l}:wL: Tiuc]Kn].tgn]:Sgc]"
lgc]:y}g:tac];kin]luk]:Agn],lImL;eS kin]tac];kin]l}:lIyw]. sc],mk];mn]:l}:"
1. hG]:Siup],pn]nUm]; An]mI;AL,hL,rSuc]nc],sn].tgn]:niuc]:eSEt,kCL,l}:" (kUv];kL: An]etpqk],piUc]: kn]

Et.nUm];An]mI;AL,hL,rSuc] nG];sn].tgn]:Sgc]n}.etmI;Tat]:Ek<lUw]rI,nm]liUw]nUm]; An]mI;AL,hL,r
Suc]nG];Kn].tgn]:niuc]:) tUv];l}a;KUn];elL;nUm];An]mI;AL,hL,rSuc]Kn].tgn]:Sgc] l}:tI:lgk];Kgc]: (5)"
2. Sc]wL:luk]:Agn], kin]tac];kin]An]hG]:kin]nn].mUt];n}siuc] miUw]:etpn]kin]Tqc]:pgk]:niuc]:nn]. hG]:tiUw];
pn] 10 SI,SI," Aw]tac];kin]tac],siUw]; PiUm].Tqm]pn]kCL,l}g:l}g;" Aic],niUw]lgc]:y}g:tac];kin] luk]:Agn],
eShG]:tiUw]; pn]tac];kin]El: nUm];An]mI;AL,hL,rSuc]kCL,tik];tik];" l}a;mqc],pn]tac];kin]nC];Kaw];tac];
24 sUw]:mUc];nn]. hG]:tUv];tI:lgk];Kgc]: (6)" Siup],pn]luk]:Agn], kin]tc];kac]wn];El:kac]Kiun];"
3. luk]:Agn],Tuk],lImI;nm].nk]; tiUw];mL;wn];niuc]: 10 krm]," Sc]wL:cw];l}a;luk]:Agn],lItiUw];mL; luk].tI:

Kn].tgn]:niuc]: mL;Tiuc]Kn].tgn]:Sgc]yw]. nm].nk];Sm].Am],tiUw];mL;Tqc]:nC];Kaw];tac];pUn].liUw] 3 wn];
(lgc]:tUk];Sum];pgk]:km];Sgc]) El: yc];l}:kum];Tic];lgc]:kin]yqm].yU,n}siuc] wUn].Sgn],lgc]:sp];tit];
siUw].mqc]; Am],nn] tac];pQn]Kaw];hiuc]"
 kUt],sqt]:tUv];tac];pQn]Kaw];hiuc] - miUn]nc], TI,pI,' AQt].S]' TL<lat].S]SI<mI;yL;'
tac];pQn]hUw]sC]' tac];pQn]siUw].mqc];tp];kC]: mI;/Am],mI;"
 kUt],sqt]:tUv];tac];pQn]tac],siUw]; - miUn]nc], tgc].kCL,' pgt],kC]:' yU,TI,A},' siUw].mqc];tac];pQn]
pL,rL,S}.siUw];n}. mI;/Am],mI;" KYL;mqc];tgc].pn] (tUv];tI: lgk];Kgc]: (7)"
4. Sc]wL:nC];KYat].nn]. nm].nk];luk]:Agn],yc];mI;cw];l}a; - 2 yU,eS nim]yU,siUc].nn] tL,Sgc]wUc]:'

kC]:ekL:h}akCL,eS Am],mI;siUw].mqc];Sc]sp];tit];n}siuc] hG]:SUc],tUw]kCL,hgc]: OPD tL,Kw]:sU; Pqn]kan]
lQc].lUtac];kin]An]Tqm]hqc]; (SFP) kCL,"
lgk];Kgc]: 5
Kn].tgn]:Sgc] - nUm];An]mI;Tat]:AL,hL,rSuc] (High energy milk)
Tuk],lIpn]kin] 6 miuw]. nC];Kaw];tac]; 24 sUw]:mUc];
Kaw];tac];An]Tuk],lIKqn]:pn] 6 miuw]. = Kqn]:pn] 4 sUw]:mUc];niuc]:pgk]:
tac];nm]eA,niuc]:miuw]. = 200 SI,SI, x nm].nk]; (kI,lUw],krm],)
miuw].pgk]:km];nC];Kaw];tac]; 24 sUw]:mUc];
231
AL,hL,r
17
l}a;KUn];elL;tL,sn].tgn]: 2 – nUm];An]mI;Tat]:AL,hL,rSuc] (H.E.M -1L)
SUn],KUw];Kgc]KUn];elL;El: tac];nm]eA, - l}a;hQt];Sac]: -
nUm];Pgc] 80 g tc]:nm].hG]:liUt],yw]. Siup],tc]:hG]:liUt],Tqc]:5-
kiUw]wan] 50 g 7minit]."
nm].mn];kin] 60 g Aw]KUw];Kgc]An]etl}:KUn];elL;nn]. KUn];elL;pn]
w}a;eSSC],KUw];Kgc]sgm];nc],pL:niUw]n}.yw].hG]:Aw] nC];nm].Aun],"
nm].tUm]:Suk];SC],hG]:tQm]niuc]:lI,tL," Aw]w}.hG]:yQn]yw]. sc],tk];SC],w}.nC];kgk];"
Sc]wL:mI;TUc]Tat]:lQk];tI: UNICEF pn]n} hG]:PiUm].
Tqm]KUn];elL;pn]"
yL,kQp];w}.El:sC].Kiun];nUm];tI:KUn];elL;yw].eS kin]Am],mUt];km];Siuw]:nn].
lL;lL;" kgp]:wL:etsac]:hQt];hC]:tgc].kCL,l}:"
lgk];Kgc]: 6
Kaw];yam]; tUw]yac],miuw].Kw]: (Examples of meal)
6 mUc]; kac]nC]sw]. HEM Kn].tgn]:Sgc]
8 mUc];kac]nG]sw]. tac];kin]pk],ktI, - Kw]:tUm]: + kUv]: + K},k},
10 mUc];kac]nC] HEM Kn].tgn]:Sgc]
12 mUc];kac]wn]; tac];kin]pk],ktI, - Kw]: + TUw], + pLAqp],
2 mUc]; w}a;wn]; HEM Kn].tgn]:Sgc]
4 mUc]; hUw]Km]: tac];kin]pk],ktI,-Kw]:mubn];El:kiUw]wan]' Kw]:' nm].mn]; El:K},k},
6 mUc];Km]: HEM Kn].tgn]:Sgc]
10 mUc]; kac]Kiun]; HEM Kn].tgn]:Sgc]
lgk];Kgc]: 7
l}a;yUt];yL
1. Siup],pn] Folic acid, Vitamin B El: Zine supplement
2. pn]yL Mebendazole 100 mg BID x 3 wn]; (Am],nn] Albendazole - tUv];hqc];yL
tL,pn]tI:KYat].)
PiUm].Tqm]pn] Ferrous sulphate wa};eShp].yUt];yLtI:hgc]:kUn];pQn]nC];l}: 2 wUc]:yw].
Am],nn] miUw]:l}:K}a.luk]:Agn],Kiun]:mL;sn].tgn]:Sgc]
< 5 kg: 50 mg OD tL, 3 liUn]
5 – 9 kg: 100 mg OD tL, 3 liUn]
> 10 kg: 200 mg OD tL, 3 liUn]
232
AL,hL,r 17
lgc]:kiuc].kac].Kat],Tat]:AL,hL,rh}a.hqc]; An]luk]:Agn],AL,yuSip];p}aEl:kUn];lUc]pQn]
lgc]:Kat],Tat]:AL,hL,rpan]kac] An]luk]:Agn],AL,yuSip];p}aEl: kUn];lUc]pQnn
] }. Sc]siUw].wL: Am],pQn]
h}a.hqc]; Am],nn] Am],yU,lIh}a.hqc];n}siuc] km]:nm]Et. etAm],Aw]Kw]:sU; Pqn]kan]lQc].lUtac];kin]
An]Tqm]hqc];" tL,hU.l}:lgc]:Kat],Tat]:AL,hL,r An]luk]:Agn],AL,yuSip];p}aEl: kUn];lUc]pQn]nn].
Aw]SUn],Suc]El: nm].nk];mL;Sgn],np].El: eKL:tgp],eteA,liUw] tI:An]Tuk],lImI;nn].yw]."
luk]:Agn],pan]maw],h}a;' Saw]ha}; eA,liUw]nm].nk]; tI:Aw]SUn],Suc]Sgn],np].Aw]Tuk],lImI;nn].
(Adolescents) 70% (tUv];tI: eKL:PiUm].Tqm])
Am],nn] mI;Pac]hac]:tac];pQn]h}a.hqc]; (tUw]yac],)
 Am],mI;lgc]:pQn]Sc]eS P}a,KCLkG]:miUn]kn]
 pQn]tac];pQn]mL<rit].mat].S] – ygm]pUn].tI:h}a.hqc];
 yam];kac]Kiun]; Am],hn]tLlI
 kgp]:liUt]:sac]h}a.hqc];El: PiUk],liUc]
 Kat],Tat]:wI,tL,min],El:Tat]:el<
kUn];lUc] BMI mI; eA,liUw] 16 (tUv];tI:eKL:PiUm].Tqm] Am],nn] Sgn],np].
Aw] nm].nk];(kg)/SUn],Suc]2 (m)
kUn];ekL.nn]. etygm]El: kC]:P}a,KCLmiUn]kn]
Em:pL;tgc].El: Em:luk]:Agn], hgp]:Kqn]mI;eA,liUw] 170 mI,lI,mI,tL, (MUAC < 170mm)

An]yc];pn]luk]:Agn],kin]nUm];yU,
Sc]wL: hn]Pac]hac]:tac];pQn]An]wL:mL;nc],pL:niUw]n}.n}siuc] mk];mn]:l}:wL: Kat],Tat]:AL,hL,rn}eS

tk];et l}:sC].l}a;yUt];yLlQc].lUpn]"
Kn].tgn]: 1
l}a;PiUm].Tqm]pn]AL,hLr Kn].tgn]:niuc]:tgn]:tL,kUn];lUc]n}. etmiUn]kn]tc];l}a;lQc].lUyUt];yL tL,luk]:
Agn], Kn].tgn]: 2' kUv];kL:tac];nm]eA,etAm],miUn]kn]El: Tuk],lIhG]:km];km];kin] (eA,Sut]; niuc]:
wn]; 6 miuw].)" kQw],lUv]:tac];nm]eA,nn]. hG]:tUv];tI:lgk];Kgc]: (8)" yLwI,tL,min],El: yLptI,
KYI<wnekL: Tuk],lI pn]kUn];Kat],AL,hL,rkU:ekL." tL,l}a;yUt];yL pQn]Kk].pQn]tgn]:nn]. hG]:tUv];tI:
lgk];Kgc]: (9)"
233
AL,hL,r
17
lgk];Kgc]: 8
sn].tgn]:niuc]: - nUm];An]mI;Tat]:AL,hL,rSuc]
miuw].pgk]:km]; An]Tuk],lIpn]kin] 6 - 8 miuw]. nC];Kaw];tac]; 24 sUw]:mUc];
Kaw];tac]; An]Tuk],lIKqn]:pn] 6 miuw]. = Kqn]:pn] 4 sUw]:mUc];niuc]:pgk]:
8 miuw]. = Kqn]:pn] 3 sUw]:mUc];niuc]:pgk]:
tac];nm]eA,etL,miuw]. etAic]niUw]AL,yuKgc]kUn];pQn]-
7 - 10 KUp], 135 SI,SI, x nm].nk];/miuw].pgk]:km];nC];Kaw];tac]; 24 sUw]:mUc];
11 - 18 pI< 65 SI,SI, x nm].nk];/miuw].pgk]:km];nC];Kaw];tac]; 24 sUw]:mUc];
18 - 75 pI< 55 SI,SI, x nm].nk];/miuw].pgk]:km];nC];Kaw];tac]; 24 sUw]:mUc];
>75 pI< 45 SI,SI, x nm].nk];/miuw].pgk]:km];nC];Kaw];tac]; 24 sUw]:mUc];
lgk];Kgc]: 9
l}a;yUt];yLsgm];Kk].tgn]:
etmiUn]kn]tc];l}a;yUt];yLtL,luk]:Agn],Kat],Tat]:AL,hL,rh}a.hqc]; (lgk];Kgc]: 4)"
 yLKL:siUw].mqc]; An]ep.l}:l}al}asiUw].mqc];
 pn]wI,tL,min]eA,pgk]:lQw]kUv];" (tL,luk]:Agn],yC],liUw]niuc]:KUp],nn]. pn]hqc];yL 2 Sqn])
 pn]yLwI,tL,min]tac],siUw]; miUn]nc],luk]:Agn],Kat],AL,hL,rkm]:nm]"
 muk].sum];lUc]p}a;yU,lIlum]:fL. etAm],pn]hqc];hG]:pn]yLKYL;mqc];tgc]. tL,luk]:Agn],maw],ha};'
Saw]ha};El: kUn];lUc]"
Kn].tgn]: 2
Sc]wL:lgc]:y}g:tac];kin]lImL;yw].n}siuc] Et.Kn].tgn]:n}.l}:" miUw]:Tiuc]mL;Kn].tgn]:n}.n} kUn];pQn] et
k}.km];km];tgc].m}:Kw]:El: liUw]eSpn]nUm];An]mI;AL,hL,rSuc]nn]. Tuk],lIpn]tac];kin]Tqm]hqc]; An]mI;
nC];piun].tI:pL;sgm];"
➔ kUv];kL:An]Tuk],lIfac].nn].Et. tac];kin]An]PiUm].Tqm]pn]nn]. Am],Tuk],lIpQn]wL: pn]kin]Kw]:

nm]nm]" (kgp]:wL: Kw]:n}.ethQt];hG]:tgc].Aim],w};n}eStL.Am],mI;AL,hL,rSc]nm])" kgp]:n}Sc]wL:et
kin]Kw]: Am],nn] Kw]:S}g;n}siuc] hG]:kin]eA,eA,kUv];"
tL,miuw].pgk]:km];nC];Kaw];tac]; 24 sUw]:mUc];nn]. hG]:tUv];tI: lgk];Kgc]: 10"
234
AL,hL,r 17
lgk];Kgc]: 10
nUm];An]mI;Tat]:AL,hL,rSuc] + tac];kin]nC];piun].tI: tL,Kn].tgn]: 2
Kaw];yam]; tUw]yac],miuw].Kw]: - 6 HEM Meals
6 mUc]; kac]nC]sw]. HEM Kn].tgn]:Sgc]
8 mUc];sw]. tac];kin]pk],ktI, - Kw]: + pLAqp], + Kw]:mun];
10 mUc];kac]nC] HEM Kn].tgn]:Sgc]
12 mUc];kac]wn]; Kgc]kin]pk],ktI, - Kw]: + TUw], + Pk];yiUw]:nac];KQw]
2 mUc]; w}a;wn]; HEM Kn].tgn]:Sgc] + kUv]:
6 mUc];Km]: HEM Kn].tgn]:Sgc] + Kgc]kin]pk],ktI, - Kw]:' K},k},
El:Pk];yiUw]:nac];KQw]
l}a;yUt];yLsgm];Kk].tgn]: hG]:tUv];tI: lgk];Kgc]: 4"

Sc]wL:luk]:Agn], AL,yuSip];p}aEl: kUn];lUc]An]Kat],Tat]:AL,hL,r kin]l}:lImL;' nm].nk];PiUm].
Kiun]:mL;' Am],mI;lgc]:sp];tit];siUw].mqc];Sc]yw].El: lUiw]eSnn].-
 luk]:Agn],AL,yuSip];p}a mI;nm].nk]; An]Tuk],lIpQn]sgm];nc],SUn],Suc]liUw] 80% eSPac]hac]:
tac];pQn] lIKiun]:mL;n}siuc]
 kUn];lUc] BMI mI;nm]liUw] 16 eS Pac]hac]:tac];pQn] lIKiun]:mL;n}siuc]
 Em:pL;tgc].El:Em:lQc].nUm]; hgp]:Kqn]mI;nm]liUw] 170 mI,lI,mI,tL, (MUAC < 170mm) eSPac]hac]:
tac];pQn] lIKiun]:mL;n}siuc] pn]lUc];hUc];yLl}:"
17.2 tac];pQn]Kat],Tat]:wI,tL,min],
Kat],Tat]:wI,tL,min],eA, (Vitamin A deficiency)
tL,eKL:mun];hUw]y}g: lgc]:tac];pQn]Kat],Tat]:wI,tL,min],eA,n}. hG]:kCL,tUv];tI:nC];pp]. Burma Border
Primary Eye Care Manual n}ettQm]TUn]:liUw]"
eKL:piut],tI:pgc],
tac];pQn]Kat],Tat]:wI,tL,min]eA,n}. pQn]tac];pQn]yC],lUc] An]hQt];hG]:tLmgt],El: pQn]eKL:lm],lgc]:
An]hQt];hG]:luk]:Agn],km]:nm]Am],yU,lI" km]:nm]Et.ethQt];hG]:pQn]tac];pQn]tgc].kCL,El: pgt],kC]:nn].
yw]."tac];pQn] Kat],Tat]:wI,tL,min]eA,n}. km]:nm]ethQt];hG]:tum].tiUw].luk]:Agn], lQk].kUv];n}eStL.
sac]:hQt];hG]:tum].tiUw]. kUn];lUc] miUn]nc],nac];yic]; AL,yupan]Siup],siUw].Pn];l}:nn].yw]."
235
AL,hL,r
17
Pac]hac]:tac];pQn]
Pac]hac]:tac];pQn]Kat],Tat]:wI,tL,min]eA,n}. ettUv];hn]l}:nC];tL" Pac]hac]:n}. ethUm]:pL;tLmgt],
kac]Kiun]; (tLmgt],k},)' h}g;pI,tgt]. (Bitot’s spots) (h}g;Kaw]mUn],nC];niUw].tLKaw])' kqw].tLSC]hqc]:El:
kqw].tLSC]lU. siUw];n}.yw]."
nc],hiuw]eteh.kc]: Pgn];sL.sgm];lc]El: Tiuc]liun];Sut];tLl}:mgt],nn]. Tuk],lIkUt],sqt]:KUn].hL
tac];pQn] sQm]sw].eS yUt];yLhG]:Tuk],mqn]:n}. pQn]lgc]:An]lm],lgc]:Et.Et."
lgc]:yUt];yL
yLmQt].wI,tL,min],eA, mI;Sgc]Sqn]; Sqn];mQt]. 200,000 IU (International Unit )El: 25,000 IU"
hG]:lUtUv];hqc];yL tI:tw]:yL" mat]:m}atqm]: wn];El: hqc];yLAn]pn] lUc];nC;] pp].mat]:m}a
pa};yU,lInn].hG]:lI"
luk].Agn],lQk].liUw] 6 liUn] luk].Agn], 1 KUp],El: yC],liUw] (Am],nn] >8kg)

wn];An] (D 1) 50,000 IU wn];An]mk];mn]:tac];pQn] (D 1) 200,000 IU
mk];mn]:tac];pQn]
Tqc]:wn];niuc]: (D 2) 50,000 IU Tqc]:wn];niuc]: (D 2) 200,000 IU
w}a;eSniuc]:wUc]: (D 8) 50,000 IU w}a;eSniuc]:wUc]: (D 8) 200,000 IU
luk].Agn], 6 – 11 liUn] (<8kg ) nac];yic];pan]Siup],siUw].Pn];l}:
wn];An] (D 1) 100,000IU 100,000 IU OD tL,Sgc]wUc]:
mk];mn]:tac];pQn] (Am],nn] 25,000 IU niuc]:wUc]:niuc]:pgk]:)tL, 8 wUc]:"
Tqc]:wn]niuc]: (D 2) 100,000IU
w}a;eSniuc]:wUc]:yw]. (D 8) 100,000IU
pqk].Sm].wL: Kw]l}:hp].hqc];yLeh.kc]:mL;Am],hiuc]n}eStL. hG]:pn]hqc];yLwI,tL,min],eA,tL,yUt];yL

miUn]nc], -
➔ kUn];pQn]An]mI;Pac]hac]:mk];mn]:l}:tqt]:etL; Am],nn] Pac]hac]:tac];pQn] Kat],Tat]:wI,tL,
min],eA,kU:ekL.
➔ kUn];pQn]Kat],Tat]:AL,hL,rpan]kac]El:h}a.hqc];kU:ekL.
➔ luk]:Agn], An]mI;mak],lqc]kU:ekL. luk]:Agn], An]etl}:hp].yUt];yLnC];hgc]:kUn];pQn]nC];
kgp]:pQn]tac];pQn]SQn]:tac];pgt], sp];tit];siUw].mqc]; El:pQn]tgc].kCL,h}a.hqc];kU:ekL."
236
AL,hL,r 17
lgc]:eh.kc]:
lgc]:tac]; An]hQt];hG]:Kat],Tat]:wI,tL,min],eA,n}.Et. kgp]:wL:Am],l}:kin]tac];kin] An]mI;Tat]:wI,
tL,min], eA,nn].yw]." wI,tL,min],eA,n}. etmI;nC];mC]Pk];KQw]' K},' niUw].l}al}aSqn];' mak],mUc]:' mak],
Sac];ePL;' mak],pk].El: mak],m}.mak],tgk],l}al}aSqn];nn].yw]." nm].nUm];Em:luk]:Agn],n}. pQn]tI:
lm],lgc]:Sut];An] wI,tL,min]eA,Agk],' Kw]:' kUv]:El: mak],sgk];siUw];n}.etmI;wI,tL,min],eA,Ait];
Ait]; Am],nn] Am],mI; lL;lL;" kgp]:wL:kUn];km]:nm] Am],mI;ciun];tL,Siuw].niUw].' K},El: tac];kin]
An]mI;wI,tL,min],eA,l}:El: sc],l}:sqk],yLmQt].wI,tL,min],eA,pn]luk]:Agn], El:Em:pL;tgc]."
wI,tL,min],eA, hqc];mQt]. 200,000 IU n}. kum],tL,luk]:Agn],niuc]:ekL. tL,SI,Tiuc]hUk];liUn]yw]."
- luk]:Agn],kiUt],mC], 50,000 IU miUw]:kiUt],
- luk]:Agn],lQk].liUw] 6 liUn] (Sc]wL:p},l}:pn]miUw]:kiUt],mL;mG],) 50,000 IU
- luk]:Agn], 6 liUn]Tiuc] 1 KUp], 100,000 IU 4 - 6 liUn]niuc]:pgk]:
- luk]:Agn], 1 KUp],El:yC],liUw] 200,000 IU 4 - 6 liUn]niuc]:pgk]:
- Em:luk]:Agn], (nC];Kaw];tac];kiUt],yw]. 1 liUn]) 200,000 IU miUw]:kiUt],luk]:El:
200,000 IU Tqc]:wn];niuc]:
mUiw]:p},pn]wI,tL,min],eA, tL,hqc];yLeh.kc]:nn]. hG]:sqt]:tUv];wL: miUw]:pUn].mL; 4 liUn]n}. sgc],mI;PC]l}:
pn]kin]mL;hiuw]"
tL,tgc];" " Sc]wL:etl}:pn]hqc];yLeA,liUw]n}siuc]-
km]:nm]n}.etpQn]mQt]. 200,000 IU" kgp]:n}Sc]wL:etl}:pn]hqc];yLeA,liUw] (miUn]nc], - etl}:pn]
hqc];yL 100,000 IU n}siuc]) hG]:Aw]kim];kqt];eS ygt],SC]nC];pak],luk]:Agn], 3 ygt],"
➔ etAm],l}:pn]hqc];yLwI,tL,min],eA,nm] tI:em:pL;tgc].Am],nn] mI;Pac]hac]:pL;tgc]. (AL,yu 15-
50pI<)"
➔ Sc]wL:l}:pn]hqc];yLyUt];yL nC];Kaw];tac];niuc]:liUn]pUn].mL;n}siuc] Am],tap]:pn]Tqc]:"
cw];l}a;siUc].nn]n}. hG]:pC].niuc]:liUn]yw]. sc],mL;Tt];Sac]tac];pQn]Tqc];km];niuc]:"
Aac]:Aic]
tac];pQn]Kat],Tat]:AL,hL,r (17.1)' tac];pQn]kQw],lUv]:tL (11)' tac];pQn]tgc].kCL, (12.1)' tac];pQn]
SQn]:tac];TUv]:sC] (21)' tac];pQn]mak],lqc] (15.3)"
Kat],Tat]:wI,tL,min],pI,niuc]: ( Beri Beri)

eKL:piut],tI:pgc],
lgc]:Kat],Tat]:wI,tL,min],pI,niuc]:n}. kgp]:wL: tac];kin]An]kin]yU,kU:wn];nn]. Am],mI;Tat]:wI,tL,min],
tQm]TUn]:eSEl: sc],l}:pQn]Pac]hac]:tac];pQn]Ep,rI Ep,rInn].yw]." tac];pQn]An]n}.n}. etpQn]kn]
km]:nm] sgm];lqn]lin]miUc];T};-man]:eS km]:nm]Et.Em:pL;tgc].' Em:luk]:Agn],An]yc];lQc].nUm];El:
luk]:Agn],Kw]siUw];nn].yw]." etsac]:mI;Pac]hac]:tac];pQn]l}al}aSqn]; miUn]nc], Ep,rIEp,rIhqc]:El: Ep,rI
Ep,rIym]; Am],nn] hUm]:kn]w}." lgc]:Kat],Tat]: wI,tL,min],pI,niuc]:sgm];lqn]lin]n}. etAm],h}a.hqc];"
237
AL,hL,r
17
1. Kat],Tat]:wI,tL,min]pI,niuc]: An]kUn];lUc]pQn]
Pac]hac]:tac];pQn]
k. Ep,rI Ep,rIhqc]:
pQn]Am],h}a.hqc]; pQn]h}a.hqc];
- nL - AUn]:Agn], - p} Am],nn] nc]:cgm]yw].luk].Kiun]:hc];kUv];Am],l}:
- tin]miuw];Aap]:miUn]m}:w}.' - Sc]kUt],yip];tUv];SQn]:AL,yUc],n}lgc]:hU.tUw]Am],tQm]TUn]:
nQt];San]
K. Ep,rI Ep,rIym]; (Wet Beri beri)

 nL:El:tin]miuw];kC]:' tp];yC],
 TUv]:sC]kp].
 hqc];tgt],liUt]:Suc]eS hqc];hUw]sC]eA,
lgc]:yUt];yL
pQn]Am],h}a.hqc]; (Ep,rI Ep,rIhqc]:)
 Vitamin B1 PO 100 mg OD tL, 7 wn];"

w}a;nn]. 10 mg OD tL, 6 wUc]:"
pQn]h}a.hqc];
(Ep,rI Ep,rIym];El: Ep,rI Ep,rIhqc]: An]mI;Pac]hac]:h}a.hqc];)
 Vitamin B1 IM 100 mg TID tL, 1 wn];' w}a;nn].
 Vitamin B1 PO 100 mg OD tL, 7 wn];"
 w}a;nn]. 10 mg OD tL, 6 wUc]:"
kgp]:wL: kUn];pQn]etsac]:Kat],Tat]: wI,tL,min],tac],siUw];ekL:pQn]l}:El: hG]:wUn].Sgn],tL,pn]yL pI,-

hUm]:( B-Complex ) Am],nn] wI,tL,min],l}al}asiUw]; (Multivitamins) pL;sgm];"
kgp]:wL:mak],pU.n}. ethQt];hG]:wI,tL,min],pI,niuc]:lU.lqw]pqt]:eS Am],pQn]hqc];Sc]El: lat]:EnwL:

miUw]:Pgc];kin]yLwI,tL,min],pI,niuc]:yU,nn]. yLAUm]pU.Am],nn] kin]nQc]:kUw]:"
hHG]:kin]yLwI,tL,min],pI,niuc]: kgn],etkin]Kw]: niuc]:sUw]:mUc];"
238
AL,hL,r 17
lgc]:eh.kc]:
lat]:EnkUn];pQn]wL: nc],hiuw]etAm],hG]:l}:Kat],Tat]:wI,tL,min],pI,niuc]:nn]. Tuk],lIhQt];sgm];
miUn]nc],-
 kin]tac];kin]l}al}aSqn]; (tUw]yac], - tUw]liUc]' niUw].' mak],m}.El: Pk];yiUw]:nac];KQw])"
 ciUc].ew:kin]nQc]:kUw]:El: AUm]pU. mUiw]:etkin]Kw]:El: w}a;kin]Kw]:yw]." Sc]wL: K}:kin]n}ekL:
Kqn]:pn] la}l}asUw]:mUc];yw].sc],kin]"
 miUw]:Suk]:Kw]:nn]. hG]:Suk]:nm].lQw]kUv];" (kgp]:wL: Sc]Suk]:l}al}anm].n} Tat]:wI,tL,min],pI,niuc]:
etsac]:lU.Sum];kCL,pqt]:nn].yw].)" miUw]:huc]Pk];nn]. tL,etSC],nm].ekL: PiUw],tL.etSC],
nm].l}al}a hG]:SC],nm].Suk]:Kw]:tqn];Aw]"
tL,eh.kc]: yL,hG]:Em:pL;tgc].El:luk]:Agn],Kw] Kat],Tat]:wI,tL,min],pI,niuc]:nn]. hG]:pn]yL Vitamin

B1 PO 100 mg Em:pL;tgc].kin]kU:wn];El: Em:luk]:Agn],An]lQc].nUm];yU,nn]. hG]:pn]tL, 6 liUn]"
2. Kat],Tat]:wI,tL,min]pI,niuc]: An]luk]:Agn],AL,yulQk].liUw]niuc]:KUp],pQn]
kgp]:wL:Em: An]pn]luk]:kin]nUm];yU, Sm].Kat],Tat]:wI,tL,min],pI,niuc]: Am],nn] tac];kin]An]Em:

luk]:Agn], kin]kU:wn];siUw];nn]. mI;Tat]:wI,tL,min],pI,niuc]:eA,El:Sc] luk]:Agn],AL,yulQk].liUw]
niuc]:KUp],An]kin]nUm];Em: mQw];lQw]km]:nm]nn]. etk}.pQn]tac];pQn]Ep,rIEp,rI"
tac];pQn]An]n}.n}. pQn]eP;yC],lUc]tgn]:tL,luk]:Agn],eS nC];Kaw];tac]; Am],l}awn];kUv];ekL:
etsac]:hQt];hG]:luk]:Agn],t}al}:nn].yw]."
Pac]hac]:tac];pQn]
luk],Agn],An]yU,lImL;kgn],n}eStL. Sc]mI;Pac]hac]:sgm];nc],pL:tC]:n}. nm]liUw]An]niuc]:n}siuc]
hG]:wUn].Sgn], pQn]tac];pQn]Ep,rIEp,rIw}.kgn],"
 TUv]:sC]yap],' TUv]:sC]w};eS hqc];TUv]:sC]n}. niuc]:minit].  yQw]:eA,kCL,pqt]:

etSuc]Tiuc] 50 p}a'  Am],kin]nUm];lIlI
 Sc]Aw]KiUc]:Tgm],hU Tgm],tUv];pgt],n} etpQn]pk],ktI,kUv];"  tp];yC],
 kC]:tc];tUw]"  hak]:
 SQc]h}:luk]:Agn],etlqk]:l}a:pqk],piUc]kCL, Am],nn] SQc]h}a kCL,"  pQn]can];
 tUw]Sgm],"
 hqc];liUt]:tgn]:w};"
cw];l}a;siUc].n}n}. pQn]cw];l}a;tI:Kiuk].Kk].El: Sc]Am],yUt];yLl}:tn];Kaw];yam];n} sac]:hQt];hG]:t}al}:"
239
AL,hL,r
17
lgc]:yUt];yL
- hp].kUn];pQn]w}.yUt];yLtI:hgc]:kUn];pQn]nC];
- Vitamin B1 IM 50 mg (0.5 cc) TID tL, 1 wn];"
- Vitamin B1 PO w}a;nn]. 10 mg OD tL, 6 wUc]:"
- yUt;] yLpn]Em:luk]:Agn],sgm]; 100 mg OD tL, 7 wn];" w}a;nn]. 10 mg OD tL, 6
wUc]:"
lgc]:Tuk],lISp];lqc];En Em:luk]:Agn],Et. kgp]:wL:lgc]:AUm]pU.El: kin]nQc]:kUw]:n}. etsac]:hQt];hG]:
Pac]hac]:tac];pQn] h}a.hqc];l}:El: hG]:ciUc].ew:tac];kin]siUw];nn]. mgk]: 6 wUc]:"
hG]:kin]yLwI,tL,min],pI,niuc]: niuc]:sUw]:mUc]; mUiw]:p},kin]Kw]:"
Vitamin B1: 1 vial = 1 cc = 100 mg
Aac]:Aic]
tac];pQn]Kat],Tat]:AL,hL,r (17.1)' tac];pQn]AQk].KY]A},wI,' AQt].S] (15.3)' tac];pQn]T};r}W; (10.2)"
17.3 pI;pUn].tI: (Obesity)

eKL:piut],tI:pgc],
nm].nk];kUn];ekL.niuc]: nm]liUw]pUn].tc];SUn],Suc] An]Kw]Tuk],lImI;nn]. hgc].wL:pI;pUn].tI:nn].yw]."
lgc]:pI;pUn].tI:n}. pQn]lgc]:Kat],Tat]:AL,hL,rSqn];niuc]:eS km]:nm]Et. kUn];lUc]etpQn]kn]nm]"
lgc]:pI;pUn].tI:n}. km]:nm]kgp]:wL:kin]tac];kin] An]mI;Tat]:Ek,lUw],rI<nm] Am],nn] lgc]:tUc].niuc]
tUw]eA, Am],nn] Am],k}.tUc].niuc]lL;lL;" kgp]:tac];pQn]eSAn]An]eS hQt];hG]:pI;pUn].tI:n}. pQn]
lgc]:pQn]l}:yap]," lgc]:pI;pUn].tI:n}. etpQn]l}:kgp]:tac];pQn]mak],ln] An]Sac]:ehL,mUn];l] Am],hQt];
kan]nc],pk],ktI,El: l}:kin]yLmac]siUw]. mac]Sqn];n}eStL. pQn]km]:eA,kUv];" kgp]:pI;pUn].tI:n}.
pQn]eP;An]niuc]: An]etpQn]tac];pQn]l}:c}a: (miUn]nc],- tac];pQn]hUw]sC]' tac];pQn]lI.nC];mak],kqw];'
tac];pQn]lup],kp];sQp];kC]:El: yQw]:wan])"
lgc]:pI;pUn].tI: tL,kUn];lUc]AL,yu 18 pI<Kiun]:niUw] sgm];nc],lgc]:mk];mn]:Kgc]l}asiuc]:miUc];nn]. Sc]
(BMI) Suc]liUw] 30 (tUv];lgk];Kgc]: BMI tI:nC];eKL:PiUm].Tqm]tac];lc]pp].) n}.pgc],wL: pI;pUn].tI:yw]."
tL,tgc];" tL,Em:pL;tgc].Et. etsC].tiuw];lgk];Kgc]: BMI Am],l}:' etl}:tqk]:hgp]:Kqn]eS Sgn],np].
Aw]kUv];"
nC];pgt];tgn]:tI:hw];yU,n}.Et. Sc]wL: BMI Suc]liUw] 27.5 n}. mk];mn]:wL:

pQn]kUn];mI;eP; An]sac]:pQn]tac];pQn]kgp]:pI;pUn].tI:n}yw]."
240
AL,hL,r 17
pn]tac];hU.lgc]:kin]tac];kin]hG]:Tuk],mqn]:El: hG]:lQn]:Agk],hqc];sgm];"
 miUw]:kin]Kw]:nn]. yL,kin]nm]pUn].tI:El: yLkin]An]mn];pUn].tI:" hG]:ciUc].ew: lgc]:kin]mn];
tUw]St]; (miUn]nc], - mn];mU)" hG]:kin]TUw],' Pk];yiUw]:nac];KQw]' mak],m}. El:nm].nm]nm]"
 ciUc].ew:lgc]:kin]tac];kin]yg}: miUn]nc], mak],AUm]' Kw]:mun];Kw]:pgc]; An]KUw]:nm].mn];' nm].wan]
nm].sQm];siUw];n}.El: ciUc].Ew:kin]lw]:"
 hQt];lgc]:tUc].niuc] lQn]:Agk],hqc]; tI:eA,Sut]; niuc]:wn]; mgk]: 30 minit].kU:wn]; (miUn]nc],
p}tac];lQn]:' lQn]:mak],nc]' hQt];SUn]sgm];him];hiUn]; Et,Aw]siUw];n}.kCL,)"
kgp]:wL: yLmac]siUw];etl}:lqk]:l}a:hqc];yL (Dose) pn]tL,kUn];pI;pUn].tI:El: miUw]:etpn]yL tL,kUn];

pI;pUn].tI:n}.tk];etl}:fac].eSpn]"
tUv];hqc];yL (Dose) tI:tac];lc]pp].piUc]nm];n}."
241
p}a;yU,lItac];p}a;sC]
18
km]:nm]Et. tac];pQn]pa};sG]km]:nm]n}. tUv];Pac]hac]:tac];pQn]An]lQw]kUv];eS etAm],sac]:hU.l}:"
Sc]wL: etAw]lgc]:kin]lw]:nm] pQn]tUw]yac],n}siuc] kin]kgp]:Tat]:sC]tUk];' sC]Am],nim] Am],nn] sQp];
sC]" p}a;yU,lIpa};sC] (Tat]:sC]' tac];wUn].El: l}a;hQt];l}a;Sac]:) An]Am],pk],ktI,n}. pQn]l}:kgp]:
lgc]:mk];mn]: tac];pQn]kQw],lUv]:sit];sC]' lgc]:Am],pk],ktI,Kgc]Sun],tUw]kUn]; Am],nn] pn]hLkQw],lUv]:
tUw]ekL:pQn]l}:" mUiw]:etmk];mn]:wL: kUn];ekL.niuc]:mI;tac];pQn]pa};sC]nn]. Tuk],lIwUn].Sgn],KUn].
hLtac];pQn]tac],siUw]; An]pQn]l}: sgm]; (tUw]yac], -kUn]; pQn]eKL:pgm];n}. etk}.m}:sC]' kUn];pQn]An]mI;
Tat]:kiUw]wan],eA,n}. sC]etAm],k}.nim])" kgp]:n} mUiw]:etmk];mn]:nn]. Tuk],lITam]tUv];hG]:tQm]TUn]:
eSkgn]," Tuk],lITam] lgc]:yam]:kin]yLmw];km] Am],nn] vL;hQt];h}a.etL, mL;hiuw]siUw];n}.pL;sgm];"
An]Tuk],lIAw]mL;wUn].SC],Tqc]:An]niuc]:Et. l}a;hQt];Sac]:mac]siUw];etkQw],Kgc]:kn]tc];fic]:Ec:fic]:Tuc];
nC];piun].tI:eS lgc];hQt];Sac]:mac]siUw];tL,fic]:Tuc];mac]An]n}. pQn]lgc]:pk],ktI,kUv];"
lgc]:yUt];yLtac];pQn]kQw],lUv]:sC]n}. pn]yLkUv]; etAm],kum],TUn]:" Tuk],lIAup],AUw];tiUc],pac],pn]sgm];
Am],nn] sC].l}a;Aup],AUw];eSyUt];yLpn]sgm];" nC];Kk].lik]: 5 nn].ethn]eKL:mun];kQw],lUv]:
sC].l}a;pn]tac];K}:sC]eS yUt];yLpn]" nC];Kaw];tac];tI:yc];pL;tgc].yU, Am],nn] pn]luk]:Agn],
kin]nUm];yU,nn]. Tuk],lI kiut];yut];pn]yLtL,tac];pQn]kQw],lUv]:s]C Am],nn] pn]hG]:eA,liUw]Sut];"
tac];pQn]kQw],lUv]:sC]An]pQn]kn]km]:nm]Et.
18.1 sC]Am],pk],ktI, (Mood disorder)

eKL:piut],tI:pgc],
sC]Am],pk],ktI, etmI;Sgc]Sqn]; -
 sC]tUk];Am],pk],ktI, (Depression disorder)
 sC]tUk];/sC]Kiun]:Am],pk],ktI, (Bipolar disorder)
Kaw];yam];sC]tUk];mI;niuc]:pgk]: Am],nn] nm]liUw]niuc]:pgk]:eSEl: Am],mI;Kaw];yam];sC]Kiun]:n}siuc] mk];mn]:
l}:wL: pQn]tac];pQn]sC]tUk];"
tac];pQn]sC]tUk]; sC]Kiun]:Sm]. Kaw];yam];sC]tUk];mI;niuc]:pgk]: Am],nn] nm]liUw]niuc]:pgk]:El: Kaw];yam];

sC]Kiun]: mI;niuc]:pgk]: Am],nn] nm]lUwi ]niuc]:pgk]:nn].yw]."
tL,mk];mn]:tac];pQn]sC]tUk];n}. etpQn]sgm];nc],pL:tC]:n}. tI:eA,Sut]; 5 eKL:El: nC]; 5 eKL:
242
pa};yU,lItac];pa};sC] 18
nn].etmI; sC]Am],lIEl: Tat]:sC]tUk]; Am],nn] Am],pL;sC]Sc]eSAit];n}yw]."
- Tat]:sC]tUk];eSsC]Am],lItc];wn]; - nm].nk];tUw]tUk];ygm];
- km]:nm] Am],pL;sC]K}:hQt];kan]El: Am],SiUw];sC] - Am],mI;hqc];eSEl:hiUw].AUn]:
- ngn];Am],lp]; - wUn].Sgn],wL: sw]:kw],pQn]kUn];Am],l}:lgc]:
Am],nn] mI;tac];Pit];
- Am],mI;SmL,TI.
- wUn].K}:Aw]tUw]sw]:kw],t}a Am],nn] Kp];Kiuc]
Aw]tUw]sw]:kw],t}a
Sc]wL:mI;Pac]hac]:siUw];n}. huic]liUw]Sgc]wUc]:kgn], sc],etmk];mn]:wL:pQn]tac];pQn]sC]tUk];l}:" Pac]hac]:
An]hU.l}:wL:kUn];pQn]sC]tUk];n}. ethn]l}:wL: nL:tLmgc]' Am],yum].Am],KUw]' k}.nc]:tI:sgk]. eStI:
tI:' yU,nim]nim]eS Am],KG]:lat]:nm]"
tL,mk];mn]:tac];pQn]sC]Kiun]:n}. etcm],sgm];pL:tC]:n}. tI:eA,Sut]; 3 eKL:"

- ATac],yC],tUw]sw]:kw], - pL;sC]lgc]:lC]lgc]:niuc]:c}a:
- Am],tap]:ngn];nm] - tUc].tiun],pUn].tI: (lgc]:Kw]:tUc],wUc];kUn];'
- lat]:w}; lgc]:hUm]:kL,m)
- wUn].Am],l}:lgc]:l}:tac]; - sC].Kaw];yam];sgm]; lgc]:mUn]:SiUw];pqt]:km]:nm]
Sc]wL:mI;Pac]hac]:siUw];n}. hiuc]liUw]Sgc]wUc]:kgn], sc],etmk];mn]:wL:pQn]tac];pQn]sC]Kiun]:l}:"
lgc]:yUt];yL
lgc]:yUt];yLlUv]:Am],sC].yL
 lgc]:pn]tac];K}:sC] (tUv]; 18.5 pL:tC]:)
 pn]hqc];kUn];pQn] hG]:tUc].niuc]hQt];Sac]:tL,eS,' hG]:luk].sw].El: lQn]:Agk],hqc];pn]nm]nm]"
lgc]:Aw]yLeSyUt];yLpn]
tac];pQn]sC]tUk];
 Selective Serotonin Reuptake Inhibition (SSRI): tUw]yac],- yLmQt]. Fluoxetine 20 g
pn]hqc];yLpk],ktI, (Normal dose): 40 mg etL,wn];" etl}:pn]kin]kCL,tL, 6 liUn]"
Tuk],lIm}atgc];w}.wL: tL,hG]:yLepL;tiUw].mL;n}. etsC].Kaw];yam]; 6 - 8 wUc]:' kUv];kL: Pgn];sL.yL
Sm]. etAgk],w}a;eSkin]yLkCL,yw].niuc]:wUc]:" kgp]:n} Tuk],lISp];lqc];lgc]:n}. pn]kUn];pQn]hG]:
pgc],sC]lIlI" kgp]:wL:yLn}. etsac]:hQt];hG]:kUn];pQn] lqk]:l}a:Kaw];yam];ngn];l}:El: Tuk],lIpn]
kac]nC]sw]."
Pgn];sL.yL - nm].nk];ettiUw];mL;' hiUw],Agk],nm]' nQt];nLsgm];niw].miuw];"
tL,tgc];" " miUw]:et,pn]kin] nG]; 1 - 2 wUc]:Agn]tac];nn]. sC]KG]:Aw]sw]:kw],t}a Sm].Kqn];et
Suc]Kiun]:mL;El: tL,kUn];pQn]sC]tUk];h}a.hqc];nn]. Tuk],lIpn]yL Diazepam 5 mg TID tL, 2
wUc]:pL;sgm];"
243
18 pa};yU,lItac];pa};sC]
 Sc]wL: Am],mI; (SSRI) Am],nn] w}a;eSpn] (SSRI) 8 wUc]:yw].Am],tiUw].n}siuc] hG]:kiut];pn]
(SSRI) El: pn] Tricyclic antidepressant (TCA)' miUn]nc], Amitriptyline hqc];yLpk],ktI,
(Normal dose) etpQn]nC];wUc]:kac] 75 Am],nn] 150 mg etL,wn];" Sc]pQn]l}: hG]:kUt],sqt]:
yLAn]mI;nC];liUt]:pn]tL,eS,"
tL,kUn];pQn]An]Am],sac]:kum];Tic];lum];lL;sgm];l}:nn].yL,pn]yLnm]"
 Sc]wL:yLsiUw];tI:pn]mL;n}.Am],tiUw].n}siuc] hG]:SUc],kCL,yUt];yL tI:mI;lgc]:yUt];yLp}a;yU,lI tac];sC]"
 Sc]wL:kUn];pQn]An]sC]tUk];nn]. ngn];Am],lp];pUn].tI:n}siuc] tL,Kaw];pgt];nn]. hG]:pn]kin]yL
Diazepam Am],nn] Oxazepam 5 mg"
tac];pQn]sC]Kiun]:
tac];pQn]sC]Kiun]:n}. Tuk],lIyUt];yLtI:hUc];yL An]mI;lgc]:yUt];yL p}a;yU,lItac];sC]km];Siuw]:nn].kUv];"
kgp]:wL: Pgn];sL.yL (Lithium, valproate) tL,yUt];yLtac];pQn]siUc].n}n}. tk];etl}:lum];lL; sm]
tc];kUn];pQn]" kUv];kL: tL,kUn];pQn] An]kiuc].kac].sC]Kiun]:mL;El: p},SUc],kCL,hUc];yLl}:nn]. pn]yLhQt];
hG]:sG]yQn]lUc]; miUn]nc], yL Diazepam Am],nn] Oxazepam l}:yU," Am],nn] yUt];yLpn]
mUin]nc],yUt];yLkUn];ygc],l}: (tUv];pL:tC]:)"
18.2 pQn]KIsC]m}:sC]pUn].tI: (Anxiety disorders)
eKL:piut],tI:pgc],
lgc]:m}:sC]KIsC]pUn].tI:An]wL:nn]. miUw]:hw];kUw]eSlgc]:lgc]:eS Agk],mL;nn].yw]." lgc]:m}:sC]KIsC]pUn].
tI:n}. kgp]:kiuc].kac].m}:sC]eS lgc]:m}:sC]nn]. hUm],cm];tac];sC]mL; Am],nn] m}:sC]yU,tL,eS,nn].yw]."
miUw]:pQn]siUc].n}nn]. hUw]sC]ettgt],w};mL;' lgc]:tUc].niuc]tUw]ekL: etw};mL;El: kUn];ekL:et tuin],tUw]
w};mL;" An]n}.n}. pQn]lgc]:tUw].tgp],pk],ktI, Kgc]tUw]kUn];kgp]:lgc]:m}:sC]yw].' kUv];kL:miUw]:lgc]:m}:sC]Suc]
Kiun]:mL; Am],nn] miUw]:Am], sac]:p}g,wac];l}:nn]. etpQn]pn],hLAgk],mL;"
 lgc]:tUw].tgp],pk],ktI, kgp]:lgc]:m}:sC]Et. etpQn]hUw]K}:' sC]Am],nim]El: Sc]pQn]hiuc]mL;n}siuc]
sac]:pQn]tac];pQn]m}:sC]KIsC]pUn].tI:mL;" Sc]h}a.hqc];mL;liUw]nn].Et. ngn];Am],lp];' sC]Sn],'
Tat]:sC] tUk];' Agk],sC]h}a.' kiuc].kac].yQn]lUc];kCL,El: Pac]hac]:Am],han].sC]Kgc]sC]El: tUw]"
 Pac]hac]:Am],han].sC]Kgc] sC]El:tUw] – Pac]hac]:siUc].n}n}. etpQn]l}: miUw]:lgc]:m}:s]Cn}.
nm]liUw]pUn].tI: liUw]tI:Kam],l}:nn].n}siuc] etpQn]mL;" miUw]:pQn]siUc].n}nn]. etsQp];' nLEl:
etsac]:pQn]l}:Tiuc]t}aPak],kgn],yw]." km]:nm]Et. kUn];pQn]etlat]:Enlgc]:sQp];sgm];tUw]
Kw]kUv]; etAm],k}.lat]:cw]:hak]:tac];pQn] An]kQw],lUv]:sC]nn].kL:hiuw]"
244
lgc]:yUt];yL
Aup],AUw];Kw] ekL.etL,ekL.' pL;sC]pL;eKL;Tgm],pn]An]tI:Kw]lat]:' pn]hqc];Kw]siUw];n}.eSEl: Kt];sC]hL
tac];hQt];hG]:kUn];pQn]sC]nim]lUc];"
etl}:Kt];sC]hLtUv]; lgc]:Pit];pk],ktI,tac];sC]Kw] (sC]tUk];' pI,tI,Aqt].S]Aqt].S] Am],nn] tac];
pQn] kQw],lUv]:sC]) eS pn]lgc]:yUt];yLkQw],lUv]:tac];pQn]nn]."
lgc]:Aw]yLeSyUt];yLpn]
 tL,tac];pQn]KIsC]m}:sC]h}a.hqc];nn]. h]G:pn]yL diazepam ( 5-15 mg PO mqc],hqc];yLpn]eS
hG]:pn] nm]Sut];tL, 2 wUc]:) tL,hG]:sC]nim]mL;"
 kgp]:n} Sc]wL:etl}:yUt];yLhiuc]hiuc]n} Tuk],lIwUn].Sgn],sC].yLtac],siUw];"
 yLAn]sC].km]:nm]Et. etpQn] SSRI An]mI; fluoxetine hUm]:pL;sgm];" hqc];yLEt. km]:nm]
etmiUn]kn]tc];yLtL,yUt];yLtac];pQn]sC]tUk]; - nuic]:wn]; 40 mg"
 lgc]:yUt];yLtac],siUw]; An]sC].yLnn]. kgp]:wL:etl}:kUt],sqt]:yL An]mI;nC];liUt]:yU,
tL,eS,El: ethQt];l}:yap],"
lgc]:yUt];yLtac],siUw];
Aic]niUw]lgc]:hQt];Sac]:kUn];pQn]eS yUt];yL - l}a;yUt];yLAn]n}.n}. PU:hap],kan]p}a;yU,lI An]l}:
Piuk];mL;kQw],lUv]:lgc]:n}.lIlIkUv]; sc],Tuk],lIpn]lgc]:yUt];yL" l}a;yUt];yLAn]n}.n}. etc}a;kn]tc];
l}a;yUt];yL lUv]:kan]Aup],AUw]; (tUv;] pL:tC]:)"
18.3 tac];pQn]sC]tUk];An]pQn]w}a;lc]mI;lgc]:tum].tiUw].sC]h}a.
hqc];(Post Traumatic stress disorder)
eKL:piut],tI:pgc],
 tac];pQn]n}. etpQn]l}: kgp]:yam]:hUp].vL; lgc]:An]lIkUw]h}a.hqc];mL;' kUw]eSlgc]:lgc]:h}a.hqc];
Am],nn] kUw]Kaw];hiuc]eSEl:pQn]mL;nn].yw]:" kgp]:l}:hUp].vL; lgc]:siUc].nn]El: lgc]:m}:sC]
nm]pUn].tI:mL; etL,Tiuc]hQt];hG]:tum].tiUw].lgc]:yU,Sac]:kin]Sw];mL;l}:nn].yw]:"
 lgc]:An]sac]:hQt];hG]:pQn]tac];pQn] miUn]nc],kUn];An]yam]:hUp].vL;lgc]:miUk]:liUc];mL; Am],nn]
p}a:t}amL; siUw];n}. pQn]lgc]:kUn];p}a:eP; l}:hUp].vL;mL;km]:nm]"
cw]:hak]:
 yam]:l}:hn]vL; lgc]:hQt];h}a.An]lIkUw] tL,ASak]:kUn];pgk]:niuc]: Am],nn] yam]:hn]vL;Siup],
Siup],kn]nC];Kaw];tac];lC]Kaw];tac];niuc]:"
245
 sw]:kw], yam]:l}:TUp];vL;lgc]:hQt];h}a.mL; Am],nn] l}:hn]piUn]:tac],ekL. Tuk],hQt];h}a.tC]:tL
sw]:kw],"
 l}:p}a:lgc]:hQt];h}a.nn].mL;El: miUw]:p}a:nn]. m}:sC]kUw]Tuk],tI.vgp];vL;Kiun];"
Pac]hac]:tac];pQn]
 tum].tiUw].lgc]:emLyU,mUn]:SiUw];El:Kw]:hLkUn];  lgc]:tac];yam]: lqk]:l}a:kCL,' emLhQt];h}a.mL;'
 Am],K}:lat]:etL,piUn]: Am],nn] lat]:eA, Am],mI;SmL,TI."
 Am],mI;lgc]:Sc]eSEl: kUw]eSlgc]:lgc]:Kiun]:  Kaw];yam];ngn]; lqk]:l}a:mL;"
mL;h}a.hqc];  Pac]hac]:tac];yam]:tUw]Kaw];yaw];'
 km]:nm]- etmI;Pac]hac]: An]Am],tqk],lqc]; Pac]hac]:tac]; yam]:sC]siUw];n}. Sc]Am],
miUn]nc], hUw]K}:' ngn];Am],lp];' eKL:etL, l}:yUt];yLekL:Am],h}a El: km];km];l}:kCL,
sQp];' hiUw].AUn]:' sC]pgt];c}a:' Am],mI;lgc]: hgc]:yLtL,hp].lgc]:yUt];yL"
tac];eSkUw]El: pa};sC]Am],pk],ktI,
lgc]:yUt];yL
lgc]:yUt];yL An]Am],sC].yL
 lgc]:pn]tac];K}:sG] (tUv];pL:tC]:)
 l}a;yUt];yL hG]:lUt];ygn],tac];m}:sC]"
 lgc]:yU,Sw]; tI:An]mI;lgc]:hUm],lUm]:lIn}. pQn]An]lm],lgc]: tgn]:tL,kUn];An]lgt]:lgc]:
hQt];h}a.mL;"
 lgc]:Kw]:sC]pgc],sC] - hp].Tgm],lgc]:tI:Kw]Aup],AUw];hG]:Tgm]," Tam]tUv];wL: kQw],lUv]:lgc]:tI:l}:
hUp].vL;mL;nn]. nG];sG]pQn]siUc].hiuw]El: pn]hqc];sC]kUn];pQn]"
 lat]:etL,kUn];pQn]" Tgm],kUn];pQn]" Tam]tUv];piun];tac];pQn]hG]:lI" tUw]yac], - hUw]Et,K}:
Am],nn] ngn];Am],lp];miUw]:lC] ? miUw]:An]l}:TUp];vL;nn]. PwKw]pQn]siUc].hiuw]Pgc]:? Kt];sC]
KUn.] hLpn],hL tI:hQt];hC]:pQn]tac];pQn]"
 Kt];sC]Tgm], lgc]:pn]hLkUn];pQn]" Aic]niUw]lgc]:Kw]lat]:EneS yL,Tac],lQk].niUw]Kw] kUv];kL:pL;
sC]nC];lgc]:tI:Kw]lat]:El: Kt];sC]hG]:Kw]lat]:Agk],mL;hc];kUv];" liUw]eSnn]. hG]:kUn];pQn]l}:hU.
wL: Kw]Am],l}:yU,hc];kUv];ekL.lQw]El:pgc],sC]nUiw] lgc]:An]Kw]l}:mI; tac];KIsC]m}:sC]"
lgc]:Aw]yLeS yUt];yLpn]
 wUn].Sgn],tL,pn] SSRI miUn]nc],yL fluoxetine"
 Sc]wL:kUn];pQn] ngn];Pn]ha}.n}siuc] pn]yL haloperidol ( 1-2 mg ) An]hqc];yLtqm],n}
etsac]:s}g:l}:" tL,kUn];pQn] An]ngn];Am],epL;lp];nn]. hG]:pn]yL Diazepam (5mg)"
kUv];kL:yL Diazepam n}. pQn]yLAn]sp];yin].l}:El: yL,pn]pUn].liUw] 1-2 wUc]:"
246
18.4 sCy
] gc],wUn]; (Psychosis)
eKL:piut],tI:pgc],
pQn]Pac]hac]:kUn]; An]mI;tac];pQn]kQw],lUv]:sC]h}a.hqc];" kUn];pQn] Am],sac]:sqk],EPcw];l}a; An]pQn]Et.
yU,El: lgc]:wUn].Sgn],ekL.lQw]' lgc]:hn]Pit];wUn].Pit];yU,nn]. hG]:Tuk],mqn]:l}:"
lgc]:wUn].Sgn],ekL.lQw] – tI:Am],mI;Sc] Am],pQn]Sc]nn]. kUn];pQn]Sm].mUin]hac]:l}:cin];' l}:hn]'

l}:A}aEl: wUn].Sgn],wL:pQn]yU,mI;yU,nn].yw]." tUw]yac], - pqk].Sm].wL: Am],mI;PC] yU,him];Kw]' lat]:
etL,Kw]eStL. kUn];pQn]l}:yin];wL: mI;kUn];lat]:etL,Kw]yU, Am],nn] hn]Kgc]An]Am],mI;etL,nL:
Kw]Sc]" An]lm],lgc]:Et. etl}:pgc],sC]wL: kUn];pQn] Am],l}:Sac]:Kiun]:mL;ekL.lQw] nG];sG]Kw]Tac],wL:
pQn]lgc]:Et.El: mac]pgk]:etpQn]lgc]:An]lIkUw]Et.Et."
lgc]:hn]Pit];wUn].Pit]; (lgc]:yum],ym]Pit];) – mI;tac];yum],ym]Pit];lUc]lac] An]Am],Kw]:l}:'
Am],pgc],sC]l}:tc]; kUn];nC];tUc],wUc]; Am],nn] fic]:Tuc];Kgc]Kw]" p}a;wUn].Kgc]Kw]km]:nm] etpqk],piUc]:eS
pQn]lgc]:An]Am],k}.mI;PC]wUn].Sgn]," tUw]yac], - kUn];pQn] hU.tac];nC];sC]piUn]:l}:' lat]:wL: luk].tI:
km],PL,tac],luk]:mL;' lgc]:An]Kw]yum],yU,nn]. kgp]:wL:pQn]lgc]:pqk],piUc]:El: pqk].Sm].wL:pQn]lgc]:lIKG]:KUw]
tgn]:tL,piUn]:n}eStL. tL,Kw]Et. yum],ym]nqn]:nLwL: pQn]lgc]:Et.nn].yw]."
 miUw]:lgc]:wUn].Sgn],ekL.lQw] Am],nn] lgc]:hn]Pit];wUn].Pit]; nm]pUn].tI:mL;El: kUn];pQn]n}.

etAm],lum];lL;tUw]sw]:kw],El: etyqk]:yU,tc];tUc],wUc];Kw]mL;" lgc]:Am],lIliUw]nn].Et. kUn];
km]:nm] etwUn].Sgn],wL: Kw]pQn]kUn];ygc],El: yUt];yLpn]ekL: etAm],pgc],Sc]n}yw]." kUv];kL:
tI:Et.mn]; Sc]Aw]yLAn]Tuk],mqn]:yUt];yLpn]siuc] kUn];pQn]kQw],lUv]:sC]n}. lIKiun];mL;l}:yU,"
 kgp]:wL:kUn];pQn] An]kiuc].kac].ygc],h}a.hqc];n}. Am],pgc],sC]wL: him];hgm];Kw] pQn]Sc]mI;Sc]yU,El: tL,
etlat]:etL,Kw]n}.yap]," kUv];kL: sgm];nc],pun]:Pgn];PU:hap],kan]p}a;yU,lIekL.niuc]: Tuk],lIKt];sC]
hG]:kUn];pQn]hU.wL: Kw]yU,tI:lC]yU,El: Kw]pQn]Sc]yU,' tUw]yac],- lat]:EnwL: Kw]yU,hUc];yLyU,El:
l}:yUt];yLpn]Kw]yU,"
lgc]:yUt];yL
pn]yLkin] phenergan 25 mg + haloperidol 5 mg Am],nn] yLSm]; tL,kUn];pQn] An]kiuc].kac].
ygc],h}a.hqc]; (sC].lgt],yL An]lQw]kn]eSSup],Aw]yLtc];Sgc]An]Sm];km];lQw]kn]l}:)"
kgp]:wL: yLAn]sG].siUw];n}. pQn]yLAn]hqc];eS Pgn];sL.yLekL:hqc];El: tk];etl}:pC].tUv]; lum];lL;
kUn];pQn]sm]sm]yU,tL,eS," tL,yUt];yLkUn];pQn]Kaw];hiuc]n}. etAic]niUw]tac];pQn] An]pQn]nm] pQn]eA,
eS tL,yUt]; yLsiUc].nn]n}. Tuk],lIpQn] PU:mI;p}a;hU.lgc]:yUt];yL An]mI;tUw]TUp];nm]nn].kUv];"
247
Pgn];sL.yL
 tac];pQn]kQw],lUv]:sC] An]mI;lgc]:tUw]Sn],  mak],tLpn],mUn]; (Occulogyric crisis)'
hUm]:sgm]; (Parkinsonism) km]:nm]Et. etpQn]luk]:Agn],s}a;"
 tin]Sn],miuw];Sn],  eKL;lim], (Torticollis)' km]:nm]Et.etpQn] luk]:
 KQc]: Agn],s}a;"
 tL,etEt,tUc].niuc]yap],
 Am],mI;lgc]:tUc].niuc]
 Am],suk];l}:lIlI
Sc]wL:mI;Pac]hac]:tac];pQn]pL,kin]San]< (Parkinsonism) – hG]:pn]hqc];yL haloperidol eA,lUc];"

Pgn];sL.yLn}. Aw]yL biperiden (Akineton) 2 mg pn]kin] nuic]:wn]; 1-3 pgk]:eS
yUt];yLpn]l}:"
18.5 lgc]:pn]tac];K}:sC] (Counselling)
eKL:piut],tI:pgc],
 l}a;yUt];yL tgn]:tL,kUn];An]yam]:mI;sQp]; la};niuc]:yw]." mac]ekL.ekL:hgc].wL: Aup],lat]:eS
yUt];yLpn]n}yw]."
 l}a;yUt];yLAn]n}.n}. etAup],lat]:tc];kUn];pQn]' Aup],AUw];tiUc],pac], lgc]:pn]hLKw]eSEl:
pn]tac]; s}g:Tqm]la};niuc]:nn].yw]."
 kgp]:Aup],AUw];lat]:etL,siUc].n}El: etsac]:hLpn]hLkUn];pQn]eS etsac]:hLtac];Agk],tI:lI
tgn]:tL, tac];pQn]kQw],lUv]:sC]Kgc]kUn];pQn]l}:nn].yw]."
pk];piUc]mac]siUw]; (Some of the rules)

lgc]:Tic];Sim];eKL:mun];kUn];pQn] (Confidientility)- eKL:mun];kUn];pQn] An]l}:mL; miUw]:Aup],AUw]; pn]
tac];K}:sC]Kw]nn]. Sc]kUn];pQn]Am],pn]KGac]. etAm],l}:mgk],lat]:EnPC]" liUw]eSwL:kUn];pQn]mI;yiUc];
Aan]; ethQt];ha}.tI:eSekL.ekL. Am],nn] tUw]sw]:kw],n}Et. Tuk],lIlat]:EnpI:ngc].kUn];pQn]"
Sc]wL: hw];Tic];Sim]; eKL:mun];kUn];pQn]l}:n}siuc] Kqn];ethQt];hG]:tac];yum],ym]nC];Ek: tUw]sw]:kw],El:
kUn];pQn]l}:nn].yw]."
lgc]:yum],ym] - tk];etl}:Sac]:lgc]:yum],ym] nC];Ek:kUn];pQn]El:PU:pn]tac];K}:sC]" kgp]:wL:
tL,hG]:lgc]: pn]tac];KG]:sC] pQn]Pgn];lInn]. tk];etl}:mI;lgc]:yum],sC]kn]"
248
lgc]:Kw]:sC]pgc],sC] (Empathy)- PU:pn]lgc]:tac];K}:sC] tk];etl}:Kt];sC]pgc],sC]cw];l}a;kUn];pQn] hG]:lI

eSpiUn]:kL:nc],pgc]pQn]l}:" tL,etKw]:sC] pgc],sC]An]wL:nn]. luk].tI:tLkUn];pQn]eS hn]Tiuc]PwKw]'
Kt];sC]hG]:pgc],sC] An]kUn];pQn]pQn]siUc].nn]yU,El: yU,tqn];tI:tUw]Kw]eS wUn].pgc],sC]pn]Kw]nn].yw]."
Am],w}.sC]ATac],lQk].kUn];pQn] (Non Judgement) – An]kUn];pQn]lat]:Enlgc]:Kw]etL, PU:pn]lgc]:
tac];K}:sC]n}. pQn]kgp]:Kw]yum],ym]n} PU:pn]lgc]:tac];K}:sC] Tuk],lIpgc],sC]cw];l}a;n}.lIlI" kgp]:wL:
cw];l}a;sC] kUn];pQn]n}. tum].tiUw].c}a:El: lgc]:pgc],sC]tc]; lgc]:km].s}g:tI:PU:pn]lgc]:tac];K}:sC]n}. pQn]
An]lm],lgc]:Et.yw]." pqk].Sm].wL: Am],Pgm].sgm];lgc]:An]Kw]lat]:eStL. Am],ATac],lQk].
kUn];pQn]n}. pQn]An]lm],lgc]:tL,pn] lgc]:tac];K}:sC]Et.Et."
TWm], - PU:pn]tac];K}:sC]n}. tk];etl}:pQn]PU:TWm],tI:lI" miUw]:Aup],lat]:nn]. Sc]Kw]KG]:kuit];
sUw]:kqp]:sUw]:km];n} hG]:Kw]kiut];eS yL,nqt]:Kw] hG]:Kw]Aup],lat]:yw].yw].El: p}g,pn]Kw]lat]:
lgc]:An]Kw]K}:lat]:"
PL,SL,tUw] (Body-language)- l}a;kUn];pQn]nc]:El: l}a;tUc].niuc]Kw]n}. km]:nm]etmgk],lat]:Tiuc]
nC];sC]Kw] wUn].Sc]yU," miUw]:Aup],AUw];kn]nn]. lgc]:Tuk],lIhG]:Kw]hU.wL: pL;sC]pL;eKL;Tgm],Kw]n}. pQn]An]
lm],lgc]:El: tL,hQt];siUc].nn]n}. Tuk],lIhQt];sgm];piUc]nc],pL:tC]:n}.
hG]:Kuk];sC]l}: eKL:kCam]; SOLAR

Square: hG]:nc]:etL,nL:tc];kUn];pQn]" tUv];kUn];pQn]Siuw]:Siuw]:" yL,nc]:him];"
Open: yL,Aw]miuw];kgt],k}, El:yL,kUm]:hUw]w}."
Leaning miUw]:kUn];pQn]lat]:nn]. Aw]tUw]kiUc];kCL,tac];kUn];pQn]eSTgm], hG]:kUn];pQn]hn]Tiuc]wL:
Forward: pL;sC]eSTWm],yU,"
Attentive: nc],hiuw]epL;ethU.l}:wL: pL;sC]pL;eKL;TWm],yU,nn]. hG]:cgk];hUw]pn]pQn]km];pQn]km];
EnTiuc]wL: pgc],sC]Kw]yU,"
Relaxed: Kaw];yam];miUw]:pn]lgc]:K}:sC]yU,nn]. hG]:hQt];hG]:kUn];pQn]SL,sC]' Kt];sC]yL,hG]:Aiut],Aat],
Am],nn] sC]Am],nim]" Sc]PU:pn]lgc]:K}:sC] hQt];hac]:SL,sC]siuc] kUn];pQn]ekL: etlqk]:
l}a:SL,sC]mL;"
Kaw];yam];Aup],AUw];pn]lgc]:K}:sC] (The counselling Session)
pL:tC]:n}. pQn]piUc]nm];mac]eKL: tL,Et,pn]lgc]:K}:sC]etL,kUn];pQn] –
1. Tuk],lIEt,lUv]:
Sp];lqc];En lgc]:KG]:s}g:Kw]' mgk],lat]:EnwL: sw]:kw],pQn]PC]El: mI;pun]:Pgn];Sc]l}al}a (pQn]emLyL'
PU:hap],kan]tL,kUn];tc];nm]) Sp];lqc];EnwL: tL,s}g:Kw] hG]:l}:mI;Pgn];lIEk:pn]hL Kw]nn]. sw]:kw],
KG]:hU.sk];Kw]nm]liUw]n}." Tam]tUv];wL: sgc],mI;Sc]etK}:Tam]El:tgp],pn]Kw]l}:" tk];etl}:lat]:Suiw]:
Siuw]:etL,Kw]" tL,etAup],kn]nn]. hLtI:yQn]yQn]' SL,yL,sC]El: pQn]tI:nuic]:eKLeKL"
249
2. piun];KiUw];pI:KiUw];ngc]. (Family history)
Tam]tUv];lgc]:PwKw]El: kgp]:Sc]El: l}:mL;Tiuc]tI:n}:" Tam]tUv];lgc]: miUw]:yU,nC];miUc];nn].
pQn]siUc].hiuw]" Tam]tUv];piun];tac];pQn] An]yam]:pQn]mL;El: lgc]:fic]:Tuc];Kw]"
3. hLtUv];wL: pn]hLKgc]Kw]pQn]AI:Sc]
Tam]tUv];kUn];pQn]wL: etL:lQw]mI;pn]hLSc]l}al}aPgc]:" pn]Kaw];yam]; tL,Kw]etAup],lat]:' pn]Kaw];
yam];hG]:Kw]kiut];kGL,miUw]:tuik].lat]:yU,nn].El: hG]:yiUn].TWm],pn]" kGam];Tam]pL:tC]:n}. An]et
sac]:Tam]l}: -
 miUw]:l}:Aup],lat]:lgc]:pQn]mL;nn]. pQn]siUc].hiuw]w}."  Sc]wL:hUw]K}:yU,' sQp];sgm];niUw].sgm];tUw]yU, n}
 sgc],ngn];lp];/Am],lp];l}:lI'lgc]:An]pQn]mL; siuc] Tam]tUv];wL: pQn]mL;w}a;eS mI;pn],hL
nn].sgc],hQt];hG]:Pn]ha}.Tuic]Kiun]; lgc]:sUiw]; sC]:/Am],sC]:"
nn].hiuw]"  Tam]tUv];Kaw];yam]; An]mI;pn]hLmL;wL:
 kgp]:pn]hLAn]pQn]mL;eSnC];Pwsgc],mI;Sc]lqk]:l}a: hiuc]kL: hiuw]yw]."
 sgc],tum].tiUw].p}a;yU,lIhiuw]/Am],tum].tiUw]."  Tam]tUv];kUn];pQn]wL: wUn].Sgn],tL,et Ek:
pn]hLAn]nn].siUc].hiuw]"
 hUm]:Aup],AUw];hLtUv];tac];Agk],/eKL:tgp],pn],
hL" kUbv];kL: yL,wUn].lL;lL;wL: SUkUv];
etpQne] kL.Ek:pn],hLpn]Kw]"
4. miUw]:Aup],kum]kn]yU,nn]. hG]:lam];wUn].Tiuc]cw];l}a;sC]kUn];pQn]
 kUn];pQn] sgc],sC]lm]' mgc]sC]/sC]tUk];yU,hiuw]"  KUn].hLtUv];wL: Kw]wUn].siUc].hiuw] kQw],lUv]:
 sgc],Aap]:pQn]Et.yU,hiuw]" tUws] w]:kw],Kw]' sgc],Kw]ATac],yC],/A
 lam];tUv];wL: sgc],ygc],yU,hiuw]" Tac],lQk]. tUw]sw]:kw],Kw]' sgc],Kw] wUn].
 sgc],lgc]:liUt]:lUm];Kw] Tuk],lIpQn]siUc].nn] yU, wL: Kw]n}.Am],mI;lgc]:lISc]' tUw]yac],
hiuw]' tUw]yac], - miUw]:Aup],Tiuc]lgc]:Am],lI Am],wL:Kt];sC] Am],nn] hQt];Sc]ekL:
Am],nn] lgc]:sC]Am],lInn].Kw]Sm].yum].yU, Am],Agc],man]Sc]eSpgk]: (Pac]hac]: KIsC]
hiuw]/tUv]; Aap]:mUn]:SiUw];yU,hiuw] Am],nn] kp].sC])"
miUw]:lat]: lgc]:mUn]:SiUw];nn].sgc],Kw]Sm]. sC]  sgc],kUn;] pQn]yam]:hQt];h}a.etL,piUn]:"
Am],lIyU,hiuw]/ h}:yU,hiuw]"  etL,lQw] sC]K}:hQt];h}a.etL,piUn]: Am],nn]
K}:Aw]tUw]sw]:kw],t}a mI;/Am],mI;"
pqk].Sm].wL: etKUn].hn]lgc]:siUw];n}.l}:mUt];n}eStL. Am],sC]:Aup],kn] pgk]:km];Agn]tac];nn]. pgk]:

lQw]kUv];' kUv];kL: hUp].vL;Aup],AUw];kn]l}al}apgk]:yw]. kUn];pQn]sc],yum],sC]mL; SUiw];SL,sC] kgp]:l}:
lat]:etL,nm] mL;nn].yw]." kGam];Tam]siUw];n}. Am],sC]:wL: etl}:Tam]kGL,Siuw]:Siuw]:siUc].nn] PU:pn]
lgc]:K}:sC]tUv];sgm]; lgc]:tUw].tgp],El: cw];l}a;sC]kUn];pQn]eS lam];hU.Aw]l}:"
250
pgp]:km];Agn]tac]; An]hUp].TUp];tc];kUn];pQn]nn]. yL,Kt];sC]Tam]kCam];Tam]nm]lL;lL;"
5. SUc],kUn];pQn]kCL,yLtUw]tac],tI: (Referral)
yU,tI:PU:pn]lgc]:tac];K}:sC]ekL.niuc]:eS Tuk],lItqp];tt];wL: etl}:SUc],kUn];pQn]kCL,Sun]tac],tI:
Am],nn] hUc];yLtac],tI:hiuw]/Am],SUc]," kUn];pQn] Aap]:etTuk],l}:hp].lgc]:yUt];yL Am],nn] lgc]:
eh.kc]: tL,Ew:pqt]:pn]hLAn]hUp].vL;yU," kUv];kL: siUc].hiuw]ekL:lI lgc]:etSUc],tUw]kCL,tac],tI:n}.
tk];etl}:hG]: kUn];pQn]pgc],sC]yw].El: l}:KCac].Kw]yw]. sc],Tuk],lISUc],kCL,"
eKL:lm],lgc]:mac]eKL: An]Tuk],lImat]:m}a
 kgp]:wL: kUn];pQn]sun].eS Aw]lgc]:Sun],tUw]Kw]mL;mgk],lat]:EnEl: tk];etl}:np].ym] lgc]:
n}.pn]"
 lat]:lgc]:Am],lIAn]pQn]mL; piut],lat]:En lgc]:An]Km]AUk];Km]sC]yU,El: muc]:mgc];wL: etmI;
tac];lqk]:l}a:yU,n}eS An]kUn];pQn]Kt];sC]lat]:Agk],mL;siUw];n}.ekL: pQn]lgc]:ht];sun].An]niuc]:
El:yU,tI:PU:pn]lgc]:tac];K}:sC]pn]kUn];pQn]eSTuk],lIpn]hqc];El: Tic];Sim];pn]eKL:mun];kUn];pQn]"
 PU:pn]lgc]:tac];K}:sC] Tuk],lIhac]:hqn]; tL,etl}:Tgm],l}:cin]; lgc]:An]Am],mUn]:SiUw];sC]El:
lgc]:h}a.sL.eS miUw]:cw];l}a;siUc].n}nn]. Tuk],lIw}.sC]l}:lIlIEl: sG]nim]nim]eS pn]tac];hn]
Tiuc]tI:lIl}:"
 PU:pn]lgc]:tac];K}:sC] etl}:hU.w}.wL: Kw]l}:hap],kan]pun]:Pgn];An]yC],lUc]yU," PU:pn]lgc]:tac];
K}:sC] etpQn]PU:mI;eAL;sL,tL,PwkUn];pQn]nm]n}nn]. Tuk],lISC],sC]lgc]:n}.pL;sgm];" kgp]:tac];
yum],sC]Kgc]kUn];pQn]El: PU:pn]lgc]:tac];K}:sC]Kw] etmI;eAL;sL,etL,kUn];pQn]nn]. Am],Tuk],lI
Aw]mL;sC].tac];tI:Pit];" Sc]Am],w}.StI.hn]Tiuc]lgc]:n}.n}siuc] PU:pn]lgc]:tac];K}:sC]ekL: Am],
hU.tUw]eSEl: sac]:lqk]:l}a:pQn]SUn],niuc]:Kgc]pn]hLmL;nn].yw]:"
liun];Sut];
yiUc];Aan];lgc]:pn]tac];K}:sC]etL,kUn];pQn]n}. pQn]lgc]:tL,s}g:Tqm]kUn];pQn] hLtac];Agk],pn]hLKw]El:
sac]:yum],ym]tUw]sw]:kw],mL;eS pQn]AQn]pQn]hqc]; hG]:Kw]kCL,sU;PwtI:An]lgt]:lqw];El: mUn]:SiUw];
liUw]/yU,lI liUw]nn].yw]." pqk].Sm].wL: Am],sac]:hQt];hG]:yiUc];Aan];An]n}. yw].tUw]:l}:kU:siUw];siUw];
nc],tI:Aan];w}. n}eStL. kgp]:pgc],sC]Kw]:sC]lgc]:pn]hLKw]' Enl}:wL:hn]sC]pn]hLKw]El: miUw]:kUn];pQn]
luk].tI:hgc]:pn]tac];K}:sC] yac]:Agk],kCL,nn]. hG]:Kw]l}:hp].lgc]:mn]:sC]El: lgc]:Aun],sG]nn].yw]."
251
pn]hLlWc]:kUit],luk]:
19
Sc]KG]:hU.hUw]yg}:n}suic] hLAw]l}:tI:nG];pp].piUc]nm];lgc]:kUit],luk]:sgm];lqn]lin]miUc];T}; - miUc];man]:l}:yU,"
 ARC - pp].piUc]nm];pa};yU,lIEP:sUiw].Pn];El: luk]:Agn],"

