BODY TEMPERATURE ABG ANTHROPOMETRIC MEASUREMENTS

Subnormal <36.6°C pH: 7.35-7.45 HCO3: 22-26mEq/L IDEAL BODY WEIGHT

Normal 37.4°C pCO2: 35-45 B.E.: +/- 2mEq/L
Subfebrile 35.7 – 38.0°C pO2: 80-100 O2 sat: 97% Age Kilograms Pounds
Fever 38.0°C At Birth 3kg (Fil)
High fever >39.5°C 7
3.35kg (Cau)
Hyperpyrexia >42.0°C NORMAL LABORATORY VALUES 3-12 Age (mo) + 9 / 2 Age (mo) + 10 (F)
mo Age (mo) + 11 (C)
AGE HR (bpm) BP (mmHg) RR (cpm) NB Infant Child Adole 1-6 y Age (y) x 2 + 8 Age (y) x 5 + 17
RBC 4.8-7.1 3.8-5.5 3.8-5. M: 4.6-6.2 7-12 y Age (y) x 7 – 5 / 2 Age (y) x 7 + 5
Preterm 120-170 55-75/35-45 40-70 F: 4.2-5.4
Term 120-160 65-85/45-55 30-60 WBC 9-30,000 6-17,500 5-10,000 6-10,000
0-3 mo 100-150 65-85/45-55 35-55 Given Birth Weight:
PMNs 61% 61% 60% 60% Age Using Birth Weight in Grams
3-6 mo 90-120 70-90/50-65 30-45 Lymph 31% 32% 30% 30%
6-12 mo 80-120 80-100/55-65 25-40 < 6 mo Age (mo) x 600 + birth weight (gm)
Hgb 14-24 11-20 11-16 M: 14-18
1-3 yrs 70-110 90-105/55-70 20-30 6-12 mo Age (mo) x 500 + birth weight (gm)
F: 12-16
3-6 yrs 65-110 95-110/60-75 20-25 Hct 44-64% 35-49 31-46 M: 40-54
6-12 yrs 60-95 100-120/60-75 14-22 F: 37-47 Expected Body Weight (EBW):
12-17 yrs 55-85 110-135/65-85 12-18 Platelets 140-300 200-423 150-450 150-450 Term Age in days – 10 x 20 + Birth Weight
Ret 2.6-6.5 0.5-3.1 0-2 0-2 Pre-Term Age in days – 14 x 15 + Birth Weight
BP cuff should cover 2/3 of arm
-: SMALL cuff: falsely high BP
-: LARGE cuff: falsely low BP COUNT (%) Age of Infant Ideal Weight
4-5 months 2 x Birth Weight
BMI BT 1-5 min 1-6 1-6 1-6 1 year 3 x Birth Weight
CT 5-8 min 5-8 5-8 5-8 2 years 4 x Birth Weight
Asian Caucasian PTT 12-20sec 12-14 12-14 12-14 3 years 5 x Birth Weight
Underweight <18.5 <18.5
Normal 18.5 – 22.9 18.5 – 24.9 5 years 6 x Birth Weight
Overweight ≥ 23.0 25 – 29.9 7 years 7 x Birth Weight
at risk 23 – 24.9 10 years 10 x Birth Weight
Obese I 25 – 29.9 30 – 39.9
Obese II ≥ 30 >40

APGAR
LENGTH / HEIGHT
(50 cm) Age Transverse-AP 0 1 2
Inches Blue / Pink body/ Blue Completely
Diameter ratio A
Age Centimeters Inches At Birth 1.0 Transverse = AP Pale extremities pink
At Birth 50 20 1y 1.25 Transverse > AP P Absent Slow (<100) > 100
1y 75 30 6y 1.35 Transverse >>> AP Coughs,
(-)
2-12 mo Age x 6 + 77 Age x 2.5 + 30 G Grimaces Sneezes,
Response
Cries
FONTANELS (-) Some flexion / Active
A
Age Gain in 1st Year is ~ 25cm Movement extension movement
0-3 mo + 9 cm 3 cm per mo Appropriate size at birth: 2 x 2 cm (anterior) Good,
R Absent Slow / Irregular
3-6 mo + 8 cm 2.67 per mo Closes at: Anterior = 18 months, or as early strong cry
6-9 mo + 5 cm 1.6 cm per mo as 9-12 months
Posterior = 6 – 8 weeks or 8 – 10: Normal
9-12 mo + 3 cm 1 cm per mo 4 – 7: Mild / Moderate Asphyxia
2 – 4 months
0 – 3: Severe asphyxia

HEAD CIRCUMFERENCE GCS

(33-38 cms) THORACIC INDEX
Function Infants/Young Older
TI = transverse chest diameter Eye 4- Spontaneous Spontaneous
Age Inches Centimeters AP diameter Opening 3- To speech To speech
At Birth 35 cm (13.8 in)
2- To pain To pain
< 4 mo + 2 in + 5.08cm Birth : 1.0 1- None None
(1/2 inches / mo) (1.27cm / mo) 1 year : 1.25
Verbal 5- Appropriate Oriented
5-12 mo + 2 in + 5.08cm 6 years : 1.35
4- Inconsolable Confused
(1/4 inches / mo) (0.635cm / mo) 3- Irritable Inappropriate
1-2 yrs + 1 inch 2.54 cm 2- Moans Incomprehensible
3-5 yrs + 1.5 in + 3.81cm 1- None None
(1/2 inches / year) (1.27cm / mo) Motor 6- Spontaneous Spontaneous
6-20 yrs + 1.5 in + 3.81cm 5- Localize pain Localize pain
(1/2 inches / year) (1.27cm / mo) 4- Withdraw Withdraw
3- Flexion Flexion
2- Extension Extension
1- None None

EXPANDED PROGRAM ON IMMUNIZATION ADVERSE REACTIONS FROM VACCINES

VACCINE AGE DOSE # ROUTE SITE INTERVAL BCG 1. Wheal ► small ► abscess ► ulceration ► healing / scar formation in
BCG-1 Birth 0.05mL 1 ID R- 12 wks
or 6 wks (NB) Deltoid 2. Deep abscess formation, indolent ulceration, glandular enlargement,
0.1mL suppurative lymphadenitis
(older) DPT 1. Fever, local soreness
DPT 6 wks 0.5mL 3 IM Upper 2. Convulsions, encephalitis / encephalopathy, permanent brain
Outer damage
thigh OPV Paralytic Polio
OPV 6 wks 2 drops 3 PO Mouth 4 wks HEPA B Local soreness
HEPA B 6 wks 0.5mL 3 IM Antero- 4 wks MEASLES 1. Fever & mild rash
lateral 2. Convulsions, encephalitis / encephalopathy, SSPE, death
thigh
MEASLES 9 mos 0.5mL 1 SC Outer 4 wks ACTIVE PASSIVE
upper BCG Diphtheria
arm DPT Tetanus
BCG-2 School entry 0.1mL 1 ID L- OPV Tetanus Ig
Deltoid Hep B Measles Ig
TetToxoid Childbearing 0.5mL 3 IM Deltoid 1 mo then Measles Rabies (HRIg)
Hib Hep A Ig
women 6-12 mos
MMR Hep B ig
Tetanus Toxoid Rubella Ig
Varicella
 H.E.A.D.S.S.S. H.E.A.D.S.S.S. NUTRITION

Sexual activities Home Environment AGE WT. CAL CHON

◦ Sexual orientation? ◦ With whom does the adolescent live? 0-5 mo 3-6 115 3.5
◦ GF/BF? Typical date? ◦ Any recent changes in the living situation? 8-11 mo 7-9 110 3.0
◦ Sexually active? When started? # of persons? ◦ How are things among siblings? 1-2 y 10-12 110 2.5
Contraceptives? Pregnancies? STDs? ◦ Are parents employed? 3-6 y 14-18 90-100 2.0
◦ Are there things in the family he/she wants to 7-9 y 22-24 80-90 1.5
Suicide/Depression change?
◦ Ever sad/tearful/unmotivated/hopeless? 10-12 y 28-32 70-80 1.5
◦ Thought of hurting self/others? 13-15 y 36-44 55-65 1.5
Employment and Education
◦ Suicide plans? 16-19 y 48-55 45-50 1.2
◦ Currently at school? Favorite subjects?
◦ Patient performing academically?
Safety ◦ Have been truant / expelled from school? TCR β = Wt at p50 x calories
◦ Use seatbelts/helmets? ◦ Problems with classmates/teachers? TCR = CHON X ABW
◦ Enter into high risk situations? ◦ Currently employed?
◦ Member of frat/sorority/orgs? ◦ Future education/employment goals? Total Caloric Intake : calories X amount of
◦ Firearm at home? intake (oz)
Activities
◦ What he/she does in spare time? Gastric Capacity : age in months + 2
F.R.I.C.H.M.O.N.D. ◦ Patient does for fun?
◦ Whom does patient spend spare time? Gastric Emptying Time : 2-3 hours
◦ Fluids ◦ Hobbies, interests, close friends?
◦ Respiration 1:1 1:2
◦ Infection Drugs Alacta Bonna
◦ Cardiac ◦ Used tobacco/alcohol/steroids? Enfalac Nursoy
◦ Hematologic ◦ Illicit drugs? Frequency? Amount? Lactogen Promil
◦ Metabolic Affected daily activities? Lactum S-26
◦ Output & Input [cc/kg/h] N: 1-2 ◦ Still using? Friends using/selling? Nan Similac
◦ Neuro Nestogen SMA
◦ Diet
Nutraminogen
Pelargon
Prosobee

THE SEVEN HABITS OF

HIGHLY EFFECTIVE PEOPLE
by Stephen R. Covey

Habit 1: Be Proactive
Habit 2: Begin with the end in mind
Habit 3: Put First Things First
Habit 4: Think Win-Win
Habit 5: Seek first to understand and
then to be understood
Habit 6: Synergize
Habit 7: Sharpen the saw

EXPECTED LA SALLIAN
GRADUATE ATTRIBUTES
(ELGA)

1. Competent & safe physicians

2. Ethical & socially responsible
Doctors / practitioners
3. Reflective lifelong learners
4. Effective communicators
5. Efficient & innovative managers
 DIARRHEA ACUTE DIARRHEA (at least 3x BM in 24 hrs) ETIOLOGY of AGE

◦ Chronic : >14 days, non-infectious causes 4 Major Mechanisms Bacteria Viruses

◦ Persistent : >14 days, infectious cause Aeromonas Astroviruses
1. Poorly absorbed osmotically active substances in Bacillus cereus Caloviruses
lumen Campylobacter jejuni Norovirus
◦ ORS vol. after each loose stool 1 day 2. Intestinal ion secretion (increased) or decreased Clostridium perfringens Enteric Adenovirus
absorption Clostridium difficile Rotavirus
<24 mo 5-100mL 500mL 3. Outpouring into the lumen of blood, mucus Escherichia coli Cytomegalovirus
2-10 y.o. 100-200mL 1000mL 4. Derangement of intestinal motility Plesiomonas shigelbides Herpes simplex virus
>10 y.o. As much as wanted 2000mL Salmonella
Shigella
Rotaviral AGE (vomiting first then diarrhea) Staphylococcus aureus
For severe dehydration / WHO hydration Vibrio cholerae 01 & 0139
Ingestion of rotavirus ► rotavirus in intestinal villi
(fluid: PLR 100cc/kg) Vibrio parahaemolyticus
►destruction of villi
Yersinia enterocolitica
Age 30mL/kg 75mL/kg
(secretory diarrhea ▼absorption ▲ secretion) ► AGE
<12 1H 5H Parasites
>12 30 mins 2½H Balantidium coli
Blastocyctis hominis
Assessment of dehydration (Skin Pinch Test)
Cryptosporidium
Patient in SHOCK ◦ (+) if > 2 seconds Giardia lamblia
◦ no dehydration if skin tenting goes back
◦ 20-30cc/kg IV fast drip immediately
◦ but in infants 10cc/kg IV (repeat if not stable) Amoeba Metronidazole
◦ If responsive & stable 75/kg x 4-6 hours Ascariasis Al/mebendazole
Cholera Tetracyline
Shigella TMP/SMX (Cotri)
Salmonella Chloramphenicol

