Clerkship Pediatrics Medication Orders 1

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EMERGENCY DRUGS
Epinephrine
0.01-0.03 mkd q 3-5 min
Atropine
0.02-0.03 mkd
Maximum of 0.5mg
1-2mg subcutaneously q 20 minutes
Adenocard: 6mg initially then 12mg next
Adenosine: 6mg/2mL
Calcium Gluconate 10%
1cc/kg/shift
Preparation: 100mg/mL/10mL ampuole
Captopril
0.3-0.5.0 mkd q 12 hrs
Maximum of 6 mkD in 2-4 doses
Capoten: 25mg tablet
Lidocaine
1.0mkd bolus
20-50 mcg/kg/minute
Hydralazine
IV: 0.1-0.2 mkd q 4-6 hrs
PO: 0.75-1 mkD in 2-4 doses
Maximum of 7.5 mkD
Apresoline: 10mg tablet; 25mg tablet; 20mg ampoule
Nifedipine
0.25-0.5 mkd q 4-6 hrs
Nipride
0.5-1.5mcg/kg/minute
Department of Paediatrics 2011 and jed_steven1987

1
Urecholine
2.9mg/m2/day q 8 hrs PO
Sodium Bicarbonate
1.5-2.0 mkd
Mannitol 20%
LD: 0.4-1.0 mkd
MD: 0.25-0.5 q 4-6 hrs
Preparation: 1.2% solution (1med/mL)
Naloxone
0.1 mkd q 2-3
Plain: 0.4 mg/mL
Neonate: 0.02 mg/mL
ANTI-STAPHYLOCOCCAL
Nafcillin
100-200 mkD q 6
Vigopen: 250mg/5mL
Co-Amoxiclav
40-60 mkD bid
Augmentin: 156mg/5mL; 312mg/5mL
Fluocloxacillin
100-200 mkD
Vancomycin
45-60 mkD q 8-12 hrs
Cloxacillin
50-100 mkD qid
Prostaphlin-A: 125mg/5mL

2
Orbenin: 250mg tablet; 500mg tablet
Oxacillin
100-200 mkD IV
Prostaphlin
Stafloxin
100-200 mkD
OTHER BETA LACTAMS

Imipenem-Cilastatin
60-100 mkD q 6-8 hrs
Neonate: 20 mk q 18-24 hrs
Piperacillin-Tazobactam
300-400 mkD q 6-8 hrs
Piperacillin
200-300 mkD q4-6 hrs
Meropenem
20 mkd q 8 hrs
Meningitis: 40 mkd q 8 hrs
FIRST GENERATION CEPHALOSPORINS

Cephalexin
25-100 mkD q 6-8 hrs
Cephadrine
50-100 mkD q 6-12 hrs
Cefadroxil
30 mkD bid

3
Maximum of 2grams
Cefalothin
50-100 mkD qid
Cefazolin
50-100 mkD q 8 hrs
SECOND GENERATION CEPHALOSPORINS

Cefaclor
20-40 mkD q 8-12 hrs
Ceclor/Xelent: 125mg/5mL; 250mg/5mL
Cefuroxime
PO: 20-30 mkD bid
IV: 50-100 mkD q 8hrs
Pneumonia: 150mkD q 8 hrs
Cefamandole
50-100 mkD qid
THIRD GENERATION CEPHALOSPORINS

Cefotaxime
150mkD q 6-8 hrs
Newborn - < 7 years: 100mkd q 12 hrs
> 12 years: 1gram/kg/day q 6-8 hrs
Adults: 2grams/kg/day q 8-12 hrs
Meningitis: 200mkD q 8-12 hrs
Ceftriaxone
50-75 mkD OD

4
Meningitis: LD: 75 mkd
MD: 80-100 mkD
Ceftazidime
150 mkD q 8 hrs
Neonate: 25-50mkD q 12 hrs
Fortum
Cefoperazone
100-150 mkD q 8-12 hrs
Cefoxitin
80-160 mkD q 6-8 hrs
Mefoxin
Cefixime
8 mkD q 12-24 hrs
Tergecef 100mg/5mL
FOURTH GENERATION CEPHALOSPORINS

Cefepime
100-150 mkD q 8-12 hrs
FLUOROQUINOLONES
Ciprofloxacin
15-30mkD q 12 hrs
PENICILLINS
Penicillin