 SMRU - kQw],lUv]:lgc]:kUit],luk]:eS kuic].kac].pQn]eP;Kuik].Kk].mL;"
 WHO - l}a;Ek:lit]:pn]hL An]sac]:pQn]eP;tL,Em:pL;tgc].El: Em:yU,f}; - pp].piUc]nm];
tL,Em:kQp]; El:emLyL"
19.1 lUit]:tUk];miUw]:Sn],eT,num],
= Sn],eT,p},Tuuic] 22 wUc]:eSEl: lUit]:tUk];
tUk];luk]: (Abortion)
eKL:piut],tI:pgc],
yU,yU,eStUk];luk]: (ygt],luk]:) Am],nn] kgp]:lgc]:hQt];Sac]:eSlgc]:lgc]:El: tUk];luk]:kGL, mUiw]:Sn],
eT,p},Tuic] 22 wUc]:nn]. hgc].wL:tUk];luk]:n}yw]." lUit]:tUk];miUw]:Sn],eT,num],n}. sac]:pQn]
l}:_mI;Pac]hac]: Aap]:ettUk];luk]:' tUk];tc];SQc]:' tUk];luk]:An]Am],mUt];SQc]:' lUit]:pQn]kgc].El:
tUk];luk]:n}yw]." la};yUt];yLekL: etpqk],pUic]:sgm];nc],l}a;tUk];luk]:"
tL,mk];mn]:tac];pQn]n}. hG]:sC].l}a;Aw]kim];SUp];pQt];tc];miuw];eSkUt],sqt]:El: sC].miuw];tc];Sgc]P}a,kUt],

sqt]:pn]tL,eS," hLtUv];pgt];niUw]. An]pQn]pgt];pQn]tgn]:eS tUk];lUc];mL;" Sc]wL:mI; pgt];niUw].
pQn]pgt];pQn]tgn]: Km]w}.tI:pak],hUc];luk]:n}siuc] hG]:sn]Agk],pqt]:km];lQw]"
(Sc]pQn]l}:) tgn]:tL,kUn];lUit]:tUk];miUw]:Sn],eT,num],kU:ekL. hG]:epL.AU<TrL.Sw];tUv];

tL,mk];mn]:tac];pQn] hG]:Tuk],mqn]:"
mI;Pac]hac]:Aap]:ettUk];luk]: (Threatened abortion)

eKL:piut],tI:pgc],
AL,yuSn],eT,p},Tuic] 22 wUc]:eSEl: lUit]:tUk]; Am],nn] tWc].Aiw]:"
252
pn]hLlWc]:kUit],luk]: 19
Pac]hac]:tac];pQn]
 lUit]:yg}.tUk];nG];kUc]KUic]:Ac],kL,Ait];Ait];'  lUit]:tUk];yU, kUv];kL:Am],hn]pgt];nUiw]. pQn]
Am],luim];tUw]" (Mild cramping abdominal pgt];pQn]tgn]:tUk];mL;sgm];" (No product
pain) passed)
 tggc].sQp];lim],Ait];Ait];  pak],hUc];luk]:pik].w}."
lgc]:yUt];yL
1. Aw]kUn];pQn]ngn];luiw]:w}.tI:hUc];yLeS yUt];yLpn]etL,Tuic]lUit]:epL;kuit]; sc],kg}:pn]mUiw];"
2. Sc],lat]:kUn];pQn]wL: Sc]lUit]:tUk];Tqc]:suic] hG]:Kuin];pgk]:mL;tI:hgc]:yL' hUc];yL"
tUk];luk]:mUt];SQc]: (Complete abortion)
eKL:piut],tI:pgc],
Sn],eT,An]yU,nG];hUc];luk]: tUk];lUc];mL;tc];SQc]:"
Pac]hac]:tac];pQn]
 lUit]:yg}.tUk];lUc];mL;tI:KUic]:Ac],kL,"
 tgc].Aiw]:tWc].sQp];"
 hn]Sn],eT,tUk];Agk],lUc];mL;tc];SQc]:"
 wa};eSnn]. lUit]:ekL:tUk];Ait];Ait];' pak],hUc];luk]:tup],' hUc];luk]:hQw],yup]:lUc];kGL,lg};lg};eS
tgc].ekL: Am],sQp];yw]."
lgc]:yUt];yL
 Aw]ngn];liuw]:w}.tI:hUc];yL"
 Sc]wL:tgc].sQp];suic] hG]:pn]yL Paracetamol "
 kUt],sqt]:tUv];lUit]:wL: sgc],hqc];lUit]:eA,"
tUk];luk]:An]Am],mUt];SQc]: (incomplete abortion)

eKL:piut],tI:pgc],
pgt];nUiw].Sn],eT,mac]pgt];mac]tgn]:tUk];lUc];mL;n}eStL. mac]pgt];mac]tgn]:Sm].kuit];w}. nG];hUc];luk]:n}.
hgc].wL: tUk];luk]:An]Am],mUt];SQc]:n}yw]."
Pac]hac]:tac];pQn]
 lUit]:tUk];lUc];mL;tI:KUic]:Ac],kL,nm]nL,eS  tI:pak],hUc];luk]:nn]. etl}:hn]pgt];nUiw].pQn]pgt];
luim];tUw] El:Aw]mL;hUc];yL" pQn]tgn]:"
253
19 pn]hLlWc]:kUit],luk]:
 tgc].Aiw]:"  pak],hUc];luk]:etpiUt],w}."
 pgt];nUiw].pQn]pgt];pQn]tgn]:tUk];lUc];mL;"
lgc]:yUt];yL
1. Aw]kim];cip]: Am],nn] Aw]KUic]:lut],pgt];nUiw]. sUiw];An]mI;tI:nC];hUc];luk]:pqt]:mUt];mUt];"
2. Sc]wL:Am],Aw]Agk],pqt]:pgt];nUiw].l}: Am],nn] lUit]:lUc];Am],Kat],suic] –
 hG]:SG],pn] IV NSS / RL / Haemacel " (lgc]:pQn]SWYk]. tUv];tI: kn] 7.6)"
 wUn].w}.tL,SCac];lUit]:pn]"
 Oxytocin IV 10-20 IU ' Misoprostal (Sc]wL:mI;) Am],nn] pn] Ergometrine IV/IM 0.2 mg "
 SUc],kUn];pQn]kGL,tI:hgc]:yL/hUc];yLAn]sac]:Kut],hUc];luk]:l}:"
Sn],eT,ta}nG];tgc]. (Missed abortion)
eKL:piut],tI:pgc],
luk]:Agn],ta}kCL,nG];hUc];luk]: kUv];kL:luk]:Agn],Am],l}:tUk];Agk],mL;"
Pac]hac]:tac];pQn]
 lUit]:tUk];Ait];Ait]; Am],nn] lUit]:Am],tUk];lL;lL;"
 pak],hUc];luk]:Am],piUt],"
 hUc];luk]:etlQk].liUw] tI:wUn].Sgn],w}."
lgc]:yUt];yL
 km]:nm]Et. yU,yU,eS ettUk];luk]:kGL,hc];kUv];"
 nc],huiwe] thG]:luk]:Agn], tUk];lUc];w};w};nn].Aw] Misoprostal SG],w}.tG]:pak],hUc];luk]:"
 Sc]wL:luk]:Agn], ta}nG];tgc].l}:lUin]pa}yw]. Am],tUk];lUc];mL;hc];kUv];n}suic] hG]:SUc],kUn];pQn]
kGL,Kut],hUc]; luk]:"
Sn],eT,t}anC];tgc].El:pQn]kgc]. (Septic abortion)

eKL:piut],tI:pgc],
Sc]wL:luk]:Agn],ta}nG];tgc]. Am],nn] kgp]:tUk];luk]:An]Am],mUt];SQc]:eS pgt];nUiw].kuit];w}. nG];hUc];
luk]:El: sUiw].mqc];tac];pQn]Kw]:n}yw]." kgp]:lUit]:mI;kgc].n}.eS etsac]:eP:tiun];kGL,sgt],tUw]: nG];tUw]
kUn];El: sac]:pQn]eP; tum].tUiw].Tuic]kUn];l}:nn].yw]."
254
Pac]hac]:tac];pQn]
 mI;Pac]hac]:miUn]nc], lgc]:tUk];luk]:  nm].mQn]tU, ettUk];lUc];mL;tI:KUic]:Ac],kL,"
An]Am],mUt];SQc]:El: hUm]:tc];-  pak],hUc];luk]:sQp];
 mI;lUm];naw]"  lup],kum],kUn]:sQp];kqn];"
 kiuc].kac].lium];tUw]"
lgc]:yUt];yL
 yUt];yLpn]mUibn]nc],la};yUt];yLtUk];luk]: An]Am],mUt];SQc]: hUm]:tc];
 Sc]wL: miUw]:pL;tgc].yU,nn]. Am],l}:Sm];mL;n}siuc] hG]:Sm];pn]yLeh.kc]:tac];pQn]kac];Kqc]"
 pn]]yLptI,KYI<wn (Antibiotic) yLkin] tL, 7-10 wn];" (etl}:pn]kin] mUiw]:p},Kut],hUc];luk]:)"
 Ampicillin IV 1g QID El: Gentamicin IV/ IM 7mg/kg OD (nm]Sut]; 36mg)El:
 Metronidazole PO 50mg TID
 Sc]wL:Kqn];mL;suic] lqk]:l}a:kin]yL Amoxicillin El: Metronidazole"
 Sc]wUn].Sgn],wL:pQn]tac];pQn]lUv]:lgc]:hUm]:kL,meSpQn]mL;n}suic]tUv];lgc]:yUt];yL tI:kn] 13.5"
et,Sn],eT, An]Am],pk],ktI,(et,tI:lgt],SUc],K},/ngk]:hUc];luk]:) (Ectopic pregnancy)
eKL:piut],tI:pgc],
Sn],eT,et,ngk]:hUc];luk]:An]wL:n}.km]:nm]Sn],eT,kGL,et,tI:lgt],SUc],K},(fallopiantube) nn].yw]."
Sc]wL:AL,yuSn],eT,yG],mL;mgk]: 8 wUc]: (mac]pgk]:mac]lG]Sm].sw].eS 8 wUc]:) suic] lUit]:ettUk];eS
etsac]:hQt];hG]:lgt],SUc],K},tqk],n}yw]." kgp]:lgt],SUc],K},tqk],El: hQt];hG]:liUt]:l}haw].hqc];eS sac]:
hQt];hG]: kUn];pQn]luim];tUw]/kiuc].kac].lium];tUw]El:etpQn]eP;l}:Tiuc]t}akgn],yw]."
Pac]hac]:tac];pQn]
 epL;sqt]:tUv];yQw]:n} etpL;tWc]."
 tI:hUw]nw],etsQp];kqn];haw],hqc]; km]:nm]etsQp];Pa},lQw]"
 lUit]:nw]:etyg}.tUk];lUc];mL;km];Ait];Ait];"
 hn]lUit]:tUk];Ait];Ait];n}eStL. mI;Pac]hac]:kiuc].kac].lium];tUw]l}:"
 kgp]:wL:lUit]:tUk];nC];hUc];luk]:El: etmI;liUt]:Agk],mL;tac];ngk]:Ait];Ait];kUv];"
 kUt],Tt];tUv];tI:hU;KUic]:Ac],kL,suic] etsQp]; Am],nn] pak],hUc];luk]:etsQp];Pa},lQw]"
tUv];Pac]hac]:kUn];pQn]eSmk];mn]: Am],nn] Sc]pQn]l}:epL.AU;trL.Saw];eStqp];tt];'
epL;kUt],Tt];tUv]; hn]wL:sp];Sn],eT,yU,n}eStL. Am],hn]mI;Sn],eT,nG];hUc];luk]:"
miUw]:Sn],eT,yc];tuik].num],nn]. Sc]wL:pgt];tC]:tgc]. sQp];haw].hqc];n}siuc]

hG]:wUn].Sgn],wL: lgc]:et,Sn],eT,tI:lgt],SUc],K},w}.Agn]tac];"
255
lgc]:yUt];yL
1. SCac];pn] IV NSS Am],nn] Ringer"
2. Sc]wL:lUit]:tUk];nm]suic] tk];etl}:SGac];lUit]:pn]"
3. SUc],kUn];pQn]kGL,PL,tt];tI:hUc];yLw};w};"
Sn],eT,mak],Ait], (Hydatidifrom Mole)

tUv];tI: tgn]: 19.6
19.2 lUit]:tUk];mUiw]:Sn],eT,yG],ek, (p},Tuic]Kaw];yam];kUit],eS lUit]:tUk];)

= wa};eSEt,Sn],eT,l}: 22 wUc]:eSlUit]:tUk];
Sn],eT,yG],Ek,eS lUit]:tUk];n}.pQn]Pac]hac]:An]mI;eP;El: yL,w}.mw]mac]
lL;lL;"
lgc]:tac];An]hQt];hC]:pQn]km]:nm]Et.-
1. hUk].lUc];Agn]tac]; (Placenta Pravevia) - hUk].tac];mUt]; Am],nn] pQn]pgt];pQn]tgn]:
mL;Auit];w}.tI: pak],hUc];luk]:"
km]:nm] = lUit]:tUk];eStL.tgc].Am],sQp];"
2. hUk].Pat],Agk], (Placenta abruption) - (hUk].yan]Agk],PLhUc];luk]:)"

km]:nm] = tgc].sQp];haw].hqc];' hUc];luk]:kqn],' Tgm],tUv];lUm];tgt],hUw]sG]luk]:Agn], etAm],cin];
(Sc]wL:hUk].yan]Agk],PLhUc];luk]:Ait];Agt];n}suic] etl:}cin];SQc]tgt],hUw]sG]luk]:Agn],yU,)"
epL;wL:kUn];pQn] pQn]hUk].lUc];Agn]tac];n}suic] tuin];etAm],l}: Aw]muiw];sam];tUv];tI:
hU;KUic]:Ac],kL,lL;lL;" kgp]:wL:SQn]:lUit]:tI:hUk].etsac]:tqk], Am],nn] hUk].etsac]:yan]Agk],
hUc];luk]:mL;" kgp]:n} Tuk],lIAw]kim];SUp];pQt]; (speculum) eS tUv];tI:pak],hUc];luk]:suic]
etl}:hn]hUk]. Am],nn] Sa}eh,Pat],l}:"
lgc]:yUt];yL
 hp].kUn];pQn]w}.tI: hgc]:kUn];pQn]nC];"
 SG],KQm]ekL,kqn],vU,lL, m}a 16-18 eSpn]NS/Ringer" (Sc]wL:mI;Pac]hac]:luim];tUw]n}suic]
hG]:SCac]; lUit]:pn]sgm];)"
256
1. Sc]wL:lUit]:tUk];EA,lUc];kGL, Am],nn] kuit];yut];kGL,El: hUc];luk]:et,AUn]:mL; hqc];tgn]:
hUw]sG]luk]:Agn],lImL; (> 120 bpm) n}siuc]
 Suip],yUt];yLkUn];pQn]nC];hgc]:kUn];pQn]nG];eS lgc]:tL,SUc],kCL,hUc];yLnn]. hG]:tUic],pac],tc];emLyL/Em:
kQp];Kw]"
 lgc]:n}.Am],sG]:lgc]:Kuik].Kak].n}eStL.mUiw]:p},SUc],kUn];pQn]kGL,hUc];yLlUc]nn].etl}:epL. AU<trL.Sw];
(Aw]KWm];piw],tUiw], KUic]:Kuit];kap]:eST},hac]:nC];tWc].) eS kUt]:sqt]:tUv]; Pac]hac]:hUk].yan]Agk],
hUc];luk]:"
 Sc]wL:AL,yuSn],eT,l}: 34 wUc]:lUc];tG]:n}suic] hG]:pn]yL dexamethasone (tgn]: 19.2)"
liUt]:Am],tUk];lL;lL; tI:eA,Sut];p},tQm] 24 sUw]:mUc];n}suic] yL,pn]kUn];pQn] lUc];hUc];yLlL;lL;"
2. Sc]wL:lUit]:tUk];haw].hqc]; Am],nn] hUc];luk]:kqn],w}. Am],nn] Am],l}:cin];SQc]tgt],hUw]sG]luk]:Agn],

n}suic] -
 hG]:SCac];pn] IV eS SUc],kUn];pQn]kGL,hUc];yLlUc]km];lQw]"
3. Sc]wL:pak]hUc];luk]: puit],mL;lIlIeS sm]etkUit],n}suic]-

 hG]:kUn];pQn]kUit],luk]:tI:hgc]:yL"
19.3 lUit]:Tgk], wa};kUit],luk]:

(lUit]:Tgk],mUiw]:yU,f}; = lUit]:tUk];nm]lUiw] 500 mI,lI,mI,tL,)"
lUit]:Tgk], mUiw]:yU,f};n}. pQn]lgc]:niuc]:An]hQt];hG]:Em:luk]:Agn],t}akn]km]:nm] nC];km],fL,n}.yw]:"
lgc]:tac];An]hQt];hG]:pQn]km]:nm] –
1. hUc];luk]:AUn]:Am],mI;hqc];hup],(UterineAtony) _ pQn]ygn].kgp]:yam]:kUit],luk]:PLEPEl: nac];yic];

siUw];An]yam]:kUit],luk]: 5 ekL.Kuin]:nUiw]' yam]:l}:Sm];yL Oxytocin w}.Kaw];huic] Am],nn] mI;Pac]hac]:
hUc];luk]:tqk],"
2. hUk].kuit];w}.nG];hUc];luk]: (Retained Placenta) - hUk].kuit];w}.Km]w}.nG];hUc];luk]: Ait];Agt];"
3. KUic]:Ac],kGL,Sik], Am],nn] lUit]:kgn]:lUit]:kam]: (laceration or Haematoma) - km]:nm]

ygn].pUiw]:hg};Sik],nn].eS SQn]:lUit]:tI:KUic]:Ac],kL,El: hUw]hUc];luk]:tqk],eS lUit]:tUk];"
Tuk],lIkUt],sqt]:tUv];lIlItL,eS,wL: hUk].luk]:tUk];lUc];mL;mUt];yw].hiuw]/p},mUt];"
257
cw];la};An]etsac]:mk];mn]:l}:wL:lUit];Tgk],mUiw]:yU,f};-
 nG];Kaw];tac]; 5 minit].nn]. PL:AnL;m}; Am],nn] Pqn],hgc]; ym];kGL,tc];mUt];"
 lUit]:suim];lUc];Am],kuit];Am],Tat],"
 lUit]:tUk];nm]lUiw] 250cc El: Siup],lUc];haw].haw].hqc];hqc];yU,tik];tik];"
 kUn];pQn]kUit],luk]:tac],tI:eS hgt]:mL;tI:hgc]:yLn}eStL. lUit]:Am],kuit];yut];"
lgc]:yUt];yL
lUit]:Tgk],mUiw]:yU,f};n}. pQn]An]lm],lgc]:Kiuk].Kk].' yL,pG].tUv]; El: hG]:yUt];yLpn]km];lQw]"
lgc]:Tuk],lIhQt];Sac]:km]:nm]Et.
 ygn];tac];sg}:Tqm]kUn];him];hgm];' Aw]tin]kUn];pQn] yuk].Kuin]:hG]:Suc]lUiw]hUw]eS pn] Oxygen "
 nc],huiw]hUc];luk]: etmI;hqc];hup],nn]. Aw]muiw];lup]:pn]tI:tgc]. (tI:hUc];luk]:) hG]:pQn]hUv],kqn],
mL;yw]. pn]yL Syntocinon 10 IU IM"
 SG],KQm]ekL, cannulas m}a 16-18 eSpn]Tat]:nm].nm]nm]" (lgc]:pQn]SWYk]. tUv];tI:tgn]: 7.6)"
 SG],lgt],yQw]:w}.eS etl}:pG].Tt];tUv];wL: Tat]:nm].An]pn]yU,El: yQw]:An]Agk],mL;
sgc],mn]; PQc],pQc];kn]yU,hiuw]n}yw]."
 mat]:m}aw}. miUw]:tqk]:hqc];lUit]:kU:pgk]:' kUt],Tt];hqc];tgt],lUit]:El: hqc];hup],hUc];luk]:pn] 5
minit].nuic]:pgk]:"
 tL,kUt],tUv];Pac]hac]:hqc];lUit]:eA,El: tac];nqn]:nLmQt].lUit]:lqc]nn]. tk];etl}:Aw]liUt]:
mL;kUt], tUv];" Sc]wUn].Sgn],wL:Tuk],lIl}:SCac];lUit]:n}suic] etl}:kUt],kum],lUit]:w}.sgm];"
Sc]wL:hUk].p},tUk];n}siuc]
 Sc]wL:mUn].luk]:kqn],yU,n}suic] sn]Sa}eh,nn].lg};lg};eS
Aw]hUk].Agk],mL;sgm];nc],lgk];la};An]Tuk],mqn]:"
 Sc]wL:hQt];Am],l}:El: liUt]:yc];lUc];yU,n}siuc] Aw]miuw];sUk];Kw]:kCL,yw]. Aw]miuw];Pak]:hUk].eS
yip];Aw] hUk].Agk],mL;"
 Sc]wL: hQt];sgm];nc],pL:niUw]yw]. yc];p},yw].tUw] Am],nn] hQt];Sc]Am],l}:n}siuc] hG]:SUc],kUn];
pQn]kGL,hUc];yL"
 hG]:pn]yLptI,KYI<wn tLhqc];yLeh.kc]: (yLkin] Amoxicillin El: Metronidazole)"
hUk].lUc];eSEl: lUc];mUt];yw].n}siuc]
 hG]:nUt]:pn]tI:hUc];luk]: hQt];hG]:lUit]:kgn]: An]Km]w}.yU,nG];hUc];luk]:lUc];/Agk],mL;" Siup],nUt]:pn]
etL,Tuic]hUc];luk]:epL;pQn]hUv],kqn],Kuin]:mL;" hUc];luk]: pQn]hUv],Kuin]:mL;yw].n}eStL. sgc],mn];AUn]:
kGL,Kuin];hiuw]nn
} n]. Tuk],lIkUt],Tt];tUv];Kuin];"
 Sc]wL:hUc];luk]:Am],kqn],Kuin]:mL;eS AUn]:yU,sUic].nn]suic] hG]:pn]yL Methergyne 0.25 mg IV
(pn]TiUc];TiUc];) Sc]wL:kUn];pQn]mI;tac];pQn]lUit]:Suc]suic] hG]:pn] Synto sgm];"
258
 Suip],pn]nm].kUiw] NSS 500cc hUm]:tc]; Synto 20 IU 15 tgm],/ minit].kGL,tik];tik];"
 wUn].Sgn], tL,etpn]yL Misoprostol tI:hU;Pa}:lUc]"
hUk].lUc];eStL.Am],lUc];SQc]:
 Aw]muiw];sUk];Kw]:nG];hUc];luk]:eS sg}:Aw]Agk],pqt]: lUit]:kgn]:An]yU,w}.tac];nG];"
 epL;wL:lgk];la};n}. Am],yw].tUw]:n}siuc] tL,Kut],pn]hUc];luk]:nn]. hG]:SUc],kUn];pQn]kGL,hUc];yL"
 pn]yLptI,KYI<wn tLhqc];yLeh.kc]: (yLkin] Amoxicillin El: Metronidazole )"
SQn]:tac];kUit],luk]:Sik], (Lacerations)
tUv];tI:An]lUit]:lUc];mL;nn].eS hLtI:Sik],mn];" (him];KUic]:Ac],kL,' KiUc]:Ac],kL,' pak],hUc];luk]:)
 Aw]kim];cip]: tL,hQt];hG]:lUit]:kuit];eS Kuin];Em;yQp].pn]tI:Sik]," wa};eSyQp].yw].kUt],tUv];Kuin];wL:
sgc],mI;lUit]:suim];lUc];mL;Tqc]:yU,hiuw]" Sc]wL:KUic]:Ac],kL, Sik],Tuic]hU;Pa}:lUc]n}suic] tL,etyQp].pn]
nn]. Tuk],lIpQn]emLyLkUv]; Am],nn] SUc],kUn];pQn]kGL,tI:hUc];yL"
Sc]wL:lUit]: tUk];haw].hqc];yU,n}suic]-
 Tuk],lIwUn].tL,etSCac];lUit]:pn] tqn];tI:An]An]kuic].kac].l}:Sum];kGL,"
 SC],pn]KQm]ekL, Cannula m}a 16-18 eSpn] IV NSS/ Ringer El:hUm};tc]; Haemacel "
 Suip],pn] NSS 500cc elL; Synto 20IU eSpn] 15 tgm],/1 minit].Siup],kGL,tik];tik];"
 hG]:SCac];pn]lUit]:sgm];" kgp]:l}:SCac];lUit]:yU,n}El: tL,SUc],kUn];pQn]kGL,hUc];yLnn]. Am],Tuk],lIhG]:
TiUc];lL;lL;"
 tL,lUit]:kuic].kac].lUc];haw].hqc];nn]. hG]:Aw]muiw];sg}:tQk];w}.tI:hUc];luk]: Am],nn] tQk];w}.SQn]:lUit]:
yG], Aortic"
 SUc],kUn];pQn]kGL,hUc];yL"
tL,tgc];
 lUit]:tUk]; mUiw]:kUit],luk]:eA,liUw] 500cc n}. pQn]lgc]:Sm],mtL,yU,yw]."
 lUit]:lUc];Ait];Agt]; nG];Kaw];tac];kUit],luk]:yw].Am],p},l}awn];n}. pQn]lgc]:Sm],mtL,yU,yw]." et
mUin]nc],lUit]:hUw]lUin]eS nG];Kaw];tac];nuic]:wUc]: etlUc];eA,kCL,tik];tik];eSha}kGL,"
19.4 Sn],eT,p},TUn]:lUin]eS kUit],

= AL,yu Sn],eT,p},Tuic] 37 wUc]:eShUc];luk]:mI;hqc];mip],mL;
kU:lgc]:lgc]:
 lgc]:yUt];yLEt. Aic]nUiw]cw];la};AL,yuSn],eT,El: mUiw]:kUit],nn].yw]."
 kUt],Tt];tUv];tL,eS,wL: sgc],mI;tac];pQn] mUin]nc], naw]nUk].' sUiw].mqc];Kw]:lgt],yQw]:' tac];pQn]
pgt],'tac];pQn]naw]S}:kG]:kgp]:wL:tac];pQn]sUiw];n}.sac]:hQt];hG]:Sn],eT,p},TUn]:lUin]eSkUit],nn].yw]."
259
lgc]:yUt];yL
 Sc]wL:pQn]tac];pQn]nc],An]lat]:mL;n}suic] yUt];yLpn] sgm];nc],l}a;yUt];yLtac];pQn]nn].kCL,"
tL,lUm];naw]Kuin]:nn]. pn]yL Paracetamol "
(k) AL,yuSn],eT,l}: 28 wUc]:lUc];tG]:-

Sc]luk]:Agn], mUiw]:AL,yuSn],eT,l}: 28 wUc]:lUc];tG]:suic] ygn].Sn],eT,num],nL,pUn].El: tL,etmI;
sG] (AL,yu) n}.KG]:yap],Puit],w}."
 nc],huiw]hqc];mip],hUc];luk]:etlUt];ygm];nn].hG]:pn]yL Nefedipine Am],nn]Salbutamol (tUv];pL:tC]:)"
(K)AL,yu Sn],eT, l}: 28-34 wUc]:' pak],hUc];luk]:piUt], 4 cm yw]. kUv];kL:nm].Aap],p},tqk],-

Kt];sG]ham]: hqc];mip],hUc];luk]: Am],p},hG]:kUit],luk]:Agn],"
 hG]:ngn];liUw]:tI:kU;ngn];"
 pn]yL Nefidipine 20mg STAT' Sc]wL:pn]yLyw]. 1 sUw]:mUc];eS hqc];mip],hUc];luk]: yc];tuik].mI;
yU,suic] (nC];Kaw];tac]; 10 minit].nn]. nm]liUw] 2 pgk]:' 1pgk]:huic] 20 Sqk].kan].n}) hG]:pn]
Nefidipine 20mg TID tL, 72 sUw]:mUc]; etL,Tuic]hqc];mip].hUc];luk]:epL;kuit];)"
 Sc]wL:kUn];pQn]mI;hqc];lUit]:tqm], (Am],nn]) tac];pQn]hUw]sG]n}suic] yL,pn]yL Nefidipine"
Sc]wL:Am],mI; yL Nefidipine hG]:pn]yL Indomethacin Am],nn] yL Terbutalin (Tuk],lItUic],
pac],tc];emLyL)"
 nc],huiw]pgt],luk]:Agn],etmI;hqc];nn]. hG]:pn]yL Dexamedasone 24 mg tL, 24 sUw]:mUc]; (8mg
IM TID tL, 1 wn];) Am],nn] Betamethasone 12mg IM OD tL, 2 wn];" huic] 48
sUw]:mUc];yw]. Pgn];yLsc],kg}:Agk]," Sc]wL:hqc];mip],hUc];luk]: pQn]Kuin]:mL;pak],hUc];luk]: piUt],mL;tik];
tik];yU,n}suic]hG]:kuit]; pn]yL Dexamedasone El:hac]:hqn];tL,kUit],luk]:pn]"
(c)AL,yuSn],eT,l}: 34 wUc]:Kuin]:nUiw] Am],nn] pak],hUc];luk]:piUt],kCac]:liUw] 4 cm' TUc]nm].Aap],

ekL:tqk],yw]."
Am],tap]:ham]:hqc];mip],hUc];luk]:"
- hac]:hqn];tL,kUit],luk]:Agn],pn]"
 Sc]wL:p},Tuic]lUin]kUit],eS nm].Aap],tqk], (AL,yuSn],eT,p},Tuic] 37 wUc]:eS nm].Aap],tqk],)
kUv];kL: hUc];luk]:Am],mI;hqc];mip],' Pac]hac]:sUiw].mqc];Kw]:ekL:Am],mI;n}suic] –
 nc]huiw]sUiw].mqc]; etAm],Kw]:Tuic]Em:El:luk]:Agn],l}:nn]. pn]kin]yL Erythromycin
500mg QID tL, 7 wn];"
 nC];Kaw];tac];etkiUt],luk]:nn].ekL: hG]:pn]yL ampicillin 2 gram IV QID etL,Tiuc]
epL;kiUt],luk]:"
 Sc]wL:mI;Pac]hac]:sUiw].mqc];Kw]:n}suic] hG]:pn]yL Amoxicillin, Gentermycin El:
Metronidazol"
260
 AL,yuSn],eT,nm]lUiw] 34 wUc]:yw]. nm].Aap],tqk],suic] pn]yL Dexamedasone sgm];"
pn]yL hG]:hUc];luk]:mI;hqc];mip], tL,AL,yuSn],eT,An]l}: 37wUc]: tL,km].sg}: kUit],pn]"
 tL,lum];lL;luk]:Agn],An]kUit],mG],nn]. hG]:tUv];tI: kn] 24"
19.5 liUt]:Suc]mwUi ]:pL;tgc].El:Agk],sgk];miUw]:pL;tgc].

(Pre-Eclampsia and Eclampsia)
liUt]:Suc]miUw]:pL;tgc].n}. km]:nm]ethU.l}:mUiw]: Sn],eT,l}: 20 wUc]:Kuin]:nUiw]nn].yw]." cw];la};tac];
pQn]An]n}.n}. sac]:pQn]l}:etL,Tuic]kUit],luk]:eS mac]pgk]:mac]lG]ekL: sac]:pQn]Kiun]:mL;wa};kUit], luk]:nn].
yw]." liUt]:Suc]miUw]:pL;tgc].n}. pQn]eP;An]ha}.hqc];Tuic]t}al}: tgn]:tL,Em:El:luk]:n}yw]." liUt]:Suc]
miUw]:pL;tgc].n}. etlqk]:la}:pQn]Agk],sgk];miUw]:pL;tgc].mUiw]:lG]n}nn]. lam];Kat]:yap],w}.El: Tuk],lIPac].
Et.Et.yw]."
mUiw]:pL;tgc].yU,nn]. hqc];lUit]:Kuin]:-hqc];lUit]:tac];nUiw] 140mmHg El:lUit]:tac];tG]: 90 mmHg

Am],nn]
mUiw]:mL;Enhgc]:yLpgk]:Agn]tac]; = lUit]:tac];tG]:Kuin]:mL;Tqc]: 15 mmHg (mUiw]:pL;tgc].yam];lQw])"
eKL:piut],tI:pgc],
(1) liUt]:Suc]miUw]:pL;tgc].(Tan]:nuic]:)  hqc];lUit]:Suc]lUiw]140/90mmHg El:
 mI;Tat]: Protein nG];yQw]:
 kG]: (tin]' miuw];' nL:) nm].nk];kuic].kac].Kuin]:mL;'
pqk].Sm].wL:mI;lgc]:kC]:n}eStL. tL,mk];mn]:tac];
pQn]pL;tgc].mI;kgc]. Tan]:Am],ha}.hqc];nn]. Am],kG]:
ekL:mk];mn]:l}:"
Kaw];tac];An]sac]:pQn] - Sn],eT,l}: 20 wUc]: etL,Tuic]wa};eSkUit],yw]. 6 wUc]:"
(2) liUt]:Suc]miUw]:pL;tgc]. (Tan]:ha}.hqc];) 

hqc];lUit]:Suc]lUiw] 160/110 mmHg El:

mI;Tat]: 3+ Protein nG];yQw]:

kG]:h}a.hqc];"
Kaw];tac];An]sac]:pQn] - Sn],eT,l}: 20 wUc]: etL,Tuic]wa};eSkUit],yw]. 6 wUc:] "
hUw]K}:' tgc].pgt];nUiw]sQp];' Sa}tLtUv];Am],hn]sqc]:sUiw];n}. pQn]Pac]hac]:ha}.hqc];tac];pQn]liUt]:Suc]miUw]:pL;
tgc].El: cw];la};tac];pQn]An]n}. sac]:lqk]:la}:pQn] Agk],sWk];miUw]:pL;tgc].l}:kU:Kaw];yam];n}yw]."
lgc]:SQn]:Sa}AL,yUc],tum].tgp],lUt];ygm];n}. pQn]Pac]hac]: An]eth}a.hqc];mL;nn].yw]."
(3) Agk],sgk];miUw]:pL;tgc].  Pac]hac]:liUt]:Suc]miUw]:pL;tgc]. + can]; Am],nn]

luim];tUw]"
261
(4) tac];pQn] HELLP  K},lUit]:lqc]tqk],"
 Enzimes tI:tp]; etnm]Kuin]:mL;"
 K},lUit]:etEA,ygm];lUc];kGL,"
cw];la};An]sac]:pQn]mL;tac];pQn]km]:nm]
 luk]:hUw]Saw] (luk]:cw]:)"  pL;tgc].miUw]:pUn].mL;nn]. yam]:Agk],sgk]; Tan]:
 nac];yic];AL,yu 35 Kuin]:nUiw]" Am],h}a.hqc];mL;"
 luk]:PLEP"  Sn],eT,mak],Ait],"
 yam]:pQn]tac];pQn]lUit]:Suc]'  nm].Aap],luk]:Agn],nm]"
Sc]wL:kUn];pQn]Agk],sgk];mUiw];pL;tgc].Tan]:Am],ha}.hqc];eSmL;tI:hgc]:kUn];pQn]ngk]:(OPD)n}suic-]
 tgc]:Tam]puin];tUw]kUn];pQn] mUiw]:pL;tgc].pgk]:Agn]tac];nn].wL: sgc],yam]:pQn]tac];pQn]lUit]:Suc]"
 kUt],tUv];pp].Sa}ma}Em:pL;tgc]. tL,tUv];lgc]:liUt]:Suc]"
 Tam]tUv]; lgc]:Pac]hac]:kG]:sgm];nL:' tin]' muiw];' hUw]K}:' tgc].pgt];nUiw]sQp];El: tLAm],hn]sqc]:lI
sUiw];n}."
 tgc]:Tam]wL:luk]:Agn], sgc],tUc].' sgc],lUit]:lUc];' sgc],tgc].sQp];kgp]:hUc];luk]:mip],"
 kUt],Tt];tUv];tI:hUw]Kw], lWc]:AL,yUc],tum].tgp],sgc],mI;/Am],mI;"
lgc]:yUt];yL
miUw]:p},pQn] - pL;tgc].mI;kgc].
Sc]wL:Sn],eT,l}:(37)wUc]:lUc];tG]:suic]-
 hp].kUn];pQn]w}.tI: hgc]:kUn];pQn]nG];eS tqk]:pn]hqc];lUit]:sgm];nc],Kaw];yam];mn];"
 pn]yL Methyldopa (aldomet) 250mg PO BID-TID eS Kuin:] pn]hqc];yLkGL, km];Ait];
Ait]; etL,Tuic] 750 mg PO TID (niuc]:pgk]: etAm],l}:pn]pUn].lUiw] 3 mg)"
 tL,tgc];" "Pgn];yLetAgk],nG];Kaw];tac]; 2-3 wn];"
 Sc]wL:pn]yLtQm] 7 wn];yw].El:hqc];lUit]:yc];p},lUc];n}suic] hG]:pn]yL Nefidapine 20mg BID
eS Kuin]:hqc];yLkGL,km];Ait];Ait];" niuc]:wn]; nm]Sut]; 60 mg' Am],nn] pn]yL
Propranolo 40mg BID eS Kuin]:hqc];yLkGL,km];lg};lg};' nuic]:wn]; pn]l}:nm]Sut]; Tiuc] 360
mg"
 etAm],l}:pn]yLyQw]:"
 Sc]wL:hqc];lUit]:pQn]pk],ktI,mL;Kuin];yw].n}suic] pn]lUc];hUc];yLl}:" etl}:hG]:mL;hUc];yL tL,kUt],
tUv];hqc];lUit]: nuic]:wUc]:Sgc]pgk]:' tL,kUt],yQw]:nuic]:wUc]:nuic]:pgk]:" Sp];lqc];EnkUn];pQn]wL: hUw]K}:'
tLAm],hn]sqc]:El: tgc].pgt];nUiw]sQp];n}. pQn]Pac]hac]: liUt]:Suc]miUw]:pL;tgc].n}yw]."
262
Sc]wL:AL,yuSn]eT,l}: 37 wUc]:Kuin]:nUiw]n}suic] - pn]yL Methyldopa El: SCac];pn]yL hG]:hUc];
luk]:mI;hqc];mip],eS hac]:hqn];tL,kUit],luk]:pn]]"
Sc]wL:AL,yuSn],eT,l}: 34 wUc]:lUc];tG]:n}suic] – h]G:pn]yL Dexamethasone (tUv];tI: 19.4)El:
Methyldopa eSwUn].tL,SUc],kUn];pQn]kGL,hUc];yL"
Siup],pn]yLetL,Tuic]w}a;kUit],luk]:eS lUt];ygm];hqc];yLkGL,lg};lg};etL,hqc];lUit]:epL;pQn]pk],ktI,mL;"
Agk],sgk];miUw]:pL;tgc].Tan]:ha}.hqc];
kgp]:n}la};yUt];yLAn]w};El: lIeSpiUn]:Et. s}g:kUit],pn]luk]:nn].yw]."
 SG], NSS Am],nn] Ringer tL,pn]Tat]:nm].kUn];pQn] (2-3 Lt/24 sUw]:mUc];)"
 Sc]wL:pQn]l}: hG]:pn]yL Magnesium Sulphate (Mgso4)"
 Sc]wL:hqc];lUit]:mI;nm]lUiw] 180/110 n}suic] hG]:pn]yL Hydralazine IV 5mg"
 An]Tuk],lIw}.StiEt. kgp]:wL:yLn}. sac]:hQt];hG]:hqc];lUit]:tUk];w};eS kUn];pQn]sac]:luim];tUw]
l}:El: etl}:pn] 2.5 mg IV Agn]tac];kgn],"
 SUc],kUn];pQn]kCL,kUit],luk]:tI:hUc];yLw};w};"
 Sc]wL: lgc]:SUc],kUn];pQn]kGL,hUc];yL yap],Puit],n}suic] hac]:hqn];tL,kiUt],luk]:pn]"
 mUiw]:pn]yL Mgso4 yU,nn]. etl}:kUt],tUv];yQw]: An]Agk],mL;nn]. tI:EA,Sut];
nuic]:sUw]:mUc]; etl}:mI; 30 cc n}yw]."
yL Magnesium Sulphate (Mgso4)2cc of 50% Mgso4 = 1gm Mgso4

can];Kiun]: hqc];yLAn]Et,pn] 4mg(8cc)50% Mgso4 nn]. 72cc IV fluid = 8 cc
El: elL;pn]eS etl}:SG],pn]nG];Kaw];tac]; 20
hqc];yLtI:etl}:Suip],pn]etL, minit]." 20 cc /5 minit]."
5gram(10cc) El: 500cc D5w=100cc
elL;kn]yw].eS etl}:SG],pn] nG];Kaw];tac];
nuic]:sUw]:mUc];" (1 mg MgSO4/hr)
tL,eh.kc]:can];Kiun]: 4gram(8cc)IMhUm]:tc];mUt]; =8gram
Sc]wL:pn]yL Magnesium Sulphate nm]pUn].kCL,n}siuc] kUn];pQn]sac]:kiut];TUv]:sC]kCL,pqt]:"
Sc]pQn]siUc].n}mL; hac]:hQn];sgm];nc],
 kuit];pn]yL Magnesium Sulphate El:pn]yL 10% Calcium gluconate 10 cc IV
nG];Kaw];tac]; 3 minit]."
 SG],TUc]lUm];TUv]:sG]pn]tI:SUp];kUn];pQn] tL,km].sg}:hG]:kUn];pQn]l}:TUv]:sG]ca}:Kuin]:mL;"
263
yL Hydralazine 1cc= 5mg

 Sc]wL:hqc];lUit]:tac];nUiw]nm]lUiw] 200 mmHg El: hqc];lUit]:tac];tG]:nm]lUiw] 120 mmHg –
hG]:Et,pn] 5mg IV ( 1cc) lg};lg}; (nG];Kaw];tac];nm]liUw] 5 minit].)"
 Sc]wL:hqc];lUit]:tac];nUiw] nm]lUiw] 200 mmHg El: hqc];lUit]:tac];tG]:nm]lUiw] 120 mmHg -
25mg Hydralazine El: 500cc Ringer Am],nn] NSS nn]. elL;kn]eSpn] 20tgm], / 1
minit]."
kan]Em;hqc];ygt],lUc];nm].yLn}. tL,hG]:hqc];lUit]:tac];tG]:mI;eA,liUw] 100mmHg" kgp]:n}miUw]:Em;pn]
yU,nn]. 5 minit].nuic]:pgk]: etl}:kUt],tUv];hqc];lUit]:kUn];pQn]" Sc]wL:hqc];lUit]:kUn];pQn] ygm];lUc];yU,
n}suic]Suip],pn]kGL,mUin]kw]," kUt]tUv];hqc];lUit]: 30 minit].nuic]:pgk]:" Sc]wL: hqc];lUit]: tac];tG]:ygm];
lUc];Tuic] 90mmHg yw].n}suic] kuit];pn]yL Hydralazine l}:" SG], IV l}al}aeS 30 minit].nuic]:pgk]:
hG]:kUt],tUv];hqc];lUit]:" Sc]wL:lUit]:tac];tG]:Kiun]:mL;Kiun]; 100mmHg n}suic] hG]:pn]yLtQk];lUit]:Kuin];"
 Sc]wL:Am],mI;yL Hydralazine El:hqc];lUit]:Sm].mI; 180/100 mmHg Kuin]:nUiw]n}suic] hG]:pn]yL
Nefidapine tqn];" Sc]hqc];lUit]:tuik].Suc]liUw] 180/100mmHg yU,n} hG]:Et,pn]hqc];yL
nc],kw],Kiun];"
Agk],sgk];mUiw]:pL;tgc]. (Eclampsia)
 lgc]:yUt];yLkUn];pQn]Agk],sgk];miUw]:pL;tgc].Et. Agn]tac];Sut]; etl}:hQt];hG]:Pac]hac]:kUn];pQn]
nim]eSkgn], sc],kg}:hac]:hqn];tL,etkUit],luk]:"
 etl}:yUt];yL mUin]nc],l}a;yUt];yLliUt]:Suc]miUw]:pL;tgc].Tan]:ha}.hqc]; mUiw]:etSUc], kUn];pQn]
kCL,hUc];yL' hG]:pn]yL Magnesium Sulphate sgm];"
 miUw]:lC]cw];l}a;kUn];pQn]nim]yw].n}ekL: hG]:SUc],kUn];pQn]kCL,km];Siuw]:"
 nc],huiw]kUn];pQn]etlgt]:eP;nn]. Aw]kUn;] pQn]ngn];SI:kqc];Pa},Sa}.w}."
 tUv];yL,hG]:KI:tUiw],' KI:Kak],El: hak]:sUiw];nn].mL;Auit];w}. tI:SQn]:tac];lgt],lUm];TUv]:sC]"
 Sc]wL:kUn];pQn] tuik].pQn]can];yU,tik];tik];eS yL Magnesium Sulphate Sm].Am],mI;n}suic]
hG]:pn]yL Diazepam tqn]; (tL,tgc];" " yLAn]n}.mn];sac]:kGL,tum].tUiw]. tac];lUm];TUv]:sG]luk]:
Agn],nC];tgc].El: miUw]:luk]:Agn],kUit],Agk],mL;nn]. hG]:hac]:hQn]; tL,sg}:Tqm]ASak]:luk]: Agn],)"
 SG],pn]lgt],yQw]:eS etl}:pG].tUv];wL:yLAn]SG],pn]kCL,El: yQw]:An]Agk],mL;nn]. sgc],mn];
PQc],kn]hiuw] n}yw]."
 Sc]wL:Am],sac]:SUc],kUn];pQn]n}suic] pn]yLAn]hG]:hUc];luk]:mI;hqc];mip],eS hG]:sg}:kUit],luk]:Agn],pn]"
Diazepam 1cc = 10mg

Sc]pQn]can];n}suic] 10mg IV SG],pn]lg};lg};" Siup],pn]Tqc]: 40 mg elL; D5w 500cc eSSCac];pn]
nG];Kaw];tac];huic]liUw] 24 sUw]:mUc];"
Sc]wL:kUn];pQn]tuik].epL,can];yU,n}suic] hG]:pn]Tqc]: 5 mg IV SG],pn]lg};lg};"
yL Diazepam n}.sac]:tum].tUiw].lgc]:TUv]:sG]luk]:Agn],El: Agn]tac];Sut];Et. Tuk],lIlUik]:sG].yL
Magnesium Sulphate "
264
tL,tgc];
 kUn];pQn]tac];pQn]n}. 25% k}.pQn]pL;wa};eSkUit],luk]:" lgc]:yUt];yLEt. etmUin]kn]kUv];"
 Siup],yUt];yL tL,tac];pQn] mUiw]:nL:p},pQn-] pL;tgc].mI;kgc].Tan]:ha}.hqc];El: pL;tgc].mI;kgc].
kCL,Tqc]: 48 sUw]:mUc]; wa};eSkUit],yw]."
 yL Methyldopa, Nefidapine El: Propranolol n}.Am],Tuk],lIkuit];pQt]:km];lQw]" et
l}:kUt],Tt];tUv];Kuin];kUn];pQn]kU:wUc]:eS lUt];ygm];yLn}.kGL,km];lg};lg};"
mUiw]:nL:p},pQn-] pL;tgc].mI;kgc].Tan]:h}a.hqc];El: pL;tgc].mI;kgc]. = etl}:sg}:kUit],pn]luk]:Agn],km];lQw]
19.6 Sn],eT,mak],Ait], (TUc]nm].tI:Sn],eT,lU.)

eKL:piut],tI:pWc],
Sn],eT,mak],Ait],n}. pQn]lUv]:Sn],eT,El: hUk].yG],Kuin]:Am],pk],ktI,nn].yw]." lqk]:l}apQn]Kqn],
SUiw]<n}ekL: Am],lL:lI:mI;nc],kw]," Sn],eT,mak],Ait],n}. etAm],hn]tUw]Sn],eT, (luk]:Agn],) mI;
nG];hUc];luk]:" Pac]hac]:Sn],eT,mak],Ait],n}.ethn]l}: mUiw]:AL,yuSn],eT,l}: 10-16 wUc]: nn].yw]."
Pac]hac]:tac];pQn]
 mUiw]:et,sp];Sn],eT,nn]. et,eAL.hak]:haw].hqc];lUiw]kUn];pL;tgc].Sm],mtL,El: hUiw].hUiw].AUn]:
AUn]:"
 lUit]:El: hUv],mak],Ait],tUk];lUc]; (miUn]luk]:mak],m}. mak],Ait],)"
 tac];Suc]hUc];luk]: etyG],liUw]AL,yuSn],eT," (AL,yuSn],eT,l}:mgk]: 3 lUin] kUv];kL: tac];Suc]
hUc];luk]:yG], nc],l}:mgk]: 7 lUin]sUiw];n}.yw].)"
 Am],l}:cin];SQc]tgt],hUw]sG]luk]:Agn],"
 kUv];kL:epL;kUt],tUv];yQw]:Sm]. mI;Pac]hac]:sp];Sn],eT,yU,"
 mI;Pac]hac]:tac];pQn]eKL;nQc] (kn] 10.2)' hUw]sG]tgt],w};' hUiw].AUn]:' sG]tUc].tuin],ca}:'
Am],emLyU,nim]nim]' nL:hUtLeh' Am],Kam],lqt],l}:' hLlgc]:tac];Am],hn]Sc] yU,yU,eSygm]lUc];kGL,'
muiw];Sn],tin];tin];"
lgc]:yUt];yL
 SUc],kUn];pQn]kGL,epL.AU<TrL.Sw];El: Kut],hUc];luk]:tI:hUc];yL" (Sc]wL:etKut],hUc];luk]:Et.ygn].
hUc];luk]:sac]:pgc],eS etSum];lUit]:nm]El: Tuk],lIhac]:hqn]; tL,SCac];lUit]:pn] hG]:Kqm.] lqp]:
(epL;Am],mI; lUit]: Am],nn] hLlUit]:Am],l}:n}suic] yL,epnqt]:Kut],hUc];luk]:)"
 Sc]wL: Pac]hac]:kUn];pQn]haw].hqc];w}.n}suic] hG]:SGac];pn] Ringer/NSS "
 kUn];pQn] sac]:pQn]hqc];liUt]:eA,haw].hqc];El: tk];etl}:SCac];lUit]:pn]"
265
Pgn];sL.P}a,lc]
 sUiw].mqc];Kw]:' Sc]wL:Kut],hUc];luk]: hUc];luk]:sac]:pgc],"
 hUv],mak],Ait], etEP:tiun];sgt],kGL,tc];tUw]mUin]kqn],SUiw],"
hgc].TUp];kUn];pQn]
hgc].kUn];pQn]mL; 1 lUin] 1 pgk]: mL;EnKuin];tI:hgc]:yLkU:lUin] tL,Kaw];tac]; 1 pI<" kUt],Tt];yQw]:
tUv];lgc]:sp];Sn],eT, (Sc]pQn]l}:kUt],Tt];B-HCG) 2 liUn]niuc]:pgk]:" Tuk],lIhG]:kin]yLeh.ham]:
Sn],eT,El:lat]:EnwL:Am],Tuk],lIp}g,hG]:sp];Sn],eT, tI:EA,Sut];nuic]:pI< (tUv];tI: kn] 20.2)"
Sc]wL:kUn];pQn]KG]:l}:luk]:Tqc]:n}suic] ygn].wL:sac]:pL;tgc].Sn],eT,mak],Ait],Tqc]:El:
Tuk],lIAw]sG]SG],eS lum];lL;pG].tUv];lIlI"
266
hUw]eKL:tac],siUw];
20
20.1 tac];pQn]lUm];mL:mU
eKL:piut],tI:pgc], cw];l}a;ygn].pUiw]:Tat];f};fL.nC];Agk];eALhQt];kan]nm]Kiun]:mL;El: hQt];hG]:lgc]:
hU.tUw]' la};yU,Sac]:El: lgc]:tUc].niuc]tUw] kuic].kac].l}:lqk]:la}:kCL,n}. hgc].wL:pQn]tac]; pQn]mL:mUn}yw]."
lgc]:mk];mn]:tac];pQn]n}. Sc]wL:pQn]lUm];mL:mUnm]lUiw]eS (2) pgk]:n} mk];mn]:wL: pQn]tac];pQn]mL:mU
n}yw]." tac];pQn]mL:mU etmI;la}sUiw].la}Sqn];"
Sc]wL: epL,lUm];mL:mUhuic]lUiw]eS(5) minit].n}sbic] Sgn],l}:wL:pQn]mL:mUha}.hqc];
El:
etl}:yUt];yLpn]Kn]Kn]w};w};" (tUv];tI:lgc]:pQn]can]; tgn]:-7.2)
tac];pQn]mL:mUkm]:nm] An]pQn]kn]n}.
pQn]can];AQn]sk].tc];tUw] (etKQc]:kCL,tc];tUw]eS pQn]can];)
 Sc]wL:pQn]tac];pQn]sUiw].n}n}. kUn];pQn]etkuic].kac].luim];tUw]kGL,' hUm]:tc]; tUw]Sgm],/Am],Sgm], El:
tin]muiw];siUw];n}. etsk].Kiun]:sk].lUc];ha}.hqc];" (mac]pgk]: kUn];pQn]etyQw]:ln]Agk],mL; Am],nn]
etKUp];lin].sw]:kw],) miUw]:lUm];mL:mUyQn]lUc];kCL,nn]. kUn];pQn]etK}:ngn];hqc];"
 tgn]:tL:luk]:Agn],lQk].nn]. pqk].Sm].wL: Am],hn]Pac]hac]:sqc]:lqc];eStL. mak],tLetPqp].yup];
Pqp].yup];' km]tLmuiw];El: nip],SuUp];w}."
 mUiw]:pQn]can];nn]. Sc]wL:kUn];pQn]hU.tUw]n} pgc],wL:Am],l}:pQn]lUm];mL:mU" kUv];kL: pQn]Pac]hac]:
pQn]can];tac],siUw];"
miUw]:pan]pQn]luk]:Agn], luim];tUw]sUw]:kqp]: (Childhood absences attacks)
luk]:Agn],tuik].lat]:kGam]; Am],nn] tuik].lQn]:yU,eS kuic].kac].Am],tUc].nuic]kGL,mgk]:(1)minit].eS
Kuin];tUc]. nuic]lQn]:Kuin];" Kw]etAm],hU.tUw]wL: Kw]luim];tUw]kGL,"
Sc]wL:kUn];pQn] mI;Pac]hac]:mUin]nc], tin]' muiw]; sk].haw].hqc]; Am],nn] etAm],
mI;hqc];eSAUn]:kCL,tc];tUw] Am],nn] KQc]:kCL,n}sbic] hG]:wUn].wL:sac]:pQn]lUm];mL:mUl}:"
AUp],AUw];tiUc],pac],kn]tc];emLyL"
 lgc]:mk];mn]:tac];pQn]mL:mU An]lm],lgc]:liUw]pUin]:nn]. Aw]eKL:mun];tI:kUn];hn]miUw]:epL,mL:mU"
pQn]lUm];' pQn]can];n}. Am],sG]:tac];pQn]mo:mUtL,eS,- tk];etl}:wUn].pL;tac];pQn]tac],siUw];"
267
20 hUw]eKL:tac],siUw];
mI;lUm];naw]eSluim];tUw] tUw]yac], - tac];pQn]naw]nUk]. yG];hUm],Agk];eALkG:] '
lUm];m}:Kuin]:Suc]' Agk];eALkG]:"
Am],mI;lUm];naw]eSluim];tUw] tUw]yac], - Tat]:kiUw]wan]nC];liUt]:eA,' Kat],Tat]:nm].
nC];tUw]h}a.hqc];' tum].tiUw].vL;tI:kgk];hUw]' kin]yL:m' kin]
lw]:' hqc];hQt];kan]mak],kqw];eA, (nC];yQw]:mI;Tat]:
pQn]can]; miUw]:pL;tWc]. Am],mI; yU,rIyL;nm])
lUm];naw]eSkm];km];luim];tUw] tUw]yac], - AWk],sgk];miUw]:pL;tWc]."
tUw]yac], - Kqn],SiUw]<Agk];eAL' Cystic ercosis"
 kUn];pQn]An]pQn]can];kU:ekL.nn]. etl}:kUt],sqt]:tUv];Agk];eALEl: SQn]:AL,yUc],Kw] kU:ekL."
 Sc]wL:hLtac];pQn] tI:kUn];pQn]can];nn].Am],l}:n}sbic] etl}:hQt]; ECG eSkUt],sqk]:tUv];"
kgp]:wL:kUn];pQn] An]hqc];tgt],hUw]sG]Am],Pqc],nn]. sac]:pQn]can];eSTiuc]mL;nn].yw]."
lgc]:yUt];yL
 tUv];tI:tac];pQn] pQn]can]; tI:kn] (7.2)
 yLAn]etl}:pn] sgm];nc],l}a;kan]An]Tuk],lIpn]yLAgn]tac];
tac];pQn]mL:mUkU:An]An] yLAn]Tuk],lIpn] yLAn]Am],Tuk],lIpn]
Seizure type Medication to treat Medication to avoid
luk]:Agn],AL,yU. (1KUp],lUc];tG]:) Phenytoin
Infant under 1 year Phenobarbitone Sodium Valporate
KQc]:Kqc]tc];tUw]eSlium];tUw]
luk]:Agn], Sodium Vaporate
KQc]:Kqc]tc];tUw]eSlium];tUw] Carbamazipine
Phenytoin
luk]:Agn], Sodium Valporate Carbamaizipine
luim];tUw]kCL,sUw]:kqp]: Phenytoin
kUn];lUc] Sodium Vaporate
KQc]:Kqc]tc];tUw]eSlium];tUw] Carbamazipine
Phenytoin
 Sc]wL:nC];nuic]:pI<n}. kUn];pQn]yam]:pQn]can];nm]lUiw]eS 2 pgk]:sbic] wUn].Sgn],tL,pn]yL:yo"
 Sp];lqc];EnkUn];pQn]wL: etl}:hp].lgc]:yUt];yLKaw];huic]El: Sc]wL:kuic].kac].kiut];yL:yLpqt]:sbic]
etsac]:pQn]can];h}a.hqc];mL;liUw]kw],"
 Sp];lqc];Enlgc]:tac];pQn]mL:mUEl: lat]:Enl}a;eh.kc]:tac];pQn]"
 Sc]wL:kUn];pQn] ygm];hp].Aw]tac];yUt];yLyU,n}sbic] etl}:Et,pn]yLnuic]:Sqn];kUv];"
268
hBw]eKL:tac],sUiw]; 20
 Sc]wL:yUt];yLtc];yLSqn];lQw]hqc];yLSuc]Sut];eS Am],lIKiun]:mL;n} Tuk],lIAup],AUw];tiUc],pac],
tc];emLyL"
 mUiw]:etyUt];yLnn]. etl}:Et,pn]hqc];yL:yLeA,eA, etL,Tuic]tac];pQn] epL;lIKiun]:mL; Am],
nn] etL,Tiuc]Am],mI;Pgn];sL.yLetL,kUn];pQn]nn]. Kuin]:pn]hqc];yL:yLl}:"
 pn]hqc];kUn];pQn] hG]:mL;entI:hUc];yLkU:lUin]"
 Sc]sUiw].wL: l}:yUt];yLKuin];kUn];pQn] ekL.An]hw];yam]:yUt];yLnn].tL,eS,n} Kqn];etlI
Et.Et." (kUn];pQn]nuic]:ekL. emLyLla}ekL.yUt];yLn}. etAm],lI)
hqc];yL tL,kUn];lUc] (Adult drug doses)

tL,tgc];
➔ tgn]:tL,hqc];yL:yLluk]:Agn], tUv];tI:lgk];pn]yL:yL"
lgc]:kiut];yL:yLlUm];mL:mU (Stopping Anti – Epilepsy Medication)

kUn];pQn]km]:nm] w}a;eSkin]yL:yLkGL,l}apI<yw].n} etAm],pQn]lUm];mL:mUTqc]:"
Sc]wL:kUn];pQn] Am],pQn]lUm];mL:mUmL;l}: (2) pI<pa}yw].El: miUw]:kUt],tUv];

SQn]:AL,yUc],ekL: lIyU,n}siuc] wUn].Sgn]tL,kuit];pn]yL:yLl}:"
Tuk],lIhQt];sbBic].huiw]n}nn]. AUp],AUw];kn]tc];kUn];pQn]eStqp];tt];kCL," Sc]wL: kuit];yL:yLpqt]:n}sbic]

kUn];pQn]mac]ekL. etsac]:kUw]pQn]tac];pQn]mL:mUKiun];mL;Tqc]:" kUn];pQn]mac]ekL.Sm]. epL;pQn]l}: K}:kuit];yL:
yLpqt]:w};w};"
 wa};eSkuit];yL:yLyw]. kUn];pQn]nm]liUw] 60% Am],pQn]tac];pQn]Tqc]:"
 wa};eSkuit];yL:yLyw]. kUn];pQn] eA,liUw] 40% sac]:pQn]tac];pQn]mL;Tqc]:yU,"
 Sc]wL: emLyLEl:kUn];pQn] hUm]:kn]tqp];tt]; tL,etkuit];yo:yLn} etl}:pn] hqc];yL:yL
eA,lUc];kGL,l}g;l}g; 4 wUc]: 1 pgk]:"
 Phenytoin n}. 4 wUc]: 1 pgk]: etl}:pn]eA,lUc]; 50mg "
 Carbamazepine n}. 4 wUc]: 1 pgk]: etl}:pn]eA,lUc]; 100mg "
 Phenobarbetone n}. 4 wUc]: 1 pgk]: etl}:pn]eA,lUc]; 30mg "
 Sodium Valporate n}. 4 wUc]: 1 pgk]: etl}:pn]eA,lUc]; 200mg "
lWc]:eh.kc]:
 tL,eh.kc]:Am],hG]:pQn]tac];pQn]Tqc]:nn]. etl}:yUt];yLpn]Kaw];hiuc]"
 nc],hiuw]etAm],hG]:Kw]mI;eP; lgc]:tiUw].vL;mat],sQp]; Am],nn]Pgn];sL.sgm];lc]nn].
Aw]kUn];pQn]mL:mU An]lium];tUw]yU,nn]. tm];wac];w}. mUin]nc],l}a;tm];wac];kUn];lium];tUw]"
269
Aac]:Aic] tac];pQn]naw]nUk]. (kn] 15.2)' yG];hUm],Agk];eALkG]: (kn] 15.1)' lUm];m}:Kuin]: ha}.
hqc]; (kn] 7.4)' Agk];eALkG]: (kn] 15.3)' Tat]:kUiw]wan]nG];lUit];tUk];ygm]; (kn] 10.1)' Kat],
Tat]:nm].h}a.hqc]; (kn] 12.1)' yLmL. (kn] 23.1)' lw]: (kn] 23.1)' Agk],sgk];miUw]:pL;tgc]. (kn]
19.5)' Cysticercosis (tac];pQn]An]pQn]kgp]:mqc];tiUk],) (kn] 12.4)"
20.2 kan]wac];Pqn]nL:hUin]; (Family Planning)

Sc]wL:etAup],AUw]; lgc]:kan]]wac];Pqn]nL:hUin];n}.sbic] Tuk],lIAup],pL;eKL:mun];nc],pL:tG]:n}.-
 Tam]wL: kUn];pQn]mI;luk]:Agn],la}ekL.?
 sgc],yam]:tUk];luk]: ?
 sWc],yam]:pQn]hUw]K}:Pa},lQw] ?
 pQn]Em:tuik].lQc].nUm];yU,hiuw] ?
 sgc],kUn];pQn] hU.l}a;wac];Pqn]nL:hUin];l}al}asiUw]; ?
 sgc],kUn];pQn]kUw]lWc]:hQt];mn] ?
 Tam]wL: sgc],yam]:mI;lUit]:lqc] Am],nn] lUit]:PUik],lUc]; (An]Am],pk],ktI,)?
 miUw]:kUt],sqt]:kUn];pQn]nn].hG]:kUt],sqt]:tUv]; hqc];lUit]:' tp];' nUm]; Am],nn] pak],hUc];luk]:wL:
sgc],mI;Sc] Pit];pk],ktI,hiuw] ?
 sgc],kUn];pQn]pL;tgc].yU,? Sc]wUn].Sgn],wL: pL;tgc]. hG]:kUt],sqt]:km];lQw]"
 kUt],sqk]:tUv]; lgc]:lUit],lqc]/lUit].PUik],lUc];"
TUc]yac] (Condom)
TUc]yac]n}. etAw]rL,pL,hQt];w}.eS pa}mn];etpik].w}." mn];mqn]:kn]lIlItc];KUic]:Ac],kL,PU:sa}; miUw]:Kqc]
tUw]" mUiw]:hUm]:kL,mnn]. mn];eteh.ham]:pn] nm].can]PU:sa}; Am],hG]:Kw]:kGL,nG];KUic]:Ac],kL,PU:yic];l}:"
TUc]yac]nuic]: An]n}. etsG].l}:nuic]:pgk]:kUv];"
Pgn]; mUiw]:hUm]:kL,mnn]. Sc]wL:sG].tiuw];TUc]yac]kU:pgk]:n} etmI;Pgn];lIEt.Et.yU,yw]."
cw];l}a;An]Am],Tuk],lIsC].TUc]yac]
kUn];An]Am],mqn]:tc];Tat]:rL,pL, etmI;eStL. Am],nm]" nm].yLliun]:l} Nonoxynol-9 An]tL;
w}.tac];ngk]:TUc]yac]nn]. hQt];hG]:Am],mqn]:ekL:sac]:pQn]l}:El: hG]:lqk]:la}:TUc]yac] An]pQn]KiUc]:m}a
tac],An]sC].tiuw];"
270
eKL:lm],lgc]:
nm].mn];tL;Piw]wt].S]lin]; (Vaseline)' nm].mn];' Nystatin (yLtL;hw]:)Am],nn] Canestan
sUiw];n}. sac]:hQt];hG]:TUc]yac]mac]eSpgc],n}El: yL,sG].sgm];"
TUc]yac]n}.pQn]KiUc]:miuw];An]lQw] tL,eh.kc]:tac];pQn]
An]sp];tit];l}:kgp]: lgc]:hUm]:kL,m
hUm]:tc];siUw].mqc];tac];pQn]AQk].KY]A},wI,"
yLkin]eh.ham]:Sn],eT, (Oral Contraceptive Pill)

la};hac]:hqn];yL:yL - yL:yLn}.ethUm]:pL; Oestrogen El: Progesterone "
Pgn];yL:yL - epL;kin]kU:wn];sbic] etEh.ham]:Sn],eT,pn]l}: 95%"
cw];la};tI:An]Am],Tuk],lIpn]yL:yL – cw];l}a;sgm];nc],pL:tC]:n}. etAm],l}:pn]yL-

 PU:yic];AL,yu 40 Kuin]:nUiw] El: PU:yic];An]lut],lqn];yL:AL,yu 35 Kuin]:nUiw]"
 kUn];tI:An]mI;tac];pQn]hUw]sG]
 kUn];An]pQn]hUw]K}:'hUw]mw];
 kUn];An]pQn]lUit]:Suc] lUit]:tac];nUiw]mI; 140 El:lUit];tc];tG]: 90 pa}El: kUn];An]mI;
tac];pQn]yQw]:wan]"
 kUn];pQn]kqn],SiUw]<tI:hUc];luk]:' nUm];pQn]kqn],SiUw]<El: tp];pQn]kqn],SiUw]<Am],nn] tp];kG]:"
 tgn]:tL,Em:lQc].nUm]; sgc],lIpn]yL:yL Progestorone/Am],lIpn]nn]. etl}:tUic],pac],
tc];emLyL"
 kUn];An]nL:lUin]Am],p},yam]:mL;eSpgk]:"
 pI;hqc];pUn].tI:' BMI (nm].nk];An]Aw]SUn],Suc]eSSgn],np].w}.) Suc]liUw] 30 Kuin]:nUiw]"
 PU:yic];An]kin]yL:yL Carbamazepine Griseofulvin Phenobarbital Phenytoin Rifampicin
sUiw];n}.yU,nn]. Am],Tuk],lIpn]"
Pgn];sL.yLAn]pQn]km]:nm]
nUm];etKQc]:Kqc]eSsQp];' eAL.hak]:' nm].nk];tUw]Kuin]:' hqc];sG]tUk];' lUit]:Suc]"
271
pUic]nm];
 mUiw]:p},pn]yLeh.ham]:Sn],eT,nn]. etl}:Tam]eKL:mun];tqt]:tqt]:etL;etL;El: kUt],sqt]:hG]:
tQmT ] Un]:" An]lm],lgc]:liUw]nn].Et.sgc],mI;tac];pQn] mUin]nc],lat]:mL;pL:nUiw]nn].yw]." kUt],
sqt]:pn]lgc]:pL;tWc]." Tt];tUv];tI;tgc].El: tI:nUm];wL: sgc],mI;hUv],kqn],kqn],hiuw]" epL;mI;
eKL:Tam]sbic] hG]:AUp],AUw];tiUc],pac],tc];emLyL"
 kUn];lut],lqn];yL:n}. lat]:enwL:hG]:kbit];lut],lqn];yL:"
 mUiw]:p},pn]yLnn]. etl}:lat]:enPgn];sL.yL An]sac]:pQn]' Pgn];sL.km]:nm]n}. wa};eS
kin]yLhiuc]liUw] 1 lUin]Tuic] 3 lUin]nn]. etAm],pQn]yw]." Sc]kin]yLkac]Kuin];n} etAm],
epL;hQt];hG]:KC]:eAL. KC]:hak]:"
 wa};eSnL:lUin]mL;yw]. 2 pgk]:El: lUit]:tuik].tUk];Ait];Ait];yU,n}sbic]pn]yL Oestrogen An]
elL;w}.nn]. 50 Am],nn] 60 Micrograms l}:yU," (mUiw]:p},pn]yLnn]. etl}:Tam]wL: sgc],
pQn]tac];pQn] hUc];luk]:kG]:' sgc],mI;Sc]kuit];w}.nG];hUc];luk];' sgc],lium];kin]yL' kin]yLptI,KYI<wn
yU,El:tgc].kGL,)" Sc]wL:Am],pQn] sUiw];An]Tam]w}.pL:nUiw]n}.n} pn]yLl}:"
eKL:etl}:lat]:enpn] PU:yic];An]kin]yLeh.ham]:
1) nuic]:wn]; hG]:kin]nuic]:mQt]."
2) Et,kin]yL:yLmQt].yG,] mUiw]:nL:lUin]mL;wn];Agn]tac];Sut];"
3) etl}:kin]yLkU:wn];" Sc]kin]yLtUk];luin];pqt]: 12 sUw]:mUc];n}siuc] mUiw]:Kuk];sG]l}:nn].
hG]:kin]Kuin];km];lQw]" yLAn]kuit];nn].ekL: kin]mUin]kw],eS sG].pL;TUc]yac]to, 7 wn];"
4) mUiw]:mI;lum];naw]El: PU:sa};Am],yU,hUin];nn].ekL: etl}:Suip],kin]yL"
5) epL;yLkap]:kw],SQc]: etl}:Et,kin]yLkap]:mG],Kuin];km];lQw]"
6) mUiw]:mI;lUm];naw]El: sG].tiuw];yLKL:sUiw].mqc];nn]. Pgn];yLEh.ham]:Sn],eT,ettUk];ygm];"
kgp]:nn] mUiw]:mI;lUm];naw]El: mUiw]:kin]yL:yLKL:sUiw].mqc];etL,Tuic] 7 wn]; etl};kin]yLkU:
wn];El: sG].TUc]yac]pL;sgm];"
yLSm]; (Depo)
l}a;hac]:hqn];yL:yL
yLSm];eh.ham]:Sn],eT, 3 ml n}.etpL;yL:yL Medroxyprogesterone acetate 150 mg" nG];yLSm];
n}. Am],pL;yL Oestrogen El: pn]Em:lQc].nUm];l}:yU," (pqk].Sm].wL:wa};eSkUit],luk]:
yw].pn]l}:km];Siuw]:n}eStL.ekL: kgp]:sac]:hQt];hG]:lUit]:lUc];nm]El: wa};eSkUit],luk]:yw]. 6 wUc]:pa}
sc],pn]yLSm];n}. pQn]An]lIeSpUin]:"
272
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1 pgk]:" mUiw];p},Sm];yLnn]. etl}:kUt],tUv];lgc]:sp];tgc]."
Pgn];yL
eh.kc]:Sn]eT,pn]l}: 95% "
cw];l}a;An]Am],Tuk],lISm];pn]yL:yL
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 tUw]sw];kw], Am],nn] nG];pI:ngc].sUiw].KUiw]; yam]:pQn]ta}Pak],' kUn];An]yam]:pQn]tac];pQn]hUw]sG]w}a;
An]ALyu.l}: (45) Kuin]:nUiw]"
 PU:yic];An]AL,yu 40 Kuin]:nUiw]eS mI;tac];pQn]lUit]:Suc]' yQw]:wan] Am],nn] pI;pUn].tI:nn].
Tuk],lIAup],AUw];tiUc],pac],tc];emLyL"
Pgn];sL.yL An]pQn]km]:nm]
nL:lUin]Am],mL;man],' nL:lUin]Am],mL;eSAit]; (PU:yic];mgk]: 50% n}.wa};eSSm];yLEh.ham]: Sn],eT,
hUic] 12 lUin]yw].n} nL:lUin]etAm],mL;" kUv];kL:epL;kbit];Sm];yLyw]. lUit]:etmL; Kuin];)" KG]:eAL.
KG]:hak]:' nm].nk];tUw]Kuin]:''
lgc]:lm],lgc]:
etl}:lat]:enkUn];pQn] hG]:tgc];w}.wn];TI. An]etl}:Sm];yLTqc]:pgk]:nuic]: (11-12 wUc]:)"
tL,Sm];yLnn]. epL;tUk];luin]; 1 wUc];n} etl}:kUt],sqt]:tUv];yQw]:wL: sgc],sp];tgc]./Am],sp];"
(k) Sc]wL:sp];tgc]. yL,Siup],Sm];yLEh.ham]: (Depo)"
(K) Sc]sUiw].wL:Am],sp];tgc]. Sm];pn]yL (Depo)El: lat]:EnpL;wL: etl}:sG].TUc]yac]sgm]; tL,
14 wn];" Sc]wL:nL:lUin]Am],mL;siuc] hG]:mL;hUc];yLKuin];"
SG],KUv],nG];hUc];luk]:
(IUD)
IUD n}.Aw]plt].Stik].AUn]:hQt];w}.eS etmUin]hac]:Pac] (T) w}." Sc]wL:SG],nG];hUc];luk]:siuc] et
eh.ham]:pn]Sn],eT,l}:"
Pgn]lIPgn];sL.
IUD n}.mI;Pgn];lISuc]" eh.ham]:Sn]eT,l}: 98%" etAm],l}:sG].An]kw],Kuin];" Sc]sUiw].wL:KG]:l}: luk]:
sbic] wa};eSAw]KUic]:eh.ham]:Sn]eT,Agk],yw]. etsp];tgc].l}:Kuin];km];lQw]yU," la};eh.ham]:Sn]eT,
An]n}.n}. mI;Pgn];lItL, kUn];An]mI;luk]:ekL.lQw]El: PU:yic];An]kUw]tL,etTm];mn]"
273
cw];l}a;An]Am],Tuk],lIpn]
PU:yic];An]sp];Sn]eT,w}.El: sUiw].mqc];Kw]:nG];hUc];luk]:' lgt],SUc],K},El:hUin];K},sUiw];nn].Am],Tuk],lI
SC],pn]"
kgp]:pUiw]:SG],KUv], (IUD) El:mac]pgk]; ethQt];hG]:hUc];luk]:Sik],' Am],hU.tUw]eS IUD Agk],mo;tc];ngk]:'
Sgk]:ho SQn]:m}mn];Am],hn]"
Pc]KQm]tC]:Piw]nc] (Norplant)
l}a;hac]:hqn];yL:yL
nG];yLPc]KQm]n}.etmI; Progestorone An]etsium];Agk],mL;l}g;l}g;El: eteh.ham]:pn]Sn],eT,"
(Norplant n}.etmI; 6 lqm]: Am],nn] 2 lqm]:) eS etPc]tI:tG]:Piw]nc]Kqn]" Norplant
n}.pn]Em:lQc]. nUm];luk]:Agn],ekL:l}: (kUv];kL:pG].etL,Tuic] wa};kUit],yw]. 6 wUc]:)" Sc]wL:sp];tgc]. 3
lUin]El: tUk];luk]:siuc] wa};eStUk];luk]:yw]. 7 wn]; Pc]KQm]l}:yw]." KG]:Pc]KQm]km];lQw]ekL:l}:yU,"
hqc];yL
hqc];yL Norplant n}. etEh.ham]:Sn],eT,l}:tL,Kw];tac]; 4 pI<" Norplant II eh.ham]:Sn],eT, l}:
3 pI<" kUv];kL: mUiw]:p},Pc]KQm]nn]. etl}:kUt],tUv];wL: sgc],sp];tgc]./Am].sp];"
Pgn];yL eh.ham]:Sn],eT,l}: 95%"
cw];l}a;An]Am],Tuk],lIpn]yL
Sc]wL:pQn]nc],pL:tG]:n}. yL,pn]yL
 kUn];mI;tac];pQn] tp];kG]: Am],nn] kqn],SiUw]<nUm];"
 tUw]sw]:kw], Am],nn] nG];pI:ngc].sUiw].KUiw]; An]yam];mI;tac];pQn]kQw],lUv]:SQn:] lUit]:Agk],
(tUw]yac], - t}aPak], Am],nn] hUw]sG]w}a;)"
 PU:yic];AL,yu 18 pI<lUc];tG]: El: 45 Kuin]:nUiw]"
 kUn];An]nL:lUin]Am],mL;man],"
nL:lUin]etAm],mL;man],' nL:lUin]etAm],mL;eSAit]; (Am],nn]) mac]pgk]:mac]lG] lUit]:tUk]; Ait];
Ait];Agt];Agt];' KG]:eAL.KG]:hak]:' nm].nk];tUw]Kuin]:"
274
Tm];mn] (Sterilisation)
tL,Tm];mn]n}. etl}:kGL,tI:hUc];yL
 Tm];mn]PU:sa}; - Tm];mn]tI:lgt],SUc],nm].can]"
 hQt];mn]PU:yic]; - Kgt],mt].lgt],SUc],K},w}.
20.3 lgc]:hQt];h}a. An]Aic]niUw]lgc]:pQn]s}a;/yic];

(Gender Based Violence (GBV))
(kQw],lUv]:eKL:An]Tuk],lIyip];km]sgm];nn].
hG]:Kiun];tUv];Kiun];pp].lgc]:hQt];h}a.sL.An]Aic]niUw]lgc]:pQn]s}a;/yic]; An]A},AL,SI,Kp].Kiuc]Pim];Agk],mL;)"
lgc]:hQt];h}a.An]Aic]niUw]lgc]:pQn]s}a;/yic]; (GBV)n}. pQn]lgc]:hQt];h}a. An]Aic]niUw]tI:Kw]pQn]yic]; Am],
nn]s}a;eShQt];ha}.etL.ekL.niuc]:" lgc]:hQt];h}a.n}. ethUm]:pL;sgm]; hQt];hG]:sQp];tac];tUw]' sQp];tac];sC]
Am],nn] kgp]:lgc]:tac];lic],eS hQt];hG]:tum].tiUw].tUw]sC]' lgc]:lWk],ciUt]:wL: ethQt];siUc].nn] sUic].n}'
ep.kin]El: hQt];hG]:lU.Sum];lgc]:lgt]:lqw];siUw];n}.yw]." km]:nm]Et.kUn];An]Tuk],vL;lgc]:hQt];h}a./
lgt]:mL;n}.pQn]nac];yic]; n}eStL. An]tum].tiUw].etL,kUn];s}a;ekL:mI;" lgc]:hQt];h}a. An]Aic]niUw]lgc]:
pQn]s}a;/yic]; (GBV) n}. ethUm]:pL;miUn]nc], lgc]:kn].sn]El: hQt];h}a.etL,kn]nC];nL:hiUn];El: lgc]:
hQt];h}a.tac],siUw];l}al}a;" tI:Sun]p}a:eP;nC];miUc];T};km]:nm] An]l}:hp].hU. lgc]:hQt];h}a.km]:nm]Et. pQn]
lgc]:hQt];h}a.etL,kn]nC];nL:hiUn];"
eKL:piut],tI:pgc],El:eKL:kCam];sC].
lgc]:ygm];hp]. ethUm]:pL;l}:sC]hc];kUv];' tUw]yac],- tL,Pgm].l}:sC] tL,hUm]:pL;lgc]:kL,meSAn]An]nn].
ekL:l}:sC] etl}:mI;nm].kt]. hp].hU.Pgn];lIPgn];sL. An]etpQn]kgp]:lgc]:l}:sC]nn]." sgm];nc],m}amIkU:
siuc]:miUc]; (tI:pac],kum]lUc]Sun],l}:luk]:Agn],) nn].luk]:Agn],AL,yulQk].liUw] 18 n}.p},sac]:pn]lgc]:Pgm].
l}:sC] kQw],lUv]: lgc]:hUm],kL,ml}:" sgm];nc],m}amI:AL<yL< (lgc]:hQt];Pit];) mUic];T};AL,yuAn]pn]lgc]:
Pgm].l}:sC]l}:nn].pQn] 15 pI<"
lgc]:Tic];Sim];kaCm];lp]. – Tic];Sim];eKL:mun]; An]ekL.lgt]:mL;lat]:Enpn]nn].hG]:lI Am],hG]:PC]hU.
liUw]eSwL:etl}:l}a;can];pn] PU:mI;pun]:Pgn];An]Suc]liUw] Am],nn] tL,l}:tac];s}g:Tqm]" tI:wL:Tic];
Sim];Am],hG]:PC]hU.An]wL:nn]. pI:ngc]. Am],nn] AUv];ekL.sw]:kw],kUv];ekL:Am],hG]:hU.nn].yw]." Sc]PU:
lgt]:mL; lUc];l}a;miuw];nC];wC]l}:sC]nn].kgn], sc],etsac]:lat]:En PU:An] ets}g:Tqm]siUw];nn].l}:"
pun]:Pgn];PU:hap],kan]p}a;yU,lInn].tk];etl}:lat]:EnkUn];pQn]wL: etlat]:EnPC]' lat]:yw].etl}:
Pgn];lIPgn];sL.Sc]l}al}asiUw];n}.yw]." PU:An]lgt]:lgc]:hQt];h}a.mL; etAm],ygm];hp].hG]:pn]eKL:mun];
sw]:kw], etL,piUn]:yam];lC]ekL:l}:"
luk]:Agn], - sgm];nc],m}amI:T}; ekL.An]AL,yulQk].liUw] 15 pI< pgc],wL:pQn]luk]:Agn],yU,"
lgc]:tac]; - lgc]:tac];An]PU:lgt]:lgc]:hQt];h}a. mL;lat]:Enygn];tac];s}g:liUw]"
275
PU:hQt];h}a. – pQn]PU:lUc];miuw];hQt];h}a. kQw],lUv]:lgc]:hUm],kL,m Am],nn] hQt];h}a.hG]:l}:tum].tiUw].
sQp];tUw]"
lWc]:hQt];h}a.nC];nL:hiUn]; etsac]:hUm]:pL;-
 kn].sn]'Aan];kn].sn] (Aw]Kgc]eSAn]An]SC],Kw]:nC];Ac],kL,nac];yic]; Am],nn] nC];hU;Pa}:lUc])
 tQk];tQc]ep.kin]lgc]:hUm]:kL,metL,luk]:Agn],
 hQt];h}a.kn].sn]hQt];hG]:l}:sQp];
 lWc]:hQt];h}a.nC];nL:hiUn]; hUm]:pL;-
 hqc];tUw] (sC].AQn]hqc];hQt];tI:kn]' tUw]yac], - tc]:sC]hG]:sQp];eSEl: Aw]tLmiuw];mc]SC],)"
 sC].eKL:kCam];' p}a;sC]eShQt];h}a.etL, (SQc]lc]SC], Am],nn] sC].eKL:kCam];lgk],ciUt]: Am],nn]
hG]:kUw] Am],nn] hG]:SQc]yQn]lUc];kCL,)"
 kQw],lUv]:tUc],wUc];kUn];El:Tat]:sC] (yip];siUk]:yU,lc]pgc]kan]' hQt];hG]:l}:yU,ekL.lQw]' hQt];hG]:
kUw]' hQt];hG]:l}:A}a")
 kQw],lUv]:p}a;mak]:mI; (Am],pn]ciun];tc];mUt];eS yiut];Aw]w}.km]:PWc]:' mip],cqn]; PU:Tuk],vL;
hqt];h}a. hG]:pn]ciun];An]sw]:kw],l}:mL;nn].km]:Pgc]: Am],nn] eh.ham]:PU:Tuk],vL;hQt];h}a.
Am],hG]:kCL,hQt];kan]"
tL,tgc];" " lgc]:hQt];h}a.kQw],lUv]:lgc]:kL,mlC]eSAm],wL:' pqk],Sm].wL: Am],Pit]; etL,m}amI:

kU:siuc]:miUc]; Am],nn] fic]:Tuc];PC]n}eStL. tk];etl}:Aw]sC]SC], hQt];Sac]:pn]tI:hgc]:yL"
pk];piUc]tL,lum];lL;El: hQt];Sac]:pn]PU:An]lgt]:lgc]:hQt];h}a.mL; - PU:lgt]:mL; mI;Sun],l}: hQt];