TREATMENT PLAN A TREATMENT PLAN C

4 Rules of Home Treatment Treat severe dehydration QUICKLY!

1. Give extra fluid (as much as the child will take) 1. Start IV fluid immediately
2. If the child can drink, give ORS by mouth while the
> Breastfeed frequently & longer at each feeding IV drip is being set up
> if the child is exclusively breastfed, give one or 3. Give 100mL/kg Lactated Ringer’s solution
more of the following in addition to breastmilk
◦ ORS solution First give Then give
◦ food based fluid (e.g. soup, rice, water) Age
30mL/kg in: 70mL/kg in:
clean water Infants
1 hour* 5 hours
(<12mo)
How much fluid to be given in addition to the usual
Children
fluid intake? 30 min* 2 ½ hours
(12mo-5yrs)
Up to 2 years: 50-100 mL after each
loose stool
Repeat once if radial pulse is very weak or not
2 years or more: 140-200 mL detectable
:- give frequent small sips from a cup ◦ reassess the child every 15-30 min.
:- if the child vomits, wait for 10 min then if dehydration is not improving,
resume give IV fluid more rapidly
:- continue giving extra fluids until diarrhea
stops ◦ also give ORS (~5mL/kg/hr) as soon as the child
can drink [usually after 3-4 hours in infants; 1-2
2. Give Zinc supplements hours in children]
◦ reassess after 6 hrs (infant) & 3 hrs (child)
Up to 6 mo: 1 half tab per day for 10-14 days
6 months or more: 1 tab or 20mg
OD x 10-14 days

3. Continue feeding
4. Know when to return

TREATMENT PLAN B

Recommended amount of ORS over 4 hour period

Age up to: 4 mo – 4 mo 12 mo – 12 mo 2 yrs – 2 yrs 5 yrs
Wt: <6kg 6-9.9kg 10-11.9kg 2-19kg
(mL) 200-400 400-700 700-900 900-1400

◦ Use child’s age only when weight is not known

◦ Approximate amount of ORS (mL)

CHILDS WT (kg) x 25
◦ if the child wants more ORS than shown, give more
◦ give frequent small sips from a cup
◦ if the child vomits, wait for 10 min then resume
◦ continue breastfeeding whenever the child wants

AFTER 4 HOURS
◦ reassess the child & classify dehydration status
◦ select the appropriate plan to continue treatment
◦ begin feeding the child while at the clinic
 ORS

• Glucolyte 60 • Pedialyte 45 0r 90

IV-FLUID COMPOSITIONS (Commonly Used for Infants and Child):

-: for acute DHN secondary to GE or other forms -: prevention of DHN & to maintain normal
of diarrhea except CHOLERA. In burns, post- fluidelectrolyte balance in mild to moderate
surgery replacement or maintenance, mild-salt dehydration.
loosing syndrome, heat cramps and heat
exhaustion in adults. Glucose 45mEq Glucose 90mEq
Na: 20mEq Na: 20mEq
Glucose: Cl: Gluconate: K: 35mEq K: 80mEq
100mmol/L 50mmol/L 5mmol/L Citrate: 30mEq Citrate: 30mEq
Na: Mg: Dextrose: 20g Dextrose: 25g
60 mol/L 5mmol/L
K: Citrate:
20 mmol/L 10 mmol/L
• Pedialyte mild 30
-: to supplement fluid & electrolyte loss due to
• Hydrite active play, prolonged exposure, hot and humid
-: 2 tab in 200ml water or 10sachets in 1L water environment

Glucose: Cl: Glucose: Glucose: 30mEq Mg: 4mEq

111mmol/L 80mmol/L 11mml/L Na: 20mEq lactate: 20mEq
Na: HCO3: Na: K: 30mEq Ca: 4mEq
90 mmol/L 5mmol/L 90 mmol/L Energy:
K: K: 20kcal/ 100ml
20 mmol/L 20 mmol/L

ETIOLOGY OF PNEUMONIA

Bacterial
- Streptococcus pneumoniae
- Group B streptococci (neonates)
ARI PROTOCOL (PROGRAM FOR THE CONTROL OF ARI)

- Group A streptococci
- Mycoplasma pnemoniae (adolescents)
- Chlamydia trachomatis (infants)
- Mixed anearobes (aspiration pneumonia)
- Gram negative enteric (nosocomial pneumonia)

Viral
- Respiratory syncitial virus
- Parainfluenza type 1-3 (Croup)
- Influenza types A, B
- Adenovirus
- Metapneumovirus

Fungal
- Histoplasma capsulatum (bird, bat contact)
- Cryptococcus neoformans (bird contact)
Child Age 2months up to 5years

- Aspergillus sp. (immunosuppressed)

Young Infants < 2months old

- Mucormycosis
- Coccidioides immitis
- Blastomyces dermatitides
- Pneumocystis carinii
(immunosuppressed)
(immunosuppressed,
HIV, steroids)

SMR GIRLS
LUDAN’S METHOD (HYDRATION THERAPY) Stage Pubic Hair Breasts
1 Preadolescent Preadolescent
MILD MODERATE SEVERE Sparse, lightly pigmented, straight, Breast & papilla elevated, as small
DEHYDRATION DEHYRATION DEHYDRATION 2
medial border of labia mound, areola diameter increased
< 15 kg, < 2 y/o 50 cc/kg 100 cc/kg 150 cc/kg Breast & areola enlarged, no contour
3 Darker, beginning to curl, ▲amount
> 15 kg, 2 y/o 30 cc/kg 60 cc/kg 90 cc/kg separation
D5 0.3% in 1st hr: ¼ Plain LR 1st hr: ⅓ Plain LR Course, curly, abundant but amount < Areola & papilla formed secondary
4
6-8 hours Next 5-7 hrs: Next 5-7 hrs: adult mound
¾ D5 0.3% in ⅔ D5 0.3% in Adult, feminine triangle, spread to Mature, nipple projects, areola part of
5
5-7 hours 5-7 hours medial surface of thigh general breast contour

HOLIDAY-SEGAR METHOD (MAINTENANCE) SMR BOYS

Stage Pubic Hair Penis Testes
WEIGHT TOTAL FLUID REQUIREMENT 1 None Preadolescent Preadolescent
0 - 10 kg 100 mL / kg Scanty, long slightly Enlarged scrotum, pink
2 Slightly enlargement
11- 20 kg 1000 + [ 50 for each kg in excess of 10 kg] pigmented texture altered
Darker, starts to curl, small
> 20 kg 1500 + [ 20 for each kg in excess of 20 kg] 3 Longer Larger
amount
Resembles adult type but
NOTE: Computed Value is in mL/day Larger, glans &
4 less in quantity, course, Larger, scrotum dark
Ex. 25kg child breadth ▲ in size
curly
Answer: 1500 + [100] = 1600cc/day Adult distribution, spread
5 Adult size Adult size
to medial surface of thigh
 ATYPICAL PNEUMONIA
> 3-12 mo
-: extrpulmonary manifestations - RSV
-: low grade fever - Other respiratory viruses
-: patchy diffuse infiltrates - Streptococcus pneumoniae
-: poor response to Penicillin - Haemophilus influenzae (Type B)
-: negative sputum gram stain - C. trachomatis
- M. pneumoniae
- Group A Streptococcus
Etiologic Agents Grouped by Age
> 2-5 yrs

DENGUE PATHOPHYSIOLOGY
> Neonates (<1mo) - RSV
- GBS - Other respiratory viruses
- E. coli - Streptococcus pneumoniae
- other gram (-) bacilli - Haemophilus influenzae (Type B)
- Streptococcus pneumoniae - C. trachomatis
- Haemophilus influenza (Type B) - M. pneumoniae
- Group A Streptococcus
> 1-3 months - Staph aureus
* Febrile pneumonia
- RSV > 2-5 yrs
- Other respiratory viruses - Streptococcus pneumoniae
- Streptococcus pneumoniae - Haemophilus influenzae (Type B)
- Haemophilus influenza (Type B) - C. trachomatis
- M. pneumoniae
* Afebrile pneumonia - Group A Streptococcus
- Chlamydia trachomatis - Staph aureus
- Mycoplasma homilis
- CMV

DENGUE Dengue Fever Syndrome (DFS) Dengue Shock Syndrome

> MOT: mosquito bite (man as reservior) Biphasic fever (2-7 days) with 2 or more of the ff: Manifestations of DHF plus signs of circulatory failure
1. rapid & weak pulse
> Vector: Aedes aegypti 1. headache 2. narrow pulse pressure (<20mmHg)
2. myalgia or arthralgia 3. hypotension for age
> Factors affecting transmission: 3. retroorbital pain 4. cold, clammy skin & irritability / restlessness
- breeding sites, high human population density, 4. hemorrhagic manifestations
mobile viremic human beings [petechiae, purpura, (+) torniquet test]
5. leukopenia DANGER SIGNS OF DHF
> Age incidence peaks at 4-6 yrs
1. abdominal pain (intense & sustained)
> Incubation period: 4-6 days Dengue Hemorrhagic Fever (DHF) 2. persistent vomiting
3. abrupt change from fever to hypothermia
> Serotypes: 1. fever, persistently high grade (2-7 days) with sweating
- Type 2 – most common 2. hemorrhagic manifestations 4. restlessness or somnolence
- Types 1& 3 - (+) torniquet test
- Type 4– least common but most severe - petechiae, ecchymoses, purpura
- bleeding from mucusa, GIT, puncture sites Grading of Dengue Hemorrhagic Fever
> Main pathophysiologic changes: - melena, hematemesis
a. increase in vascular permeability 3. Thrombocytopenia (< 100,000/mm3)
▼ 4. Hemoconcentration
extravasation of plasma - hematocrit >40% or rise of >20% from baseline
- hemoconcentration - a drop in >20% Hct (from baseline) following
- 3rd spacing of fluids volume replacement
- signs of plasma leakage
b. abnormal hemostasis [pleural effusion, ascites, hypoproteinemia]
- vasculopathy
- thrombocytopenia
- coagulopathy

MANAGEMENT OF DENGUE MANAGEMENT OF HEMORRHAGE

A. Vital Signs and Laboratory Monitoring

Monitor BP, Pulse Rate
We have to watch out for Shock (Hypotension)
Torniquet Test: SBP + DBP = mean BP for 5 mins.
2 URINARY TRACT INFECTION

if ≥20 petechial rash per sq. inch on antecubital fossa

(+) test Suggestive UTI:
- Pyuria: WBC ≥ 5/HPF or 10mm3
Herman’s Rash: - Absence of pyuria doesn’t rule out UTI
- usually appears after fever lysed - Pyuria can be present w/o UTI
- initially appears on the lower extremities
- not a common finding among dengue patients Presumptive UTI:
- “an island of white in an ocean of red” - (-) urine culture
- lower colony counts may be due to:
* overhydration
Recommended Guidelines for Transfusion: * recent bladder emptying
* previous antibiotic intake
Transfuse:
- PC < 100,000 with signs of bleeding Proven or Confirmed UTI:
- PC < 20,000 even if asymptomatic - (+) urine culture ≥ 100,000 cfu/mL urine of a single
- use FFP if without overt bleeding organism
- FWB in cases with overt bleeding or - multiple organisms in culture may indicate a
signs of hypovolemia contaminated sample

> if PT & PTT are abnormal: FFP

> if PTT only: cryprecipitate

3-7cc/kg/hr depending on the Hct (1st no.) level

(D5LR)
10-20cc/kg fast drip PLR - hypotension, narrow pulse
pressure fair pulse

Leukopenia in dengue: probable etiology is

Pseudomonas

therefore: give Meropenem or Ceftazidime

TREATMENT OF RHEUMATIC FEVER

ACUTE GLOMERULONEPHRITIS RHEUMATIC FEVER
A. Antibiotic Therapy
Complications of AGN JONES CRITERIA:
- 10 days of Oral Penicillin or Erythromycin
- CHF 2° to fluid overload
- IM Injection of Benzethine Penicillin
- HPN encephalopathy A. Major Manifestations
- ARF due to ê GFR - Carditis (50-60%)
*** NOTE: Sumapen = Oral Penicillin!
- Polyarthritis (70%)
- Chorea (15-20%)
B. Anti-Inflammatory Therapy
STAGES of AGN - Erythema Marginatum (3%)
- Oliguric phase [7-10days] – complications sets in - Subcutaneous Nodules (1%)
1. Aspirin (if Arthritis, NOT Carditis)
- Diuretic phase [7-10days] – recovery starts
Acute: 100mg/kg/day in 4 doses x 3-5days
- Convalescent phase [7-10days] – patients are B. Minor Manifestations
Then, 75mg/kg/day in 4 doses x 4 weeks
usually sent home - Arthralgia
- Fever
2. Prednisone
- Laboratory Findings of:
2mg/kg/day in 4 doses x 2-3weeks
Prognosis ▲ Acute Phase Reactants (ESR / CRP)
Then, 5mg/24hrs every 2-3 days
- Gross hematuria 2-3 weeks Prolonged PR interval
- Proteinuria 3-6 weeks
- ▼C3 8-12 weeks C. PLUS Supporting Evidence of Antecedent
- microscopic hematuria 6-12 mo or Group-A Strep Infection
PREVENTON
1-2 years - (+) Throat Culture or Rapid Strep-Ag Test
- HPN 4-6 weeks - ▲Rising Strep-AB Test
A. Primary Prevention