5
IV: Penicillin G 100,000-250,000 units/kg/D q 4-6 hrs
PO: Penicillin G 100,000-250,000 units/kg/D q 4-6 hrs
Penicillin V 25-50 mkD q 4-8 hrs
IM: Penicillin G Benzathine
300,000-1.2 M units q 3-4 weeks
Penicillin G Procaine
25,000-50,000 units/kg/D x 10 days
Amoxicillin
40-60 mkD q 8 hrs
Otitis Media: 80 mkD
Ampicillin
Neonate: 50-100 mkD q 12 hrs
Meningitis: 150 mkD q 8 hrs
Children: 100-200 mkD q 6 hrs
Meningitis: 200-400mkD q 6 hrs
Ampicillin + Sulbactam
25 mkD q 6 hrs
AMINOGLYCOSYDES
Amikacin
Neonate: 10-15 mkD neonates
Child: 15-25 mkD q 8-12 hrs
Amikacide: 100mg/2mL; 250 mg/2mL
Tobramycin
2.5 mkD q 8-12 hrs
Nebcin
Gentamycin

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2.5 mkD q 8-12 hrs
Kanamycin
15 mkD q 12 hrs
Weight in Daily Dosage in Daily Dosage in
Kilograms Milligrams Milliliters
1.00 15.0 0.4
1.25 18.8 0.5
1.50 22.5 0.6
1.75 26.2 0.7
2.00 30.0 0.8
2.25 33.8 0.9
2.50 37.5 1.0
2.75 41.2 1.1
3.00 45.0 1.2
3.50 52.5 1.4
4.00 60.0 1.6
4.50 67.5 1.8
5.00 75.0 2.0
Amount per 24 hours to be given in divided doses.
ANTI-AMOEBIC
Metronidazole
30 mkD q 6-8 hrs
Flagyl: PO: 125mg/5mL; 250mg tablet
IV: 500 mg; 100 mg
Servizole: 200mg/5mL
Tinidazole
7
50-60 mg OD x 3 days if with AGE and liver involvement
Etofamide
15-20 mkD tid
Kitnos: 40mg/5mL; 250mg tablet; 500mg tablet
Furozolidone
5-7 mkD q 6 hrs
ANTIFUNGAL
Nystatin
0.5-1 mL tid to qid x 7 days
Neonate: 400,000 units/day
Infant/Child: 1M-2M units/day
Mycostatin: 100,000 units/mL; 500,000 unit tablet
Amphotericin B
IV: 4-6 mkD
Preparation: 500mg + 10 mL distilled water
Griseofulvin
10 mkD SD
Adult: 500-1000 mg/day but not more than 10 mkd single
or divided dosea
Child: 10 mkD in divided doses
Grisovin: 125mg tablet
Fluconazole
Oral Candidiasis: LD: 6 mkd
MD: 3 mkD OD
Oesophageal Candidiasis: LD: 6-12mkD
MD: 3-12 mkD OD

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Systemic Candidiasis: 6-12 mkD for 28 days
Prophylaxis: IV: LD: 12 mkD
MD: 6 mkD
PO: 6 mKd
Ketoconazole
>2 years: 3.3-6.6 mkD SD
Nizoral: 200mg/tab
Terbinafine HCl
Not established in paediatric patients
Fingernail Onychomycosis: 250mg tablet OD x 6 weeks
Toenail Onychomycosis: 250mg tablet OD x 12 weeks
Lamisil: 250 mg/tab
MACROLIDES
Erythromycin
30-50 mkD Q 6-8 hrs
Maximum of 2grams/day
Erythrocin: 200 mg/5mL; 400mg/5mL;
100mg/2.5gtts
Azithromycin
10 mkD OD x 3 days
Clarithromycin
15 mkD q 12 hrs or 7.5 mkd
Klaricid: 125 mg/5mL (do not refrigerate)
OTHER ANTIBIOTICS

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Vancomycin
45-60 mkD q 8-12 hrs
Co-Trimoxazole
6-20 mkD q 12 hrs (based on Trimethoprim)
Triglobe: 45mg/5mL
Bactrim: 160 mg/5mL; 40mg tablet; 80mg tablet
Macrobid: 40mg/5mL
Clindamycin (IM, IV or PO)
10-40 mkD q 6-8 hrs
Dalacin C 75mg/5mL
Chloramphenicol (IV or PO)
50-75 mkD q 6-8 hrs
Chloromycetin
Chloramol
Tetracycline
40-60 mkD
ANTI-HELMINTHIC
Oxantel pamoate
10-20 mkd
Mebendazole
100 mkd bid x 3 days
Antiox: 100mg tablet; 500mg tablet; 20mg suspension
Combantrin: 125mg tablet; 250mg tablet;
125mg/5mL suspension
>15 years old 500 mg
10-14 years old 375 mg