Sac]:tL,Tic];Sim];kuc],Sik]:KL, (np].ym]tUw]sw]:kw],)" PU:hQt];h}a.pQn]PU:An]yL.kw]; Sun],l}:El: PU:
hap],kan]p}a;yU,lIKw] Tuk],lIw}.pQn]lgc]:nk];nLeS etl}:lat]:pn]" tL,hQt];h}a.kU:lgc]:nn]. Tuk],lI
hQt];sgm];nc], piUc]nm]; 4 eKL:pL:tC]:n}.-
Tic];Sim];kCam];lp].pn]' pn]lgc]:hUm],lUm]:' np].ym]' Am],w}.sC]sqk],EP

(PU:hap],kan]p}a;yU,lI w}.sCw] L:s}a;El:yic];hUw]mL,pQc];kn])
lgc]:hQt];Sac]:pn]kUn];pQn] ( Managing GBV Cases)

yiUc];m}a - tL,kUt],sqt]:tac];ngk]:tUw]pn]El: Tt];Sac]kUn];pQn] tL,l}:hp].lgc]:yUt];yLEl:
SUc],kCL, yUt];yLtac],tI:"
eKL:yiUc];Aan]; - Aw]piun];p}a;yUt];yLEl: piun];tum].tiUw].mat],sQp];' hLtUv];h}g;sQp];eS mat]:m}aw}."
yUt];yLpn]" hn]Tuk],mqn]:siUc].hiuw]ekL: SUc],kUn];pQn]kCL,yUt];yLtac],tI:"
276
1. lgc]:KUn].hLTt];Sac]eKL:mun];
(k) Aup],kum]tc];kUn];pQn] nC];hgc]:niuc]:eKLeKL" kp];Siup],miut]:kiuw];tc];kUn];pQn]" lat]:EnwL: etTic];
Sim];eKL:mun];Kw]pn]" lat]:En lgc]:tgc]:Tam]El: kUt],sqt]:kU:Kk].tgn]: An]ethQt];Sac]:" Tam]
kUn];pQn]wL: sgc],mI;eKL:Tam]Sc]etTam]- mUiw]:KUn].hLTt];Sac]eKL:mun];nn]. sgc],kUn];pQn]KG]:hG]:eS ekL.
ekL. yU,sgm];hiuw]" mat]:m}algc]:An]kUn];pQn]lat]:EnEl: lgc]:kUt],Tt];"
(K) Sp];lqc];EnwL: kU:siUw];siUw];An]Kw]lat]:Ennn]. etTic];Sim];pn]hG]:pQn]kCam];lp]. liUw]eSwL:
1) kUn];pQn]l}:sC] tL,hG]:tac],EnekL.An]etpn]tac];s}g:liUw]nn].hU.
2) kUn];pQn]yU,nC];eP; - miUn]nc],Aan];Aw]tUw]sw]:kw],t}a Am],nn] Tuk],lgk],ciUt]:wL: et
Aw]t}a
3) kUn];pQn]en;wL: PU:hap],kan]Aqn],kYI,AUw],' PU:hap],kan]yU,Aqn], (UN) Am],nn] Siuk];T};
l}:tQk];tQc]hQt];h}a.etL,Kw]
4) kUn];pQn] AL,yulQk].liUw] 15 pI<"
p}a;wUn].An]KG]:Aw]tUw]sw]:kw],t}a
Sc]kUn];pQn]wL: Kw]Aan];etAw]tUw]sw]:t}an}siuc] tk];etl}:SC],sC]lgc]:n}. nk];nk];nLnL
Tam]tUv];wL: Kw]Aan];Aw]tUw]t}asiUc].hiuw]" Sc]Kw]lat]:En Am],Tuk],lIhG]:kUn];pQn]miUw];kCL,
liUw]eSwL: Kw]l}:hUp].tc];PU:lum];lL;Kw]" pqk].Sm].wL: San]Kt];tc];kac]sC]kUn];pQn]eStL.
An]n}.pQn]eKL:niuc]: An]Am],Tuk],lITic];Sim];eKL:mun];El: tk];etl}:lat]:Entac],ekL."
mk];m}algc]:hQt];h}a.nC];nL:hiUn];
nac];yic];km]:nm] nk];sC]' Am],KG]:lat]:Enlgc]:An]sw];kw],vL;hQt];h}a." lat]:EnwL: Kw]mI;Sun],l}:
tL,yU,tI:Am],mI;lgc]:hQt];h}a.etL,Kw]El: nC];Sun],p}a:eP;n}. mI;kUn];tc];nm] An]ets}g:Kw]l}:"
2. lgc]:yUt];yLEl:lgc]:mat]:m}aeKL:mun]; (Medical treatment and documentation)
mat]:m}aeKL:mun];kU:siUw];siUw]; Am],wL:pQn]hac]: Am],wL:pQn]tUw]lik]: hG]:tqk],lqc];"

(2 k) kUt],sqt]:tUw]kUn];pQn] (Physical examination)
lWc]:kUt],sqt]:tUw]kUn];pQn]nn]. Tuk],lIhUm]:pL;
k) kUt],sqt]:An]lm],lgc]:tI:tUw] (lUm];m}:tUw]' hqc];tgt],liUt]:' SQn]:tac];TUv]:sC]' hqc];liUt]:)
K) lQp]:hQn];pC].tUv]; Pac]hac]:kU:lgc]:lgc]:Kgc]kUn];pQn]El: lgc]:hQt];Sac]:tUc].niuc]Kw]" l}a;nuc]:KUw];
Kw]' l}a;kin]l}a;yqm].Kw]' lgc]:hn]Tiuc]nUiw]Kw]kU:siUw];siUw];"
c) kUt],sqt]:tUv];tUw]' Aw]KiUc]:Tgm],hUeSkUt],sqt]:' Aw]miuw];yip];km]eSsqt]:tUv];' Aw]muiw];t}g,
eS sqt]:tUv]; KUn].hLTt];Sac]hUw]etL,tin]" hLtUv];h}g;sQp]; Am],nn] hac]:h}g;sQp]; tI:tUw]
lIlIeS mat]:m}aw}. (lgc]:tqm]:hac]:tUw]kUn];tac];nL:tac];lc]eS mat]:m}an}. ets}g:l}:nm])"
KUn].hLTt];Sac] hUw]etL,tin] tL,hLtUv];h}g;sQp]; (h}g;lQk].lQk].ekL:yw].)' h}g;y}a;' h}g;mat],sQp];'
h}g;sm].' SQn]:m} Am],nn] h}g;SiUw]:m}:' h}g;KUp];' h}g;sn]KUn]hUw]' h}g;kC]:' sQp];' sQp];c}a:' kgp]:l}:
eh.kc]:tUw]sw]:kw],eSl}:h}g;sQp]; (h}g;sQp];tI:Sn]miuw];' niUw].nc]PU:hQt];h}a. An]sp];tC]:nQp].
miuw];) siUw];n}.lQk].lQk].lgk].lgk].n}eStL. tk];etl}:kUt],sqt]:tUv];hG]: sgt],es;tc];tUw]"
277
yL,kUt],sqt]:pgt];kum],kUn]:lL;lL; - kUv];kL: kgp]:lgc]:hQt];h}a.eS pQn]h}g;sQp];El: etl}:
yQp].pn]n}.Et. Tuk],lIyQp].pn]l}:"
(2 K) sgm];nc],An]Tuk],lIyUt];yLnn]. yUt];yLpn]"
k) tL,h}g;mat],sQp];El:lup],hk]; - lac].sQp];yw]. SC],yLpn]" Am],nn] SUc],tUw]kCL,hUc];yL"
Sc]wL:lqp]:etpQn]tac];pQn]kac];Kqc]l}:n} hG]:Sm];yLeh.kc]:kac];Kqc]pn]" (kn]22.4)
K) kUn];pQn]An]Tuk],kn].sn]nn]. nc],hiuw]epL;etAm],sp];tac];pQn] kgp]:lgc]:hUm],kL,m' siUw].
mqc];AQk].KY]A},wI,' siUw].mqc];tac];pQn]tp];kC]:niUw].liUc]El: Am],hG]:sp];Sn],eT,nn]. hG]:yUt];
yL pn]km];lQw]"
 lgc]:eh.kc]:tac];pQn] An]sp];tit];l}: kgp]:lgc]:hUm],kL,m- Ceftriaxone 125 mg IM
STAT; Metronidazole 2 g STAT; Azithromycin 1 g STAT Am],nn] Doxycycline 100
mg BID tL, 7 wn]; ( kn] 13.5 )"
 lgc]:eh.kc]: lgc]:sp];tit];siUw].mqc];AQk].KY]A},wI, - w}a;eSTuk],kn].sn]yw]. tk];et
l}:eh.kc]:sQm]sw]." Sc]wL: pn]yLl}:nC];Kaw];tac]; 1-2 sUw]:mUc];n}Kqn];lI" Sc]wL:pUn].kCL,
72 sUw]:mUc];yw].n}siuc] tL,eh.kc]:nn]. TiUc];kCL,pqt]:yw]." tUv];Kiun];tI: lgc]:eh.kc]:
miUw]:tiUw].vL;yw]. tI:kn] 6" yLeh.kc]:tL,Tuk],vL;lgc]: kn].sn] pI,AI;pI, 1 TUc] 2
TUc]n}. Tuk],lIkQp];w}.kU:hgc]:yL" (tUv];wn]; mUt];AL,yuyLeSsc],pn])"
 lgc]:eh.kc]:tac];pQn]tp];kC]:niUw].liUc] – Sc]wL: kUn];pQn]p},yam]:Sm]; yLeh.kc]:tac];pQn]
tp];kC]: El: Sc]wL:mI;yLyU,n}siuc] hG]:Sm];pn]sw].sw].sQw];sQw];" lat]:EnhG]:kin]yLhG]:
mUt];" HBV1: w};l}:kL:hiuw]ekL:lIkL:nn]. (1 ml IM )' HBV2 w}a;eS 1 liUn]' HBV3
w}a;lc]kin]yLpgk]: Agn]tac];Sut];yw]. 6 liUn]"
 lgc]:eh.kc]:sp];Sn],eT, - mUiw]:etpn]yLKiuk].Kk]. tL,eh.ham]:Sn],eT,nn]. hG]:kUt],
sqt]: tUv];lgc]:sp];Sn],eT,eSkgn]," Sc]wL:sp];Sn],eT,yU,yw].n}siuc] Am],tap]:
pn]yLeh.kc]:" Sp];lqc];EnwL:mUiw]:p},vL;kn].sn]nn].Kw]epL;sp];tgc].w}.yU,yw]." Sc]wL:
kUn];pQn]mL; w}a;lc]vL;kn].sn].yw]. 120 sUw]:mUc]; (5 wn];) El:kUt],sqt]:yw].Am],
pL;tgc].n}siuc] hC]:sC].yLeh.ham]:Sn],eT, An]mI;tUw]yL levonergsterol hUm]:kn]-
➔ hqc];yLAgn]tac];Sut]; (First dose) = 4 mQt].El: hqc];yLpgk]:km];Sgc] (Second
dose) (w}a;kin]yLpgk]:Agn]tac];yw]. 12 sUw]:mUc];) = 4 mQt]." tL,eh.kc]:
➔ yL,hG]:tUn].El:hak]:nn]. hG]:pn]yL metoclopramide 10 mg PO w}.Agn]tac];
niuc]:sUw]:mUc]; mUiw]:p},pn]kin]yLeh.ham]: Sn],eT,kU:pgk]:"
Sc]wL: An]pQn]mL;yc];yU,nC];Kaw];tac]; 7 wn]; w}a;eS 120 sUw]:mUc]; (5 wn];)yw].n}
tL,pn]yLeh.ham]:Sn]eT,nn]. tUk];liun];yw]." kUv];kL: Sp];lqc];EnwL: IUD yc];s}g:
l}:yU," epL;hiuc]eS 7 wn];yw].n}. tL,eh.ham]:Sn],eT,nn]. tUk];liun];pqt]:yw]." kUt],
sqt]:lgc]:sp];Sn],eT,eS lat]:hG]:mL;EntI:hgc]:yLTqc]:"
278
c) w}a;eSpn]lgc]:yUt];yLtc];mUt];yw]. hG]:Tam]lgc]:hUm],lUm]:kUn];pQn]"
Tam]tUv];wL: w}a;eSluk].tI:hgc]:yLpgk]:miUw];kCL,yw]. kUn];pQn]sgc],etmI;lgc]:hUm],lUm]:hiuw]/ sgc],
etmI;kUn];mL;hQt];h}a.hiuw]" Sc]wL:mI;n}siuc] Sp];lqc];En lgc]:s}g:liUw] An]etpiuc]: Aic]l}:
miUn]nc], PU:hap],kan] GBV ' sum];nac];yic];' PU:mI;pun]:Pgn];lgc]:hUm],lUm]: nC]; Sun]p}a:eP;
Et,Aw]siUw];n}.kCL,"
3. lgc]:Suip],SUc],kUn];pQn]kCL,yUt];yL
lgc]:Suip],SUc],kUn];pQn]kCL,yUt];yLn}. etl}:Aic]niUw]kac]sC]PU:lgt]:mL;El: tk];etl}:Aup],kum]kn] tc];
PU:An]lgt]:mL;"
p}a;yU,lI SUc],kCL,yUt];yLtI:hUc];yL
lgc]:s}g:liUw]p}a;sC] tL,lgc]:s}g:liUw]p}a;sG]nn]. SUc],kUn];pQn]kGL,pn]PU:hap],kan] GBV
COERR Am],nn] muk].sum];nac];yic];
lgc]:hUm],lUm]: PU:hap],kan] GBV' muk].sum];nac];yic];' PU:mI;pun]:Pgn];
lgc]:hUm],lUm]:nC];Sun]p}a:eP;' sw]:nL:tI:T}; Am],nn] UNHCR "
lgc]:lum];JtL; lum];JtL; Sun]p}a:eP;' sw]:nL:tI:T}; Am],nn] UNHCR "
kQw],lUv]:lgc]:lum];JtL;El:m}amI:nn]. hG]:tUv];Tqc]:nL:lik]:niuc]:"
4. nt]. (Kin];) mL;Tqc]:Pa},lc]

tL,lUlgm]sgm];tUv];cw];l}a;l}:nn]. Kiun];hG]:mL;sU;Kiun]; miUw]:tQm] 2 wUc]:' 1 liUn] El: 3 liUn]" mat]:
m}a wn];etnt].mL;Tqc]:Pa},lc]" tI:eA,Sut];Tuk],lInt].mL;sgm];nc],Kaw];yam];pL:niUw]" Sc]wL: kUn];
pQn] KG]:mL;Agn]tac];Kaw];yam]; An]nt].m}aw}.n}ekL: Tuk],lIhQt];sgm];kac]sC]kUn];pQn]"
Aac]:Aic]
tac];pQn]An]sp];tit];kgp]:lgc]:hUm],kL,m (kn] 13.5)' mat],sQp]; (kn] 22.4)' pI,AI;pI, (kn] 6)"
279
piUc]nm];tL,pn]lgc]:s}g:liUw] kQw],lUv]:lum];JtL;El:m}amI:hG]:kUn];pQn]
PU:lgt]:mL;mI;Sun],liUk]:l}:wL: etsC].lum];JtL;tI:Sun]p}a:eP; Am],nn] lum];JtL;T};hiuw]" etmI;lgc]:

eh.kc]:kUn];p}a:eP; sgm];nc],m}amI:T};w}.yU," lum];JtL;Sun]p}a:eP;ekL: mI;kU:Sun]yU," lWc]:kn].sn]
Am],nn] lgc]:hQt];h}a.nC];nL:hiUn];An]h}a.hqc]; (lgc]:Aan];Aw]kUn];t}a) Et.tI:lum];JtL;Sun]Am],sac]:
tqp];tt];pn]l}:" Sc]wL: kUn];pQn]KG]:Aw]liUc]: sgm];nc],m}amI:T}; tac];ngk]:Sun]p}a:eP;n}siuc] tk];et
l}:lat]:EneKL:mun]; sgm];nc],pL:tC]:n}.pn]kUn];pQn]hG]:tqk],tqk],lqc];lqc];"
1. lgc]:sgm];nc],pL:tC]:n}.etSgn],l}:wL: pQn]lgc]:kan]hQt];h}a. (crime) sgm];nc],m}a:mI:T};kQw],lUv]:

kan]hQt];h}a." Sc]kUn];pQn]mI;kac]sC] KG]:Kw]:sU;lum];trL;T};n} Kw]ekL:sac]:kCL,tUic],tI: PU:mI;Am];
nat]:T};l}:" Sc]wL:eSekL.ekL. yip];' sup], Am],nn] kgt], Tqc]:ekL.niuc]:eS hQt];hG]:Kw] Am],
han].sG] Am],nn] miUn]wL:yL.kw];Kw]' hQt];siUc].n}etL,luk]:yic]; Am],nn] luk]:s}a;Kw] (An]AL,
yulQk].liUw] 15 pI<)' Am],sC]:PUw]Kw]eSEl: AL;Tm],mhG]:hUm]:kL,msgm];' hUm]:kL,m sgm];luk]:yic];Kw]
An]AL,yulQk].liUw] 15 pI<' hQt];hG]:mat],sQp];' lgk],ciut]: Am],nn] Kc]tac],ekL."
2. miUw]:tUic].w}.tI:PU:mI;Am];nat]:T};yw].
etmI;lgc]:kUt],sqt]:Sgp],Tam]' Sc]wL:Kw]hLlk];Tan] l}:
kum],TUn]: Kw]ekL:etAw]lgc]:yiun]:sU;lum];JtL;El: PU:tqp];tt];JtL;Kw]ekL: ettqp];tt];wL:
ekL.Tuk],en;wL: hQt];h}a.nn]. Pit];hiuw]/Am],Pit];sgm];nc],m}amI:kan]hQt];h}a."
3. PU:tqp];tt];JtL;Kw]ekL: etAw]eKL:kCam]; An]kUn];pQn]mgk],lat]:w}.' etAw]eKL:kCam]; An]ekL.

Tuk],en;wL:pQn]PU:hQt];h}a.mgk],lat]:w}.' eKL:kCam];An]PU:hn]sgm]; (Sc]mI;) mgk],lat]:w}. El:
lk];Tan](miUn]nc], nm].tUw]) tL,tqp];tt];wL: PU:Tuk],en;wL:hQt];h}a.nn]. Pit];hiuw] Am],Pit];"
4. pn]eKL:mun];sgm];nc],tac];lc]wL: - Kw]tk];etl}:lat]:lgc]: Sm].kCL,Sm].mL;Kiun];' ethQt];hG]:

kUn];nC];pgk].ygm],hU.' kan]Aw]lgc]:sgm];nc],m}amI:n}.yap],' ekL.An]Tuk],en;wL:hQt];h}a. Am],nn]
pI:ngc].Kw] etlgk],ciut]:kUn];pQn] tL,hG]:kiut];yut];Aw]liUc]:tac];m}amI:' lgc]:KUn].hLsgp],Tam]El: lgc]:
Kiun]:lum];Kiun]:s}; (Kuin]:lum];JtL;) etsC].Kaw];yam];hiuc]' miUw]:liun];Sut]; lgc]:kan]Aw]liUc]:tac];m}amI:
n}.eKL:tgp],et sac]:Agk],mL;wL: kUn];Tuk],en;wL:hQt];h}a.nn]. Am],Pit];n}ekL:pQn]l}:' An]n}.
Am],l}:pgc],wL:lgc]:An] Kw]lat]:nn]. Am],Tuk],Et.Am],sC]: kUv];kL: kgp]:lk];Tan] An]mI;yU,
nn]. Am],kum],TUn]:tgn]:tL,etsI.wL: Kw]hQt];Pit];ekL:pQn]l}:"
PU:lgt]:mL; ekL.liUk]:tL,Kw]:sU;lum];JtL;T};lC]eSAm],wL: etmI;lgc]:s}g:liUw]Kgc] UNHCR mL;km].s}g:

ethUm]:pL; kL:sC].s}a,tac];m}amI:' kL:PU:tac]lat]:El:kL:kCL,mL;" nC];Kaw];tac]; Kiun]:lum];JtL;nn].
kUn];pQn]etAm],Tuk],p}g,w}.hG]:hQt];ekL.lQw]"
280
20.4 lgk];la};yUt];yLhQt];hG]:tac];pQn]mw]SL,mL;
eKL:piut],tI:pWc],
lgk];la};yUt];yL hQt];hG]:tac];pQn]mw]SL,mL; (Palliative Care) n}. sg}:Tqm]tL,kUn];pQn]An]sm]ta}"
yUic];Aan];Kgc]lgk];la};sg}:Tqm]An]n}.tL,hQt];hG]:kUn];pQn]sm]t}ann].mw]SL,mo;" yU,tI:wL:pQn]PU:hap],kan]
pa};yU,lIeS etl}:Kt];sG] hQt];hG]:kUn];pQn]Kw] yU,lUm]mw]SL,mgk]:tI:ethQt];pn]l}:' Am],sC]:yUt];yL
tUw]kUv]; lgc]:lum];lL;hG]: mw]SL,ekL:Tuk],lIhQt];pn]" kUn];nG];hiUn];' pI:ngc].El: t};ekL.n}. Tuk],lI
pQn]kUn];sm]sG] pG].lum];lL;kUn];pQn]"
PU:hap],kan]pa};yU,lI Tuk],lITgm],tac];hn]Tuic]kUn];pQn]El: kUn];pC].kUn];pQn] An]Kw]wUn].Sgn],wL:lgc]:mL;
yLtUw] tI:hUc];yLn}. hUp].TUp];tac];yap],Puit],El: lgc]:Suk].Sak].Sc]l}al}a" hw];ekL:etsac]:sg}:kUn];
pQn] sgm];nc],lgk];la};An]ethQt];hG]:tac];pQn]mw]SL,n}.eS hQt];pn]l}:"
lgk];la};hQt];hG]:tac];pQn]mw]SL,
 KUw];Kgc]El:yL:yL An]etl}:sC]."
 Pqn]kan] tL,hQt];hG]:sQp];mw]SL, (kn] - 7.5)" Tuk],lIsC].lgk];l}a;l}al}asiUw]; tL,hQt];
hG]:sQp];Kw]mw]SL,El: AUp],AUw];kn]tc];kUn];pQn]wL: An]lG]Sm].hQt];hG]:sQp];mw]SL,mL;"
 hQt];hG]:Pac]hac]:tac];pQn]tac],siUw];mw]SL, tUw]yac], - nG];SUp];' nC];lgt],Aiun]tac];kin]
pQn]mw]:' nystatin' tgc].kGL,Kaw];huic-] yLAn]pL;yL:Pin], opioids (mUin]nc], codein)
 mUiw]:kUn];pQn]p},h}ann]. etl}:sg}:Tqm]KUw];Kgc]KUic]:sG].tI: epL:Em:pI:ngc].kUn];pQn]An]etl}:sC].
lUm];lL;kUn];pQn]"tUw]yac],-tL,etSG],sQp];nn].Tuk],lIs}g:Tqm]pn]TUc]miuw];El:KiUc]:km].kqm]"
sg}:Tqm]pa};sC]
 kQw],lUv]:lgc]:tac];pQn]El: Pgn];yUt];yLnn]. tk];etl}:Siuw]:yUw];"
 pqk].Sm].wL: Kw]pQn]tac];pQn] An]Tuk],lImqc],yqk]:n}eStL. etl}:np].ym]kUn];pQn]"
 mUiw]:lum];lL;kUn];pQn]nn]. etl}:hU.sG]kUn];pQn]" tUw]yac], - pn]KGac].kUn];pQn]El: pI:ngc].
kUn];pQn] hUp].TUp];kn]"
 mac]pgk]:mac]lG] kUn];pQn]n}.etsG]pit];' sG]pgt];' KI:kUw]' KI:Aa}El: sac]:sG]lQk]." kgp]:n} PU:
hap],kan]pa};yU,lIKw]pgc],sG]eSTgm],pn]tac];hn]Tuic]kUn];pQn]El:pn]hqc];sG]kUn];pQn]n}. pQn]lgc]:
Sac]:tac];Agk],pn] pn]hLAn]niuc]: An]p},tqp];tt];l}:nn].yw]."
 lgc]:SiUc],Sim];pn]eKL:lp].pn]n}. pQn]eKL:lm],lgc]:An]nuic]: tgn]:tL,kUn];pQn]El: kUn];hiUn];
kUn];pQn]Kw]:sU;sm]sC]kn]nn].yw]."
lgc]:kUn];him];hgm]; Kw]:sg}:Tqm]
lgc]:kUn];him];hgm];Kw]:(km]:nm]Et.kUn];him];hiUn];)sg}:Tqm]pn]n}. ethQt];hG]:PU:lum];lL;kUn];pQn]Kw]mw]SL,sC]
sUw]:kqp]." tUw]yac],-ygn].kUn];him];hiUn];mL;s}g:tUv];kUn];pQn]pn]kqp].km];El:kUn];pC].kUn];pQn]ekL:sac]:mI;Kaw];
yam];tL,hQt];Sac]:tac],lgc]:Pgc]:miUn]nc],Kw]:hUm]:hQt];tac];lU,tac];tan];tI:wt].Am],nn]lQn]:Agk],hqc];"
281
tac];pQn]kQw],lUv]:SQn]:tac];TUv]:sC]
21
21.1 tac];pQn]lgt],lUm];TUv]:sG]pgt];nUiw]
lgt],lUm];TUv]:sG] kiuc].kac].sp];tit];tac];pQn]h}a.hqc]; (ARI )-sum];lgt],lUm];TUv]:sG]sp];tit];tac];pQn]
lgt],lUm];TUv]:sG]pgt];niUw] sp];tit];tac];pQn] (URTIs ) Am],nn] lgt],lUm];TUv]:sG] pgt];tC]:
sp];tit];tac];pQn] (LRTIs )
eKL:piut],tI:pgc],
lgt],lUm];TUv]:sG]sp];tit];tac];pQn]An]wL:n}. pQn]hU' KU:lc]' eKL;' lgt],lUm];El: lgt],lUm];Sqn];
kac]sQm]sUiw];n}. hgc].wL:sp];tit];tac];pQn]lgt],lUm];TUv]:sG]pgt];nUiw]n}yw]." tac];pQn]sUiw];n}. km]:nm]
pQn]ygn]. sUiw].mqc];w};rt].S] etpQn]sUw]:Kaw];kUv];eS etha}kGL,hc];kUv];mn];" Am],sp];tit];Tiuc]pgt],"
Sc]wL:pQn]tac];pQn]n}.huic] 7 wn]; Am],nn] tac];pQn]mn];haw].hqc];mL;lUiw]kw],suic] sac]:pQn]ygn].sUiw].mqc];
pqk],TI;rI;yL; Am],nn] pQn]K}:wt];yG],nUk].n}yw]."
Pac]hac]:tac];pQn]
 km]:nm] - lUm];m}:Kuin]:' hUw]K}:' mak],ln]kG]:' A}"
 tgn]:hU - hUlqc]' sQp];Kuin]:' nm].ngc]Agk],' hUnUk],"
 KU:lc] - KI:muk]:yg}.' nL:kG]:eS kUn].kUn].Kuin]:Kiun]:"
 eKL; - eKL;sQp];' eKL;hap],' lin].k},etkG]: etAUm]ngc]"
Aic]nUiw]Pac]hac]:tac]:pQn]eSsqk],EPl}:wL:sp];tit];tac];pQn]lWt],lUm];TUv]:sG](URTI) An]Am],haw].hqc];'
pan]kac] El: haw].hqc];n}yw]."
lgt],lUm];TUv]:sG]pgt];nUiw] sp];tit];tac];pQn]An]Am],haw].hqc]; (Mild URTI)

sp];kt];
sp];kt];Ait];Agt];eSpQn]mL;tac];pQn]lgt],lUm];TUv]:sG]pgt];nUiw] (URTI)An]Am],haw].hqc];n}. pQn]ygn].
sUiw].mqc];w};rt].S]n}yw]." km]:nm] kUn];hw];PG]ekL:k}.pQn]yU,El: Am],pQn]eP;Sc]" tUc],wUc];him];hgm];tI:
lG]eSAm],wL: kUn];km]:nm] etpQn]tac];pQn]An]n}. mUiw]:lQw]kn]ekL:mI;"
282
tac];pQn]kQw],lUv]:SQn]:tac];TUv]:sC] 21
kUc]lup],KU:lc]sQp]; (sinusitis)
kUc]Tm]:nC];KU;lc]An]niuc]:Am],nn] nm]liUw]nn].sp];tit];siUw].mqc];nn].yw]." kUn];km]:nm]An]pQn]tac];
pQn]An]n}.n}. etpQn]kUn];sUiw];An]sp];kt]; Am],nn] kgp]:sp];tit];siUw].mqc];w};rt].S] eSEl:pQn]
nn].yw]." w}a;eSkUc]lup],KU:lc]sQp]; kgp]:sp];tit];sUiw].mqc];w};rt].S]nn]. sUiw].mqc];pqk],TI;rI;yL;sac]:
Kw]:sgm];Tqc]:" kUn];pQn]An]pQn]tac];pQn]kUc]lup],KU;lc]sQp];ygn].sUiw].mqc];pqk],TI;rI;yL;n}. Pac]hac]:tac];
pQn] kUn].kUn].Kuin]:Kuin]:' hUw]K}:' Am],yU,lIsUiw];n}. ethaw].hqc];mL;liUw]kw],"
kUc]eKL;kG]:sQp]; (Pharyngitis)
kUc]eKL;kG]:sQp];n}.pQn]tac];pQn]An]k}.pQn]km]:nm]El: mac]pgk]:mac]lG] kUn];pQn] etpQn]eKL;sQp];An]lQw]
El:Auin]Kgc]kin]n}etsQp];" km]:nm] Pac]hac]:ethaw].hqc];mL;nC];Kaw];tac]; 2-3 wn]; epL;huic]kGL,mgk]:
nuic]:wUc]:ekL: etha}kGL,km];lg};lg};"
hUkG]: tUv];tI:kn] 21.1"
lgc]:yUt];yL
 pQn]Ait];Agt];kUv];Et. Am],tap]:pn]yL" hG]:kUn];pQn]kin]nm].nm]nm]" Sc]pQn]luk]:Agn], kin]
nUm];suic] pn]kin]nUm];nm]nm]" etAm],l}:pn]yLKL:sUiw].mqc];"
 Sc]wL:lUm];m}:Kuin]:Ait];Agt];kUv];n}suic] Aw]PL:sup].nm].eSsQt].pn]tUw]" epL;wL:Tuk],lIpiut],n}
ekL:hG]: puit],Pt].lUm];pn]" tL,lUm];m}:tUk];' KUp];KUp];Kuin]:Kuin]:El: hUw]K}:etha}nn]. hG]:pn] yL
Paracetamole" ham]:nuc]:SUiw]:KUw];nLnL El:hUm],PL:nLnLpn]kUn];pQn]n}yw]."
 yLptI,KYI<wnn}. epL;Tat]:Am],mqn]:kUn];pQn]suic] sac]:hQt];hG]:pQn]tgc].kGL,' eAL.hak]:' Agk],
mun],man], sUiw];n}El: epL;pQn]lgt],lUm];TUv]:sG]pgt];nUiw] An]Am],haw].hqc]; Am],Tuk],lIpn]kin]
yLptI,KYI<wn Sc]n}yw]."
lgt],lUm];TUv]:sG]pgt];nUiw]sp];tit];tac];pQn]pan]kac]
lin].k},kG]: (Tonsillitis)
pQn]lin].k}, An]mI;tc];lc]SuUp];hw];nn]. sp];tit];sUiw].mqc];eSkG]:mL;nn]. hgc].wL:lin].k},kG]:n}yw]."
lgc]:Kan]sG]n}. etmUin]kn]tc];kUc]eKL;kG]:sQp];nn].yw]." kUv];kL:ethaw].hqc];lUiw]kUc]eKL;kG]:sQp];" pUic]lUc]
mn];Et. lgc]:nUiw].m}:El:Am],yU,lInn]. ethaw].hqc];liUw]" mUiw]:Auin]tac];kin]tac];yqm]. Am],nn]
ngn];KI:kqc];n} etsQp];haw].hqc];" hUv],mak],ln]etkG]:Kuin]:mL;' lin].k},etkG]:AUm]ngc]El: mI;tum],Kaw]Kaw]"
ygn].sUiw].mqc];w};rt].S]eSpQn]lin].k},kG]:n}. huic] 3-4 wn];yw].ekL: etha}kGL, hc];kUv];mn];" tum],AUm]
ngc]tI:lin].k}, (tUv];tac];lc])' lup],kp];lup],etL,sQp]; (tUv];tI:kn] 8.4) pQn]mak],kqw];kuic].kac].kG]:
AUm]ngc] (tUv];tI:tgn]: 13.3) siUw];An]Pgn];sL.mL;tc];lc]n}. nc],huiw]eteh.kc]:l}:nn]. wUn].Sgn],
tL,pn]yLptI,KYI<wn"
283
21 tac];pQn]kQw],lUv]:SQn]:tac];TUv]:sC]
lgc]:yUt];yL
 pn]yL Penicillin V PO (500mg QID' luk]:Agn], 15mg/kg QID) tL,10 wn];"
Sc]wL:pn]eA,liUw] 10 wn];suic] etAm],eh.kc]:l}:tac];pQn]eKL:etL,sQp];l}:)" Sc]mI;n}
hG]:pn]yL Benzathine Penicillin (50.000IU/kg)IM STAT " Sc]wL: Am],mqn];tc];yL Penicillin
hG]:pn]yL Erythomycin (10mg/kg) IM " pn]yLtQk];lUm];m}:" hG]:kUn];pQn]kin]nm]. nm]nm]'
epL;pQn]luk]:Agn],kin]nUm];n} hG]:Em:pn]kin]nUm];nm]nm]"
Sc]wL:kUn];pQn]Am],KG]:kin]KG]:yqm].suic] Aw]kUn];pQn]ngn];hgc]:yLeS SCac]; IV pn]" pn]yLptI,KYI<wn
sgm];nc],pL:tG]:"
 luk]:Agn], pn]yL Benzathine Penicillin (50.000IU/kg) IM STAT dose
Am],nn] Benzyl Penicillin (50mg/kg QID) IV tL, 10 wn];"

kUn];lUc] pn]yL Ampicillin 1gram QID IV Am],nn] IM
Am],nn] Benzathine Penicillin 2,4 gram QID IV
Sc]wL:kUn];pQn]Auin]l}:yU,suic] pn]yLkin] Penicillin V(500mg QID)tL, 10 wn];"

A}tUc];luk]:Agn],(Croup)
wa};eSsUiw].mqc];w};rt].S]Kw]:yw].SQc]hap],' TUv]:sG]yap],' A}hut],Kw]:luik].luik].n}. hgc].wL:A}hut],n}yw]."
kUn];An]pQn]haw].hqc];n}. etTUv]:sG]yap]," Aic]nUiw]Pac]hac]:haw].hqc];tac];pQn]eS la};yUt];yL et
pqk],pUic]:kn]" Sc]wL:Am],haw].hqc];n} yU,yU,ekL:etha}kGL,kUv];mn];" Sut],Aa}nm].Aun],n}. ets}g:hG]:
lIKiun]: (hG]:fac].yL,hG]:Aa}nm].Aun],hup],SG],)" Sc]wL:TUv]:sG]yap],mL;lUiw]kw],' hiUw].AUn]:' Piw]nc]Sgm],'
Kat],Tat]:nm].suic]SG],Sa}ma}kUn];pQn]nG];eSyUt];yLpn]" wUn].Sgn],tL,pn]yL Steroids El:
Adrenaline Sut],lUm]tI:KU:lc]"
A}hut], (Pertussis or whooping cough)
lgc]:etl}:fac].tUv];tac];pQn]
tUv];tI:eKL:PiUm].Tqm]
A}hut],n}. sac]:eP:tUin];ca}:eS sp];tit];kn]ca}:Et.Et.yw]." tac];pQn]An]n}.pQn]ygn]. sUiw].mqc];

pqk],TI:rI;yL; Berdetella Pertussis yw]." tac];pQn]A}hut],n}. etEt,pQn]mL;tI:lgt],lUm]; TUv]:sG]
pgt];nUiw] An]Am],h}a.hqc];El: w}a;eSpQn]l}: wUc]:Sgc]wUc]:yw]. etmI;Pac]hac]:A}' km]:nm] etpQn]kac]
Kuin];eShak]:pL;n}yw]."Sc]pQn]pgt],kI:mL; Kqn];etSuk].Sak].liUw]kw], (luk]:Agn],lqc]El: luk]:Agn],lQk].
etk}.pQn]kn]nm])" pn]yL Erythromycin hG]:kUn];An]mI;him];hgm];kUn];pQn]kU:ekL.n}. pQn]tL,yUt];yLEl:
eh.kc]:tac];pQn]Am],hG]:eP:kGL,sp];tit];kUn];tac],ekL.nn].yw]." lgc]:Am],hG]:luk]:Agn],Kat],Tat]:nm].
n}.ekL:etl}:SC],sC]Et.Et." yLEh.kc]:tac];pQn]A}hut],n}. eh.kc]: Am],pn]luk]:Agn],pQn]haw].hqc];l}:"
284
lgt],lUm];TUv]:sG]pgt];nUiw]sp];tit];tac];pQn] haw].hqc]; (Severe URTI)
lin].k},kG]:AUm]ngc] (Peri Tonsillar Abscess)

kUn];pQn]mI;lUm];naw]Kuin]:' Auin]yap],El: lin].k},kG]:Pa},lQw]suic] Tuk],lIpn] yLptI,KYI<wnyU,(tUv];tI:
lgc]:yUt];yLlin].k},kG]:pL:niUw])" Sc]wL:sm]pQn]n}ekL: etl}:PL,sup],ngc]Agk],pqt]:"
lin].hUm],lgt],lUm]; kiuc].kac].sQp];kC]:haw].hqc]; (Acute Epiglottitis)

lin].hUm],lgt],lUm]; kiuc].kac].sp];tit];sUiw].mqc];pqk],TI;rI;yL;eS kC]:ha}.hqc];" luk]:Agn],AL,yu 2-5 KUp],
etk}.pQn]kn]km]:nm]" tac];pQn]An]n}. etkuic].kac].pQn]mL;eS Pac]hac]:tac];pQn] etlqk]:l}a:haw].hqc];
w};" luk]:Agn],An]yU,lIyU,ekL.niuc]:n}. etkuic].kac].eKL;sQp];El: lUm];naw]etkuic].kac].Kuin]:haw].hqc];"
luk]:Agn], etTUv]:sG]w};' mUiw]:TUv]:sG]Kw]:nn]. etl}:cin];SQc]emL; (KlUt].KlUt].) hqc];hqc];' ygn].
TUv]:sG]yap],El: nc],huiw]lUm];etKw]:nG]:pgt],nm]nm]nn]. Kw]etAw]hUw]c}akCL, tac];lc]eS yiut]:eKL;
TUv]:sG]yw]." ygn].Auin] yap],El: ethQt];hG]:nm].l}a;l}lUc];mL;tik];tik];" sUiw].mqc];Kw]:eS hQt];hG]:
lin].hUm],lgt],lUm];kG]:n}. etAuit];SC],lgt],lUm];eS hQt];hG]:TUv]:sG]yap],El: sac]:ta}l}:w};nn].yw]."
pQn]cw];l}a;Kuik].Kak].El: etl}:yUt];yL pn]km];lQw]"
lgc]:yUt];yL
 yL,hQt];hG]:luk]:Agn],Suk].yuc]:sG]"
 yL,Aw]hUw]luk]:Agn],lm],lUc];tac];tG]:' yL,Aw]Sc]eSAn]An]tQk];lin].tUv];nG];kUc]eKL;lL;lL;"
 Aw]yL Adrenaline (5cc Kgc] 1:1000) pn]Sut],lUm]tI:KU:lc]"
 pn]yL Ceftriaxone IV/IM STAT "
 SUc],kUn];pQn]kGL,hgc]:yL/hUc];yLKn]w};"
tac];pQn]eKL;hip], (Diptheria)
tac];pQn]eKL:hip],n}. pQn]tac];pQn]sp];tit];siUw].mqc]; luk].tI:kUn];ekL.niuc]:A}' sam]eSKI:tUiw], An]

Agk],mL;tI:nG];kUc]eKL;Kw]nn]. kCL,sp];tac],ekL.El: pQn]tac];pQn]An]sac]:sp];tit];l}:nn].yw]."
tac];pQn]eKL:hip],n}.pQn]kgp]:kgc].An]sUiw].mqc];pqk],TI;rI;yL;hQt];tqk],eP:Agk],mL;nC];tUw]nn].yw]." Sc]wL:
kUn];pQn]pQn]lin].k},kC]:El: yC];Piw]hUik],kac]haw]pQn]SIkGan];f};' mak],ln]tI:eKL;kG]:' lUm];naw]Kuin]:Suc]'
yQw]:eA,sUiw];n}.suic]hG]:wUn].Sgn],wL: pQn]tac];pQn]eKL;hip]," epL;wUn].wL: lqp]:etpQn]tac];pQn]n}suic]
hG]:SUc],kUn];pQn]kGL,hgc]:yLkm];Siuw]:"
285
lgc]:yUt];yL
 yqk]:kUn];pQn]w}.hc];kUv];" SUc],kUn];pQn]kGL,hgc]:yL/hUc];yLw};w};"
 Sc]pQn]l}:n}suic] Aw]pgt];nUiw]. nG];Ek:hUik],kac]haw]El: KU:lc]mL;lQc].siUw].mqc];tL,kUt],sqt]:"
 Sc]wUn].Sgn],wL: pQn]tac];pQn]l}:n}suic] hG]:pn] yLptI,KYI<wn"
 Benzathine Penicillin- kUn];lUc] 2.4 gram QID IV tL, 14 wn];"
luk]:Agn], 50mg/kg QID IV tL, 14 wn];"
Am],nn] Erythromy kUn];lUc] 1 gram QID PO tL, 14 wn];
luk]:Agn], 15mg/kg QID PO tL, 14 wn];"
 pn]yLEk:kgc].hQt];hG]:lUit]:mUt];SG]"(sgm];nc],pL:tG]:n}.)
sac]:Am],Tuk],mqn]:yLEl: tL,etpn]yLEk:kgc].hG]:lUit]:mUt];SG]nn]. etl}:Pac].eSpn]n}yw]." pn]
0.1ml sc eSpG].tUv];nG];Kaw];tac]; 15 minit]." Sc]wL:Am],mI;Pac]hac]: An]Am],Tuk],mqn]:yL -
Agk],tum],KUm];' pQn],Piun],lqc]tI:him];hgm];An]sam];yLw}.n}suic]pn]Tqc]: 0.25 ml sc "
 pG].tUv];cw];la};nG];Kaw];tac]; 15 minit].eSSuip],pn] IV Am],nn] IM Tqc]:"
Sc]wL:Am]Tuk],mqn]:yLeS kiuc].kac].lium];tUw]n}suic] luk]:Agn], mg/kg
hG]:Sm];pn]yL Adrenaline IM kUn];lUc] –0.75 mg/ pgk]:
 kUn];sUiw];An]yU,sm]kUn];pQn]nn].ekL: etl}:Sm];pn]yL Benzathine Penicillin IM pgk]:lQw]

Am],nn] Erythromy PO tL, 7 wn];"
 tUic],pac],tc];emLyLeS hQt];sgm];nc], piUc]nm];tL,tac];pQn]An]sp];tit];l}:nG];Sun]p}a:eP;"
K}:wt];nUk]. (Avian Influenza A)

K}:wt];nUk]. “A” (H5N1) An]kUn];km].pL:nm]pQn]
eKL:piut],tI:pgc],
tac];pQn]K}:wt];nUk].n}. pQn]tac];pQn]An]sp];tit];l}:kgp]:tiUw].vL;kn] An]pQn]tI:nUk].kUv];El: hn]
pQn]mL;Ait];Agt];Et.pQn]mU" sUiw].mqc];w};rt].S] Avian influenza Kgc]tac];pQn]K}:wt];nUk].n}. pQn]sUiw].
Pn];An]nuic]:tqk],eP:kGL,nC];siUw].Pn];Kw]kUv];" kUv];kL:mac]pgk]:mac]lG] An]tI:tqk],EP:nn]. pUn].Kam]:
mL;eSsac]:sp];tit];sU;Tuic]tI:kUn];" sUiw].mqc];w};rt].S]naw]K}:wt];nUk].An]eP:tiun];yU,nn]. siUw].mqc];
w};rt].S] H5N1 n}.pQn]eP;yG],lUc]El: lgc]:m}:sC]yC],liUw]piUn]: tgn]:tL,p}a;yU,lIsiUw].KiUw];kUn];yam];lQw]
n}.yw]." kUn];An]sp];tit];tac];pQn]An]n}.n}. Kiuc]:niuc]: l}:ta}kGL,n}yw]." Sc]wL:cw];la};pn]n} sUiw].
286
mqc];w};rt].S] H5N1 n}.sac]:tqk],ya}: yQn];pQn]eP; tac];pQn]yG],lUc] EP:tiun];kGL,tc];km],fL,yw]."
tac];pQn]n}.luk].tI:nUk].eS sac]:sp];tit];sU;kUn];l}:km]:nm]nn].Et. ygn].Sut],mqn]:vL;Pun],Pgc]
nm].An]mI;sUiw].mqc]; Am],nn] kGL,tUiw].vL; An]mI;sUiw].mqc];km];Siuw]: siUw];n}.yw]."
Pac]hac]:tac];pQn]
 hUw]K}:' nUiw].m}:' KUp];KUp];Kuin]:Kuin]:sgm];tUw]  tgc].kGL,"
 Pac]hac]:tac];pQn]lgt],lUm];TUv]:sG] (A}'  TUv]:sG]yap], (hUiw].AUn]:)"
eKL;sQp];' KI:muk]:l})"  pgt],kI:"
lgc]:KUn].hLmk];mn]:tac];pQn] - sgm];nc],eKL:mk];mn]:muk].sum];lUc]p}a;yU,lIlum]:fL.
 kUn];An]lqp]:etsp];tac];pQn]w};rt].S] H5N1
kUn];pQn] An]kuic].kac].pQn]tac];pQn] lgt],lUm];TUv]:sG]pgt];tG]:El: hLlgc]:tac];pQn]Am],l}:' lUm];naw]
Suc]lUiw] 38 Mc' A} Am],nn] TUv]:sG]yap],"
El: mUiw]:p},mI;Pac]hac]:tac];pQn] pUn].mL; 7 wn];nn]. yam]:mI;lgc]:TUp];vL;lgc]:niuc]: Am],nn] nm]liUw]
sgm];nc],pL:tC]:-
 l}:tiUw].vL;' yU,sm] (nC];niuc]:mI,tL,) tc];  l}:kin]vL;nUiw].lip]; Am],nn] Am],
kUn];pQn] An]Tac],TiUm]wL:pQn] H5N1 Am],nn] Suk]; Am],lip]; An]l}:mL;tI:nC];
pQn]l}:' Am],nn] mk];mn]:wL:pQn] (tUw]yac],- piun].tI:An]hU.lIwL: tUw]St];
kgp]:l}:yU,lum];lL;kUn];pQn]l}:lat]:etL,kn]El: Am],nn] kUn]; An]tuik].sp];tit];
tUiw].vL;kn]) tac];pQn]yU, nC]; 1 lUin]pUn].mL;"
 yam]:tUiw].vL; nUiw].lip]; Am],nn] nUk].TUin],  l}:tUiw].vL; nUiw].St];' tUw]St];
eSAn]An] (tUw]yac], - yip];vL;' hqm]ta}' An] Am],sC]:nUk].TUin], Am],nn]
TUv]:KUn]' tqp];Pn];' huc]KUw]:) Am],nn] pUn].mL; tUw]St]; Am],mI;pik], (miUn]nc], mqw];'
1 lUin]nn]. l}:tUiw].vL; kUn];An]lqp]:pQn] mU) An]l}:mk];mn]:wL: pQn] H5N1"
H5N1 Am],nn] pQn]l}:' Am],nn]
 l}:tUiw].vL;tUw]yac],kUn];El: tUw]
mk];mn]:wL:pQn] H5N1 Am],nn] l}:tUiw].vL; KI: St];tL,kUt],sqt]:nC];hgc]:lqp],
Am],nn] piun].tI: An]hU.lIwL: tUw]St]; Am],nn] tac],tI:"
Am],nn] kUn];An] tuik].sp];tit];tac]; pQn]mL;"
287
tac];pQn]kQw],lUv]:SQn]:tac];TUv]:sC]
21
 kUn];pQn]An]lqp]:etpQn] H5N1
eKL:piut],tI:pgc], lqp]:etpQn] 1 eKL:piut],tI:pgc], lqp]:etpQn] 2

kUn];pQn]An]Tac],TiUm]wL: pQn]sgm];nc], eKL:pL:  kUn];pQn]kuic].kac].pQn]tac];pQn]lgt],lUm];TUv]:
niUw]El: eKL:An]PiUm].Tqm]mL;pL:tC]:niuc]:eKL: sG]haw].hqc]; An]sm]t}aEl: hLlgc]:tac];
 nC];Pqn], (X-Ray) nn].l}:hn]mQt].Kaw]Kaw] Am],hn] kUv];kL:mI;lgc]:kgc].ka},eSlgc]:lgc]:
Am],nn] lk];Tan]kuic].kac].pQn]pgt],kI: hUm]: mUin]nc], Kaw];yam];' tI:yU, kQw],lUv]:lgc]:
tc]; l}:hn]hqc];hQt];kan]lgt],lUm];TUv]:sG] EP:tiun];tac];pQn]El: tiUw].vL;An]Aap]:
eA, (Agk],SI,kiYn],nG];lUit]:ygm];tUk];' TUv]: etsp];tit];tac];pQn] Am],nn] mk];mn]:
sG]w};pUn].tI:)" Am],nn] wL: pQn] H5N1"
 l}:eKL:tgp],tI:hgc]:lqp],wL:pQn] naw]K}:wt];
nUk]. A n}eStL. Am],mI;lk];Tan]tQm]TUn]:
tgn]:tL, mk];mn]:wL:pQn] H5N1"
 kUn];pQn]An]mk];mn]:wL:pQn]H5N1
kUn];ekL.An]mI;eKL:mun]; tQm]TUn]: tc];An]Tac],TUim]El: An]lqp]:pQn]" eKL:tWp],hgc]:lqp], PCR An]
Am],mUin]kn] (tUw]yac],- nC]; Primers tL, influenza A eKLeKLEl: K},lUit]:kam]: protein H5 )
Sgc]An]nn].wL: mI;sUiw].mqc]; H5 yU,"
sC].hgc]:lqp],eSKUn].hLmk];mn];tac];pQn]
CBC ' epL. AQk].S]er; tI:nL:AUk];' lQc].sUiw].mqc];nG];hgc]:lqp], tL,kUt],sqt]:El: PCR"
lgc]:yUt];yL
kUn];pQn]An]Tac],TUim] Am],nn] An]lqp]:etpQn]l}:nn]. Tuk],lISUc],kUn];pQn]kGL,hUc];yL lUc]pgc]suic]:
Kn]w}; nc],kL:pQn]l}: hUm]:tc];etl}:fac]. Am],hG]:tac];pQn]EP:tiun];l}:" (SG],PL:pUk].SuUp]; (mask)
SC],TUc]muiw];El: hG]:yU,sm] Am],nn] tiUw].vL;kUn];pQn]eA,liUw]piUn]:)"
mUiw]:p},l}:SUc],kUn];pQn]nn]. Tuk],lIhQt];Sac]:sgm];pUic]nc],pL:tC]:n}."
 w}.hc];kUv]; - etl}:Aw]kUn];pQn]w}.hc];kUv];" Am],Tuk],lIpn]PC] Kw]:yQm]:sC];kUn];pQn]"
 yUt];yLpn]lUm];naw] - pn]Tat]:nm].kUn];pQn]hG]:tQm]TUn]:"
 lgc]:Eh.kc]:sp];tit];tac];pQn] - kUn];pQn] etl}:hUm],SuUp]; El:KU:lc]w}.tL,eS," miUw]:A}
Am],nn] sam] nn].etl}:Aw]Pqn],tUm];SuUp];w}.yw]."
 yLKL:sUiw].mqc]; - tL,yUt];yLsUiw].mqc];pqk],TI;rI;yL; An]etKw]:mL;Tqc]:nn]. Tuk],lIpn]
288
tac];pQn]kQw],lUv]:SQn]:TUv]:sC] 21
(IV/IM Ampicillin El: Gentamicin)"
 Steroids n}. sG].tL,yUt];yLtac];pQn]TUv]:sG]yap], An]kuic].kac].pQn]mL;nn].yw]."
 yLtuik];sUiw].mqc];w};rt].S] - kgp]:wL: yLAn]Am],tap]:etl}:sG].eSsG].n}. sac]:hQt];hG]:siUw].mqc];
tiuw]yLl}:El: Am],Tuk],lISiuw].yLsiUw];n}.mL;sC].hc];kUv];" Sc]wL:tk];etl}:sC].n}suic]hUc];yLKw]
etPUim].Tqm]pn]yU,yw]."
lgc]:eh.kc]:
etl}:yqk]:kUn];pQn]yU,hc];kUv];eKLeKLsQm]sw]." Suk]:muiw];hG]:mUt];SG] (lgc]:Tuk],lIPac].An]sC].kn] tc];
km],fL, kn] - 5)" PU:hap],kan]pa};yU,lItc];SQc]: sUiw];yip];tUiw].vL;kUn];pQn]nn]. etl}:SG],Pqn],
pUk].SuUp];' TUc]muiw];' KUw];nuc]:An]hUm],tUw]l}:tc];tUw]El: Sc]wL:tk];etl}:tiuw];suic] hG]:tuiw];pL;
man],tLsgm];" hqm]tUw]St];sgm];hUin];sUiw];sp];tit];sUiw].mqc];tac];pQn]nn].ta}pqt]:mUt];tL,hG]:tac];pQn]Am],
eP:kCL,Tqc]:"
yLeh.kc]: yLEh.kc]:naw]K}:wt];nUk].( H5) tL,kUn];n}.Am],mI;"
Aac]:Aic] tac];pQn]pgt],sp];kt]; (kn] 21.1)' tac];pQn]pgt],kI: (kn] 21.2)'

yG];hUm],Agk];eALkG]: (tUv];tI:tgn]: 15.1)"
hUkG]: (Ottitis)
eKL:piut],tI:pgc],
hUkG]:An]wL:n}. pQn]hUsp];tit];sUiw].mqc];eSsQp];kG]:nn].yw]." hUkG]:n}. etmI;Sgc]Kn].tgn]:-ngk]:hUkG]:El:
kac]hUkG]: (nG];hUkG]:)n}yw]." luk]:Agn],kUit],mG],El: luk]:Agn],lQk].n}. etAm], emLlat]:wL: hUsQp];"
kgp]:n}epL;mI;Pac]hac]: mI;lUm];naw]An]Am],hU.lgc]:tac];' eAL.hak]:' h}:' sG]lm]sG]pgt];El: tgc].kGL,sUiw];
n}. n}siuc] h]G:kUt],sqt]:hUluk]:Agn],"
1.ngk:] hUkG]:sQp]; (Ottitis external)

eKL:piut],tI:pgc], SQn]:tac];hUtac];ngk]: sp];tit];tac];pQn]Piw]nc] (ngk]:hU)"
Pac]hac]:tac];pQn]
 sQp];kqn];' him];hgm];SQn]:tac];ngk]:hUlqc]' mac]pgk]:mac]lG] kG]:AUm]ngc]"
 lI,hUpQn]pk],ktI," mac]pgk]:mac]lG] ethn]sUiw].mqc];hQp]; mI;sgm];SQn]:tac];ngk]:hU "
 mI;mac]siUw].mac]An]Kw]:kGL,nG];hU (An]tI:Am],Tuk],lImI;nG];hU' miUn]nc], mQt].Pk];)"
289
lgc]:yUt];yL
 Aw]nm].mUt];SC] Am],nn] Normal Saline lac].hUpn]hC]:mUt];SG]" pUic]lUc]mn];miUw]:mI;ngc]El:
nm]."
 mI;mac]siUw].mac]An]Kw]:kGL,nG];hUsuic] yLAw]nun];kuv]eS,nG];hU" nc],huiw]etAgk],nn]. Aw]nm].mn];
lac].pn]lg}:lg};" (mac]pgk]:mac]lG] etl}:hQt];siUc].n}pn]tL, 2-3 wn]; sc],kg}:Agk],mL;)"
 Aw]nun];kuv]sup].nm].yLeS tL;pn]tI:sQp];"
 yUt];yLnc]tI:wL:mL;kU:wn]; etL,Tuic]sQp];epL;ha}" (km].nm]ethuic] 3-5 wn];)"
 Sc]wL:KUp];KUp];Kuin]:Kuin]:El: mI;lUm];naw]suic] hG]:yUt];yLpn]" (tUv];tI: kn] 7.4 El:7.5)"
 huic]lUiw] 5 wn];yw]. Am],p},ha}suic] hG]:pn]yLkin] Cloxacillin"
2. kuic].kac].pQn]hUkG]:sQp]; (Acute Ottitis media)
eKL:piut],tI:pgc],
nG];hU (lc]lI,hU)kuic].kac].sp];tit];sUiw].mqc];pqk],TI;rI;yL; Am],nn] w};rt].S]haw].hqc];"
Pac]hac]:tac];pQn]
 KUp];KUp];Kuin]:Kuin]:ha}.hqc]; (km]:nm] kac]Kiun];)' nUiw].m}:"
 h}:' sG]pit];sC]pgt];' eAL.hak]:' tgc].kGL,"
 lI,hUetlqc]' kG]:pgc];' ygn].pUiw]:Agk],ngc]El: ethn]pQn]hU;pQn]hU;w}."
lgc]:yUt];yL
 Sc]wL:mI;ngc]Agk], hG]:Aw]nun];kuv]sup].nm].mUt];SG] Am],nn] Normal Saline eSlac].pn]hG]:
mUt];SG]"
 yUt];yLpn] lgc]:lUm];naw]El:KUp];KUp];Kuin]:Kuin]: (tUv];tI: kn] 7.4 El:7.5)"
 pn]yLkin] Amoxicillin tL, 10 wn];" Sc]wL:kUn];pQn]Am],mqn]: Amoxicillin suic] hG]:pn]yL
Cotrimoxazole tL, 10 wn];"
3. kac]hU (nC];hU) kG]:sQp];Kaw];huic] (Chronic ottitis media)
eKL:piut],tI:pgc], kac]hU (nG];hU)nn]. AUm]ngc]w}.Kaw];huic]El:lI,hUtqk],"
290
Pac]hac]:tac];pQn]
 hUetAUm]ngc]huic]mgk]: 2 wUc]:Kuin]:pL:nUiw]"
 Am],mI;lUm];naw] ' Am],kUn].Am],Kuin]:"
lgc]:yUt];yL
 Sc]wL:mI;hG]:pn]yLptI,KYI<wn yLygt], (tUw]yac],-Cadexcin ear drops ) tI:eA,Sut];tL, 2wUc]:"
 Aw]nun];kuv]SG],w}.nG];hU;hUeS Sc]pQn]luk]:Agn], etl}:sG].Em:mn];la}:pn] 6 sUw]:mUc]; nuic]:pgk]:"
(etl}:SC],kGL,etL,Tuic]hUepL:hqc]:)
 tL,SG],yLsQp];nn]. Sc]wL:Am],pQn]l}:n}suic] hG]:pn]yLkin] Amoxicillin tL, 2 wUc]:"
➔ tL,tgc];" " Sc]wL:mI:lUm];naw]' kUn].kUn].Kuin]:Kuin]:n}suic] etl}:yUt];yLsgm];nc],la};yUt]; yL
tac];pQn]kac]hU (nG];hU)kG]:nn].yw]."
epL;wL:hUkG]:sQp];n}suic] sac]:pQn] lup],hUkG]: sgm];lc]mL;Tqc]:El: (sac]:sp];tit];sU;lup],hUtac];lc])
etl}:Pac].yw]." Sc]wL:pQn]n} etsQp];kC]:h}a.hqc];El:etsQp];c}a:" etl}:PL,tt];El:
tk];etl}:SUc],kUn];pQn]kGL,hUc];yL" hG]:pn]yL Amoxicillin w}.Agn]tac];kWn],"
lgc]:eh.kc]:
Sc]wL:hUluk]:Agn],kG]:yU,n}suic] epL:Em:luk]:Agn],Am],lIlut],lqn];yL:" Sc]hU.wL:pQn]hUkuic].kac].sp];
tit];tac];pQn]h}a.hqc];El: yUt];yLpn]sQm]sw].km];Siuw]:n} etEh.kc]:pn]tac];pQn] kac]hU (nG];hU)
sQp];Kaw];huic]El: lup],hUkG]:l}:"
Aac]:Aic] lgt],lUm];TUv]:sG]pgt];niUw]sp];tit];siUw].mqc]; (kn] 21.1)"
21.2 tac];pQn]pgt],kI: (Pneumonia)

lgt],lUm];TUv]:sG]pgt];tC]: sp];tit];tac];pQn](LRTIs)
eKL:piut],tI:pgc],
pgt],kI: Am],nn] lgt],lUm];TUv]:sG]pgt];tG]:sp];tit];tac];pQn]n}.ygn].wL: pgt],El:lgt],lUm];lQk].
sp];tit];sUiw].mqc];w};rt].S]' pqk],TI;rI;yL;' siUw].mqc];pL,rL,S}. El: hQp];eSpQn]mL;n}yw]." Aic]niUw]
pgt],kI:An]luk]:Agn],pQn]El:kUn];lUc]pQn]eS eKL:piut],tI:pgc],ekL: etpqk],pUic]:kn]kCL,"
291
eKL:piut],tI:pgc],pgt],kI: An]luk]:Agn],pQn]
pgt],kI: tac];w};lUm];TUv]:sG]nG]; AL,yu 2 lUin]lUc];tG]: 60 km];Kuin]:nUiw]
1 minit]. AL,yunG];Ek: 2-11 lUin] 50 km];Kuin]:
nUiw] AL,yunG];Ek: 1-5 KUp], 40
km];Kuin]:nUiw]
pgt],kI:haw].hqc]; pgt],kI:El:lin].tgc].lgk]; Kw]:
kCL,tac];nC];AUk];
pgt],kI:haw].hqc];pUn].tI: pgt],kI:haw].hqc];El: mI;Pac]hac]: nUiw].nc]Sgm], (SISuUp];Sgm],) lUm];TUv]:
eSAn]An]mUin]nc], Enw}.Tqc]: sGk] uit];pqt]:haw].hqc];' kin]nm]. kin]nUm];
lgk];P}a,niuc]:n}." yap],"
eKL:piut],tI:pgc],pgt],kI: An]kUn];lUc]pQn]
pgt],kI: mI:lUm];naw] ' A} El: SQc]lUm];TUv]:sG]Am],pk],ktI, (tUv];pL:tG]:)"
Pac]hc]:tac];pQn]kUn];lUc] An]haw].hqc];
TUv]:sG]w}; (lUm];TUv]:sG]luk]:Agn],AL,yu 5 pI<Kuin]:nUiw]El:kUn];lUc] nG];nuic]:
minit].nn]. nm]liUw] 30 km];"
niUw].nc]Sgm], (SI,SuUp];El: nQp].muiw]; pQn]SISgm],mL;)
StiAm],lI' tUv];hn]
An]tqk],lqc];
hqc];lUit]:tqm], (hqc];lUit]:tac];nUiw]mI; 90mmHg El:hqc];lUit]:tac];tG]:mI; 60mmHg )
hqc];tgt],lUit]:w}; (nG]; 1 minit].n}. tgt], 120 km];Kuin]:nUiw])
Pac]hac]:tac];pQn]
 TUv]:sC]yap],' TUv]:sG]w};"  lgc]:kUt],Tt];- niUw].nc]Sgm],' KU:lc]kI:hup],'
 A}' Agk],KI:tUiw], (SIlUic] SIKQw]) lin].tgc].lgk];Kw]: Am],nn] TUv]:sG]tiun]:
 A}Agk],lUit]:" Am],nn] Am],PQc],pQc];kn]
 AuUk];sQp]; (mUiw]:A}' mUiw]:TUv]:sG]hqc];hqc];)"  Aw]muiw];tg},tUv];tI:pgt],- SQc]Am],sqc]:lI"
 sG].KUic]:Tgm],hUkUt],Tt];- lUm];TUv]:sG]Am],
pk],ktI,"
liUw]eSnn]. kUn];pQn]pgt],kI: etsac]:mI;Pac]hac]:sp];tit];siUw].mqc];sgm];"
 mI;lUm];naw] ' kt];Sn],"  hqc];tgt],hUw]sG]w};"
 yU,Am],lIsG]lIeKL;"  hqc];lUit]:tUk];"
epL;Aw]KiUc]:Tgm],hU TWm]tUv];tI:pgt], etl}:cin];SQc]TUv];sG]Am],pQn]pk],ktI,"
292
- SQc]TUv]:sC] Tgm],tUv];pgt],tc];Sgc]Pa},eS tqk]:nUic];kn]' Tt];Sac]tI:Am],miUn]kn]" tac];nm]
eA,pgk]:km]; (Quantity) - ygn].tac];pQn]eS lUm];Kw]:tI:pgt],EA,El: epL;Tgm],tUv];etcin];SQc]
pgk]:km]; eA,lUc]; Am],nn] SQc]h}akCL,pQn]km];pQn]km];" SQc]l}g;SQc]hqc]; - SQc]TUv]:sG]n}. Sm],mtL,
pUin]:yU,Pa},nUiw]pgt],El: lgt],lUm];eS l}:cin];SQc]lUm];Puit].Kw]:kGL,nG];lgt],lUm];TUv]:sG]" Sc]wL: l}:
cin];SQc]lUm];TUv]:sG] tI:nUiw]pgt],An]Kw]:kGL,nG];lgt],lUm];nn].yU,suic] pQn]Pac]hac]:tac];pQn]pgt],kI:
yw]." mUiw]:lUm]; Puit].Kw]:kGL, nG];lgt],lUm];Agn],El: TUc]lUm];Agn],nn].etl}:cin];SQc] “sI.”n}yw]."
- SQc]miUn]f};m}:m}.(Crepitations) - mUiw]:KI:tUiw],El:lUm]; Kw]:kGL,nG];pgt],nn].ekL:etl}:cin];SQc]yw]."
Sc]wL:A}yw].eSha}kGL,n}suic] Am],sG]:Pac]hac]:tac];pQn]" SQc]Sm],mtL,An]yC];hUm],pgt],pgt];nUiw] TU
vL;kn]nn]. etl}:cin];SQc] “sU.sI.” hqc];hqc];yw]." yG];hUm],pgt],pgt];nUiw] Sc]Tap]:Tuv]vL;kn]nn].
etpQn]SQc]Agk],mL;yw]." (yC];hUm],pgt],kG]:n}. pQn]ygn].tac];pQn]TI,pI, El: pgt],kI:)"
- SQc]mw]nC];pgt], - SQc]An]l}:cin];yU,lg};lg};nn]. pQn]SQc]nm].Kw]:pgt],yw]." An]pQn]mL;siUc].n}n}.
pQn]ygn].lUm];Kw]:Km]w}. nG];tI:An]Am],mI;lUm];yU,w}.nn].yw]."
- Rhonchi n}.pQn]SQc]KUn]yw]." lUm];An]Puit].Kw]:mL;nG];lgt],lUm];lUc]nn].l}:Km]w}.(pQn]pgt];pQn]tgn]:)"
- lgc]:TUv]:sC]yap], (wheeze)n}. pQn]ygn].mgc]eKL:El: pQn]SQc]lUm];Puit].Kw]:mL; nG];lgt],lUm];An]

kqp]:nn].yw]." kUn];pQn]tac];pQn]mgc]eKL:sG]kp].' kUn];pQn]lgt],lUm];tip],Kaw];huic]' tac];pQn]pgt],kG]:nn].
l}:cin];SQc] tI:nG];pgt], tc];Sgc]Pa},yw]." Sc]wL:l}:cin];SQc]An]wL:mL;pL:nUiw]nn]. nG];pgt],Pa},lQw]kUbv];
eS wa};eSA}yw].Sm].ha}kGL,n}suic] etpQn]kgp]:hUv],kqn],SUiw]< (Am],nn]) pQn]eSsiUw].eSAn]mL;Auit];
lgt],lUm];w}.yw]."
sgm];nc],Pac]hac]:tac];pQn]' Sc]pQn]l}:n} epL.tUv];AQk].S]er;tI:nL:AuUk];"
kUn];pQn]An]etmI;eP;l}:
 AL,yu 2 lUin]lUc];tG]: Am],nn] AL,yu  kUn];Agk],mak],lqc]"
65 pI<Kuin]:nUiw]"  kUn];An]l}:PL,tt];mm].Agk],"
 kUn];pQn]An]Kat],Tat]:AL,hL.r Am],nn]  kUn];pQn]An]mI;tac];pQn]hUw]sG]"
pQn]lUit]:sac]h}a.hqc];"
Sc]wL:kUn];pQn] An]pQn]kUn];lUc]mI;Pac]hac]:ha}.hqc];nuic]:An] Am],nn] nm]lUiw]nuic]:An] Am],nn]

kUn];pQn]An]yU,nG];kum],An]tI:eteP;l}:n}suic] hG]:yUt];yLnc],la};yUt];yLpgt],kI:h}a.hqc];"
293
lgc]:yUt];yL
lWc]:yUt];yLetAic]niUw] Pac]hac]:tac];pQn]' AL,yu El: l}al}aeKL:"
Am],mI;Pac]hac]:ha}.hqc];El:Am],yU,nG];kum],An]mI;eP; - yUt];yLpn]tI:hgc]: OPD (Am],pQn] haw].hqc];)

mI;Pac]hac]:haw].hqc]; El:/Am],nn] yU,nG];kum]mI;eP; - hp].yUt];yLpn]nG];hgc]: IPD (pQn]haw].hqc];)
lgc]:yUt];yLpgt],kI:(Am],pQn]ha}.hqc];)
 pn]kin]nm].nm]nm]" yUt];yLpn]lUm];naw]"
 pn]yL Vitamin A tgn]:tL,Eh.kc]: hG]:luk]:Agn],AL,yu 12 pI<lUc];tG]:"
 pn]yLptI,KYI<wn Amoxicillin"
(hqc];yL)sp];tit];sUiw].mqc];
kum],AL,yu (hqc];yL)sp];tit];sUiw].mqc];h}a.hqc]; pgk]:km];
Am],h}a.hqc]; - pan]kac]
Mg cc/tablets mg cc/tablets
0-1 KUp], 62.5mg 2.5 cc 125mg 5cc = 1/2 mQt]. TID
1-5 KUp], 125mg 5cc = 1/2 mQt]. 250mg 10cc = 1 mQt]. TID
6-12 pI< 250mg 10cc = 1 mQt]. 500mg 2 mQt]. TID
kUn];lUc] 500mg 2 mQt]. 1g 4 mQt]. TID
 tac];pQn]pgt],kG]:An]km];km];pQn]El: kin]yLyU,ekL: yc];Siup],pQn]yU, (etl}:yUt];yL hG]:tqt]:etL;

lIlI) n}. Tuk],lIwUn].Tuic] tac];pQn]pgt],kI:An]pqk],piUc]: (Mycoplasma Pneumonia An]mI;sUiw].
mqc];pqk],TI;rI;yL; eKLeKLEl:pQn]mL;)nn].yw]." hG]:pn]yL Erythromycin Am],nn] Doxycycline tL,
10 wn];"
 tac];pQn]pgt],kI:yc];k}.k}.pQn]Kiun];yU, Am]nn] tuik].Suip],pQn]yU, (w};eSAw]yL Amoxicillin El:

yL Erythromycin Am],nn] Doxycycline n}.yUt];yLlIlIyw].) n}suic] Tuk],lIwUn].Sgn],
tac];pQn]TI,pI,"
Sc]wUn].Tac],wL: pQn]tac];pQn]TI,pI, (An]mI;Pac]hac]: A} 2-3 wUc]:Kuin]:nUiw]' nm].nk];tUw]lUt];
ygm];lUc];' A}Agk],lUit]: Am],nn]hUiw],Agk],kac]Kiun];) n}suic]' hG]:tUv];tI: (Annex ' l}a;yUt];yLtL,
tac];pQn]An]lqp]:etpQn]TI,pI, - tUv];tI:kn] 21.5)
294
lgc]:yUt];yLtac];pQn]pgt],kI: An]pQn]haw].hqc];
 Aw]kUn];pQn]ngn];hUc];yL" yUt];yLpn]lUm];naw]" etl}:Aw]kUn];pQn]ngn];Aic] (half sitting
position) Aw]"
 pn] IV tL,kum];Tic];cw];l}a;kUn];pQn]El: pn] Oxygen "
 tL,yUt];yLluk]:Agn], AL,yu 12 pI<lUc];tG]:nn]. hG]:pn]yL Vitamin A "
yLptI,KYI<wn -
luk]:Agn], Ampicillin IV/IM 50mg/kg QID + Gentamicin IV/IM 7 mg/kg OD tL, 5 wn];"
Sc]wL: yLtiUw].tac];pQn]luk]:Agn],yU, hG]:lqk]:l}a:pn]yLkin] - Amoxicillin
(25mg/kg TID) El: hG]:Siup],pn]yL IV/IM Gentamicin OD kCL,Tqc]:tL, 5 wn];"
(hqc];yL Amoxicillin El: Gentamicin dose tL,luk]:Agn],kUit],mG],nn]. hG]:kCL,
tUv];tI: lgk];pUic]yLEl: la};lum];lL;luk]:Agn],kUit],mG], tI:eKL:PiUm].Tqm])"
kUn];lUc] Ampicillin IV/IM 1 gram QID+ Gentamicin IM/IV 7mg/kg OD tL, 5 wn];"
yLkin] Amoxicillin 500mg TID pn]sgm];lc] tL, 7-10 wn];"
Sc]wL:yUt];yLTuic] 3 wn];yw]. Am],lIKuin]:mL;n}suic] kuit];pn]yL Ampicillin El: Gentamicin eS

Suip],pn]yL Ceftriaxone tL, 10 wn];" tL,luk]:Agn],n}. wUn].tL,PiUm].yL Cloxacillin pn]sgm];"
tL,tgc];"
➔ Sc]wL:Am],SG],KQm]ekL, Cannula l}:n}suic] pn]yL Ampicillin IM hqc];yL mUin]kn]tc]; IV"
➔ tL,hG]:hU.cw];la};kUn];pQn] lIKuin]:mL; Am],nn] ha}.sL.kCL,nn]. kUt],tUv];lUm];naw]' hqc];lUit]:
tgn]:El: hqc];TUv]:sG]kUn];pQn]tL,eS,"
luk]:Agn],AL,yu 1 pI<lUc];tG]: Am],mI;lUm];naw] (Am],nn]) mI;lUm];naw] Ait];Agt];nn].

kuic].kac].TUv]:sG]w};mL;n}suic] Tuk,] lIwUn].tUv];tac];pQn] Beriberi " (kn] 17.2 )"
lgt],lUm];TUv]:sG]pgt];tG]:sp];tit];tac];pQn] An]lak],l}a;
lgt],lUm];sQp];kC]: (Bronchitis)
*kUn];pQn] An]tuik].pQn]lgt],lUm];kG]:yU,nn]. miUw]:A}etmI;KI:tUiw], (with sputum) huic]mgk]: 1-2 wUc]:n}
eStL. Am],mI;lUm];naw]El:Am],mI;Pac]hac]:hqc];tgt],hUw]sG]w}; Am],nn]hUw]sC]tgt],w};Am],pQn] pk],ktI,"
kgp]:tac];pQn]lgt],lUm];kG]:n}. km]:nm]pQn]ygn].sUiw].mqc];w};rt].S]El: Am],tap]:pn]yLptI,KYI<wnekL:l}:"
pQn]tac];pQn]lgt],lUm];kG];Kaw];huic]eStn]w}.n}. pQn]Pac]hac]:tac];pQn] lgt],lUm];TUv]:sG]Kaw];hiuc]An]nuic]:
yw]." (kQw],lUv]:tac];pQn] lgt],lUm];TUv]:sC]kC]:nn]. hG]:tUv]; pL:tG]:)"
295
lgt],lUm];lQk]. nC];pgt],kG]: (Bronchiolitis)
*lgt],lUm];lQk].nC];pgt],kG]:n}. pQn]kgp]:sUiw].mqc];w};rt].S] Kw]:sp];tit];tI:lgt],lUm];lQk].An]hgc].wL:
Bronchitis nn].yw]." mUiw]:lgt],lUm];kG]:Kuin]:mL;El: KI:tUiw],ettQm]w}.eS hQt];hG]:luk]:Agn], TUv]:sG]
yap],yw]." Pac]hac]:An]pQn]Ait];Agt];Et. KI:muk]:l}El:A}" Pac]hac]:An]pQn]ha}.hqc];Et.ethn]kUn];
pQn]TUv]:sG]w};El: pgt];' lin].tgc].etlgk];Kw]:' KU:lc]tn]' lUm];tgt],hUw]sG]w};El: sG]pgt];sG]lm]ca}:"
mac]pgk]:mac]lG] Am],sG].KiUc]:Tgm],hUn}eStL. l}:cin];SQc]TUv]:sG]luk]:Agn]," An]pQn]Ait];Agt];nn].
Am],tap]:yUt];yLKuik].luik].ekL:l}:" kgp]:tac];pQn]lgt],lUm];Agn],nC];pgt],kC]:n}. pQn]kgp]:sUiw].mqc];w};rt].S]
El: sG].yLptI,KYI<wnekL: etAm],tUiw].Sc]" mUiw]:luk]:Agn], TUv]:sC]yap],nn]. hG]:pn] Oxygen"
ygn].hak]:El: pQn]tac];pQn]pgt],kI: (Aspiration pneumonia)

*ygn].hak]:El:pQn]tac];pQn]pgt],kI: - kUn];pQn]An]StI.Am],epL;lInn]. hak]:tac];kin]Agk],Kuin];
(Sut],nUm]vL;hak]:An]Agk],mL;Am],nn]nm].kUt];y}g:AL:hL,r) El: sac]:pQn]pgt],kI:mL;nn].yw]."
Sc]kUn];pQn]luim];tUw]yU,suic] hG]:w}.w}.nc],hac]:luim];tUw]nn].tL." (tUv];tI: kn] 7.1)" Sc]wL:kUn];pQn]
An]luim];tUw]w}.yU,nn]. mI;Pac]hac]:sUiw].mqc];Kw]:lgt],lUm];TUv]:sG]n}suic] pn]yL Ampicillin IV El:
Metronidazole IV eSyUt];yLpn]"
pgt],kI:ygn].sUiw].mqc];hQp]; (Fungal Pneumonia)

*pgt],kI:ygn].sUiw].mqc];hQp];n}.
Am],SU:mI;kUn];pQn]n}eStL. Sc]wL:kUn];pQn] mI;hqc];Kam],tUw]eA,suic] (tUw]
yac],-kUn];pQn] HIV/AIDS ' kUn];kin]yL:mw];km] An]sac]:hQt];hG]:hqc];Kam],tUw]tUk]; Am],nn] kUn];mI;
tac];pQn]tac], An]sUiw];n}.) sac]:pQn]l}:yU,yw]." (tUv];lWc]:tac];pQn] HIV/AIDS tI:kn] 15.3)"
pgt],kI:kgp]:mQt].lUit]:Kaw] AI<rUw]SI<nUw]PI;l]lik].( Eosinophilic)