- 10 days of Oral Penicillin or Erythromycin

> Hyperkalemia may be seen due to Na+ retention
- IM Injection of Benzethine Penicillin
> Ca++ decreases in PSAGN
> ▲ in ASO titer
- normal within 2 weeks
- peaks after 2 weeks
- more pronounced in pharyngeal infection
than in cutaneous

B. Secondary Prevention
BRONCHIAL ASTHMA (GINA GUIDELINES)

Controlled Partly Controlled Uncontrolled

Day
none > 2x per wk
symptoms
Limitation of
none any
activities
3 or more symptoms
Nocturnal Sx
none any of Partly Controlled
C. Duration of Chemoprophylaxis (awakening)
Asthma in any week
Need for
< 2x per wk > 2x per wk
reliever
Lung
normal < 80%
function
Exacerbation none > 1x per yr 1x / week
 KAWASAKI DISEASE
TREATMENT SEIZURES
CDC-CRITERIA FOR DIAGNOSIS:
ADOPTED FROM KAWASAKI Currently Recommended Protocol:
(ALL SHOULD BE PRESENT) > Seizures: sudden event caused by abrupt,
A. IV-Immunoglobulin uncontrolled, hypersynchronous
A) HIGH Grade Fever (>38.5 Rectally) PRESENT discharges of neurons
for AT LEAST 5-days without other Explanation 2g/kg Regimen Infusion EQUALLY Effective in
“High Grade Fever of at least 5 days” Prevention of Aneurysms and Superior to 4-day > Epilepsy: tendency for recurrent seizures that are
DOES NOT Respond to any kind of Antibiotic! Regimen with respect to Amelioration of Inflammation unprovoked by an immediate cause
as measured by days of
B) Presence of 4 of the 5 Criteria Fever, ESR, CRP, Platelet Count, Hgb, and Albumin > Status epilepticus: >30min or back-to-back
1. Bilateral CONGESTION of the Ocular Conjunctiva w/o return to baseline
(seen in 94%) NOTE: There is a TIME FRAME of 10 days
2. Changes of the Lips and Oral Cavity (At least ONE) > Etiology:
3. Changes of the Extremities (At least ONE) - V ascular : AVM, stroke, hemorrhage
4. Polymorphous Exanthem (92%) B. Aspirin - I nfections : meningitis, encephalitis
5. Cervical Adenopathy = Non-Suppurative Cervical - T raumatic :
Adenopathy (should be >1.5cm) in 42%) HIGH Dose ASA (80-100mg/kg/day divided q 6h) - A utoimmune : SLE, vasculitis, ADEM
should be given Initially in Conjunction with IV-IG - M etabolic : electrolyte imbalance
HARADA Criteria THEN - I diopathic : “idiopathic epilepsy”
- used to determine whether IVIg should be given Reduced to Low Dose Aspirin (3-5mg/kg/day) - N eoplastic : space occupying lesion
- assessed within 9 days from onset of illness AND - S tructural : cortical malformation,
1. WBC > 12,000 Continued until Cardiac Evaluation COMPLETED prior stroke
2. PC <350,000 (approximately 1-2 months AFTER Onset of Disease) - S yndrome : genetic disorder
3. CRP > 3+
4. Hct <35%
5. Albumin <3.5 g/dL
6. Age 12 months
7. Gender: male

• IVIg is given if ≥ 4 of 7 are fulfilled

• If < 4 with continuing acute symptoms,
risk score must be reassessed daily

TYPES OF SEIZURES CLASSIFICATION BY CAUSE SIMPLE FEBRILE SEIZURE

A. Partial Seizures (Focal / Local) A. Acute Symptomatic A. Criteria for an SFS
– Simple Partial (shortly after an acute insult) – < 15 minutes
– Complex Partial (Partial Seizure + – Infection – Generalized-tonic-clonic
Impaired Consciousness) – Hypoglycemia, low sodium, low calcium – Fever > 100.4 rectal to 101 F (38 to 38.4 C)
– Partial Seizures evolving to Tonic-Clonic – Head trauma – No recurrence in 24 hours
Convulsion – Toxic ingestion – No post-ictal neuro abnormalities (e.g. Todd’s
paresis)
B. Generalized Seizures B. Remote Symptomatic – Most common 6 months to 5 years
– Absence (Petit mal) – Pre-existing brain abnormality or insult – Normal development
– Myoclonic – Brain injury (head trauma, low oxygen) – No CNS infection or prior afebrile seizures
– Clonic – Meningitis
– Tonic – Stroke B. Risk Factors
– Tonic-Clonic – Tumor – Febrile seizure in 1st / 2nd degree relative
– Atonic – Developmental brain abnormality – Neonatal nursery stay of >30 days
– Developmental delay
C. Idiopathic – Height of temperature
SIMPLE FEBRILE SEIZURE – No history of preceding insult
vs. – Likely “genetic” component C. Risk Factors for Epilepsy
COMPLEX FEBRILE SEIZURE (2 to 10% will go on to have epilepsy)
– Developmental delay
Febrile Seizure: – Complex FS (possibly > 1 complex feature)
“A seizure in association with a febrile illness in the – 5% > 30 mins => _ of all childhood status
absence of a CNS infection or acute electrolyte – Family History of Epilepsy
imbalance in children older than 1 month of age – Duration of fever
without prior afebrile seizures”

TUBERCULOSIS
A. Pulmonary TB
– fully susceptible M. tuberculosis,
– no history of previous anti-TB drugs
– low local persistence of primary resistance to
Isoniazid (H)
2HRZ OD then 4HR OD or 3x/wk DOT
– Microbial susceptibility unknown or initial drug
resistance suspected (e.g. cavitary)
– previous anti-TB use
– close contact w/ resistant source case or living
in high areas w/ high pulmonary resistance to
H.
–
2HRZ + E/S OD, then 4 HR + E/S OD or
3x/week DOT
B. Extrapulmonary TB
– Same in PTB
– For severe life threatening disease
(e.g. miliary, meningitis, bone, etc)
2HRZ + E/S OD, then 10HR + E/S OD or
3x/wk DOT
Clinical Features:
RESPIRATORY DISTRESS SYNDROME
(Hyaline Membrane Disease) 1. Tachypnea, nasal flaring, subcostal and
intercostal retractions, cyanosis, grunting
o Male, preterm, low BW, maternal DM, & perinatal 2. Pallor – from anemia,
asphyxia peripheral vasoconstriction
3. Onset – within 6 hours of life
o Corticosteroids: Peak severity – 2-3 days
• most successful method to induce fetal lung Recovery – 72 hours
maturation
• Administered 24-48 hours before delivery Retractions:
decrease incidence of RDS o Due to (-) intrapleural pressure produced by
• Most effective before 34 weeks AOG interaction b/w contraction of diaphragm & other
respiratory muscles and mechanical properties of
o Microscopically: diffuse atelectasis, eosinophilic the lungs & chest wall
membrane
Nasal flaring:
o Due to contraction of alae nasi muscles leading to
Pathophysiology: marked reduction in nasal resistance
1. Impaired/delayed surfactant synthesis & secretion Grunting:
2. V/Q (ventilation/perfusion) imbalance due to o Expiration through partially closed vocal cords
deficiency of surfactant and decreased lung • Initial expiration: glottis closed
compliance lungs w/ gas
3. Hypoxemia and systemic hypoperfusion inc. transpulmo P w/o airflow
4. Respiratory and metabolic acidosis • Last part of expiration: gas expelled against
5. Pulmonary vasoconstriction partially closed cords
6. Impaired endothelial &epithelial integrity
7. Proteinous exudates Cyanosis:
8. RDS o Central – tongue & mnucosa (imp. Indicator of
impaired gas exchange); depends on
total amount of desaturated Hgb
 UMBILICAL CATHERIZATION
NEWBORN RESUSCITATION Cathether length
Indications • Standardize Graph
AIRWAY: open & clear • Vascular access (UV) – Perpedicular line from the tip of the shoulder to
Positioning • Blood Pressure (UA) and blood gas monitoring in the umbilicus
Suctioning critically ill infants • Measure length from Xiphoid to umbilicus and add
Endotracheal intubation (if necessary) 0.5 to 1cm.
Complications • Birth weight regression formula
BREATHING is spontaneous or assisted • Infection – Low line : UA catheter in cm = BW + 7
Tactile stimulation (drying, rubbing) • Bleeding – High line : UA catheter = [3xBW] + 9
Positive-pressure ventilation • Hemorrhage – UV catheter length = [0.5xhigh line] + 1
• Perforation of vessel
CIRCULATION of oxygenated blood is adequate • Thrombosis w/ distal embolization Procedure
Chest compressions • Ischemia or infarction of lower extremities, bowel • Determine the length of the catheter
Medication and volume expansion or kidney • Restrain infant and prep the area using sterile
• Arrhythmia technique
• Air embolus • Flush catheter with sterile saline solution
• Place umbilical tape around the cord. Cut cord
RESUSCITAION MEDICATIONS Cautions about 1.5-2cm from the skin.
• Never for: • Identify the blood vessels.
– Omphalitis (1thin=vein, 2thick=artery)
Atropine 0.02 ml/k IM, IV, ET
– Peritonitis • Grasp the catheter 1cm from the tip. Insert into the
Bicarbonate 1-2 meq/k
• Contraindicated in vein, aiming toward the feet.
Calcium 10 mg elem Ca/k slow IV – NEC • Secure the catheter
Calcium chloride 0.33/k (27 mg Ca/cc) – Intestinal hypoperfusion • Observe for possible complications
Calcium gluconate 1 cc/k (9 mg Ca/cc)
1g/k = 2 cc/k D50 Line Placement
Dextrose
4 cc/k D25 • Arterial line
Epinephrine 0.01 cc/k IV, ET • Low line
– Tip lie above the bifurcation between L3 & L5
• High line
– Tip is above the diaphram between T6 & T9

BILIRUBIN

PRETERM:
mg/dl mmol/L
0-1 hr 1-6 17-100
1-2 d 6-8 100-140
3-5 d 10-12 170-200

TERM
mg/dl mmol/L
0-1 hr 2-6 34-100
1-2 d 6-7 100-120
3-5 d 4-12 70-200
1 mo <1 <17

KRAMERS CLASSIFICATION OF JAUNDICE

SERUM
ZONE JAUNDICE
BILIRUBIN
I Head & neck 6-8
Upper trunk
II 9-12
to umbilicus
Empirical dose Lower trunk
III 12-16
6 months ¼ tsp TID QID to thigh
6 mos – 2 yrs ½ tsp Arms, legs,
IV 15
2-6 1 tsp below
6-9 1 ½ tsp V Hands & feet 15
9-12 2 tsp