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5-9 years old 250 mg
< 5 years old 125 mg
ANTIVIRAL
Methisoprinol
50-100 mkD
Isoprinosine: 250mg/1mL
Inosiplex
50mkD
Immunosin: 250mg/5mL
Acyclovir
10-15 mkD
Zovirax: 250mg/5mL; 200mg tablet
ANALGESICS
Fentanyl
Refer to http://www.drugs.com/dosage/fentanyl.html for
adult or paediatric dosing as classified by purpose.
Low: 2mkD
Moderate: 2-20mkD
High: 2-50 mkD
Ibuprofen
5-10 mkd q 6 hrs
Dolan: 100mg/5mL; 200mg/5mL
Mefenamic Acid
3-5 mkD

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Ponstan: 50mg/5mL
Midazolam
0.1 mkd
Dormicum: PO: 5mg tablet
IV: 5mg/mL
Morphine
0.1-0.2 mkD
Preparation: 10 mg/mL
Nalbuphine
0.1 mkD
Nubain: 10mg/mL
Pancuronium
0.4-0.1 mkD
ANTACIDS
Ranitidine
4-5 mkD q 8 hrs
Famotidine
0.7 mkd q 12 hrs
Omeprazole
0.6-0.7 mk OD
Preparation: 20mg; 40mg
Cimetidine
10-20 mkD q 12 hrs
Preparation: 200mg/mL

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ANTI-EMETIC
Metoclopramide
0.1 mkd q 8 hrs
ANTI-ASTHMA
Salbutamol
Children < 6 years: 0.12-0.15 mkd q 8 hrs
>6 years: 2mg/dose tid or qid
Terbutaline
SQ: 0.005 mkd
PO: 0.075 mkd
Drip: 0.003 mkH
Bricanyl: PO: 1.5mg/5mL; 2.5mg/5mL
IV: 0.5mg/mL
Theophylline
3-5 mkd
Nuellin: 80mg/15mL; 50mg tablet;
125mg tablet; 250mg tablet
Apnea:
Neonates: LD: 6-10 mkd
MD: 2-4 mkd q 12 hrs
6 weeks – 6 months: 10 mkD
6 months – 1 year: 12-18 mkD
1 year – 9 years: 20-24 mkD
9 years – 12 years: 16 mkD
12 years – 16 years: 13 mkD
Aminophylline

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Drip: 0.5-0.9 mk/hour + equal amount of diluents
Neonates: LD: 6 mkd IV or PO
MD: 2.5-3mkd q 12 hrs IV or PO
Children:
6 weeks – 6 months 0.5 mk/hour
6 months – 1 year 0.7 mk/hour
1 year – 9 years 1 mk/hour
9years – 12 years 0.9 mk/hour
12 years – adult 0.7 mk/hour
Preparation: 25mg/mL
Doxophylline
6-9 mkd q 12 hrs
Ansimar: 100mg/5mL
Other options for asthma:

 Epinephrine
0.01 mkd subcutaneous administration
 Aminophylline
LD: 5-6 mkd over 20 min
MD: 1mk/hour; or
1 mk IV q 6 hrs
 MgSO4
25-75 mkd IV drip for 20 minutes then q 8 hrs
 Terbutaline
Drip: 0.1-0.4 mcg/kg/minute
Preparation: 500mcg/mL

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ANTI-HISTAMINES
Diphenhydramine
3-5 mkD tid to qid
Preparation: 12.5 mg/5mL; 25mg capsule
Hydroxyzine
1mkD once to two times a day
Iterax: 2mg/mL; 10mg tablet
Cetirizine
0.25 mkD
Virlix: 10 mg/mL
Loratadine
> 3 years, < 30kg: 5mg/day
>30 kg: 10mg/day
Ketotifen
0.025mkd q 12 hrs
Zadec: 1mg/5mL
Zaditen: 0.2mg/mL
Levocetirizine
Number of drops = weight in kilograms x 0.25
Xyzal
ANTI-CONVULSANTS
Carbamazepine
< 6yo initial: 5 mkD in 2-4 doses;
May increase q 5-7 days by 5mg/kilo
6-12 yo initial: 10 mkD in 2-4 doses