* pgt],kI:ygn].mQt].lUit]:Kaw]Eosinophilic n}. ygn].mQt].lUit]:Kaw] Eosinophilic Kw]:kGL,nG];pgt], yw]."
tac];pQn]An]n}. km]:nm]pQn]ygn].sUiw].mqc];pL,rL,S}. (tUv]; Paragoniums pL:tC]:'mqc];tUik],An]yU,sgm];
lm];S}: (kn] 12.4)' tac];pQn]tin]sac]. (kn] 15.2)' ygn].kC]: Am],nn] ygn].Am],Tuk],mqn]:Tat]:
(hUm]:tc];tac];pQn]TUv]:sC]kp].- kn] 21.4) eSpQn]mL;yw]." yUt];yLsgm];nc],lgc]:tac];An]hQt];hG]:pQn]"
pgt],kI:kgp]:sUiw].mqc];tUik],Pqp]. (Paragonimus)
* pgt],kI:ygn].sUiw].mqc];tUik],Pqp]. Fluke (tUik],Pqp].tUw]pgt];) n}. pUic]lUc]mn]; ethQt];hG]:tum].tiUw].
pgt]," lgc]:tac];hQt];hG]:pQn]Et. ygn].kin]pUlip];' kuc]:lip]; Am],nn] An]Am]],Suk];lI" Pac]hac]:
tac];pQn]n}. etmUin]kn]tc];tac];pQn]TI,pI,El: epL;A}etmI;KI:tUiw],' mI;lUm];naw]' nG];KI:tUiw],pL;lUit]:
(SIlUit]:mUin]SItgc];)' hak]:Agk],lUit]:' AuUk];sQp];El: nm].Kw]:nC];yC];hUm],pgt]," tLkUt],Tt];hG]:hU.tqt]:
etL;nn]. hG]:Aw]m},klUw]SkUp]. tUv];KI:tUiw],n} ethn]K},mqc];tiUk]," (kUt],tUv]; Pa}:ekL: ethn]K},mqc];
tiUk],l}:mUin]kn] kgp]:wL:miUw]:kUn];pQn]A}nn]. etsac]:Auin]KI:tUiw],lUc];nG];tgc]. nn].yw].)" pn]yL
296
Praziquantel 25mg/kg nuic]:wn]; 3 pgk]:tL, 2 wn];eSyUt];yLpn]" yL Praziquantel n}. pn]
Em:pL;tgc].An]AL,yuSn]eT,l}: 6 Tuic] 9 lUin]l}:yU,"
lgc]:Eh.kc]:El: yLEh.kc]:
tL,kUn];pQn]An]yam]:PL,tt];mam].Agk], mI;Pac]hac]: sUiw].mqc];Kw]:lgt],lUm];TUv]:sG] pgk]:TI.nuic]:n} hG]:
pn]yL Amoxicillin" kUn];pQn]sUiw];n}.Tuk],lISm];yLEh.kc]: pneumococcal w}.yw]." Sc] CD4 kUn];
pQn]tac];pQn] HIV/AIDS ygm];lUc];n}suic] Tuk],lIpn]yL Cotrimoxazole sgm];" (tac];pQn] HIV/AIDS
tUv];tI: kn] 15.3)"
Aac]:Aic] tac];pQn] Ep,rI, Ep,rI (kn] 17.2)' tac];pQn]TI,pI, (kn] 21.5)' tac];pQn]TUv]:sC]
kp]. (kn] 21.4)' tac];pQn]tp];kG]: (kn] 12. 3)' tac];pQn] HIV/AIDS (kn] 15.3)"
21.3 tac];pQn]lgt],lUm];TUv]:sC]Kaw];huic]
tac];pQn]lgt],lUm];TUv]:sC]tn]Kaw];huic] (Chronic Obstructive Pulmonary Disease)
eKL:puit],tI:pgc],
tac];pQn]lgt],lUm];TUv]:sG]tn]Kaw];huic] (COPD) n}. pQn]tac];pQn]pgt],Kaw];huic] An]hQt];hG]: lgt],lUm];
kqp]:El: lUm];Kw]:lUm];Agk],EA,nn].yw]." pUic]lUc] An]l}:pQn]tac];pQn] lgt],lUm]; tn]Kaw];huic]n}.
ygn].lut],lqn]; yL:nn].yw]." tac];pQn]An]n}.n}. ethUm]:pL;cw];la}; kQw],lUv]:lgt],lUm];TUv]:sG]
l}al}aAn]"
 lgt],lUm];TUv]:sG]kG]:Kaw];huic] - lgt],lUm];TUv]:sG]kG]:"
 pgt],lU.lqw]Kaw];huic] - sac]:hQt];hG]:lgt],lUm];lQk].El:TUc]lUm];(alveoli)lU.lqw]"
 tac];pQn]lgt],lUm];tn]Kaw];huic] _ mac]pgk]:mac]lG] pQn]ygn].eSAn]An] Am],mqn]:Tat]:'
pQn]ygn]. cw];la};him];hgm];"
Pac]hac]:tac];pQn]
Pac]hac]:tac];pQn]lgt],lUm];tn]Kaw];huic]n}. etmUin]kn]tc];Pac]hac]:tac];pQn]mgc]eKL: (Asthma ) n}eS
tL. kgp]:wL:lgc]:lU.lqw]kgp]:lgt],lUm];tn]n}. pQn]lgc]:lU.lqw]etL,sUw]:kCL,El: Pac]hac]:tac];pQn]ekL:
etmI;kCL,etL,sUw]:"
 A}Agk],pL;KI:tUiw],eS tac];pQn]etha}.hqc];mL;km];lg};lg};"
 Agk],AQn]Agk],hqc];Ait];Agt];ekL:hUiw].AUn]:' SQc]TUv]:sG]etemL;hI;hI;' etpQn]ha}.hqc];kGL,km];
lg};lg}; pqk].Sm].wL:nc]:yc].luiw]:yU,ekL:ethiUw]."
297
 mI;KI:tUiw],yU,tL,eS, - kgp]:lgt],lUm];tI:lU.lqw]kGL,nn]. hQt];Sac]:KI:tUiw],Agk],mL;tik];tik];"
tac];pQn]lgt],lUm];pgc]; (Bronchiectasis)
eKL:puit],tI:pgc],
tac];pQn]lgt],lUm];pgc];n}. pQn]tac];pQn]lgt],lUm];Kaw];huic]yw]." ygn].lgt],lUm];pgc];Kiun]:kCac]:Kiun]:mL;El:
KI:tUiw],Sm].Kqn];etKm]yU,nC];lgt],lUm];lQk].El:Kqn];hQt];hG]:sp];tit];siUw].mqc];Tqc]:yU,tik];tik];"lgc]:sp];
tit];siUw].mqc];Tqc]:yU,tik];tik];n}.hQt];hG]:lgt],lUm]tn]' lgt],lUm];tn] Sm].hQt];hG]:TUc] lUm];kiut];yut];
hQt];kan]kCL,pqt]:"
Pac]hac]:tac];pQn]
 A}Agk],KI:tUiw],kU:wn];"  pQn]S}:nt]. (Sinusitis ) Kaw];huic]"
 hak]:Agk],lUit]:"  mUiw]:TUv]:sG]Kw]:Agk],nn]. epL;Aw]KUic]Tgm],hU Tgm],tUv];
 SQc]TUv],sG]emL;hI;hI;" etcin];SQc]Klgk];Klqk];hqc];"
tac];pQn]TUc]lUm];lQk].nC];pgt], (Interstitial Lung Disease)

eKL:puit],tI:pgc],
tac];pQn]TUc]lUm];lQk].nG];pgt],n}. pQn]ygn].yC];niUw].Agn], (soft tissue) An]lU.lqw]nn]. hQt];hG]: PL
nc]TUc]lUm];nC];pgt],lU.lqw]nn].yw]." ygn].PLnc]TUc]lUm];nLKiun]:mL;El: kan]Kw]:Agk],lUm]; kqt].S]
(gas) ekL:Am],lImL;' ygn].wL:kCL,tum].tiUw].vL;SQn]:liUt]:Agn],nC];pgt],pL;El:liUt]: An]l}Kw]:pgt],ekL:
eteA,kCL,sgm];" nG];kL:lgc]:tac];l}al}algc]: An]hQt];hG]:pQn]nn]. ygn].yG];niUw]. (soft tissue) kqn],nL
Kiun]:mL;lg};lg};n}.ekL: pQn]piUc]lUc]hQt];hG]:pQn]tac];pQn]An]nuic]:"
Pac]hac]:tac];pQn]
 mUiw]:Et,pQn]nn]. Am],hn]Pac]hac]:  Clubbing (pa}muiw];etyG],' sQc],kap],lQp].muiw];ha}"
tac];pQn]Sc]"  lgc]:hQt];kan]pgt], tUk];ygm];"
 Agk],SI,kYin],nC];lUit]:EA,"  mUiw]:TUv]:sG]Kw]:nn].l}:cin];SQc]emL;Klgp].
 mUiw]:yc].liuw]:nn]. TUv]:sG]w};" Klqp]."
 hqc];tgt],lUit]:tI:eKL;Suc]"
kUt],Tt];Pac]hac]:tac];pQn]kUv];ekL: hn]tac];pQn]l}:n}eStL. Sc]pQn]l}: epL.AQk].S]er;tUv];tI:
pgt];AUk]; (CXR) n}.etpQn]An]km].sg}:nm]Et.Et."
298
Pgn];sL.sgm];lc] tac];pQn]pgt],Kaw];huic]
 sUiw].mqc];km];km];Kw]:tI:AuUk];"  mQt].lUit]:lqc]tqk],EP:nm]mL;" (raised haematocrit)
 Kat],Tat]:AL,hL,r El:  pQn]kG]: ygn].lUv]:hqc];hUw]sG]EA,El: Agk],SI,kYin],
nm].nk];tUk];" nG];mak],kqw];eA,"
 hqc];hUw]sG]eA,lUc];"
lgc]:yUt];yL
tac];pQn]pgt],Kaw];huic] km]:nm]n}. pgt],sac]:lU.lqw]kCL,etL,sUw]:" lgc]:yUt];yLn}. tL,sg}:hG]:lgc]:TUv]:
sG]yap], nn].Sak],SL,kUv];"
 kuit];luiw]:lgc]:lut],lqn];yL:"
 sg}:hQt];hG]:lgt],lUm];kCac]: - pn]yL salbutamol,Atrovent, Aminophylline"
 tL,Eh.kc]:lgc]:pQn]kG]: - pn]yL prednisolone 30-40mg OD Oral tL, 2 wUc]:" w}a;nn]. Suip],
pn] (maintenance dose)" mUiw]:p},pn]yL Steroid nn]. etl}:KYL;mqc];tgc].pn]Agn]tac];
(kn] 12.4)
 tL,yUt];yL lgc]:kuic].kac].pQn]h}a.hqc];kgp]:sUiw].mqc];Kw]:El: lgc]:pQn]kG]:ygm];lUc]; - pn]yL
Amoxicillin Am],nn] Doxycycline"
 lgc]:yUt];yLtL,eh.kc]:
 tL,hG]:mI;lgc]:tiun],tUw]yU,nn]. Agk],AQn]hqc];Ait];Agt];tL,eS,"
 PUim].Tqm]AL,hL,rEl: pn]tac];hn]Tuic]lgc]:kin]yqm]."
 kUn];pQn]An]k}.pQn]sUiw].mqc];Kw]:nn]. hG]:pn]yLptI,KYI<wn tL,Eh.kc]:"
 lgc]:yUt];yLtL,hqt];hG]:SQn]:tac];lUm];TUv]:sG]lImL;Kuin];"
 tL,kam]:nUiw].SQn]:tac];lUm];TUv]:sG] etmI;hqc];Kuin]:mL;nn]. etl}:Agk],AQn]:hqc]; TUv]:sG]"
 lgc]:lQn]:Agk],hqc];tUw]
 lgc]:yUt];yLtUw]kw], - pn]tac];hU.kQw],lUv]:tac];pQn] hG]:pgc],sG]El:kum];Tic];lgc]:yUt];yL"
yUic];Aan];lgc]:pn]tac];yUt];yLtac];pQn]pgt],Kaw];huic]
 hQt];hG]:sUiw].mqc];EP:tuin];TUic];"  tL,eh.kc]: lgc]:Pgn];sL.sgm];lc]"
 hG]:Pac]hac]:tac];pQn]mw]SL,"  nc],huiw]kUn];pQn]etpgc],sG] kQw],lUv]:tac];pQn]
 hQt];hG]:lgc]:lQn]:Agk],hqc];lIKuin]:" nn]. etl}:Aup],AUw];pn]tac];hU.
 hQt];hG]:lgc]:yU,Sw];kUn];pQn] lIKuin]:mL;nc],kL:  pUk];pgc]pn] pa};tUw]El:pa};sG]
pQn]l}:"  hQt];pn] Am],hG]:km];km];l}:mL;Enhgc]:yL"
 tL,eh.kc]:lgc]:pQn]ha}.hqc]; (tac];pQn]mgc]eKL:
El:tac];pQn]lgt],lUm];tn]Kaw];huic])"
299
pC].sgm];tUv];cw];la}; tum].tgp],Kiun];lgc]:yUt];yL
 lgc]:TUv]:sG]lImL; Am],nn]ha}.hqc];mL;lUiw]kw],"  kUn];pQn]tUc].nuic]l}:mUin]kw], kUv];kL: tUc].nuic]
 Pac]hac]:l}al}asiUw];lImL; Am],nn] ha}.hqc]; l}:w};mL;liUw]kw],"
liUw]kw],"  kUn];pQn]tUc].nuic]l}:mUin]kw], kUv];kL: Am],
 kUn];pQn]mI;cw];la};tUc].nuic]lImL;liUw]eSmUiw]:p}, epL;hUiw].miUn]kw],"
l}:mL;yUt];yL"  kUn];pQn]ngn];lp];l}:lUiw]kw],"
lgc]:Eh.kc]:
nc],huiw]eteh.kc]:tac];pQn]pgt],Kaw];huic]El:Pgn];sL.sgm];lc]nn]. kUn];pQn]tk];etl}:kuit];yc].
lgc]:lut],lqn];yL:" pn]tac];K}:sC] lgc]:Agk],AQn]:hqc];An]ca}:c}a: tL,hG]:mI;lgc]:tUc].tuin],yU,tL,eS,'
lgc]:tac];kin]An]Tqm]hqc];' lgc]:kin]yqm]. El: pn]yLptI,KYI<wn tL,kUn];pQn]An]pQn]sUiw].mqc];Kw]:"
Aac]:Aic] tac];pQn]mgc]eKL: (kn] 21.4)' tac];pQn]TI,pI, (kn] 21.5)"
21.4 tac];pQn]mgc]eKL:An]kuic].kac].pQn](TUv]:sG]kp].)
tac];pQn]mgc]eKL:n}. pQn]yWn].lWt],lUm];kG]:Kaw];huic]eS lUm];Kw]:AWk],tn]El: kuic].kac].pQn]mL;nn].yw]."
tac];pQn]mgc]eKL:n}. pQn]yWn].Am],mqn]:Tat]:eSAn]An]' sUiw].mqc];Kw]: El: Pun],lUm]; (tUw]yac], -
kGn];lqn];yL:)" epL;sG]. Steroids eSyUt];yL (tUv];tac];tG]:) n}.sac]:hQt]; hG]:lWc]:pQn]kG]:ha}Kqn];
l}:n}yw]." Salbutamol n}.sW}:hG]:TUv]:sG]ca}:lUm]kUv];' Am],sW}:lWc]: pQn]kG]:ha}KQn];l}:"
tac];pQn]mgc]eKL:n}. luk]:AWn],El: kUn];num],Kw]k}.pQn]nm]n}yw]."
tac];pQn]mgc]eKL:n}.sac]:hQt];hG]:kUn];t}al}: El:luk]:AWn],nan];yG],"
Pac]hac];tac];pQn]
 mUiw]:TUv]:sG]AWk],etcin];SQc]emL;hit].hgt]."  Am],sac]:TUv]:sG]yaw];yaw];El:Kuin]: Suc]Suc]l}:"
 hUiw].AUn]:"  A} (km]:nm]k}.A}kac]Kuin];' mUiw]:lQn]:Agk],hqc]; El:
 nL:AuUk];sQp];kqn];" tUc].niuc]nn]. eth}a.hqc];liUw])"
➔ Sc]wL:kUn];pQn] mI;tac];pQn]mgc]eKL:An]lQw]kUv];n}. lUm];naw]etAm],mI;' Am],mI;lWc]:A}AWk],lUit]:
El:KI:tUiw],pQn]SIKQw]"
300
tqp];tt];lgc]:ha}.hqc];nm]eA,tac];pQn]hc];kUv];"
kUn];pQn]n}.pQn]Ait];AWt];' pan]kac]' ha}.hqc]; Am],nn] sac]:Tuic]ASak]:kUn];pQn]hiuw]n} nn].
etl}:tqp];tt];" lWc]:sqk],EPtac];pQn]siUc].n}n}. pQn]An]lm],lgc]:Et.Et."
kgp]:wL:lWc]:yUt];yLekL: etpqk],pUic]:kn]kCL,nn].yw]."
tL,etkUt],Tt]; tqp];tt];lgc]:ha}.hqc];nm]eA,nn]. (tUv];lWk];Kgc]:pL:tG]:)

 hqc];tWt],lUit]:"  l}:cin];SQc]TUv]:sG]emL;hit].hgt]. Am],nn]
 hqc];TUv]:sG]" Am],emL;"
 Kn].tgn]:tac];nm]eA,lWc]:TUv]:sG]yap],"  kam]:nUiw].hUt]; (lin].tWc].hUt];Kw]:mI;/Am],mI;)"
 mUiw];kUn];pQn]TUv]:sG]nuic]:pWk]:nn]. lat]:kGam];  PWn];lIlWc]:TUv]:sG]huic]Sut];(tUv];tc];tG]:n}.)"
l}:la}eKL:"
Peak flow meter n}. pQn]KUic]:sG].Sm],mtL,' kL:Kn]Tuk],' Suiw].Aw]l}:ca}:ca}:El: etmI;kU:hgc]:yL"

(yWn];Aw]tI: PU:kgn];An]nuic]:)" Sc]wL:mI;Pac]hac]:mUin]nc],pL:nUiw]n}.nuic]:An] Am],nn] nm]liUw]
nn].n}suic] miUw]:Aw]Kuin]:hUc];yLnn]. hG]:kUt],sqt]:mat]:m}a peak flow w}.eS sG]. Salbutamol
Am],nn] Prednisolone eSyUt];yLpn]" w}a;yUt];yLpn]yw]. hG]:kUt],sqt]:mat]:ma} peak flow
kU:pgk]:tI:mL;hgc]:yL"
tL,tWc];" "etAm],sac]:Aw] peak flow kUt],sqt]:pn]luk]:AWn],AL,yu 7 KUp],lUc];tG]:eS mat]:ma}
pn]l}:"
sG]. Peak flow eSkUt],sqt]:mat]:m}an}. etsac]:tqp];tt];lgc]:h}a.hqc];nm]eA,kUn];pQn] hG]:cw];l}a;

tqt]:etL;wL: ygn].lgc]:yUt];yLEl: kUn];pQn]sgc],lIKiun]:mL;hiuw] El: lWc]:TUv]:sG]huic]yaw];hiuw]n}yw]."
Sc]wL:yUt];yLpn]hG]:Tuk],mqn]:yw]. Am],hn]lIKuin]:mL;n}suic] pgc],wL:Am],sG]: tac];pQn]mgc]eKL:" wUn].Sgn],
lgc]:tac];pQn]tac],An]"
lWk];piUc] Peak Flow (tUv];tI:eKL:PiUm].Tqm])tqk]: peak flow pn]sgm];nc],AL,yuEl:tac];Suc]kUn];pQn]"
etl}:Pac].wL: kUn];pQn]mgc]eKL:n}. sac]:pQn]pL;tac];pQn]tac],An] mUin]nc], lgt],lUm];sQp];kC]:'

tac];pQn]TI,pI,' hqc];hUw]sC]eA, Am]nn] lgt],lUm];pgt],pgc]; (pgt],Am],hQt];kan])' mqc];tiUk],"
lgc]:etl}:Pac].tL,kUn];pQn]mgc]eKL:n}. etl}:KUn].hLtac];pQn]tac],An]pL;eS yUt];yLsgm];kCL,
mUiw]:lQw]kn]km];Siuw]:"
301
lWc]:KUn]hLmk];mn]:tac];pQn]mgc]eKL:n}. tUv];tI:puin];tac];pQn]kUn];pQn]' kUt];Tt]; El: (tUv]; Peak
Flow ) eSmk];mn]:l}:yU,yw]."
lWc]:yUt];yL
lWc]:yUt];yL tac];pQn]mgc]eKL:An]kiuc].kac].pQn]n}. etmI;Sam]tWn]:"(lm],lgc]: kU:tWn]:)
1. lWc]:km].sW}: - Oxygen
2. lgc]:yUt];yLKaw];pWt]; - Salbutamol
3. lWc]:yUt];yLkG]: - Steroids (Prednisolone)" mUiw]:p},pn]yL Steroids kUn];pQn]nn].
etl}:pn]yLKYL;mqc];tWc].tL,eS," (tWn]: 12.4)
 etl}:pn]yLsUic].huiw]An]wL:nn]. etAic]nUiw]lWc]:ha}.hqc];tac];pQn]El: yLAn]mI;w}. mUin]nc],
(yLmQt].' yLnUm]' yLSm];' yLmip],AI;)"
 mac]pWk]:mac]lG] epL;cw];la};kUn];pQn]ha}.hqc];mL;suic] hG]:sG].yLtac],An] mUin]nc], Aminophylline IV
El: Adrenaline IM"
ettqp];tt]; lgc]:ha}.hqc];nm]eA,El: yUt];yLpn]sUic].hiuw]"
etAm],hn]Pac]hac]:tac];pQn]tc];mUt];" Sc]wL:mI;Pac]hac]:nm]liUw]mL;eSAn]An]suic] pQn]lgc]:PiUm].
lgc]:ha}.hqc];nm]mL;tik];tik];nn].yw]."
➔ nc],huiw]lWc]:yUt];yLetSc],etL,nn]. etl}:km];km];em;kUt],Tt];cw];la};kUn];pQn]"
lgc]:tqp]tt]; lgc]:h}a.hqc];nm]eA, tac];pQn]mgc]eKL:An]kiuc].kac].pQn]ha}.hqc];

pQn]Ait];AWt];/pan]
pQn]ha}.hqc]; pQn]Tiuc]sac]:ta}l}:
kac]
TUv]:sG]yap], mUiw]:p}tac]; mUiw]:nWn];lUc]; pQn]tL,eS,
lat]:kGam]; pQn]Sm],mtL,/lat]: lat]:l};nuic]:eKL:" luk]: Am],lat]:l}:" luk]:AWn],
l}:Ait] AWt]; AWn], Am],sac]:kin]Kw]: Am],sac]: kin]Kw]:l}:"
l}:"
cw];la};lWc]:hU.tUw] m}:sG] sC]pit];sC]pgt]; Am],nn] cw]lp]; Am],nn] kGac]"
tQt],SI,SI,El:
Am],tUc].niuc]
SQc]TUv]:sG]emL;hit].hgt]. mUiw];TUv]:sG] l}:cin];hqc]; Am],l}:cin];SQc]Sc]
AWk],sm]et
Sut];
lin].tWc].lgk];Kw]: Am],mI;/ mI;Ait]; km]:nm]mI; mI;lWc]:tUc].nuic]
AWt]; An]Am],pQn]pk],ktI,
302
hqc];TUv]:sG]/minit]. nm] kUn];lUc] = 30/min Kuin]: (w}; Am],nn] TUic];)
nUiw]" luk]:AWn], 5 pI< Kuin]:
nUiw] = 40/minKuin]:nUiw]"
5 pI<lUc];tC]: = 50/min
Kiun]:nUiw]
hqc];tWt],lUit]:/minit]. Suc] kUn];lUc] =120/min Kuin]: (w}; Am],nn] TUic];)
nUiw]" luk]:AWn], 5 pI< Kuin]:
nUiw] = 120/minKuin]:nUiw]"
5 pI< lUc];tC]:=140/min
Kiun]:nUiw]
Peak flow wa};eSyUt]; etmI;nm]lUiw] mI; 33% Tuic] 70% Kgc] mI;eA,eSSm],mtL,
yLpn] An]pQn]Sm],m Sm],mtL,An]Tuk],lImI; An]Tuk],lImI; 33 %
tL, 70%
wa};eSmk];mn]:lgc]:h}a.hqc];nm]eA,yw]. (pQn]Ait];AWt];' pQn]ha}.hqc];' pQn]Tiuc]tI:t}al}:)

yUt];yLpn]kUn];pQn]"
pQn]Ait];AWt];/
pQn]ha}.hqc]; sac]:pQn]Tiuc]tI:ta}l}:
pan]kac]
Aw]Kuin]:hUc];yL Am],tap]: kU:pgk]: kU:pgk]:
Salbutamol sG]." sG.] " sG]."
inhaler with sUw]:mUc];Agn], sUw]:mUc];Agn],tac];-Sut], Sut],Kw]: 10-15 nc],tI:
spacer** tac];-Sut],Kw]: Kw]: 10-15" wa};nn]. 4 etl}:Sut], etL,Tiuc]mI;
8-10" wa};nn]. sUw]:mUc];nuic]:pWk]: etL,Tiuc] lgc]:tgp],Kiun];yLtQm]tQm]* (sG].
4 sUw]:mUc]; nuic]: mI;lgc]:tgp],Kiun];yLtQm]tQm]* nebuliser n}.etlI liUw])
pWk]: etL,Tiuc]mI; (sG]. Nebulizer n}.etlI
lgc]:tgp],Kiun];yL liUw])
tQm]tQm]*
Prednisolone Am],tap]:pn] tuin];etl}:pn]" tuin];etl}:pn]"
kUn];lUc]-1mg/kg/day OD kUn];lUc] 1mg/kg/day OD
luk]:AWn], - wn];Agn] luk]:AWn],- wn];Agn]tac];
tac]; 1mg/kg BID 1mg/kg BID
wa};eSnn]. etLTiuc]lIKuin]: wa};eSnn]. etLTiuc]lIKuin]:
mL;tQm]TUn]:-1mg/kg OD mL;tQm]TUn]:-1mg/kg OD
303
Oxygen Am],tap]:pn] pn]yU," Am],pn]Am],l}:
6+liters/minute tuin];etl}:pn]"
6+liters/minute
Salbutamol Am],pn]ekL:l}: pn]hUm]:tc]; Oxygen" tuin];etl}:pn]hUm]:kn]tc];
nebulizer nuic]:sUw]:mUc]; - 5 mg 3 Oxygen"
pWk]: (4)sUw]:mUc];nuic]:pWk]: nuic]:sUw]:mUc]; -5 mg 3 pgk]:
etL,Tiuc] mI;lgc]:lIKiun];mL; kU:sUw]:mUc]; etL,Tiuc]mI;
tQm]TUn]:* lgc]:lIKiun]:mL;tQm]TUn]:*
Hydrocortisone Am],tap]:pn] wUn].w}. sG].l}:yU,
IV*** Sc]wL:etl}:pn]ekL: pn]
Aminophylline Am],tap]:pn] wUn].w}. IV 5mg/kg (nm]Sut]; 500mg)
IV Sc]wL:etl}:pn]ekL: pn] tL,sUw]:mUc];p}a' 6
sUw]:mUc];niuc]:pgk]:
Salbutamol IV Am],tap]:pn] Am],tap]:pn] sG].l}:yU,
Adrenaline IM Am],tap]:pn] Am],tap]:pn] wUn].w}. Sc]wL:etl}:pn]ekL:
pn]
Salbutamol Sc]wL:Am],mI;yL Sc]wL:Am],mI;yLnUm]/yLmip], Sc]wL:Am],mI;yLnUm]/yLmip], AI;
tablet nUm] AI;
*lWc]:lIKuin]:mL;tQm]TUn]: - Peak flow' hqc];TUv]:sG]' hqc];tWt],hUw]sG]pQn]pk],ktI,mL;' kUn];pQn]sac]:

TUv]:sG] El: lat]:kGam];mUin]kw],' Am],mI;lWc]:sC]pit];sC]pgt];El: sG]Suk].yuc]:' SQc]TUv]:sG] An]emL;
huit].hgt].nn]. eA,lUc]; Am],nn] ha}kGL,' Am],mI;lgc]:lin].tWc].lgk];Kw]:kCL,nC];AUk];"
** mUiw]:Sut],yL Salbutamol nn].sG].tiuw]; spacer eSSut],n}.etTuic]tI:lI" Sc]wL:Am]mI;n} Aw]
tw]:An]mUt];SG]El:sac]:SG],nm].l}:mWk]: 1.5/2 litre mUin]nc],tw]: Spirit Am],nn] Fanta mL;sI;
hU;pWc], pQc];mWk]:miUn] ventoline inhhaler tL,SuUp];Sut],l}:" inhaler etmqn]:tc];hU;n}.lIlI (sp];Aw]
kL:huiw]lIkL:nn].)" yLnn].etl}:SG],w}Tuic] 3-15 Kit], (Aic]nUiw]cw];la};ha}.hqc]; Kgc]tac];pQn]) eShG]:
kUn];pQn]
Sut],tI:pa}tw]:" Aw]nm].El:Sp].pYL, lac].tw]:hG]:mUt];SG]yw]. Aw]lUm];pw],hG]:hqc]:"
tw]:n}.etAm],l}:Aw] Pqn],sQt].hqc]:' (epL;AWm]Am],hqc]:lI Salbutamol ettit];sp];w}.tI:nC];tw]:)"
***tL,tWc]; - Sc]wL:kUn];pQn]Am],kin]yL Prednisolonel l}: pn] Hydrocortisone IVl}:'
SWn]pn]la};sG].KUic]:TUv]:sG] Inhaler pn]kUn];pQn]" Sc]wL:Pac]hac]:tac];

pQn]Am],lIKuin]:mL;n} Kuin];em;kUt],Tt];Kiun];"
304
hqc];yLtL,tac];pQn]mgc]eKL:
1.Salbutamol 4. Aminophylline IV
Sut],Kw]: Sut],nuic]:pWk]: salbutamol etmI; etAm],l}:pn] IV km];Suiw]:"etl}:elL;
100microgram D5S Am],nn] Normal Saline eSpn]"
(Kiun]:hqc];yLpn]Tiuc] 10-15 puffs Sc]wL: kin]yL Theophylline Am],nn]
l}:)(tL, 500-100 micrograms ) Aminophylline w}.n}suic] etAm],l}:
nuic]:pgk]: 15 minit]." pn] loading dose"
yLkin] – kUn];lUc] loading dose 250mg over 30
2KUp],lUc];tG]: 4mg TID or QID minutes
kUn];lUc]
maintenance dose:
luk]:AWn], 2-6 KUp], 0.1mg/kg QID
0.5mg/kg/hr
6 - 12 KUp], 1-2mg TID/ QID
luk]:AWn], loading dose 5g/kg over 20
2mg TID or QID minutes
maintenance dose: 1mg/kg/hr
IV kUn];lUc] 250 micrograms over 10minutes
2. Prednisolone
yLkin-]
kUn];lUc] pn]kac]nG] 1mg/kg OD
luk]:AWn], pn]kac]nG] 1-2mg/kg OD tI:nm]Sut]; 40mg
3. Hydrocortisone
IV: kUn];lUc] 250mg TID
luk]:AWn], KUp],lUc];tG]:
1 25mg TID
1 - 5 KUp], 50mg TID
6 - 1 KUp], 100mg TID
la};pn]yLkin] Prednisolone w};w}; mgk]:tI:etw};l}:"
Pgn];sL.yL
 yL salbutamol n}. tL,sG].miUw]:Am],mI; yLnUm] Am],nn] Kiuc]:km].kqm]nUm]n}eStL. Pgn];sL.
etnm] El: hqc];yLAgk],TiUc];"
 ygn].yL salbutamol, SteroidsEl: Aminophyllin sUiw];n}.eS sac]:hQt];hG]:Tat]: potassium
tUk];ygm];l}:" etsac]:tUk];ygm];pUn].tI: Tuic]tI:mI;eP;ta}l}:yw]." Sc]pQn]l}: hG]:kUt],Tt];
tUv]; Tat]:pUw],tqt],SI,yam] (potassium)"
305
 tL,Em:pL;tgc].nn]. ciUc].ew:sG].yL Aminophyllin"
 yL Steroids n}.Tqc]:hqc];sUiw].mqc];Kw]: (Infection )nm]yw]." mUiw]:sG].yL Steroids nn]. mqc];tUik],
(hUm]:tc]; strongy loides)' siUw].mqc];AmI;pL;' tac];pQn]TI,pI,El: sUiw].mqc];pqk],TI; rI;yL;
siUw];n}.sac]:haw].hqc];mL;yw]."
 etl}:Tam]puin];tUw] tL,tac];pQn]TI,pI, siUw].mqc];AmI;pL; El:Pac]hac]:sUiw].mqc];Kw]:tac],sUiw];" tL,
eh.kc]:mqc];tUik], Am],hG]:EP:tUin];nn]. hG]:pn]yL Albendazole" (tUv];tI: kn] 12.4)"
tac];pQn]mgc]eKL:Kaw];huic] (Chronic Asthma)

la};Eh.kc]:/yUt];yLKaw];huic]
tL,eh.kc]:tac];pQn]mgc]eKL:Kaw];huic]n}. hG]:sG]. Steroids inhaler n}.kGL,tL,eS," Sc]pQn]l}: hG]:sC].yL
Sut],mn]; km];Siuw]: miUn]nc], Beclomethasone nuic]:wn]; 2 pgk]:" lgk];l}a;Sut],yLhG]:sgt],tUw]:
kGL,nn]. pQn]An] lm],lgc]:w}.El:Sc]sG].Aqp], (sprite) n}ekL: etmI;Pgn];lIEt.Et." tac];nm]
eA,Et. etAic]nUiw]lgc]:tgp],Kiun];yw]."
 kUn];pQn]nG];(pQn]Ait];Agt];) pn] Steroids hqc];yLeA, (tUw]yac], - Sut],nuic]:km];-BID)
An]yc];mI;Pac]hac]:tac]; (Sc]Am],mI; inhaler - pn]yLkin] prednisolone)" Sc]wL: Pac]
pQn]yU, - hac]:tac];pQn]Agk],mL;n}suic] hG]:pn]Sut],yL salbutamol inhaler
Pan], spacer (Agm]lUm];Sut],nUm])"
 kUn];pQn]An]pQn]haw].hqc]; pn]yL Steroids pan]kac] (tUw]yac], - Sut],Sgc]pgk]:- BID)"
tan],tan],El: mL;Kuin]:hUc]; (Sc]Am],mI; inhaler - pn]yLkin] prednisolone)" Sc]wL:Pac]
yLyw].lUc];kGL, hac]:tac];pQn]Agk],mL;n}suic] hG]:pn]Sut],yL salbutamol inhaler"
 kUn];pQn]An]pQn]haw].hqc];El: pn]yL Steroids nm]nm] (tUw]yac], - Sut], 4 pgk]:- BID)"
mL;Kuin]:hUc];yLyw].lUc];kGL, (Sc]Am],mI; inhaler - pn]yLkin] prednisolone)" Sc]wL:Pac]
hac]:tac];pQn]Agk],mL;n}suic] hG]:pn]Sut],yL salbutamol inhaler"
 etl}:KQn];kUn];pQn]mL;EnKuin]; tI:hgc]:kUn];pQn]ngk]:" (kUt],Tt];tUv];lgc]:hqc];TUv]:sG]Suc]Sut];)"
etl}: pn]yLTan]:nuic]:yw]. Tan]:nuic]:ygm];lUc];lg}:lg}: etL,Tuic]kum];Tic];cw];l}a;tac];pQn]l}:"
Sc]wL: Pac]hac]: tac];pQn]Agk],mL;Kuin];n}suic] pn]yL Steroids inhaler hG]:Suc]Kiun]:Tqc]:"
 kUt],Tt];kUn];pQn]Kuin];kU:lUin] Am],nn] mUiw]: Steroids inhaler sm]etSQc]:"
 kUt],Tt];tUv];hqc];TUv]:sG]An]w};Sut];" PUim].Tqm]tac];nm]yL kGL,etL,Tuic]hqc];TUv]:sG]kUn];pQn]

pQn]pk],ktI, mL;Kuin];tL."
 nc],huiw]etAm],l}:cin];SQc]TUv]:sG]hgt].hgt].hqt].hqt].nn]. Suip],pn]yLmUin]mUiw]:kw],kGL,tik];tik];"
306
 Sc]wL: mgc]eKL:sC]kp].kUn];pQn]lUc];mL;eA,liUw] nuic]:lUin]nuic]:pgk]:n}suic] kuit];pqt]:yL Steroids"
Sc]wL: Pac]hac]: tac];pQn]Agk],mL;Kuin];n}suic] pn]Sut],yL salbutamol Kiun];"
tL,kUn];pQn] An]Pac]hac]:tac];pQn]k}.k}.Agk],nn]. Sc]wL:Am],mI; Steroids inhaler n}siuc] hG]:pn]
yLkin] Steroids (hqc];yLEA,) l}:" (tUic],pac],tc];emLyL)"
sC].yL Sabultamol An]lQw]kUv];eSEl: Am],sac]:eh.kc]: tac];pQn]mgc]eKL:l}:"
21.5 tac];pQn]pgt],kG]:TI,pI,
lgc]:etl}:fac].pC].tUv];tac];pQn]
eKL:puit],tI:pgc],
tac];pQn]pgt],kG]:TI,pI,n}. pQn]tac];pQn]An]sac]:sp];tit];kn]l}:eS pQn]ygn].sUiw].mqc];pqk],TI;rI;yL;
Mycobacterium tuberculosis (mac]pgk]:mac]lG] Mycobacterium bovis El: Mycobacterium
africanum)sUiw];n}.yw]." tuberculosis bacilli (TB bacilli) n}ekL:hgc].l}:yw]."
tac];pQn]pgt],kG]:TI,pI,n}. etsac]:sp];tit];kn]l}:kgp]:lUm];" cw]:hak]:lm],lgc]: lgc]:eP:tiun];Et.
kUn];pQn] An]mI;sUiw].mqc]; Pulmonary TB A}El: kUn];pQn]An]mI;KI:tiUw],mI;siUw].mqc];w}. (tUw]yac],-
Aw] microscopy eSkUt],tUv];KI:tUiw],n}etl}:hn] TB bacilli)nn].yw]." miUw]:kUn];An]mI;siUw].mqc];
hQt];hC]:A} Am],nn] KI:sam] tubercle eS Pgc]tgm],nm].la}; An]PUc].Agk],mL;tI:lgt],lUm];sUiw];nn].
etpL;sUiw].mqc];mL;sgm];" tgm],nm].la}; An]PUc].piw]yU,nG];lUm];nn]. etyU,l}:Kaw];huic]yw]." Sc]wL:
kUn];him];hgm];nn].Sut],vL;lUm]; An]mI;sUiw].mqc]; nn].n}suic] etsac]:sp];tit];tac];pQn]l}:yw]."
kUn];An]sp];tit];sUiw].mqc];yw].n}. etAm],mI;Pac]hac]:yU,Am],lIEl: hgc].wL:kUn];An]sp];tit]; sUiw].
mqc]; An] “nim]” Am],nn] “yQn]” n}yw]." mUiw]:Pac]hac]:tac];pQn]pgt],EnAgk],mL;nn]. mk];mn]:wL:
tac];pQn]TI,pI,n}yw]." nC];kUn];sUiw];Am],mI; HIV/AIDS nn]. An]sp];tit]; tac];pQn]TI,pI, nG]; 10ekL.
n}. mI;mgk],nuic]:ekL.kUv];An]EnPac]hac]:tac];pQn]TI,pI," kUv];kL: tL,nC];kUn];sp];tit];tac];pQn]
HIV/AIDS Kw]n}. mI;cw];la};tL,pQn]tac];pQn]TI,pI, etnm]lUiw] kUn];sUiw];Am],mI; HIV/AIDS Tiuc] 10
pun]:yw]." tac];pQn]TI,pI,n}. pUic]lUc]mn];etpQn]tI:pgt], (Pulmonary tuberculosis) eStL.pgt];tgn]:
tUw]kUn];tac],tgn]: mUin]nc], mak],ln]nm].liUc]' yC];hUm],pgt],' lup],El:lup],Sn]lc]' Agk];eAL' tgc].'
tL' KUic]:Ac],kL,El: SQn]:tac];Pa}:Agn],(yQw]:) El:Piw]nc]sUiw];n}.sac]:pQn]l}:kU:tI:yw]."
Sqn];tac];pQn]TI,pI,
1. tac];pQn]TI,pI, An]pQn]tI:pgt], - (An]k}.pQn]nm]lUiw]eSpUin]:)"
2. tac];pQn]TI,pI, An]pQn]ngk]:pgt],
307
pgt];tgn]:An]k}.pQn]nm]lUiw]eSpUin]: pgt];tgn]:An]pQn]eA,
 yC];hUm],pgt],"  KUic]:Ac],kL,El:SQn]:tac];yQw]:PU:sa};"
 mak],ln]nm].liUc] (An]k}.pQn]nm]lUiw]eSpUin]:Et.  KUci ]:Ac],kL,El:SQn]:tac];yQw]:PU:yic];"
mak],ln]sgm];eKL;)"  mak],kqw];"
 Agk];eAL"  hUv],mak],ln]An]mI;nUiw]mak],kqw];"
 tgc]."  Piw]nc]"
 yC];hUm],hUw]sG]"
 lup],Sn]lc]' lup],tac],tI:El:lup],kp];lup],etL,"
Pac]hac]:tac];pQn]
Pac]hac]:tac];pQn]TI,pI,pgt],n}. An]lm],lgc]: etmI;
 A} 2 wUc]: Am],nn] 3 wUc]:Kuin]:nUiw] (Agk],KI:tUik], Am],nn] Am],Agk],)"
 nm].nk];tUw]tUk];ygm];"
kUn];sUiw];An]kUt],sqt]:hn]wL: mI;sUiw].mqc];TI,pI,nC];KI:tUiw], 90% Kuin]:nUiw]n}. Am],hiuc]Am],nan];

etA}mL;yw]." tac];pQn]lgt],lUm];kiuc].kac].sp];tit];sUiw].mqc];km]:nm]n}. huic] 3 wUc]:eSetlIKiun]:mL;"
kgp]:n} kUn];pQn]ekL.An]A}huic] 2 wUc]:Kuin]:nUiw]n}. sac]:pQn]tac];pQn]TI,pI,El: Tuk],lIAw]m},KlUw],
SkUp].eS kUt],Tt];tUv];KI:tUiw],tL,hLsUiw].mqc];tac];pQn]"
Pac]hac]:tac];pQn]tac],siUw];
 Pac]hac]:kQw],lUv]:lgt],lUm]; - A}Agk],lUit]:' AUk];sQp];' kqn]; El:hUiw].AUn]:"
 Pac]hac]:tac];pQn]kU:lgc]:lgc]: - mI;lUm];naw]' hUiw],Agk],kac]Kiun];' hUiw].AUn]:ca}:' Am],K}:kin]K}:yqm].
El: lUit]:hUw]lUin]Am],mL;' (hG]:tUv]; lgc]:yUt];yLAn]wUn].Sgn],wL:pQn]tac];pQn]TI,pI, nC];eKL:
PiUm].Tqm] 1)"
Pac]hac]:tac];pQn]niUw]tUw]
 Am],mI;Pac]hac]:tac];pQn]TI,pI,An]tqt]:etL;El: Am],pqk],piUc]:kn]Sc]tc];Pac]hac]:tac];pQn]pgt],
tac],An]"
 Pac]hac]:tac];pQn]km]:nm] - mI;lUm];naw] ' hqc];tgt],hUw]sG]w}; (hqc];tgt],lUit]:w};)' tum],Agk],
sgm];niw].muiw];"
 Pac]hac]:An]kQw],lUv]:lgt],lUm]; - km]:nm]Et. Pac]hac]:tac];pQn]An]Am],pk],ktI, etAm],
mI;Sc]" epL;wL:Aw]KiUc]:Tgm],hUeSTgm],tUv];tI:AUk];n}suic] etl}:cin];SQc]TUv]:sG]hqc]; (TUv]:sG]kp].)'
etl}:cin]; SQc]eKL:eKL:EK:EK:' SQc]TUv]:sG]hI;hI;ehL;ehL;' SQc]mgc]eKL:sUiw];n}.yw]."
308
Pac]hac]:tac];pQn]TI,pI, An]pQn]Pa},ngk]:pgt], etmI;mUin]nc],pL:tG]:sUiw];n}.yw].-
 ygn].tac];pQn]TI,pI,eSnm].Kw]:pgt], - AUk];kp].AUk];sQp];' Sc]wL:kUt],tUv];n}suic]etl}:cin]; SQc]
lUm];hI,' Am],mI;SQc]lUm];Kw]:lUm];Agk], Am],nn] mI;eA,"
 ygn].tac];pQn]TI,pI,eSmak],ln]kG]: - mak],ln]kG]:' km]:nm]etpQn]mak],ln]tI:eKL;Sgc]Pa},"
 tac];pQn]TI,pI,tI:lup],Sn]lc] Am],nn] lup], - hac]:Pac]lqk]:la}:kGL,' sp];tit];sUiw].mqc];nC];lup],
Kaw];huic]"
 Agk];eAL - Pac]hac]:yG];hUm],Agk];eALkG]: (hUw]K}:' lgc]:hU.tUw]eA,lUc];' luim];tUw])"
 pQn]tac];pQn]TI,pI,tI:tgc]. - tgc].man];nm].' tWc].pQn]hUv],"
tac];pQn]TI,pI,pgt], (pulmonary TB)
 Aw]m},KrUw],SkUp].eSkUt],tUv]; Acid fast Bacili (AFB) An]mI;nG];KI:tUik], (l}a;Aw] Acid
eSlac].SIKI:tUiw], nn].kgp]: Bacili kUv];mI;lgc]:Tc].Kam],l}:El: sgc],hgc].wL: AFB n}yw].) tL, 3
wn];Tt];kn]- lgk];l}a; n}. c}a:' w}; El: pQn]SQn]:tac];An]yum],ym] wac];sG]l}:nn].yw]."
 Culture (lQc].siUw].mqc]; Bacili nC]; media An]l}:hQt];w}.pQn]tUw]Kqn]:kac] – pQn]lgk];la};tL,
kUt],Tt]; An]tqt]:etL;An]nuic]:yw]." kUv];kL:lgk];la};An]n}. tL,etl}:hU.eKL:tgp],
sgm];nc],lgk];l}a;Sm],mtL,n}.etl}:pG].Tiuc] 2-4 wUc]:' etl}:mI;nm].kt].pa};hU.sn].Suc]El:
kL:Kn]yG],yw]." kUn];pQn] An]Tuk],lI sC].l}a;n}.kUt],sqt]:pn]Et.-
 kUn];pQn]An]lqp]:etpQn]tac];pQn]TI,pI,n}eStL. kUt],Tt];tUv];KI:tUik], 3 pgk]:yw]. ekL:
Am],hn]sUiw].mqc];
 kUn];pQn] An]yUt];yLeSEl: hU.tqt]:etL;wL:yLAm],tUiw].
 kUn];pQn]An]pQn]tac];pQn]TI,pI,ngk]:pgt],
 kUn];sUiw];An]sp];tit];tac];pQn]TI,pI,El: l}:hp].Aw]lgc]:yUt];yLeStL.luin]:yL"
 Drug Sensitivity Test (DST) kUt],Tt];tUv];lgc]:luin]:yL- lgc]:luin]:yL (Drug Resistant TB )
El: luin]:yLpUn].tI: Multi-drug Resistant(DR/MD) Tuk],lIsG].tiuw];lgc]:yUt];yLAn]Tuk],mqn]:
(adapted treatment)sgm];nc],kUn];pQn]An]mI;sUiw]. mqc];"
 epL.AQk].Ser;tUv];tI:AuUk]; (Chest x Ray) - kUn];pQn]TI,pI, El: luk]:Agn],sUiw];An]pQn] TI,pI,
An]kUt],Tt];yw]. Am],hn]sUiw].mqc];nG];KI:tUiw],"
 Tuberculin skin test kUt],Tt];sUiw].mqc];TI,pI,tI:Piw]nc] - hU.wL:sp];tit];tac];pQn]TI,pI,
kUv];kL:p},hn] Pac]hac]:tac];pQn]TI,pI,"
309
lWc]:KUn].hLmk];mn]:tac];pQn]TI,pI,tac],lgc]:
 Aw]KQm]lQk].lut],Aw]eS;l]nC];mak],ln]An]  Thoracocentesis kUt],tUv];eS;l]tI:AuUk];
kG]:yU,nn].eS kUt],tUv]; FNAC " El: kUt],tUv];nm].nG];yC];hUm],pgt],"
- ygn].tac];pQn]TI<pI,El:nm].Kw]:pgt],"
 C X R (AQk].Ser;tI:AuUk];)-ygn].tac];pQn]  Lumbar puncture Aw]K}Sn]lc]tI:Aqw]mL;
TI,pI,El:ethn]nm].Kw]:pgt],' yG];hum],hUw] kUt],Tt];eS Kuin];kUt],tUv];Agk];eALEl:
sG]kG]:" nm].AL,yUc], CSF - ygn].tac];pQn]TI,pI,
 epL.AQk].S]er;tI:lup],Sn]lc]El:lup],tac], El:pQn]yG];hUm],Agk];eALkG]:mL;"
tI: - sG].tiuw];tL,tac];pQn]TI,pI,tI:lup],  tqc];Kw]:tgc].eSAbdominal paracentesis
El: lup],Sn]lc]" kUt],tUv];nm].peritoneal fluid- tac];pQn]
TI,pI,tI:tgc]."
lgc]:yUt];yL
sG].tiuw];l}a;yUt];yLAn]l}:Pgn];lI regimen eSyUt];yLtac];pQn]TI,pI,h]G:h}al}: - tI:pgc],Et.
 etAm],l}:Kat],yLTI,pI,' etl}:kin]yLkU:wn];"
 l}a;sG].tiuw];lgc]:yUt];yL Multi drug therapy (sG].yL 4-5 Sqn];eSyUt];yL)"
 tI:eA,Sut];etl}:kin]yL 6-8 lUin]"
 sG].tiuw];yLSqn];lI"
yLAn]Tuk],lIlUik]:sG].pQn]hUw]tI;El: hqc];yLAn]Ennm];sC].tiuw];
(hqc];yLAn]Aic]nUiw]nm].nk];tUw]eSEl:etl}:pn] tUw]yac],mn]; tUv];tI: annex)"
yLTI,pI, hqc];yLtL,kUn];lUc]El: hqc];yL pk],ktI,
SQn]:tac];pn]yL
(tUw]pgt];) luk]:Agn],(mg/kg)
Isoniazid(H) Oral 4-6mg/kg 5mg/kg
Rifampicin(R) Oral 8-12mg/kg 10mg/kg
Pyrizonamide(Z) Oral 20-30mg/kg 25mg/kg
Ethambutol(E) Oral 15-20mg/kg 15mg/kg
Streptomycin(S) Intramuscular injection 12-18mg/kg 15mg/kg
(mUiw]:p},lUik]:lgc]:yUt];yL regimen nn].Tuk],lIhU.puin];tUw]kUn];pQn]miUn]nc], AL,yu' nm].nk];tUw]' lgc]:

yam]:pQn]tac];pQn]tp]; An],nn] mak],kqw]; mI;/Am],mI;' sgc],sp];tgc].w}. El: sgc],yam]:kin]yLTI,pI,
sUiw];n}.yw].)"
310
lWc]:KUn].hLtac];pQn]sQm]sw].eS yUt];yLhC]:Tuk],mqn]:n}siuc] sac]:tt];Kat],l}a;pn],tUc],sp];tit];

tac];pQn]An]n}.l}:" kgp]:n}El: KG]:pn]tac];hn]Tuic]nk];nk];nLnLwL: kUn];pQn]ekL.lG]eSAm],wL:
Sc]A}hiuc]liUw] 2 wUc]:El: mI;Pac]hac]:tac];pQn]TI,pI,mac]siUw];n}suic] etl}:kUt],sqt]:tUv];
sUiw].mqc];TI,pI,sQm]sw]."
l}a;yUt];yL
l}a;yUt];yLAn]Tuk],lIliUk]:sC].Et.pQn]piUc]nm];l}a;yUt];yLAn]muk].sum];lUc]pa};yU,lIlUm]:fL. (Standard
short course regimen) yw]."
lgc]:yUt];yLmG],- tgn]: 1
Kaw];tac];miUw]:Et, Kaw];tac];Siup],lc]
(2 lUin]) (4 lUin])
mI;sUiw].mqc];nG];KI:tUiw],/Am],mI;sUiw].mqc];nG];KI:tUiw],
2HRZE 4HR
tac];pQn]TI,pI,ngk]:pgt],
tac];pQn]TI,pI,yG];hUm],Agk];eALkG]: 2HRZE 4HR
Sc]wL:yUt];yL huic] 2 lUin] (Kaw];tac];miUw]:Et,) yw].El: sUiw].mqc];TI,pI, yc];mI;yU,nC];KI:tiUw],n}suic]
hG]:sC]. HRZE eSTuk],lISuip],pn]kCL,Tqc]:tL,nuic]:lUin]"
Kuin];yUt];yL-tgn]: 2
mI;sUiw].mqc];nG];KI:tUiw],' Am],mI;sUiw].mqc];nG];KI:tUiw],' tac];pQn]TI,pI,ngk]:pgt],
Kaw];tac];miUw]:Et, Kaw];tac];Siup],lc]
(3 lUin]) (5 lUin])
Sc]wL: miUw]:yUt];yLpUn].mL;nn]. l}:pn]yL E tL,
2SHRZE/1HRZE 5HRE
5 lUin]lUc];tG]:
Sc]wL: miUw]:yUt];yLpUn].mL;nn]. l}:pn]yL E tL,
2SHRZE/1HRZE 5HRE
5lUin]Kiun]:niUw]
Sc]wL:yUt];yL huic] 3 lUin] (Kaw];tac];miUw]:Et,) yw].El: sUiw].mqc];TI,pI,yc];mI;yU,nC];KI: tiUw],n}suic]
hG]:sC]. HRZE eSTuk],lISuip],pn]kCL,Tqc]:tL,nuic]:lUin]"
lgc]:lm],lWc]:
tL,tWc];" " nc],huiw]etEh.kc]:l}:lgc]:luin]:yL (DRTR) El: lgc]:yLAm],tUiw].nn].
etl}:kin]yLkU:wn];eS hp].Aw]lgc]:yUt];yLh]G:yw].tUw]n}. pQn]An]lm],lWc]:Et.Et."
311
eKL:An]Tuk],lIwUn].nk];nk];nLnLtL,lgc]:yUt];yL -
pL;tgc]. (sp];Sn],eT,)
 kUn];pQn]An]tuik].l}:hp].Aw]lgc]:yUt];yLyU,nn]. Tuk],lIciUc].ew:pL;tgc].w}.kWn], (tUv];tI:lgc]:
wac];Pqn]nL:hUin]; kn] 20.2)"
 yL Rifampicin n}.sac]:hQt];hG]:Pgn];yL OC pill tUk];ygm];l}:" hG]:pn]yLEh.ham]:Sn],eT, tac],
An]" (mUin]nc],-Depopravora yLSm];)"
 Sc]wL:pL;tgc]. (sp];Sn],eT,) yU,n}suic] kgp]:wL:yL Streptomycin sac]:hQt];hG]:hUluk]:Agn],
nC];tWc].' nUk], (deafness) El: Am],Tuk],lIpn]" hG]:pn]yL Ethambutol tqn];"
luk]:Agn],El:kUn];AL,yuEk,
 etAm],l}:pn]yL Ethambutol "
lgc]:eh.kc]:El: yLeh.kc]:
eh.kc]:tac];pQn]TI,pI,l}:mUin]nc],pL:tG]:n}.yw]."
Sm];pn]yLeh.kc]: BCG tL,luk]:Agn],

muk].sum];lUc]pa};yU,lIlUm]:fL. El: IUATLD Kw] tuik];SUn];hG]:Sm];yLeh.kc]:pn]luk]:Agn],AL,yu 1
KUp],lUc];tG]: nC];piun].tI:An]mI;tac];pQn]TI,pI,nm]"
 etsac]:Eh.kc]:pn]tac];pQn]TI,pI,yG];hUm],Agk];eALkG]:ha}.hqc];' tac];pQn]TI,pI,mQt].lQk]. An]luk]:
Agn],lqc]pQn]"
 Sc]wL:luk]:Agn],l}:hp].Tat]:AL:hL,rtQm]TUn]:yU,n}suic]Pgn];yLetyU,l}:huic]Tiuc] 15 pI<yw]."
 luk]:Agn],An]sp];tit];sUiw].mqc]; HIV An]yU,nC];mUic]; sUiw];tac];pQn]TI,pI,lUic],nm]nn].
ham]:kUn];An] pQn] AIDS kUv]; Am],hG]:Sm];pn]yLEh.kc]:TI,pI,lL;lL;"
yU,Sw];Tic];Sim];hG]:pa};yU,lIKqm].lqp]:
 mUiw]:sam]El:A}nn]. hG]:Aw]es: Am],nn] Pqn],tUm];SuUp];w}.tL,eS,"
 miUw]:kac]wn];nn]. etl}:Puv],Pk];tUlUc]El: hU;lqc]; hQt];hG]:l}:lqt],El:lUm];lI"
 kgk];Kam], (tUw]yac], _etl}:TUm],nm].la};' KI:tUiw], SG],nG];kgk];TUm], Am],nn]nG];kUv]yuk];yak];"
 KI:tUik],'nm].la};An]kUn];pQn]TI,pI,Kw]TUm],nn].etl}:Aw]pqt]:lIlI" (Pw]f}; Am]],nn] Pc]
lin]pqt]:)"
 lWc]:mUt];SG]tUw]kw], - Suk]:muiw];' Aap],nm].' S}a,hUw]' lg};KUw];El: kqt];nQp].tin] nQp].muiw];"
312
hQt];hG]:tUw]Kic];kqn],Kqc]
 yL,lut],lqn];yL:' ngn];Aim],Aim],' kin]AL,hL,rAn]etpQn]Pgn];lItL,pa};yU,lI' lQn]:Agk],AQn]
hqc];"
Aac]:Aic] tac];pQn]kQw],lUv]:lgt],lUm];TUv]:sG] (kn] 21)' HIV (kn] 15.3)
Pgn];sL.yL (Drug Side Effects)
Pgn];sL.yL yLAn]sac]:pQn]l}: yLEh.kc]:

Peripheral neuropathy (Pac]hac]: Isoniazid tL,Eh.kc]:n}. etk}.pn]yLwI,tL,min],
miUw]:sw].- San]:(paresthesia) eS B6 10 mg kn]"
w}a;nn].nQt]; (prickling) El: lgc]:yUt];yL- pn] wI,tL,min], B6 100
p}atin]m}:yw]. p}amuiw];m}:mL; sgm];) – 200 mg kU:wn];" pn]hqc];yLSuc]
(high dose) n}. ethQt];hG]:Pgn];yL
Isoniazid yup]:ygm];)"
tac];pQn]tp];kG]:nUiw].lUic] Hepatitis In descending order kuit];liuw]:lgc]:yUt];yL"
(Jaundice) – luk].tI:nUiw]lUc];tG]: Sc]wL:Pac]hac]:tac];pQn]tp];kG]:h}akGL,n}
 Pyrazinamide sgc],kg}:Kuin];Et,sG].yL"
 Rifampicin Sc]wL:tac];pQn]tp];kG]:nn].pQn]mL;Kuin];
 Isoniazide Am],nn] tp];kG]:ha}.hqc];mL;n}suic] sG].la};
yUt];yL Regimen 2 SHE+10 HE"
AL,yUc],tLyup]:ygm];(Eye) Ethambutol kuit];luiw]:w}.mgk]:nuic]:wUc]:eSetsac]: Kqn];
(Am],hn]sqc]:lI' hqc];hn]l}: yup]: mL;yU," Sc]wL:pn] 15mg/kg dosage
ygm];lUc];' Am],hn] SIlqc]-SIKQw])" n}.Am],k}.pQn]eP;Sc]"
Vestibulo-ototxicity (Ear) Streptomycin ygm];pn]hqc];yLlUc]; sgm];nc],nm].nk];
(mUiw]:et,mn]; hUw]etmw];' mw];wuic]. El:pn]nm]Sut];niuc]:wUc]: 3pgk]:" Sc]wL:
mw];wac].' hUemL;) El: pQn]kgc].tI: Pac]hac]:tac];pQn]ha}.hqc];mL; mI;Pgn];sL.mL;
mak],kqw]; (Renal toxicity) Tqc]:n}suic] hG]:kuit];yLw}.km];lQw]" tL,
kUn];pQn] An]AL,yuyG], El:nm].nk];mI;
35kg lUc];tG]:nn]. pn] 500 mgn}.pQn]
lgc]:tm];sG]l}: El:Pgn];yLtiUw].lIsgm];"
313
Skin manifestationkQw],lUv]: All agents in Pac]hac]:tac];pQn]Ait];Agt]; -

Piw]nc] Am],nn] descending order: etKUm];eSetAgk],tum],Agk],pUm]' tL,hQt];
lgc]:Tat]:Am],mqn]:kn] km]:nm]"  Streptomycin. hG]:Pac]hac]:ha}kGL,nn]. hG]:pn]yL
Generalized hypersensitivity  Ethambutol. Chlophenarimine El: Calamine lotion
 Pyrazinamide Sc]wL:ha}.hqc];mL; (Steven Johnson
 Rifampicin Syndrome)
 Isoniazid - mI;lUm];naw]eStum],lqc]' tc],tG]nm].
la};tc]El:tum],mak],lqc]etAgk],mL;' Sc]
wL:pQn] Mucocutaneous eruption - n}
suic] kuit];yLpqt]:km];Siuw]:" Sc]wL: Pac]
hac]:tac];pQn]ha}kGL,yw].n} Suip],pn]yLkCL,"
lup],kp];lup],etL,sQp]; Pyrazinamide tL,hG]:Pac]hac]:tac];pQn]ha}kGL, hG]:pn]yL
(eKL:etL,sQp];) Paracetamol"
Gastrointestinal upset Rifampicin kin]Kw]:Ait];Agt];yw]. sc],kin]yL" lgc]:
(K}:eAL.' K}:hak]:' tgc].sQp];) yUt];yLhG]:sQp];tUk];ygm]; (Symptomatic
treatment) - mUiw]:p}, kin]yLTI,pI, 2
sUw]:mUc]; Am],nn] wa};eSkin]yLTI,pI,
yw]. 3 sUw]:mUc];nn]. hG]:pn]yL
Cimetidine or Metochlorpramide "
pQn]SWYk].' Agk],Piun],lqc] sgm];Piw] Rifampicin etl}:kuit];luiw]: pn]yL Rifampicin
nc]' mak],kqw];Am], hQt];kan]"
Kw]:sm] lQp]:hQn];tUv]; Pgn];sL.yL

 mat]:m}aw}. yLAn]sac]:hQt];hG]:pQn]"
 lgc]:tac];tac],An] An]sac]:pQn]l}: (mUin]nc], - ygn].tac];pQn]hw]:eSKUm];' ygn].sUiw]. mqc];
tac];pQn]tp];kG]:nUiw].lUic]eShQt];hG]:Piw]nUiw].lUic]Kuin]:mL;) sUiw];n}.Tuk],lIAw]Agk],pqt]:"
 kUt],Tt];tUv]; eP;Kgc]Pgn];sL.yLEl:Pgn];Kat],yL"
 Sc]wL:mI;Pgn];sL.yLAit];Agt];kUv];n}suic] pn]hqc];hG]:Suip],kin]yLkCL,El: yUt];yLpn]Pac]hac]:
tac];pQn]An]pQn]yU,sgm]; (mUin]nc],- tL,KUm]; pn]yL Chlorpheniramine' kUn].kUn].Kuin]:Kuin]:
pn]yL Paracetamol ' hG]:kin]yLmUiw]:etngn]; siUw];n}.kCL,)"
 Pgn];sL.yLAit];Agt]; (Minor side effects ) n}.huic]mgk]: 2-3 wUc]:suic]etKqn];kCL,Kuin];n}yw]."
314
Annex.1 pUic]nm]; tL,sG].tL,kUn];pQn]An]Tac],TUim]wL:pQn]TI,pI,
lWc]:kUt]:sqt]:An]Aic]niUw]Pac]hac]:tac];pQn]
(tUw]yac], -A}l}: 2 wUc]:Kuin]:nUiw]' nm].nk];lUt];lUc];)
Aw]m},KlUw],SkUp]. kUt],tUv];tUw]yac],KI:tUik], 3 An]"

Sc]wL: hn]siUw].mqc];TI,pI, Sc]wL: Am],hn]siUw].mqc];TI,pI,
Broad-spectrum antibiotics pn]yLKL:sUiw].mqc];hqc];yLSuc]
tL,first course(pgk]:TI.nuic]:) 5 wn];"
yUt];yLpn]tac];pQn]TI,pI,"
Sc]wL: Am],lIKiun]:mL;
Sc]hn]wL: mI;siUw]. Check X-Ray epL.AQk].S]er;tUv];tI:nL:AuUk];"

mqc];TI,pI,yU,n}siuc]
Sc]wL:Am],mI;Pac]hac]: pQn]TI,pI,
pn]yLptI,KYI<wn tL,pgk]:km];Sgc] 5 wn];"
Sc]wL: Am],lIKiun]:mL;
etl}:pn]yL TI,pI,Sc]n}nn]. ekL.tqp];tt];pn] Tuk],lIpQn]emLyL
315
Annex.2 tUw]yac], lgc]:pn]yL An]Aic]nUiw]nm].nk];kUn];pQn]tac];pQn]TI,pI,
lgk];pUic](1) tUw]yac], (Category I )lgc]:sqk],EPyL tL,pn]kUn];lUc] pQn]TI,pI,
nm].nk]; (kI,lUw],)
30 - 39 40 – 54 55 - 70 70 Kuin]:nUiw]
Kaw];tac];miUw]:Et, - kU:wn];
H 100 mg 1.5 2.5 3 3.5
R 150 mg 2 3 4 5
Z 400 mg 2 3 4 5
E 400 mg 1.5 2 3 3.5
S 1 g(in TB meningitis) 0.5 0.75 1 1
Kaw];tac];Siup],lc] - kU:wn];
H 100mg 1.5 2.5 3 3.5
R 150mg 2 3 4 5
lgk];pUic](2) tUw]yac], (Category I )lgc]:sqk],EPyL tL,pn]luk]:Agn], pQn]TI,pI,
nm].nk];(kI,lUw],)
5 - 10 11 - 20 21 - 30
H 100mg 1/2 1 2
R 150mg 1/2 1 2
Z 400mg 1/2 1 2
E 400mg - - 1
S 1g(in TB meningitis) 1/4 1/3 0.5
H 100mg 1/2 1 2
R 150mg 1/2 1 2
316
lgk];pUic](3) tUw],yac], yLkin]hUm]:kn] An]st];wac];pQn]piUc]t}aw}.(fixed-dose)tL,kUn];lUc] pQn]TI,pI,
nm].nk]; (kI,lUw],)
30 – 39 40 - 54 55 - 70 70 Kuin]:nUiw]
HRZE(75mg+150mg+400mg+275mg) 2 3 4 5
Am],nn] HRZ (75mg+150mg+400mg) 2 3 4 5
S1g (in TB meningitis or CAT ll) 0.5 0.75 1 1
HR(75mg+150mg) 2 3 4 5
Add E400mg inCATll 1.5 2 3 3.5
lgk];pUic](4) tUw],yac], yLkin]hUm]:kn] An]st];wac];pQn]piUc]t}aw}. (fixed-dose) tL,luk]:Agn],

pQn]TI,pI, (paediatric formulation)
nm].nk]; (kI,lUw],)
Tuic] 7 8-9 10-14 15-19 20-24 25-29
HRZ (30mg+60mg+150mg) 1 1 ½ 2 3 4 5
E400mg - - - - 1 1
S1g 0.25 0.25 0.25 0.33 0.50 0.50
HR (30mg+60mg) 1 1 ½ 2 3 4 5
317
tac];pQn]Piw]nc]
22
tac];pQn]Piw]nc]n}. pQn]tac];pQn]An]k}.k}.pQn]yU,yw]." tac];pQn]Piw]nc]km]:nm]n}. pQn]ygn].pUiw]:
Am],mI;lgc]: mUt];SG]tUw]Kic];El: pQn]mL;nn].yw]."
kQp];puin];tUw]kUn];pQn] kUt],sqk]:tUv];kUn];pQn]tc];tUw]eS lat]:enpn]Pac]hac]:tac];pQn]
 sQp];Et,yQn];mUiw]:lG]"  sQp];pQn]tI:lG]"
 sQp];Et,yQn];tI:lG]"  sQp];pQn]nm]mgk]:kL:hUiw]"
 sQp];sgc],EP:Agk],"  sQp];pQn]SISc]"
 sQp];sgc],KUm];"  sQp];mI;Pac]hac]:sUic].huiw]"
 tgn]:tL,etpQn]mL;tac];pQn]Piw]nc]sgc],mI;puin]; (sQp];Pqp].hiwu ] sQp];pgc];)
tUw]Sc]"  sQp]; sgc],m}:/kt];"
➔ Aw]puin];hQt];kan]kUn];pQn] El:puin];tUw]
An]Am],mqn]:Tat]:kUn];pQn]"
mUiw]:p},Et,yUt];yLSc]nn]. etl}:Aw]Sp].pYL,El: nm].Suk]:pn]sQp];hG]:mUt];SC]"
eKL:Pac]." "tac];pQn]Piw]nc]Sc]eSAm],wL: sUiw].mqc];sac]:Kw]:l}:" Sc]wL:sQp];

mI;ngc]/lqc]/lUit],/Abn], Am],nn] kUn];pQn]mI;lUm];naw]n}siuc] etl}:Aw]yLptI,KYI<wneS
yUt];yL"
22.1 sQp];yQn]; (Impetigo)

eKL:piut],tI:pgc], tac];pQn]sQp];yQn];n}. pQn]kWp]:sUiw].mqc];pqk],TI;rI;yL;eSpQn]mL;tac];pQn]Piw]nc]
nn].yw]." km]:nm]etpQn]EP:tiun];ca}: tI:luk]:Agn]," lgc]:sp];tit];n}. kgp]:tiUw].vL;km];Suiw]:"
km]:nm]ygn].pUiw]: mUc]:mqc];KUp]; Am],nn] ya};vL;eSpQn]mL;nn].yw]." epL;Kaw];hUic]mL;siuc] sQp];ekL:et
eP:Agk]," sQp];n}. etmI; Pac]hac]:mUn];mUn];El:Pqp].' etKQc]:Kqc]w}.eStac];yG],etmI; 0.5 Tuic] 3 cm"
mac]pgk]:mac]lG]sQp];etym];w}." etl}:yUt];yLpL;tac];pQn]tac],An] mUin]nc], hw]:' tUm],KUm];' tUm],lqc]'
hw]:mUv] sQm]sUiw];n}.sgm];"
1. Agk],tum],sQp];pQn]Kqp]; (localised) pgt];tUw]Kic];eStI:tI: Agk],tum],eA,lUiw]eS 3 tum],El:
mI;ngc]/Piw]nc]pQn] SIlqc]" km]:nm]Et. etpQn]tI:tac];him];SuUp];' tI:lc]hU' sgm];tin] Am],nn] sgm];
muiw]; siUw];n}.yw]." Am],mI;lUm];naw]" Sc]wL:tac];pQn]n}. luk]:Agn],pQn]n}siuc] etl}:yUt];yL mUin]nc],
pQn]tac]; pQn]sQp];yQn];haw].hqc];nn].yw]."
318
tac];pQn]Piw]nc] 22
lgc]:yUt];yL
 Aw]nm].El:Sp].pYL, Am],nn] Aw]nm].yL:yLKL:sUiw].mqc];eS Suk]:pn]hG]:mUt];SG]" (tUw]yac],
- Savlon Am],nn] Chlorhexidine)
 sQp];An]hqc]:KQc]:nn]. kgk];Agk],pqt]:" kqt];pn]nQp].muiw];" Sc]wL:Tuk],lITLekL: TLhUw]pn]"
(Sc]pQn]tum],sQp];yQn];tI:hUw]tc];nm])
 tL;yL (Gemtaian Violet ) pn]nuic]:wn];Sgc]pgk]:"
 Sc]wL:pQn]tI:nL: etl}:Aw]nm].yL:yLKL:sUiw].mqc]; (antiseptic) eSSuk]:pn] BID tqn];
Gentian Violet "
 etl}:w}.sQp];hG]:hqc]:" (Sc]wL:pQn]tI:kum],kUn]:luk]:Agn],n} etAm],l}:nbc]:kUn]pn])
 etAm],l}:pn]luk]:Agn],kGL,hUc];hQn]; etL,Tuic]sQp];epL;hqc]:"
 etl}:yUt];yLpL;kUn];An]sp];tit]; (Treat contact) tI:kUn];pQn]"
2. sQp];yQn];An]ha}.hqc]; luk]:Agn],kUit],mC],pQn]tum],sQp];yQn];tI:lQw]nm]lUiw]eS 3 tum],Am],nn]

tI:tUw]Kic]; pQn]tum],sQp];yQn];nm]lUiw]eSnuic]:tI:"
lWc]:yUt];yL
 etl}:yUt];yLmUin]nc],tac];pQn]Agk],tum],sQp];pQn]Kqp]; (localised)"
 pn]yL Cloxacillin 500mg QID tL, 7-10 wn];" tgn]:tL,luk]:Agn],pn] 25mg/kg/dose QID
to, 7 wn]; Am],nn] Sc]wL:Am],mqn]: Penicillin hG]:pn] Erythromycin 25mg/ kg QID 7
wn];Tuic] 10 wn];"
 sQp];yQn];An]mI;ngc]nn]. etl}:PL,Agk],pqt]:"
22.2 sQp];AUm]ngc] (Abscess)

eKL:piut],tI:pgc],
nG];eS;l]mI;ngc]tQm]w}." tI:sQp];nn].etlqc]' etsQp];' m}:eSetkG]:w}." etsac]:mI;lUm];naw]El:
mak].ln]kC]:" Sc]wL: yLptI,KYI<wnAm],tiUw].Tuic]tI:n}siuc] etl}:PL,hg};sQp]; Aw]ngc]Agk],yU,yw]."
sQp];mac]An]n}.Am],m}:/Am],sQp];" kgp]:nn]Sc]sUic].wL:hn]sQp];AUm]ngc]mUin]sUic].n}n}.
hG]:wUn].Sgn],tac];pQn]TI,pI,yU,"
sn].tgn]:nuic]: (First stage): Piw]nc]hqc]:KQc]:

 etl}:Aw]nm].Aun],eS sQt].pn]nuic]:wn];SI,pgk]:"
319
22 tac];pQn]Piw]nc]
 tgn]:tL,ethQt];hG]:sQp];lIKiun]:nn] hG]:pn]yL Paracetamol Am],nn] Aspirin "
 Am],tap]:sC].yLptI,KYI<wn (Antibiotic) hG]:pn] Cloxacillin tL, 7 wn];kUv]; (Am],nn]
Sc]wL:Am], mqn]: Penicilin hG]:pn] Erythromycin) miUn],nc], -
 K},eS;l]kG]:sQp]; (Cellulitis) (tUv];tI:pL:tG]:)"
 Pac]hac]:kU:lgc]:lgc]: ( general symptoms) (mI;lUm];naw]/kt];Sn],)"
 luk]:Agn],AL,yu 1 KUp],lUc];tG]:"
 tI:hUw]' tI:eKL; (Am],nn]) tI;muiw]; pQn]sQp]; El: mI;ngc]"
 Sc]wL:tI:nUm]; mI;ngc]El: kG]:n}siuc] hG]:pn]yL Cloxacillin 500mg QID tL, 10 wn];"
sn].tgn]:Sgc] sQp];ha}.hqc];" Piw]nc]eStI:tI: (tI:mI;nm].ngc]) An]AUn]:w}.nn]. etl}:sI;nm].ngc]

Agk],pqt]:"
lWc]:yUt];yL
 etl}:sG].TUc]muiw]; El: KUic]:km].kqm] An]KL:sUiw].mqc];yw]."
 sG].yLnL hQt];hG]:sQp];eA,lUc];"
 Aw]mit]:An]KL:sUiw].mqc];yw].nn].eS PL,"
 Aw]nm]].ngc]Agk],eS Suk]:pn]hg};sQp];" etl}:yL.pqt]:An]kG]:AUm]ngc]mUt];mUt];"
 Aw]nm].yL Normal Saline eSSuk]:pn]sQp];"
 Aw] Gauze sup].nm].yL Normal Saline eS lac].pn]nG];hU;sQp];"
 SG],yLpn]nG];hU;sQp];kU:wn]; etL,Tuic]nUiw].epL;tQm]mL;Kuin];" etAm],l}:Aw] Gauze sup]:yL:yL
Iodine eSSuk]:pn]" epL;hQt];sUic].nn]siuc] ethQt];hG]:eS;l]An]mG],ta}El: etl}:Aw]
nm].yL:yL Normal Saline eSSuk]:pn] etL,Tuic]sQp]; epL;Agk],nm].SG]mL;"
etAm],l}:Kgk];EK,yL.hg};sQp];" ygn].wL:ethQt];hG]: Cavernous Sinus pik].El:pQn]eP;"

Sc]wL:pQn]n}siuc] Aw]yL:yLptI,KYI<wn Sm];pn]nG];SQn]:lUit]:"
22.3 eS;l]sQp];kC]: (Cellulitis)

tI:pgc],
kgp]:siUw].mqc];pqk],TI;rI;yL; Kw]:kGL,tI:tG]:Piw]nc]eSEP:Agk]," etlqc]/kG]: El:sQp];" (Am],mUin]sQp];
kG]:AUm]ngc])" epL;pQn]sUic].n}siuc] sQp];ekL:etyG],/kG]:mL;" lUm];naw]etKuin]:Suc]ekL:pQn]l}:" kgp]:sUiw].mqc];
Streptococcus Pyogenes El: Staphylococcus Aureus eSpQn]mL;nn].yw]." sUiw].mqc]; Kw]:tI:hg};sQp];'
hg};yQn];' hg};PL,tt];eS Kw]:sU;nG];tUw]" Tuk],lItUv];wL:sUiw].mqc];luk].tI:lG]Kw]:mL;"
320
tac];pQn]Piw]nc] 22
eP;lUc]tac];pQn] eS;l]kG]:sqp];n}.Et. pQn]tac];pQn] Sqp],tik].eK<mI;yL;nn].yw]."