MKD COMPUTATION
LUMBAR PUNCTURE • To diagnose other medical conditions such as:
– viral and bacterial meningitis Wt x mkd x preparation [mg/mL] = mL per dose
• the technique of using a needle to withdraw – syphilis, a sexually transmitted disease
cerebrospinal fluid (CSF) from the spinal canal. – bleeding around the brain and spinal cord e.g. 12kg x 10mg x 5ml = 5mL per dose
– multiple sclerosis, (affects the myelin coating of 120mg
SPINE the nerve fibers of the brain and spinal cord)
• spinal cord stops near L2 – Guillain-Barré syndrome, (inflammation of the * If per day, divide total (mL) by the # of divided doses
• lower lumbar spine (usually between L3-L4 or nerves)
L4–5) is preferable Dose x preparation x frequency = mkd
Complication weight
CSF • Local pain
• clear, watery liquid that protects the central • Infection
nervous system from injury • Bleeding Paracetamol Drops = Wt: move 1 decimal
• cushions the brain from the surrounding bone. • Spinal fluid leak point to the left
• It contains: • Hematoma (spinal subdural hematoma Age Wt
– glucose (sugar) • Spinal headache 1 10 kg
– protein • Acquired epidermal spinal cord tumor 2 12
– white blood cells 3 14
• Rate : 500ml/day or 0.35ml/min Caution & Contraindications 4 16
• Range : 0.3-04 ml/min • Increased ICP 5 18
• Volume : 50ml (infants) • Bleeding diasthesis 6 20
150ml (adults) • Traumatic Tap
• Overlying skin infection 1 drop = 1/20 mL
Indication • Unstable patient 1 teaspoonful = 5 mL
• to diagnose some malignancies (brain cancer and 1 tablespoonful = 15 mL
leukemia) 1 wineglassful = 60 mL = 2 ounces
• to assess patients with certain psychiatric 1 glassful = 250 mL = 8 ounces
symptoms and conditions. 1 grain = 60 mg
• for injecting chemotherapy directly into the CSF 1 pint = 500 mL
(intrathecal therapy) 1 quart = 1000 mL
1 ounce = 30 mL
1 Kg = 2.2 lbs
1 lb = 0.45359 Kg
 BETA LACTAMS FLUOROQUINOLONES
Penicillin 50-100 mkD q6 Ciprofloxacin 7.5-15 mkD
Pen G Crystalline 100,000-200,000 ukD q12 T: 250mg, 500mg
50,000-100,000 ukD q8/q12 V: 2mg/mL infusion
(< 7days) Levofloxacin 8mkD q12 (250mg max)
T: 250mg, 500mg
75,000-150,000 ukD q6-q12
V: 5mg/mL infusion
(>7days)
Benzathine Penicillin 500,000 u/K single dose (early
1.2 m.u., 2.4 m.u/vial
AMINOGLYCOSIDES
syphilis)
Amikacin 15 mkD LD
50,000 u/K max dose 2.4 M
V: 50mg/mL, 125mg/mL, 10 mkD q12 (MD)
u/dose (syphilis) 250mg/mL
Sumapen 50 mkD q6 Gentamycin 5-8 mkD q8-q12
Phenoxymethyl penicillin V: 40mg/mL, 80mg/2mL
125/5 – 200,000 u/5mL
Neltilmicin 6-8 mkD OD
250/5 – 400,000 u/5mL
V: 50mg/mL, 75mg/mL
Ampicillin 50-100 mkD q6/q8 (neonates)
D: 125mg/1.25mL 100-200 mkD q4/q6
S: 125mg/5mL, 250mg/5mL OTHERS
100-150 mkD q8-q12 (meningitis
C: 250mg, 500mg Chloramphenicol 50-100 mkD q6-q8 PO
neonates)
V: 125mg, 250mg, 500mg, S: 125mg/5mL 50 mkD q6 IV
1gm 200-400 mkD q4/q6 (meningitis) C: 250mg, 500mg 25 mkD q6 (neonates)
Ampicillin-Sulbactam 100-200 mkD q8 IV V: 1gm
Sultamicillin (Unasyn) 1.5-12gm/day IV Co-trimoxazole 5-8 mkD q12
S: 250mg/5mL 50mkD q12 (<30kg) S: 40mg/5mL (200), 80mg/5mL
C: 375mg, 750mg (400), 160mg/5mL (800)
2.25gm (single dose, gonorrhea) T: 400mg/80mg, 800mg/160mg
V: 750mg, 1.5gm
Amoxicillin 30-50 mkD q8
D: 100mg/mL
Clindamycin NB: 5mkD q8-12 po
S: 75mg/5mL granules Infant/child:
S: 125mg/5mL, 250mg/5mL
C: 250mg, 500mg V: 1gm C: 150mg, 300mg 15-25mkD q6 IV
V: 150mg/mL SIVP in 30mins
Amoxicillin-Clavulanic 30-50mkD q8 po 20-30 mkD q6 PO
Acid (Co-Amoxiclav) 50-100mkD q8 IV Vancomycin <1200g (0-4wks) 15mkdose OD
S: 156.25/5 (125), 228.5/5 V: 500mg >1200g (0-1wk) 20mkdose OD
(200), 312.5/5 (250), 457/5 (1-4wks) 30mkdose OD
(400) Infant/child:
T: 375mg, 625mg
V: 600mg (500), 1.2gm
20mkdose q8 PO
(1000) 60mkD q8 1-3 hr infusion
Amoxicillin-sulbactam 30-50mkD q8 po Metronidazole 30-50 mkD q8-q12 PO
(Ultramox) 50-100mkD q8 IV S: 125mg/5mL 15 mkD LD, 7.5 mkD q8
S: 250mg/5mL, T: 500mg
T:500mg V: 5mg/mL
V: 500/250mg , 1000/500
Piperacillin-Tazobactam 200-300 mkD q6 ANTI-VIRALS
V: 4gm/500mg, 2gm/250mg 150-300 mkD q8 (<6months) Acyclovir 10-20 mkD q6
Aztreonam 50 mkD q6-q8 (children) S: 200mg/5mL 200mg 5x daily (adult, children, >
V: 1gm T: 200mg, 400mg, 800mg 2 y/o)
30 mkD q6-q8 (1wk-2y/o)
V: 250mg
Meropenem 20 mkD q12 (septic) ½ adult dose (children < 2 y/o)
V: 500mg, 1gm 40 mkD q12 (meningitic) Amantadine 5-9 mkD q12 (<8y/o)
Imipenem 15 mkD (max 2gm/D) T: 100mg, 250mg 100-200mg (>8 y/o; not >
V: 500mg V: 500mg 200mg/D)
50 mkD/ 1-2 gm q6-q8 (max
4gm/D; adult) Methisoprinosol 50 mkD q6-q8
(Isoprinosine)
S: 250mg/5mL
CEPHALOSPORINS
T: 500mg
Cefalexin 1st gen 25-50 mkD q6 (max 4gm/D)
D: 100mg/mL
S: 125mg/5mL, 250mg/5mL, MACROLIDES
C: 250mg, 500mg, 1gm Erythromycin 30-50 mkD q8-q12 (max 1gm)
Cefazolin 1st gen 20-50mkD q6-q8 D: 100mg/2.5mL
V: 500mg, 1gm 100mkD (severe infection) S: 200mg/5mL, 400mg/5mL,
Clarithromycin 15 mkD q12 (max 1gm/D)
S: 125mg/5mL, 250mg/5mL
Cefaclor 2nd gen 20-40 mKD q8 T: 250mg, 500mg
D: 50mg/mL
V: 50mg/mL
S: 125mg/5mL, 250mg/5mL
C: 250mg, 500mg Azithromycin 10 mkD x 3 days
Cefuroxime 2nd gen 20-40 mkD q12
S: 200mg/5mL 10 mkD 1st day, 2 mkD 2nd-5th day
C: 250mg, 500mg
S: 125mg/5mL, 250mg/5mL 50-100 mkD q8 IV V: 500mg
T: 250mg, 500mg,
V: 750gm, 1.5gm
Cefoxitin 2nd gen 80-160 mkD q4-q6 (max 12gm/D) ANTI-FUNGAL
V: 500mg, 1gm 20-40 mkD (infants) Fluconazole 12 mkD LD
T: 50mg, 100mg, 150mg 6 mkD MD
Ceftazidime 3rd gen 100-150 mkD q8 IV
200mg
V: 250mg, 500mg, 1gm, 2 gm
V: 2mg/mL
Ceftriaxone 3rd gen 50-100 mkD OD IV Ketoconazole 5 mkD OD (<15kg)
V: 250mg, 500mg, 1gm, 2gm T: 200mg 100 mkD OD (>20kg)
rd
Cefotaxime 3 gen 100-200 mkD q4-q6 200 mkD OD (>30kg)
V: 250mg, 500mg, 1gm
Griseofulvin 10 mkD
Cefixime 3rd gen 3-8 mkD q12 T: 125mg, 500mg
D: 20mg/mL Amphotericin B MD 0.5-1 mkD OD
S:100mg/5mL V: 5mg/mL, 50mg/10mL
C: 100mg, 200mg
Cefepime 4th gen 50mkD q8-12 x 10 days
V: 500mg, 1gm, 2gm 500mg-1gm q12 (>12 y/o) ANTI-PARASITIC
Pyrantel Pamoate 11 mkD x 3 doses OD
S: 125mg/5mL
T: 125mg
Mebendazole 200 - 500 mkD OD single dose
TETRACYLINE
S:20mg/mL, 50mg/mL
Tetracycline 25-50 mkD T: 100mg, 500mg
C: 250mg, 500mg
Doxycycline 4.4 mkD
C: 100mg 2.2 mkD
 ANTI-TUBERCULOSIS COUGH & COLDS
Rifampicin (R) 10-20 mkD OD AC Chlorpheniramine 0.2-0.3 mkD
D: 100mg/5mL maleate >12 y/o: 5mL TID or 1 tab TID
S: 200mg/5mL S: 2mg/5mL
C: 150mg, 300mg, 450mg T: 4mg
Isoniazid (H) 10-20 mkD OD AC V: 10mg/mL
S: 200mg/5mL Ambroxol
C: 75mg, 100mg, 200mg, 30mg/tab >10y/o 1 tab TID
300mg, 400mg
5-10 y/o ½ tab TID
Pyrazinamide (Z) 15-30 mkD OD PC
S: 250mg/5mL
C: 400mg, 500mg
Syrup (15mg/5mL) >10y/o 10mL TID
6-10 y/o 5mL BID-TID
Ethambutol (E) 15 mkD OD
C: 275mg, 400mg, 800mg 2-5 y/o 2.5mL BID
5-25mKD (<2 months)
Streptomycin (S) 10 mkD OD Q 48 or EOD
V: 1gm Infant drops (6mg/mL) 1-2 y/o 1.25mL BID
7-12 mons 1mL BID
<6 mons 0.5mL BID
Carbocisteine
ANTI-HISTAMINES
Syrup (100mg/5mL) 2-3 y/o 5mL TID
Cetirizine 6mons-1y/o 1mL OD
4-7 y/o 10mL TID
D: 2.5mg/mL, 10mg/mL 1-2 y/o 2.5 mg BID (5 drops BID)
S: 1mg/mL, 5mg/5mL 8-12 y/o 15mL TID
1mL OD or BID
T: 10mg
2-5 y/o ¼ tab BID or ½ tab OD
Syrup (250mg/5mL) 2-3 y/o 2.5mL TID
5mL OD or 2.5mL BID
4-7 y/o 5mL TID
6-12 y/o ½ tab BID
8-12 y/o 7.5 mL TID
10mL OD or 5mL BID
>12 y/o 1 tab OD
Drops (50mg/mL) <2 mons 0.3mL TID
Diphenhydramine 1-2 mg/kg IV (max 100mg/dose) 3-6 mons 0.6mL TID
S: 12.5mg/5mL
C: 25mg, 50mg
7-12 mons 0.9mL TID
3-5 mkD PO 13-24mons 1.2mL TID
V: 50mg/mL
2-6 y/o 2.5 mL q6/q8
Erdosteine >30kg 10mL BID
6-12 y/o 5mL q6/q8 S: 175mg/5mL 20-30kg 5mL TID
Hydroxyzine HCl 1-2 mkD q12 PO C: 300mg 15-19kg 5mL BID
S: 2mg/mL Adult: 25mg BID -QID
T: 10mg, 25mg Procaterol (Meptin) < 5y/o 0.25mKD BID-TID
S: 5mcg/mL >6y/o 5mL or 25mcg/tab OD-BID
Loratadine 1-2 y/o 2.5mL OD T: 25mcg, 50mcg
S: 1mg/mL, 5mg/5mL 2-12 y/o <30kg 5mL Adult 20mL or 50mcg/tab OD-BID
T: 10mg >30kg 10mL Salbutamol + >12 y/o 10mL TID, 1 cap BID-TID
>12y/o: 1 tab OD Guaifenesin 6-12 y/o 1tsp TID
Chlorphenamine <1y/o: 2.5mL TID 2-6 y/o ½-1tsp TID
maleate 1-3y/o: 2.5-5mL TID Acetylcysteine Children: 100mg BID-QID
S: 2mg/5mL >6y/o: 5mL TID (Fluimucil) Adult: 200mg BID-TID, 600mgOD
T: 4mg Sachet: 100mg, 200mg
7-12y/o: ½ tab TID
V: 10mg/mL S: 100mg/5mL
Adult: 1 tab TID or 2 tsp TID T(effervescent): 600mg
IV/IM: 1mL OD Guaifenesin 6-12 y/o 5mL TID-QID
Promethazine HCl 1mg/kg IM S: 100mg/5mL Adult: 5-10mL TID-QID
(Phenergan) C: 200mg 1-2cap TID-QID
V: 25mg/mL
Phenylpropanolamine
Fexofenadine 120mg OD
Drops (6.25mg/mL) 1-2 y/o 1mL QID
T: 120mg, 180mg
7-12 mons 0.75mL QID
4-6 mons 0.5mL QID
1-3 mons 0.25 mL QID
ANALGESIC & ANTI-PYRETIC
Aspirin 60-80 mkD Syrup (12.5mg/5mL) 2-6 y/o 2.5mL QID
T: 80mg, 100mg, 325mg R D: 100mkD (1st 2 wks), 75 mkD 7-12 y/o 5mL QID
(4 wks)
Anti-inflammatory: 60-90 mkD
Kawasaki: 80-100mkD q6
Indomethacin 1-2 mkD x 3 (PDA) NEUROLEPTICS & ANTI-CONVULSANTS
C: 100mg Diazepam 0.2-0.3 mkD
Ibuprofen 6-8 mkd q6 T:,5mg,10mg/tab Max dose: <5y/o: 5mg;
D: 100mg/2.5mL V: 5mg/mL, 10mg/mL >5y/o: 10mg
S: 100mg/5mL, 200mg/5mL Drip: 50mg (10cc) 250cc 0.9 NSS
C: 200mg, 800mg to run at 1cc/kg/hr
Mefenamic Acid 6.5 mkd q6 Carbamazepine 20-60mg/day inc by 20-60mg OD
S: 50mg/5mL
(Tegretol) (<4 y/o)
C: 250mg, 500mg
100mg/day inc by 100mg weekly
Meperidine 6 mkD/ 0.5-1 mkD
(4y/o)
Midazolam 0.2 mkd
T: 15mg
10-20 mk MD
V: 1mg/mL, 5mg/mL Mannitol 20% 2.5-5cc/kg q6-q8
Morphine 0.1-0.2 mkd q6 (max 15mg) Phenobarbital 10-20 mkd LD
T: 10mg, 30mg, 60mg, 20mg/5mL; grain 1 60mg 5 mkD q12 MD
100mg T: 15mg, 30mg, 60mg, 90mg Max: 1-2gms (300mg)
V: 10mg/mL V: 130mg/mL
Nalbuphine 0.1-0.2 mkd IM, IV Phenytoin (Dilantin) 10-20 mkd LD
V: 10mg/mL S: 30mg/5mL, 125mg/5mL 5 mkD q12 MD
Naproxen 5-7 mkD q8-q12 (>2y/o) V: 50mg/mL Max: 1 gm
T: 275mg, 550mg Valproic Acid 15mkD (LD) OD/BID
Paracetamol 10-15 mkd q4 S: 250mg/5mL 20mKD q8 (MD)
D: 100mg/mL V: 100mg/mL
S: 120mg/5mL, 250mg/5mL
T: 80mg, 500mg
V: 150mg/mL, 300mg/2mL
Supp: 125mg, 250mg
 GASTRO MEDS & ANTI-ULCERS RESPIRATORY MEDICATIONS & BRONCHODILATORS
Al Mg (OH)3 (Maalox) 2-4 tabs 20 mins pre meal and S Aminophylline 3-5 mkD (0.6-0.9mk/hr)
Al Mg (OH)3 + 2-4 tsp or tab QID 5mg/mL LD: 3-6mg/kg x 20-30mins
dimethicone MD: 2mkd q8
Bisacodyl (Dulcolax) 5-10 mg (6-12 y/o) MD: 1-9y/o 0.8 1-1.2hr
T: 5mg 10-15 mg (>12 y/o) 9-12 y/o: 0.7 0.9hr
Supp: pedia 5mg, adult 2-16 y/o 0.5 q6-8
10mg Eg
Hyoscine-N-butylbromide 12 y/o: 1-2 tab 3-5x a day, max 20kg (wt x dose) / preparation
(Buscopan) 100mg/day (20 x 5) / 5 20cc SIVP as LD
T: 10mg Infants young children 0.3-0.6
V: 20mg
(20 x 2) / 2 8cc SIVP q8 as MD
mkD Hydrocortisone (Solu- 10mkd LD, 4-9mkd MD
Cimetidine 5 mkD q6 LD, 5-10 mkD q6 Cortef) 10-20 mkD LD
T: 200mg, 400mg V: 100mg, 200mg, 250mg 5-6 mkD q8 MD (asthma)
V: 100mg/mL, 150mg/mL
3-5m mk/dose IV
Ranitidine 1 mkD q8
T: 75mg, 150mg, 300mg Salbutamol 0.15-0.30 mkD q6
Adult: 150mg BID or 300mg OD
V: 25mg/mL S: 2mg/5mL
T: 2mg
Dicycloverine 6 mons-2 y/o 0.5-1mL QID
D:5mg/mL
Terbutaline 0.075 mkd q6 PO
2-5 y.o 2.5-5mL QID
S: 10mg/5mL 1.5mg/5mL syrup, 0.01 mkd (max 0.5cc)
6-12 y/o 5 mL QID 5mg/2minebule
T: 10mg
Domperidone 0.2mL kg/dose q8
D: 5mg/mL ANTI-HYPERTENSION / CARDIAC/ DIURETIC/ EMERGENCY
S:1mg/mL 5mg/5mL MEDICATION
T:10mg
Aldactone 2-3.5 mkD
Erceflora 1 vial BID x 5 days
Amiodarone 10mkd 30min-1hr LD
Lactulose 2mL/kg/dose q6
Aspirin 65 mkD
Omeprazole 0.6-0.7 mkD OD
R D: 1st 2 weeks 100mkD
C:20mg,40mg
V: 40mg 4 weeks 75mkD
Nitrofuroxide <6 mons: 1 tsp BID Anti-inflammatory 60-90 mkD
(Ercefuryl) >6 mons: 1tsp TID Kawasaki: 100 mkD,q6
S:218g/5mL (-) ever: 8-10 mkDs
C:200mg Acetazolamide 20 mkD
Prozinc <6 mons: 10mg (Diamox) 250 – 375 mg/day
Drops 0.5-1mL OD (1mL >6 mons: 20mg T: 250 mg
10mg elemental n) Captopril 0.5-1 mkD q8
Syrup 2.5-5mL OD (5mL Ca Gluconate 25 mkd q8
20mg elemental n)
V: 100mg/mL Dilute 1 mL n 2 mL sterile water
Racecadotril (Hidrasec) <9kg: 10mg/sachet TID
Ca Chloride 0.33/kg (27mg ca/cc)
9-13kg: 10mg/2sachet TID
Ca Carbonate 30-50 mkd q8
13-27kg: 30mg/sachet TID
>27kg: 30mg/2sachet TID Digoxin 0.05 mg/kg IV/IM
Adults: 100mg/cap TID Diazoxide 5mg rapid IV push
Furosemide 1 mkd q6-12 IV
T: 20,40,60mg
NEPHRO MEDICATIONS V: 20mg/mL
Prednisone Nephrotic: >40mg/day Hydralazine 0.15-0.3 mkdose q4-6 IV
ypoalb: <2.5mg/dL T: 10mg, 25mg, 50mg 1-3mkD q4-6 po
60mkD x 4-6 weeks then 40mkD V: 20mg
(am) x 2-3 months Nifedipine 0.25 mkD q4-q6 PO
Alternate day dose C: 5mg, 10mg
If steroid resistant: 2 protein q8
weeks Amlodipine 5mg/tab OD-BID
If steroid dependent: relapse T: 5mg, 10mg
within 28 days Propranolol 1-2 mkD q6-12
requent relapse: relapse> 12x T: 5mg, 10mg
per month
Cyclophosphamide 2-3 mkD single dose 8-12 weeks DRIPS
DOPAMINE DRIP
STEROIDS Dopamine
Betamethasone 0.0178-0.25 mkD q6-q8 (max 1-2 mcg/kg/min
T: 500mcg 9mg/D)
V: 1mL, 2mL DOPA DRIP
Dexamethasone 0.5-1mkD for ICP Wt x 60 x desired dose
T: 500mcg, 750mcg, 4mg 1 mkD q4-q6 for cerebral edema Conc. of dopa drip
(forte tab) 0.2-0.5 mkd for bacterial
V: 2mg/mL, 4mg/mL,
meningitis Desired dose
5mg/mL
5mg – 10mg iv q6 (adult dose) Renal: 2-5
Hydrocortisone 10-15 mkD LD, 4-6 mkD q6-q8 MD Cardiac: 5- 10
T: 20mg (asthma) Adrenergic: 7-8
V: 100mg, 200mg, 250mg, 3-4 mkD (Dengue)
400mg, 500mg Concentration Dopa D5W
Prednisone 1-2 mkD q12 100 6.25 43.75
S: 10mg/5mL BSA x 60 mkD (Nephrotic) 200 12.5 37.5
T: 5mg, 20mg
400 25 25
800 (Premix) 11 39

Ex. Start Dopa drip

AMINOPHYLLINE DRIP Dopa 12.5
Dose: 0.2-0.4 D5 37.5
wt x dose 3 x 0.4 0.6cc 50cc x 4-5ugtts
2 2
Ex.
Aminophylline 0.6 cc
D5 99.4 cc
100cc OR 80cc x 12 hours at 8- 9 ugtts/min
 EPINEPHRINE DRIP AMINOPHYLLINE PUSH
Prep: 1mg/ml Prep: 25 mg/ml
Dose: 0.1 – 1mkdose
Dilute 25 mg/ml vial in 4cc PNSS to make 25 mg/5ml
(Wt x dose x 6) x 0.1(running rate) concentration
Then get 1cc to have 5 mg/ml concentration
Ex. Start Epi drip
Epi 1 cc Neonates
D5 99 cc LD: 4-6
100 cc x ugtts/min MD: 1.5-3mkdose q8-12
OR
Dose: 0.5-1mkdose Order: give 2.4cc of aminophylline as loading dose EAD
then after 12 hours give 1.2 cc IV q8
Wt x 60 x dose
20 OR

Ex. Start Epi drip 3-5mkD (0.6-0.9mk/hr)

Epi 1 cc LD 3-6mg/kg x 20-30mins
D5 49 cc MD 2mkdose q8
50 cc x ugtts/min MD 1-9y/o 0.8- 1-1.2hr
9-12y/o 0.7- 0.9hr
Titrate by 0.1 dose 12-16y/o 0.5
q6-8 (5mg/ml)
Epinephrine 0.01 mg/kg (1:10,000 IV)
0.1 mg/kg q3-4mis (ET) Ex: 20kg wt x dose 20x5 20cc SIVP as LD
0.1-0.5 ug/kg/min (drip) Prep 5 8cc SIVP q8
2 ½ amps 48.5cc D5
0.5cc epi 1.5cc NSS q15 x 3 doses
pre-extubation then q4-6 TERBUTALINE DRIP
(racemic)
(0.1-0.4ug) x wt. x 60 x =
500ug/ml
LIDOCAINE DRIP Ex.
Dose: 2-10mkdose OR 0.5-1.0mkd q10mins, max 5mg/kg Terbutaline
Bolus: 1-2mkdose D5
80cc OR 100cc x 10 ugtts/min (8hrs)
Wt x 60 x dose = running rate
4000
BRICANYL DRIP
Ex. Start Lidocaine drip
Lidocaine 10cc Dose: 30-40ug
D5 40cc
50cc x ugtts Wt x dose = in cc
500
Lanoxin TDD: 0.035 x wt Ex.
LD: ¼ TDD x 4 doses q6 Bricanyl
MD 1/10 TDD x 2 doses q12 D5
OR 120cc x 24 hours
Wt x 0.004 x 2
0.05 (elixir) MULTIVITAMINS
<3 months: 0.3mL OD
should not exceed weight of px 3-12 months: 0.6mL OD
0.04/kg loading divide by 4doses 1-2 y/o: 1.2mL OD
0.04 maintenance/ dose 2-6 y/o: 2.5mL OD
0.5max/day 7-12 y/o: 5mL OD
>12 y/o: 20mL or 1 tab OD
Elixir 0.05 mg/ml
Tab 0.25mg/tab
ANTI-SEIZURE DRUG
IV 0.025mg/ml or 0.5mg/2cc
1st line 2nd line
Tonic-Clonic Valproic Acid, Lamotrigine
Carbama epine, (Lamictal)
NITROGLYCERIN DRIP
Phenytoin Oxycarba epine
Dose: 0.25-5ug/kg/min dose; can start at 0.15
(Trileptal)
Prep: 10mg/ml or 100mg/10ml
Absence Valproic Acid Exthosuximide
Lamotrigine
Running rate = Wt x 60 x dose
Myoclonic Na valproate Lamotrigene
100
Partial Carbama epine Lamotrigene
Phenytoin Oxacarba epine
Ex. Start Nitroglycerin drip
NT 5 cc Undentifiable Valproic acid Na valproate
D5 45 cc Lamotrigene
50 cc x ugtts/min
ANTI-SEIZURE DRUGS
Carbamazepine 10-30 mkd bid- tid
MILRINONE DRIP Clonazepam 0.1-0.3 mkd tid-qid
Dose: 0.3-5ug/kg/min Ethosuximide 15-40 mkd tid-qid
Prep: 10mg/ml Phenobarbital 2-5 mkd bid-tid
Phenytoin 5-8 mkd bid,tid
Running rate = Wt x 60 x dose Valproic acid 30-80 mkd od,bid,tid,qid
200 Gabapentin 15-45 mkd tid
Lamotrigine 5-15 mkd bid, tid
Ex. Start Milrinone drip Topiramate 5-9 mkd bid
Mil 10 cc Leviteracitam 20-40 mkd bid
D5 40 cc Oxcarbazepine 8-10 mkd bid
50 cc x ugtts/min (5cc/hr)

Defibrillation: 2.5 oules/kg x 3

 FLUIDS ARTERIAL BLOOD GAS
IVF Dext Na Cl K Lac Kcal/L HCO3
Acidosis ph<7.35
D5 50g 170 Alkalosis ph>7.45