(Septicaemia - pqk],TI;rI;yL; EP:Kw]:nG];lUit]:)
➔ An]lm],lgc]:tL,Eh.kc]:kgc].Kw]:nG];lUit]:n}. etl}:KUn].hLmk];mn]:tac];pQn]sQm]sw].El:
pn]yLKL:sUiw].mqc];eS yUt];yLpn]nn].yw]."
lgc]:yUt];yL
 etAm],l}:Aw] KL/muiw]; An]pQn]tac];pQn]tUc].nuic]El: etl}:w}.Suc]lUiw]hUw]sG]"
 hG]:SG],yL An]ym];El: Aw]An]kt];Tap]:pn]"
 yL,PL,hg};sQp];"
 Sc]wL:kUn];pQn]yC],liUw] 12 pI<yw].n}siuc] pn]yL ASA tL,hg};sQp]; El: kG]:" tL,luk]:Agn],
12 KUp],lUc];tG]:Et. hG]:pn]yL Paracetamol"
 epL;pQn]mUin]nc],pL:tG]:n}. hG]:pn]yLKL:sUiw].mqc];
1. hg}:sQp];An]Am],ha}.hqc];
 Cloxacillin PO (tL,luk]:Agn], 25mg/kg QID – tL,kUn];lUc] 500mg QID tL, 7 wn];
El: nt].mL;EnKuin];"
 kUn];An]Am],mqn]:yL Penicillin nn]. hG]:pn] Erythromycin" (tL,luk];Agn], 25mg/kg
QID El: tL,kUn];lUc] 500mg QID) PO"
 wa};eS 3 wn];yw]. kUn];pQn]Am],lIKiun]:mL; Am],nn] h}a.hqc];mL;lUiw]kw],n}siuc]
etl};Aw]kUn];pQn] ngn];tI:hUc];yL" yUt];yLpn] nc],tac];pQn]ha}.hqc];"
2. hg};sQp];tI:An]ha}.hqc];- lUm];naw]Kuin]:/kUn];pQn]Am],yU,lI
 SG],Sa}ma}kUn];pQn]nG];eS Aw]ngn];tI:hUc];yL" Sc]pQn]l}:hQt]; blood culture "
 Benzyl Pencillin (tL,luk]:Agn],AL,yu 1 KUp],lUc];tG]: 25mg/kg QID' tL,kUn];lUc] 1.2g
QID) El: IV Cloxacillin (tL,luk]:Agn], 50mg/kg' tL,kUn];lUc] 1g QID)
 wa};eS sUw]:mUc];yw]. Am],lIKiun]:mL; Am],nn] h}a.mL;lUiw]kw],n}siuc] hG]:PiUm].Tqm]pn]

48
Gentamicin OD (tL,luk]:Agn],lqc] 4mg/kg' tL,luk]:Agn],El: kUn];lUc] 7mg/kg)"
22.4 sQp;] mat], (Wounds)

lgc]:yUt];yL
 lac].pn]sQp]; hG]:mUt];SG]" Aw]nm].yL:yLKL:sUiw].mqc]; (antiseptic)eS lac].pn]sQp];"
 Aw]yL Gentian Violent tL;pn]"
 pn]kGam];hU.lgc]:lum];lL; tL,Eh.kc]:tac];pQn]kac];Kqc] (tUv];tI:pL:tG]:)"
321
22 tac];pQn]Piw]nc]
 tL,sQp];h}g;yG],nn]. Aw]kUiw]wan] El: A},AUw],tin];elL;kn]eStL;pn]n}. ethQt];hG]:sQp];
sQw];hqc]:" tL,tgc]; - nc],huiw]mUt]. etAm],mL;tgm]l}:nn]. etl}:Aw]nm].SG],nG];Aac],eS
hgc];tG]:KLkU, tc]; 4 Kgn]w}."
 lac].eS SG],yL:yLpn]kU:wn]; etL,Tuic]sQp];epL;hqc]:El: mUt];SG]"
 yL,yQp].h}g;sQp]; An]pQn]mL;huic]lUiw] 6 sUw]:mUc];"
 tL,h}g;sQp;] An]ha}.hqc];El: liuk].nn]. hG]:SUc],kCL,hUc];yL"
 Sc]wL:pQn]tac];pQn] mUin]nc], tac];pQn]lin].hUw]sC]hUw]:' yQw]:wan]' tac];pQn]p}aSQn]:liUt]:sQp];
kqn]; (tin]kt];eSsQp];kqn];)' hqc];Kam],tUw]tUk];ygm];' mat],sQp];tI:tgc].' kgp]:lup],hk];El:
pQn]sQp];mL;' sQp];tI:niUw].yiUw]:(Tissue)ta}' sQp];An]yG],lUiw] 5 cm' sQp];An]mI;Pun],muk].
mI;l}ala}siUw];tit]; yU,siUw];n}. etl}:Aw]yL:yL Cloxacillin eSyUt];yLpn]"
lgc]:lum];lL;sQp];mat],El: lgc]:Eh.kc]:tac];pQn]kac];Kqc]
kUn];pQn]An]l}:hp].yLEh.kc]:tQm]TUn]: kUn];pQn]An]l}:hp].yLEh.kc]:
mI;eP; yLPiUm].hqc];yLEh.kc]:km];luin];Sut]; Am],tQm]TUn]: (3 pgk]:lUc];tG]:)
5 KUp],lUc];tG]: 5 KUp],Kuin]:nUiw] 10 KUp],Kuin]:nUiw]
Et,pn] Am],nn] pn]yL
yLTqm]hqc];yL
eA,* Am],mI; Am],mI; Eh.kc]:hG]:tQm]TUn]:" (Course
Eh.kc]:
tQm] tL,yLEh.kc]:- 5 pgk]:)
yLptI,KYI<wn'' yLptI,KYI<wn''
la};yUt];yL la};yUt];yL Serotherapy'
yLTqm]hqc]; yLTqm]hqc];yL
nm]** Serotherapy' yLTqm]hqc];yLEh.kc]:"
yLptI,KYI<wn ptI,KYI<wn
yLTqm]hqc];yL Et,pn] Am],nn] pn]yL
Eh.kc]: Eh.kc]: hG]:tQm]TUn]:"
*sQp];mat],An]Am],epL;mI;eP; (hg};mat],sQp];Ait];Agt];/ hg};Kan],vL;)
**sQp];mat],An]mI;eP; hg};sQp];An]luik].' sQp];nG];pac]tuik];' lup],hk];El:pQn]sQp];' sQp];tI:niUw].yiUw]:
(tissue)ta}' sQp];f};m}:' ygn].KUw];Kgc]eSAn]An]El: pQn]sQp];mL;' sQp];An]hbic]lUiw] 6 sUw]:mUc];"
yLptI,KYI<wn" " Cloxacillin 5 wn];"
yLPiUm].hqc];yLEh.kc]:" Aw] Tetanus Toxoid 0.5 ml Sm];tI:kam]:nUiw]. Am],nn] tI:kum],kUn]:"
l}a;yUt];yL
Serotherapy " " tL,kUn];lUc]- Thetanus Immune Globulin 250 units IM STATSm];pn]
tI:him];hgm];h}g;sQp];" Sc]wL:sQp];hbic]liUw] 24 sUw]:mUc]; Am],nn] sUiw].mqc];
Kw]:ha}.hqc]; Am],nn] pQn]h}g;sQp];f};m}:n}siuc] hG]:Sm];pn] TIG 500 units IM
STAT tI:kam]:nUiw].km];Siuw]:"
322
tac];pQn]Piw]nc] 22
22.5 sQp];f};m}: (Burns)

puin];tac];pQn]
 f};m}:vL;miUw]:lC]"
 f};Sc]m}:SC]," epL;m}:kgp]:f};fL.n} etha}.hqc];lUiw] miUw]:Et,m}:vL;"
 AL,ybkUn];pQn]l}:kL:hbiw] ? tL,luk]:Agn]lQk].El:kUn];Tw]:nn]. sQp];f};m}:n}. etha}.hqc]; liUw]"
 sgc],Sbt],nUm]vL;kGn];f};? hLtUv];h}g;f};m}:KUn]KU;lc]El: h}g;pQw]f};m}:SC],pak], sgm];him];hgm];KU;lc]
El: pak],"
Tt];Sac]tac];pQn]
tUv];Pac]hac]:hg};sQp];f};m}: tbin]:hiuw]luik].eS sqk],EPhg};sQp];f};m}:pn] sgm];nc],pL:tC];n}.
hg};f};m}:sn].nUiw]Piw]nc] lqc]' hqc]:El:sQp];" Am]],k}.mI;h}g;f};pgc];"
hg};f};m}:sn].nUiw]tI:Piw]nc]lbik].Ait];nuic]: etpQn]SIKgc],El: h}g;f};pgc];piUw]."
hg};f};m}:lbik].Kw]:nC];Piw]Ait];nuic]: h}g;sQp];pQn]mQt].SIPUik], Am],nn] SIKgc],El: mac]tI:
etAm],hU.sQp];"
hg}:f};m}:Piw]nc]tQm]tQm] PUik]," etmI;mQt].SIKgc], Am],nn] SITan],mI:" hqc]:"
kUn];pQn]An]vL;f};fL.m}:nn]. etl}:kUt],sqt]: ECG"
tL,hU.wL:f};m}:Piw]nc]kCL,kL:huiw]nn]. hG]:Aw]muiw];kUn];pQn]Pa},nuic]:eS mL;Sgn],np].tUv];"

tI:PL,muiw];kUn];pQn] wac];l}:nuic]:PL,muiw];nn]. mk];mn]:wL:f};m}: 1 % Kgc]Piw]nc]tc];mUt];"
Am],tap]:np].Sgn],pL;hg};sQp];f};m}:sn].nUiw]Piw]nc]"
f};m}: sgm];nL:' muiw];' eKL: El: him];hU;Pa}:lUc]n}. Kqn];pQn]hg};sQp]; An]ha}.hqc];liUw]"
lgc]:sqk],EPmk];mn]:sQp];f};m}:
sQp];f};m}:An]Am],ha}.hqc]; sQp];f};m}:An]ha}.hqc]; (hp].w}.tI: IPD )
 cw];la};kUn];pQn]lIyU,"  Sut],vL;kgn];f};' tI:nL:mI;hg};f};m}:' f};m}:
 tI:nL:' muiw];' eKL:El: hU;P}a:lUc] Am],mI;h}g; KUnK] U;lc]' TUv]:sC]mI;SQc]"
m}:"  f};m}:tI:nL:' muiw];' eKL: Am],nn]hU;P}a:lUc]"
 tI:hg};f};m}: - m}:Piw]nc]mac]tgn]: 10%  tI:hg};f};m}: - m}:Piw]nc]mac]tgn]: nm]liUw]
lUc];tG]:" m}:Piw]nc]tc];mUt]; 2% lUc];tG]:" 10%" m}:Piw]nc]tc];mUt];nm]liUw] 2%"
323
22 tac];pQn]Piw]nc]
lgc]:yUt];yL
 yUt];yLtac];pQn]tc];tUw]- PiUm].Tqm]Kuin];Tat]:nm]."
 yUt];yLhg};sQp];- hg};sQp];f};m}:n}. etsQp];hqc];"
 him];hgm];sQp];- hQt];hG]:sQp];sQw];hqc]:' Eh.kc]:Am],pn]sUiw].mqc];Kw]:' Eh.kc]:Am],pn]Piw]nc]hU,"
lgc]:yUt];yLKuik].Kak]. la};Tt];Sac]
Sc]wL:Sut],vL;kgn];f};' kgn];hUp],vL;tI:nL:n}siuc] pn] Oxygen eS
lgt],lUm];El:lUm];TUv]:sG]
SUc],kCL,hUc];yLkm];Siuw]:"
Sc]wL: pQn]hg};f};m}:ha}.hqc];n}sbic] hG]:pn] 16G Cannulas Sgc]An] El:
lgc]:lUit]:pn],wUn];nG];tUw]
PiUm].Tqm]Tat]:nm].pn] (kUn];lUc] NSS 1L El: luk]:Agn], 20 ml/kg)
Aw] Cling film hUm],w}.nUiw]hg};sQp];f};m}:" pn]yL Paracetamol' Tramadol
tL,hQt];hG]:sQp];lIKiun]:
Am],nn] Morphine"
la};Siup],yUt];yLpn]sQp];f};m}:ha}.hqc];
 ygn].f};m}:eS Sum];Tat]:nm].El: etl}:PiUm].pn]Tat];nm].nG];SQn]:lUit]:" tac];nm]eA,Tat]:
nm]. An]etl}:PiUm].Tqm]pn]nn]. np].Sgn],l}:nc],pL:tG]:n}."
nm]. Ringer tI:etl}:pn] = nm].nk];tUw] (Kg) x piun].tI:hg};sQp];f};m}: (%)
 Tat]:nm].Kiuc]:nbic]: An]etl}:SC],pn]nn]. hG]:SC],pn]nG];Kaw];tac]; 8 sUw]:mUc];eS An]kuit];

yU,nn]. h]G:pn] 16 sUw]:mUc];Pa},lc]"
 SG],lgt],yQw]:eS tUv];tac];nm]eA,yQw]: An]Agk],mL;"
 sG].tuiw];lgk];Kgc]:nm].Kw]:Agk],eS pG].tUv];lgc]:PQc],pQc];pn]" Sc]wL:yQw]:An]Agk],mL;n}. niuc]:sUw]:
mUc]; eA,lUiw] 0.5ml/kg siuc] etl}:wUn].Sgn], tL,pn]Tat];nm].nm]nm] mUiw]:lQw]kn]"
 etl}:pG].tUv];kU:Kaw];yam];"
lgc]:yUt];yLsQp];
tk];etl}:yUt];yLpn]kUn];pQn] hG]:sQp];lIKiun]:kU:ekL. (kn] 7.5)" pn]yL Paracetamol, Tramadol
Am],nn] Morphine" l}a;niuc]:tI:hQt];hG]:sQp];lIKiun]:l}:lIEt. hUm],h}g;sQp];f};m}:w}.pn]" kgp]:wL:epL;et
lac].h}g;sQp];eS SC],yLpn]n}. etsQp];hqc];nL,El: Tuk],lIpn]yLEk:KUp];Kiun]: Agn]tac];eSkgn],"
324
22
tac];pQn]Piw]nc]
lgc]:yUt];yLhim];hgm];h}g;sQp];
 Aw]nm].yL KL:siUw].mqc]; (An]Am],mI; EAl]kUw],ehL;) eSlac].h}g;sQp];hC]:mUt];SC]"
 lgc]:Eh.kc]:tac];pQn]kac];Kqc] (tUv];tI:hg};sQp];tgn]: 22.4)
 Aw]yL Silver Sulfadiazine tL;pn]h}g;sQp];" (ciUc].ew:sG].yLtL;ptI,KYI<wn)
 sG].PL: bandages tI:KL:siUc].mqc];w}.yw]. hUm],pn]"
 Sc]wL: wa};eS 21 wn];yw]. sQp];Am],hqc]:n}siuc] etl}:sG].la};yUt];yoPL,tt];Aw]Piw] nc]
tac],tI:mL;tqn];eSyUt];yLpn]"
22.6 pQn]KUm];pQn]hw]: (Scabies)

eKL:piut],tI:pgc],
pQn]KUm];pQn]hw]:n}. pQn]kgp]:sUiw].mqc];pL,rL,S}. (Parasitic)eSEl:pQn]mL;nn].yw]." tac];pQn] An]n}.
pQn]kn]km]:nm]El: sp];kn]l}:ca}:" tuiw].vL;sm]sm]km];Siuw]:kUv];ekL:sp];kn]l}:" wa};sUiw].mqc];Kw]:
kGL,nG];Piw]nc]yw]. ethQt];hG]:Piw]nc]kG]:pgc];Kiun]:mL;"
Pac]hac]:tac];pQn]
etKUm];(km]:nm] kac]Kuin];)' ethn]tum],sQp];lQk].lQk].El: hg};y}a; sgm];Ek:niw].tin]niw].muiw]; Aqw]' kic],
eh. Am],nn] cw]:KL El: l}al}atI:" kUn];nG];hiUn];ekL:sac]:pQn] tac];pQn]KUm];n}.miUn]kn]" tac];pQn]
KUm];n}.sac]:pQn]l}:l}al}awUc]: etL,Tiuc]l}al}alUin]kgn],yw]." KUm];siUw];n}. sUiw].mqc];sac]:Kw]:mL;l}:" kgp]:n}
yUt];yL lgc]:sUiw].mqc];Kw]:Agn]tac];" (tUv];tI:tac];pQn]sQp];yQn]; 22.1)" wa};eSnn]. sc],yUt];yL
tac];pQn]KUm];pQn]hw]:"
lgc]:yUt];yL
 yUt];yLlgc]:sUiw].mqc];Kw]: (sQp];yQn];) Agn]tac];"
 Aw]nm]. El: Sp].pYL. Aap],lac].tUw]Kic];kUn];pQn]tc];tUw]"
 Aw]yL Permethrin Lotion 5% Am],nn] Benzyl Benzoate Lotion tL;pn]kUn];pQn]tc];
tUw] lUiw]eSnL:El:KUic]:Ac],kL, (kUn];lUc] 25% luk]:Agn], 12%)" yL,tL;pn]tI:nUiw].num],"
epL;yL:yLhqc]:yw]. sc],nbc]:SBiw]:KUw];An]mUt];SG]" (etl}:tL;yLw}.hiuc] 12 sUw]:mUc];)" nc],hiuw]
etciUc].ew: kan]Suk]:lac].pqt]:yL:yLnn]. tL;yL Permethrin kac]Kuin];n}. etpQn]An]
Tuk],mqn]:liUw]piUn]:" (yL,tL;yL Permethrin pn]luk]:Agn], An]AL,yu 2 lUin]lUc];tG]:)"
 kqt];nQp].muiw];El:Aw]yL Permethrin SG],pn]tG]:nQp].muiw];"
 nC];Kaw];yam];lQw]kn]nn]. yUt];yLpn]pL;kUn];nG];hUin];El: kUn];An]yU,sm]kUn];pQn]"
 Aw]nm].lBit],El: Sp].pYL,eS Sk].pn]KUw];nuc]:kUn];pQn]" Aw]KUw];ngn]; (tUw]yac], -
325
22 tac];pQn]Piw]nc]
PL:hUm],) Agk],tak],lqt], tL, 2 wn];" Am],nn] SG],nG];TUc]yac]An]pik].hI,w}. tL, 4 wn];"
 KUm];An]ha}.hqc]; (Norwegian Scabies) nn]. etl}:Aw]yL Permethrin 5% tL;pn]wn];
TI.nuic]: El: yLtL; BBL tL;pn] 2-7wn];" wa};eSnn].tL;pn]siUc].n}Kiun];tL,l}al}awUc]:"
 lat]:pn]kUn];pQn]wL: yc];tuik].etKUm];yU,tL,l}al}awUc]:' tI:KUm];yU,siUc].n}n}. pQn]Pac]hac]:
sUiw].mqc];pL,rL,S}.Et,t}aEl: pQn]nn].yw]." mac]Pw],etl}:sC].yL Calamine mL;tL;h}g; KUm];"
w}a;eSyUt];yLyw].El: KUm];Am],lIKiun]:mL;n}sbic] etl}:Tt];Sac]Kiun];lgc]:tL;yLwL: sgc],l}:

tL;Kqm].lqp]:/Am],Kqp]:lqp]:" Tt];Sac]pL; lgc]:yUt];yLkUn];hiUn];kUn];pQn]An]yU,sgm];kn]"
22.7 tac];pQn]Piw]nc]An]pQn]kgp]:sUiw].mqc];hQp];
(Fungal Infections)
eKL:piut],tI:pgc], mw]:
kgp]:sUiw].mqc];hQp];Kw]:kGL,nC];Piw]nc] Am],nn] yC];Piw]mac]El:pQn]mL;nn].yw]." km]:nm] ethn]tI: kUn];
pQn] An]yam]:sG].yL:yLptI,KYI<wnmL;' kUn];pQn]yQw]:wan]' kUn];tI:An]hqc];Kam],tUw]tUk];ygm]; El: Em:
pL;tgc]. sQm]Aw]sUiw];n}.kCL," km]:nm]Et.etpQn]tI:nG];pak], (pQn]pak],mw]: mQt].PiUk],PBik], yU,nC];pak],
An]Aw]pqt]:l}:El: epL;Auin]tac];kin]n}etsQp];) El: mw]:Agk],nG];KUic]:Ac],kL,nac];yic];" sQt].pqt]:
Am],nn] Kut], pqt]:mw]: etL,Tuic]epL;hn]yC];Piw]pQn]SIlqc]" (kn] 9.1, 13.5)
lgc:] yUt];yL
mw]:nC];pak],
 miUw]:kin]Kw]:yw]. hG]:Aw]yL:yL Gentian Violet tL;pn]kU:pgk]:"
 Sc]wL:pQn]luk]:Agn],kin]nUm]; ygt],pn]yL Nystatin km];Suiw]:" wa};eSlac].muiw];Em:hG]:mUt];SG]
yw]. hG]:Aw]niw].miuw];sm]:Pgc]yLAn]Ait],w}.eS tL;pn]nC];pak],hG]:sgt], 1 wn]; 4 pgk]:"
 epL;pQn]ha}.hqc]; Am],nn] GV Am],tiUw].n}siuc] hG]:sC].yL Nystatin (An]Ait],hG]:pQn]Pgc]w}.)
Am],nn] yLAUm] (tL,AUm]w}.nG];pak],)"
tL,yUt];yLpn]kUn];pQn] HIV/AIDS (kn] 15.3 )"
mw]:nG];KUic]:Ac],kL,nac];yic];
 Aw]yLSG],nG];KUic]:Ac],kL,nac];yic]; Nystatin 100000 IU OD" hG]:SG],w}.Kaw];miUw]:ngn];tL, 14wn];"
 hG]:pn]yL Nystatin tL, 2-4 wUc]:' Sc]wL:Am],lIKiun]:mL; Am],nn] pn]yL Clotrimazole 200
mg SG],nG];KUic]:Ac],kL,tL, 3 Kuin]; Am],nn] 100 mg tL, 6 Kuin];"
326
tac];pQn]Piw]nc] 22
 Sc]wL:ngk]:KUic]:Ac],kL,kUn];pQn] kG]:w}.n} hG]:pn]pL;yLtL; Clotrimazole, Econazole"
eKL:piut],tI:pgc],hw]:
tac];pQn]sUiw].mqc];hQp];sp];tI:Piw]nc]" sQp];ethqc]:eSpQn]wUc];kGac]:w}." etsac]:eP:Agk],mL;km];lg}; lg};
(sC].Kaw];yam];l}awUc]:Tuic]l}alUin])" sQp];tac];nG]; etAm],mI;Sc] tac];him];hgm];sQp];Sm].etmI; kQt];eS
etKUm];ha}.hqc]; kUv];kL:Am],sQp]; Am],nn] Am],mI;lUm];naw]" mac]pgk]:mac]lG] etmI;ngc]"
Sc]wL:pQn]tI:hUw] pgt];tI:An]pQn]nn]. etAm],mI;KUn]hBw]"
lgc:] yUt];yL
 Aw]nm]. El: Sp].pYL, Suk]:lac].pn]hG]:mUt];SC]"
 Sc]wL:pQn]tI:hUw] hG]:TLKUn]hUw]pqt]:"
 tL;yL Whitfield Ointment BID tL, 3 wUc]:" yLtL; Whitfield Ointment pn]luk]:Agn],
Am],nn] tI:nL: "
 Sc]wL:hbic] 3 wUc]: El: Am],lIKiun]:mL; Am],nn] tL,luk]:Agn],nn]. hG]:pn]yLtL;
Clotrimazole BID tL, 3 wUc]:"
 epL;pQn]ha}.hqc]; Am],nn] yUt];yLmUin]nc],pL:nUiw]El: Am],lIKiun]:n}siuc] etl}:EnemLyL
Am],nn] pn]yL Griseofulvin (kUn];lUc] 500mg kU:wn];' luk]:Agn], 10mg/kg/day
nuic]:pgk]:) pn]etL,Tuic] 6 wUc]: Am],nn] etL,Tuic]KUn]hUw]Agk],mL;Kuin];' km]:nm]Et. ethbic]
6-8 wUc]:" (tL,tgc]; - PU:sa}; Am],Tuk],lIhQt];hG]:em;pL;tgc]. nG];Kaw];tac]; 6 lUin] nn].'
PU:yic]; Tuk],lIpG]. 1 lUin] w}a;eSyUt];yLyw].sc],pn]sp];Sn],eT,")
 epL;pQn]hw]:tI:nc]hUw]n}sbic] Tuk],lIyUt];yLtac];pQn] An]Kw]:mL;Tqc]:nn].Agn]tac];"
(ygn].yLtL;kUv];eS etAm],epL;k}.h}a)" tL,eh.kc]: Am],hG]:pQn]Tqc]:nn]. etl}:sC]. yLtL;
Griseofulvin tL, 3 lUin]"
 wUn].Sgn],tL,pn]yLkin] Fluconazole " (kUn];lUc] 150 mg etL,wUc]: El: luk]:Agn],
8mg/kg etL,wUc]: tL, 8-12 wUc]:)"
Sc]wL:Am],lIKiun]:mL; etl}:kUt],sqt]:tUv];hG]:tqt]:etL;wL: Am],sG]:tac];pQn]lUc]" (kn] 22.14)
327
22 tac];pQn]Piw]nc]
22.8 Tat]:Am],mqn]:El:pQn]mun],man], (Allergy/ Urticaria)
eKL:piut],tI:pgc],
ygn].Am],mqn]:Tat]:El: etKUm];tI:Piw]nc]"
Pac]hac]:tac];pQn]
etmI;Pac]hac]:El: tac];yG],tum],l}al}asUiw];' tum],etPUk].lqc]eS lqk]:l}a:tac];yC],El:hac]:Pac]w};
(nG];Kaw];tac];Am],l}aminit].) sgm];tc];tUw]" Pin u ],ettuic],Agk],km];nuic]:kUv]; (etpQn]l}aminit].
etL,Tiuc] huic] 24 sUw]:mUc];)" etKUm];ha}.hqc];"
Am],mqn]:Tat]:eSpQn]mL;n}. pQn]l}:km]:nm] ygn].piUw]:

 yL:yL- Sc]wL:pQn]kUn];pQn]tI:l}:hp].Aw]yL:yLAn]mG], (Quinine, Amoxycillin,
Cotrimoxazole)
 mqc];KUp];' KUn]mqw];' mqc];tUik],' SInC];nm].kin]' tiUw].vL;tUn]:m}./lQk];' tac];kin]tac];yqm]."
tL,tgc];" "km]:nm]Et. ygn].Sc]El:Am].mqn]:Tat]:n}nn]. ethLlgc]:tac];Am],l}:"
lgc]:yUt];yL
 Aw]nm].eShQt];hG]:yQn]lUc];"
 kiut];pqt]:lgc]:An]hQt];hG]:pQn]- kuit];pqt]:yL:yLAn]mG],' kuit];pqt]:lgc]:tBiw].tUn]:m}.' lQk];
El: tac];kin]tac];yqm]."
 kqt];nQp].muiw]; tL,Eh.kc]:Am],hG]:sUiw].mqc];Kw]:"
 Sc]wL:KUm];ha}.hqc]; hG]:pn]yL Chlorpheniramin (kUn];lUc] 4 mg' luk]:Agn], 0.1mg/kg Kqn]:
4-6 sUw]:mUc];niuc]:pgk]:)etL,KUm];epL;h}a"
Dexamethasone IV Am],nn] IM Am],nn]

Sc]wL: kG]:pgc];tI:nL: Aw]ngn];hUc];yLeSpn] Hydrocortisone sodium succinate IV Am],nn]
IM
luk]:Agn], - 0.01 mg/kg/ dose
epL;TUv]:sG]yap], pn] Adrenaline IM
kUn];lUc] 0.5 mg/ dose
tUv]; l}a;yUt];yLkiuc].kac].lium];tUw] (kn] 7.6 )
328
tac];pQn]Piw]nc] 22
22.9 tac];pQn]hw]: (Eczema)

eKL:piut],tI:pgc],
Am],mI;lgc]:tac];Sc]eS Piw]nc]kG]:Agk],pQn]yum],pQn]ygm],nn]. hgc].wL:tac];pQn]hw]:n}yw]."
Pac]hac]:tac];pQn]
tI:tUw]Kic];eStI:tI: etKUm];" km]:nm]etpQn]tc];tUw] (pQn]tI:Pa},nL:cgk];Sgk], El: lc]hUw]Kw],)"
hw]:n}.mac]pgk]:mac]lG]pQn]kGac];w}.tI:lQw] Am],nn] eP:Agk],' hqc]: Am],nn] ym]; kUv];kL: etpQn]Kaw];
hUic]" hw]:hqc]:n}. etKUm];ha}.hqc];El: etmI;nm].yac]tqc]Agk],mL;" etAgk],tI:lQw]eS pQn]pQn]ha}ha}yU,
l}apgk]:" lgc]:sUiw].mqc];Kw]:Tqc]: (yQn];mL;) n}.ekL: k}.pQn]kn]km]:nm]"
Sc]wL:sUiw].mqc];Kw]: hG]:yUt];yLAgn]tac]; (tUv];tI: sQp];yQn];) wa};nn].sc],yUt];yLhw]:"
lgc]:yUt];yL
 yL,ya};" SG],Tuc]muiw];ngn]; fac].w}.kac]Kuin]; kUw]Am],hU.tUw]eSkCL,ya};vL;"
 Aw]nm].lac].kUv]; - yL,sG].Sp].pYL, tI:pQn]hw]:" yL,Aw]nm].TUsQp];"
 miUw]:lg};KUw];nuc]: lg};hG]:mUt];SG]lIlI' epL;sUic].nn] Sp].pYL,sc],etAm],l}:kuit];nUiw]SUiw]:KUw];"
 Sc]wL:sQp];hqc]: hG]:Aw] Vaseline tL;pn]"
 epL;pQn]ha}.hqc]; hG]:wUn].tL,yLtL; Steroid (miUn]nc], - Betamethasone Am],nn]
Hydrocortisone Sc]wL:mI;)"
 Sc]wL:KUm];ha}.hqc];n} Aw]yL Chlorpheniramine eSyUt];yL"
➔ yL:yLtL; Steroid n}.etmI;hqc];yLkU:siUw];" Hydrocortisone n}.hQc];yLeA,'
Betamethasone n}.hqc];yLetSuc]liUw]" epL;sG].yLtL; Steroids hqc];Suc]Kaw];hbc i ]ns} bic]
ygn].wL:sac]:hQt];hG]:Piw]nc] lU.El: etl}:w}.StieSsC]." hG]:sC].yLhqc];eA,Sut];El:
Kaw];pgt];liUw]piUn]: mgk]:kL:etpgt];l}:"
22.10 tac];pQn]mak],hqc];(lQk].)(Herpes Simplex)

eKL:piut],tI:pgc],
tac];pQn]mak],hqc];(lQk].) n}.ygn].sUiw].mqc];w};rt].S] Herpes simplex eSpQn]mL;tI:Piw]nc]El: sn].
yG];Piw]mac]sUiw];nn].yw]." wa};eSsUiw].mqc];w}rt].S]Kw]:pgk]:niuc]:yw].nn]. siUw].mqc];etkbit];w}.nG];tUw]
tL,eS," Sc]wL: kUn];pQn] Am],yU,lITqc]:' sG]Suk].Sak]. Am],nn] kt]; Am],nn] tiUw].vL;
lqt],hiuc]n} etpQn]Kiun];Tqc]:"
329
22 tac];pQn]Piw]nc]
sUiw].mqc];tac];pQn]n}. km].nm]etpQn]tI:lQw]tL,eS," tI:An]k}. pQn]km]:nm]n}. tI:pic],SUp];' nC];pak],'
tL El: tI:KUic]:Ac],kL," tac];pQn]nm].yac]tqc] (lQk].) n}.epL;tuiw].vL;n}sac]:EP:sp];l}:"sQp];nm].
yac]tqc]n}.epL;hbic]mgk]: 10 wn];sbic] etha}kGL,hc];kUv];" kUv];kL: Am],hbic]Am],nan]; k}.Agk],pQn]mL;Tqc]:"
Pac]hac]:tac];pQn]
 tI:Piw]nc] Am],nn] SUp]; Am],nn] tI:KUic]:Ac],kL, yG];Piw]mac] etmI;sQp];nm].SG]SG]tQm]
w}.eS etAgk],pQn]kgc]w}."
 mUiw]:kUn];pQn]mL;hUc];yLnn].mac]pgk]:mac]lG]nm].yac]tqc]ettqk],w}.El:Piw]sQp];sn].nUiw]etkqn],w}."
 etsQp];ha}.hqc];" mUiw]:sQp];p},Agk],nn].etsQp]; etSqp],El: KUm];"
 nG];pak],etsQp];El:kin]tac];kin]tac];yqm].etyap]," tI:nG];pak],El: tI:nUiw]pic],SUp]; etpQn]
sQp];" km]:nm]Et. etk}.pQn]hUik],kG]:mL;"
Pgn];sL.sgm];lc]
epL;pQn]tI:nG];mk],tLn}. sac]:pQn]ha}.hqc];eS hQt];hG]:yG];hUm],hUv]tLkG]: (Keratitis)El: hQt];hG]:tLmgt],
l}:" (tUv];tI: kn] - 11.2)"
Sc]wo:tI:KUic];Ac],ko,Em:po;tgc].mI:tum],nm].yac]tqc]n} mUiw]:Pgc];kUit],nn].sac];sp];sU;luk]:Agn],El:
pQn]EP;yC],lUc]to,luk]:etkUit],mL;Et.Et."
lgc]:yUt];yL
epL;pQn]l}:sQp];An]ha}.hqc];El: sQp];nw]:Am],nn]sQp];mak],hqc]; An]pQn]tI:nL:eS EP:mL;tI:tLn}sbic]
pn]yLkin] Aciclovir pgk]:TI.nuic]:nG];Kaw];tac]; 48 sUw]:mUc];El: 1 wn]; 200 mg 5 pgk]: tL, 7 wn];"
1. nUiw]Piw]nc]
 Aw] Savlon lac].sQp];eSw}.hG]:hqc]:"
 Aw]yL:yL GV tL;pn] (tL;tI:nL:Am],l}:)"
2. pQn]nG];SUp];
 Aw]nm]. El: kUiw] pUn]:lac].pak],pn]"
 Aw] GV tL;pn]" Sc]wL: sUiw].mqc];tac],An]Kw];mL;Tqc]:n} Aw] Amoxicillin eSyUt];yLpn]"
3. pQn]nG];tL
 Aw]nm].Abn],kt];eSlac].pn]"
 SG],yL Terramycin Eye Ointment
 tL,ettiUc],pac],l}:nn]. SUc],kUn];pQn]kCL,sU;emLyL"
330
tac];pQn]Piw]nc] 22
4. pQn]tI:KUic]:Ac],kL, - tUv]; STI (kn]-13.5)
 Aw]nm].El: Sp].pYL,lac].pn]sQp];" tgn]:tL,ethQt];hG]:sQp];lIKiun]:nn]. pn]yL:yL
Paracetamol" TUc]yac] (Condom) n}.etEh.kc]:pn] tgn]:tL,Am],eP:Agk],sp];tit];
tac];pQn] Tqc]:"
 Sc]wL:mUiw]:kGL,yQw]:nn]. mI;tac];yap],Puit],n} lUw],pn]yL:yLkin] Acyclovir" yL:yL
Acyclovir n}.Am],mI;eP;tgn];tL,Em:pL;tgc]." nm].yac]tqc] An]pQn]tI:KUic]:Ac],kL,nn].
Sc]wL:pQn]mUiw]:sm]etkUit], luk]:n}etl}:PL,tgc].kUit],Agk],nn].yw]." tL,hQt];sUic].nn]n}.
tk];etl}:SUc],kCL,sU;emLyL"
22.11 Varicella Zoster
tac];pQn]mak],lqc];Kaw] (Chickenpox)
eKL:piut],tI:pgc],
pQn]tac];pQn] An]k}.pQn]kn]km]:nm]eS ygn].sUiw].mqc];w};rt].S]eSpQn]mL;El: sac]:EP:Agk],l}:ca}:"
kUn];him];hgm]; Am],nn] kUn];nG];hiUn];ekL:sac]:mI;Pac]hac]:tac];pQn]An]miUn]kn]"
Pac]hac]:tac];pQn]
 mI;lUm];naw]Ait];Ait];" hUw]K}:" Am],lIyU,"
 KUm];' mI;Pac]hac]:l}al}asUiw];" tac];nG];tum],sQp];mI;nm].SG]SG]" sik];nUiw]sQp];mac]An] etKqc]"
 pQn]tc];tUw]- km]:eA, etpQn]tI:tin] ' muiw]; eS km]:nm]etpQn]tI:tUw]Kic];"
lgc]:yUt];yL
 Aw]nm].El:Sp].pYL,lac].pn]"
 kqt];nQp].muiw]; tL,Am],hG]:ya};vL;sQp];"
 Aw]yL:yL GV eStL;pn]tI:nUiw]sQp];" Sc]wL:sUiw].mqc]; Kw]:mL;Tqc]:n}sbic] etl}:pn]
yLptI,KYI<wn (tUv];tI:tac];pQn]tum],sQp]; tgn]:-22.1)
 pn]yL Paracetamol tL,yLlUm];naw]"
 epL;pQn]KUm];ha}.hqc];kUv]; sc],kg}:pn] Chlorpheniramine tL, 1-3 wn];"
 epL;tI:tL mI;sQp];n} SG],yL Terramycine eye oilment"
331
22 tac];pQn]Piw]nc]
mak],hqc]; (lUc]) (Herpes Zoster)
eKL:piut],tI:pgc],
tI:nUiw]Piw]nc]eStI:tI: mI;tum],nm].lqc]lqc]w}." ygn].siUw].mqc];w};rt].S]An]hQt];hG]:pQn]tac];pQn]mak],
lqc];Kaw]eSpQn]mL;nn].yw]." kUv];kL: tac];pQn]mak],hqc];(lUc])n}. w}a;eSpQn]mak],lqc];Kaw]l}apI<yw]. sc],
pQn]mL;nn].yw]." tac];pQn]mak],hqc];(lUc]) n}. pQn]l}:kU:ekL.n}eStL. kUn];An]mI;hqc];Kam],tUw]eA,n}.
etpQn]km]:nm]" (tUv];tI: HIV kn]-15.3)
Pac]hac]:tac];pQn]
 mUiw]:p},Agk],tum],nn]. kUn];pQn]etmI;lUm];naw]El: kt];Ait];Ait];" Am],yU,lI"
 sgm];tUw] tI:etAgk],sQp];El: sQp];p},Agk],nn]. etsQp];ha}.hqc];"
 wa};eS 5 wn];yw]. ethn]tum],sQp];pQn]SIlqc]w}.eS etmI;nm].SG]SG]w}.nG];tum],sQp];"
etmUin]mak],hqc];(lQk].)" kUv];nL,etEP:Agk],piun].tI:nm]lUiw]eSmak],hqc];(lQk].)"
 wa};eSnn]. sQp];ekL:etlqk]:la}:pQn]nm].ngcm] L;eS ettqk],Agk],' nc]ekL:etkqn],eSKqc]w}."
 tum],sQp];ekL: etAgk],mL;sgm];him];SQn]:AL,yUc], (Dermatome) tI:An]Tuk],tum].tiUw]." km]:
nm] etpQn]tI:nL:AuUk];n}eStL. Am],wL:Piw]nc] Am],nn] yC];Piw]mac]tI:lG]ekL: hn]pQn]sQp];
l}:yU," (etAic]niUw]tI:wL: SQn]:AL,yUc],An]lG] vL;yLlU.El: pQn]mL;nn].yw].)"
 sQp];n}.etpQn] Pak],nuic]:tUw]Kic];kUv];"
lgc]:yUt];yL
 etl}:yUt];yLmUin]nc],mak],hqc];(lQk].)"
 Aw]PL:sup].nm].yQn]yQn]eS sQt].pn]tUw]Kic];"
 hQt];sgm];pUic]yUt];yLsQp]; (kn] - 7.5)" Sc]wL: pn]yLKUp];Kuin]:yw]. Am],lIKiun]:mL;n}siuc] etl}:
pn]yL Amitryptiline "
 Sc]wL:pQn]tI:tL Am],nn] ha}.hqc];n}sbic]SUc],kCL,sU;emLyL" Sc]wL: mI;yL Acyclovir n}Et.
sac]:lIKiun]:l}:yU," kUv];kL:etl}:pn]yL:yL wa};eSAgk],sQp];yw].nG];Kw];tac]; 48 sUw]:mUc];
kUv];"
 tac];pQn]An]n}. sac]:sp];kCL,sU;l}:tI: kUn];An]p},yam]:pQn]tac];pQn]mak],hqc];Kaw]"
332
tac];pQn]Piw]nc] 22
22.12 mqc];tiUk],Kw]:Sgn].yU,tC]:Piw]nc]
(Cutaneous Larua Migrans)
eKL:piut],tI:pgc],
tac];pQn]An]n}. ygn].K},mqc];tUik],pak],mQt]; An]yU,sgm];tUw]St]; (mL' mqw];) eSpQn]mL;nn].yw]." K},
tUik],nn].etmI;sgm];nG];KI:mL' KI:mqw];" kUn];An]Am],tuiw];Kqp];tin]eS p}kCL,p}mL; nUiw]lin]sUiw];nn]. sac]:
yQp],vL; tUw]ngn]tiUk], An]sac]:sI;Kw]:nG];Piw]nc]sn].ngk]:kUn];l}:nn].yw]." wa};nn]. tUw]tiUk],Agn],
etKw]:kGL,yU, tG]:Piw]nc] (SQn]:tac];tI:Kw]kGL,nn]. pQn]hg};SQn]:SIlqc]w}.)" km]:nm]etpQn]tI:tin]"
Pac]hac]:tac];pQn]
 pQn]SQn]:SIlqc]niUw]Piw]nc]El: KUm];ha}.hqc];" tUw]Agn],tiUk],n}. nuic]:wn];etkGL,l}:mI,lI,mI,tL, Ait];
nuic]:kUv];"
 km]:nm]etpQn]tI: KL El: tLtin]"
 sBiw].mqc];tBw]Agn],n}. yB,l}:nC];Kaw];tac];l}al}awBc]:eS ett}akCL,hc];kUv];"
lgc]:yBt];yL Mebendazole 100mg BID pn]tL, 3 wn]; Am],nn] Albendazole 400mg OD

pn]tL, 3 wn];"
lgc]:Eh.kc]: hG]:tbiw];Kqp];tin]"
22.13 Larva Currens

eKL:piut],tI:pgc],
tac];pQn]An]n}.pQn]kgp]:sUiw].mqc]; Strongyloides stercoralis tBw]Agn],nn].yw]."
Pac]hac]:tac];pQn]
pQn]SQn]:SIlqc]tI:Piw]nc] nC];wUc]:kac] eKL; El: hUw]Kw],eS etKUm];ha}.hqc];" SQn]:SIlqc]n}. etyU,hiuc]
Kaw];tac];nuic]:wn];etL,Tuic]Sgc]wn];" mun],man],ekL: etpQn]pQn]h}ah}a"
lgc]:yUt];yL pn]yL:yL Albendazole 400mg OD tL, 3 wn];"
lgc]:Eh.kc]: hG]:tbiw];Kqp];tin]"
333
22 tac];pQn]Piw]nc]
22.14 tac];pQn]tut]: (Leprosy)
tac];pQn]tut]:n}. etmUin]nc],tac];pQn]Piw]nc]l}al}asiUw];'
SQn]:AL,yUc],' lup],' El: tac];pQn]tL sQm]sUiw];n}.nn].yw]."
eKL:piut],tI:pgc],
tac];pQn]tut]:n}. pQn]kgp]:sUiw].mqc];pqk],TI;rI;yL; Mycobacterium " tL,etsp];tit];tac];pQn] nn].
yap],n}eStL. kUn];An]Am],hp].Aw]lgc]:yUt];yL' kUn];An]sUiw].mqc];sp];w}.tI:Piw]nc]' kUn];pQn]tac];
pQn]tut]:n}. sac]:hQt];hG]:siUw].mqc]; EP:Agk],tac];KU:lc]sgm];lUm];TUv]:sC]" yip];Piw]nc] kUn];pQn]tut]:
n}. Am],sp];tit];tac];pQn]l}:" kUn];mI;siUw].mqc];tut]:n}. Sc]wL:l}:hp].lgc]:yUt];yL tQm]TUn]:n}sbic]
etAm],hQt];hG]:sp];tit]; tac];pQn]l}:" kUn];km]:nm]tBiw].vL;sUiw].mqc];pqk],TI;rI;yL; An]hQt];hG]:pQn]tut]:
l}:eStL.Am],k}.hn]sp];tit];tac];pQn]"tL,mk];mn]:tac];pQn]nn].etmI;yU,2eKL:"
epL;hn]mUin]nc],pL:tG]:n}. etl}:wUn].Sgn],tac];pQn] tut]:"
 mI;h}g;pQn]wUc];nUiw]Piw]nc]eStL. Am],KUm];' pQn]mL;hbic]tL,Kaw];tac]; 6 liUn] Am],nn] hiuc]liUw]
nn].' Am],mUin]tac];pQn]Piw]nc]tac],siUw];' Aw]yL:yLtac],siUw];yUt];yLekL:Am],h}a"
 kUn];pQn]ekL.lG]eSAm],wL: Sc]wL:mI;lgc]:lqk]:la}:niUw]Piw]nc]' Pac]hac]:SQn]:AL,yUc], (kG]:' lgc]:hU.
nUiw].ettUk];ygm];' etAm],mI;lgc]:tUc].nuic]) Piw]nc]PBik],An]pQn]h}g;nn].mI;lgc]:hU.nUiw].eA,' SQn]:
AL,yUc], etnLEl: yG],mL;n}siuc] lqp]:etpQn]tac];pQn]tut]:l}:"
kUn];pQn]hg};sQp]; An]Am],sQp];' hg};sQp];f};m}: Am],nn] sQp];tI:pQn]sgm]; tin]' muiw];sUiw];n}.tc];mUt];
etl}:wUn].Sgn],tac];pQn]tut]:"
Pac]hac]:tac];pQn]
Piw]nc] Maculae(mqm],) km]:nm]pQn]h}g;' nG];kac]PBik],El:Kgp],kG]:lqc]w}." Papules (kG]:Kuin]:' nL'
pQn]wUc];) km]:nm] SIlqc]" Plaques (kG]:' EP:Agk],kCL,) km]:nm] SIlqc]"
SQn]:AL,yUc], SQn]:AL,yUc],sgm]; tin]' muiw];' eKL;El: kgk];hUw] (ngk]:Agk];eAL) siUw];n}.etyG],nL
Kiun]:mL;" SQn]:AL,yUc],hgp]:ngk]:sQp];' tiUw].vL;n} etsQp];c}a:' lgc]:hU.tUw]sgm];Piw]nc]
eA,lUc];' kam]:niUw].Am],mI;hqc]; (niw].muiw];etecL;' eKL:muiw];ecL;tUk];' tin]ekL: etKQc]:'
nL:etmit];kCL,Pa},nuic]:)kam]:niUw].ethQw],lUc];"
tL nUiw].tL (tc];nL:) etAm],mI;lgc]:hU.tUw]' Am],sac]:lp];tL (lagophthalmus)' Kgp],
tLtac];tG]:etpin]:(Entropion)' KUn]tLhUc]:' KUn]tLSQn]:lQk].lUc];El: tqc];Kw]:kCL,
nC];tL' tLhqc]:pQn]sQp];' tLsQp];' kqw].tLSC]lU.' tLmgt],"
334
tac];pQn]Piw]nc] 22
Sc]wL:piun].tI:pgt];tI:SUyU,nn]. mI;KUc];kan]kum];Tic];tac];pQn]tut]:n}siuc]
kUn];tI:An]wUn].Sgn],wL:pQn]tac];pQn]nn]. hG]:SUc],kGL,hUc];yLlUc] tL,KUn.] hLEl:
yUt];yLtac];pQn]"
Sc]wL:piun].tI:pgt];tI:SUyU, Am],mI;Pqn]kan]kum];Tic];tac];pQn]tut]:n}siuc] hG]:hQt];sgm];nc],pL:tG]:-

 Aw]puin];tUw]tac];pQn]" nG];Kaw];pgt]; (3 wUc]: Am],nn] eA,lUiw]) El: KUm];n}siuc] tuiw].tac];
tL,etpQn]tac];pQn]tut]:n}.eA,"
 Aw]nun];kuv]El:KQm] kUt,] sqt]:tUv];tI:Piw]nc]" Sc]wL:Am],mI;lgc];hU.nUiw].n} mk];mn]:wL: pQn]
tac];pQn]tut]:" miUw]:AL,yUc],hU.sQp];p},h}akCL,nn]. AL,yUc],hU.tuiw].vL;n}. eth}akCL,Agn]tac];"
eKL:etKw]:hUm]:pL;mUiw]:kUt],sqt]:tac];pQn]
1. hG]:kUt],sqt]:Piw]nc]tc];mUt]; tI:hn]lqc];lIlI" wUc];tI:An]Am],pk],ktI,(puc],man],)' SIlqk]:la}:'
hqc]:' tUv];lgc]:KUn]hUc]: sQm]sUiw];n}.kCL,"
2. kUt],sqt]:tUv];wL: lgc]:SQn]:AL,yUc], yG],El:nL mI;/Am],mI;"
 Ulnar kUt],sqt]:tUv];tG]:cgk];Sgk], (hG]:ecL;Sgk],eSkUt],sqt]:tUv];)"
 Median tac];nL:cgk];Sgk],El: tac];nL:eKL:muiw];"
 Radial kUt],sqk]:tUv];tI:lc]muiw];' mUiw]:p},Tuic]eKL:muiw];
 Peroneal (Lateral Popliteal) Pa},nUiw]him];hUw]Kw],lup],KLtc];nUiw]Sut]; (hG]:ecL;hUw]Kw],eS
kUt],sqt]:)"
 Tibial eKL:tin] tI:lc]tLtin]nC];"
 Posterior Auricular kUt],sqt]:tUv]; eKL;' tG]:hU' lc]hU" hG]:wa},nL:tUv];kGL, Pa},nuic]:"
 kUt],sqt]:SQn]:AL,yUc], An]sm]tc];h}g;sQp];niUw]Piw]nc]"
3. Aw]nun];kuv] Am],nn] es:eStuiw].tUv];wL: sgc],lB.Sum];lgc]:hU.tUw]El: kUt],sqt]:tUv];
Piwn ] c] An]Am],pk],ktI,' muiw];' tin] El: nL:" liUw]nn]. hG]:kUt],sqt]:tUv]; lgc];hU.sQp];
mI;/Am],mI; (sC].KQm]) El: lgc]:lU.Sum]; hU.kt]; hU.m}: mI;/Am],mI;"
4. Aw]nun];kuv]eS tiUw].kUt],sqt]:tUv];wL: lgc]:hU.tUw]SQn]:AL,yUc],kqw].tLSC] mI;/Am],mI;"
5. kUt],sqt]:tUv]; hqc];kam]:nUiw].tI:tin]' muiw];El:nL:wL: tUk];/Am],tUk];' lgc]:hQw],lUc]; mI;/Am],mI;"
(Peroneal)- Aw]pa}tin]ecL;Kuin]:nUiw] (ecL;eKL:tin])' miUw]:Kuin];pg},nn]. tUv];wL: sgc],tin]lUc];
Kuin];/Am],lUc];Kuin];" Sc]wL:tin]Am],lUc];Kuin];n} pgc],wL:SQn]:AQn]tin]Am],sn]" (Tibial)- tQk];
pa}tin]lUc];tG]: - (yQt],eKL:tin]) (Radial)-Aw]eKL:muiw];ecL;kCL,tac];lc]" (sn]eKL:muiw];)
(Median) - Aw]PL,muiw];wac];c}aw}.nUiw]PiUn]eS hG]:Aw]nQw].Em:miuw];sp];Kw]:tc];nG];" (Ulnar)-
Aw]PL,muiw];wac];c}aw}.nUiw]PiUn]eShG]:Aw]nQw].Em:miuw]; hac],Agk],tc];ngk]:" hG]:Aw]nQw].kg}:kI:Agk],tc];
ngk]:sgm];" sG].Aw]niw].sI. kI:Agk],tc];ngk]:" hG]:Aw]niw].muiw];eSyip];Es:w}.yL,hG]:tUk];"
(Facial)-SQn]:AL,yUc],tI:nL:sG].lp];tL"
335
22 tac];pQn]Piw]nc]
hG]:Kut],Aw]Piw]nc]tI:tUw]Kic]; 4 Am],nn] 6 tI: w}.pQn]tUw]yac]," mip],KU:lc]eS Aw]tUw]yac],w}.sgm];"
 Aw]tG]:man],hU Pa},Sa}./KGa}' tI:SUp];Sgc]An]tiUw].kn]El: Aw]Sgc]tI: tI:Am],l}:pQn]Sc]"
 Aw]mit]:eS PL,Kw]:hG]:tac];yaw]; 5 mm' tac];luik]. 2-3 mm" nc],hiuw]etEh.kc]: yL,hG]:
lUit]:Agk],El: yg}.tUk];nn]. mUiw]:p},PL,El: Kaw];yam];PL,nn]. hG]:mip],Piw]nc]w}." Aw]Sn]mit]:
Kut],pn]h}g;mit]:"
 Aw]pgt];nUiw].tm];nUiw]man],eS KQc]:hG]:tac];kGac]:pn],tUc], mI; 7mm" ygm].SIsgm];nc],l}a; Ziehl
Nielsen El:kUt],sqt]: (Acid-fast-bacclli-AFB) "
lgc]:mk];mn]:tac];pQn]n}. etAic]niUw]lgc]:kUt],sqt]:tUw]yac], nC];Piw]nc] Am],nn] KU;lc]An]Aw]
mL;tI:Piw]nc] An]mI;Pac]hac]:lqk]:la}:' SQn]:AL,yUc],him];Agk],tbm],tbt]: “Lepromatous Leprosy”"
pqk].Sm].wL: lgc]:kBt],sqt]:tBv];Piw]nc]El: KB:lc] Am],hn] siUw].mQc];n}eStL. kBn];pQn]ekL:yc];
sac]:pQn] tac];pQn]tbt]:l}:yB," kBn];pQn]km]:nm]k}.pQn]tac];pQn]tut]: “tuberculoid type”
eSetAm],kUt],vL;siBw].mQc];"
lgc]:yBt];yL
lgk];la};sC].yL:yLeSyBt];yLn}. pQn]lgk];la}; An]ca}:eSpBin]:yw]." Sc]wL: kBn];pQn]sC].yLTuk], mqn]:
El: kin]sgm];Kaw];yam];n}sbic]etsac]:hQt];hG]:siUw].mQc];ta}El: Am],sac]:EP:sp];tac],ekL.l}:" kBv];kL:
Sc]wL:yBt];yLSQn]:AL,yUc],nibc]:wBc]:yw]. Am],ha}n}sibc] sac]:etlB.Sbm];SQn]:AL, yUc],etL,sBw]:El:
lgc]:eh.kc]:Am],hG]:SQn]:AL,yUc],lU.lqw]n}. pQn]An]lm],lgc]:Et.Et.yw]."
SQn]:AL,yUc], Kqn]' KL' tL lU.Sum];kCL,etL,sUw]:yw].El: lgc]:pn]tac];eh.kc]:' lum];lL;tUv];Tiuc]

hG]:Piw]nc] pQn]Kiun];mUin]kw],' lgc]:Sup];tiuw];tL,eh.kc]:tin]' lgc]:pBk];pgc] pa};sC]' l}a;yUt];yLpn] hG]:
hQt];kan]' lgc]:s}g:Tqm] KUw];Kgc]El: hqc];sC]siUw];n}. pQn]lgc]:An] tk];etl}:s}g:Tqm]pn] Kaw];yaw];
pun]:tL,kUn];pQn]El: lgc]:hUm]:miuw];kUn];pQn]"
lgc]:yUt];yLtc];yL:yL
Dapsone 100mg (OD) kB:wn]; El: Clofazimine 50mg (OD) kB:wn];"
Rifampicin 600mg nbic]:lBin]nbic]:pgk]: El: Clofazimine 300mg nbic]:lBin] nbic]:pgk]:"
yL:yLkin] nbic]:lBin] nbic]:pgk]:nn]. Tbk],lIkin]sgm];nc], emLyLSc]," l}a;sC].yLSam]Sqn];(mQw];)hUm]:kn]
n}. tI:eA,Sut];Tuk],lIpn]tL, 2 pI<El: pn]kin]yL:yLkCL,tik];tik];etL,Tiuc]epL;Am],hn] siUw].mqc];
nC];tUw]" An]l}:kUt],sqt]:tUw]yac],Piw]nc] 3 tI:nn]. Kqn]:niuc]:liUn]eS kUt],sqt]:tL, 2 pgk]:"
Pgn];sL.yL
 yL Dapsone n}.sac]:hQt];hG]: mQt].lBit]:lqc]lU.lqw]eS sac]:pQn]tac];pQn]lBit]:sac]El: Tuk],lI
kUt],sqt]:Tat]: G6PD " Sc]Tat]: G6PD eA,n} Tuk],lIw}.sm]tUw]eS lbm];lL;kBn];pQn]"
336
tac];pQn]Piw]nc] 22
 yL Dapsone n}. mac]pgk]:mac]lC] sac]:hQt];hG]:pQn]mBn],man], haw].hqc];l}:"
 yL Clofazimine n}. sac]:hQt];hG]:PQw]nc]l}a:SIpiUk],mak],sgk];' SInm].Ag}:eS Sc]wL: kbit];yLn}
ekL: SIPiw]nc] etAgn,] lBc];mL;Kiun];lg};lg};"
 Aw]yL Ethionamide Am],nn] yL Prothionamide siUw];n}. tac]tqn];yL Clofazimine l}:"
kBv];kL: sac]:tbm].tiUw].tp];"
 yL Rifampicin n}. pqk].Sm].wL:hQt];hG]:yQw]:pQn]SIpiUk],mak],sgk];eStL. Am],hQt];hG]:pQn]eP;"
cw];l}a;tI:etl}:yBt];yLtac];pQn]tut]: Kbik].Kak].n}. etmI;mBin]nc],pL:tC]:n}."

1. mBiw]:Pgc];pn]yLnn]. mI;Pac]hac]:Am],mqn]:yLhaw].hqc];" kgp]:hqc];Kam],tBw] siun],tiuk];etL;El: hQt];hG]:
tum].tBiw].SQn]:AL,yUc],mC], Am],nn] Piw]nc]lU.lqw] El: etpQn]hUm]:pL;-
k) SQn]:AL,yUc],kC]:Kiun]:w};El: Pgc];tBiw].AQn] etsQp];
K) Am],sac]:tBc]. (eKL:muiw];ecL;tUk];' AQn]tin]etsn] El: nL:etmit];kCL,Pa},nuic]:)
c) sQp];An]kw],tI:Piw]nc]nn].etsQp];' epo;tiuw].n}etsQp];El:sac]:pQn]sQp];Kiun]:mL;"
lgc]:yUt];yo- etl};yc].liuw]:' pn]yL Aspirin, Prednisolone dose Suc] (kUn];lUc] 40-
60mg kU:wn];) n}sbic]ethQt];hG]:SQn]:AL,yUc],sQp];nn].etlIKiun]:mL; nG];Kaw];tac]; wn];Sgc]
wn];" wa};eSnn].etl}:ygm];hqc];yLpn] tL,Kaw];tac]; 3 Tiuc] 4 lUin]" Suip],pn] yLtut]:kCL,"
2. Pac]hac]:Am],mqn]:yLhaw].hqc];n}. ethn]tI:kUn];pQn] An]Am],l}:hp].lgc]:yUt];yLtQm]TUn]:El:

hqc];Kam], tUw]tUk];ygm];kCL,eSpQn]mL;nn].yw]." tI:Piw]nc]nn]. sQp];eteP:Agk],mL;liUw]kw],eS sQp];
tI:kw],nn].ekL:etpQn]tum],tut]: (nL' c}a;mUin]' haw].hqc];' Agk],tum],) eSyG],Kuin]:mL;liUw]kw],nn].yw]."
lgc];yUt];yL - pn]yLtut]: El: Prednisolone mUiw]:lQw]kn]eS yUt];yL"
3. km]:nm] mUiw]:yUt];yLnn]. etAm],yU,lIEl: mI;lUm];naw]" ygn].hqc];Kam],tUw]tUk]; l}:Piun].Kuin];

l}al}asiUw];El: ettum].tiUw].SQn]:AL,yUc],' kam]:nUiw].' lup],El:eKL:etL,sQp];' mak],ln]kG]:' kqw].tL
SC]kG]:' K},hm]sQp];' nG];yQw]:mI;Tat]:prUw],tin];' Agk],tum],lqc] (lqc]eSsQp]; An]sac]:yQn];pQn]sQp];l}:)"
lgc]:Am],yU,lItI:wL:mL;n}. sac]:hQt];hG]:Tiuc]ta}kgn],yw]."
lgc]:yUt];yL - yLkin] Thalidomide n}.lIeSpUin]:" kUv];kL: hLSuiw].yap],El: etAm],l}:pn]
nac];yic];kin] liUw]eSwL:Kw]etAm],Aan];Aw]luk]:" hG]:pn]hqc];yL Clofazimine Suc] (nuic];wn];
300mg huic]liUw] 3 lUin]) Am],nn] yLkin] Chloroquine ekL:sG].l}:yU," yL Prednisolone n}.
tL,sG].yUt];yL tac];pQn] An]haw].hqc];kUv]; (miUw]:Am],mI;yL Thalidomide kUv];sc],sG].)El: kgp]:
pQn]tac];pQn]Kaw];hbic]eS haw].hqc];nn]. tL,etkuit];kin]yLn}.etyap],"
lgc]:eh.kc]:
lgc]:eh.kc]: KL' Kqn]El: tL An]Am],hU.tUw]yU,yw].nn]. pQn]lgc]:lm],lgc]:"
 Kqp];tin]etl}:nL" tUwy ] ac], - hG]:tuiw];Kqp];tin]yac]tL,yL,kL; tL,Eh.kc]: lQk];m},nL;yC],El:
337
22 tac];pQn]Piw]nc]
nUiw].tc];nG];Kqp];tin]etl}:AUn]: (rL,pL,AUn]:) tL,eh.kc]:nm].nk]; An]lUc];mL;tI:tin]An]
 Am],mI; lgc]:hU.tUw]El: hQt];hG]:lU.lqw]"
 Tuk],lISG],TUc]muiw]; miUw]:Pgc];hUc]tUm]:El: hQt];kan]"
 Tuk],lIsG].man],tL (An]Am],pL;hqc];S}atL) tL,Eh.kc]:kqw]:tL"
 Tuk],lIEs:tin]El:muiw]; nC];nm]. nuic]:wn]; 30 minit]. tL,sg}:hG]:Piw]nc]An]hqc]:nn]. AUn]:
Agn],mL;yw]. tL,eh.kc]:Piw]nc]tqk],' sQp];El: siUw].mqc];Kw]:nG];h}g;sQp];nn]. Tuk],lI Aw]nm].
mn];mak],m}.Pk];KQw]eStL;pn]kU:wn];"
 eKL:etL,lup],KQc]:Kqc]n}.ekL: hG]:tUc].niuc]tL,eS,eS eh.kc]:l}:El: Tuk],lIhQt];kCL,l}g;l}g;' lIlI'
tL,eS, kU:wn];"
lgc];pn]pa};hU.
Tuk],lIpn]tc];hU.kUn];pQn] lgk];la};eh.kc]: Kqn]' KL El: tL An]Am],hU.tUw]yw]." Am],hQt]; Sc]n}.
etlIliUw]piUn]: kUv];kL:km]:nm]ekL: Am],pQn]l}:" lgc]:lm],lgc]:Et. nG];nuic]:wn];nn]. km];km];hG]:kUt],
sqt]: tUv];Kqn]KLwL:sgc],mI;lgc]:tum].tiUw].pQn]sQp];El: nqt]:lum];lL;yUt];yLpn]km];Siuw]:" Tuk],lIwUn].
El: eh.kc]:eP;An]sac]:etpQn]l}: mUin]nc], Am],hG]:f};m}:vL;n}.ekL: pQn]An]lm],lgc]:"
lgc]:Piun].PU;pn]Kiun];
kan]PL,tt];El: l}a;Agk],hqc];yUt];yLn}. pQn]pgt];tgn]:lm],lgc]: tL,yUt];yLpn]sQp]; An]pQn] tI:
tin]' muiw];' nL:' lup],El: kam]:niUw]. AQn]ta}kGL,siUw];nn]." kam]:niUw].tI:SQn]:AQn]t}akCL,yw].n}. sC].
l}a;PL,tt];eS yUt];yLlqk]:l}a:pn]l}:" kUv];kL: lgc]:yUt];yLlUv]:yLEl: kan]PL,tt];n}. et
Am],sac]:hQt];hG]: lgc]:hU.tUw]SQn]:AL,yUc],mUin]kw],mL;Kuin];l}:"
la};eh.kc]: 3 Kn].tgn]:
 hLtac];pQn]sQm]sw].eS yUt];yLpn]"
 hU.Pgn];sL. An]etmL;tc];lc]sQm]sw].eS yUt];yLhG]:Tuk],mqn]:"
 nc],hiuw]etlum];lL;Kuin];tUw]sw]:kw],l}:nn]. pn]tac];hU.kUn];pQn]"
tL,tWc];
kUn];pQn]tut]:km]:nm]n}. hqc];sG]ettUk];El: k}.sG]lQk]. kgp]:wL: Pac]hac]:tUw]Kic];An]lqk]:la}:
pqk],piUc]:El: kUn];him];hgm];ekL:sqk],EPKw]nn].yw]." lgc]:hU.wL:kUn];pQn]hqc];sG]tUk];eS pn]tac];sg}:
Tqm]El: yUt];yLpn]n}. pQn]lgc]:lm],lgc]:" kQw],lUv]:tac];pQn]n}.eS tL,Aw]ep.lgc]:
kUn];him];hgm]; sqk],eP' p}g,yU,ekL.lQw]El: kgp]:Am],hU.lgc]:tac];pQn]eSkUw]pUn].tI:siUw];n}. pQn]An]
lm],lgc]: tL,lUlgm]lum];lL;kUn];pQn]Kaw];hiuc]kCL,nn].yw]."
338
sC].KUw];Kgc] Pit];P}a,
(Substance abuse) 23
sC].KUw];Kgc]Pit];P}a,An]wL:nn]. hQt];hG]:kUn];ekL.niuc]: l}:piuc]:Aic]KUw];Kgc]An]nn].mL; (sp];yL:mw];km])"
Sc]wL:kUn];ekL.niuc]: mI;Pac]hac]:nc],pL:tC]:n}.Sam]eKL: Am],nn] nm]liUw]nn].n}siuc] etsac]:lat]:
l}:wL: kUn];ekL.nn]. tk];etl}:piuc]:Aic]KUw];Kgc]An]nn].yU,n}yw]."
 mI;kac]sC] KC]:sC].tiuw]; KUw];Kgc]nn].haw].hqc];"
 tL,Am],kin] Am],sC].KUw];Kgc]nn]. kum];Tic];tUw]sw]:kw],yap], (Et,Aw]Kaw];tac];An]Et,sC].'
kiut]; yut];sC].El: tac];nm]eA,KUw];Kgc])
 miUw]:Am],sC]. nC];Kaw];tac];niuc]:nn]. mI;Pac]hac]:kiut];yut];Agk],mL;' miUw]:sC].Kiun];nn]. Pac]hac]:An]
nn]. h}akCL,Kiun];"
 tL,hG]:l}:Pgn];tum].tiUw].miUn]kU:pgk]:An]yam]:sC].mL; (hqc];Kam],)nn]. etl}:sC].nm]liUw]mL;tik];tik];
 KUw];Kgc]An]nn]. pQn]An]lm],lgc]:liUw]piUn]:tL,PwkUn];ekL.nn].mL;"
 pqk].Sm].wL: kUn];ekL.nn]. hU.lIyU,wL: Pgn];sL.lgc]:kin]/sC].KUw];Kgc]An]nn].n}. pQn]siUc].hiuw]n}
eStL. yc];l}:Siup],sC].tiuw];yU,"
23.1 pQn]kgc].ygn].lw]:El: yL:mw];km]

eKL:piut],tI:pgc],
kiuc].kac].pQn]kgc.] " "miUw]:kUn];ekL.niuc]: sC].nm]/kin]nm]hqc];pUn].tI: (tUw]yac],-lw]:El:yL:mw];km]) El:
Kiun];Am],sac]:Aw]Agk],tI:tUw]Kiun];w};w};" Pac]hac]:n}. etmI;etL,Tiuc] yLmw];km]epL;h}akCL,nC];tUw]kUn];"
lgc]:tum].tgp],tUw]kUn]; miUw]:kiut];yc].kin]lw]: Am],nn] yL:mw];km]" "kin]/sC]. KUw];Kgc]mac]An]mL;

Kaw];hiuc] (tUw]yac], - kUn];An] km];km];kin]yL:mw];km]yU,)n} kUn];ekL.nn]. etl}:piuc]:Aic] KUw];
Kgc]An]nn].mL;" w}a;liun];mL; tL,hG]:Kw]yU,Sw];hQt];Sac]:kCL,l}: nc],pk],ktI,nn]. Kw]tk];etl}:
sC].tiuw];KUw];Kgcn
] n]."
Pac],hac]:tac];pQn] - Pac]hac]:kUn];pQn]n}. etSan]Kt];kn]tc]; Pgn];yL:mw];km]"
Pac]hac]:kiut];yc].nn]. etmI;yU,l}al}awn];"
Sc]wL: kUn];sC].tiuw];yL:mw];km]Kaw];hiuc] KC]:kiut];yc]. sC].tiuw];yL:mw]:km] Am],nn] lw]:n}siuc]

tk];etl}:hac]:hqn]; lgc]:tUw].tgp],kiut];yc].An]h}a.hqc];w}.sgm];" hUm]:lUv]: kUn];pn]lgc]:K}:sC]
p}a;hU. El: pI:pI:ngc].ngc]. etl}:tUv];sgm];kCL,Kaw];yaw];' Sc]Am],nn]n}
kUn];pQn]etkCL,sC].tiuw]; yL:mw]:km]Kiun];"
339
23 sC].KUw];KWc] Pit];Pa},
lw]:
1. kiuc].kac].pQn]kgc].ha}.hqc]; (Acute intoxication)
eKL:piut],tI:pgc],
pQn]kgc].ygn].lw]:n}. etpQn]Agk],mL; miUw]:kin]nm]pUn].liUw]An]tUw]kUn];hp].l}:El: pQn]mL;nn].yw]."
lgc]:pQn]kgc].n}. etlqk]:l}a:l}a;tUc].niuc] Am],nn] lgc]:Pit];pk],ktI,Kgc]tUw]kUn];mL;" Tqc]:P}a,niuc]:Et.
lat]:l}:wL: kUn];ekL.nn]. Am],sac]:tUc].niuc]tUw]miUn]kw],l}:El: Am],Tuk],lI ehL:lUt].kL;lL;lL;"
Pac]hac]:tac];pQn]
 A}alw]:"  tUc].tiun],tUw]pUn].tI:
 hak]:"  kum];Tic];sC]Am],l}:
 lgc]:tUc].niuc] yU,Sw];lqk]:l}a:"  lgc]:kp];San]hQt];Sac]: eA,lUc];"
 sC]pit];sC]pgt];"
yiuc]:lw]:nm]mL;tik];tik]; kUn];ekL.nn]. Kqn];etmw];mL;tik];tik];El: lium];tUw]kCL,nn].yw]."
lgc]:yUt];yL
 Sc]wL: lium];tUw]n}siuc]
 miUw]:yc];lium];tUw]yU,nn]. hG]:Aw] IV NSS eS PiUm].Tqm]Tat]:nm].pn]"
 miUw]:kUn];pQn] kin]l}:mL;nn]. hG]:kin]nm].mak],m}.pn]nm]nm] (>3 lI,tL,) tL,hG]:liup]:AI;lw]:
An]yU,nC];tUw]Agk],kCL,"
 hG]:Pac].tUv]; lgc]:Tat]:kiUw]wan]nC];liUt]:eA, (tUv];tI: kn] 10.1)
 kUt],sqt];tUv]; yQw]:An]Agk],mL;El: Pac]hac]:lm],lgc]: (miUn]nc], hqc];TUv]:sC]' hqc];
hUw]sC]tgn]:) kU:sUw]:mUc]; etL,Tiuc]kUn];pQn]epL;tiun],mL;"
 hak]:An]hak]:Agk],mL; sac]:kCL,Aiut];lgt],lUm];TUv]:sC]El: etl}:Aw]kUn];pQn]ngn];KI:
kqc];w}." (lium];tUw]' kn] 7.1 El: tac];pQn]pgt],kI:ygn],hak]:' kn] 21.1)
 Sc]wL: AUn]emL; Am],nn] KC]:hQt];h}a.n}siuc]

 hG]:pn] Diazapam 10 mg IV" Sc]wL:Tuk],lIpn]Tqc]:n} wa}; 30 minit].yw]. hG]:pn]Tqc]:
km];niuc]:"
 PiUm].Tqm]Tat]:nm].pn] (kin] Am],nn] Sm];pn] IV )" kUt,] sqt]:Tat]:kiUw]wan]nC];liUt]:
eA,eS Sc]wL:mI;n}ekL: hG]:yUt];yLpn]"
340
sC].KUw];KWc] Pit];Pa}, 23
tL,lgc]:kiuc].kac].pQn]kgc].lw]:h}a.hqc];n}. An]sac]:mI;eP;nn]. etpQn]Tat]:

kiUw]wan]nC];liUt]:eA,n}.Suc] (kn] 10.1 )" kin]lw]:Kaw];hiuc]n}. sac]:pQn]
tac];pQn]Kat],Tat]:wI,tL,min], B1 " (tac];pQn] Ep,rI, Ep,rI, kn] 17.2 )
2. lgc]:tum].tgp],tUw]kUn]; miUw]:kiut];yc]. (Withdrawl Reaction)

Pac]hac]:tac];pQn]
 mI;lUm];naw]Ait];Ait]; (Pac]hac]:h}a.hqc];)  Pac]hac]:kQw],lUv]:SQn]:AL,yUc], - sC]Am],
 pQn]can]; (Pac]hac]:h}a.hqc];) nim]' Sn], (ecL;eKL:muiw];kCL, ecL;eKL:miuw];mL;)
 hUw]sC]tgt],w}; (hqc];tgt],liUt]:w};)  SQc]El:AL,yUc],hn] lgk],/Pac];' hn]El:
 Agk],hiUw], l}:cin]; An]Am],mI;
 hak]:' eAL.hak]:  sC]Suk].Sak].' lgc]:tiun],tUw]pUn].tI:' sC]kUw]'
ngn];Am],lp];"
lWc]:yUt];yL
 pn]yL Diazepam 10 mg IV l}al}apgk]: etL,Tiuc]kUn];pQn]yQn]lUc];kCL,"
 lUt];ygm];pn] yLkin] Diazepam eA,lUc];l}g;l}g; (tUw]yac],- 10 mg BD tL, 2 wn]; 5 mg
TID tL, 2 wn]; 5 mg OD tL, 2 wn]; eSEl:kiut];liuw]:pqt]:) n}. etsac]:eh.kc]:Pgn];sL.
sgm];lc]l}:"
 Sc]wL:mI;Pac]hac]:lgn] (sC]sw]:kw],ygk],sw]:kw],) n}siuc]hG]:pn] Chlorpromazine 25 mg PO QID"
 wI,tL,min],- Thiamine 100 mg/wn];' wI,tL,min] pI, 12 1 mg/wn];' folic acid 5 mg/wn];"
yL:lm]' yL:PiUk],' emL,Pin];

yLmw];km]siUw];n}. lut],Aw] Am],nn] lut],Kw]:KU;lc] Am],nn] Sm];Kw]:SQn]:liUt]:l}:"
1. kiuc].kac].pQn]kgc].ha}.hqc]; (Acute Intoxication)
Pac]hac]:tac];pQn]
 tUc].tiun],tUw]pUn].tI: (KUw]yU,tL,eS,)  hUw]mw]; (K}:ngn];)
 Piw]niUw]. Piw]nc]lqc] (nL:miUn]Aap]:m}:w}.'  TUv]:sC]hqc];hqc];El: hqc];TUv];sC]TiUc];"
Piw]nc]lqc])  lUm];m}:tUw]tUk];ygm];"
 Piw]nc]KUm]; (km]:nm]Et. emL,Pin];)  hUw]sC]tWt],w};' hqc];liUt]:tUk];"
 hU;tLlm]lQk].lUc];
341
lWc]:yUt];yL
kgp]:wL: Am],mI;eKL:mun];kQw],lUv]:lgc]:sC].emL,Pin];pUn].tI:El: Am],l}:SC],w}.nC];pp].n}." tk];etl}:
yUt];yLsgm];nc],Pac]hac]:tac];pQn]kCL,kUv];" liUw]eSnn]. etsac]:eh.kc]:Pgn];sL.sgm];lc]El: yLsC]
nim]l}:yU,"
2. lgc]:tum].tgp],tUw]kUn]; miUw]:kiut];yc]. (Withdrawl Reaction)

Pac]hac]:tac];pQn]
 m}:sC]' sC]kUw]' sC]Am],nim]  Sn], - ecL;eKL:miuw];kCL, ecL;eKL:miuw];mL;"
 hqc];TUv]:sC]w};"  kam]:niUw].ethUt];lUc];
 nm].nC];tUw]Agk],mL;nm]- hiUw],Agk],' KI:muk]:  kam]:niUw].sQp];
l}' nm].tLl}"  nL: Aap]:miUn]m}:' miUn]kt];
 hU;tLlm] kCac]:mL;"  kin]Am],wan]' Am],K}:kin]
 KUn]niUw].yUk]./kI:"  tgc].Kiun]:tgc].sQp];/tWc].Aiw]:
lWc]:yUt];yL
 pn]yL Diazepam 10 mg IV l}al}apgk]: etL,Tiuc]kUn];pQn]yQn]lUc];kCL,"
 lUt];ygm];pn] yLkin] Diazepam eA,lUc];l}g;l}g; (tUw]yac],- 10 mg BD tL, 2 wn]; 5 mg
TID tL, 2 wn]; 5 mg OD tL, 2 wn]; eSEl:kiut];liuw]:pqt]:)n}. etsac]:eh.kc]:Pgn];sL.
sgm];lc]l}:"
 yL Methadone El: Clonidine n}. sC].tiuw];kn]tac],tI:yU,n}eStL. pgt];tI:hw];yU,siUw];
n}.Et. Am],mI;tL,sC].tiuw];" Aic]niUw]Pac]hac]:tac];pQn]eS yUt];yLpn]kCL,"
yL:mL. (yL Amphetamines)

yL:mL. l}al}aSqn]; etmL;elL;kn]w}.nC];mQt].lQw]kn]ekL:l}:" nC];yLniuc]:mQt].nn]. etSC],w}. yL:mw];
km]l}al}asiUw];" yLmL.n}. lut],Kw]:nC];KU;lc]' lut],kGn];' Aiun]kin] Am],nn] Sm];Kw]:SQn]:AQn] sQm]
siUw];n}.kCL,yw]:"
pqk].Sm].wL: sC].tiuw];pgk]:lQw]kUv];ekL: yL:mL.n}.etsac]:kiuc].kac].hQt];hG]:pQn]pn]hLp}a;sC]h}a.hqc];l}:yU,yw]."
342
sC].KUw];KWc] Pit];Pa}, 23
Pac]hac]:tac];pQn]
 hiUw].AUn]:h}a.hqc];  SQc]El:AL,yUc],hn] lgk],/Pac];' hn]El:
 Am],KC]:ngn];" l}:cin]; An]Am],mI;
 m}:sC]' sC]kUw]' sC]Am],nim]  wUn].Sgn],wL: piUn]:etKC]:hQt];h}a.etL,Kw]
 sC]Suk].Sak].haw].hqc]; (hUm]:tc];KC]:Aw] tUw]sw]: (Paranoia)' kUw]wL: piUn]:ethQt];h}a.miUk]:liUc];
kw],t}a) etL,Kw] (Persecution)' wUn].Sgn],wL: sw]:
kw],mI;eAL;sL,Am];nat]:etL,kU:siUw];siUw];'
etL,kUn];kU:ekL. (Omnipotence)"
yL:mL.mac]An]n}. ethQt];hG]:pQn] Pac]hac]:tac];pQn]h}a.hqc];liUw]n}."

 lUm];m}:tUw]Kiun]:Suc]h}a.hqc];"
 hQt];hG]:liUt]:tUk];tac];nC];El: Kqc]pQn]kgn]:sgm];nC];SQn]:liUt]:tc];tUw]"
 kam]:niUw].lU.lqw]"
 kiuc].kac].pQn]can];' mak],kqw];kiuc].kac].Am],hQt];kan]' tp];pQn]kgc].El: pn]hLtac];pQn]hUw]sC]"
lgc]:yUt];yL
 Chlorpromazine 25 – 50 mg IM n}. nc],hiuw]etAm],hG]:pQn] sC]pit];' sC]pgt];' sC]h}a.nn].
etlqk]:l}a:pn]w};"
 Ammonium chloride 500 mg PO 4 sUw]:mUc];niuc]:pgk]: (tL,hQt];hG]:Tat]:nm].kUt];nm]mL;'
tL,liup]:AI;Tat]:Aqm],PL<tmin]; (yLmL.) Agk],kCL,nC];tUw]"
23.2 AUm]pU.
eKL:piut],tI:pgc],
hUv],pU.n}. pQn]mak],An]l}:mL;tI:tUn]:pU." kgp]:wL: hqc];pU.An]sac]:hQt];hG]: sC]mUn]: SiUw];Ait];Agt];'
sac]:hQt];hG]:mw];Ait];Ait];' sac]:hQt];hG]:sC]Suk].yuc]:eA,lUc]; El: hQt];hG]:Am],epL;KC]:kin]Kw]:l}:Ait];
Agt];El: sc],kQw].kin]kn]" Aic]niUw]hqc];pU. An]wL:mL;n}.eS sc],sqk],EPw}.wL: pU.n}.pQn]yL:mw];km]
Sqn];niuc]:n}yw]." miUw]:kin]tL,eS,nn]. pU.n}.sac]:hQt];hG]: tum].tiUw].p}a;yU,lI pQn]tc]; Kqn],SL,tI:
tWc].El:nC];SUp]; Aik],pL;hQt];hG]:hiUk],lU. sQm]siUw];n}.kCL,nn].yw]." kgp]:wL: kUn];km]:nm] An]yU,sgm];
lqn]lin] miUc];T}; - miUc];man]: AUm]pU.kn]nm]El: tL,pn]p}a;hU.eKL:mun]; kQw],lUv]:eP;AUm]pU. An]
pQn]l}:n}. sc],pQn]lgc]:lm],lgc]:Et.Et.yw]."
343
Pac]hac]:tac];pQn]
hqc];pU. An]hQt];hG]:mw];
 sG]mUn]:sC]SiUw]; hUm]:tc];tUc].tiun],tUw]pUn].tI: (KUw]yU,tL,eS,)
 tUw]Aun],
 hQt];kan]l}:nm]liUw]
 ngn];Am],lp];
hqc];pU. An]l}:hn]km]:nm]
 hQt];hG]: hiUw],Agk],nm]liUw]
 hQt];h]G:nm].l}a; nm]liUw]
 sC]Sn],' hUw]sC]tgt],w}; (hqc];tgt],liUt]:Suc])
 hQt];hG]:tac];pQn]mWc]eKL: h}a.hqc];liUw]kw],"
 Sc]AUm]tL,eS,n} ethQt];hG]:SUp];El: KQw]:pQn]SIlqc]yU,tL,eS,"
 hQt];hG]: kUn];mI;lUm];mL:mU pQn]can];nm]liUw]kw],"
Pgn];sL.sgm];lc]
Kqn],SiUw]<nC];pak]," "nC];miUc];El: tUc],wUc];An]k}.AUm]pU.kn]nm]n}. etpQn]kqn],SiUw]<nC];pak],kn]nm]
yw]." kgp]:wL:yC];miUk], (yC];tc],tC] - Mucosa ) An]pQn]SIlqc]etlU.Sum];kCL,pqt]:yw]. yC];SIKaw]
(Leucoplacy) etKw]:mL;tqn];tI:El: hQt];hG]:tac];pQn]kqn],SiUw]<lam];kCL,l}:c}a:" miUw]:yc];sw].yU,nn].
etAm],hn]Pac]hac]:tac];pQn]l}:c}a:c}a:" tac];pQn]kqn],SiUw]<nC];pak],n}. etyUt];yLyap],' kL:yUt];yLekL:
kL:El: piun].tI:tI:hw];yU,n}. Am],mI;tI:yUt];yL"
lgc]:AUm]pU.n}. hQt];hG]: Kat],Tat]:wI,tL,min], pI,1 sgm];" kUn];pQn]An]k}.pQn] tac];pQn]Ep,rI,Ep,rI,
(peripheral beri beri)n}. Tuk],lIlat]:pn]hG]:kiut];yc].lgc]:AUm]pU."
Aac]:Aic] pn]hLKQw]: (kn] 9)' tac];pQn]mWc]eKL: (kn] 21.4 )' tac];pQn]Kat],Tat]:wI,tL,min],

pI,1 (kn] 17.2 )"
344
eKL:PiUm].Tqm]
(Appendix) 24
eKL:PiUm].Tqm]n}.hUm]:pL;l}atgn]:w}. kn]
1. lgc]:etl}:fac].tUv];tac];pQn]El: lgc]:siUw].mqc];EP:tiun];haw].hqc]; 24.1
(tac];pQn]kL,l)
2. HB sC].l}a;(LOVIBOND) eS tqk]:tUv];El: hLSUn],PQc],pQc];liUt]: 24.2
3. (PEAKFLOW ) lgk];Kgc]:Pik].PlUw]; 24.3
4. lgk];Kgc]:pn]Knqn]; nm].nk];/SUn],Suc] 24.4
5. lgk];Kgc]:St],SUn],tUw] 24.5
6. nm].kiUw] sC].kin]tL,Tat]:nm].nC];tUw]hqc]: 24.6
7. Kp].m}aKaw];yam];pn]yLeh.kc]: 24.7
8. lWk];Kgc]:yUt];yLnaw]nUk]. 24.8
9. hqc];yLyL:yL (DRUG DOSES) 24.9
10. yL:yL tL,miUw]:pL;tWc]. 24.10
11. piUc]nm];tL,luk]:Agn],kiUt],mC],El: niuc]:pI<lUc];tC]: 24.11
12. lWc]:Aac]:Aic] 25
24.1 lgc]:etl}:fac].tUv];tac];pQn]El:lgc]:siUw].mqc];eP:
tiun];haw].hqc]; (tac];pQn]kL,l)
(Surveillance and Outbreak)
lgc]:etl}:fac].tUv];tac];pQn]n}. nc],hiuw]etpQn]Pgn];lIetL,kUn]; An]l}:K}a.tI:yU,mL; yU,sgm];lqn]
lin] miUc];T};-miUc];man]:n} l}:Et,sC].mL;nn].yw]." tL,eKL:mun];PiUm].Tqm]nn]. hG]:tUv];tI: lk];piUc]eKL:
mun];p}a;yU,lI El: eKL:mun];kQw],lUv]:lgc]:etl}:fac].tUv];tac];pQn]Kgc] CCSDPT"
eKL:yiUc];Aan];lgc]:l}:hQt];lk];piUc]siUw];n}.Et.-
1. tL,pC].tUv];Tt];Sac] l}a;pQn]tac];pQn]tI:Sun]p}a:eP;sgm];lqn]lin]T};yU,tL,eS,"
2. tL,tUv];hn]Tiuc]tac];pQn]An]eP:tiun];haw].hqc]; (tac];pQn]kL,l) tI:Sun]p}a:eP; sgm];lqn]lin]