D10 100g 340 Respiratory Acidosis pCO2 >45

D20 200g 680 Respiratory Alkalosis pCO2 <35
D50 500g 170 Metabolic Acidosis CO3 <24 dec BE
Metabolic Alkalosis CO3 >24 inc BE
LRS 130 109 4 28 Ca-3
ypoxemia pO2 <85
NSS 154 154
D5 0.9NaCl 50 154 154 Note
D5 50 77 77 or every 10mm g pCO2 p of 0.05
0.45NaCl or every 10mm g pCO2 p of 1
D5 0.3 NaCl 50 51 51
PLR 130 110 43 27 <10 27
D5LR 50 130 110 4 Ca: 3 27 pH HCO3 pCO2
D5IMB 50 25 22 20 23 170 23 Metabolic Acidosis
Mg: 3, Metabolic Alkalosis
PO4: 3 Respiratory Acidosis
D5NM 50 40 40 13 170 16 Respiratory Alkalosis
Mg: 3
D5NR 50 140 98 5 Mg: 3, MECHANICAL VENTILATOR
luc: 23 NICU iO2 100
Pip/PEEP: 18/4
Rh Immunoglobulin WinRho TV:wt x 10 x 6 – 8
Dengue IT -0.5 – 18cc
Dose: 50ug/kg/dose
Prep: 300ug/vial Child PEEP 2-4cm 2O
I vial x 9-10mins PIP 20-30 cm 2O
Dilute to complete 8.5cc to run for 10mins/vial Rate – 16-20
se D5 to dilute TV: 10-15ml/kg

Kawasaki Pressure Vent: Restrictive Lung Disease

Dose: 75ug/kg as single dose Volume vent: Non pulmo
Contraindication: hct <100, Rh TV : wt x 10
Request CBC PC OD after 24hrs x 3days
AC control with peep
DESFERAL SIMV back up
Dose: 20-45 per/kg/dose T piece io2 only
infuse in 100cc PNSS then give before and after BT to run
for 6hrs Head Circumference (cm/mo) ( c/ )
5cc/kg prbc x 2hrs x 4doses q8 or as ordered 0-3 months 2 11
FENTANYL 3-6 months 1 110
Prep: 100mcg/2ml 6-9 months 0 0 100
Dose: 1-4mcg/kg dose q2-4 SIVP; 5-10 for anesthesia 9-12 months 0 0 100
1-3 y/o 02 100
Ex: t 1kg 4-6 y/o 1 m/y 90-100
Dilute 100mcg/2ml solution in 8cc sterile water to make a
concentration of 10mcg/ml, DESIRED WEIGHT
then give 0.1cc (1mcg/kg) q4 SIVP At birth 3kg ( ilipino) or 3.25kg (Caucasian)
< 6 months (Kg) Age in months x 600 birth weight
AMPHOTERICIN B >6 months (Kg) Age in months x 500 birth weight
Prep: 50mg/vial, 2 – 6 years old (Kg) Age in years x 2 8
Dose: 0.1mkD, max 30-35mk in 3wks 6-12 years old (lbs) Age in years x 7 5
Should be properly covered
AGE OF INFANT IDEAL WEIGHT
Dilute 50mg vial in 10cc D5 to make a concentration of 4-5 months 2 x birth weight
5mg/10ml, 1 year old 3 x birth weight
then aspirate 1cc 4ccD5 5mg/ml, 2 years old 4 x birth weight
then aspirate from the solution, 1cc 9cc D5 1mg/ml, 3 years old 5 x birth weight
then aspirate from the solution 1cc to make 0.1mg/ml 5 years old 6 x birth weight
7 years old 7 x birth weight
t 1kg
10 years old 10 birth weight
Test dose: 0.1mk
BLOOD GAS ANALYSIS
1cc of the solution 19cc D5 x 30mins
Day1 0.25mk: 2.5cc 17.5cc D5 x 4hrs NB & Infants Children & Adults
Day2 0.5mk: 5cc 15cc D5 x 4hrs pH 7.25-7.45 7.35-7.45
Day3 0.75mk: 7.5cc 12.5cc D5 x 4hrs pCO2 27-40 35-48
Day4 1mk: 10cc 10cc D5 x 4hrs then OD pO2 54-95 83-100
HCO3 20-22 22-27
IVIG TRANSFUSION BE -10 to -2 -7 to -1 2
Prep: 2.5gm,5gm,2500mg,/50ml vial O2 sat 40-90 95-99
Dose: 2g/kg single dose
Pre-meds: diphen hydrocort DESIRED LENGTH
At birth 50 cm
Ex: wt 10kg Birth to 3 months 9 cm 3cm/month
t x dose vials x 50ml ml in 12hrs 3-6 months 8 cm 2.67cm/month
prep 6-9 months 5 cm 1.6cm/month
test dose: wt x 0.01 x 30 mins 9-12 months 3 cm 2cm/month
1 year and above Age in years x 5 80
 HEAD CIRCUMFERENCE HOLIDAY SEGAR
1-4 months 5.08cm (1.27cm per month)
4 -12 months 5.08cm (0.635cm per month) 10 Kg 100 x eight
1-2 years 2.54cm 24hours
3-5 years 3.81cm (1.27cm per month) 10Kg: eight -10 x 50 1000
6-20 years 3.81cm (1.27cm per month) 24 hours
20Kg eight-20 x20 500
WATERLOW CLASSIFICATION 24 hours
Wasting
IVF
<20Kg: D5IMB (500cc is the only preparation)
Actual weight x 100
>20Kg: D5NM
Ideal weight for actual length/height
Add 10 if there are losses ( ever, vomiting, lbm )
Classification: Normal 90 , Mild 80-90 , Moderate 70-80 , Severe 70

Stunting WHO Hydration

Plan A
Actual eight/Length x 100 <24 months 50-100mL
Ideal Length/ eight for Age 2-10 years old 100-200mL
>10 year old Ad libitum
Classification: Normal 95 , Mild 90-95 , Moderate 80-90 , Severe 80
Plan B
AGE HR RR BP eight (Kg) x 75mL to be given in 4 hours
Preterm 120-170 40-70 55-75/40-70
0-3 months 100-150 35-55 65-85 / 45-55 Plan C
3-6 months 90-120 30-45 70-90 / 50-65 Age 30cc/kg 70cc/kg
<12 months 1st hour 5 hours
6mons -1 y/o 80-120 25-40 80-100 / 55-65
>12 months 30 minute 2 ½ hours
1-3 y/o 70-110 20-30 90-105 / 55-70
3-6 y/o 65-110 20-25 95-110 / 60-75
6-12 y/o 60-95 14-22 100-120 / 60-75
ORAL REHYDRATION SOLUTIONS
12 y/o 55-85 12-18 100-135 / 65-85
Na Cl K Glucose
O/ DO 90 80 20 111
ENDOTRACHEAL TUBE SIZE
Pedialyte 45 45 35 20 140
Oreges (250mL) 90 80 20 111
ET Size age in years 4
ydrite (2/200) 90 80 20 111
4
Si e in mm 16 age in years /4 lucolyte (per L) 63 50 20 126.53
ormulated ORS 50 50 20 20
ET Level ET si e x 3 OR Add 6 to infant s weight Reformulated ORS 75 65 20 75

Weight Gesta age Tube size TOTAL FLUID REQUIREMENTS (TFR)

<1000 <28 2.5 0-1 150 mkD
1000-200028-34 3.0 1-3 140 mkD
2000-300034-38 3.5 4-6 120 mkD
>3000 >38 3.5-4.0 7-9 100 mkD
NB 3.0-3.5 10-12 90 mkD
Infant 3.5-4.0 13-15 70 mkD
1 year 4.0-4.5 16-17 50 mkD
3years 4.5-5.0
6years 5.0-5.5 BSA
10years 6.0-6.5
0-5 wt x .05 .05
Adolescent 7.0-7.5
6-10 wt x .04 .1
Adult 7.5-8.0
10-20 wt x .03 .2
20-40 wt x .02 .4
> 40 wt x .01 .8
LUDAN S HYDRATION Hema/Endo
Square root of wt x ht
MILD MODERATE SEVERE
3600
<15 Kg 50 100 150
>15 Kg 30 60 90
FLUID LIMITATION
Mild
t x factor (50 or 30) ugtts/min D5 0.3 NaCl
ER: BSA 500
6 or 8 hours
Wards BSA 400 ½ O in 24hrs
Moderate
t x actor (100 or 60) cc
DE TROSITY
1st hour: 1/4(PNSS or PLR) to run for 1 hour Example
Next 7hours: 3/4 (D50.3NaCl) to run for 7 hours
Incdextrosity from D5 to D7.5
Severe
t x actor (150 or 90) cc T R 210, d5imb 70cc x 8-9ugtts/min x 3doses
0.055 x 70 4cc
1st hour: 1/3 (PNSS or PLR) to run for 1 hour
Next 7hours: 2/3 (PNSS or PLR) to run for 7 hours D5imb 66cc
D50-50 4cc
IVF 70cc x 8-9ugtts/min x 3doses
se PLR if with O, PNSS if without O
se D5.03 if 0-7 years old, D5LR if 8-10 years old

DE TROSITY
D5 D .5 D10 D12.5 D15 D1 .5 D20 D50
0 .055 .11 .17 .22 .28 .33 1.0
 NEWBORN WEIGHT GAIN MAGNESIUM SULFATE
Prep: 250mg/ml
Birth weight regained on 10th DOL; 2-3 wks preterm D: 100-200mg/kg/dose over 30mins
D: 20-30mg/kg/day
Preterm 15-20gm/day
Term 20-30gm/day Ex: wt 3.2kg

Fullterm age in days – 10 x 20 B oading dose: t x 200

Preterm: age in days – 14 x 15 B 3.2kg x 200 640mg / 250
2.56cc EAD in 30mins
FLUIDS IN NEONATES
A. Term aintenance dose: t x 30
60cc/kg/day, inc daily by 10 until 150 3.2kg x 30 96mg x 24hrs
2304mg / 250
B. Preterm 9.2ml in 24 hrs
A A (>2.5kg) 70cc/kg/day
LB (<2.5kg) 70CC/kg/day Order:
VLB (<1.5kg) 80cc/kg/day Mg SO4 9.2ml D5 14.8ml to make 24cc to run at
ELB (<1kg) 100cc/kg/day 1cc/hr for 24hrs
250mg/ml
C. Types of Fluids LD: 100-200mg/kg/dose over 30mins
1st 24hr : electrolyte free, D5 , D10 MD: 20-30mg/kg/day
Next 24hrs: with electrolytes, D5 0.3NaCl then D5imb

D. TPN CPAP
Electrolytes Preparation Normal Settings
i 2 A 2 PEEP
NaCl 2.5mEq/mL 2-4 mEq/kg/day 60 3 3 6
KCl 2 mEq/mL 1-3 mEq/kg/day 80 1.5 4.5
10 Cagluc100mg/mL 100-400 g/kg/d
7 AA 7g/100mL 0.5-3 g/kg/day iO2 and PEEP already set

NaCl: 3mEq/kg/day wt / 2.5 mEq/ml 1.1 / 3 1. Determine CA first

KCl: 2mEq/kg/day wt / 2 mEq/ml 1.1 / 3
Ca: 200g/kg/day wt / 100g/ml 1.1 / 3 CA 100 – iO2 PEEP (60-80) x 4-6
AA: 3g/kg/day wt 100 1.1 / 3 79 (K)
7 2. PEEP – CA O2

DE TROSITY Dr.Murallon CPAP

D10 ml D50-50
D10 10 iO2 compressed air (0.21) O2 (0-5lpm)
D7.5 7.5 compressed air O2

D50-50 (10 x T R) – 5 (T R – total electrolytes) ex. 5 (0.21) 1 0.34

45 / 3 6

D5 T R – Electrolytes – D50 /3 BPD regimen

Budesonide q8
To check, compute D10 Salbutamol q6
50 x D50-50 urosemide q12
5 x D5
Total divided by T R SODIUM
If < 10: correct
De icit: (desired-actual) x wt x 0.6
GLUCOSE INFUSION RATE 137 - 129 x 11 x 0.6 53
NB and Infants 6-8mg/kg/min aintenance:wt x (2-3meq)
Children 4-6 mg/kg/min Deficit Maintenance total infusion
ive 50 - 1st 8 hours
IR 0.167 Dextrosity ugtts/min 25 - next 8 hrs
eight 25 - next 8 hrs

Normal:135-145 meq/L
INTRALIPID igni icant hyponatremia: 120 meq/L
Prep: 10 , 20 aintenance dose: 2-3 meq/kg/24 hr
Dose: 0.5-3g/kg/day ; inc by 0.5 until 3 is reached
20 20g/100ml Prep: 2.5meq/ml/amp
ast orrection: (values <120meq)
Ex: t 2.35kg 4ml/kg of 2.5 meq/ml prep
t x 3 x 100 x 1.1 ( or every ml of NaCl 4ccsterile water)
20

38cc x 20-24hrs at 1.9cc/hr CALCIUM

100-300 mg/kg/day
Prep: 100mg/ml
G-CSF (Granulocyte-Colony Stimulating Factor)
Ex 2.6kg
Brand: ilgrastim 2.6x100x 1 2.6 /3 0.9cc in IV for 8 hrs
Prep: 300mcg/ml 100
Dose: 5mcg/kg/day OD IV or SQ
0.9ml of 10 Cagluc add in 100 ml
To boost the immune system
Stimulates the production of BC
 POTASSIUM TOTAL PROTEIN SPILLAGE

Nephro TP / bsa - g/day

0.2-0.3meq/kg/hr 1000x TP / BSA x 24hmg/m2/hr
Ex. t 10kg
0.2 x wt (10) 2meq x 24 hrs 48meqs (deficit) N <4mg/m2/hr or 100mg/m2/day
2 x wt (10) 20meq (maintenance)
68 meqs or nephrotics
Prep: 2meq/ml if >40mg/m2/hr or 4g/day
start pred at 60mg/m2
Intensivist
t x 50 x transcellular K /3
ALBUMIN TRANSFUSION
Transcellular K 50mmol/kg Prep: 12.5gm/50ml (25 ) OR 10gm/50ml (20 )
2.5 – 3 0.05 (5 ) Dose: 0.5 - 1gm per day;
2 – 2.5 0.10 (10 ) 1ml 0.25gmto run for 2-4hrs as q12 or OD
1.5 – 2 0.20 (20 )
t 0.81
Cardio t x 50 3.2ml
Desired – actual x wt x 0.3 deficit 12.5
t x 2 meq/kg/day maintenance
Ca Carbonate (TUMS)
Deficit Maintenance total infusion q8 Prep: 500mg tab
3 Dose: 50mkD
40meq/day/L maximum; excess will cause arrhythmia CaGluconate
Prep: 10cc/vial
Max 10cc vial EAD q8 SIVP in 30mins
NaHCO3 Alkalka
Base excess x wt x 0.3 (half correction) Prep: 10mg tab 10meq
0.6 (full correction) Dose: 1-2mkD
May give 2 tabs q8
To be given as 50 slow IV push K: 0.2-0.5kg/hr, inc to 0.5 if sx noted
50 incorporate in IV to run 6-8hrs
1-2meqs/kg if deficit is too large NEPHORITIC SYNDROME
CHLORIDE: 5meq/100ml Prednisone
NEP ROLO >40mg/kg/day, hypoalb<2.5mg/dl
ESTIMATED GFR 60mg/kg/day x 4-6 weeks theN
t in cm x 0.55 /serum crea(mg/dl) 40mg/kg/day (am) x 2-3mos alternate day dose

t in cm x BSA x 0.48 /serum crea x 1.73 m2 If steroid resistant: 2protein q 8 weeks

steroid dependent: relapse within 28 days
Values frequent relapse: relapse >12x per month
90-120mL/min Normal
< 89 mL/min Renal Insufficiency Cyclophosphamide
< 30 mL/min CR (Chronic Renal ailure) 2-3mk/24hrs single dose 8-12wks
< 10 mL/min ESRD 500m/kg/m2/day x 3-5days
(max 1g/day x 3days)
CREATININE CLEARANCE
Methylprednisone: 30mkD x 3-5days (max 1gm)
Creatinine Clearance ml/min

or urine vol> 1liter 24 HOUR URINE PROTEIN

TV ml x cr mg x 1.73m2 Urine protein 1.12
1440 min x Crea mg x bsa
100mg/g x urine protein
or urine volume <1 liter BSA x 24 hours
wt kg x 140-age x 0.85
72 x Serum crea mg x bsa Example
100 x 1.12 6.86 normal
Creatinine clearance 0.68 x 24
K x height (cm)
Plasma crea (mmol/L)

K 29 (<2.5 kg)
URINE CONCENTRATING ABILITY
40 (0-18mos)
49 (2-16yrs girls) Osmolality
49 (2-13yrs boys) rine osmolality : more precise than usg
62 (13-16 yrs boys) rine osmolality (usg-1.000) x 40000
Normal 400to 600 mOsm/L
Normal 80-120
Renal impairment 50-80 Serum osmolality 2Na glucose (mg/dl)/18 bun
Renal insufficiency 20-50 (mg/dl)/2.8
Renal failure5-20 Normal 230 to 300 mOsm
remia <5
Urine Specific Gravity
To get creatinine clearance divided by 120 Each 15 mmol/L (2.7 g) glucose : inc S by 0.001
Creatinine divided by 88.4; K in decimal point (0.29); Each 4 g/L Protein : inc S by 0.001
if >3 renal failure
PHLEBOTOMY
ANION GAP
FFP transfusion:
Normal : 20 t x EBV (70-80) x 0.15 (.10-.15)
ive ½ 30-1hr before phlebo, then remaining
Na - ( CO3 Cl ) during phlebotomy
134 – (12 98) 24
PNSS can be also be used
1meq/kg Na CO3 if with hypoxic spells
 ACUTE GLOMERULONEPHRITIS DIABETIC KETOACIDOSIS2
TYPICAL COURSE Insulin drip
Latent : few days- 3 wks >2yo 0.1u/kg/hr
Oliguric : 7 - 10 days <2yo 0.05u/kg/hr
Diuretic : 7- 10 days
Convalescent : 7 - 10 days make 5u in 50cc pnss or
10u in 100cc pnss to run cc/hr (running rate is
NORMALIZATION OF URINE SEDIMENT equivalent to weight in kg)
ross hematuria : 2 - 3 wks
Complement level : 6 - 8 wks EC
Protenuria : 3 - 6 mos Na, K, Phos, Mg, Ca
Micro- hematuria : 6 - 12 mos ba1c
BS
Bladder Capacity age x 2 o x 30 B N, Crea
AB
Normal bladder residual <5cc or 10 of bladder rine ketones
capacity means greater risk for TI
Strict uo q1 with monitoring sheet at bedside
Clean catch : >100,000/ml
Catheter : >100/ml May start Na CO3 at 1meq/kg sivp to run for 30 mins
Suprapubic : 1 col/ml
DIABETIC KETOACIDOSIS3

NEPHROTIC SYNDROME
Remission: protein free/ edema free x 3-4 mos
Relapse recurrence of edema or proteinuria
Steroid Responsive (-) protein after 4-6 weeks
Steroid Resistant ( ) protein after 4-6 weeks of
continuous daily divided doses of prednisone (60mkd);
use methyl prednisolone
Steroid Dependent
- if you withdraw the tx, protenuria recur
- 2 consecutive relapses occurring during therapy
or w/in 14 days of completing steroid therapy
Fre uent Relapser
- responds to corticosteroid treatment but
experiences 2 relapses w/in 6 mos after the
initial response
- has 4 relapses w/in any 1 yr
If plasma glucose 14-17mmol/L (250-300) give PNSS
If less than 250 CB give D5 0.45nacl to prevent rapid
decrease in plasma glucose conc and hypoglycemia:
500 d5 0.9 nacl 500 d5w d5 0.45 nacl
If less than 100 CB give D10 0.45 NaCl
hen rbs is decreasing by > or 100mg/hr, may titrate
insulin drip by 25 until 0.05u/kg/hr
DIABETIC KETOACIDOSIS4
Transition of Insulin IV to SQ
Clinical improvement
No acidosis
Oral intake

RENAL FAILURE STAGES to prevent rebound hyperglycemia, stop iv infusion only

DIMINISHED RENAL RESERVE after 60min of giving the 1st sq in ection of regular
- R 50-80 insulin
- may still be asymptomatic
Split-mixed insulin in ection
CHRONIC RENAL INSUFFICIENCY <2yo 0.5u/kg/day
- R 30-50; >2yo 1u/kg/day
- ypocalcemia; decrease tolerance to stress pubertal 0.8-1.5u/kg/day

CHRONIC RENAL FAILURE AM: 2/3 2/3 intermediate 1/3 short

- R 10-30 PM: 1/3 2/3 intermediate 1/3 short
- Anemia,hpn, bone problem, metab
disorder Fluids with the CBG of
- dialysis 300 PNSS 1L 40meqs KCl x 28gtts/min
100-300
END STAGE RENAL DISEASE D5 0.45 NaCl x 28cc/hr (D5 500 D5 0.9 NaCl
- R <10 40meqs KCl)
- Kidneys are small and contracted 100
- dialysis, kidney transplant D10 0.45 NaCl x 28cc/hr (D10 500 D5 0.9 NaCL
40meqs KCl)
DIABETIC KETOACIDOSIS
Antibodies
1CA, 1AA, ADA, 1A2
NUTRITION
(if should wof development of dm in the future)
Approximate daily water re uirements of filipino
Start of symptoms infants and children
80-85 of islet cells have been destroyed
Age Water (ml/kg)
Diagnosis (Signs and Symptoms +) 0-3days 120
BS more than or equal to 126 or RBS more than 10days 150
200 1-5mos 150
heavy glycosuria (more than 55mmol/L) 6-12mos 150
possible ketonuria 1-3yrs 140
4-6yrs 120
Additional workups insulin levels, c-peptide 7-9yrs 100
10-12yrs 90
Management 13-15yrs 70
luid requirement in 48hrs: 2 M deficit 16-19yrs 50
48
Deficit: wt x 30
48 hr maintenance dose: 2 x M
 NUTRITION
Daily re uirements per kg desirable Body Weight
(Filipinos) for Calories and Proteins

Age cal/kg protein g/kg

0-5 mos 115 3.5
6-11 mos 110 3.0
1-2yrs 110 2.5
3-6yrs 90-100 2.0
7-9yrs 80-90 1.5
10-12yrs 70-80 1.5
13-15yrs 55-65 1.5
16-19yrs 45-50 1.2

1g cho 4 cal
1g chon 4 cal
1g fats 8 cal
1000cal 1kcal
1kcal 4.184 k

In general, the ave distribution of calories would be:

11 proteins
35 fats
60 carbohydrates

ANALGESIC & ANTI-PYRETIC

Aspirin 60-80 mkD
T: 80mg, 100mg, 325mg R D: 100mkD (1st 2 wks), 75 mkD
(4 wks)
Anti-inflammatory: 60-90 mkD
Kawasaki: 80-100mkD q6
Indomethacin 1-2 mkD x 3 (PDA)
C: 100mg
Ibuprofen 6-8 mkd q6
D: 100mg/2.5mL
S: 100mg/5mL, 200mg/5mL
C: 200mg, 800mg
Mefenamic Acid 6.5 mkd q6
S: 50mg/5mL
C: 250mg, 500mg
Meperidine 6 mkD/ 0.5-1 mkD
Midazolam 0.2 mkd
T: 15mg
V: 1mg/mL, 5mg/mL
Morphine 0.1-0.2 mkd q6 (max 15mg)
T: 10mg, 30mg, 60mg,
100mg
V: 10mg/mL
Nalbuphine 0.1-0.2 mkd IM, IV
V: 10mg/mL
Naproxen 5-7 mkD q8-q12 (>2y/o)
T: 275mg, 550mg
Paracetamol 10-15 mkd q4
D: 100mg/mL
S: 120mg/5mL, 250mg/5mL
T: 80mg, 500mg
V: 150mg/mL, 300mg/2mL
Supp: 125mg, 250mg
 Criteria for Respiratory Distress in Children With Pneumonia
Signs of Respiratory Distress
1. Tachypnea, respiratory rate, breaths/mina
Age 0–2 months: >60
Age 2–12 months: >50
Age 1–5 Years: >40
Age >5 Years: >20
2. Dyspnea
3. Retractions (suprasternal, intercostals, or subcostal)
4. Grunting
5. Nasal flaring
6. Apnea
7. Altered mental status
8. Pulse oximetry measurement <90% on room air

Variables PCAP – A PCAP – B PCAP – C PCAP – D

Minimal Risk Low Risk Moderate Risk High Risk
Co – morbid illness None Present Present Present
Compliant caregiver Yes Yes No No
Ability to F/U Possible Possible Not possible Not possible
(+)Dehydration None Mild Moderate Severe
Ability to feed Able Able Unable Unable
Age >11 months >11 months <11 months <11 months
Respiratory Rate
2 - 12 months >50/min >50/min >60/min >60/min
1 – 5 years >40/min >40/min >50/min >50/min
>5 years >30/min >30/min >35/min >35/min
Signs of respiratory failure Supraclavicular/intercostal
a. Retraction None None Intercostal/subcostal /subcostal
b. Head bobbing Present Present
c. Cyanosis Present Present
d. Head grunting None Present
Signs of respiratory failure
a. Apnea None None None Present
b. Sensorium Awake Awake Irritable Lethargic, stupurous/comatose
Complications None None Present Present
Action plan OPD OPD Admit to regular ward Admit to ICU