T};l}:"
3. tL,hQt];Sac]:lgc]:eh.kc]:El: kum];Tic];lgc]:eP:tiun];tac];pQn] hG]:Kiut];tn];Kaw];yam]; tI:Sun]p}a:
eP; sgm];lqn]lin]T};"
345
24 eKL:PUim].Tqm]
tac];pQn]An]etl}:fac].tUv];sgm]; (Disease under surveillance)
tac];pQn]tWc].kiuc].kac].kCL,h}a.hqc];' tWc].ngc],' tWc].kCL,kL,l' tac];pQn]naw]S}:kC]: (Typhoid fever)' tac];

pQn]mak],lqc]' tac];pQn]TI,pI,' tac];pQn]eKL;tip], (diphtheria)' tac];pQn]A}hut],(Pertussis)' pUw],lIyUw],
(suspected poliomyeliti)' tac];pQn]naw]liUt]:Agk], (dengue fever)' naw]nUk].(Malaria)' tac];pQn]
tin]sac].(Filariasis)' SKrap].t}.Pat].S] (Scrub Typhus)' tac];pQn] yC];hUm],Agk];eALkC]: (Menigitis)'
SQn]:AL,yUc],Agk];eALkC]: (Encephalitis)' tac];pQn]yQw]:nU (Leptospirosis)' tac];pQn] An]sp];tit];
kgp]:lgc]:hUm]:kL,m(STD)El: tac];pQn]An]Am],sC:] pk],ktI,El:haw].hqc];' t}a An]Am],hU.lgc]:tac]; Am],
nn] t}aAn]wUn].Sgn],wL:ygn].sp];tit];siUw].mqc];" (tL,eKL:piut],tI:pgc],tac];pQn]Et. hG]:tUv];tI: nL:
lik]: tac];nL:"
lgk];piUc]An]fac].tUv];tac];pQn]n}. kU:tI:An]pn]lgc]:yUt];yLp}a;yU,lI etpgc],lqc];pn] hgc]:
kan]p}a;yU,lIEs:miUc];' hgc]:kan]p}a;yU,lIes:tWn]:El: hgc]:kan]lUc]tac];pQn]tI:eP:tiun];l}:"
lgc]:pgc],Kaw],n}. etmqc],pQn]cw];l}a; 3 piUc] sgm];nc],pL:tC]: -
1. pgc],lqc];pn]yU,tL,eS,
hgc]:kan]p}a;yU,lISun]p}a;eP; etSUc],l}a;can];sgm];AI;em;l]kCL,sU;pn] hgc]:kan]es:miUc];El: etSUc],
Piun]miUn]kCL,sU; hgc]:kan]p}a;yU,lIes:tWn]:El: hgc]:kan]lUc] tI:kum];Tic];tac];pQn] An]sp];eP:l}:
Agn]tac];wn];Ti 15 kU:liUn]" hgc]:kan]p}a;yU,lISun]p}a;eP; etSUc],l}a;can];tQm] kCL,sU; CCSDPT
wn];Ti 15 kU:liUn]"
tac];pQn]An]etl}a;can];kCL,hgc]:kan]lUc] tI:kum];Tic];tac];pQn] An]sp];eP:l}:n}. etmI;KiUc]:m}a sgm];
nc],tI:Enw}."
lWc]:etl}:fac].tUv];sgm];tac];pQn]
2. lgc]:etl}:pgc],lqc];Kn]w};
tac];pQn]tWc].kCL,kL,l' tac];pQn]mak],lqc];' tac];pQn]eKL;tip],' tac];pQn]pUw],lIyUw],An]kiuc].pQn]h}a.hqc];'
tac];pQn] yC];hUm],Agk];eALkC]:kgp]:siUw].mqc]; Meningococcal' tac];pQn]An]Am],sC]:pk],ktI,El:haw]. hqc];'
t}a An]Am],hU.lgc]:tac]; Am],nn] t}a An]wUn].Sgn],wL:ygn].sp];tit];siUw].mqc];siUw];n}. tk];etl}:
SUc],pn] Kaw],sU;hgc]:kan]lUc]tI:kum];Tic];tac];pQn]An]sp];eP:l}:El: CCSDPT Kn]w}; nC];Kaw];tac]; 24
sUw]:mUc];"
tac];pQn] An]etl}a;can];kCL,sU;hgc]:kan]lUc] tI:kum];Tic];tac];pQn]An]sp];eP:l}:nC];Kaw];tac]; 24

sUw]:mUc];n}. etmI;KiUc]:m}asgm];nc],tI:Enw}."
lWc]:etl}:SUc],Kaw], Kn]w};
346
eKL:PUim].Tqm] 24
3. lgc]:tac];pQn]eP;tiun];w}; (pQn]kL,l)
Sc]wUn].Sgn],wL: lqp]:etpQn]tac];pQn]kL,l Am],nn] pQn]tac];pQn]kL,lmL;n}siuc] tL,kUt],sqt]:
tUv];l}:nn]. etl}:l}a;can];pn] hgc]:kan]p}a;yU,lIes:wQc]; Am],nn] es:tgn]:km];lQw]"
wC]l}a;can];tac];pQn]eP;tiun];w}; (pQn]kL,l)
Sc]wL:kgp]:tac];pQn] An]wL:mL;pL:niUw]eSEl: l}a;pQn]tac];pQn]eP:tiun];w};kCL,siuc] tk];etl}:SUc],Kaw],
sU;hgc]:kan]lUc]p}a;yU,lIEl: SUc],Kaw],nC];Kaw];tac]; 24 sUw]:mUc];"
pk];piUc]l}a;kQp];eKL:mun];
miUw]:TUp].vL;tac];pQn] An]eP:tiun];w};nn]. hG]:SUc],fqk],S] Am],nn] AI;em;l] wC]l}a;can]; tac];pQn]
kCL,sU; CCSDPT " Tqc]:l}a;niuc]:An]ethQt];l}:Et. Siup],PUn];l]kCL,sU;hgc]:kan] HIS (Email:
ccsdpt@inet.co.th Am],nn] his@ccspt.org Phone: 053 279 536)"
Sc]wL:mI;cw];l}a; lqp]:etpQn]tac];pQn]sp];eP:w};El: l}:pgc],Kaw]sU;n}siuc] PU:mI;pun]:Pgn];Kw]etsac]:

s}g:tqm]: tUc],wUc];piun].tI: tI:siUw].mqc];eteP:tiun];kCL,l}: etsac]:s}g:fac].tUv];tac];pQn]kU:wn]; Am],
nn] tLeS,"
tL,eKL:mun];hUw]y}g: - tUv];tI:lk];piUc]eKL:mun];p}a;yU,lI
eKL:piut],tI:pgc],tac];pQn] An]etl}:pk];tLtUv];sgm]; (Disease under surveillance)

1. tgc].kCL, An]kiuc].kac].pQn]ha}.hqc]; (Acute diarrhea) - kUn];pQn]tgc].kCL,nm]liUw] 3 pgk]: Am],nn]
kCL,w}; Am],nn] pQn]nm].nC]; Kaw];tac]; 24 sUw]:mUc]; hUm]:lUv]:Tat]:nm].nC];tUw]hqc]: Am],nn]
Am],hqc]:"
2. tac];pQn]tgc].ngc], - nC];P}a:kUn];pQn]tI:tgc].kCL, mI;liUt]:pL;mL;sgm]; Am],nn] kUt],sqt]:nC];hgc]:

lqp].eS mk];mn]:l}:tqt]:etL;wL: pQn]kgp]:siUw].mqc];SI<kYI<l t}Sqn]TrI< Sqn]; 1 (Shigella
dysentery type 1)"
3. tac];pQn]tgc].kCL,kL,l – kUn];pQn]AL,yuyC],liUw] 5 KUp], An]pQn]Tat]:nm].nC];tUw]hqc]:h}a.hqc];

kgp]:tgc].kCL,pQn]nm].haw].hqc];' kUt],sqt]:PUp].vL;siUw].mqc]; Vibriocholerae 01 Am],nn] 0139 ' (miUw]:
siUw].mqc]; sp];eP:haw].hqc];nn]. pqk].Sm].wL: Am],l}:kUt],sqt]:nC];hgc]:lqp],eSmk];mn]:eStL.
AL,yukUn];pQn] Tuk],lInp].Sgn],yC],liUw] 2 KUp],Kiun]:mL;)"
4. tac];pQn]naw]S}:kC]:(Typhoid fever) – 4.1 lqp]:etpQn]tac];pQn]naw]S}:kC]: - kUn];pQn]mI;lUm];naw]

nm]liUw] 38.5 MC (tC]:kic],Eh.) An]hiuc]liUw] 7 wn];eS kUt],sqt]:yw].Am],l}:pQn]naw]nUk].El: Am],
mI;lgc]:tac];Sc]tac],siUw]; An]hQt];hG]:mI;lUm];naw]El: hUm]:pL;sgm];Pac]hac]:eSAn]An] miUn]nc],-
347
24 eKL:PUim].Tqm]
tgc].sQp]; El:/Am],nn] tgc].kCL, El:/Am],nn]tgc].pik]. El:/Am],nn] hqc];tgn]:hUw]sC]Am],tgn]:
hqc]; nc],tI:Tuk],lIpQn]sgm];nc], lUm];naw]An]Kiun]:mL;"
- 4.2 mk];mn]:l}:wL: pQn]tac];pQn] naw]S}:kC]:- kUn];pQn] An]Aw]lUt
i ]:kCL,lQc].siUw].mqc]; nC];hgc]:lqp],
eS kUt]:sqt]:yw].mI;siUw].mqc]; Salmonellatyphi"
5. tac];pQn]TI,pI, - kUn];pQn]mC], An]Tuk],mk];mn]:wL:pQn]tac];pQn]TI,pI, kgp]:mI;Pac]hac]:cw];l}a;sgm];nc],

pL:tC]: (Aic]niUw] eKL:mk];mn]:tac];pQn]Kgc]muk].sum];lUc]p}a;yU,lIlum]:fL.)"
 tac];pQn]TI,pI,pgt],' TUp].vL;siUw].mqc];TI,pI,nC];pgt], - Aw]m}klUw,] SkUp].kUt], sqt]:nm].l}a;kUn];
pQn]El: pQn] positive tL, Acid-Fast Bacilli (AFB) eA,Sut]; Sgc]pgk]: Am],nn]Aw]m}klUw],S
kUp]. kUt],sqt]:nm].l}a; kUn];pQn]El: pQn] positive tL, Acid-Fast Bacilli (AFB) niuc]:pgk]:El:
An]kUt],sqt]:vL;n}. Sc]PU:yUt];yLpn] mk];mn]:wL: mI;Pac]hac]: miUn]kn]tc];tac];pQn]TI,pI,
An]sp];eP:yU, Am],nn] Aw]m},klUw],SkUp]. kUt],sqt]:nm].l}a; kUn];pQn]El: pQn] positive
tL, Acid-Fast Bacilli (AFB)niuc]:pgk]:El: Aw]siUw]. mqc];kCL,lQc].yw]. kUt],sqt]:wL:pQn] positive
tL, Acid-Fast Bacilli (AFB) eA,Sut];niuc]:pgk]:"
 tac];pQn]TI,pI,pgt],' Am],PUp].vL;siUw].mqc];TI,pI,nC];pgt], - Pac]hac]:tac];pQn]Sm]. miUn]tc]; tac];
pQn]TI,pI,eS Sm].mI;cw];l}a;nc],pL:lc]n}. An]lC]An]niuc]:' kUt],sqt]:nm].l}a; Sam]pgk]:yw].
Am],TUp];siUw].mqc]; Acid-Fast Bacilli (AFB)' Aw]AQk].S]er;epL.tUv];yw]. TUp].vL;Pac]hac]: miUn]
tac];pQn] TI,pI,' pqk].Sm]wL: pn]yLKL:siUw].mqc];l}al}aSqn];yw].n}eStL. Pac]hac]:tac];pQn]Am],lI
Kiun]:mL;' emLyL mk];mn]:etpn]yLTI,pI,hqc];yUt];yLhG]:KUp].hgp]:"
 tac];pQn]TI,pI,ngk]:pgt],' liUw]eStI:pgt],yw]. pQn]tI:pgt];Ac],kL,tac],tI: (TI,pI,yC];hUm],hUc]; Kw]:'
TI,pI,tiuc],nm].liUc]' TI,pI,tgc].' TI,pI,Ac],kL,lic],El: SQn]:tac];yQw]:' TI,pI,Piw]nc]' TI,pI,eKL:
etL,lup], El:lup],' TI,pI,yC];hUm],Agk];eALkC]:) lgc]:mk];mn]:tac];pQn]n}. Tuk],lIpiUc]:Aic] lgc]:kUt],
sqt]: An]Aw] siUw].mqc]; An]Am],sG]:tI:pgt],nn]. lQc].kUt],sqt]: Am],nn] Aw]kgn]:niUw].lQk].
kUt],sqt]:nC];hgc]:lqp],' sgm];nc],Pac]hac]:tac];pQn] An]miUn]kn] tc];tac];pQn]TI,pI,tI:eP:tiun];yU,
El: emLyLmk];mn]:etpn]yLTI,pI, yUt];yLhG]:KUp].hgp]:" kUn];pQn]kU:ekL. Am],wL:pQn]TI,pI,nC];pgt],'
ngk]:pgt], tk];etl}:SC],nC];Sa}m}a tac];pQn]TI,pI, pgt],tc];mUt];"
6. tac];pQn]mak],lqc] (measles)- kUn];pQn]An]mI;lUm];naw] 38.5 MC Am],nn] Suc]liUw]nn]. Tp];kn]
Sam]wn];eS mI;tum]lqc] maculopapular (Am],mI;tum],nm].SC]) sgm];tUw]El: mI;cw];l}a; eSAn]An]
miUn]nc],KI:muk]:l} Am],nn] A} Am],nn] tLsQp];"
7. tac];pQn]eKL;tip], (diphtheria) - pQn]tac];pQn]pgt];niUw]SQn]:tac];TUv]:sC]El: etpQn]eKL;sQp];'

niUw].Aun],' mI;lUm];naw]Ait];Ait];' tgm],Tgm];Sin];sQp];' eKL;h}gsQp]; El:/Am],nn] KU;lc]" Am],nn]
Aw]kgn]:niUw].lQk].kUn];pQn]kUt],sqt]:tI:hgc]:lqp],yw]. TUp];vL;siUw].mqc]; Corynebacterium dishtheriae"
348
eKL:PUim].Tqm] 24
8. tac];pQn]A}hut], (Pertussis) - kUn];pQn] An]A}hiuc]pUn].liUw] 2 wUc]:' miUw]:A}nn]. A}Tiuc]epL;
etpQn]can];El:/Am],nn] miUw]:A}yw].nn].SQc]A}eth}akCL,sgm];SQc]TUv]:sC] mI;SQc]nC];kUc]eKL; El:/Am],
nn] miUw]:A}yw].nn].hak]:"
9. tac];pQn]SQn]:AQn]kiuc].kac]AUn]:haw].hqc]; (Acute flaccid Paralysis) - kUn];pQn] An]SQn]:AQn]

kiuc].kac].AUn]:kCL,' t}akCL, hUm]:tc]; luk]:Agn],AL,yulQk].liUw] 15 KUp],An]mI;Pac]hac]: Guillain-Barre
Syndrome El: kUn];pQn]kU:ekL. An]lqp]:etpQn] tac];pQn]pUw],lI,yUw],"
10. tac];pQn]naw]K}:liUt]:Agk], (Dengue infection) - kUn];pQn] An]mk];mn]:tI:hgc]:lqp],wL: mI;siUw].

mqc];naw] K}:liUt]:Agk], Am],nn] miUw]:siUw].mqc];yc];eP:tiun];h}a.hqc];yU,nn]. kUn];pQn] An]
mI;lUm];naw]hiuc]liUw] 7 wn];El: Am],pQn]naw]nUk]. hUm]:tc];mI;Pac]hac]:sgm];pL:lc]n}. eA,Sut];Sgc]An]
miUn]nc],hUw]K}:' sQp];Kiun]: tac];lc] hUv],tL' sQp];niUw].' eKL:sQp]; (kUn].kUn].Kiun]:Kiun]:tc];tUw])'
Pac]hac]:liUt]:Agk], (hUm]:tc];mI;tum],lqc] sgm];nc], l}a;kUt],sqt]: tourniquet test)"
11. tac];pQn]naw]nUk]. (Malaria) - kUn];pQn] An]kUt],sqt]:hn]wL: mI;siUw].mqc];naw]nUk]. (PF, PV, PM

Am],nn] hUm]:kn]w}.)"
12. tac];pQn]tin]sac]. (Filariasis) – Aw]liUt]:kUn];pQn] kUt],sqt]:tI:hgc]:lqp],yw].TUp];vL;siUw].mqc];

Wuchereria Bancrofti Am],nn] Brugia Malayi "
13. tac];pQn]SKrap]. t}.Pt].S] (Scrub Typhus) - kUn];pQn]kiuc].kac].mI;lUm];naw] (nC];Kaw];tac]; 48

sUw]:mUc];)' Am],mI;siUw].mqc];naw]nUk].El: miUw]:pn]yLyw]. lIKiun]:mL; nC];Kaw];tac]; 24 sUw]:mUc];' mI;h}g;
sQp]; miUn]nc],f};lqn];yL:sI;SC],sgm];tUw]El: mI;Pac]hac]:cw];l}a;sgm];nc],pL:lc]n}. eA,Sut]; 2 An]
miUn]nc], Piun],lqc]' tgm],nm].liUc]sgm];tUw]kC]:' hUw]K}:haw].hqc];' kiuc].kac].kCc]h}a.hqc];"
14. tac];pQn]yC];hUm],Agk];eALkC]: (Menigitis) - kUn];pQn]kiuc].kac].mI;lUm];naw]Suc]liUw] 38 MC ' Am],mI;

siUw].mqc]; naw]nUk].' mI;Pac]hac]:sgm];nc],pL:lc]n}. eA,Sut];niuc]:An] miUn]nc],tac];pQn]yC];hUm],Agk];eAL
hUm]:kn] (hUw]K}:' kgc],ekL:KQc]:) Am],nn]mI;Pac]hac]: Kerng’s sign Am],nn] luk]:Agn],lQk].liUw] 1 KUp],
nn]. KI:mgp]:kC]: Am],nn] K}eKL:Kun],' yC];hUm],Agk];eALkC]: kgp]:siUw].mqc]; Meningococcal' kUn];pQn]kiuc].
kac].mI;lUm];naw]' Agk],tum],lqc] tum],Sgm],mL;El: mI;Pac]hac]:sgm];nc],pL:lc]n}. niuc]:An] miUn]nc],kam]:
niUw].eKL;KQc]:' lium];tUw]pQn]km]; hU.tUw]pQn]km];' Pac]hac]:yC];hUm],Agk];eAL kC]:tac],siUw]; Am],nn] eKL:
mk];mn]:hgc]:lqp],"
15. tac];pQn]SQn]:AQn]AL,yUc],kC]: (Encephalitis) -kUn];pQn]mI;lUm];naw]El: Am],mI;siUw].mqc];naw]nUk].'

lium];tUw]pQn]km]; hU.tUw]pQn]km];' hUw]K}: Am],nn] can];Kiun]:"
16. tac];pQn]yQw]:nU (Leptospirosis) - kUn];pQn] An]kiuc].kac].mI;lUm];naw]h}a.hqc];El: Am],mI;siUw].

mqc]; naw]nUk]. hUm]:tc];Pac]hac]:sgm];nc],pL:lc]n}. eSAn]An] miUn]nc],niUw].liUc]' hUw]K}:' yQw]:Agk],SI
lqc]km],' mI;h}g;liUt]:Agk],sgm];niUw].tLKaw]' Am],nn] mak],kaw]:pQn]nUKiun]:El: lgc]:mk];mn]:tI:hgc]:lqp],
Am],nn] tac];pQn]tiuk].eP:tiun];yU, (pQn]kL,lyU,-hL<lUc];yU,)"
349
24 eKL:PUim].Tqm]
17. tac];pQn]An]sp];tit];l}:kgp]:lgc]:hUm]:kL,m(STD) – mI;Pac]hac]:tUk];Kaw]' mI;Pac]hac]:tUk];Kaw]An]

Am],mUinp] k],ktI, hUm]:tc]; pQn]sQp];tI:Ac],kL,lic],' tac];pQn] eKL:tI:lup],kum],kUn]:kC]:' tgc].n}g.sQp];Kiun]:
El: sQp];miUw]:hUm],kL,m' miUw]:kUt],sqt]:nn]. ethn]mI;tUk];Kaw]sgm];Ac],kL,nac];yic]; El:/ Am],nn]
niUw].m}:Tiuc] 38 MC El: Suc]liUw]nn]."
24.2 HB(LOVIBOND) WITH HCT EQUIVALENTS

sG].tiuw];la}; Lovibond eStqk]: Haemoglobin El: lUit]: PQc],pQc];kn] (Haemtocrit)
lWc]:ha}.hqc]; hUw]pak], eS;l]lUit]:
tUv];tI: Disc g/100ml
Kw]:hUm]:po;
20 3.3 +++ 10
24 4.0 12
28 4.7 14
32 5.3 ++ 16
36 6.0 18
40 6.7 20
46 7.3 + 22
52 8.7 26
58 9.7 29
64 10.7 32
70 11.7 35
76 12.7 38
84 14.0 42
92 15.3 0 46
100 16.7 50
110 18.3 55
120 20.0 60
130 21.7 65
350
eKL:PUim].Tqm] 24
24.3 lWk];KWc]: PEAK FLOW

lWk];KWc]:lUm];TUv]:sG] pk],ktI,Suc]Sut];
PU:sa};
tac];Suc](cm) 157 160 162 165 167 170 172 175 177 180 182 185 187
AL,yu (pI<)
15 525 525 525 525 530 535 535 540 545 545 550 555 560
20 565 570 575 580 580 585 585 590 595 595 600 605 610
25 590 600 605 605 610 615 615 620 625 630 630 635 640
30 605 610 615 620 620 625 630 635 640 640 645 650 650
35 610 615 620 620 625 625 630 635 640 640 645 650 650
40 600 605 615 615 615 620 625 630 630 635 635 640 645
45 585 595 600 600 605 610 610 615 615 620 625 630 635
50 570 575 585 585 590 590 595 600 600 605 610 610 615
55 560 565 570 575 575 580 585 590 590 595 600 605 605
60 550 555 560 560 565 570 570 575 580 585 590 600 600
65 540 545 550 550 555 560 560 565 570 575 580 590 590
70 530 535 540 540 545 550 550 555 560 565 570 575 580
PU:yic];
tac];Suc](cm) 147 150 152 155 157 160 162 165 167 170 172 175 177
AL,yu(pI<)
15 435 440 450 455 455 460 465 465 470 475 475 480 485
20 450 450 455 460 460 465 470 475 480 480 485 490 490
25 450 455 460 460 465 470 475 480 480 485 490 490 495
30 455 455 460 465 470 475 480 480 485 490 490 495 500
35 455 455 460 465 470 475 480 480 485 490 490 495 500
40 450 450 455 460 465 470 475 480 480 485 490 490 495
45 445 450 450 460 460 465 470 475 475 480 485 485 490
50 440 440 445 450 455 460 460 460 470 470 475 480 480
55 430 430 435 440 445 450 450 455 460 460 465 470 470
60 415 420 425 430 430 435 440 445 450 455 455 460 460
65 400 405 410 415 415 420 435 430 435 440 445 445 450
70 390 390 395 400 400 405 410 410 415 420 425 430 440
351
24 eKL:PUim].Tqm]
24.4 lgk];Kgc]:pn]Knqn];nm].nk];lUv]:Sun],Suc]
Z-Score NCHS/CDC
lWk];piUc]tL,PU:yic];El:PU:sa}; (tac];Suc]luk]:AWn],etL,Tuic] 84.5cm)
tac];Suc] nm].nk]; -1.5 z- -2.5 z- -3.5 z- -4.5 z- tac];Suc] nm].nk]; -1.5 z- -2.5 z- -3.5 z- -4.5 z-
(cm) pan]kac] Score Score Score Score (cm) pan]kac] Score Score Score Score
kg kg
50.0 3.4 2.8 2.6 2.2 1.8 68.0 7.9 6.8 6.4 5.7 4.9
50.5 3.4 2.8 2.6 2.2 1.8 68.5 8.0 6.9 6.5 5.8 5.0
51.0 3.5 2.9 2.7 2.3 1.9 69.0 8.2 7.1 6.7 5.9 5.1
51.5 3.6 3.0 2.7 2.3 1.9 69.5 8.3 7.2 6.8 6.0 5.3
52.0 3.7 3.1 2.8 2.4 1.9 70.0 8.5 7.3 6.9 6.1 5.4
52.5 3.8 3.1 2.9 2.4 2.0 70.5 8.6 7.5 7.0 6.3 5.5
53.0 3.9 3.2 2.9 2.5 2.0 71.0 8.7 7.6 7.2 6.4 5.6
53.5 4.0 3.3 3.0 2.5 2.1 71.5 8.9 7.7 7.3 6.5 5.7
54.0 4.1 3.4 3.1 2.6 2.1 72.0 9.0 7.8 7.4 6.6 5.8
54.5 4.2 3.5 3.5 2.7 2.2 72.5 9.1 7.9 7.5 6.7 5.9
55.0 4.3 3.6 3.3 2.8 2.2 73.0 9.2 8.0 7.6 6.8 6.0
55.5 4.4 3.6 3.4 2.8 2.3 73.5 9.4 8.2 7.7 6.9 6.4
56.0 4.6 3.8 3.5 2.9 2.4 74.0 9.5 8.3 7.8 7.0 6.2
56.5 4.7 3.9 3.6 3.0 2.5 74.5 9.6 8.4 7.9 7.1 6.3
57.0 4.8 4.0 3.7 3.1 2.5 75.0 9.7 8.5 8.1 7.2 6.4
57.5 4.9 4.1 3.8 3.2 2.6 75.5 9.8 8.6 8.2 7.3 6.5
58.0 5.1 4.2 3.9 3.3 2.7 76.0 9.9 8.7 8.3 7.4 6.6
58.5 5.2 4.3 4.0 3.4 2.8 76.5 10.0 8.8 8.4 7.5 6.7
59.0 5.3 4.4 4.1 3.5 2.9 77.0 10.1 8.9 8.5 7.6 6.8
59.5 5.5 4.6 4.2 3.6 3.0 77.5 10.2 9.0 8.5 7.7 6.9
60.0 5.6 4.7 4.3 3.7 3.1 78.0 10.4 9.1 8.6 7.8 6.9
60.5 5.7 4.8 4.5 3.8 3.2 78.5 10.5 9.2 8.7 7.9 7.0
61.0 5.9 4.9 4.6 3.9 3.3 79.0 10.6 9.3 8.8 8.0 7.1
61.5 6.0 5.1 4.7 4.1 3.4 79.5 10.7 9.4 8.9 8.1 7.2
62.0 6.2 5.2 4.8 4.2 3.5 80.0 10.8 9.5 9.0 8.1 7.3
62.5 6.3 5.3 5.0 4.3 3.6 80.5 10.9 9.6 9.1 8.2 7.4
63.0 6.5 5.5 5.1 4.4 3.7 81.0 11.0 9.7 9.2 8.3 7.4
63.5 6.6 5.6 5.2 4.5 3.9 81.5 11.1 9.8 9.3 8.4 7.5
64.0 6.7 5.7 5.4 4.7 4.0 82.0 11.2 9.9 9.4 8.5 7.6
64.5 6.9 5.9 5.5 4.8 4.1 82.5 11.3 10.0 9.5 8.6 7.7
65.0 7.0 6.0 5.6 4.9 4.2 8/3.0 11.4 10.1 9.6 8.7 7.8
65.5 7.2 6.1 5.8 5.0 4.3 83.5 11.5 10.1 9.6 8.7 7.8
66.0 7.3 6.3 5.9 5.2 4.4 84.0 11.5 10.2 9.7 8.8 7.9
66.5 7.5 6.4 6.0 5.3 4.6 84.5 11.6 10.3 9.8 8.9 8.0
67.0 7.6 6.5 6.1 5.4 4.7
67.5 7.8 6.7 6.3 5.5 4.8
352
eKL:PUim].Tqm] 24
et,Aw]tac];Suc] 85.0 cm Tt];Sac]SUn],Suc]luk]:AWn],
tac];Suc] nm].nk]; -1.5 z- -2.5 z- -3.5 z- -4.5 z- tac];Suc] nm].nk]; -1.5 z- -2.5 z- -3.5 z- -4.5 z-
(cm) pan]kac] Score Score Score Score (cm) pan]kac] Score Score Score Score
kg kg
85.0 12.0 10.4 9.8 8.7 7.7 108.0 17.8 15.5 14.7 13.2 11.6
85.5 12.1 10.35 9.9 8.8 7.7 108.5 18.0 15.7 14.8 13.3 11.7
86.0 12.2 10.6 10.0 8.9 7.8 109.0 18.1 15.8 15 13.4 11.8
86.5 12.3 107 10.1 9.0 7.9 109.5 18.3 15.9 15.1 13.5 11.9
87.0 12.4 10.8 10.2 9.1 8.0 110.0 18.4 16 15.2 13.6 12.0
87.5 12.5 10.9 10.3 9.2 8.1 110.5 18.6 16.2 15.4 13.8 12.2
88.0 12.6 11.0 10.4 9.3 8.2 111.0 18.8 16.4 15.5 13.9 12.3
88.5 12.8 11.1 10.5 9.4 8.2 111.5 18.9 16.5 15.7 14.0 12.4
89.0 12.9 11.2 10.6 9.5 8.3 112.0 19.1 16.7 15.8 14.2 12.5
89.5 13.0 11.3 10.7 9.6 8.4 112.5 19.3 16.8 15.9 14.3 12.6
90.0 13.1 11.4 10.8 9.6 8.5 113.0 19.4 16.9 16.1 14.4 12.8
90.5 13.2 11.5 10.9 9.7 8.6 113.5 19.6 17.1 16.2 14.6 12.9
91.0 13.3 11.6 11.0 9.8 8.6 114.0 19.8 17.3 16.4 14.7 13.0
91.5 13.4 11.7 11.1 9.9 8.7 114.5 19.9 17.4 16.5 14.8 13.1
92.0 13.6 11.8 11.2 10.0 8.8 115.0 20.1 17.6 16.7 15.0 13.3
92.5 13.7 11.9 11.3 10.1 8.9 115.5 20.3 17.7 16.8 15.1 13.4
93.0 13.8 12.0 11.4 10.2 9.0 116.0 20.5 17.8 17.0 15.3 13.5
93.5 13.9 12.1 11.5 10.3 9.0 116.5 20.7 18.1 17.2 15.4 13.7
94.0 14.0 12.2 11.6 10.4 9.1 117.0 20.8 18.2 17.3 15.6 13.8
94.5 14.2 12.3 11.7 10.4 9.2 117.5 21.0 18.4 17.5 15.7 13.9
95.0 14.3 12.4 11.8 10.5 9.3 118.0 21.2 18.5 17.6 15.8 14.1
95.5 14.4 12.5 11.9 10.6 9.4 118.5 21.4 18.7 17.8 16.0 14.2
96.0 14.5 12.6 12.0 10.7 9.4 119.0 21.6 18.9 18.0 16.2 14.3
96.5 14.7 12.8 12.1 10.8 9.5 119.5 21.8 19.1 18.1 16.3 14.5
97.0 14.8 12.9 12.2 10.9 9.6 120.0 22.0 19.3 18.3 16.5 14.6
97.5 14.9 13.0 12.3 11.0 9.7 120.5 22.2 19.4 18.5 16.6 14.8
98.0 15.0 13.1 12.4 11.1 9.8 121.0 22.4 19.6 18.7 16.8 14.9
98.5 15.2 13.2 12.5 11.2 9.8 121.5 22.6 19.8 18.8 16.9 15.0
99.0 15.3 13.3 12.6 11.3 9.9 122.0 22.58 20.0 19.0 17.1 15.2
99.5 15.4 13.4 12.7 11.4 10.0 122.5 23.1 20.2 19.2 17.3 15.3
100.0 15.6 13.6 12.8 11.5 10.1 123.0 23.3 20.4 19.4 17.4 15.5
100.5 15.7 13.7 12.9 11.6 10.2 123.5 23.5 20.6 19.6 17.6 15.6
101.0 15.8 13.8 13.0 11.7 10.3 124.0 23.7 20.7 19.7 17.7 15.7
101.5 16.0 13.9 13.2 11.8 10.4 124.5 24.0 21.0 19.9 17.9 15.9
102.0 16.1 14.0 13.3 11.9 10.4 125.0 24.2 21.2 20.1 18.1 16.0
102.5 16.2 14.1 13.4 12.0 10.5 125.5 24.4 21.3 20.3 18.2 16.2
203.0 16.4 14.3 13.5 12.1 10.6 126.0 24.7 21.6 20.5 18.4 16.3
103.5 16.5 14.4 13.6 12.2 10.7 126.5 24.9 21.8 20.7 18.6 16.4
104.0 16.7 14.5 13.7 12.3 10.8 127.0 25.2 22.0 20.9 18.7 16.6
104.5 16.8 14.6 13.8 12.4 10.9 127.5 25.4 22.2 21.1 18.9 16.7
105.0 16.9 14.7 14.0 12.5 11.0 128.0 25.7 22.4 21.3 19.1 16.9
105.5 17.1 14.9 14.1 12.6 11.1 128.5 26.0 22.6 21.5 19.2 17.0
106.0 17.2 15.0 14.2 12.7 11.2 129.0 26.2 22.8 21.7 19.4 17.1
106.5 17.4 15.1 14.3 12.8 11.3 129.5 26.5 23.1 21.9 19.6 17.3
107.0 17.5 15.2 14.5 12.9 11.4 130.0 26.8 23.3 22.1 19.7 17.4
107.5 17.7 15.4 14.6 13.0 11.5
353
24 eKL:PUim].Tqm]
lWk];KWc]:pn]Knqn];nm].nk];tL,SUn],Suc]
tL,luk]:AWn],yic];AL,yunG];Ek: 10-18 pI< (NCHS/ CDC/WHO)
Kat],Tat]:AL,hL,rtac];kin]
pan]kac] ha}.hqc];
tac];Suc] (cm) 100% 85% 80% 75% 70% 60%
133.5 29.3 24.9 23.4 22.0 20.5 17.6
134.0 29.6 25.2 23.7 22.2 20.7 17.8
134.5 30.0 25.5 24.0 22.5 21.0 18.0
135.0 30.3 25.8 24.2 22.7 21.2 18.2
135.5 30.6 26.0 24.5 23.0 21.4 18.4
136.0 31.0 26.4 24.8 23.3 21.7 18.6
136.5 31.3 26.6 25.0 23.5 21.9 18.8
137.0 31.7 26.9 25.4 23.8 22.2 19.0
137.5 32.0 27.2 25.6 24.0 22.4 19.2
138.0 32.4 27.5 25.9 24.3 22.7 19.4
138.5 32.7 27.8 26.2 24.5 22.9 19.6
139.0 33.0 28.1 26.4 24.8 23.1 19.8
139.5 33.4 28.4 26.7 25.1 23.4 20.0
140.0 33.7 28.6 27.0 25.3 23.6 20.2
140.5 34.1 29.0 27.3 25.6 23.9 20.5
141.0 34.4 29.2 27.5 25.8 24.1 20.6
141.5 34.7 29.5 27.8 26.0 24.3 20.8
142.0 35.1 29.8 28.1 26.3 24.6 21.1
142.5 35.4 30.1 28.3 26.6 24.8 21.2
143.0 35.8 30.4 28.6 26.9 25.1 21.5
143.5 36.1 30.7 28.9 27.1 25.3 21.7
144.0 36.4 30.9 29.1 27.3 25.5 21.8
144.5 36.8 31.3 29.4 27.6 25.8 22.1
145.0 37.1 31.5 29.7 27.8 26.0 22.3
145.5 37.4 31.8 29.9 28.1 26.2 22.4
146.0 37.8 32.1 30.2 28.4 26.5 22.7
146.5 38.1 32.4 30.5 28.6 26.7 22.9
147.0 38.4 32.6 30.7 28.8 26.9 23.0
147.5 38.8 33.0 31.0 29.1 27.2 23.3
148.0 39.1 33.2 31.3 29.3 27.4 23.5
148.5 39.5 33.6 31.6 29.6 27.7 23.7
149.0 39.8 33.8 31.8 29.9 27.9 23.9
149.5 40.1 34.1 32.1 30.1 28.1 24.1
150.0 40.5 34.4 32.4 30.4 28.4 24.3
150.5 40.8 34.7 32.6 30.6 28.6 24.5
151.0 41.2 35.0 33.0 30.9 28.8 24.7
151.5 41.5 35.3 33.2 31.1 29.1 24.9
152.0 41.9 35.6 33.5 31.4 29.3 25.1
152.5 42.3 36.0 33.8 31.7 29.6 25.4
153.0 42.6 36.2 34.1 32.0 29.8 25.6
153.5 43.0 36.6 34.4 32.3 30.1 25.8
154.0 43.4 36.9 34.7 32.6 30.4 26.0
154.5 44.8 37.2 35.0 32.9 30.7 26.3
155.0 44.2 37.6 35.4 33.2 30.9 26.5
155.5 44.6 37.9 35.7 33.5 31.2 26.8
156.0 45.1 38.3 36.1 33.8 31.6 27.1
156.5 45.5 38.7 36.4 34.1 31.9 27.3
157.0 46.0 39.1 36.8 34.5 32.2 27.6
157.5 46.5 39.5 37.2 34.9 32.6 27.9
158.0 47.0 40.0 37.6 35.3 32.9 28.2
158.5 47.6 40.5 38.1 35.7 33.3 28.6
159.0 48.2 41.0 38.6 36.2 33.7 28.9
159.5 48.9 41.6 39.1 36.7 34.2 29.3
160.0 49.7 42.2 39.8 37.3 34.8 29.8
160.5 50.5 42.9 40.4 37.9 34.4 30.3
161.0 51.6 43.9 41.3 38.7 36.1 31.0
354
eKL:PUim].Tqm] 24
lWk];KWc]:pn]Knqn];nm].nk];tL,tac];Suc]
tL,luk]:AWn],s}a;AL,yunG];Ek: 10-18 pI< (NCHS/ CDC/WHO)
Kat],Tat]:AL,hL,rtac];kin]
pan]kac] ha}.hqc];
tac];Suc] (cm) 100% 85% 80% 75% 70% 60%
130.5 27.2 23.1 21.8 20.4 19.0 16.3
131.0 27.5 23.4 22.0 20.6 19.3 16.5
131.5 27.8 23.6 22.2 20.9 19.5 16.7
132.0 28.0 23.8 22.4 21.0 19.6 16.8
132.5 28.3 24.1 22.6 21.2 19.8 17.0
133.0 28.6 24.3 22.9 21.5 20.0 17.2
133.5 28.9 24.6 23.1 21.7 20.2 17.3
134.0 29.2 24.8 23.4 21.9 20.4 17.5
134.5 29.5 25.1 23.6 22.1 20.7 17.7
135.0 29.9 25.4 23.9 22.4 20.9 17.9
135.5 30.2 25.7 24.2 22.7 21.1 18.1
136.0 30.5 25.9 24.4 22.9 21.4 18.3
136.5 30.8 26.2 24.6 23.1 21.6 18.5
137.0 31.1 26.4 24.9 23.3 21.8 18.7
137.5 31.4 26.7 25.1 23.6 22.0 18.8
138.0 31.8 27.0 25.4 23.9 22.3 19.1
138.5 32.1 27.3 25.7 24.1 22.5 19.3
139.0 32.4 27.5 25.9 24.3 22.7 19.4
139.5 32.7 27.8 26.2 24.5 22.9 19.6
140.0 33.1 28.1 26.5 24.8 23.2 19.9
140.5 33.4 28.4 26.7 25.1 23.4 20.0
141.0 33.8 28.7 27.0 25.4 23.7 20.3
141.5 34.1 29.0 27.3 25.6 23.9 20.5
142.0 34.4 29.2 27.5 25.8 24.1 20.6
142.5 34.8 29.6 27.8 26.1 24.4 20.9
143.0 35.1 29.8 28.1 26.3 24.6 21.1
143.5 35.5 30.2 28.4 26.6 24.9 21.3
144.0 35.8 30.4 28.6 26.9 25.1 21.5
144.5 36.1 30.7 28.9 27.1 25.3 21.7
145.0 36.5 31.0 29.2 27.4 25.6 21.9
145.5 36.9 31.4 29.5 27.7 25.8 22.1
146.0 37.2 31.6 29.8 27.9 26.0 22.3
146.5 37.6 32.0 30.1 28.2 26.3 22.6
147.0 37.9 32.2 30.3 28.4 26.5 22.7
147.5 38.3 32.6 30.6 28.7 26.8 23.0
148.0 38.6 32.8 30.9 29.0 27.0 23.2
148.5 39.0 33.2 31.2 29.3 27.3 23.4
149.0 39.3 39.3 31.4 29.5 27.5 23.6
149.5 39.7 33.7 31.8 29.8 2.8 23.8
150.0 40.0 34.0 32.0 30.0 28.0 24.0
150.5 40.4 34.3 32.3 30.3 28.3 24.2
151.0 40.8 34.7 32.6 30.6 28.6 24.5
151.5 41.1 34.9 32.9 30.8 28.8 24.7
152.0 41.5 35.3 33.2 31.1 29.1 24.9
152.5 41.9 35.6 33.5 31.4 29.3 25.1
153.0 42.3 36.0 33.8 31.7 29.6 25.4
153.5 42.6 36.2 34.1 32.0 29.8 25.6
355
24 eKL:PUim].Tqm]
154.0 43.0 36.6 34.4 32.3 30.1 25.8

154.5 43.4 36.9 34.7 32.6 30.4 26.0
155.0 43.8 37.2 35.0 32.9 30.7 26.3
155.5 44.2 3.6 35.4 33.2 30.9 26.5
156.0 44.6 37.9 35.7 33.5 31.2 26.8
156.5 45.0 38.3 36.0 33.8 31.5 27.0
157.0 45.4 38.6 36.3 34.1 31.8 27.2
157.5 45.8 38.9 36.6 34.4 32.1 27.5
158.5 46.7 39.7 37.4 35.0 32.7 28.0
159.0 47.1 40.0 37.7 35.3 33.0 28.3
159.5 47.5 40.4 38.0 35.6 33.3 28.5
160.0 48.0 40.8 38.4 36.0 33.6 28.9
160.5 48.4 41.1 38.7 36.3 33.9 29.0
161.0 48.8 41.5 39.0 36.6 34.2 29.3
161.5 49.3 41.9 39.4 37.0 34.5 29.6
162.0 49.8 42.3 39.8 37.4 34.9 29.9
162.5 50.2 42.7 40.2 37.7 35.1 30.1
163.0 50.7 43.1 40.6 38.0 35.5 30.4
163.5 51.2 43.5 41.0 38.4 35.8 30.7
164.0 51.6 43.9 41.3 38.7 36.1 31.0
164.5 52.1 44.3 41.7 39.1 36.5 31.3
165.0 52.6 44.7 42.1 39.5 36.8 31.6
165.5 53.1 45.1 42.5 39.8 37.2 31.9
166.0 53.6 45.6 42.9 40.2 37.5 32.2
166.5 54.1 46.0 43.3 40.6 37.9 32.5
167.0 54.6 46.4 43.7 41.0 38.2 32.8
167.5 55.1 46.8 44.1 41.3 38.6 33.1
168.0 55.6 47.3 44.5 41.7 38.9 33.4
168.5 56.2 47.8 45.0 42.2 39.3 33.7
169.0 56.7 48.2 45.4 42.5 39.7 34.0
169.5 57.3 48.7 45.8 43.0 40.1 34.4
170.0 57.8 49.1 46.2 43.4 40.5 34.7
170.5 58.4 49.6 46.7 43.8 40.9 35.0
171.0 59.0 50.2 47.2 44.3 41.3 35.4
171.5 59.6 50.7 47.7 44.7 41.7 35.8
172.0 60.2 51.2 48.2 45.2 42.1 36.1
1772.5 60.8 51.7 48.6 45.6 42.6 36.5
173.0 61.4 52.2 49.1 46.1 43.0 36.8
173.5 62.1 52.8 49.7 46.6 43.5 37.3
174.0 62.7 53.3 50.2 47.0 43.9 37.6
174.5 63.4 53.9 50.7 47.6 44.4 38.0
356
eKL:PUim].Tqm] 24
24.5 lWk];KWc]:tac];yG],Suc]tUw]kUn];
kUn];lUc] (18pI< Kuin]:nUiw]) nm].nk]; (kg)/tac];Suc] 2 (m)
tac]; lWk];piUc]tac];yG],Suc]tUw]kUn]; tac]; lWk];piUc]tac];yG],Suc]tUw]kUn];
Suc] Suc]
(cm) 18.5 18 17.5 17.0 16.5 16 (cm) 18.5 18 17.5 17.0 16.5 16
140 36.3 35.3 34.3 33.3 32.3 31.4 165 50.4 49.0 47.6 46.6 44.9 43.6
141 36.8 35.8 34.8 33.8 32.8 31.8 166 51.0 49.6 48.2 46.8 45.5 44.1
142 37.3 36.3 35.3 34.3 33.3 32.3 167 51.6 50.2 48.8 47.4 46.0 44.6
143 37.8 36.8 35.8 34.8 33.7 32.7 168 52.2 50.8 49.4 48.0 46.6 45.2
144 38.4 37.3 36.3 35.3 34.2 33.2 169 52.8 51.4 50.0 48.6 47.1 45.7
145 38.9 37.8 36.8 35.7 34.7 33.6 170 35.5 52.0 50.6 49.1 47.7 46.2
146 39.4 38.4 37.3 36.2 35.2 34.1 171 34.1 52.6 51.2 49.7 48.2 46.8
147 40.0 38.9 37.8 36.7 35.7 34.6 172 34.7 53.3 51.8 50.3 48.8 47.3
148 40.5 39.4 38.3 37.2 36.6 35.5 173 55.4 53.9 52.4 50.9 49.4 17.9
149 41.1 40.0 38.9 37.7 36.6 35.5 174 56.0 54.5 53.0 51.5 50.0 48.4
150 41.6 40.5 39.4 38.3 37.1 36.0 175 56.7 55.1 53.6 52.1 50.5 49.0
151 42.2 41.0 39.9 38.8 37.6 36.5 176 57.3 55.8 54.2 52.7 51.1 49.6
152 42.7 41.6 40.4 39.3 38.1 37.0 177 58.0 56.4 54.8 53.3 51.7 50.1
153 43.3 42.1 41.0 39.8 38.6 37.5 178 58.6 57.0 55.4 53.9 52.3 50.7
154 43.9 42.7 41.5 40.3 39.1 37.9 179 59.3 57.7 56.1 54.5 52.9 51.3
155 44.4 43.2 42.0 40.8 39.6 38.4 180 59.9 58.3 56.7 55.2 53.5 51.8
156 45.0 43.8 42.6 41.4 40.2 38.9 181 60.6 59.0 57.3 55.7 54.1 52.4
157 45.6 44.4 43.1 41.9 40.7 39.4 182 61.3 59.6 58.0 56.3 54.7 53.0
158 46.2 44.9 43.7 42.4 41.2 39.9 183 62.0 50.3 58.6 56.9 55.3 53.6
159 46.8 45.5 44.2 43.0 41.7 40.4 184 62.6 60.9 59.2 57.6 55.9 54.2
160 47.4 46.1 44.8 43.5 42.2 41.0 185 63.3 61.6 59.9 58.2 56.5 54.8
161 48.0 46.7 45.4 44.1 42.8 41.5 186 64.0 62.3 60.5 58.8 57.1 55.4
162 48.6 47.2 45.9 44.6 43.3 42.0 187 64.7 62.9 61.2 59.4 57.7 56.0
163 49.2 47.8 46.5 45.2 43.8 42.5 188 65.4 63.6 61.9 60.1 58.3 56.6
164 49.8 48.4 47.1 45.7 44.4 43.0 189 66.1 64.3 62.5 60.7 58.9 57.2
190 66.8 65.0 63.2 61.4 59.6 57.8
357
24 eKL:PUim].Tqm]
24.6 nm].kiUw]tL,PUim].Tqm]Tat]:nm].nC];tUw]
(Oral rehydration Solutions)
Pgc]Tat]:kUiw] (ORS)
l}a;KUn];elL;nm].kiUw]
Aw]Pgc]Tat]:kUiw]nuic]:TUc] SG],elL;nm].Aun],kt];"
etl}:elL;nm].kL:huiw]An]wL:nn]. hG]:tUv]; tI:Enw}.niUw]TUc]"
Tat]:nm].kUiw]An]sac] (Dilute ORS)

Aw]Pgc]Tat]:kUiw]nuic]:TUc](nm].750 cc) + nm].1500cc + kUiw]wan]30g + Potassium
(Am],nn])
Pgc]Tat]:kUiw]nuic]:TUc](1000cc) + nm].2000cc + kUiw]wan]40 g + Potassium 2.5g
la};hQt];nm].kiUw]wan] (sugar salt solution)

nm].Aun],kt];nuic]:lit].' kUiw] 1 esL.ekL,PI, (esL.AWn],)' kUiw]wan] 8 esL.ekL,PI,"
nuic]:esL.ekL,PI, mI; 5 ml' Sc]wL:Am],mI;esL.El: kgk];n}suic] etl}:Aw]muiw]; 2
niw].vgp];Aw] 1 vgp];n}yw]."
tk];nm]. 1 kgk]; (240cc) epL;yw].Aw]muiw]; 3 niw].vgp];Aw]kUiw]" mUiw]:p},SG],kUiw]wan]
nn]. hG]:sim];tUv];Agn]tac];" yL,hG]:sQm]liUw]nm].tL SG],kiUw]nm]pUn].n}.Am],lI"
Sc]wL:AL:rSL,nm].kUiw]mqn]:yw].n}suic] Aw]]kUiw]wan]SG],niuc]:AUc]:miuw];
nm].Kw]: (Boiled rice water)

Aw]nm].Kw]:eS hQt];Tat]:nm].kUiw]
tL,tgc];" Sc]wL:luk]:Agn],Am],Kat],AL,hL,rpUn].tI:suic] Aw] AsiaMIX
tac]Kw]:kin]l}:yU,"
(1) Kw]: 1 km] (20-25grams) Suk]:Kw]:yw].eS es:nm].w}.etL,Tuic]epL;kI:"
(2) Kw]:An]es:nm].w}.nn]. etl}:tm] etL,Tuic]Kw]:epL;lqw]pUiw]."
(3) nm]. 2 kgk];(mgk]: 600cc) elL;nm].Kw]:An]pUiw].pUiw].nn].tc]:"
(4) tc]:PUt].PuUt].etL,Tuic] pun];pUk],epL;Agk],eSKUn];kGL,KUn];mL;" epL;yw].ekL:
pUc]emL:lUc];wac];w}.hG]:mn];kt];"
(5)Aw]muiw]; 3 niw].vgp];Aw]kUiw] hG]:mn];tQm]Tuic]nuic]:hk];muiw]; (1.5g) SG],nG];emL:Kw]:
eStw]"
nm].Kw]:An]hQt];w}.n}. Aw]lQc].kUn];pQn]tgc].kGL,l}:yw]."
lgc]:kQp];Sim]; nm].Kw]:An]n}.etl}:SG],kgk];' emL:An]mI;PLhUm],nn].eS Sim];w}.tI:kt];
El:tI:An]mUt];SG]"
nm].Kw]:An]n}.w}.l}:Tuic] 6-8 sUw]:mUc];' Sc]wL:huic]eSn}.suic] hG]:TWk],pqt]:SQc]:SQc]:"
358
eKL:PUim].Tqm] 24
24.7 lWk];Kgc]:Kaw];yam]; tL,yLeh.kc]:

(Schedule of Immunization)
lWc]:Sm];yLeh.kc]:n}. sac]:eh.ham]:tac];pQn]mac]An]l}:yU,yw]." yLeh.kc]: An]hLl}:nG];piun].tI:
pgt];tgn]:n}.Et. etEnw}.sgm];nc],pL:tG]:n}."
suiw]:tac];pQn] yLeh.kc]:
TI,pI, BCG
tac];pQn]mak],lqc] yLeh.kc]:mak],lqc]
tac];pQn]lup],AUn]: yLeh.kc]:lup],AUn]:
tac];pQn]eKL:hip], yLeh.kc]: Diptheria' A}hut],' kac];Kqc]
tac];pQn]A}KUn] yLeh.kc]: Diptheria' A}hut],' kac];Kqc]
tac];pQn]kac];Kqc] yLeh.kc]: DPT (Am],nn])yLeh.kc]: kac];Kqc]
An]lQw]kUv];
tac];pQn]tp];kG]: nUiw].lUic] yLeh.kc]: tp];kG]: nUiw].lUic]
1. lWk];Kgc]:Kaw];yam]; tL,Sm];yLeh.kc]: An]muk].sum];lUc]p}a;yU,lIlum]:fL.

km].Tqm]pn]w}.
Am],mk];mn]:lgk];Kgc]:An]n}.pQn]pUic]ta}"
luk]:Agn],kUit],mG], BCG +polio 0+Hep B1
AL,yu 6 wUc]: DPT1+polio1+Hep B2
AL,yu 10 wUc]: DPT2+polio2
AL,yu 14 wUc]: DPT3+polio3+Hep B3*
AL,yu 9 lUin] Measles
wa};eSSm]; DPT3 huic]nuic]:pI< Booster DPT+polio
*epL;pn] Hep B2 huic] 6

lUin]yw].pn] Hep B3 l}:yU,"
➔ Sc]wL:luk]:Agn], Agn]kn]pQn]mak],lqc]pQn]mU,pQn]sum];suic] etl}:Sm];yLeh.kc]:pn]luk]:Agn],
AL,yu nG];Ek: 6 lUin]etL, 10 pI<tac];mUt];n}yw]." Sc]wL:l}:Sm];yLeh.kc]:mUiw]:AL,yul}: 6
lUin]El: 9 lUin]yw].n}suic] epL;luk]:Agn],l}: 12 lUin]pa}mL;Sm];pn]Tqc]:n}yw]."
359
eKL:PUim].Tqm]
24
2. Em:pL;tgc].El:Em:luk]:Agn],
Kic],mUiw]:mL;Aap]:tgc].pgk]:TI.nuic]: T1
T1 yw]. huic] 1-2 lUin] T2
T2 yw]. huic] 6 lUin] T3
T3 yw]. huic] 1 pI< T4
T4 yw]. huic] 1 pI< T5
Am],nn]
AL,yunG];Ek: 15- 45 pI< Sm];l}:kU:Kaw];yam]; T1
T1 yw]. huic] 1 lUin] T2
etL,Tuic]pL;tgc].Tqc]:pgk]:nuic]: Sm];mUiw]:lG]ekL:l}: T3
tL,kUn];Kw]:mL;mG],
hgt]:mL;pgk]:TI.nuuic]: BCG +polio 0+ DPT1+Hep B1+measles
AL,yu 6 wUc]: DPT2+polio1+Hep B2
AL,yu 10 wUc]: DPT3+polio2
AL,yu 14 wUc]: Polio3+Hep B3*
AL,yu 9 lUin] Measles
wa};eSSm]; DPT3 huic]nuic]:pI< Booster DPT+polio
360
eKL:PUim].Tqm] 24
24.8 lWk];KWc]:lWc]:yUt];yLtac];pQn]naw]nUk].
(Malaria Treatment table)
hqc];yL (Dose)El:Kaw];yam];tL,yUt];yLnn]. hG]:tUv];tI:tgn]:tac];pQn]naw]nUk]. kn] 15.2"
yLkin] Artesunate
tI:lgk];Kgc]:n}. Sgn],np].hqc];yLw}. 1 mQt].mI; 50 mg
yLmQt].An]mI;hqc]; 200mg ekL:mI:yU," epL;wL:mI;yU,n}suic] hG]:tUv];hqc];yLeSSgn],np].Aw]"
nm].nk]; 4mg/kg 2mg/kg nm].nk]; 4mg/kg 2mg/kg
(kI,lUw],) Mg-tablets Mg-tablets (kI,lUw],) Mg-tablets Mg-tablets
5-7 20-28mg=1/2t 10-14mg=1/4t 37-39 148-156mg=3t 74-76mg=1 1/2t
8-9 32-36mg=3/4t 16-18mg=1/4t 40 160mg=3 1/4t 80mg=1 1/2t
10 40mg=3/4t 20mg=1/2t 41-42 164-168mg=3 82-84mg=1 3/4t
¼t
11-14 44-56mg=1t 22-28mg=1/2t 43-45 172-180mg=3 86-90mg=1 3/4t
1/2t
15 60mg=1 1/4t 30mg=1/2t 46 184mg=3 3/4t 92mg=1 3/4t
16-17 64-68mg=1 1/4t 32-34mg=3/4t 47-48 188-192mg=3 94-96mg=2t
3/4t
18-20 72-80mg=1 1/2t 36-40mg=3/4t 49-51 196-204mg=4t 98-102mg=2t
12 84mg=1 3/4t 42mg=3/4t 52-53 208-212mg=4 104-106mg=2t
1/4t
22-23 88-92mg=1 3/4t 44-46mg=1t 54 216mg=4 1/4t 108mg=2 1/4t
24-26 96-104mg=2t 48-52mg=1t 55-57 220-228mg=4 110-114mg=2
1/2t 1/4t
27-28 108-112mg=2 54-56mg=1t 58-59 232-236mg=4 116-118mg=2
1/4t 3/4t 1/4t
29 116mg=2 1/4t 58mg=1 1/4t 60 240mg=4 3/4t 1120mg=2 1/2t
33-32 120-128mg=2 60mg=1 1/4t 61-64 244-256mg=5t 122-128mg=2
1/2t 1/2t
33-34 132-136mg=2 66-68mg=1 1/4t 65 260mg=5 ¼t 130mg=2 1/2t
3/4t
35 140mg=2 3/4t 70mg=1 1/2t 66-67 264-268mg=5 132-134mg=2
1/4t 3/4t
36 144mg=1t 72mg=1 1/2t 68-70 272-280mg=5 136-140mg=2
1/2t 3/4t
361
eKL:PUim].Tqm]
24
yLkin] Chloroquine
tI:lgk];Kgc]:n}. Sgn],np].hqc];yL Chloroquine w}. 1 mQt]. = 150 mg
nm]. Total Total
Dose 1 Dose 2 Dose 3 nm]. Dose 1 Dose 2 Dose 3
doses doses
nk]; nk];
25mg/kg 10mg/kg 10mg/kg 5mg/kg 25mg/kg 10mg/kg 10mg/kg 5mg/kg
(Kg) (Kg)
(mg) (tablets) (tablets) (tablets) (mg) (tablets) (tablets) (tablets)
5 125mg 1/4t 1/4t 1/4t 38 950mg 2+ 1/2t 2+1/2t 1+1/4t
6-7 125 - 1/2t 1/4t 1/4t 39-40 975 - 2+1/2t 2+1/2t 1+1/2t
175mg 1000mg
8 200mg 1/2t 1/2t 1/4t 41 1025mg 2+3/4t 2+ 3/4t 1+1/4t
9-10 225 - 1/2t 1/2t 1/2t 42-43 1050 - 2+3/4t 2+ 3/4t 1+1/2t
250mg 1075mg
11 275mg 3/4t 3/4t 1/4t 44 1100mg 3t 3t 1+1/4t
12-13 300 - 3/4t 3/4t 1/2t 45-46 1125 - 3t 3t 1+1/2t
325mg 1150mg
14 350mg 1t 1t 1/4t 47 1175mg 3t 3t 1+3/4t
15-16 375 - 1t 1t 1/2t 48-49 1200 - 3+ 1/4t 3+1/4t 1+1/2t
400mg 1225mg
17 425mg 1t 1t 3/4t 50 1250mg 3+1/4t 3+1/4t 1+3/4t
18-19 450 - 1+1/4t 1+1/4t 1/2t 51-52 1275 - 3+1/4t 3+1/4t 2t
475mg 1300mg
20 500mg 1+1/4t 1+1/4t 3/4t 53 1325mg 3+1/2t 3+1/2t 1+3/4t
21-22 525 - 1+1/2t 1+1/2t 1/4t 54-55 1350 - 3+1/2t 3+1/2t 2t
550mg 1357mg
23 575mg 1+1/2t 1+1/2t 3/4t 56 1400mg 3+3/4t 3+3/4t 1+3/4t
24-25 600 - 1+1/2t 1+1/2t 1t 57-58 1425 - 3+3/4t 3+3/4t 2t
625mg 1450mg
26 650mg 1+3/4t 1+3/4t 3/4t 59 1475mg 4t 4t 1+3/4t
27-28 675 - 1+3/4t 1+3/4t 1t 60-61 1500 - 4t 4t 2t
700mg 1525mg
29 735mg 2t 2t 3/4t 62 1550mg 4t 4t 2+1/4t
30-31 750 - 2t 2t 1t 63-64 1575 - 4+ 1/4t 4+ 1/4t 2t
775mg 1600mg
32 800mg 2t 2t 1+1/4t 65 1625mg 4+ 1/4t 4+ 1/4t 2+1/4t
33-34 825 - 2+1/4t 2+1/4t 1t 66-67 1650 - 4+ 1/4t 4+ 1/4t 2t
850mg 1675mg
35 875mg 2+1/4t 2+1/4t 1+1/4t 68 1700mg 4+ 1/4t 4+ 1/4t 2+1/4t
36-37 900 - 2+1/2t 2+1/2t 1t 69-70 1725 - 4+ 1/4t 4+ 1/4t 2+1/2t
925mg 1750mg
362
eKL:PUim].Tqm] 24
yLkin] Mefloquine
tI:lgk];Kgc]:n}. Sgn],np].hqc];yL Mefloquine w}. 1 mQt].mI; 250 mg"
etAm],l}:pn]yLhG]:luk]:AWn],AL,yu 2 lUin]lUc];tG]: SWn].kn]SWc]pWk]:" etsac]:pQn]kWc].l}:"
Second Second
Total dose First dose Total dose First dose
nm].nk]; dose nm].nk] dose
25mg/kg 15mg/kg 25mg/kg 15mg/kg
(kI,lUw],) 10mg/kg (kI,lUw],) 10mg/kg
Mg-tablets tablets Mg-tablets tablets
tablets tablets
5-6 125- ¼ 1/4 39-41 975-1025mg=4t 2 1/2t 1 1/2t
150mg=1/2t
7-8 175-200mg=3/4 ½ 1/4 42-43 1050-1075mg=4 2 1/2t 1 3/4t
1/4t
9-11 225-275mg=1t ½ 1/2 44-46 1100-1150mg=4 2 3/4t 1 3/4t
1/2t
12-13 300-325mg=1 ¾ 1/2 47-48 1175-1200mg=4 2 3/4t 2t
1/4 3/4t
14-16 350-400mg=1 1t 1/2t 49-51 1225-1275mg=5t 3t 2t
1/4
17-18 425-450mg=1 1t 3/4t 52-53 1300-1325mg=5 3 1/4t 2t
3/4t 1/4t
19-21 475-525mg=2t 1 1/4t 3/4t 54-56 1350-1400mg=5 3 1/4t 2 1/4t
1/2t
22 550mg=2 1/4t 1 1/4t 1t 57-58 1425-1450mg=5 3 1/2t 2 1/4t
3/4t
23 575mg=2 1/4 1 1/2t 1t 59-60 1475-1500mg=6t 3 1/2t 2 1/2t
24-26 600-650mg=2 1 1/2t 1t 61 1525mg=6t 3 3/4t 2 1/4t
1/2t
27-28 675-700mg=2 1 3/4t 1t 62-63 1550-1575mg=6 3 3/4t 2 1/2t
3/4t 1/4t
29-31 725-775mg=3t 1 3/4t 1 1/4t 64 1600mg=6 1/2t 3 3/4t 2 3/4t
32-33 800-825mg=3 2t 1 1/4t 65-66 1625-1650mg=6 4t 2 1/2t
1/4t 1/2t
34-36 850-900mg=3 2t 1 1/2t 67-68 1675-1700mg=6 4t 2 3/4t
1/2t 3/4t
37-38 925-950mg=3 2 1/4t 1 1/2t 69-70 1725-1750mg=7t 4 1/4t 2 3/4t
3/4t
yLn}Am],Tuk],lIpn]- Em:pL;tWc].' kUn];yam]:pQn]tac];pQn]hUw]sG]El: tac];pQn]mL:mU' pUn].mL;nG];Kaw];tac];

63 wn];nn]. yam]:kin]yL Mefloquine w}."
363
24 eKL:PUim].Tqm]
yLkin] Quinine
tI:lgk];Kgc]:n}. Sgn],np].hqc];yL Quinine w}. 1 mQt].mI; 300 mg"
nm].nk]; (kI,lUw],) Dose=10mg/kg TID
mg Tab
<5 75 mg BID ¼ BID
6–9 75 mg TID ¼ TID
10 – 16 150 mg TID ½ TID
17 – 23 225 mg TID ¾ TID
24 – 33 300 mg TID 1 TID
34 – 50 450 mg TID 1 ½ TID
> 50 600 mg TID 2 TID
Artemether - Iumefantrine (ALN), Coartem
yLnbic]:mQt].n}. mI; Artemether 20 mg El: Lumefantrine 120 mg"

tL,yUt];yLnn]. nuic]:wn];kin]Sgc]pgk]: tL, 3 wn];" (kin]tc];nm].nUm];)
hqc];yL Coartemether - hqc];yLn}. etAic]nUiw]nm].nk];kUn];pQn]"
nm].nk]; tac];nm]mQt].yL tL,tWc];-
(kI,lUw],) Coartemether yL Lumefantrine n}. epL;kin]elL;
Tat]:nm].mn];n} etmI;PWn];lIEl:
≤15 1 tablet per dose Tiuc]tI:yw]."
16-15 2 tablet per dose kWp]:n} epL;etkin]yLAn]n}. mUiw]:lG]eS
Am],wL: etl}:kin]Kac],pWc]; (Am],nn])
26-35 3 tablet per dose nm].nUm];Aqp],n}yw]."
>35 4 tablet per dose
364
eKL:PUim].Tqm] 24
yLSm]; IV Artesunate
yLSm]; IV Artesunate n}.pun]:tL,tac];pQn]naw]nUk].ha}.hqc];( 2.4 mg/kg) Am],nn] sGG].tiuw];tL, sg}:Tqm]
kUn];mI;sUiw].mqc];naw]nUk].pUn].tI: (1.2 mg/kg)"
nm].elL;yLn}. etAm],l}:hG]:tUiw].Sqc]lqt],' mUiw]:p},l}:Sm];nn]. Tuk],lIhac]:hqn];w}.hG]:Kqm].lqp]:eS
nm].yLtI:An]kuit];lUiw]w}.nn]. etl}:Aw]pqt]:"
yL Artesunate nuic]:tw]:n}. mI;pL;nm].yLelL; 1 ml 5% sodium bicarbonate (1 vial contains 60 mg
artesunate (60 mg/ml).
tL,yUt];yLtac];pQn]naw]nUk].ha}.hqc]; - H0: Artesunate 2.4 mg/kg; H12 2.4 mg/kg, and then 2.4 mg/kg/24 hours
etL,Tuic]kUn];pQn]epL;sac]:kin]yLl}:hc];kUv];"
nm].nk]; 2,4mg/kg 1,2mg/kg nm].nk]; 2,4mg/kg 1,2mg/kg
(kI,lUw],) dose(ml) dose(ml) (kI,lUw],) dose(ml) dose(ml)
2-3 0.1 0.05 43 1.7 0.9
4-6 0.2 0.1 44-46 1.8 0.9
7 0.3 0.1 47 1.9 0.9
8 0.3 0.2 48 1.9 0.9
9-11 0.4 0.2 49-51 2.0 1.0
12 0.5 0.2 52 2.1 1.0
13 0.5 0.3 53 2.1 1.1
14-16 0.6 0.3 54-56 2.2 1.1
17 0.7 0.3 57 2.3 1.1
18 0.7 0.4 58 2.3 1.2
19-21 0.8 0.4 59-61 2.4 1.2
22 0.9 0.4 62 2.5 1.2
23 0.9 0.5 63 2.5 1.3
24-26 1.0 0.5 64-66 2.6 1.3
27 1.1 0.5 67 2.7 1.3
28 1.1 0.6 68 2.7 1.4
29-31 1.2 0.6 69-71 2.8 1.4
32 1.3 0.6 72 2.9 1.4
33 1.3 0.7 73 2.9 1.5
34-36 1.4 0.7 74-76 3.0 1.5
37 1.5 0.7 77 3.1 1.5
38 1.5 0.8 78 3.1 1.6
39-41 1.6 0.8 79-80 3.2 1.6
42 1.7 0.8
365
24 eKL:PUim].Tqm]
Quinine IV
hqc];yLAn]etl}:Et,pn] = 20mh/kg
tI:lgk];Kgc]:n}. Sgn],np].hqc];yL Quinine w}. nuic]:tw]: mI; 2cc = 600mg
tac];nm]tWm],yL IV fluid 1cc = 20drops (1cc = 20 ygt],)
AWn]tac];Sut];pn] Quinine 20mg/kg hG]:huic] 4 sUw]:mUc];
Suip],kCL,nn].pn] IV fluid la}la}kUv];Tqc]: 4 sUw]:mUc];
Aw]yL Quinine n}.KUn];elL; D5W/ D10W / D5S and NSS eSpn]l}:yU,"

tL,Em:pL;tWc].Et. hG]:KUn];elL;yLtc]; D10W eSSuc];sG]."
nm].nk]; H0 H4
(kI,lUw],) Cc of Quinine in
ygt],/minit]. Iv fluids alone ygt],/minit].
IV fluids
4-6 0.4cc in 100cc 8d/min 10cc 8d/min
13-15 1cc in 250cc
16-18 1.2cc in 250cc
19-21 1.4cc in 250cc
22-24 1.6cc in 250cc
25-27 1.8ccin 250cc
28-31 2ccin 250cc
32-34 2.2ccin 250cc
35-37 2.4ccin 250cc 21d/min 250cc 21 d/min
38-40 2.6ccin 250cc
41-43 2.8ccin 250cc
44-46 3ccin 250cc
47-49 3.2ccin 250cc
50-52 3.4ccin 250cc
53-55 3.6ccin 250cc
56-59 3.8ccin 250cc
>59 4ccin 250cc
366
eKL:PUim].Tqm] 24
Quinine IV infusion
hqc];yL (tc];nm]yL) An]etl}:Et,pn] = 10mg/kg TID

tI:lgk];Kgc]:n}. Sgn],np].hqc];yL Quinine w}. nuic]:tw]: mI; 2cc = 600mg
tac];nm]tWm],yL IV fluid 1cc = 20drops (1cc = 20 ygt],) eShQt];w}.
yL Quinine n}.Aw] D5W/D10w/D5S El: NSS sUiw];n}.eSSC],elL;kn]l}:
yLtL,nuic]:pWk]: 10mg/kg
nm].nk]; (kI,lUw],) nm].yL Quinine An]elL; yWt],/minit].

yLhqc];Sm];AQnw] }.
4-6 0.2 cc in 100 cc 8 d/mn
7-9 0.3 cc in 150 cc 13 d/mn
10-12 0.4 cc in 200 cc 17 d/mn
13-15 0.5 cc in 250 cc
16-18 0.6 cc in 250 cc
19-21 0.7 cc in 250 cc
22-24 0.8 cc in 250 cc
25-27 0.9 cc in 250 cc
28-31 1 cc in 250 cc
32-34 1.1 cc in 250 cc
35-37 1.2 cc in 250 cc
38-40 1.3 cc in 250 cc 21 d/mn
41-43 1.4 cc in 250 cc
44-46 1.5 cc in 250 cc
47-49 1.6 cc in 250 cc
50-52 1.7 cc in 250 cc
53-55 1.8 cc in 250 cc
56-59 1.9 cc in 250 cc
>59 2 cc in 250 cc
367
24 eKL:PUim].Tqm]
Quinine IM
hqc];yLetl}:et,pn] = 20mh/kg TID
tI:lgk];Kgc]:n}.Sgn],np].hqc];yL Quinine w}. nuic]:tw]: mI; 2cc = 600mg
1. yL Quinine nuic]:tw]:An] mI; 2cc n}. etl}:elL;tc];nm].fUn] 3cc eShQt];hG]:mn];mI; 5 cc"
2. Aic]nUiw]nm].nk];kUn];pQn]eSpn]yLtL." etl}:Sm];tI:kum], nuic]:Pa}, nuic]:Kuic]:yw]."
3. tI:etSm];Kqm]nn]. etl}:sQt].hG]:mUt];SG]" (Suk]:muiw];' tI:kum],An]etSm];KQm]nn].etl}:Aw]
Savlon eSsQt].pn]hG]:mUt];SG]' hG]:Sm];KQm]Kw]:luik].luik].) Sc]Am],hQt];n}suic] kum],kUn]:etsac]:kG]:
AUm]ngc]yw]."
4. lgc]:Sm];yL Quinine n}. sQp];nL,n}nn]. etl}:Sp];lqc];EnkUn];pQn]yw]."
nm].nk]; (kI,lUw],) nm].yL Quinine

An]elL;nm].fUn]w}. An]elL;nm].fUn]w}.
4-6 1cc 35-37 6cc
7-9 1.5cc 38-40 6.5cc
10-12 2cc 41-43 7cc
13-15 2.5cc 44-46 7.5cc
16-18 3cc 47-49 8cc
19-21 3.5cc 50-52 8.5cc
22-24 4cc 53-55 9cc
25-27 4.5cc 56-59 9.5cc
28-31 5cc >59 10cc
32-34 5.5cc
hqc];yLAn]etl}:Suip],pn] = 10mh/kg TID
tI:lgk];Kgc]:n}.Sgn],np].w}.hqc];yL Quinine nuic]:tw]: mI; 2cc=600mg"
etl}:hQt];sgm];nc],Kn].tgn]: 1-4 An]Enw}.pL:nUiw]"
hqc];yLnuic]:pgk]: 10mg/kg
An]elL;nm].fUn]w}. An]elL;nm].fUn]w}.
4-6 kg 0.5cc 35-37 kg 3cc
7-9 kg 0.7cc 38-40 kg 3.2cc
10-12 kg 1cc 41-43 kg 3.5cc
13-15 kg 1.2cc 44-46 kg 3.7cc
16-18 kg 1.5cc 47-49 kg 4cc
19-21 kg 1.7cc 50-52 kg 4.2cc
22-24 kg 2cc 53-55 kg 4.5cc
25-27 kg 2.2cc 56-59 kg 4.7cc
28-31 kg 2.5cc >59 kg 5cc
32-34 kg 2.7cc
368
eKL:PUim].Tqm] 24
Artemether IM
tI:lgk];Kgc]:n}. Sgn],np].hqc];yL Artemether w}. nuic]:tw]: mI; 1cc = 80mg"

tac];nm]yL tac];nm]yL tac];nm]yL tac];nm]yL
nm].nk]; tL,et,pn] tL,Supi ],pn] nm].nk]; tL,et,pn] tL,Suip],pn]
(kI,lUw],) 3.2mg/kg 1.6mg/kg (kI,lUw],) 3.2mg/kg 1.6mg/kg
cc cc cc Cc
2-3 0.1 0.05 43 1.7 0.9
4-6 0.2 0.1 44-46 1.8 0.9
7 0.3 0.1 47 1.9 0.9
8 0.3 0.2 48 1.9 1.0
9-11 0.4 0.2 49-51 2.0 1.0
12 0.5 0.2 52 2.1 1.0
13 0.5 0.3 53 2.1 1.1
14-16 0.6 0.3 54-56 2.2 1.1
17 0.7 0.3 57 2.3 1.1
18 0.7 0.4 58 2.3 1.2
19-21 0.8 0.4 59-61 2.4 1.2
22 0.9 0.4 62 2.5 1.2
23 0.9 0.5 63 2.5 1.3
24-26 1.0 0.5 64-66 2.6 1.3
27 1.1 0.5 67 2.7 1.3
28 1.1 0.6 68 2.7 1.4
29-31 1.2 0.6 69-71 2.8 1.4
32 1.3 0.6 72 2.9 1.4
33 1.3 0.7 73 2.9 1.5
34-36 1.4 0.7 74-76 3.0 1.5
37 1.5 0.7 77 3.1 1.5
38 1.5 0.8 78 3.1 1.6
39-41 1.6 0.8 79-80 3.2 1.6
42 1.7 0.8
369
24 eKL:PUim].Tqm]
24.9 lWk];KWc]:yL:yL
PO = oral BID=2 times/day = every Mcg = microgram IU = International
yLkin] 12 hours ma},KrUw],krm], Units
nuic]:wn]; 2 pgk]: = yU,nit].kU:suic]:mUic];sC].
Kqn]: 12 sUw]:mUc];
IM = Intramuscular TID = 3 times/day = every Mg = milligram S_E = Side effects
Sm];tI:kam]:nUiw]. 8 hours mI,lI,krm], Pgn];sL.yL
nuic]:wn]; 3 pgk]: =
Kqn]: 8 sUw]:mUc];
IV=Intravenous QID = 4 times/day = every g=gram Max = Maximum
Sm];tI:SQn]:lUit]: 6 hours krm], tI:nm]Sut];
nuic]:wn]; 4 pgk]:=Kqn]: 6
sUw]:mUc];
SC = subcutaneous STAT = one dose only Kg = kilogram Start = Starting
nUiw]nUiw].tG]:Piw]nc] pn]pgk]:lQw]kUv]; kI,lUw],krm], et,pn]yL
PR=perrectum PV=pervagina
SG],nG];hU;kUn]: SG],nG];hU;KUic]:Ac],kL,
ma}tgc];kU:lgc]:lgc]:
 etl}:yUt];yLhuic]la}wn];n}nn]. Aic]nUiw]tac];pQn]kUn];pQn]yw]." tUv];sgm];nc],hUw]eKL:tac];pQn]
eS yUt];yL"
 km]:nm]Pac]hac]:Pgn];sL.yLn}. etsac]:hQt];hG]:tgc].kGL,' tUn].hak]:' eAL.hak]:sUiw];n}.yw]."
 yLtc];SQc]:n}. Sc]Tat]:Am],mqn]:n}suic] etAgk],mun],man],' Agk],tum],lqc]eS etsac]:mw];lUm].
luim];tUw] (Tat]:Am],mqn]:h}a.hqc];) yU,yw]."
 miUw]:Sc],lat]: l}a;kin]yLpn]Em:pL.tgc].nn].tk];etl}:w}.Stink];nLeS Sc],lat]:pn]lIlI"
 Sc]wL: mak],kqw]; Am],nn] tp]; Am],hQt];kan]lIlIn}suic] etl}:fac].eS pn]yLhG]:Tuk], mqn]:
sgm];nc],lgk];la};" Tuk],lIpn]yL sUic].huiw]' hQt];huiw] n}nn]. Tuk],lItUic],pac],tac];emLyLlUc]Kw]
kgn],yw]."
 Sc]wL:pn]yLnm]lUiw]kCL, 2 Sqn];n}suic] lWc]:hQt];kan]yL:yL etsac]:lqk]:la}:kGL,n}yw]."
 pUic]lUc]mn];Et. kQw],lUbv]:Tat]:yL:yL An]nuic]:El:An]nuic]: tum].tUiw].kn] mUin]nc], Enw}.pL:
tG]:n}.yw]."
370
eKL:PUim].Tqm] 24
Acetylsalicylicacid=Aspirin=ASA
luk]:Agn],AL,yu PO yL,pn]yLAn]n}. tL,fac].yLAn]n}.- tac];pQn]mgc]eKL:'
12 pI<lUc];tG]: Kat],Tat]: G6PD' kUn];pQn]tac];pQn]
luk]:Agn],AL,yu 10-15mg/kg nm]Sut]; 4 hUc];Kw]:sQp];
12 pI<Kuin]:nUiw] PO QID krm],/wn]; etAm],l}:pn]yLAn]n}.- kUn];pQn]tac];
pQn]hUc];Kw]:sQp];' kUn];mI;tac];pQn]naw]
kUn];lUc] PO 300-900mgQID nm]Sut]; 4 liUt]:Agk],' pQn]lup],kp];lup],etL,kG]:' Em:
krm],/wn]; lQc].nUm];luk]:Agn],' Em:pL;tgc].sm]et
tac];nm]yL 75-100mg/day kUit],wUc]:km];luin];Sut];"
tL,eh.kc]: Pgn];sL.yL:yL-hUc];Kw]:sQp];' lgt],lUm];
TUv]:sG]tip],' lUit]:Agk],Kaw];huic]"
Tat]:yLtum].tgp],kn] - yL:yLKUp];KUp];
Kuin]:Kuin]: tac],sUiw].tac],pUic]' sum];yL:yL
Steriod' mUin]nc], Spironoloactone,
Metoclopramide
Adrenaline1:1,000
yLSm]; = 1 cc = 1 mg hqc];yLsac]:hQt];hG]:luim];tUw]pQn] (Szk].) l}:' lgc]:tUw].tgp],Am],mqn]:yLh}a.
hqc];"
luk]:Agn], 6 liUn]lUc];tC]: IM 0.05 cc  Sm];Kw]:kam]:niUw].n}. pQn]l}a;Sm];An]Tuk],mqn]:liUw]