Simple febrile seizures
Self – limiting
Short duration (<15 minutes)
Tonic – clonic features
No reoccurrence within the next 24
hours
No post – ictal pathology
Comple febrile seizures ewborn S reening in the Philippines
Longer duration (>15 minutes) Congenital hypothyroidism
May present as series of sei ures with limited time Congenital adrenal hyperplasia
interval Galactosemia
New events may reoccur within the next 24 hours Phenylketonuria
Focal sei ures, with several possible features: G6PD deficiency
Clonic and/or tonic movements
Loss of muscle tone
eginning on one side of the body, with
or without secondary generali ation
Head and/or eye deviation to one side
Sei ure activity followed by transient
unilateral paralysis (lasting minutes to
hours, occasionally days)
 phoid e er S astroenteritis
Nephrotic Nephritic
tiology S. Typhi Nontyphoidal Salmonella
serovars (eg, S. Massive proteinuria Hematuria
typhimurium, S. enteritidis Hypoalbuminemia Oliguria
Distribution of bacteria in Systemic infection Infection remains locali ed Edema Azotemia
immunocompetent host to intestine and mesenteric Hyperlipidemia/hyperlipiduria hypertension
lymph nodes
Incubation period 14 days <1 day
Common symptoms Fever, relative Diarrhea, abdominal pain,
bradycardia fever, headache, muscle
pains
Duration of symptoms 3 weeks <10 days
Predominant cell type in Mononuclear cells and Neutrophils
intestinal infiltrates lymphocytes
Fecal leukocytes Mononuclear cells Neutrophils

er iew
Self – limited disease in
infants occurring within
the first few hours of
life. Usually a result of
delayed clearance of
fetal lung li uid.
Can be ac uired 1 of 3
ways: congenital,
during birth, or after
birth. Congenital
causes include
T p sm ndii,
rubella, HS , mumps,
adenoviruses, isteri
m n yt enes, and
y terium
tu er u sis.
Group strep are
responsible for most
cases ac uired at
delivery.
h mydi tr h m tis
is ac uired during
passage through an
infected birth canal,
though it can also occur
after prolonged
membrane rupture.
Overview
Most common GI
medical/surgical
emergency occurring in
neonates. Multifactorial
etiology.
Characterized by variable
damage to the intestinal
tract.
Most commonly affects
the terminal ileum and
ascending colon.
Infants with compromised
placental blood flow are
prone to EC. Also prone
are preemies.
A B
Mild non-specific Same as Stage
systemic signs such IA, with
as apnea, addition of
bradycardia, and grossly bloody
temperature stool.
instability.
Mild intestinal signs
such as increased
gastric residuals
and mild abdominal
distention
-ray findings may
be normal or are
mild nonspecific
findings.
A B
NPO diet with antibiotics for 3 days. I F
is provided, including TPN.
Note: antibiotic theraphy is usually ampicillin, aminoglycosided or 3rd generation cephalosporin, and clindamycin or metronida ole.
RA S ACH P A H B R
Presentation Differential Diagnosis orkup reatment Medi ation
Tachypnea with Congenital pneumonia A G Supportive: Minimal medication.
variable grunting, Meconium aspiration Pulse Ox I F and Antibiotics (Ampicillin
flaring, and retracting. syndrome C R lavage or Gentamicin) may
Maternal history of Neonatal sepsis feedings. be used for 48 hours
caesarean delivery Pneumomediastinum Rarely an after birth until
without labor or Pneumothorax infant sepsis is ruled out.
precipitous delivery. Persistent newborn develops a
Resolution usually pulmonary hypertension picture of
occurs 72 hours after Respiratory distress worsening
birth. syndrome respiratory
distress.
A AL P M A
Sudden onset of Foreign body aspiration, A G mpiric Outpatient: Not
fever, cough, and heart failure, malignancy, Pulse Ox antibiotic recommended for first 3
months of age. 1st line
tachypnea. Clinical atelectasis, pulmonary C R treatment x drug is Amoxicillin. If
exam findings include embolus, pulmonary lood 10 – 14 days. penicillin allergic,
tachypnea, rales, and hemorrhage, and cultures in Patient may clindamycin, levofloxacin,
retractions. sarcoidosis. Collagen hospitali e be switched to 3rd gen cephalosporins,
Abdominal pain is vascular disease. d patients. PO at time of or macrolides
common with basilar nvironmental irritants, C C with discharge. Inpatient: Neonate 1st
pneumonia. Atypical congenital lung anomalies. diff line is Ampicillin +
pneumonia may aminoglycoside. 1 month
present with dry, and up Ampicillin.
nonproductive cough,
For moderately or
headache, malaise, severely ill patients,
fever, and cefotaxime, ceftriaxone,
pharyngitis. and levofloxacin provided
broader coverage against
PCN pneumococci.
A ithromycin,
clarithromycin, or
levofloxacin should be
added to cover atypical
pathogens. anco for
MRSA.
NECROTIZING ENTEROCOLITIS
Presentation Differential Diagnosis Workup
resentation nonspecific findings such Hypoplastic left heart syndrome A G
as vomiting diarrhea feeding Intestinal malrotation Abdominal
intolerance and high gastric residuals. Intestinal volvulus radiograph
Also may have abdominal distention acterial meningitis Abdominal
and blood in stools. eonatal sepsis pper GI series
Omphalitis aracentesis
E abdominal girth visible intestinal rematurity
loops obvious abdominal distention rinary tract infection
bowel sounds change in stool olvulus
pattern hematochezia erythema of GE
abdominal wall palpable abdominal Hirschsprung s
mass. ystemic signs include acteremia
respiratory failure peripheral Coarctation of the aorta
perfusion circulatory collapse.
Staging of C and reatment
A B A B
Patient is mildly ill. Patient is moderately Patient has severe N C Severely ill infant
ill. with an intact bowel. with perforated
Mild systemic signs bowel observed
as in IA. Stage I symptoms plus Dx re uires all of the on -ray in
Intestinal signs systemic signs of above conditions with addition to
include all signs moderate illness, such addition of hypotension, findings for IIIA.
present in stage I, as mild metabolic bradycardia, respiratory
with the addition of acidosis and mild failure, severe
absent bowel thrombocytopenia. metabolic acidosis,
sounds and coagulopathy, and/or
abdominal Abdominal neutropenia.
tenderness examination reveals
definite tenderness, Abdominal examination:
perhaps some marked distention with
erythema or other signs of generali ed
discoloration, and/or peritonitis.
RL mass.
-ray: definitive
-ray show portal evidence of ascites.
venous gas w/ or w/out
ascites.
reatment b Stage
A B A B
Support for respiratory and cardiovascular NPO x 14 days, fluid Surgical
failure, including fluid resuscitation, NPO, and resuscitation, inotropic intervention.
antibiotics x 14 days. support, and ventilator
support.
Surgical consultation should be considered.
Surgical consultation
After stabili ation, TPN should be provided should be obtained.
during the period that the infant is NPO.
TPN should be
provided during NPO
period.
 PHR CS DR M
er iew Presentation Differential orkup reatment Medi ation
Diagnosis
Characteri ed by First sign is Diabetic nephropathy U/A Pediatrics: Corticosteroids,
proteinuria, swelling of the Focal segmental Urine sediment Diuretics cyclophosphamide,
hypoalbuminemia, and face, followed glomerulosclerosis examination (Furosemide or and cyclosporine
edema. by swelling of Chronic Urinary protein spironolactone) are used to induce
the body. glomerulonephritis measurement remission.
Nephrotic range Foamy urine Membranous Renal biopsy for: Adult:
proteinuria > 3 gm/day. may be present. glomerulonephritis Congenital nephrotic Diuretics Diuretics to reduce
Hematuria and HI nephropathy syndrome Anticoagulation edema.
Many specific causes hypertension IgA nephropathy Children >8 y at Hypolipidemic
including minimal change may be present. Light chain onset agents AC inhibitors to
nephropathy, focal associated renal Steroid resistance If 2ndary to DM, reduce proteinuria.
glomerulosclerosis, disorders Fre uent relapses or AC inhibitors
membranous Minimal change steroid dependency Rituximab has
nephropathy, and disease Significant nephritic been effective in
hereditary nephropathy. Nephritis, radiation manifestations cases relapsing
Sickle cell Serum albumin after prednisone
There is usually damage nephropathy Serologic tests treatment.
to the glomerular (ANCA, ANA, Hep
structure, such as the or C, HI , anti-
endothelial surface, dsDNA, ASO)
glomerular basement
membrane, or the
podocytes.

AC L M R L PHR S
er iew Presentation P Differential orkup Medi ation
Diagnosis
Sudden onset of Symptoms: Periorbital and/or Anaphylactoid C C Antibiotics for
hematuria, Hematuria pedal edema purpura with lectrolytes underlying
proteinuria, and R C Oliguria dema and HTN due nephritis UN/Creatinine infection.
casts. Clinical dema (peripheral or to fluid overload Chronic GN Complement Loop diuretics
picture is often periorbital) Crackles with an acute levels for edema
accompanied by Headache levated P exacerbation U/A and HTN.
hypertension, edema, Shortness of breath or Ascites and pleural Idiopathic 24 hr urine asodilator
a otemia ( GFR), dyspnea on exertion effusion (possible) hematuria study for severe
and renal salt and Possible flank pain Maybe: Familial Strepto yme/AS HTN and
water retention. Most Rash nephritis O titer encephalopat
common etiology is Symptoms of systemic d Pallor IgA nephritis Nephritis- hy.
following that can ppt AGN: MPGN associated
Renal angle fullness
streptococcal Triad of sinusitis, Lupus nephritis protease
or tenderness, oint
infection (PSGN). pulmonary infiltrates, GN of chronic (NAPR) R A M
swelling, or
and nephritis infection elevated in pts
tenderness
Most often, patient is (suggesting Wegener s asculitiS with Mainly
Hematuria
a boy, 2-14 years, granulomatosis) streptococcal supportive.
who suddenly Abnormal neurologic infxn with GN Sodium and
Nausea and vomiting, examination or altered
develops puffiness of US to evaluate fluid
abdominal pain, and LOC
the eyelids and facial kidney si e. <9 restriction.
purpura (Henoch- Arthritis
edema in the setting cm suggests ed rest until
Schonlein purpura) Other signs:
of a extensive signs of
Arthralgias (SL ) Pharyngitis
poststreptococcal scarring and glomerular
infection. Urine is Hemoptysis Impetigo low likelihood of inflammation
dark and scanty. P (Goodpasture s or Respiratory infection reversibility. and
may be elevated. idiopathic progressive Pulmonary circulatory
Nonspecific infection glomerulonephritis) hemorrhage congestion
include weakness, Skin rashes Heart murmur subside.
fever, abdominal (Hypersensitivity Scarlet fever
pain, and malaise. vasculitis, SL , HSP, Weight gain
There is a latent or cryoglobulinemia)
Abdominal pain
period of 3 weeks Anorexia
following strep ack pain
infection. Oral ulcers

PH S L C CHA S H B R
Respirator
Surfactant production increases at 24 weeks AOG
Fluid compressed from lung during vaginal delivery.
1st breath initiated by response to arousal to sound, temperature change, and touch. Chemical receptors further increase respiratory drive
in response to hypoxia and hypercarbia.
1st breath overcomes airway resistance, inertia of fluid in airways, and surface tension of the air/fluid interface in the alveolus.
Alveolar distension, cortisol, and epinephrine all stimulate type II pneumocytes to produce surfactant and reduce alveolar surface tension,
thereby facilitating lung expansion.
Cardia
Umbilical vessels constrict in response to stretching and increased oxygen content at delivery.
Low resistance placenta is removed and systemic resistance increases.
Circulation through ductus venosus is reduced causing passive closure over the following 3-7 days and reducing blood return to I C.
Lung expansion drops pulmonary vascular resistance, increasing resistance to left atrium.
Increased pressure to left atrium and decreased pressure to right atrium functionally closes the foramen ovale within the first few breaths of
life.
Physiological reverse shunt from left to right commonly occurs.
Resultant drop in pulmonary artery pressure and increase in S R reverses flow across ductus arteriosus from left to right.
Ductus arteriosus is affected by blood oxygen content and circulating prostaglandins. The potent dilator PG 2 produced by placenta is lost
at birth facilitating DA closure.
Catecholamine surge at birth leads to improved myocardial function and increased CO.
Hematologi
HbF is replaced by HbA
itamin dependent cofactors are low at birth. Therefore, all newborns are given vitamin at birth.
hermoregulation
Heat produced by limb movement and brown fat.
Hepati
Con ugation of bilirubin not mature until 2 weeks after delivery. Uncon ugated bilirubin levels rise within first 48 hours due to rapid
breakdown of HbF and immature liver.
Renal
Glomeruli and nephrons are immature at birth.
Renal immaturity also affects vitamin D formation and calcium homeostasis.
er ous S stem
lood brain barrier will not mature until 6 months of age.
Parasympathetic system predominates in neonates. So it is better developed to protect against hypertension than hypotension.