6 liUn] – 6 pI< IM 0.12 cc piUn]:"
6 - 12 pI< IM 0.25 cc
 hqc];yLTuk],lIpn] 0.01 mg/kg (nm]Sut]; 0.5 mg )
luk]:Agn], 12 pI<Kiun]:niUw] IM 0.5 cc
El: kUn];lUc]  Kiun];Sm];pn] 5 minit].niuc]:pgk]: etL,Tiuc] hqc];liUt]:
El: hqc];tgt],liUt]: pQn]Kiun];pk],ktI,"
 tL,hqc];yLluk]:Agn],nn]. etl}:KUn];pn]tc]; NSS

sgm];nc],hqc];yLpk],ktI,"
 pqk].Sm].wL:mI;tac];pQn]mUin]nc],Enw}.pL:tG]:n}.eStL.
Sc]wL:mI;cw];la};pQn]Szk].suic]hG]:pn]yL Adrenalin "
yLAn]Tuk],lIfac].eSpn]-kUn];pQn]yQw]:wan]' tac];
pQn]hUw]sG]' tac];pQn]lUit]:Suc]' kUn];pQn]mak],ln]
sgm];eKL;"
Tat]:yL:yLAn]sac]:tum].tgp],kn] - betablicker,
Tricyclicantidepressants.
 Sc]wL:hUw]sG]kUn];pQn]kuit];tUc].kCL,pqt]: Am],nn] kUn];pQn]sm]ett}a hG]:Sm];pn]yL Adrenaline tI:

SQn]:lUit]:nn].lg};lg};"
371
24 eKL:PUim].Tqm]
IV Adrenaline (1:1000) Cardiac Arrest hUw]sG]kuit];
kUn];lUc] 1 mg
luk]:Agn], 0.01ml/kg (=10mcg/kg)
Albendazole
luk]:Agn], PO 200 mg stat  Sc]wL:tUik],nm]yU,n}suic] w}a;eS 3
1 - 2 KUp], wUc]: hG]:pn]yLKiun];Tqc]:"
kUn];lUc]El: 400 mg stat
luk]:Agn], 2KUp], PO Pgn];sL.yL _ hUw]K}:
Kuin]:nUiw]
luk]:Agn], PO For Strongyloides 200 mg stat
1 - 2 KUp], tL, 3 wn];
kUn];lUc]El: PO 400 mg stat
luk]:Agn], 2 tL, 3 wn];
KUp],Kuin]:nUiw]
Aluminium Hydroxide
luk]:Agn], PO 25mg/kg TID Am],nn]  yLn}.Tuk],lIkin]mUiw]:sm]etkin]Kw]: El:/Am],nn]
QID Kaw];sm]etngn];"
kUn];lUc] PO 500mg-1g TID Am],nn] Tat]:yL:yLtum].tgp],kn] – hqc];yL Ciprofloxacin,
QID Enalapril, Chloroquine, Digoxin, Doxycycline,
Isoniazid,(Nor)(O)Floxacin,Phenytoin,Rifampicin,
Tetracycline sUiw];n}. ethQt];hG]:hqc];lut],Aw]nG];hUc];
Kw]:El: nG];S}:lUt];ygm];lUc];"
Aminophylline
kUn];lUc] PO 100-300mg TID or  Tuk],lIkin]wa};eSkin]Kw]:"
QID
 yL Aminophylline n}. etAm],Tuic]tI:l}:tL,kum];
Tic];tac];pQn]mWc]eKL:" Sc]pQn]l}: hG]:sC]. Steroid
inhalers (hUm]:tc];Salbutamol inhaler)
372
eKL:PUim].Tqm] 24
hqc];yLet, hqc];yLSiup],pn] 
KUn];elL;kn] tc]; D5W Am],nn] NSS"
pn]  Sc]wL:kUn];pQn]kin]yL Aminophylline
luk]:Agn], infusion 5 mg/kg over 1 mg/kg/hr yU,yw].n}.suic] Am],tap]:Sm];pn]yw]."
30 minutes fac].tL,kUn];mI;tac];pQn] - hUw]sG]'
kUn];lUc] infusion 250 mg over 0.5 mg/kg/ tac];pQn]lUit]:Suc]' hqc];lUit]:tgt],w};'
30 minutes hr tac];pQn]mL:mU' hUc];Kw]:sQp];' tac];pQn] eKL;
nQc] sUiw];n}.yw]."
Pgn];sL.yL - sG]Sn],' hUw]K}:' ngn];Am],
lp];' hUw]sG]tgt],Am],pk],ktI,' pQn]can];"
Tat]:yL:yLAn]nuic]:El:An]nuic]:tUm].tUiw].
kn]- ciprofloxacin, cimetidine,
erythromycin,antiepileptics,corticosteroids.
Amitriptyline
luk]:Agn], PO pn] 0.1mg/kg mUiw]:kac]Kuin];" etl}:fac].eSpn]_ kUn];AL,yuSuc]' kUn];pQn]
11 KUp], w}a;eS 2-3 wUc]: yLetluin]: yQw]:wan]"
Kuin]:nUiw] El: etl}:PUim].yLpQn] yLAn]n.} etl}:fac].eSsG]. - tac];pQn] SQn]:
lUit]:hUw]sG]tip],' tac];pQn]yQw]:kuit];' tac];pQn]
0.5-2.0 mg/kg
tLmUn], (PL:)' tac];pQn]eKL;nQc]"
kUn];lUc] PO pn] 10-25mg mUiw]:kac]Kuin];" Pgn];sL.yL _ sG]nim]pUn].tI:' yQw]:kuit];' Sa}tL
w}a;eS 2-3 wUc]:yLetluin]: Am],sqc]:' hqc];tgt],hUw]sG]w};' Kic],mUiw]:suk];
El: etl}:PUim].yLpQn] 100 nn].hqc];lUit]:tUk];' sG]pgt];"
mg/day Tat]:yLtum].tgp],kn]- yL Amitriptyline
n}.Pgn];mn];Kuin]:Suc]eSyL Cimetidine,
Verapamil, Chlopromazine
(hUm]:tc];EA,l]kUw]ehL;)" Sc]wL:kuic].kac].kuit];yc].
yLsuic] hUw]etK}:' ethak]:' El: Am],K}:tUc].nuic]"
Amoxicillin
luk]:Agn], PO 10 – 25 mg etl}:Pac].eSpn] _ kUn];yam]:pQn]mun],man],"
/ kg TID
kUn];lUc] PO 250mg - 1g Pgn];sL.yL _ Sc]wL:kUn];pQn]mI;lUm];naw]El: Agk],mak],ln]n}suic]
TID sac]:Agk],mUn],man],haw].hqc];yw]." Sc]wL:eKL;sQp];El: lin].k},kG]:suic]
Am],Tuk],lIpn]yLAn]n}."
373
24 eKL:PUim].Tqm]
Treatment scheme
hqc];yL - sUiw].mqc];Kw]:Am],h}a.hqc]; hqc];yL - sUiw].mqc];Kw]:
kum],AL,yu etL,Tiuc]pan]kac] h}a.hqc]; pgk]:km];
mg cc/tablets Mg cc
AL,yu 0-1KUp], 62.5mg 2.5cc 125mg 5cc=1/2tablets TID
AL,yu 1-5 KUp], 125mg 5cc=1/2 tablets 250mg 10cc=1tablets TID
AL,yu 6-12 pI< 250mg 10cc=1 tablets 500mg 2tablets TID
kUn];lUc] 500mg 2 tablets 1g 4tablets TID
Ampicillin
luk]:Agn], PO 10 - 25mg/  etl}:kin]yL mUiw]:p},kin]Kw]: 30 minit]." Sc]wL:kin]sgm];kn]tc];
kg TID Kw]:n} hUc];Kw]:etlut],Aw]yL:yLkiuc],niuc]:" Sc]pQn]l}:pn]yLkin]
kUn];lUc] PO 500mg -1g Amoxycillin nm]liUw]"
TID
yLAn]n}.etl}:Pac].eSpn] _ Pgn];sL.yL etmUin]kn]tc];yL
Amoxycillin
luk]:Agn], - wUc]:TI.nuic]: IM/IV 25mg/kgBID 50mg/kgBID

1-3 wUc]: IM/IV 25mg/kgTID sUiw].mqc];tac];pQn] 50mg/kgTID
3 wUc]:Kuin]:nUiw] IM/IV 25mg/kgQID Kw]:haw].hqc]; IM/IV 50mg/kgQID
kUn];lUc] IM/IV 500mg QID 1-2gQID
Atenolol
hqc];yLEt,pn]
yLn}.etl}:Pac].eSpn] ' Pgn];sL.yL -tUv];tI: Propanolol"
kUn];lUc] PO 25-30mg OD, hqc];yLAn]n}. nuic]:wn]; epL;nm]liUw] 100 mg n}suic] etAm],
may increase hQt];kan]pn] tL,hUw]sG]An]lQw]kUv];n}yw]." pgc],wL: mI;Pgn];sL.
to 100mg/day mUin] Propanolol El:hG]:Pac].eSpn] kUn];pQn]yQw]:wan]El:
kUn];pQn]mgc]eKL:sUiw];n}.yw]."
Azithromycin
luk]:Agn], PO 10mg/kg OD etl}:Pac].eSpn] - kUn];mI;pn]hLkQw],
kUn];lUc] PO 250mg OD Day lUv]: lgc]:hQt];kan]tp];
1 double dose Pgn];sL.yL – etyL.kw];lgt],hUc];Kw]:'
tL,tac];pQn]sp];tit];l}: PO 1 gram STAT Am],mqn]:Tat]:eS etAgk],KUm];"
kgp]:lgc]:hUm]:kL,m Tat]:yLtum].tWp],kn] - mUin]nc],yL
Arthemeter, Aluminium Hydroxide
n}.Am],Tuk],lIpn]sgm];kn]"
374
eKL:PUim].Tqm] 24
Benzathinepenicillin
IM ygn].sUiw].mqc]; Streptococcal eS pQn]lin].k},kG]:' 25.000-50.000IU/kg
kuic].kac].pQn]tac];pQn] K}eKL:sQp];kC]: STAT(Max 1.2million
luk]:Agn], IU)
IM tL,Eh.kc]: Am],hG]:pQn] K}eKL:sQp];kC]:Tqc]: 25.000-50.000IU/kg
every 4weeks(Max 1.2
million IU/dose)
IM ygn].sUiw].mqc]; Streptococcal eS pQn]lin].k},kG]:' 1.2million IU STAT
kuic].kac].pQn]tac];pQn] K}eKL:sQp];kC]:
kUn];lUc] IM tL,Eh.kc]: Am],hG]:pQn] K}eKL:sQp];Tqc]: 1.2 million IU every 4
weeks
IM pn]miUw]:Et,pQn]kL,lac], SiPlit].S] El: 2.4 million IU STAT(in
tL,hg};sQp];kL,lac],SiPlit].S] 2 injections sites)
yLAn]n}.etl}:fac].eSpn] _ kUn];pQn]mak],kqw];Am],hQt];kan]pk],ktI,"
Pgn];sL.yL - Am],Tuk],mqn]:yLEl:Agk],mun],man],' pQn]tac];pQn]kQw],lUv]:lUit]:"
Benzylpenicillin
luk]:Agn], AL,yu IM/IV 25mg/kg 50mg/kg
1 wUc]: BID BID
AL,yu 1 IM/IV 25mg/kg mUiw]:cw];la};tac]; 50mg/kg eKL:fac].El:
- 4 wUc]: TID pQn]haw].hqc];Kuin]: TID Pgn];sL.yL
AL,yu 4 IM/IV 25mg/kg mL; (yG];hUm], 50-75mg tUv];tI:
wUc]:Kuin]: QID Agk];eALkC]:) QID Benzathinepenicillin
nUiw] hG]:pn] IM/IV"
kUn];lUc] IM/IV 600 mg - 2.4g QID
1.2g QID
Buscopen (Hyoscine Butylbromide)

AL,yu 6pI< Am],tuik];SUn];hG]:sG]. etl}:fac].eSpn] _ luk]:Agn],El:
lUc];tG]: kUn];AL,yuSuc]' kUn];mI;lUit]:Suc]' kUn];
PO Am],tuik];Sun]; pQn]eKL;lUit],El: tgc].kGL,"
6pI< hG]:sC]. Pgn];sL.yL - tgc].pik].' mI;pn]hLhqc];
Kuin]:nUiw] tgt],hUw]sG]' KG]:yQw]:' yQw]:kuit];' SUp];hqc]:'
IM/IV 5-10mg/dose Max 30mg / sG]Suk].yuc]:"
kU:wn];
Tat]:yLtum].tWp],kn] - mUin]nc],yL
Erythromycin, Antipsychotics,
Metoclopramide sUiw];n}.yw]."
kUn];lUc] PO 20mg QID
IM/IV 20mg/dose Max 100mg
et,pn]Kiun];nC]; /kU:wn];
30 minit].l}:"
375
24 eKL:PUim].Tqm]
Carbamazepine
hqc];yL hqc];yL  yLetAm],l}:kuic].kac].kuit];km];lQw]" yLAn]n}.
et,pn] Suc]Sut]; lUt];ygm];km];Ait];Ait];tL." (kn] 20.3)"
luuk]:Agn], PO 5mg/kg OD, 20mg/kg/day
increase by etl}:fac].eSpn] _ kUn];mI;tac];pQn]mak],hUw]sG]'
2,5mg to kUn];pQn]tac];pQn]tp];El: mak],kqw];"
5mg/kg TID Pgn];sL.yL - hUw]mw];' cUiw]:cw]muic]' sG]Suk].yuc]:'
kUn];lUc] PO 100 mg BID 2 g tLla};' mQt].lUit]:lqc]ygm];' mQt].lUit]: platelets
El:mQt].lUit]:Kaw]tUk];ygm];' Tat]:nm].kUiw] sodium
tUk];ygm];"
Tat]:yLtum].tgp],kn] - yLAn]n}.ethQt];hG]:
Pgn];yL Doxycycline Steroids yLEh.ham]:Sn],eT,
tUk];ygm];" Chloroquine and Mefloquine sUiw];n}.
Sm]. hQt];hG]:Pgn];yL Carbamazepine n}.tUk];ygm];"
Cefalexin
luk]:Agn], PO 10mg/kg 12.5-25mg/kg QID lgc]:yL,eppn]yLAn]n}.'
TID sUiw].mqc];tac]; Pgn];sL.yLsiUw];n}. hG]:tUv];
kUn];lUc] PO 500mg pQn]Kw]:haw].hqc]; 1g QID tI:yL Ceflriaxone"
TID
Ceftraxone
luk]:Agn], IM/IV 25mg/kg 50 - 80 mg/  hqc];yL 20mg/kg IV"
OD sUiw].mqc];tac];pQn] kg OD  elL;yLAn]n}.tc]; yLmUk],lUc]
kUn];lUc] IM/IV 1g OD Kw]:haw].hqc]; 1 – 2 g OD eSSm]; Am],nn] Sm];tI:
or BID SQn]:AQn]lg};lg;} tL,tac];huic] 2-
IM 250 mg
4 minit]."
kL,lac],ngc]nC]; STAT/OD
 Sc]wL:Sm]; IM n}suic] 1 gram
n}.etl}:EPKuic]:eS Sm];Sgc]
Pa},yw]."
etl}:fac].eSpn] _ luk]:
Agn],lqc] lUin]Am],TUn]:eS kUit],'
kUn];Kat],Tat]:nm]."
Am],Tuk],lIpn] - luk]:Agn],
lqc]mI;tac];pQn]tp];kG]:nUiw].lUic]"
Pgn];sLyL - hUw]K}:"
376
eKL:PUim].Tqm] 24
Chloramphenicol
luk]:Agn], PO 12.5 mg/kg QID  yLAn]n}. sG].tI:kUn];pQn]haw].hqc];kUv];" (tUw]yac], -
kUn];lUc] PO 500mg QID yG];hUm],Agk];eALkG]: kn] 15.1)"
 Sc]wL:lIKuin]:mL;n}suic] etl};lUt];ygm];hqc];yL"
etl}:fac].eSpn]- luk]:Agn],kUit],mG],' kUn];Kat],Tat]: G6PD"
etAm],l}:pn] - Em:pL;tgc]. El:Em:lQc].nUm];"
lgc]:sac]:pQn]kgc]. - kUn];pQn]hqc];lUit]:eA,' bond marrow
suppression lUit]:An]pn],yU,nG];tUw]kuit]; (circutory collapse)"
luk]:AWn],AL,yu IM/IV sUiw].mqc];tac]; 12.5 mg/kg BID  Sc]wL:kUn];pQn]lIKuin]:mL;n}suic]

1-2 wUc]: pQn]Kw]:haw]. etl};lUt];ygm];
hqc]; hqc];yLKuic]:nuic]:"
2 - 4 wUc]: 12.5 mg/kg BID-QID
4 wUc]:Kuin]:nUiw] 25 mg/kg QID
kUn];lUc] IM/IV 25 mg/kg QID (Max
1g QID)
Chlorpheniramine
luk]:Agn],AL,yu 1 Sc]pQn]l}:  pn]l}:tL, lgc]:Agk],mun],
pI<lUc];tG]: Am],KC]:tuik];SUn];hG]:sG]. man],El: KUm];"
AL,yu 1-2 pI< PO 1mg BID Max3mg/day
 nc],huiw],et Am],mqn]:
AL,yu 3-5 pI< PO 1 mg every 4 - 6 Max 6mg/day
hours Tat]:eS pQn]Szk].nn].
AL,yu 6-12 pI< PO 2mg every 4-6 Max 12mg/day etkin]yLAn]n}. 2wn];
hours Tp];kn]"
kUn];lUc] PO 4mg every 4-6 Max 24mg/day
hours  etl}:Pac].eSpn] -
IV 10-20 mg dose Max 40 mg/day prostatic hypertrophy '
yQw]:kuit];' tac];pQn]mL:mU"
Pgn];sL.yL - Sa}tLAm],
hn]sqc]:' hUw]K}:' yQw]:kuit];'
SuUp];hqc]:' sG]Sn],' sG]Suk].
yuc]: El: hUemL;wuic];wuic];"
377
24 eKL:PUim].Tqm]
Chlorpheniramine Maleate (IV/IM) – vial 10mg/ml
luk]:Agn],AL,yu Sc]pQn]l}:  tac];nm]yL- luk]:Agn],
1 pI<lUc];tG]: Am],KC]:tuik];SUn];hG]:sG].
200 micrograms/kg STAT
AL,yu 1- 5 pI< IV/IM 3mg 0.3cc
AL,yu 6-12 pI< IV/IM 8mg 0.8cc kUn];lUc] 10-20 mg over 1 minute STAT
kUn];lUc] IV/IM 20mg 2cc (nm]Sut]; 40 mg)
 pn] IV/IM "
Chlorpromazine
tac];pQn]pa};sC]' hqc];yL  kUn];Tw]: - hqc];yLtL,kUn];lUc]Kuic]:nuic]:' km]:nm]Et.
mI;Pac]hac]:m}:sG]pUn]. et,pn] 10-25 mg OD Am],nn] BID "
KC]:hqt];h}a.
kUn];lUc] PO 25mg TID or  lgc]:Am],mqn]:yLkgp]:tiUw].vL; - ham]:Aw]muiw];tUiw].yLAn]
75mg at night Kuit]:lqw]w}. El:nm].yLtL;"
IM 25-50mg TID
or QID  etAm],l}:kuit];luiw]:yLkm];Siuw]:" etl}:ygm];lUc];l}g;l}g;"
 miUw];Sm];yLyw].nn]. hG]:kUn];pQn]ngn];w}.nUiw]kU, Kuic]:sUw]:

mUc];"
etl}:fac].eSpn] - kUn];pQn]tac];pQn]hUw]sG]' tac];pQn]pgt],' kUn];sp];tit];tac];pQn]Am],p},huic]'

kUn];yam]: pQn]tac];pQn]tp];kG]:nUiw].lUic]' kUn];AL,yuSuc]"
etAm],l}:pn] - Em:pL;tgc].' kUn];mI;tac];pQn]mak],kqw];El:tp];haw].hqc];' kUn];pQn]lUm];mL:mU"

Sc]wL:lUm];naw]kUn];pQn]Kuin]:mL;suic] kuit];luiw]:yLn}.km];lQw]"
Pgn];sL.yL – Sn],' la};hQt];Sac]:Am],pk],ktI,' sC]Am],nim]' cUiw]:cw]' ngn];fn]ha}.' Tat]:sG]tUk];'

tac];pQn]tp];kG]:nUiw].lUic]Kuin]:haw].hqc];' Sa}tLAm],hn]sqc]:' yQw]:kqn]; (yap],)' hqc];tgt],lUit]:tUk];'
hqc];tgt], hUw]sG]w};' lUm;] TUv]:sG]TUic];' hqc];lUit]:eA,"
Pgn];sL.yLKqn];eth}a.hqc]; - nm].lw]:' yL:yLAn]hQt];hG]:sQp];kC]:tUk];ygm];' yL Pentazocine"
378
eKL:PUim].Tqm] 24
Cimetidine
kUn];lUc] PO 400mg BIDx4-6 weeks etl}:fac].eSpn] - kUn];pQn]tac];pQn]
tp]; El: mak],kqw];"
Pgn];sL.yL – tgc].kGL,' eAL.hak]:' hUw]
K}:hUw]mw];' Agk],mun],man],' hUiw].AUn]:"
Am],Tuk],lIpn] - Em:pL;tgc]."
yL,pn]hUm]:kn]tc]; yL Phenytoin El:
yL Aminophylline"
Ciprofloxacin
1. yLAn]n}. tL,kUn];pQn]naw]S}:kG]:' mak],kqw];kG]:AUm]ngc]El: sUiw].mqc];Kw]:haw].hqc];' tgc].ngc], =
10mg/kg BID 5-10 wn];"
luk]:Agn], PO 125mg BID etl}:fac].eSpn] - kUn];mI; tac];pQn]mL:mU' kUn];Kat],Tat]:
kUn];lUc] PO 250mg BID G6PD.
nm].nk]; 40 Pgn];sL.yL – tgc].sQp];' can];Kiun]:' nUiw].lUic]' hUw]mw];' ngn];
kI,lUw],lUc];tC]: Am],lp];' mak],kqw];Am],hQt];kan]"
kUn];lUc] PO 500mg BID  yL Aluminium, Ferrous Sulplate n}.hQt];hG]:S}:El:
nm].nk]; 40 hUc];Kw]:sup],Aw]Pgn];yL Ciprofloxacin tUk];ygm];"
kI,lUw],Kuin]:nUiw]
2.Chancroid tUv];tI: kn] 13.5"

kUn];lUc] PO tac];pQn]kL,lac],ngc]ngk]: pn] 500mg BID tL, 3 wn];
Cloxacillin
luk]:AWn], PO 15 mg sUiw].mqc]; wUc]:Tinuic]: 50mg/kg hUc];Kw]:etAm],sup],Aw]yL
IV /kg QID tac];pQn] BID n}.l}:lIlI" hG]:kin]yL mUiw]:
IM Kw]:haw]. 2-3 wUc]: 50mg/kg p},kin]Kw]: 1 sUw]:mUc];
hqc]; TID Am],nn] wa};eSkin]Kw]:
IV yw]. 1 sUw]:mUc];"
4 wUc]: 50mg/kg Pgn];sL.yL -tac];pQn]
tp];kG]:nUiw].lUic]' tac];pQn]
Kiun]:nUiw] QID
lUit]:sac]"
kUn];lUc] 500mgQ kUn];lUc] 1-2gQID Tat]:yLtum].tgp],kn] -
ID yLAn]n}.hQt];hG]:Pgn];yL
eh.ham]:Sn],eT,tUk];ygm];"
379
24 eKL:PUim].Tqm]
lgk];Kgc]:Kaw];yam];sG].yL Cloxacillin
kum],AL,yu hqc];yL - sUiw].mqc];Kw]: hqc];yL - sUiw].mqc]; pgk]:km];
Am],h}a.hqc]; Kw]:Tan]: haw].hqc];
mg cc/tables mg cc/tabs
AL,yu 0-2 pI< 62.5mg 2.5cc 125mg 5cc= ½ tabs QID
AL,yu 2-9 pI< 125 mg 5cc = ½ tabs 250 mg 10cc = 1tab QID
AL,yu 9 pI< Kiun]:niUw] 250 mg 10cc = 1tabs 500 mg 2 tables QID

Codeine
luk]:Agn], PO 0.5mg/kg Kqn]: 4
sUw]:mUc]; nuic]:pgk]: tUv];Kuin];tI:tgn]:sQp];kqn];
7.5"
kUn];lUc] PO 30-60mg/klg Kqn]: 4 nuic]:wn];tI:nm]Sut];
Pgn];sL.yL - tUv];tI:
sUw]:mUc]; nuic]:pgk]: 240 mg
Pentazocine
Cotrimoxazole
luk]:Agn],kUit], 120 tL,kUn];sp];tit];sUiw].mqc]; HIV n}.tUv];Kuin];tI: lgc]:

mC],Tuic] 5 lUin] PO mg Sc]wL: Eh.kc]:tac];pQn] kn] 15.3 "
BID sUiw].mqc]; etl}:fac].eSpn]- kUn];pQn]mgc]eKL:' kUn];Kat],Tat]:
AL,yu PO 240 tac];pQn] G6PD ' Em:pL;tgc]."
6 lUin]- 5pI< mg Kw]:haw]. Am],Tuk],lIpn] - kUn];mI;tac];pQn]kQw],lUv]:lUit]:'
BID hqc]; tac];pQn]mak],kqw];El: tp];Am],hQt];kan]'"
AL,yu PO 480 PUim].pn] Pgn];sL.yL – mQt].lUit]:lqc] mQt].lUit]: platelets
6 - 12 pI< mg yL El:mQt].lUit]:Kaw]tUk];ygm];n}suic] kuit];liuw]:yLn}.km];
BID Sgc]pun]:" Siuw]:"
kUn];lUc] PO 960 Tat]:yLtum].tgp],kn] - yLAn]n}.hQt];hGG]:Pgn];yL
mg Glibenclamide nm]tiUw];Kuin]:mL;"
BID
Dexamethasone
yL IM Am],nn] IV n}. h]G:Sm];pn]lg};lg};" 1 tw]:mI; = 1cc = 4mg
*hqc];yLtL,pQn]KUm];h}a.hqc];El: pQn]SWYk]. kgp]:Am],mqn];Tat]:yL
luk]:Agn],nm].nk];mI; 8 IV/IM 1 mg 0.5 cc

kI,lUw],lUc];tG]:
8 - 15 kI,lUw], IV/IM 3 mg 0.75 cc
15 - 30 kI,lUw], IV/IM 5 mg 1.25 cc
30 kI,lUw],Kuin]:nUiw] IV/IM 8 mg 2 cc
kUn];lUc] IV/IM 12 mg 3 cc
380
eKL:PUim].Tqm] 24
Diazepan
*tL,pgt],luk]:Agn], An]lUin]Am],TUn]:eSkUit],etkqn],Kqc]nn]. - hG]:pn]yL Dexamethasone
IM 24 mg in 24 hours (8 mg IM TID)
Dextrose 50%
luk]:Agn],El:kUn];lUc] Sm];IVpn]lg};lg}; 1ml/kg nm].yLn}.sac]:pn]tc];Suk].yuc]:tI:lUit]:"
SG],pn] cannula m}alQk].yG],n}.etlI"
tL,lgc]:yUt];yLnn].tUv];hqc];yL tI:kn] 7.2"

luk]:Agn], PO 0.04-0.2mg/kg  pn]hqc];yL IV l}g;l}g;' nm]Sut]; 0.5cc nC]; 30 sqk].kn]."
BID or TID
PR 0.5mg/kg STAT  Am],Tuk],lIpn]yLn}.Kaw];huic]" kin]mgk]: 2 wUc]:kUv];ekL:
IV 0.3 Mg/kg STAT yLsac]:luin]:El: sp];tit];yL" nc],huiw] etcUic].Ew:
(Max : 3mg/ kg/ l}:Pgn];sL.yLnn]. etl}:ygm];yLlUc]; km];Ait];
day) Ait];yw]."
kUn];lUc] PO 2-10 mg BID or
TID  tUv];Kuin];tI: pQn]can]; kn] 7.2 "
IV/PR 10 – 20 mg
STAT  yLn}. tL,sG].tiuw]; Pgc];mUiw]:tuit];lw]: (hG]:tUv];Kuin];tI:
kn] 23.1)"
etl}:fac].eSpn] - kUn];pQn]tac];pQn]kQw],lUv]:lgt],lUm];
TUv]:sG]' kUn];sp];lw]: El: yL:"
Am],Tuk],lIpn] - kUn];mI;tac];pQn]tp]; El: pgt],hQt];
kan]EA,' kUn];pQn]mgc]eKL:' kUn];mI;tac];pQn]Tat]:sG]tUk];'
kUn];mI;tac];pQn]hUw]sG] mL:ygc],Kaw];huic]"
Am],Tuk],lIhUm]:kn]tc];yL Chlorpheniramnie;Phenytoin"
Doclofenac
luk]:Agn], PO 1 mg/kg BID or TID nuic]:wn]; pn]l}:nm]Sut]; 50 mg Pgn];sL.yL-
kUn];lUc] PO 25 – 50 mg TID nuic]:wn]; pn]l}:nm]Sut]; 150 mg tUv];tI:
Ibuprofen"
IM 75 mg OD
381
24 eKL:PUim].Tqm]
Digoxin
tL,tWc];" "kUn];pQn]hqc];hUw]sG]hQt];kan]eA,eS kin]yLtac],An]ekL: tuik].mI;Pac]hac]:tac];pQn]yU,nn].
Tuk],lIsG].tiuw];yL Digoxin n}yw]."
kUn];lUc] PO 0.125 - 0.250 mg hqc];yLet,pn]nn]. hG]:tUv];tI: hqc];hUw]sC]EA, 8.2"
OD etl}:Pac].eSpn] - kUn];mI;eKL;nQc]' kUn];AL,yuSuc]'
kUn];Tw]: PO 0.0625 - 0.125mg kUn];An]Tat]: Potassium nG];lUit]:tUk];ygm];' Sc]wL:
OD Tuk],pn]yLyQw]:suic] lUik]:Aw]yL spironolactone pn]"
Pgn];sL.yL- eAL.hak]:' Sa}tLAm],hn]sqc]:' cUiw]:cw]
cw]lp];' sG]Suk].yuc]:' Tat]:sG]tUk];"
Tat]:yLtum].tgp],kn] - Sc]wL:pn]yL Erythromycin
Quinine n}suic]ethQt];hG]:Pgn];yL Digoxin nm]Kuin]:mL;"
ygn].yLn}.eSAn]sac]:pQn]eP; - Sc]wL:sG].hUm]:
kn]tc];yL Furosemide; Hydrochlorothiazide;
Steroids; Propranolol n}suic] ethQt];hG]:Tat]:
Potassium nG];lUit]:tUk];ygm];lUiw]kw],Et.Et.n}yw]."
Doxycycline
luk]:Agn],AL,yu Sc]pQn]l}: Pgn];sL.yL - Am],mqn]:Tat]:eSAgk],mun],man],'
8 pI<lUc];tG]: Am],KC]:tuik];SUn];hG]:sG].
hUw]K}:"
luk]:Agn],AL,yu PO 2mg/kg BID or Am],Tuk],lIpn] - Em:pL;tgc]. El: luk]:Agn],
8 pI<Kuin]:nUiw] 4mg/kg OD AL,yu 8 pI<lUc];tG]:"
Tat]:yLtum].tgp],kn] - yL Aluminium, Iron
n}.hQt];hG]:S}:El: hUc];Kw]:sup],Aw]Pgn];yL
Doxycycline tUk];ygm];" yL carbamazapine,
phenobarbita, phenytoin n}.hQt];hG]:Pgn];yL
Doxycycline tUk];ygm];"
tL,tgc];" " tUv];tI:tac];pQn] SKrap].S] t}.
Pat].S] 15.1"
382
eKL:PUim].Tqm] 24
Enalapril
tac];nm]yL hqc];yLnm]Sut]; tUv];tI:tgn]:tac];pQn]hqc];lUit]:Suc] 8.1"
et,pn] An]pn]l}: etl}:fac].eSpn] - Sc]wL:hUm]:kn]tc]; yL
kUn];lUc] PO 5mg OD 40mg OD yQw]:tac],An]n} mak],kqw]; ethQt];kan]eA,"
kUn];Tw]: PO 2.5mg OD 40mg OD
Am],Tuk],lIpn] - Em:pL;tgc]."
Pgn];sL.yL - hqc];lUit]:tUk];haw].hqc];
mak],kqw];hQt];kan]EA,' A}hqc]: 'pQn]eP; Tat]:
Potassium nG];lUit]:tUk];ygm]; (pUic]lUc]mn];
Sc]hUm]:kn]tc];yL spironolactone)"
Tat]:yLtum].tgp],kn] - yL Aluminium n}.
hQt];hG]:hUc];Kw]: sup],Aw]Pgn];yL Enalapril tUk];ygm];"
nm].lw]:' yL Nitrates hqc];lUit]: sUiw];n}. hQt];hHG]:
PWn];yL Enalapril tUk];ygm];"
Ergometrine
yL:yLtL,sC]. wa};eSkUit],luk]:yw].lUit]:tUk];(hUw]:)El: tUk];luk]:Am],mUt];"
kUn];lUc] IM or slow 0.2mg start  Sc]wL:wa};eSkUit],luk]:yw]. lUit]:tUk];Am],kiut];n}suic]
IV Suip],pn]yLn}.l}:Tqc]: 2 pgk]:"
 pn]tI:SQn]:lUit]:n} nuic]:Kqn];etw};" kUv];kL:etl}:SG],

pn]lg};lg}; hG]:mn];huic] 1 minit].pa}pa}"
 pn],hLkQw],lUv]: lgc]:kUit],luk]:km]:nm] hG]:tUv];tI: kn]

19"
Am],Tuk],lIpn] – kUn];pQn]tac];pQn]hqc];lUit]:Suc]' tac];pQn]pL;tgc].mI;kgc].(pn]yL oxytocin)' tWc].

sQp];mUiw]:p},kUit],luk]:El: PWc];mUiw]:kUuit], (Tan]:kUit],luk]: nuic]:El: SWc])"
Pgn];sL.yL - hqc];lUit]:tUk];' eAL.hak]:' hUw]K}:' hUw]mw];' hUAWk],lUm];' tWc].sQp];' AUk];kp].' sG]Sn],'
hqc];tWt],hUw]sG]w};"
Erythromycin
luk]:AWn], 10mg/kg 15 - 25mg  tL,sC].tiuw];tI: kUn];An]Am],mqn]:yL
QID PO /kg QID Pencillin"
kUn];lUc] 250 - 500 sUiw].mqc];tac]; 750 mg-1 g
mg QID pQn]Kw]:haw]. QID Pgn];sL.yL - tWc].kCL,' AWk],mun],man],"
PO hqc]; Sc]pQn]l}: yL,pn]hUm]:tc]; yL
Aminophylline, Carbamazepine,
Cimeticline, Digoxin"
383
24 eKL:PUim].Tqm]
Ethambutol
yLAn]n}. etl}:hUm]:kn]tc];yLtac],An]eS yUt];yLtac];pQn]TI,pI," (mUiw]:lG]eSAm],wL: tk];et
Am],l}: pn]yLn}.An]lQw])" tUv];tI:tgn]: tac];pQn]TI,pI, 21.5"
luk]:Agn],El: PO 15- kUn];pQn] mL;hUc];yLmUiw]:lG]eSAm],wL: mUiw]:p},pn]yLnn]. etl}:kUt],
kUn];lUc] 20mg/kg tUv]; Sa}tLsgc],hn]sqc]:n}yw]."
OD etl}:fac].eSpn] - kUn];pQn]tac];pQn]mak],kqw];' kUn];Tw]: sUiw];n}.
etl}: lUt];hqc];yLpn]yw]."
Am],Tuk],lIpn] - kUn];Sa}tLAm],hn]sqc]:' kUn];hUnUk],"
Pgn];sL.yL _ sac]:tum].tUiw].SQn]:Sa}tL' peripheral neuritis'
etAgk],mun],man],sgm];Piw]nc]"
Ferrous Sulphate
hqc];yL tL,yUt];yLnn]. hG]:tUv];tI: tgn]: 14.1"
nm].nk];luk]:Agn], PO 50 mg BID  Pa}:lUc] etpQn]SIlm]"
5 kI,lUw],lUc];tG]:
nG];Ek: 5 - 15 PO 100 - 200 Pgn];sL.yL - hUc];Kw]:sQp];' tgc].pik]."
Tat]:yLtum].tgp],kn] - yLn}.hQt];hG]:hUc];Kw]:sup],Aw]
kI,lUw], mg BID
Pgn];yL Ciprofloxacin El: Doxycycline tUk];yWm];"
luk]:Agn], 15 PO 200 mg TID
kI,lUw],Kuin]:nUiw]El: yLn}.hQt];hG]:Pgn];yL Methyldopa tUk];ygm];"
kUn];lUc]
 miUw]:Tat]: Haemoglobin nG];tUw] pQn]pk],ktI,mL; nc],hiuw]etpn]Tat]:lQk]; yU,nC];tUw]kum],
TUn]:nn]. Tuk],lIpn]yLkin]Tqc]:tL, 3 lUin]eSyUt];yL"
 Sc]wL:luk]:An]kin]nUm];yU,nn]. pQn]lUit]:sac]siuc] hG]:pn]Em:luk]:Agn],kin]yL Folic Acid"
hqc];yLtL,eh.kc]:
nm].nk]; luk]:Agn], 5 kI,lUw],lUc];tG]: PO 50mg OD
nm].nk]; luk]:Agn], nG];Ek: 5 - 15 kI,lUw], PO 100-200mg OD
luk]:Agn], 15 kI,lUw],Kuin]:nUiw]El:kUn];lUc] PO 200mg OD
Fluconazole
yLn}. pQn]tL,kUn];pQn]AQk].KY]A},wI, nc],huiw]etEh.kc]:lgc]:sp];tit];Tqc]:El: yUt];yLnn]. hG]:sG].
yLn}." (tUv];tI:tgn]:tac];pQn]hqc];Kam],tUw]tUk]; 15.3)"
luk]:Agn], PO 2-4mg/kg/day  hqc];yLn}. Aic]nUiw]cw];la};sUiw].mqc]; HIV" tUw]yac],
kUn];lUc] PO 100-800mg OD - Aic]nUiw] Stomatitis Am],nn] Cryptococcal
Melingitis.
384
eKL:PUim].Tqm] 24
Folic acid
hqc];yL tL,yUt];yL hqc];yL tL,eh.kc]:
luk]:Agn], PO ½ tab OD(2.5mg OD) PO 2.5mg /week
kUn];lUc] PO 1tab OD (5mg OD) PO 5mg/week
Furosemide
luk]:Agn], PO kum],Pac]hac]:mak],kqw];kG]: 1 mg/kg OD
Slow IV hqc];hUw]sG]eA,' tac];pQn]lUit]:Suc] 1 mg/kg
hqc];yLSuc]Sut];
kUn];lUc] PO kG]: 20 – 80 mg daily
20 mg /wn];
PO kum],Pac]hac]:mak],kqw];kG]: 1 mg/kg OD
Slow IV hqc];hUw]sG]eA, 40 - 80mg/dose
 tac];pQn]mak],kqw];kG]:El: tac];pQn]hqc];lUit]:Suc] tUv];tI: (kn] 13.4 ,8.1)"
 km]:nm] ygn].Tat]:nm].nC];tUw]hqc]:El: yQw]:eteA," Sc]hU.wL:kUn];pQn] Kat],Tat]:nm].suic]
mUiw]:p},pn]yLAn]n}.nn]. hG]:SCac]; IV Normal Saline pn]"
etl}:fac].eSpn] – kUn];hqc];lUit]:tUk];' hqc];tp];hQt];kan]eA,"
Pgn];sL.yL - Tat]: Sodium El: Potassium nG];lUit]:EA,' hqc];lUit]:tUk];' hQt];hG]: Tat]:
kiUw]wan] nG];lUit]:nm]"
Am],Tuk],lIpn]sgm];kn]tc]; Indomethacin kgp]:wL:sac]:hQt];hG]: mak],kqw];mI;eP;pQn]kgc].El:
hQt];hG]:yQw]: eA,)"
Sc]pQn]l}: etAm],l}:pn]yL Gentamicin El: streptomycinhUm]:kn]" (tUv];tI:
Gentamicin)"
Tat]:yLtum].tWp],kn] - yLEh.ham]:Sn],eT,n}. hQt];hG]:Pgn];yLAn]n}.tUk];ygm];" yLAn]
n}.Sm]. hQt];hG]:Pgn];yL yQw]:wan]tUk];ygm];" Sc]wL:yLAn]n}.El:tc];yL Steroids pn]hUm]:
kn]suic] ethQt];hG]:Tat]: Potassium nG];lUit]:tUk];ygm];eS pQn]eP;nm]lUiw]kw],yw]."
Gentamicin
luk]:Agn], IV/IM 4mg/kg OD etl}:Pac].eSpn] - kUn];AL,yuSuc]' hqc];mak],kqw];
AL,yu 2 lUin] hQt];kan]eA, (epL;pQn]nn]suic] lUt];ygm];hqc];yL
lUc];tG]: pn])"
kUn];lUc]El: IV/IM 7mg/kg OD
luk]:Agn],AL, (Sc]wL:pI;pUn].tI:suic] Pgn];sL.yL - sac]:pQn]eP;hUEl: mak],kqw];"
yu 2 lUin] hG]:sC].nm].nk];tUw]An]
Kuin]:nUiw] mI;yU,Et.kUv];" np]. Sc]pQn]l}: etAm],l}:pn]hUm]:kn]tc];yL
Sgn],pn]hqc];yL tL, Furosemide" Sc]wL:tk];etl}:pn]hUm]:kn]suic]
nm].nk]; 20% kUv];" yLAn]nuic]: hG]:pn]kac]nG]El: Tqc]:An]nuic]: hG]:pn]
kac]Km]:"
385
24 eKL:PUim].Tqm]
Glibenclamide
hqc];yL hqc];yLSuc]Sut]; pn]hUm]:kn]tc];yL Metformin l}:"
et,pn] An]pn]l}: etl}:fac].eSpn] - sac]:hQt];hG]:Tat]:
kUn];lUc] PO 5 mg 15 mg OD kUiw]wan] nG];lUit]:kUn];Tw]:tUk];yWm];c}a:c}a:"
OD Am],Tuk],lIpn] - Em:luk]:Agn],An]lQc].
kUn];Tw]: PO 2.5 mg 15 mg OD
nUm];luk]:"
OD
Pgn];sL.yL _ Tat]:kUiw]wan]nG];lUit]: tUk];
yWm];' miUw]:kin]lw]: nL:etlqc]"
Griseofulvin
luk]:Agn], PO 10-20mg/kg OD mUiw]:sG].yLAn]n}.eS yUt];yLyU,nn]. Am],nn] wa};eS
kUn];lUc] PO 500 mg OD yUt];yLyw].nuic]:lUin] tiun];etAm],l}:pn]sp];Sn],eT,
lL;lL;" tL,PU:sa}; mUiw]:sG].yLEl: wa};eSsG].yLyw]. 6
lUin]nn]. tuin];etAm],l}:pn]em; sp];Sn],eT,lL;lL;"
yLAn]n}etl}:kin]wa};lc]kin]Kw]:"
Pgn];sL.yL _ hUw]K}:' hUw]mw];' tac];pQn]kQw],lUv]:lUit]:"
Am],Tuk],lIpn] -Em:pL;tgc].El: kUn];mI;tac];pQn]tp];kG]:
nUiw].lUic]haw].hqc];"
Tat]:yLtum].tgp],kn] - sac]:hQt];hG]:Pgn];yLeh.ham]:Sn],
eT,tUk];ygm];"
Haloperidol
tac];pQn]pa};sC]' Kat],Sti' mI;sC]KC]:hQt];h}a. tL,kUn];pQn]haw].hqc];nn]. pn]kin]yL 3-4 mg"
kUn];lUc] PO 1.5-3mg BID or TID  tL,kUn];AL,yuSuc]n}. etl}:lUt];ygm];hqc];yL
IM 2-10mg dose pn]Kuic]:nuic]:"
sC]Suk].Sak]. haw].hqc]; sUw]:kqp]: etl}:fac].eSpn] – hG]:tUv];tI: Chlorpromazine
kUn];lUc] PO Am],Tuk],lIpn]- hG]:tUv];tI: Chlorpromazine
Intractable hiccup Pgn];sL.yL _ hG]:tUv];tI: Chlorpromazine "
kUn];lUc] PO 1.5mg TID Sc]pQn]l}: etAm],l}:hUm]:pn]tc];yL
Indomethacin" (sc]:hQt];hG]:cUiw]:cw]haw].hqc];)"
386
eKL:PUim].Tqm] 24
Hydralazine
hqc];yL hqc];yLSuc]Sut];  tUv];tI:tac];pQn]lUit]:Suc] kn] 8.1,
et,pn] An]pn]l}: 19.5)
kUn];lUc] PO 25mg BID 50mg BID
hqc];lUit]:Suc]haw].hqc]; Am],Tuk],lIpn] - kUn];ta}Pak],' kUn];pQn]
kUn];lUc] IV etL,Tuic]hqc];lUit]:tC]:mI; hqc];yLSuc] tac];pQn]mak],kqw];' hqc];tgt],lUit]: mI; 140
110mmHg nn].Kqn]: Sut]; An] Kuin]:nUiw]"
Pgn];sL.yL _hqc];tgt],hUw]sG]w};' eAL.hak]:'
20-30 minit].eS pn]l:} sG]Sn],' hqc];lUit]:tUk];' hUw]K}:' hUw]mw];"
Suip],pn]yLTqc]:" 20mg
Sc]wL:pn] IV hqc];lUit]:ettUk];haw].hqc];"
Tat]:yLtum].tWp],kn] - lw]:' yLhqc];
lUit]:tUk];siUw];n}. ethQt];hG]:Pgn];yLAn]
n}.nm]Kuin]:mL;" yLEk:kG]:' yLeh.ham]:Sn],
eT,sUiw];n}. ethQt];hG]:Pgn];yLAn]n}.tUk];
ygm];"
Hydrochlorothiazide
hqc];yL hqc];yLSuc]Sut];  tUv];tI: tac];pQn]lUit]:Suc] 8.1
et,pn] An]pn]l}:
kUn]; P 12.5mg 50mg OD Pgn];sL.yL _ Tat]: Potassium nG];lUit]:EA, (hqc];yL
lUc] O OD eA,kUv];Et. etAm],pQn]Sc])' Tat]:kUiw]wan]nG];lUit]:Suc]
Kuin]:"
Am],Tuk],lIpn] -kUn];mI;tac];pQn] hqc];mak],kqw];El:tp];
eA,haw].hqc];' kUn];pQn]tac];pQn] Gout' lup],kp];lup],etL,kG]:'
Em:pL;tgc]."
Pgn];sL.tac],An] hG]:tUv];tI: Furosemide"
Hydrocortisone
Sc]wL:Tat]:Am],mqn]:eSpQn]KUm]; Am],nn] TUv]:sG]yap],n}siuc] hG]:pn]
Hydrocortisone sodium succinate (IM/slow IV) - 1vial = 100 mg
luk]:Agn], 1pI<lUc];tG]: IV/IM 25mg/4-6 H Dose: luk]:Agn], - 2mg/kg every 4 hours
1 - 5 pI< IV/IM 50mg/4-6 H kUn];lUc] - 250mg every 54 hour
6 - 12 pI< IV/IM 100mg/4-6 H
kUn];lUc] IV/IM 250mg/4-6 H
Sm];pn] IM Am],nn]] IVlg};lg};"
387
24 eKL:PUim].Tqm]
Ibuprofen
luk]:Agn], PO 2.5 – 10 mg/kg etl}:fac].eSpn] - kUn];AL,yuSuc]' kUn];mI;tac];pQn]mak],
TID Am],nn] QID kqw];hQt];kan]eA,' kUn];mI;tac];pQn]mgc]eKL:"
kUn];lUc] PO 150 – 600 mg Am],Tuk],lIpn] - Em:pL;tgc].El: Em:lQc].nUm];' kUn];An]
TID Am],nn] QID Am],Tuk],mqn]:yL ASA ' kUn];pQn]hUc];Kw]:sQp];"
Pgn];sL.yL _ hUc];Kw]:sQp];El: Pa}:Agk],lUit]:' TUv]:sG]yap],'
hUw]K}:' hUw]mw];' yQw]:Agk],lUit]:' kG]:' hqc];mak],kqw];hQt];kan]eA,"
Tat]:yLtum].tgp],kn] - yLhqc];lUit]:tUk];tac],An]n}. et
hQt];hG]:Pgn];yLAn]n}.tUk];ygm];' Sc]wL:pn]yLAn]n}. hUm]:tc];
yLyQw]:n}suic] etsac]:pQn]eP;etL,mak],kqw];" Sc]wL:pn]hUm]:
tc];yL Steroid n}suic] etsac]:hQt];hG]:hUc];Kw]: sQp];haw].
hqc];yw]."
Indomethacin
luk]:Agn], Am],KC]:tuik];SUn];hG]:sG]. tUv];tI: Ibuprofen" pn]hUm]:kn]tc];AL,hL,r"
kUn];lUc] PO 25-50mg TID or QID yL Haloperidol El: Furosemide n}. etpn]
hUm]:kn]Am],l}:"
Isoniazid
yLAn]n}. hUm]:kn]tc];yLtac],An]eS yUt];yLtac];pQn]TI,pI, (tuin];etAm],l}: pn]yLAn]n}.
An]lQw] eKLeKLlL;lL;)"
luk]:Agn], PO 5 – 10 mg OD  tUv];tI:tac];pQn]TI,pI, kn] 21.5
kUn];lUc] PO 300mg OD
Am],Tuk],lIpn] - kUn];pQn]tac];pQn]tp];' kUn];pQn] tac];pQn]
mak],kqw];' kUn];mI;lUm];mL:mU' Tat]:sC]tUk];El: kUn];sp];lw]:"
Pgn];sL.yL _ tL,eh.kc]:SQn]:AL,yUc],nC];tUw]nn].hG]:pn] B 6
10 mg OD" pQn]eP;etL, tLEl:tp];' pQn]can];' tac];pQn]
pa};sC]"
Tat]:yLtum].tWp],kn] – yLAn]n}.ethQt];hG]:Pgn];yL
Carbamazapine El:yL Phenytoin siUw];n}. tiUw];nm]Kiun]:"
Isosorbide Mononitrate
hqc];yL hqc];yLSuc]Sut]; etl}:fac].eSpn] - kUn];An]Tat]:
et,pn] An]pn]l}: ehL,mUn;] l] hypothyroidism tUk];ygm];"
kUn];lUc] PO 10mg 30mg QID Am],Tuk],lIpn] - kUn];hqc];lUit]:tUk];' kUn];mI;
BID pn]hLlin].hUw]sC]' kUn];pQn]hqc];lUit]:eA,haw].hqc];"
Pgn];sL.yL _ hUw]K}:haw].hqc];' PQw]nc] lqc]
tc];tUw]' hqc];lUit]:tUk];' hqc];tWt],hUw]sG]w};"
388
eKL:PUim].Tqm] 24
Mebendazole
luk]:Agn],AL,yu PO 100mg BIDx3day Am],Tuk],lIpn] - Em:pL;tgc].nG]; 3 lUin]'
1 pI<Kuin]:nUiw] luk]:Agn], AL,yu 1 pI<lUc];tG]:"
Metformin
hqc];yL et,pn] hqc];yLSuc]Sut];  tUv];tI:tgn]:tac];pQn]yQw]:wan] 10.1"
An]pn]l}:
kUn];lUc] PO 500mg TID 1g TID  pn]hUm]:tc];yL Glibenclamide l}:"
yLn}.Am],Tuk],lIpn] - Em:pL;tgc].El: Em:lQc].nUm];' kUn];mI;tac];pQn]mak],kqw];hQt];kan]eA,' kUn];mI;

tac];pQn]hqc];hUw]sG]eA,' kUn];sp];lw]:"
Tat]:yLtum].tgp],kn] - PWn];lw]:' Cimetidine/Propranolol sUiw];n}.hQt];hHG]: Tat]:kUiw]wan]nG];lUit]:
tUk];ygm];nm]liUw]"
yLeh.ham]:Sn],eT,' Steroids, Hydrochlorothiazide, Furosemide sUiw];n}. ethQt];hG]:
lgc]:hQt];kan] hHG]:Tat]:kUiw]wan]nG];lUit]:tUk];ygm];eA,lUc];"
Methyldopa
hqc];yL hqc];yLSuc]Sut];  tac];pQn]lUit]:Suc] 8.1
et,pn] An]pn]l}:
kUn];lUc] PO 250mgBID 3 g daily Am],Tuk],lIpn] - kUn];mI;tac];pQn]Tat]:sG]tUk];'
kUn];Tw]: PO 125mgBID 2 g daily kUn];mI;tac];pQn]tp];"
Pgn];sL.yL - eAL.hak]:' pin],SUp];hqc]:' pin],SUp];kG]:'
kG]:sWm];tUw]' hUw]K}:' nWn];fn]ha}.' nUiw].lUc]' lUit]:sac]'
hqc];AWk];lup],eA,"
Tat]:yLtum].tgp],kn] - lw]:' Propranolol El:yL
hqc];liUt]:tUk];tac],An]n}. ethQt];hG]:PWn];yLAn]n}.
nm]Kiun]:mL;yw]." yLhQt];hG]:kG]:ygm];lUc];' yLTat]:lQk];'
yLEh.ham]:Sn],eT,' Steroids sUiw];n}. ethQt];hG]:
PWn];yLAn]n}.yWm];lUc];"
Metoclopramide
luk]:AWn], PO/IM/IV 0.12mg/kg each dose(TID) Am],Tuk],lIpn] - luk]:AWn], El:
kUn];lUc] PO/IM/IV 10-15 mg each dose kUn];Tw]:'
(TID Am],nn] QID) Pgn];sL.yL - sG]Sn],' lWc]:tUc].niuc]
Am],nim]Sw];' cUiw]:cw] cw]lp];"
389
24 eKL:PUim].Tqm]
Metronidazole
luk]:Agn],AL,yu 1 PO/IV 7.5mg/kg BID etl}:fac].eSpn] – Sc]kin]hUm]:kn]tc];lw]:n}
lUin] suic] hQt];hG]:mI;lgc]:tum].tgp], pQn]eP;l}:"
1 lUin]Kuin]:nUiw] PO/IV 7.5mg /kg TID Pgn];sL.yL - hUw]K}:' nUiw].lUc]' hUc];Kw]:sQp];'
kUn];lUc] PO/IV 500mg TID Am],KC]:kin]Sc]"
sUiw].mqc];tac];pQn]hQp]; Tat]:yLtum].tgp],kn] - yLAn]n}.hQt];hG]:Pgn];yL
PO/IV 750mg TID
Phenytoin nm]Kuin]:mL;"
Metoprolol
hqc];yL hqc];yLSuc]Sut]; hqc];yLtL,etpn]nn]. tUv];Kuin];tI: tgn]:hqc];hUw]sG]
et,pn] An]pn]l}: eA, 8.2"
kUn];lUc] PO 25 mg OD - 100 mg OD etl}:fac].eSpn] - tUv];Kuin];tI: Propanolol"
BID Suc]Kiun]: Sc]wL:hqc];yLnm]liUw] 100 mg etL,wn];n}. etAm],
mL;Tiuc] sC]:mI;Pgn];etL,mak],hUw]sG]An]lQw]kUv];yw]."
100mg Pgn];sL.yL - eKL:Tuk],lIfac].Et. kUn];mI;tac];pQn]
BID/wn];
mgc]eKL:' tac];pQn]yQw]:wan]"
Niclosamide
luk]:Agn], nm].nk]; PO 500mg STAT  mUiw]:p},pn]yL Niclosamide nn]. hG]:pn]yL
10 kI,lUw],lUc];tG]: Metoclopramide 10mg miUw]:kUn];pQn]tiun],ngn];
nm].nk];nG];Ek: PO 1gram STAT n}yw]."
11 - 35 kI,lUw],
kUn];lUc] PO 2gram STAT  yLAn]n}.etl}:kQw].Auin]kin]Aw]"
Nitrofurantoin
luk]:Agn], 3 lUin] Sc]pQn]l}:  tL,tac];pQn]sUiw].mqc];Kw]:lgt],yQw]:"
lUc];tG]: Am],KC]:tiuk];SUn];hG]:sG].
luk]:Agn], 3 lUin] PO 1.5mg/kg QID Am],Tuk],lIpn] - kUn];Kat],Tat]:G6PD' Em:pL;
Kuin]:nUiw] tgc].yG],Ek,"
Pgn];sL.yL:yL - sac]:pn]eP;hUc];Kw]:El:
kUn];lUc] PO 50-100mg QID lm];S}:l}:"
390
eKL:PUim].Tqm] 24
Norfloxacin
kUn];lUc] PO 400 mg BID tL,yUt];yLtac];pQn] sUiw].mqc];Kw]:hUc];yQw]:El: lgt],yQw]:nn]. Sc]wL:
yL Cotrimoxazole El: Cephalexin Am],sC].l}:n} sc],sC].
Norfloxacin"
Pgn];sL.yL - yLAn]n}.etl}:fac].eSpn] - Tat]:yLtum].tiUw].
kn] - siUw];n}. tUv];Kuin];tI: Ciprofloxacin"
Nystatin
luk]:Agn], To suck in mouth 100,000 IU QID
kUn];lUc] To suck in mouth 100,000 IU QID
PV 100,000-200,000 IU QID SG],nG];hU;KUic]:Ac],kL, mUiw]:et
ngn];"
Omeprazole
kUn];lUc] PO 20-40mg OD etl}:fac].eSpn] - kUn];mI;tac];pQn]tp];' Em:pL;tgc]."
Pgn];sL.yL - sac]:pn]eP;hUc];Kw]:El: S}:"
Oxytocin(syntocinon)
kUn];lUc] tUk];luk]: IV 10-20 IU STAT sG].tiuw];Pgc];mUiw]:kUit],luk]:" (tUv];tI:
Am],mUt]; piUc]nm];Em:pL;tgc].)"
lUit]:tUk]; IV/IM 10IU STAT,then 20IU tUv];tI:eP;Em:pL;tgc]. (kn] 19)
in 500cc NSS at 30
drop /minSc]wL:lUit]:
Pgn];sL.yL - nUiw].pgc]:tI:hUc];luk]:
tUk];eA,lUc];n} ygm]; etSn],' eAL.hak]: El: hqc];hUw]sG]
hqc];yL lUc];pn]sgm];" tgt],Am],pQn]pk],ktI,"
Paracetamol (Acetaminophen)
luk]:Agn], PO 15mg/kg QID nuic]:wn];tI:  Kqn]: 4 sUw]:mUc]; pn]nuic]:pgk]: kUv];kL:et
nm]Sut]; 2 g Am],l}:pn]nm]liUw] hqc];yLtI:Enw}."
PO 5mg/kg QID
IM 10mg/kg QID etl}:fac].eSpn] - kUn];sp];lw]:' kUn];mI;
kUn];lUc] PO 500mg -1gQID tac];pQn]hqc];tp];EA,"
IM 300mg QID nuic]:wn];tI:
Pgn];sL.yL - Sc]wL:pn]yLnm]pUn].lUiw] hqc];
nm]Sut]; 2 g yLtI:pn]w}.n} sac]:hQt];hG]:tp];lU.l}:"
391
24 eKL:PUim].Tqm]
Penicillin V (Phenosymethylpenicillin)
luk]:Agn], PO 75-15mg/kg QID  Sc]wUn].Sgn],wL: lin].k},kG]:ygn].sUiw].mqc]; Streptococcal n}
kUn];lUc] PO 250-500mg QID tL,Eh.kc]: K}eKL:sQp];kC]:nn]. hG]:pn]yL tL, 10 wn];"
lgc]:etl}:Pac].eSpn]El: Pgn];sL.yL - hG]:tUv];Kuin];tI:
Benzathine Penicillin"
Pentazocine
luk]:Agn], SC/IM 0.5 - 1mg/kg  Kqn]: 3-4 sUw]:mUc];eSpn]l}:" kUv];kL:et
Slow /dose Am],l}:pn]nm]liUw] hqc];yLtI:Enw}."
IV
kUn];lUc] nuic]:wn];pn] Am],Tuk],lIpn] – miUw]:TUv]:sG]yap],' kUn];tuik].sp];
SC/IM 30 -60 mg/
lw]:yU,' kUn];yam]:mI;hg};sQp];tI:Agk];eAL' yG];hUm],
Slow dose l}:nm]Sut]; Agk];eALkC]:' lUit]:suim];nG];Agk];eAL' hqc];pgt], kuic].
IV 360 mg kac].hQt];kan]eA,"
etl}:fac].eSpn] - hqc];hUw]sG]EA,' pQn]can];"
Pgn];sL.yL - eAL.hak]:' tgc].pik].' cUiw]:cw]'
hqc];TUv]:sG]TUic];' Tat]:sG]tUk];"
Phenobarbital ( Phenobarbitione)
tac];pQn]mL:mU hqc];yL et,pn] hqc];yLSuc]Sut]; etAm],l}:kuic].kac].kuit];kin]yLn}.km];Siuw]:"
An]pn]l}: etl}:kin]eA,lUc];km];Ait];Ait];l}g;l}g;"
luk]:Agn], PO 5mg/kg at night 8mg/kg etl}:fac].eSpn] - luk]:AWn],El: kUn];
kUn];lUc] Tw]:' yLn}.hQt];hG]:cw]ngn];l}:El:hC]:Sp];lqc];
PO 60mg at night 180mg
EnkUn];hQt];kan]nG];hUc];kan] El: kUn];ehL:
lUt].Kw]etl}:w}.Sti"
Am],Tuk],lIpn] – kUn];pQn]mI;lgc]: TUv]:sG]
Am],pQn]pk],ktI,"
Sc]wL: epL,can];tc];tUw] (miUw]:sG].yL DiasepamAm],ep.l}:) suic] hG]:pn]]yLn}. hqc];yLSuc]Suc]

Agn]tac];eS SUc],kCL,hUc];yL"
hqc];yLSuc]Sut]; Pgn];sL.yL - cUiw]:cw]' Am],KC]:tUc].KC]:nuic]' sG]luk]: AWn],
An]etl}:pn] etAm],nim]' kUn];Tw]:sG]etSuk].yuc]:' hqc];lUit]:tUk];
Agn]tac]; (km].nm]yWn].Sm];tI:SQn]:)' AWk],mun],man],' eS;l]lUit]:
Am],pQn]pk],ktI,' hqc];TUv]:sG]Am],pk],ktI,eS lUm];TUv]:
luk]:Agn], Infusion 10-20mg/kg over sG]kuit];' (km].nm]yWn].Sm]; Kw]:tI:SQn]:w};w};)
Pgn];sL.hqc];yLnm]pUn].tI: - p}tac];Am],pQn]pk],ktI, El:
30min
lat]:kGam];Am],pI,
kUn];lUc] IV 10mg/kg over 30 Tat]:yLtum].tgp],kn] - Chloramphenicol, Doxycycline,
min
Metronidazole, Steroids sUiw];n}.hQt]; hG]:PWn];yL
Phenobarbital (Phenobarbitione)tUk];ygm];"
392
eKL:PUim].Tqm] 24
Phenytoin
tac];pQn]mL:mU hqc];yL et,pn] hqc];yLSuc] etAm],l}:kuic].kac].kuit];luiw]:yLkm];Siuw]:" etl}:
luk]:AWn], PO 2.5mg/kg BID Sut];An] lUt];ygm];hqc];yLkm];lg};lg};" etl}:kin]hUm]:kn]tc];
hqc];yLtL,Suip],pn] pn]l:} Kw]: Am],nn] wa};eSkin]Kw]:"
luk]:AWn], PO 5 - 8mg/kg /24 hr etl}:fac].eSpn] – kUn];hqc];lUit]:tUk];' hUw]sG]
kUit],mG], in 2-3 doses Am],hQt];kan]l}:lI]' tp]];Am],hQt];kan]l}:lI
AL,yu (lUt];ygm]; hqc];yLpn])"
PO 8 -10mg/kg /24 hr
in 2-3 doses
Am],Tuk],lIpn] - kUn];mI;hqc];tgt],hUw]sG]TUic];"
6 lUin] - Pgn];sL.yL - sG]Suk].yuc]:' hUw]K}:hUw]mw];' KL
3pI< Sn], muiw];Sn],' ngn];Am],lp];' Tat]:sG]tUk];'
AL,yu PO 7.5 - 9mg/kg /24 hUik],kG]:' hqc];lUit]:eA,"
4 - 6pI< hr in 2-3 doses Pgn];sL.hqc];yLnm]pUn].tI: - lat]:kGam];Am], pI,'
AL,yu PO 7 - 8mg/kg /24 hr 300mg/2 p}tac];Am],pQn]pk],ktI,' tLKuin]:' Sa}tL
7- 9pI< in 2-3doses 4hr Am],hn]sqc]:' lgc]:hQt];Sac]:lqk]:la}:"
Tat]:yLtum].tgp],kn] - Aspirin, Isoniazide,
AL,yu PO 6 -7mg/kg / 24 hr
Chloramphenicol, Cotrimoxazole, Cimetidine,
10-16pI< in 2-3 doses
Metronidazole, sUiw];n}.hQt];hG]:PWn];yL Phenytoin
kUn];lUc] PO 200 – 300mg/24 500mg/2 nm]Kuin]:" yL Phenytoin n}.et hQt];hG]:PWn];yL
hr in 1-2doses 4hr in 1 Doxycycline, Steroids, Aminophylline El:
hqc];yLtL,Suip],pn] or 2 doses yLeh.ham]:Sn],eT,tUk]; ygm];"
200-500mg /24 hr
in 1-2doses
Sc]wL: can];Kiun]:tc];tUw] sG].yL Diasepam yw].Am],ep.l}:n}suic]

hqc];yL hqc];yL hqc];yLSuc]Sut];
et,pn] tL,Suip],pn] An]pn]l}:
kUn];lUc]El:luk]:Agn], infusion 15 mg/kg over See PO Start 1.5 g
1 hour dose
Praziquantel
PO pun]:tL,mqc];tgc]. 20mg/kg STAT pn]Em:pL;tgc]. 3 lUin] TI.Sgc]
kUn];lUc]El:luk]:Agn], pun]:tL,mqc];tgc]. 25mg/kg TID x El: TI.Sam]
3days
Prednisolone
tUv];tI:tgn]:tac];pQn]TUv]:sG]mgc]eKL:' kum],tac];pQn]mak],kqw];kG]:' K}eKL:sQp];kC]: 21.4, 13.4
luk]:AWn], PO 1-2mg/kg OD Pgn];sL.yL - Tat]: Potassium nG];lUit]:tUk];ygm];'
nm].lU.nm].nw]: kuit];w}.nG];tUw]"
Am],Tuk],lIpn] - hUc];Kw]:pQn]sQp];' mUiw]:yLKL:sUiw].mqc];Am],
ep.l}: bacterial"
tL,tgc]; - mUiw]:et,yUt];yLpn]nn].hG]:pn]yLKYL;mqc];tgc]."
393
24 eKL:PUim].Tqm]
Sc]wL:etl}:pn]yLn}.Kaw];huic]n}suic] etAm],l}:kuic].kac].kuit];yLpqt]:km];Siuw]:" etl}:lUt];ygm];
hqc];yLkm];lg};lg};"
Sc]wL:pQn] K}eKL:sQp];kC]:n}suic] etl}:PiUm].pn]hqc];yL tUv];tI:(kn] 8.4)"
Primaquine
luk]:AWn], PO 0.25 - 0.5mg/ kg OD tL, etl}:fac].eSpn] - ygn].Kat],Tat]: G6PD El:
14 wn];" 0.75 mg/kg pQn]tac];pQn]lup],kp];lup],etL,sQp];kG]:'
niuc]:wUc]:niuc]:pgk]:tL, 8 wUc]: Pgn];sL.yL - tgc].sQp];' ygn].Kat],Tat]: G6PD
kUn];lUc] PO 15 - 30mg OD tL, 14 wn];" El: mQt].lUit]:lqc]tqk],eSpQn]lUit]:sac]"
30 mg niuc]:wUc]:niuc]: pgk]:tL, Am],Tuk],lIpn]- mUiw]:pL;tgc].El: mUiw]:tuik].lQc].nUm];yU,"
8 wUc]:" 14 mg niuc]:wUc]: tL,tgc]; - tL,kUn];Kat],Tat]: G6PD n}. nc],huiw]et
niuc]:pgk]: tL, 6 wUc]:" wac];sG]l}:nn]. etl}}:pn]kU:wUc]:"
Procaine Penicillin (penicillin G procaine )1mg=1,000IU

luk]:AWn], Sm]; IM Kw]:liuk].liuk]. 20-50mg/kg OD or BID etAm],l}:pn]pQn] IV"
kUn];lUc] Sm]; IM Kw]:liuk].liuk]. 600mg-2.4g OD or BID tUv];tI:tgn]:yL Benzathine
Penicillin"
Propyl Thio Uracil (PTU)

kUn];lUc] PO 200-400mg OD pn]yLn}.etL,Tuic] TSH ygm];lUc];liUw] (50-150mg OD)"
etl}:fac].eSpn] - mUiw]:pL;tWc]."
Pgn];sL.yL - sac]:pn]eP;hUc];Kw]:El: lm];S},'K}eKL:lup],yup]:ygm];"
394
eKL:PUim].Tqm] 24
Propranolol
hqc];yL hqc];yL Am],Tuk],lIpn] - kUn];pQn]mgc]eKL:' kUn];pQn]
et, nm]Sut]; tac];pQn]lWt],lUm];tn]' hqc];tWt],hUw]sG]TUic]; (1
pn] An] minit]. 50 pWk]:lUc];tG]:)' kUn];hqc];lUit]:tUk];"
pn]l}: etl}:fac].eSpn] - Em:pL;tgc].El: Em:
kUn]; PO liUt]:Suc] 40mg 160mg lQc].nUm];' kUn];mI;tac];pQn]tp];El:mak],kqw];
lUc] BID BID (lUt];yWm];hqc];yLpn])' kUn];tac];pQn]yQw]:wan]"
Pgn];sL.yL - hqc];tWt],hUw]sG]TUic];' hqc];hUw]
PO siUw].mqc];tac];pQn] 40mg 120mg sG]EA,' hqc];lUit]:tUk];' lWt],lUm];TUv];sG]tn]'
Kw]:nC];eKL: BID or BID nWn];Am],lp];' pa}tin]p}muiw];kt];"
TID tL,tgc]; - etAm],l}: pn]hUm]:kn]tc];yL
PO Arrhythmias 10- Aminophylline.
Thyrotoxicosis 40mg Tat]:yLtum].tgp],kn] – yLAn]hQt];hG]:kG]:yWm];
TID or lUc];' yLeh.ham]:Sn],eT,' Rifampicin, Steroids
QID sUiw];n}.hQt];hG]:PWn];yL Propranolol tUk];ygm];"
PO Anxiety with 40mg 40mg TID yL Propranolol n}.hQt];hG]:PWn];yLyQw]:wan]
palpitations,Tr OD nm]Kuin]:"
emor
Pyrazinamide
yLn}.etl}:hUm]:kn]tc];yLtac],An]eSyUt];yL tac];pQn]TI,pI," tuin];etAm],l}:sG].yLAn]n}.
An]lQw]eSyUt];yLlL;lL;"
luk];AWn], PO 20-30mg/kg tUv];tI:tWn]:tac];pQn]TI,pI, 21.5
OD etl}:Pac].eSpn] - kUn];mI;tac];pQn]
kUn];lUc]nm].nk];50kI,lUw],lUc];tG]: PO 1500mg OD tp];' yQw]:wan]' tac];pQn]kw].(Gout)
kUn];lUc]nm].nk];50kI,lUw],Kuin]:nUiw] PO 2000mg OD Am],Tuk],lIpn] - kUn];mI;tac];pQn]tp];
kG]:nUiw].lUic]"
Pgn];sL.yL - sac]:tum].tUiw].tp];'
lup],kp];lup],eto,sQp];' eAo.hak]: El:
AWk],mun],man],"
395
24 eKL:PUim].Tqm]
Rifampicin
yLn}.etl}:hUm]:kn]tc];yLtac],An]eSyUt];yL tac];pQn]TI,pI," tuin];etAm],l}:sG].yLAn]n}.
An]lQw]eSyUt];yLlL;lL;" (tUv];tI:tWn]:tac];pQn]TI,pI, 21.5)
luk];AWn], PO 10 mg/kg OD yon}.hQt];hG]:yQw]:' hUiw],' nm].tosUiw];n}. pQn]SIlUic]
kUn];lUc] nm].nk]; 50 PO 450 mg OD mak],sWk];"
kI,lUw],lUc];tG]: etl}:Pac].eSpn] - kUn];mI;tac];pQn]tp];"
Am],Tuk],lIpn]-kUn];mI;tac];pQn]tp];kG]:nUiw].lUic]"
kUn];lUc]nm].nk]; 50 PO 600 mg OD Pgn];sL.yL - sac]:tum].tUiw].tp];' eAL.hak]:'
kI,lUw],Kuin]:nUiw] tgc].kGL,' Agk],mun],man],"
Tat]:yLtum].tgp],kn] - yL Aluminium
n}.hQt];hG]:hUc];Kw]:sup],Aw]Pgn];yL Rifampicin
tUk];ygm];" yL Rifampicin n}.hQt];hG]:Pgn]; yLeh.
ham]:Sn]eT,' Chlorpropamide, Phenytoin,
Propranolol, Steroids tUk];ygm];"
Salbutamol
tUv];tI:tgn]:tac];pQn]mgc]eKL: (kn]
21.4)"
PO 0.1mg/kg QID yLkin]n}.Sc]wL:tqk]:niUc];tc];yLSut],n} ethQt];kan]
luk];AWn], Resp solution 2.5-5mg/dose* Am],tQm]TUn]:eSAm],kL; sac]:pQn]eP;l}:n}yw]."
5mg/ml,0.5% Sc]pQn]l}: hG]:sG].tiuw];yLSut], Am],nn]sC]. nebulizer"
Inhaler 1 1-2 etl}:fac].eSpn] -kUn];mI;Tat]:ehL,mUn];l] Thyroid
puff=100mcg puffs/dose* nm]eSpQn]tac];pQn]eKL;nQc]' hqc];tgt],hUw]sG]Am],pk],
IM/SC 0.01-
ktI,' hqc];lUit]:Suc]' yQw]:wan]"
0.02mg/kg Pgn];sL.yL – tin]miuw];Sn],' sG]mip],cqn];' hUw]K}:'
every 4-6 hrs hqc];tgt],hUw]sG]Am],pk],ktI,' sG]Sn],' hqc];tgt],hUw]s]Gw};'
PO 2.4mg TID or Sc]pQn]luk]:Agn], ngn];Am],mqn]:pQn]miUw]:pQn]Kaw];El:
QID la};hQt];Sac]:lqk]:la}:"
etL,epL;lIKuin]:mL;nn]. etl}:km];km];Sut],nUm]pn]
Resp solution 2.5-5mg/dose*
yw]." (tUv];tI:tgn]:tac];pQn]mgc]eKL:")
5mg/ml,0.5%
Inhaler 1 1-2
kUn];lUc] puff=100mcg puffs/dose*
IM/SC 0.5mg every 4-
6 hours
Very slow IV Sc]wL:etl}:
PUim]:Tqm]Tqc]:
0.25mg
396
eKL:PUim].Tqm] 24
Sodium Valproate
For hqc];yL hqc];yLSuc]Sut];  Sc]pQn]l}: etl}:kUt],tUv];lgc]:hQt];kan]
epilepsy et,pn] An]pn]l}: tp];n}yw]."
luk];AWn], PO 5mg/kg BID or 1g
TID  etAm],l}: kuic].kac].kuit];luiw]:yLkm];Siuw]:"
kUn];lUc] PO 200 mg TID 3g kU:wn]; etl}:lUt];yWm];hqc];yLkm];lW};lW};"
etl}:fac].eSpn] -luk]:AWn],AL,yu 3 pI<
lUc];tG]:"
Am],Tuk],lIpn] - Pgc];tuik].pQn]tac];pQn]
tp];"
Pgn];sL.yL - hUc];Kw]:sQp];' eAL.hak]:'
lgc]:tUc].nuic]tUw]Kic];Am],pk],ktI,' tin]miuw];
Sn],' nm].nk];Kuin]:' tUw]etkG]:' sac]:tuim].
tUiw].tp];luk]:Agn], 3pI<lUc];tG]:' sG]Suk].yuc]:"
Tat]:yLtum].tgp],kn] - yL Aspirin n}.
hQt];hG]:Pgn];yL Sodium Valproate nm]Kuin]:"
yL Sodium Valproate n}.hQt];hG]:Pgn];yL
Chloroquine and Mefloquine tUk];ygm];"
Spironolactone
luk];AWn], PO kum],mak],kqw];kG]: 3mg/kg OD tUv];tI:tgn]: kum],mak],kqw];kG]: El: hqc];hUw]sG]
with eA, 13.4,8.2)
furosemide Am],Tuk],lIpn] - Em:pL;tgc].El: Em:lQc].nUm];'
kUn];lUc] PO kum],mak],kqw];kG]: 3mg/kg OD kUn];mI;Tat]: Potassium nG];lUit]:Suc]"
with etl}:fac].eSpn] - kUn];AL,yuuSuc]' kUn];
furosemide mI;tac];pQn]tp];El:mak],kqw];"
PO tgc].man];nm]. 100-200mg Pgn];sL.yL - hak]:' KUic]:Ac],kL,kUn];s}a;
OD up to Am],hQt];kan]' nUm];PU:sa};yG],Kuin]:' lUit]:
400mg hUw]lUin]Am],mL;man],' Am],KG]:tUc].KG]:nuic]' hUw]K}:'
PO hqc];hUw]sG]eA, 25mg OD Tat]: Potassium nG];lUit]:Suc]"
with Tat]:yLtUm].tUiw].kn] - yLn}.Sc]pn]
furosemide/ hUm]:kn]tc]; Indomethacin suic]hQt];hG]: Tat]:
Enalapril Potassium nG];lUit]:Suc]" yL Aspirin El:
yLeh.ham]:Sn],eT,n}. hQt];hG]:Pgn];yL
Spironolactone lUm];KG]:yQw]:eA,lUc];" Digoxin
n}.hQt];hG]:Pgn];yL Spironolactone lUm];KG]:yQw]:
nm]Kuin]:"
397
24 eKL:PUim].Tqm]
Streptomycin
Aw]yLn}.hUm]:kn]tc];yLtac],An]eSyUt];yLpn]tac];pQn]TI,pI," tuin];etAm],l}:sG].yLn}.An]lQw]eS
yUt];yLlL;lL;" (tUv];tI:tgn]: 21.5)
luk];AWn], IM 15mg/kg OD Sc]pQn]l}:etAm],l}:hUm]:pn]tc];yL
kUn];lUc]AL,yu nm].nk]; 50 IM 1g OD Furosemide" (tUv];tI:yL Gentamicin)"
45 lUc];tG]: kI,lUw],lUc];tG]:
nm].nk]; 50 IM 750mg OD Am] ,Tuk],lIpn] - luk]:Agn],lqc]El:kUn];
AL,yuSuc]' kUn];mI;tac];pQn]mak],kqw];' kUn];
kI,lUw],Kuin]:nUiw] hUnUk],' kUn];Sa}tLAm],lI"
AL,yu 45-60 nm].nk]; 37 IM 750 mg OD
pI< kI,lUw],lUc];tG]: Pgn];sL.yL - tum].tUiw].hU' Sa}tL ' tum].
nm].nk]; 37 IM 500mg OD tUiw].mak],kqw]; (hUm]:pL;Sn],eT,)' Agk],mun],
kI,lUw],Kuin]:nUiw] man],"
AL,yu 60 IM 500mg OD
Kuin]:nUiw]
Tetracycline
luk]:AWn],8 pI<lUc];tG]: Sc]pQn]l}: Am],KG]:hG]:sG]. yLAn]n}.Sc]wL:Am],kQp];Sim];w}.lIlIn} sac]:lU.
luk];AWn], 8 pI<Kuin]: PO 250-500mg QID ca}:n}yw]." kgp]:n} KG]:hG]:sG].tiuw]; Doxcyline"
nUiw]El:kUn];lUc] Pgn];sL.yL - Am],mqn]:Tat]:eSAgk],mun],man],'
hUw]K}:"
Am],Tuk],lIpn] - Em:pL;tgc].El:luk]:Agn], 8
pI<lUc];tG]:"
Tat]:yLtum].tiUw].kn] - yL Aluminium El:
Iron n}.hQt];hG]:hUc];Kw]:sup],Aw]yL Tetracycline
tUk];ygm];"
Tarmadol
luk];AWn], PO Sc]pQn]l}:Am],KG]:hG]:sG]. Pgn];sL.yL - hUw]K}:' hUw]mw];' tgc].pik].'
kUn];lUc] PO 50-100mg 4-6 sUw]: cUiw]:cw]' hqc];lUit]:tUk];' Sc]wL:tqk]:niUc];tUv];
mUc];niuc]:pgk]: 400 mg hqc];liUt]:tUk];n}siuc]' kum],SQn]:AQn],AL,yUc],'
Am],nn] kum]SQn]:liUt]:nC];hUw]sC] El:
Pac]hac]:sp];yL:siUw];n}. eteA,liUw]"
398
eKL:PUim].Tqm] 24
Thyroxine
kUn];lUc] PO hqc];yL 100 microgram OD
et,pn] etL,Tuic]Pac]hac]:tac];pQn] Pgn];sL.yL - etAm],l}:pn] hUm]:kn]
lIKuin]:mL;" 25 microgram tc];yL Ferrous sulphate"
n}.tL,Suip],pn]PUim]:kGL,kU:lUin]"
(km]:nm]nuic]:wn]; 100-200
microgram)"
Vitamin A
hqc];yL tL,kUn];Kat], Tat]: Vitamin A wn];TI.nuic]: wn];TI.Sgc] wn];TI.pqt],
luk]:Agn],AL,yu 6 lUin]lUc];tG]: PO 50,000IU STAT 50,000IU stat 50,000IU stat
luk]:Agn],AL,yu 6 lUin] -1 pI< PO 100,000IU STAT 100,000IU 100,000IU
Am],nn] nm].nk]; 8 kI,lUw], STAT STAT
Kuin]:nUiw]
luk]:Agn],AL,yu 1pI<Kuin]:nUiw] PO 200,000IU STAT 200,000IU 200,000IU
Am],nn]nm].nk]; 8 kI,lUw], STAT STAT
Kuin]:nUiw]
nac];yic];sUiw];An]Tuic]pan]sp]; PO 100,000IU OD tL,
Sn]eT,l}: 2 wUc]: Am],nn]
200,000IU once/
week tL, 8 wUc]:
hqc];yL tL,eh.kc]:Kat],Tat]: Vitamin A

luk]:Agn],kUit],mC], PO miUw]:kUit],mL; mUiw]:p},pn]yLnn]. tgc]:Tam]tUv];pUn].mL;
luk]:Agn],AL,yu 6 lUin] PO 4-6 lUin] nuic]:pgk]: 4 lUin] sgc],yam]:kin]yLAn]n}.n}.
-1pI< Am],nn] nm].nk]; mL;yw].yw];hiuw]"
Tuk],lIAw]yLmQt].An]hqc];yL mI;
8 kI,lUw];Kuin]:nUiw]
200,000IU nn].pn]" Sc]wL:KG]:sG].tiuw];
luk]:Agn],AL,yu 1pI<Kuin]: PO 4-6 lUin] nuic]:pgk]: yL An]hqc];mn];EA,liUw] 200,000IU n}
nUiw] Am],nn] nm].nk];
hC]:tUv];tI:tgn]: yL Vitamin A 17.2)
8 kI,lUw];Kuin]:nUiw]
Em:luk]:Agn],Kw] PO luk]:Agn],kUit],mC], et tuin];etAm],l}:pn]Em:pL;tgc].kin]
l}:pn] 200,000IU" yLAn]n}.lL;lL;"
Tqc]:wn];nuic]: pn]
Tqc]: 200,000 IU"
399
24 eKL:PUim].Tqm]
Vitamin B1 (Thiamine)
hqc];yL:yLtL,yUt];yLkUn];Kat],Tat]: Vitamin B1
luk]:Agn],AL,yu 1 IM 50mg TID tL, 1 wn];El: 10mg  tUv];tI:tgn]:Kat],Tat]: Vitamin B1
pI<lUc];tG]: PO tL, 6 wUc]:" tL,tgc];- tL,yUt]; 17.2"
yLpn]Em:luk]:Agn], hG]:tUv];tI: kUn];
lUc] Kat],Tat]:AL,hLr Ait];Agt];  tUv];tI:tgn]:lgc]:hqc];hUw]sG]eA, 8.2"
kUn];lUc]An]Kat], PO 100 mg OD tL, 7 wn]; El:
Tat]:Ait];Agt]; PO 10mg OD tL, 6 wUc]:  mUiw]:tuik].AUm]pU.nn]. etAm],l}:
kUn];lUc]An]Kat], IM 100 mg TID tL, 1 wn]; epL;yw]. kin]yLAn]n}." epL;Am],nn] Tat]:yL
Tat]:haw].hqc]; PO 100 mg OD tL, 7 wn]; epL;yw]. etlU.Sum];kCL,n}yw]."
PO 10 mg OD tL, 6 wUc]:
tL,eh.kc]:Em:pL;tgc].El: luk]:Agn],lqc]Kat],Tat]: Vitamin B1

Em:pL;tgc]. PO mUiw]:pL;tgc]. El: mUiw]:lQc].nUm];pn] 100mg OD etL,Tuic] 6 lUin]Kiun]:niUw]"
Vitamin B6 (Pyridoxine)
tL,eh.kc]:hqc];Sa}tLAUn]: mUiw]:kin]yLTI,pI, Isoniazid"
kUn];lUc]El: PO 10mg OD Sc]wL:pn]hqc];yL B6 nm]nm]suic] ethQt];hG]:Pgn];yL
luk]:Agn], Isoniazid tUk];ygm];n}yw]."
Vitamin B 12
Kat],Tat]: Vitamin B 12
kUn];lUc] IM 1mg 3x/wUc]: tL, 2 wUc]:"
24.10 yLtL,sG].tiuw];mUiw]:pL;tgc]. (Drugs during pregnancy)
 miUw]:p},kUt],Tt];yUt];yLpn] nac];yic];nuic]:ekL.n}. hG]:Tam]tUv];lgc]:sp];Sn],eT, tL,eS,"

 miUw]:etpn]yLEm:pL;tgc].nn]. tk];etl}:w}.StieSpn]"
 yLmac]An]Et. wac];sG]eSpn]l}:yU," (lgk];Kgc]: k)
 yLmac]An]n}. mUiw]:pL;tgc].yU,nn]. mac]pgk]:mac]lG]etl}:cUic].Ew: kUv];kL: etl}:sc]:tUv]; Pgn];
lIEl:eP;sL. An]Aap]:etpQn]l}:" kgp]:n} Tuk],lItUic],pac],tac];emLyLeSpn]" (lgk];Kgc]: K)
 yLmac]An]n}. mUiw]:pL;tgc].yU,nn]. Am],Tuk],lIpn]lL;lL;" (lgk];Kgc]: c)
400
eKL:PUim].Tqm] 24
lgk];Kgc]:-k
yL:yLAn]wac];sG]eS sG].tiuw];l}: tgn]:tL,Em:pL;tWc].
Aluminium Metoclopramide
Hydroxideampicillin/Amoxicillin Multivitamins
Ceftriaxone/Cephalosporins Niclosamide
Chloroquine Nystatin
Cloxacillin ORS
Dexamethasone Paracetamol
Erythromycin Penicillins
Ferrous Sulfate Quinine
Folic Acid Salbutamol
Hydralazine Vitamin B1, B2, and C
Methyldopa
lgk];Kgc]:-K
tUic],pac],tc];emLyLeS sC].tiuw]; Am],nn] fac].eSsG].
Adrenaline Furosemide
Albendazole Gentamycin
Aminophylline Hyoscine
Artesunate Indomethacin
ASA Mebendazoe
Ciprofloxacin Metroidazole
Chlorpheniramine Phenobarbital
Cotrimoxazole Praziquantel
Diazepam Perdnisolone
lgk];Kgc]: - c
yLAn]Am],Tuk],mqn]:tL,Em:pL;tWc].
Chloramphenicol Primaquine
Cimetidine Tetracyclines(including Doxycycline)
Ergometrine Vitamin A
Hydrochlorothiazide Streptomycin
Griseofulvin
Mefloquine
401
24 eKL:PUim].Tqm]
24.11 piUc]nm];tL,luk]:AWn],kUit],mG],El:niuc]:KUp],lUc];tC]:
(New born Infant guideline)
piUc]nm];An]n}. pQn]cw]:Kam],puin]. tL,km].sW}:lum];lL;pa};yU,lIluk]:AWn]," Tuk],lIhU.w}.wL: luk]:
AWn],n}. pQn]tac];pQn]Ait];AWt];eStL. sac]:yQn];pQn]ha}.hqc];l}:ca}:ca}:yw].' km]:nm] etpQn]
luk]:Agn],An]kUit],mG]," Sc]wL:mI;cw];la};sUic].n}n} etTuk],SUc],kCL,yUt];yLtac],tI:/ Am],Tuk],
SUc],n}nn]. etl}:mI;lWc]:hac]:hqn];w}.AWn]tac];"
lm];nC];
nL:
1 luk]:AWn],lUin]p},TUn]:eSkUit]:El: luk]:AWn],nm].nk];Am],tQm]TUn]: 402
2 tWn]:Pqn]kan]Eh.kc]:tL,luk]:AWn],kUit],mC], lUv]:yLptI,KYI<wn 403
3 lWc]:lum];lL;luk]:AWn], 2 liUn]lUc];tG]: pQn]kWc].lUit]:tqk],EP: 404
4 lWc]:lum];lL; pa};yU,lIluk]:AWn], AL,yu 2 lUin]lUc];tG]: 405
5 piUc]nm];tL,lum];lL;luk]:AWn], 2 lUin]lUc];tG]: pQn]pWt],kI: 406
6 pUic]nm];tL,lum];lL;luk]:AWn], 2 lUin]lUc];tG]:lUc];tC]:pQn]kWc].lUit]:tqk],EP: 407
7 la};kan]yUt];yLtWc].kCL, 408
8 piUc]nm];hqc];yLptI,KYI<wn 410
9 IV Fluids tL,Tic];Sim];Tat]:nm].nG];tUw]hG]:pQn]pkti 410
10 lUm];m}:nC];tUw] tUk];yWm]; 411
11 pWn]:tac];kin]pn]luk]:AWn], 412
12 luk]:AWn],kUit],mG],pQn]nUiw].lUic] 414
13 luk]:AWn],kUit],pL;tac];pQn]naw]nUk]. 415
14 tac];pQn]naw]nUk]. An]luk]:AWn],AL,yu 2 lUin]lUc];tG]:pQn] 415
15 PUim].Tqm]Tat]:wI,tL,min],El: AL,hL,r 416
16 luk]:AWn],kUit],mG],pQn]tac];pQn]kac];Kqc] 417
SMRU piUc]nm];luk]:AWn],kUit],mG],El: luk]:AWn],AL,yunuic]:pI<lUc];tG]:n}. PU:tqm]:El:KuUn].KGL. pQn]KU;emL

yL kQw],lUv]:tac];pQn]luk]:AWn], Claudia Turner"
luk]:AWn],lUin]p},TUn]:eSkUit]:El: luk]:AWn],nm].nk];Am],tQm]TUn]:
eKL:piut],tI:pWc],
luk]:AWn],lUin]p},TUn]:eSkUit],
luk]:AWn],An]Sn],eT,p},tQm] 37 wUc]:eSkUit],mL;"
402
eKL:PUim].Tqm] 24
luk]:AWn],nm].nk];Am],tQm]TUn]:
luk]:AWn],kUit],mL; mI;nm].nk];EA,eS 2.5 kI,lUw],krm]"
Sc]wL:emLyLp},l}:tUv]; Am],nn] p},l}:Aup],kum]kn]tc];emLyLn} etAm],l}:pn]luk]:AWn],

pWk]:mUiw];hUin];" Sc]wL:luk]:AWn],kUit],tI:hUin];n}suic] kL:nc],pQn]l}: emLyLetl}:lum];lL;tUv];Tuic]
sw].sw].sQw];sQw];yw]."
tc];SWc]kum],n}. mI;eP;sgm];nc],cw];la};-
 kWc].lUit]:tqk],EP:- tUv];tI:lWc]:lum];lL;luk]:AWn], kWc].lUit]:tqk],EP:"
 Pac]hac]:tUw]yQn]pUn].tI:
 Tat]:kUiw]wan]nG];tUw]tUk];ygm];
 mI;lWc]:yap],Puit], miUw]:pgn]:tac];kin]pn]
lWc]:lum];lL;luk]:AWn],AL,yuniuc]:pI<lUc];tC]:
 hG]:PU:hap],kan] An]yam]:lQp]:hQn];lWc]:lum];lL;luk]:AWn],mL;nn]. pG].lum];lL;"
 Kw]:yQm]:lum];lL; 6 sUw]:mUc];nuic]:pWk]:"
 kUt],sqt]:pn]lUm];naw]
 hqc];TUv]:sG]
 hqc];lUit]:tWt]:
 Sc]wL:Am],l}:lQc].nUm];luk]:AWn],huic]liUw] 8 sUw]:mUc];mL;yw].n}siuc] hG]:kUt],sqt]:Tat]:kUiw]wan]
pn]sgm];"
 Tuk],lIkUt],Tt];lum];lL;luk]:AWn], 1 pI<lUc];tG]:pn]kU:wn]; (tL,kUt],Tt];Tuic]tI:nn]. et
l}:Tgt],SUiw]:KUw];luk]:AWn],)" Am],wL:mUiw]:tuik].Kiun]:hUc];yLyU,El:Sc] miUw]:miUw];kCL,yw].El:Sc]
nuic]:wUc]:nuic]:pWk]: emLetl}:kUt],Tt];pn]"
 mUiw]:p},pn] luk]:AWn],AL,yulQk].eS 34 wUc]: lUc];hUc];yLnn].etl}:hQt]; Cranial USS performed
prior pn]"
tgn]:Pqn]kan]eh.kc]: tL,luk]:Agn],kUit],mG], lUv]:yLptI,KYI<wn (Protocol for Antibiotic

prophylaxis for the newborn infant)
eKL:An]sac]:pQn]eP;l}: tL,luk]:Agn],kUit],mG], ygn].kgc].lUit]:tqk],eP:

 luk]:AWn],lUin]p},TUn]:eSkUit], (Sn],eT,p},tQm] 37 wUc]:eSkUit],)"
 nm].Aap],Em:pL;tWc].tqk],yw].huic]lUiw] 18 sUw]:mUc];El: Em:luk]:Agn], An]Am],l}:pn]
yLptI,KYI<wn Am],nn] 4 sUw]:mUc]; mUiw]:p},kUit],nn].l}:hp]. yLptI,KYI<wnw}."
 Em:luk]:Agn], mI;lUm];naw] (Sc]Am],sG]:ygn].naw]nUk].)"
 pqk].Sm].wL: yUt];yLpn]yU,n}eStL. Em:pL;tWc].Sm].sp];tit];sUiw].mqc];tac];pQn]w}.yU,
(Sc]Am],sG]: ygn].tac];pQn]naw]nUk].)"
403
24 eKL:PUim].Tqm]
 Em:pL;tgc]. An]yam]:mI;puin];tUw]luk]:Agn],kiUt],mL;nG];Kaw];tac];wUc]:TI.nuic]:eS ta}"
 Auin]tac];kin]yap],' Am],nn] Am],hp].AL,hL,rl}:"
Sc]wL:luk]:Agn],mI;Pac]hac]:mI;eP;nc],pL:nUiw]n}.Sgc]An] Am],nn] luk]:Agn],mI;lUm];naw]n}suic]

etl}:pn]yLKL:sUiw].mqc];hG]:luk]:Agn],"
lUm];naw] = lUm];m}:Kuin]:Tiuc]/nm]liUw] 38 M c nuic]:pgk]: Am],nn] 37.5 M c Kuin]:nUiw]
Kqn]: 4 sUw]mUc];Kuin]:niuc]:pgk]:"
kUt],Tt];tUv];tac];nm]sUiw].mqc];El: eS;l]An]yU,nG];lUit]:" wa};nn].Et,pn]yL IV Ampicillin El:

Gentamycin
yLKL:sUiw].mqc];n}. etl}:pn]etL,Tuic]hU.eKL:tWp], Blood culture"
lgc]:Tuk],lIlqk]:la}:pn]yLkin]El: lgc]:kuit];luiw]:yLnn].
etl}:Aic]nUiw]eKL:Sc],emLyL"
lWc]:lum];lL;luk]:AWn], 2 liUn]lUc];tG]: pQn]kWc].lUit]:tqk],EP: (Protocol for the

management of septic infant up to eight weeks)
Pac]hac]:mI;eP;tI:luk];AWn],
 luk]:AWn],Am],kin]nUm];lIlI"  hqc];TUv]:sG]w};lUiw] 60/min"
 lUm];naw] = lUm];m}:Kuin]:Tiuc]/nm]liUw] 38 M c  Kac];"
Kuin]:nUiw] nuic]:pgk]: Am],nn] 37.5 M c Kuin]:nUiw]  lin].tWc].lWk];Kw]:kCL,ha}.hqc];"
nC]; 2 Kaw];tac]; Kqn]: 4 sUw]mUc];"  Piw]nUiw].SWm],"
 Sa}lIAWk],nm].eS mI;Sqw]tU,"
 tUw]yQn]pUn].tI:" (eA,eS 36 M c)
 hqc];TUv];sG]eA,liUw] 20/min Am],nn]
 can];Kuin]:"
kiut];TUv]:sC]sUw]:kqp].
 cUiw]:cw] Am],nn] Am],hU.tUw]"
(kiut];niuc]:pWk]:hiuc]liUw] 15 Sqk].kn].)"
sG].tiuw];yLKL:sUiw].mqc];eSyUt];yL
 sG].tiuw];lWk];Kgc]:eKL:nm];yLKL:sUiw].mqc];(yLptI<KYI,wn) liUk]:wL:etsC].yLKL:sUiw].mqc]; An]lC]"
 Aic]nUiw]cw];la};luk]:AWn],El: eKL:tWp],An]kUt],Tt];l}:mL;eS etl}:yUt];yLhuic]kL:huiw] n}nn].
tUic],pac],kn]tc];KU;emLyL"
Sc]wL:Am],lIKuin]:
Sc]wL:n]G;Kaw];tac]; 48 sUw]:mUc]; lUm];naw]Am],tUk]; Am],nn] cw];la};luk]:AWn],ha}.hqc];lUiw]kw],suic]
tUic],pac],kn]tc];KU;emLyL (tgk],tiUw],)eS lqk]:la}:sG].yL cefotaxime"
404
eKL:PUim].Tqm] 24
lWc]:lum];lL;pa};yU,lIluk]:AWn],AL,yu 2 liUn]lUc];tG]:
tI:eA,Sut]; 1 wn]; 1pWk]: etl}:EnemLyL
Am],nn] tUic],pac],kn]tc];KU;emLyL"
luk]:AWn],sWc],mI;Pac]hac]:mI;eP;
Am],nn]
lUm];naw] (= lUm];m}:Kuin]:Tiuc]/nm]liUw] 38 M c yL,luim];wUn].wL:- km]:nm]]tI:
Am],sC]: luk]:AWn],n}.etAm],AWk],
Kuin]:nUiw] nuic]:pgk]: Am],nn] 37.5 M c Kuin]:nUiw] Pac]hac]:pUic]lUc]Kgc]tac];pQn]
Kqn]: 4 sUw]:mUc];eSKuin]:") kWc].yU,nG];lUit]:
Am],nn]
sgc],m}:sC]sgm]; luk]:Agn],h}a.hqc];nL,hiuw]
? sC]: Aw]puin];tUw]kUn];pQn]
hG]:pQn]tQm]TUn]:"
Sc]wL:luk]:AWn],Am],yU,lIha}.hqc];n} yUt];yLsgm];nc],
sgc],luk]:AWn],l}:hp].lWc]:lum];lL; An]tI:Tuk],mqn]:"
El:yUt];yLKuik].Kak].sgm];nc],piUc]
nm];tL,luk]:Agn],hiuw]
Am],l}:hp]. l}:hp].
yUt];yLpn]sgm];piUc]nm]; mk];mn]:wL:Am],mI;tac];pQn]naw]nUk].
lWc]:yUt];yLKuik].Kak].tL,
luk]:AWn],pQn]ha}.hqc];
kUt],Tt];Pac]hac]:tac];pQn]tI:luk]:AWn],yw].suic] yUt];yLpn]sgm];nc],pUic]yUt];yLAn]Tuk],mqn]:
hqc];TUv];sG]EA, piUc]nm];tL,lum];lL;luk]:AWn], 2 liUn]lUc];tG]:pQn]pgt],kI:
Sa}lImI;sUiw].mqc]; piUc]nm];tL,lum];lL;luk]:AWn], 2 liUn]lUc];tG]: pQn]kWc].
lUit]:tqk],EP:
sG]Am],nim]' KI:mWm]:kG]:pWc]; piUc]nm];tL,lum];lL;luk]:AWn], 2 liUn]lUc];tG]: pQn]kWc].
lUit]:tqk],EP:
tWc].kGL, piUc]nm];tL,lum];lL;hUc];Kw]:El: lm];S}:sQp];
Piw]nc]kG]:AUm]nWc]' AWk],tum],nm]. piUc]nm];tL,lum];lL;luk]:AWn], 2 liUn]lUc];tG]: pQn]kWc].
yac]tqc] lUit]:tqk],EP:
nc],An]Enw}.pL:nUiw]n}.Am],sG]:eS piUc]nm];tL,lum];lL;luk]:AWn], 2 liUn]lUc];tG]: pQn]kWc].
An] lUit]:tqk],EP:
405
24 eKL:PUim].Tqm]
piUc]nm];tL,lum];lL;luk]:AWn], 2 liUn]lUc];tG]: pQn]pgt],kI:
sWc],hqc];TUv]:sG]luk]:AWn],nm]lUiw] 60/min
El:/Am],nn] lin].tWc].sgc],lWk];Kw]:ha}.hqc];
Sc]wL:mI;
sWc],luk]:AWn],mI;Pac]hac]:eSAn]An]mUin]nc],Enw}.pL:tG]:
Piw]nc]SWm],
km];km];pQn]lUm];TUv]:sG]kuit];
KU;lc]kI:hup],kI:hup],
Kac];emL;
mUiw]:TUv]:sG]AWk],SQc]emo; hI;hI;
mI; Am],mI;
pgt],kI:haw].hqc];pUn].tI: pgt],kI:haw].hqc];
pn]Agk],SI,kYin],
Aw]lUit]:tL,hQt]; CBC El: blood culture"

Sc]wL:Kt];sC]Aw]Tuic] 3 pWk]: El: Am],l}:tUw],yac],tL, blood culture suic]
nqt]:pn] yLptI,KYI<wn Ampicillin El: Gentamicin IM Am],nn] IV w};w};"
kUt],sqt]:mat]:m}a hqc];tWt],lUit]:' hqc];tWt],hUw]sG] El: lUm];naw] 4 sUw]:mUc];niuc]:pgk]:

Tt];Sac]pC].tUv];pL; lgc]:pgn]:tac];kin] l}:/Am],l}:"
etl}:hQt];hG]:tqt]:etL;wL: luk]:AWn], Am],pQn]Tat]:kUiw]wan]nG];lUit]:tUk];ygm];'
tUw]yQn]pUn].tI:"
406
eKL:PUim].Tqm] 24
piUc]nm];tL,lum];lL;luk]:AWn], 2 liUn]lUc];tG]: pQn]kWc].lUit]:tqk],EP:
sWc],Sa}eh,AWk],nm].nWc]El:mI;Aa}mqn]'
mI; Piw]nc]him];hWm];Sa}eh,nn].sWc],lqc]
Piw]nc]sUiw];nn].sWc],pqn]mUin]f};m}:El: nm].m}:lUk]:
Piw]nc]sWc],pQn]SIlUic]El:mI;hW};sQp];KQc]:Kqc]w}.
Aap]:etpQn]yWn].sUiw].mqc];
Staphylococcal Am],mI;
Aw]lUit]:to,CBC El: sWc],luk]:AWn],mI;Pac]hac]:eSAn]An]mUin]nc],pL:tG]:

blood culture. KI:mWm]:kG]:pWc];
pn]yL Cloxacillin El: sG]Am],nim]
Gentamicin IV/IM luim];tUw]pQn]km];
lWc]:yU,Sac]:Am],pQn]pk],ktI,
mI; Am],mI;
yC];hUm]AWk];eALkG]: lUit]:luk]:AWn],pQn]kWc].eSEP:tiun];
pn]Agk],SI,kYin], Sc]wL:Kt];sC]Aw]
Tuic] 3 pWk]:El:
Aw]lUit]:AWk],tL,kUt], CBC El: blood culture. Am],l}:tUw]yac],
Aw]yQw]:kUt],(Aw]yQw]:An]mUt];SG]' SP Am],nn] lWt],yQw]:) Am] ,nn] nC];Kaw];
sup],Aw]K}Sn]lc]tI:Aqw] (Sc]Am],mI;emLyL pn]yLptI,KYI<wnw};w};) tac]; 5 minit].
pn] Ampicillin and gentamicin IV/IM siuc]hSc]
G]:nqt ]:pn]y
wo:Aw] lLUit
KU;emLyLetl}:wUn].tL,PUim].Tqm]pn] Cefotaxime Ko:sU w
i .
] mq c ;
] w} ; w} ;"
kUt],sqt]:mat]:m} hqc];tWt],lUit]:' hqc];tWt],hUw]sG] El:

lUm];naw] 4 sUw]:mUc];niuc]:pgk]:"
Tt];Sac]pC].tUv];pL; lgc]:pgn]:tac];kin] l}:/Am],l}:"
etl}:hQt];hG]:tqt]:etL;wL:luk]:AWn],Am],pQn]
Tat]:kUiw]wan]nG];lUit]:tUk];ygm];'
tUw]yQn]pUn].tI:"
407
24 eKL:PUim].Tqm]
la};kan]yUt];yLtWc].kCL,
kUt],Tt];tUv];luk]:AWn],wL: Pac]hac]:Kat],Tat]:nm].mI;/Am],mI;
mI;Pac]hac]:Kat],Tat]:nm].ha}.hqc]; mI;Pac]hac]:Kat],Tat]:nm].Ait];AWt]; Am],mI;Pac]hac]:

mI;Pac]hac]:nc],tG]:n} SWc]An] mI;Pac]hac]:nc],tG]:n}.SWc]An]Kuin]:
Kuin]:nUiw] - Am],K}:tUc].nuic]' nUiw] - Am],nim]Sw];l}:' sG]Am],
Am],hU.tUw]' AWk];tLluk];' kin] nim]' AWk];tLluk];' tWc].m}:nm].'
nm].l}:Ait];AWt]; Am],nn] kin]nm].mUt];SQc]:' epL;mip],tUv];
Am],kin]l}:' epL;mip],tUv];Piw] Piw]nc]eSpW}, ettUk];kGL,km];lW};lW};
nc]eSpW}, ettUk];kGL,km];lW};lW};
(huic]eSSWc]Sqk].kn].)
kCL,tUv];Tqc]:nL:niuc]:
tL,PUim].Tqm]Kuin];Tat]:nm].nn]. SG],pn] IV Ringers

AWn]tac];Sut]; Suip],pn] luk]:AWn],An]tWc].kGL,kU:ekL.
pn] 30ml/kg 70ml/kg Tuk],lIpn]Tat]: Zinc -
nG];Kaw];tac];- nG];Kaw];tac]; - lQk].liUw] 6 liUn] 10mg tL, 14
1 pI<lUc];tG]: 1 sUw]:mUc]; 5 sUw]:mUc]; days
1 pI<Kuin]:nUiw] 30 minit]. 2 1/2 sUw]:mUc]; yC],liUw] 6 liUn] 20mg tL, 14
days
tqk]:tac];nm]yqw]:" tL, Sc]wL:pn]Tat]:

kUn];sa}; sG].tiuw];TUc] kUt],tUv];hqc];tWt],lUit]: 15
nm].tQm]TUn]:yw].
yQw]:" tL,kUn];yic]; n} etl}:em;kUt], minit]. 1 pWk]: etL,Tiuc] hqc];
sG].tiuw];nun];kuv]" nC];Kaw]; Tt];Kiun];" tWt],lUit]:lIKuin]:" Sc]wL: tuik].
tac];nuic]:sUw]:mUc]; etl}: mI;Pac]hac]:Kat],Tat]:nm].yU,
nm]lUiw] 1 ml/ kg" siuc] pn]Tat]:nm].sgm]; IV
hG]:w};liUw]kw],"
Sc]wL:tuik].mI;Pac]hac]: cw];la};luk]:AWn],lI hQt];Sac]:sWm];nc],

Kat],Tat]:nm].ha}.hqc]; Kuin]:mL;eStL. Sc]wL: piUc]nm]; Kat],Tat]:
yWn];tac]; yU,suic] hac]:hqn];tL,PUim]. Pac]hac]:Kat],Tat]:nm]. nm].Ait];AWt];
sW}:Tqm] Tqm]Tat]:nm].Tqc]:tac]; IV yc];kuit];w}.yU,
408
eKL:PUim].Tqm] 24
mI;Pac]hac]:Kat],Tat]:nm].Ait];AWt]; Am],mI;Pac]hac]:
mI;Pac]hac]:nc],pL:tG]:n}. 2 An] Kiun]:nUiw]-
Am],nim]Sw];l}:' sG]Am],nim],' AWk];tLluk];' lat]:pn]tI:Em:luk]:AWn],wL: etl}:km];km];
tWc].m}:nm].' kin]nm].mUt];SQc]:' epL;mip],tUv]; lQc].nUm];pn]luk]:AWn],"
Piw]nc]eSpW}, ettUk];kGL,km];lW};lW};" Sc]wL:nm].nUm];Em: Am],AWk],siuc] pn] ORS
food-based fluids Am],nn] nm].An]mUt];SG]"
pn]Tat]:nm].kUiw]tI:Em:luk]:AWn],w}.mWk]: 2 TUc]"
la};KUn];elL; Tat]:nm].kUiw]nn]. hG]:tUv];eKL: liUw]eSpn]Tat]:nm].pk],ktI,yU,yw].nn].
nm];tI:TUc]nn]." etl}:tqp];tt];tac];nm] hG]:PUim].Tqm]pn]Tqc]: sgm];nc],pL:tC]:n}."
tL,sC].Tat]:nm].kUiw] hG]:kum],nC];Kaw];yam]]; 4 luk]:AWn], AL,yu 2 KUp],lUc];tG]: hG]:pn]Tat]:
sUw]:mUc];" nm].kiUw] 50-100 ml kU:pgk]:wa};eSluk]:AWn],
KI:yw]."
Ao,yu 2liUn] 2-4 4-12 1-2 1-5 tL,luk]:AWn],AL,yu 2 KUp],Kiun]:nUiw] 100-200
lUc]; lUin] lUin] KUp], KUp], ml kU:pgk]:wa};eSluk]:AWn], KI:yw]."
tG]:
Tat]: 100 - 200 - 400 - 700- 900 -
nm]. 200 400 700 900 1400 mUiw]:lUc];hUc];yLkCL,
kUiw](ml)
np].SWn],Tat]:nm].kUiw] tL,Tic];Sim];Tat]:nm].
nG];tUw] hG]:cw];la};luk];AWn],pQn]pk],ktI,
w}a;eS 4 sUw];mUc]; Kuin];Tat];Sac]pn]Kiun]; = 150ml/kg/day
tL,hG]:hU.tac];nm]Tat]:nm].kUiw] tL,pn]niuc]:sUw]:
mUc];nn]. Aw] 24 han](sqk],)"
Sc]wL:kin]nm].l}:lIlIsuic] pn]tac];SuUp];tL.'
Am],mI;Pac]hac]:lIKuin]: Pac]hac]:Kat], Sc]wL:Am],kin]nm].l}:lIlIsuic] SG],lWt],KU;nc]
mL;eSAit];" hG]:yWn]; Tat]:nm].lIKiun]: eS lQc]. 1sUw]:mUc]; 1cc tL.' liUw]eSpn]
tac];sW};Tqm]' Tat]:nm].pk],ktI,yU,yw].nn].
(pn]Kuin];Tat]:nm].kUiw]) hG]:pn]PUim].Tqm]pn]Tqc]: sgm];nc],pL:tC]:n}."
Sc]wL:SG],lWt],KU;lc]El:Am],Kam],l}: luk]:AWn], AL,yu 2 KUp],lUc];tG]:hG]:pn]Tat]:
n}suic] hG]:SG],pn]tac];SQn]:AQn]sgm];nc], nm].kiUw] 50-100 ml kU:pgk]: wa};eSluk]:AWn],
PUim].Tqm]Tat]]:nm].tL,yUt];yL lgc]: KI:yw]."
Kat],Tat]:nm].ha}.hqc]; tL,luk]:AWn],Ao,yu 2 KUp],Kiun]:nUiw] 100-200
ml kU:pgk]:wa};eSluk]:AWn], KI:yw]."
Sc]wL:luk]:AWn],mI;lUm];naw]' tUw]sC]Am],pQn]
pk],ktI,El: tWc].kGL,pL;lUit]:n}suic]
hG]:pn]yL Ciprofloxacin 7.5 mg BID tL, 5
wn]; metronidazole 7.5 mg/kg (max
400mg) TID tL, 10 wn];"
409
24 eKL:PUim].Tqm]
piUc]nm];hqc];yLptI,KYI<wn
Gentamicin IV/IM
luk]:AWn],AL,yu 2 liUn]lUc];tG]: 4mg/kg OD
Ampicillin IV/IM
AL,yu 1 wUc]: 50mg/kgBID
2-4 wUc]: 50mg/kg TID
2-4 wUc]: 50mg/kg QID
Amoxicillin
0-1 pI<
sUiw].mqc];Kw]:Ait];AWt]; 62.5mg = 2.5cc TID
sUiw].mqc];Kw]:ha}.hqc]; 125mg = 5cc TID
Cloxacillin IV/IM
AL,yu 1 wUc]: 50mg/kgBID
2-4 wUc]: 50mg/kgTID
4 wUc]:Kuin]:nUiw] 50mg/kgQID
Cloxacillin PO
0-1 pI<
sUiw].mqc];Kw]:Ait];AWt]; 62.5mg = 2.5ccQID
sUiw].mqc];Kw]:ha}.hqc]; 125mg = 5ccQID
Cefotaxime IV/ IM
AL,yukL:huiw]eSAm],wL: 50mg/kgQID
IV Fluids tL,Tic];Sim];Tat]:nm].nG];tUw]hG]:pQn]pk],ktI,
 etl}:pQn]eKL:sinm];emLyLkUv];" (Aw]SUp];lat]:Sc],Aw]ekL:pQn]l}:)
 nG];Kaw];tac]; 48 sUw]:mUc]; AWn]tac];Sut];nn]. hG]:sG].tiuw]; 10% dextrose" wa};lc]n}.hG]:lqk]:
la}:sG].tiuw]; 0.18% saline El: 8% dextrose"
 lQc].Kw]:nm].tac];kin] mWk]:tL,nuic]:wn];"
 ygn].wL: 60 tgm],n}. pQn] 1 ml El: Sc]wL:pn] 1 minit]. 1 tWm],n}suic] ' 60 tWm], =1 ml '
1 ml = 1 sUw]:mUc];"
tL,luk]:AWn],AL,yu 2 wn]; 10% dextrose
tL,luk]:AWn],AL,yu 2-4 wn]; 8% dextrose El: 0.18% saline*
* tL,hQt]; 8% Dextrose, 0.18% Saline' sup],Aw]
100ml tI:tw]: 500ml 10% dextrose eSPiUm].Tqm] normal
salin 100ml pn]"
tL,luk]:AWn],AL,yu 4 wUc]:Kuin]:nUiw] 5% dextrose El: 0.81% saline* *
** tL,hQt]; 5% Dextrose, 0.81% Saline sup],Aw] 50 ml
tI:TUc] 500ml normal salin eSPiUm].Tqm] 50ml 50%
dextrose pn]"
410
eKL:PUim].Tqm] 24
lUm];m}:nC];tUw] tUk];yWm];
eKL:puit],tI:pWc],
 lUm];m}:mI;tqm],liUw] 36.5 MC "
 lgc]:tUw]yQn]pUn].tI:n}. sac]:pQn]eP;etL,luk]:AWn],pQn]
- Tat]:kUiw]nG];lUit]:tUk];ygm];
- nm].nk];Am],Kuin]:
- TUv]:sG]yap],
lWc]:yUt];yLtL,tUw]yQn]pUn].tI:
Kn].tWn]: 1
 lUm];m}: M
36 MC - 36.5 C
 etAm],l}:pW},luk]:AWn],ym];nm].KI:/yQw]:' nuc]:pn]KUw];An]mUt];SG]"
 Aw]PL:pUk].luk]:AWn],w}."
 Aw]AWm]nm].Aun],w}.him];luk]:AWn],"
 Aw]luk]:AWn],tac],w}.nUiw]TUc]nm].Aun], An]AUn]:nUn];"
 Kqn]: 1 sUw]:mUc]; 1 pWk]:eS kUt],Tt];lUm];m};pn]luk]:AWn],"
 Sc]wL: lUm];m};luk]:AWn],Am],Kuin]:mL; hG]:Ka}.kGL, Kn].tWn]: 2 "
Kn].tWn]: 2
 lUm];m}: M
35.5 MC - 36 C
 hG]:epL: Am],nn] Em: hgp],Aum]:kgt],luk]:Agn],w}. mUin]nc],mLkqc]klU;"
 Kqn]: 30 minit]. 1 pWk]: kUt],Tt];lUm];m};pn]luk]:AWn],"
 Sc]wL: lUm];m};luk]:AWn],Am],Kuin]:mL; hG]:Ka}.kGL, Kn].tWn]: 3"
 Sc]wL: lUm];m};luk]:AWn],Kiun]:mL;mI; 36 MC Kuin]:nUiw] nC];Kaw];tac]; 4 sUw]:mUc];lc]n}.n} hG]:
Ka}.kGL,Kn].tWn]: 1"
Kn].tWn]: 3
 lUm];m}: 35.5 MC lUc];tG]:
 Aw]luk]:AWn],SG],w}.tG]:Tat]:Aun], Radiant heater "
 Kqn]: 30 minit]. 1 pWk]: kUt],Tt];lUm];m}:pn]luk]:AWn],"
 Sc]wL: lUm];m};luk]:AWn],Suc]Kiun]:mL;mI; 35.5 MC Kuin]:nUiw]n}suic] hG]:epL: Am],nn] Em:
Aum]:kgt],luk]:Agn], mUin]nc],mLkqc]klU;"
 kUt],sqt]:Tat]:kiUw]wan]nC];lUit]:"
411
24 eKL:PUim].Tqm]
lWc]:lum];lL;luk]:AWn],nc],St];hgp],luk]: (Kangaroo Care)
 Aw]PL:SI,sQc] hk];tUp].pQn]Sam]sQc],"
 Aw]PL:An]tI:tUp].w}.nn]. hUm],niUw]tUw]luk]:Agn],w}."
 Aw]luk]:Agn],mL;Aum]:sp];tUw] Em:/epL: hG]:Piw]nc]tiUw].kn]w}.km];Siuw]:"
 Aw]luk]:AWn],SG],tI:nL:AUk];" nUiw].Em:/epL: El: luk]: etl}:tUiw].kn]"
 Aw]PL:AWm]:An]tUp],w}.Sam]sQc]nn]. wQn];w}.Em:/epL: El: luk]:kuik];kn]w}."
 nuc]:SUiw]:yG],yG], hum],w}.pWt];tG]:luk]:AWn], Am],nn] w}PL:m}"
lWc]:pgn]:tac];kin]pn]luk]:Agn],
wn];TI.niuc]:
 60 ml/kg
wn];TI.Sgc]
 80 ml/kg
wn];TI.Sam]
 100 ml/kg
wn];TI.SI,
 120 ml/kg
wn];TI.hL:
 140 ml/kg
tL,luk]:AWn], An]lUin]TUn]:eSkUit],nn]. hG]:kuit];tI: 150ml/kg/wn];"
tL,luk]:AWn], An]lUin]Am],TUn]:eSkUit], Am],nn] nm].nk];Am],Tiuc]nn]. hG]:Suip],pgn]:pn]kCL,Tqc]:
mUin]nc],pL:tC]:"
wn];TI.hUk];
 160 ml/kg
wn];TI.sQt];
 180 ml/kg
w}a;lc]wn];Tipqt],kCL,
 200 ml/kg/ wn];
412
eKL:PUim].Tqm] 24
pgn]:pn]tac];kin] sgm];lWt],SG],KU;lc]
wn];TI.niuc]:
 Kqn]: 1 sUw]:mUc];eSpgn]:pn]"
wn];TI.Sgc]
 Sc]wL: KQn]: 1 sUw]:mUc];eSlQc].El: mI;hqc];kin]Kw]:l}:mL;siuc] hG]:Kqn]: 2 sUw]:mUc];eSpgn]:pn]"
 Sc]wL: KQn]: 2 sUw]:mUc];eSlQc].El: Am],mI;hqc];kin]l}:n}suic] hG]:Kqn]:Kiun]; 1 sUw]:mUc];eS pgn]:pn]"
wn];TI.Sam]
 Sc]wo: KQn]: 2 sUw]:mUc];eSlQc].El:mI;hqc];kin]Kw]:l}:mL;siuc] hG]:Kqn]: 3 sUw]:mUc];eSSgm]pn]"
 Sc]wo: KQn]: 3 sUw]:mUc];eSlQc].El:Am],mI;hqc];kin]l}:n}suic] hG]:Kqn]:Kiun]; 2 sUw]:mUc];eSSgm]pn]"
wn];TI.SI,
 Sc]wL: KQn]: 3 sUw]:mUc];eSlQc].El: mI;hqc];kin]Kw]:l}:mL;siuc] hG]:Kqn]: 4 sUw]:mUc];eSpgn]:pn]"
 Sc]wL: KQn]: 4 sUw]:mUc];eSlQc].El: Am],mI;hqc];kin]l}:n}suic] hG]:Kqn]:Kiun]; 3 sUw]:mUc];eS pgn]:pn]"
Am],mI;hqc];kin]l}: = pgn]:niuc]:pgk]: ethak]: 2 km];Tt];kn]

Tat]:kUiw]wan]nG];lUit]:tUk];ygm];
 Sc]wL:luk]:AWn],cUiw]:cw]' luim];tUw] Am],nn] epL,can];n}suic] hG]:kUt],tUv];Tat]:kUiw]wan] nG];
lUit]:"
 Sc]wL:Tat]:kUiw]wan]nG];lUit]: mI;eA,eS 2.5mmol/l suic] hG]:SG],pn] IV glucose
1 ml/kg 50% Dextrose "
 Am],mI;Pac]hac]:tac];pQn]n}eStL. Sc]wL:Tat]:kUiw]wan]nG];lUit]:Sm].eA,eS 2.5mmol/l n}suic]
hG]:Aw] 50% Dextrose 2.5ml elL;nm]. 2.5ml eSSG],pn]tac];KU;lc]" lUiw]nn].
hG]:lQc].pn]nUm];Em:"
w}a;eS 1 sUw]:mUc];yw]. hG]:Kiun];kUt],sqt]:Tat]:kUiw]wan]nG];lUit]:pn]"
413
24 eKL:PUim].Tqm]
luk]:AWn],kUit],mG],pQn]nUiw].lUic]
pgc],wL: luk]:AWn],AL,yu 4 wUc]:lUc];tC]:et,pQn]nUiw].liUc]"
mI; hQt];sWm];nc], piUc]nm];tL,lum];

Pac]hac]:sUiw].mqc];Kw]: lL;luk]:AWn], 2 liUn]lUc];tG]:
Tam]puin];tUw]El: kUt], mI;/Am],mI; pQn]kWc].lUit]:tqk],EP:
Tt];luk]:AWn],hG]:tQm] Am],mI;
TUn]:" Aw]lUit]:luk]: sC]: Sc]wL:sw]:kw],tiuk].mI;lWc]:m}:sG]
AWn],eS hLtUv];kum], luk]:AWn],lQk],liUw] hqc];yU,n}suic] – wUn].Sgn],
lUit]:' kUt],tUv];Tat]: 24 sUw]:mUc]; Aw]lUit]:AWk],tL,kUt],Tt];
G6PD " Aw]lUit]:Em: lWc]:hQt];kan]Kgc]tp];' kUt],
luk]:Agn],eShLkum], lUit]: CMV
lUit]:w}." Am],sC]:
Tam]puin];tUw]El: kUt],Tt];luk]:AWn],hG]:tQm]TUn]:"
tac];pQn]An]Aap]:etpQn]l}:El: mk];mn]:tac];pQn] An]Am],miUn]kn]
Physiological kUit],pL;sUiw].mqc]; Billary Hypothyroidism Tat]: G6PD tUk];ygm];

Jaundice tac];pQn]Kw]: atresia lin].yG],' etL,Tiuc]luk]:AWn],AL,yul}:
lWc]:kUt],Tt]; mUiw]:pL;tWc]. luk]: SIyQw]: S}:mqn];tI:Sa}lI' SWc]wUc]: nUiw].tuik].lUic]yU,'
luk]:AWn],AL,yu AWn],nG];tgc]. km],lm] Piw]nc]hqc]:' hG]:tqt]:etL;wL: lgc]:nUiw].
2 wUc]:lUc];tG]: nan];yG]," SIPa}:nk]; hqc];tWt],lUit]: lUic]n}. Am],sG]:yWn].tac];
pQn]pk],ktI,yU," tp];El:mam].yG]," AWn],' TUic];" pQn]tac],An]eSpQn]'
nm].nk];lIKuin]:" AWk],mun],man], tp];yG]," Aw]liUt]:tL,kUt],tUv]; CBC
Em:Am],l}:m}:sG] Et,sQm]mUiw]:kUit], El: G6PD"
sWm]; mL;'tLkqn]'"
pn]hqc];sG]wL:Am],mI;eP;Sc]" tUic],pac],kn]tc];emLyL kUt],tUv];lWc]:hQt]; w}a;eS 1 wUc]:
Sc]wL:luk]:AWn], AL,yu eS pn] IM Vitamin kan] mak],ln] Kuin];em;Tt];tUv];
l}:Tuic]SWc]wUc]:yw]. K1 mg T};r}W;tI:eKL; Kiun];"
nUiw].tuik].lUic] hG];mL;EnKuin];
luk]:AWn],ekL.lG]eSAm],wL: Sc]pQn]nUiw].lUic] etl}:Aw]AWm],lqt],
tI:eA,Sut]; nuic:] wn]; 4 sUw]:mUc];"
414
eKL:PUim].Tqm] 24
luk]:AWn],kUit],pL;tac];pQn]naw]nUk].
eKL:puit],tI:pWc],
 Em:mI;sUiw].mqc];naw]nUk].El: w}a;eSluk];AWn],kiUt],mL; 7 wn]; hn]wL:mI;sUiw].mqc];naw]nUk]." luk]:Agn],
An]luk].tI:Em:pL;tWc].An]pQn]naw]nUk]. mUiw]:p},kUit], 7 wn];nn]. etl}:kUt],sqt]:pn]sUiw].mqc];
naw]nUk]." epL;Tiuc] 7 wn];yw]. etl}:kUt],pn]Tqc]:km];nuic]:" wa};kUit],yw].nG]; 1 lUin]nn].
luk]:AWn],naw]mUiw]:lG]eSAm],wL: etl}:kUt],pn] sUiw].mqc]; naw]nUk]."
luk]:AWn], sac]:pQn]eP;mUin]nc],pL:tG]:n}.
 luk]:AWn],sac]:ta}
 sac]:yUt];yLPit];PUn]kn]tc];tac];pQn]kWc].lUit]:tqk],EP:
hG]:tUv];tI: piUc]nm];tL,lum];lL;luk]:AWn],pQn]kWc].lUit]:tqk],EP:
lWc]:yUt];yL
P. falciparm
ygn].wL: cw];la};luk]:AWn], sac]:h}a.hqc];w};El: AWn]tac];Sut]; hG]:sG].tiuw]; Loading dose eS
yUt];yLpn]"
Artesunate 2.4mg/kg IM w}a;nn]. oral artesunate 2 mg/kg/wn]; tL, 7 wn];"
P.vivax
wn];Ti 0 El: wn];Ti 1 Chloroquine 10 mg base/kg niuc]:wn];niuc]:pgk]:"
wn];Ti 2 Chloroquine 5mg base/kg
tiun];etAm],l}:pn] Primaquine hG]:luk]:AWn],kUit],mG],lL;lL;"
Suip],lum];lL;luk]:AWn],kGL,mUin]kw], (tWn]: 2)
tac];pQn]naw]nUk]. – An]luk]:AWn], 2 lUin]lUc];tG]:pQn]

eKL:puit],tI:pWc],
 luk]:AWn], 2 lUin]lUc];tG]:An]kUt],vL;sUiw].mqc]naw]nUk]."
lgc]:luk]:AWn],sac]:ethak]:l}:n}.Suc]' emLlum];lL; (nurse) ekL.An]lum];lL; etl}:
pG].Tt];yLeSpn]"
415
24 eKL:PUim].Tqm]
luk]:AWn], sac]:pQn]eP;mUin]nc],pL:tG]:n}.
 luk]:AWn],sac]:ta}
 sac]:yUt];yLPit];PUn]kn]tc]; tac];pQn]kWc].lUit]:tqk],EP:
 hG]:tUv];tI: piUc]nm];tL,lum];lL;luk]:AWn],pQn]kWc].lUit]:tqk],EP:
 hqc];lUit]:eA,haw].hqc];
lWc]:yUt];yL
ygn].wL: cw];la};luk]:AWn], sac]:h}a.hqc];w};El: AWn]tac];Sut]; hG]:sG].tiuw]; Loading dose eS
yUt];yLpn]"
Artesunate 2.4mg/kg IM w}a;nn]. oral artesunate 2 mg/kg/wn]; tL, 7 wn];"
PUim].Tqm]Tat]:wI,tL,min],El: AL,hL,r
MULTIVITAMINS, FOLIC ACID AND FERROUS
luk]:AWn],kU:ekL. An]lUin]Am],TUn]:eSkUit],mL;nn]. epL;kin]nUm];l}:lIlImL; etl}:lQc].pn]Tat]:
Multivitamins El: Floic Acid"
miUw]:luk]:AWn],l}:AL,yulUin]pa} etl}:lQc].pn]Tat]: Multivitamins El: Iron"
hqc];yL Floic Acid (Dose of Folic Acid)

2.5mg (kuic],mQt].) 1 wUc]: 1 pWk]:
Vitamin K
Vitamin K n}.sW}:hQt];hG]:lUit]:kam]:' luk]:AWn],mac]ekL.etsac]:pQn]eP;l}: yWn].Kat],Tat]: Vitamin K
mUin]nc],lUit]:AWk],ha}.hqc];"
luk]:AWn],An]sac]:mI;eP;l}:
 luk]:AWn],lUin]Am],TUn]:eSkUit],mL;
 luk]:AWn],nm].nk];eA,liUw] 2.5 kg"
 luk]:AWn],An]kUit],AWk],mL;tI: Em:mI;lUm];mL:mU
 luk]:AWn],An]kUit],AWk],mL;tI: Em:tuik].kin]yLTI,pI,yU,"
luk]:AWn],An]wL:nc],pL:niUw]n}. etl}:pn] IM 1mg Vitamin , 0.1ml phytomenadion phosphate"
416
eKL:PUim].Tqm] 24
luk]:AWn],pQn]tac];pQn]kac];Kqc]
eKL:puit],tI:pWc],
tac]pQn]kac];Kqc]n}. pQn]tac];pQn]yWn].sUiw].mqc]; Clostridium tetani Kw]:eS kWc].mn];AWk],mL;Kiun]; El:
pQn]yw]." luk]:AWn],kUit],mG],n}. pQn]yWn].sUiw].mqc];Kw]:tI:Sa}lIyw]."
Sc]Em:pL;tWc]. l}:Sm];yLeh.kc]: tac];pQn]kac];Kqc]w}. (eA,Sut]; 2 pWk]:)n} sc],etsac]:eh.kc]:

tac];pQn]l}:yw]."
Pac]hac]:tac];pQn]
Pac]hac]:tac];pQn] etet,AWk],wa};eSkUit],yw]. 1 wUc]:" Pac]hac]:mn];etpQn]
 kam]:nUiw].tI:eKL;etKQc]:Kqc]"
 Auin]Kw]:nm].tac];kin]yap],"
 kam]:nUiw].etkqn],eS epL,can];cqk]:Kuin]:' An]epL,can];sUic].n}n}. ethQt];hG]:luk]:AWn], sQp];kqn];
Et.Et."
luk]:AWn], sac]:pQn]eP;mUin]nc],pL:tG]:
 luk]:Agn],sac]:ta}
 SQn]:tac];Auin]Kw]:lUc]; pUic]:El: Aiut];Km]tI:lWt],lUm];TUv]:sG]eSpQn]pWt],kI:"
 lWc]:hQt];kan]lUm];TUv]:sG] Am],pQn]pk],ktI,"
 mI;pn]hLkQw],lUv]:SQn];AL,yUc],kGL,etL,sUw]:"
lWc]:yUt];yL
 pn]yL Benzylpenicillin IV 50mg/kg km];lQw] (w}a;nn]. QID tL,niuc]:wUc]:)"
 Aw]Sa}lIAn]hqc]:Km]w}.nn]. AWk],pqt]:' hQt];lgc]:mUt];SG]pn] An]kuit];w}."
 nc],huiw]luk]:AWn], etsQw];l}:yLeh.kc]:kac];Kqc]' yLsG]nim]' SG],lWt],lUm];TUv]:sG] El:
l}:lUm];Kw]:lUm];AWk],lInn]. hG]:SUc],kGL,hUc];yLw};w}; nc],kL:pQn]l}:"
417
Piun]Aic] (Index)
25
Abortion tUk];luk]: 252
Abscess AUm]ngc] 319
Albendazole EA,pqn],tSUn]l] 129, 174, 372
Adrenaline Atuv],nlin], 65, 163, 371
Alcohol nm].lw]: 74
Allergy Am],mqn]:Tat]: 328
Aluminium AlU,mI,nIym]< 372
Aminophylline AmInUw]P},lin]; 372
Amitriptyline AmI,Trip],Tlin], 367
Amoxicillin Amgk],SI,Slin], 89, 168, 171, 210, 373
Amphetamine Aqm],PI,tmin]; 40
Ampicillin Aqm],pI,SIlin], 127, 164, 166, 374
Anemia lUit]:sac] (EA,) 148, 159
Anaphylactic shock Am],mqn]:Tat]:eS kiuc].kac].lium];tUw] 162
Anxiety disorders tac];m}:sG]Am],pk],ktI, 57, 74
Appendicitis S}:tic],kG]: 23
Artemether AL,tI,mI,tL, (yLnaw]nUk].) 369
Artesunate AL,tI,SUnQt]. (yLnaw]nUk].) 361, 365
Arthritis lup],kp];sQp];kG]: 218
Ascaris mqc];tUik],Aqt],S]kL,rit].S]
Aspiration pneumonia ygn]. Aspiration eSpQn]mL;pgt],kG]:
Aspirin Aqt],S]prin], 81, 87, 136
Asthma Aqt],SmL, tac];pQn]TUv]:sG]kp]. (mWc]eKL:) 300
Atenolol AtI<enLelL< (yLtQk];lUit]:) 374
Atypical pneumonia tac];pQn]pgt],kG]:tI:Am],Sm],mL,tL, 23
Avian influenza tac];pQn]K}:wt];yG] nUk]./k}, 286
Azithromycin ASI,trUw],ma},Sin],
Benzathine Penicillin pqn],Stic]; pqn],nI,Slin], 84, 146, 375
Benzyl Penicillin pqn],da}; pqn],nI,Slin],
Betel nut mak],mU.' yL,pU. 344
BMI (Body Mass Index) BMI Kap]:tUw]kUn]; 357
Bronchiectasis nm].Kgn]:tum]nG];lgt],lUm];pgt],
Bronchitis tac];pQn]lgt],lUm];sQp];kG]: 295
Bronchiolitis nm].la};tc]tQm]nG];lgt],lUm];Agn],pgt],eSkG]: 296
Burns sQp];f};m}: 323
Candidiasis sUiw].mqc];kqn],tI,tUiw],Kw]: 88
Carbamazepine yL:yL Carbamazepine 376
418
Puin]Aic] 25
Caries KQw]:mqc]; 87
Catarac tac];pQn]tLkqn] 106
Ceftriaxone yL Sqp],JTL,SUc]< 147, 164, 166, 172, 376
Cellulitis sQp];yQn];kG]: 320
Chancroid tac];pQn]kL,lac],ngc]ngk]: 146
Chickenpox mak],lqc];Kaw] 331
Chlamydia sUiw].mqc]; Chlamydia 147
Chloramphenicol yLKlUw],lqm],fI,nI,ekL; 103, 168, 172, 377
Chloroquine yLKlUw],rUw],kCin]; 362
Chlorpheniramine yLKlUw],fI,nI,rm],min]; 65, 164, 377
Cholecystitis TUc]lIkG]:
Cholera tgc].kGL,kL,l 118, 120, 124
Chronic Respiratory Diseases tac];pQn]lgt],lUm];TUv]:sG]Kaw];huic] 298
Cimetidine yLSI,mI,TI,tin]; 379
Ciprofloxacin yLSI,prUw],flgk],SL,Sin], 121, 168, 379
Clindamycin yLKlin],tma},Sin],
Cloxacillin yLKlgk],SL,Slin], 170, 379
Codeine kUw],tQn]; 380
Colic sQp];Aiw]:
Coma ta}luim]; 36
Common cold tac];pQn]K}:wt]; 283
Condom TUc]yac] 271
Conjunctivitis tLsQp]; (yG];tLkG]:) 109
COPD tac];pQn]lgt],lUm];TUv]:sG]tip],Kaw];huic] 306
Cotrimoxazole yL KUw],Trg},mgk],SL,dUn]l] 168, 380
Counselling lWc]:pn]tac];K}:sC] 196, 249
Croup A}tUc];luk]:Agn], 284
Cutaneous larva migrans sUiw].mqc];An]sac]:sI;Kw]:nG];Piw]nc] 333
Cystitis hUc];yQw]:kG]: 132
Danger signs Pac]hac]:mI;eP; 20, 22
Dehydration Kat],Tat]:nm]. 113
Delusion sG]wUn].Sgn],eSyum],ym]Pit];
Dengue naw]K}:lUit]:Agk], 190
Depot injection yLSm]; tI,pUw], tL,Eh.kc]:Sn],eT, 273
Depression Tat]:sG]tUk]; 57
Dexamethasone Tqk],SL,mI,tL,SUn]< 67, 164, 380
Diabetes Mellitus tac];pQn]yQw]:wan] (yQw]:sQm];) 91
Diarrhoea tac];pQn]tgc].kGL, 113, 408
Diazepam ta},yL,dI,Pqm]< 40, 164, 41
Digoxin ta},kUw],Sin]< 79, 382
419
25 Puin]Aic]
Diphtheria tac];pQn]eKL;tip], 285
Dog bite hg};sQp];mLKUp]; 213
Domestic Violence lgc]:hQt];h}a.tQk];tQc]nG];nL:hUin]; 277
Doxycycline yLtgk],SI,S}a,klin]; 105, 166, 168, 174, 382
Drug doses hqc];yL (tac];nm]eA,pgk]:km];yL) 371
Dysentery tWc].ngc], 118
Dysuria yQw]:sQp];kqn]; 133, 134
Eclampsia Agk],sgk];mUiw]:pL;tgc]. 262
Ectopic pregnancy et,Sn],eT,tI:lgt],SUc],K}, 255
Eczema tac];pQn]hw]: 329
Efavirenz AI,fL,wI,rqn].d]
Enalapril AI,nL,lL,per;l] 78, 383
Encephalitis Pac]hac]:Agk];eALkG]:kgp]:siUw].mqc];w};rt].S]] 193
Eosinophilic pneumonia ygn].mQt].lUit]:Kaw] Eosinophilic eSpQn]pgt],kI:
Epigastric pain lin].tgc].sQp]; 54
Epiglottitis lin].Puv],pik].Kgc]lgt],lUm];tI:Am],hG]:
tac];kin]/nm]. Kw]:kCL,nC];lgt],lUm];l}:
Epilepsy tac];pQn]mL:mU 268
Ergometrine AL,kUw],mTrin]; 383
Erythromycin AI,Er,trUw],ma},Sin], 383
Eschar Piunn ] Uiw]. Eschar
Eye diseases tac];pQn]tL 107
Family planning lgc]:wac];Pqn]nL:hUin]; 270
Fatigue hUiw]. KLAUn]:muiw];AUn]: 42
Ferrous Sulphate Ef;rqt].SL,l]fQk]. 227, 232,384
Fever lUm];naw] 44, 171
Folic acid Ef;rqt].Aqt].Sit]. 227, 232
Folariasis tac];pQn]tin]sac]. 174
Fluconazole frU,KUw],n dUn];l] 203, 206, 384
Fluoxetine frU,Agk],SI,tin]; 243
Follow up care nt].mL;yUt];yLKuin]; 24
Fungal infection tac];pQn]sUiw].mqc];SL; (hQp];) 296
Furosemide fiw],rUw]<SI,m}. 71, 138, 161, 181, 385
G6PD deficiency Kat],Tat]: G6PD 157
Gastritis hUc];Kw]:kG]: 54
Gastro- oesophageal reflux tac];pQn]eKL;lUit],m}: (kgp]:nm].tI:hUc];Kw]:Kuin]:mL;
disease tI:lgt],Auin]tac];kin])
Gender based violence lgc]:hQt];h}a.tI:Aic]niUw]lgc]:pQn]s}a;yic]; 277
Gental uncer/warts KUic]:Ac],kL,pQn]sQp];/hut]; 144
420
Puin]Aic] 25
Gentamicin sqn],tL,ma},Sin], 164, 168, 385

Gentian Violet yL Gentian Violet 89, 145
Gingivitis huik],kG]: 87
Glasogow Coma Scale pk];pUic]pn]Knqn]; Glasogow Coma 36
Glaucoma tac];pQn]tLmUn], 107
Glibenclamide kla},pqn],klL,ma}. 93, 386
Glomerulonephritis SQn]:liUt]:nC];mak],kqw];kC]: 138
Goiter eKL;nQc] (Agm];) 99
Gonorrhoea kL,lac],ngc]nC]; 142
Gout tac];pQn]kw]. (Gout) 220
Haematuria yQw]:pL;lUit]:
Hallucinations tac];hn]AL,yUc],Pit];pUic]:
Haloperidol Eh,lUw],Ep,rI,etL; 386
Headache hUw]K}: 57
Heart failure hqc];hUw]sG]EA, 75
Hepatitis tac];pQn]tp];kG]:nUiw].lUic] 122
Herpes simplex sUiw].mqc];w};rt].S] Herpes simplex 329
Herpes Zoster sUiw].mqc];w};rt].S] Herpes Zoster 332
High energy milk nm].nUm];An]mI;Tat]:AL,hL,rSuc] 23
HIV(AIDS) AQk].KY]A},wI, (AQt],S]-hqc];Kam],tUw]tUk];) 159,194
Hookworm mqc];tUik],pak],mQt]; 128
Hydatidiform mole Sn],eT,mak],Ait], 265
Hydralazine ha},trL,ldin]; 72, 387
Hydrochlorothiazide ha},trUw],KlUw],rUw],tI,yUiw],da}. 72, 387
Hydrocortisone ha},trUw],eKLTI,SUn]< 67, 387
Hyperglycaemia Tat]:klU;kUt].S]nm] 94
Hyperthyroidism ehL,mUn];l]mak],ln]T};rW};nG];tUw]nm] 97
Hyperopia tLmUw];lqc] 23
Hypertension lUit]:Suc] 68
Hypertensive encephalopathy ygn].lUit]:Suc]El:Agk];eALkG]: 82
Hypoglycaemia Tat]:klU:kUt].S]eA, 94
Hypothyroidism ehL,mUn];l]mak],ln]T};r}W;EA, 96
Ibuprofen Aa},pU<prUw],fqn], 388
Immunisation, schedule of lgk];pUic]Kaw];yam];Sm];yLEh.kc]: 361
Impetigo sQp];yQn]; 318
Indinavir Ain],tI,nL,wL, 32
Indomethacin Ain],tUw],mI,tSin], 136, 221,388
Insulin Ain]<SU<lin]< 93
Interstitial Lung Disease lgt],lUm];Agn],nG];pgt],kG]: 297
Intoxication vL;kgc].yL:yL
421
25 Puin]Aic]
IUD(Intra Uterine Device) SG],wqn]nG];hUc];luk]: tL,eh.ham]:Sn],eT, 273
Japanese encephalitis tac];pQn]kYL,pan],Agk];eALkG]: 162
Ketoconazole KI<TUw],KUw],nL,dUn];l] 202
Kwashiorkor kGL,KYI,eyL,ekL; 23
Lamivudine lL,mI,wiw],tin]; 32
Larva currens lL,Ew,KL,rqn], 333
Leprosy tac];pQn]tut]: 334
Leptospirosis tac];pQn]yQw]:nU lqp].tUw]Sp}arUw]Sit].S] 165, 169
Liver diseases tac];pQn]tp]; 122
Life style treatment l}a;yUt];yLlUv]:lgc]:yU,Sw];kin]Sac]: 23
Lovibond lUw],wI,pgn]; 350
Magnesium Sulphate mk],knI,SI,ym], SL,l]fQk]. 23
Malaria tac];pQn]naw]nUk]. 150, 176, 178
Malaria treatment tables lgk];Kgc]:lgc]:yUt];yLnaw]nUk]. 184, 361
Malnutrition tac];pQn]Kat],AL,hL,r 150, 224
Manic disorder tac];pQn]sit];sC] An]Am],pk],ktI, 242
Marasmus kan]lU.Sum];niUw].El:AQn]hqc];kgp]:Kat],Tat]:AL,hL,r 228
Mastoidotis tac];pQn] sUiw].mqc];Kw]:lup],lc]hU
Measles tac];pQn]mak],lqc] 209
Mebendazole yLmI,pqn],tdUn]<l] 23
Mefloquine yLmqp],flUw],kGin]; 182, 363
Meningitis tac];pQn]yG];hUm],Agk];eALkG]: 60, 162, 166, 176
Mental Health pa};yU,lIsG] 242
Metformin yLmqt],efL,min]; 93, 389
Methyldopa yLmI,ta};l]tUw],pL, 72, 389
Metoprolol yLmI,TUw],prUw],elL;l] 78, 390
Metronidazole yLmI,TrUw],na},tdUn]<l] 119, 126, 390
Migraine m},krQn]; (tac];pQn]hUw]K}:Pa},lQw]) 58
Misoprostol yLmI,SUw],prUw],SeTL;l]
Molar Pregnancy Sn],eT,mak],Ait], 265
Mood disorder sC]Am],pk],ktI, 242
Nephrotic syndrome tac];pQn]mak],kqw];An]hQt];hG]:kC]:tc];tUw] 138
Newborn and infant Guidelines piUc]nm];pa};yU,lIluk]:Agn],kiUt],mC],El:luk]:Agn],lqc] 402
Nifedipine yLnI,fI,tI,pic];
Night blindness tac];pQn]tLPac];k}, 109
Norplant Pc]KQm]tG]:Piw]nc] tL,Eh.ham]:Sn],eT, 274
Numbness nQt];nL 42
Obesity pI;pUn].tI: 240
422
Puin]Aic] 25
Omeprazole AUw],mI,prL,dUn]<l] 391

Oral contraceptive pill yLkin] tL,Eh.ham]:Sn],eT, 271
Opioid yL:Pin], 341
ORS Tat]:nm].kUiw] 114, 172, 358
Osteoathritis tac];pQn]Kl } up],kp];sQp];kC]: 219
Osteomyelitis lup],sQp];kG]:pQn]ngc] 221
Otitis hUkG]: 289
Outbreak Kaw];yam];siUw].mqc];eP:tiun];w}; (pQn]kL,l) 345
Oxytocin Agk],SI,tUw],Sin],
Pain sQp];' kqn];' kUn].Kiun]: 49
Palliative care la};lum];lo; hQt];hG]:lgc]:sQp];kqn];lIKiun]: 281
Paracetamol pL,rL,SI,temL;l] 50, 58, 172, 178, 391
Paracheck pL,rL,KYqk]. KUic]:kUt],sUiw].mqc];naw]nUk]. 187
Paragonimus pac]:kI: ygn].mqc];tUik],Pqp].
Peakflow tables lgk];Kgc]:An]TUv]:sG]l}:nm]Sut]; 351
Pentizocine pqn],TI,dUw],Sin]<l] 136, 392
PEP( Post Exposure Prophylaxis) lWc]:eh.kc]: miUw]:tiUw].vL; 30
Perodontitis kWp]:sUiw].mqc];tac];pQn]eSnUiw].hBik],lU.lqw] 88
Peritonitis Kap]:yG];tgc].kG]:
Pertussis tac];pQn]A}hut], 284
Pharyngitis hUik],kac]haw]kG]: 88
Phenobarbital fI,nUw],pL,pI,tL< 41, 392
Phenytoin fI,En,Tg}; 393
PID(Pelvic Inflammatory Disease) tac];pQn]lup],kum],(tUc],)kUn]:sQp];kC]: 142
Placenta abruption hUk].yan]Pat],hUc];luk]:sw]. 23
Pneumonia tac];pQn]pgt],kI: 291, 406
Poliomyelitis pUw],lIyUw], (tac];pQn]lup],AUn]: AQn]ta}) 211
Post Partum Haemorrhage wa};eSkUit],yw].lUit]:Tgk], (hUw]:) 258
Post Traumatic Stress Disorder wa};Tuk],tum].tUiw].sG]haw].hqc];eSpQn]mL;tac];pQn]sG]mip],kin];
Psychosis mL:' ygc],wUn]; 247
Praziquantal pL,rL,sI,kGan]tL< 393
Prednisolone prit],nI,SUw],lUn]; 202, 220, 305, 394
Pre-eclampsia liUt]:Suc]miUw]:pL;tgc]. 23
Premature labour lUin]p},TUn]:eSkUit],luk]: 261
Pregnancy pL;tgc]. (man];) 207
423
25 Puin]Aic]
Presbiopia tUm].tUiw].tL 104
Preventive care lgc]:lum];lL;tL,Eh.kc]: 19
Primaquine pra},mL,kGin]; 179, 182, 394
Propranolol prUw],prL,nUw],elL; 73, 98, 395
Propylthiouracyl prUw],pa},l]ta},AUw]yU,er,Sa},l] 98, 394
Prostatitis hUc];yQw]:kG]: 134
Pterygium tLtin], (etL:niUw].) 107
Pyelonephritis mak];kqw];kG]: 131
Quinine yLkuv],nin]; 180, 364
Rabies tac];pQn]kWc].mLygc], 212
Rape lgc]:kn].sn] 276
Respiratory diseases tac];pQn]lgt],lUm];TUv]:sG] 282
Rheumatic fever mI;lUm];naw]kgp]:tac];pQn]K}lup],kp];sQp];kC]: 83
Rheumatoid arthritis tac];pQn]K}lup],kp];sQp];kC]: 219
Ringworm mqc];tUik],mUn];
Salbutamol yLSL,l]piw],TL,emL 396
Scabies tac];pQn]KUm];pQn]hw]: 325
Scrub typhus tac];pQn]K}:lak].Sat],kgp]:lgc]:hc]:wUv],
(SKrap].t}.Pat].S]) 167
Septic abortion Sn],eT,t}anC];tgc].El:pQn]kgc]. 254
Seizures can];Kuin]:
Severe malaria tac];pQn]naw]nUk],haw].hqc]; 178
Sexually Transmitted Infections siUw].mqc];tac];pQn]sp];tit]; kgp]:lgc]:hUm]:kL,m 146
(STI)
Shock kiuc].kac].lium];tUw] 62
Sinusitis kUc]lup],KU:lc]sQp]; 283
Skin diseases tac];pQn]Piw]nc] 318
Smoking lut],lqn];yL:
Sodium Valproate SUw],tI,ym], ewL,l]prQt]. 397
Spironolactone Spa},rUw],nUw],lqt],Tgn]; 78, 139, 397
Sterilisation Tm];mn] (hQt];mn]) 275
Stomatitis nG];SUp];kG]: sQp]; 88
Stones pQn]li 136
Strabismus tLsa}. (tLAUin];) 108
Supplementary feeding program la};kan]lQc].lUtac];kin]PUim].Tqm]hqc]; 229
Stridor SQc]TUv]:sC]hqc];
Stroke ta}Pak], 60, 81
Syphilis klac],Sip].PI<lit].S] 146
Taenia(tape worm) mqc];tUik],tUw]Pqp]. 129
Temporal arteritis AQn]lUit]:KI:mqp].kG]: 61
424
Puin]Aic] 25
Tension headache ygn].mI;lgc]:tQk];tQc]sG]nL,eShUw]K}: 57

Terramycine RTL,ma},Sin], 102
Tetanus tac];pQn]kac];Kqc] 171, 323, 417
Tetracycline yL Tqt],TrL,S},klin]; 398
Thalassaemia TL<lat].SI;mI;yUiw]< 155
Thyroxin Ta},rUw],Sin]; 97, 399
Tiredness hUiw].AUn]: 42
Tonsillitis lin].k},kG]: 283
Trachoma tac];pQn]Kgp],tLsQp];Sqp], 104
Tramadol TrL,mL,etL; 398
Transfusion Tqm]lUit]: 158
Tuberculosis tac];pQn]pgt],mqc]; (kG]:) 307
Typhoid fever tac];pQn]naw]S}:kG]: 171, 172
Universal precautions lgc]:Tuk],lIfac]. An]sC].kn]tc];lum]:fL. 26
Urethritis lgt],yQw]:kG]: 135
Urticaria mun],man], 328
Vaginal discharge nm].ngc]lUc];tI:KUic]:Ac],kL, 142
Vision Sa}tL 102
Vitamin A Deficiency Kat],Tat]:wI,tL,min], eA, 235
Vitamin B1 Deficiency Kat],Tat]:wI,tL,min]pI,niuc]: 237
Weight for Height nm].nk];An]np].Sgn],sgm];SUn],Suc] 352
Worms mqc];tUik], 128
Wounds sQp];mat], 321
Xerophthalmia SI,rUp],f]tL,l]mI;yUiw]< 110
Zidovudine da},tUw],wiw],tin]; 207
Zinc dic]. 115
m}atgc];" "nC];kn]n}. etEnw}. nL:lik]:nC];kn] An]lm],lgc]:liUw]piUn]:w}.kUv];" (tUw]yac],-

lUm];naw] nL:lik]: 40)" kUv];kL: tC]:hUw]eKL: Aac]:Aic] nC];kn]nn].nn]. etsiEnw}.Kiun]; kn]
tI:Aic]:Aic]w}.yU,"
425
426
mak],hUw]sG]kuit];
lgc]:sg}:Tqmp] n]pgt],El:mak],hUw]sG]
hgc].ygn];tac];sg}:Tqm]
la};Puik];hQt];hG]:lgt],lUm];TUv]:sG]piUt],
tUv];' Tgm],' hU.Suik],
km]tUv];hqc];tgt],lUit]: El: lUm];TUv]:sG]
Sc]wL:Am],mI;
et,sG].lgc]:sg}:Tqm]pgt],El:mak],hUw]sG] TUv]:s]G"(ration 25:2)
SG], IV
Sm];pn]yL IV Adrenaline
Suip],hQt]; lgc]:sg}:Tqm]pgt],El:mak],hUw]sG] TUv]:s]G

yL Adrenaline n}.Kqn]: 3 minit].yw]. Sm];pn]Tqc]:"
Sc]wL:hiuc]kGL, 20 minit].yw].eS Am],mI;Pac]hac]:

TUv]:sC]mL;suic] hG]:kuit];yc].lgc]:Kt];sG]"
427

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BURMESE BORDER GUIDELINES

MEDICAL EDITING REALIZATION

Agencies who have contributed to this edition Contributors:

 Mae Tao Clinic  Drawings: Anchalee Areewong

 Thailand Burma Border Consortium (TBBC)

 United Nations High Commissioner for

pp].piUc]nm];lqn]lin]man]: 2007 (P}a,t};) n}. pQn]pp]. ekL,mtI,p}a;yU,lIt}; Kp].Kiuc]Ait],Agk],

tL,eKL:kCam];An]KUc]:Agk],mL;mG],mL;sC].tiuw];sUiw];n}. p},pgc],l}:wL:eKL:kCam];tI:An]Tuk],mqn]:yw]. mk];mn]:t}a

Treatment El: management – tgn]:tL, Treatment nn].pgc],l}:wL: l}a;yUt];yL Am],nn]

 Am],wL:miUw]:tqm]:piUc]liUc];pp].kU:An]El: eKL:kCam];sC].PL,SL,Aic];klQt]:etc}a:siUw];n}. emLyLKw]l}:Kw]:

lgc]:etl}:fac].tUv];sgm]; lgc]:etl}:SUc],Kaw], Kn]w};

 eKL:liun];Sut];Et. lm];nC];El:S}am}ahUw]eKL: nC];pp].piUc]nm];An]Kp];Kiuc]Ait],Agk],pgk]:km]; 4 n}.l}:

tL,tWc]; - 1 SI,SI, = 1 mI,lI,lI,tiUw],

AFB = Acid Fast Bacilli pqk].TI;rI;yL;hn]lUv]:kan]yWm].nm].AqS].

1 kQw],lUv]:lgc]:fim];Agk],pp]. pgk]:km]; (4) 6

8 tac];pQn]kQw],lUv]: hUw]sC]El: SQn]:liUt]: 68

tp];kC]: (Hepatitis) …………..………………………………………..……...…....……..…. 122

12.4 mqc];tiUk],nC];lm];S}: …………..………………………….………...…..………..……………. 128

tac];pQn]yQw]:nU ( Leptospirosis) …………………..……………………….....……..…. 165

18.4 sG]ygc],wUn]; ..…………….………………..………………………..….…………....……….…. 247

21.2 tac];pQn]pgt],kI: ………..……………………………………..…….………….…....……..…. 291

22.11 Varicella Zoster ………..………………………………..….…….……………......……..…. 331

23 sC].KUw];Kgc] Pit];P}a, 339

24.11 piUc]nm];tL,luk]:Agn],kiUt],mC],El:luk]:Agn],niuc]:KUp],lUc];tC]: ………..……...…… 402

25 Piun]Aic] ………..…………………………..……………….…….………..……..….…...…. 418

pn]lWc]:etl}:Suip],yUt];yL"lat]:EnkUn];pQn]wL: miUw]:lC]wn];lC]etl}:mL;sU; tUv];tI:kn]nL: tL,

tUv];tI: kn] 18 (p}a;yU,lIsC])

tUv];tI:tL,AL,yutc];mUt];" Pac]hac]:tac];tC]:n}.pQn]Pac]hac]: An]pQn]eP;l}:tL,luk]:AWn],

 Tam]tUv];wL: sWc],l}:Sm];yLeh.kc]: (wk].Sin];) yw].hiuw]" epL;p},l}:Sm];ekL: Sm];wk].

1. (Am],mI;lWc]:sm]pQn]n}siuc]) yL,pn]yLnm]liUw] 2-3 mQw];

4. lat]:EnkUn];pQn] l}a;kin]/sC].yL tL,Kw]

tk];etl}:w}.sC]wL: nm]./liUt]: An]AWk],mL;sWm];tUw]kUn];pQn]kU:ekL. sp];tit];siUw].mqc];tac];pQn]l}:"

kgp]:yip];miuw];kn]' lat]:etL,kn]' sup],kn] Am],nn] sC].hgc]:nm].sgm];kn]eSyw].

lgc]:kqc].km]km]:nm] - miUw]:Am],En.ngn];(eS,KYL,)sC] hC]:sC].PEPw}.kgn]," kgp]:wL:epL;hU.tqt]:etL;

mac]pgk]:mI;kUn];tiUw].vL;yw].Am],l}:Et, PEP n}siuc] Tuk],lIpn]hqc];sC]' sgm];lUv]:piUc]yUt];yLEl:

tac];pQn]tp];kC]: pI, El: SI,

lgc]:Siup],tUv];cw];l}a;kUn];pQn] (FOLLOW UP)

PU:Aw]pun]:Pgn]; PEP etTt];Sac]Kk].tgn]:pQn]eP;l}:eS

sC].tiuw]; PEP sgm];nc], tk];etl}:hQt];hC]:mn]:sC]wL:

tI:pgc],l}a;tqk]:lgc]:lium];tUw]mI;l}aSqn];nn]. nC];pp].Entac];n}. etsC].l}a;tqk]:Sek;l]klat].S]kw];

3) kUt],tUv];Pac]hac]:lm],lgc]: (hqc];tgt],liUt]:' hqc];liUt]:' hqc];TUv]:sC]El:lUm];naw]kUn];pQn]) El:

Glasgow Coma Scale Score Blantyre Coma Scale Score

- epL;hUm]:kn]yw].l}:eA,liUw] 5n} Aic]niUw] - epL;l}:Knqn];eA,liUw] 2 pgc],wL:lium];tUw]"

7.2 pQn]can];] (Convulsions)

lgk];Kgc]:- Diazepam Injection 1 vial = 10 mg/2cc

hG]:Sm];pn] IV l}g;l}g; (w};Sut]; 0.5 cc etL, 30 Sqk].kan].)

Diazepam Rectally (PR) Am],nn] IM

epL;etSm];pn] Diazepam PR Am],nn] IM n}.yL,KUn];elL;hC]:hqc];yLAgn]," sC].l}:kU:wn];

7.3 hiUw].'AUn]:Agn],'nQt];nL(Fatigue/ tireness/ Numbness)

7.4 niUw].m}: (lUm];naw])

epL;lUm];m}:luk]:Agn],nm]liUw] 37.5 MC' kUn];lUc]nm]liUw] 38 MC n}siuc] tk];etl}:yUt];yLlUm];naw]

yL,pn]yL Aqt],S]pI,rin], (Aspirin) hG]:luk]:Agn],AL,yulQk].liUw] 12 KUp],lL;lL;"

luk]:Agn],AL,yuyC],liUw] 2 liUn] (tUv];Pac],hac]:pQn]eP; tI:kn] 4)

tL,hqc];yL (Doses) nn].kCL,tUv];tI:Kgc]:S}am}ayL tgn]:liun];Sut];pp].piUc]nm]; tI:kn] 24.9{

yL,pn]yL Aspirin hG]:luk]:Agn],AL,yulQk].liUw] 12 pI< kin]lL;lL;"

 (Amitriptyline low dose) pn]yLAmit].Trip]:T}lin];eA, (pn]yLnm]n}. sC].tiuw];tL,kUn];

tgc].kiuc].kac].sQp];h}a.hqc]; ( Acute abdominal pain)

miUw]:p},pn]lgc]:yUt];yLSc]nn]. Tuk],lIkUt],tUv];kUn];pQn]lIlI" siUc].hiuw]ekL:yw]. mac]pgk]: (kUn];pQn]

An]pQn]siUc].n}km]:nm]n}. kgp]:l}:PL,tt];mL; lUv]:tac];pQn]yC];tgc].kC]:' S}:kic],kC]:' hUc];lIkC]:'

An]pQn]siUc].n}km]:nm]n}. Am],kQw],lUv]:lgc]:PL,tt]; miUn]nc],mak],kqw];kC]:' mqc];tiUk],' tgc].sQp];miUw]:liUt]:

1. GASTRO-OESOPHAGEAL RELUX DISEASE

 pn] antacids: Aluminium hydroxide 500 mg TID nC];wUc]:kac]Kw]:Km]:El:mUiw]:etngn];

3. tac];pQn] hUc];Kw]:sQp]; pqp].tiit].S] (PEPTIC ULCER DISEASE )

tL,kUn];pQn]An]sQp];tI:lin].tgc].kU:ekL. hC]:yL mebendazole Am],nn] albendazole one course