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Increase by 100mg or 5mkD at weekly
intervals until treatment levels are
achieved
Clonazepam
0.01-0.3 mkD in 2-3 divided doses
Increase by 0.5mg/24 hrs q 3-5 days until patient
responds
Diazepam
0.2-0.4 mkd
Maximum of 2-5mg
Valium: 10mg/2mL
Lorazepam
Antiemetic: 0.04-0.08 mkd q 6 hrs IV
Anxiolytic/Sedative: 0.05-0.1 mkd q 4-8 hrs
Midazolam
0.1-0.2 mkd
Anticonvulsant:
LD: 0.15mg/kg administered intravenously over 5
minutes
MD: 0.06-0.4mg/kg/hour at 1-7 mcg/kg/minute
Phenobarbital
Child:
LD: 15-20mkd
MD: 5-6 mkD q 12-24 hrs
Neonate:
LD: 20mkd
MD: 3-4 mkD q 12-24 hrs
Phenytoin

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Neonate: LD: 15-20 mkd
Maximum of 0.5mg/kg/minute
MD: 5 mkD d 12-24 hrs
Children: LD: 15-18 mkd
Maximum of 1-3mg/kg/minute
MD: 5-6 years: 8-10 mkD
7-9 years: 6-8 mkD q 12-24 hrs
10-16 years: 6-7 mkD q 12-24 hrs
Valproic Acid
10-15 mkD in 3 divided doses
Increase weekly by 5-10 mkD until patient responds
STEROIDS
Dexamethasone (PO, IM or IV)
Post-intubation: 0.5-2 mkD q 6 hrs
Anti-inflammatory: 0.08-0.3 mkD q 6-12 hrs
Bacterial meningitis:
0.6 mkD q 6 hrs for 1-4 days of antibiotics
Hydrocortisone
5 mkd q 6 hrs then gradually taper
Prednisolone
0.7 mkD
Prednisone
0.5-1 mkD
Pred10: 10mg/5mL
Methylprednisolone
1.5 mkD q 6 hrs

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ANTI-DERMATOSES
Hydrocortisone 1%
Hytone/ Lacticare
Betamethasone
Betnovate/Diprolene
Fluocinolone acetonide
Synalar/Aplosyn
Mometasone furoate
Momate/Elica
Clobetasol propionate
Dermovate
PARACETAMOL
RD: 10-15 mkd
Aeknil 300mg/2mL
Biogesic 100mg/mL; 250mg/5mL
Calpol 120mg/5mL; 250mg/5mL
Naprex 250mg/5mL
Opigesic 125mg suppository; 250mg suppository
Rexidol 150mg/5mL
Tylenol 120mg/5mL
DIGITALIZATION
LD: 0.04-0.06 mkd q 6 hrs x 4 doses

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Maximum of 1mg/day
MD: 1/8 the loading dose q 12 hrs
Pedia Elixir: 0.05mg/mL; 0.25mg/ml
PO: 0.25mg tablet
IV: 0.5mg/2mL
SPECIAL DRUGS
Sildenafil
0.3-1mkD q 6 hrs
Iloprost
0.5-2mcg/kg/dose nebulization q 2-4 hrs
Preparation: 20mcg/mL vial
1 vial = 9mL PNSS
Procaterol HCl
0.25mL/kg bid or tid
Meptin
IRON
Prophylaxis: 1-2mkD
Treatment: 4-5mkD
Ferlin drops: 15mg/mL
Ferlin syrup: 30mg/5mL
FOLATE
Preterm: 0.25mkD

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Folart drops
Folart syrup
DIURETICS
Furosemide
1-2 mkd
Lasix: 40mg tablet; 20mg/2mL ampule
Frusema: 40mg tablet; 20mg tablet
Mannitol 20%
0.5-1 gram/kg/dose
Preparation: 20grams/100mL
1gram= 5mL
Diazoxide
5-10 mkd
Preparation: 300mg/2mL
Acetazolamide
20-30 mkD
Preparation: 250mg tablet
Spironolactone
1.5-3 mkD
Aldactone: 25mg tablet
Hydrochlorothiazide
1-2 mkD
Dichlotride: 25 mg tablet; 50mg tablet
BICARBONATE

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NaHCO3 in mEq
= 0.3 x Weight (kg) x Base deficit (mEq/L)
1-2 mEq/kg IV push over 10-30 minutes
ZINC
Diarrhoea: <6 months: 10mg OD po x 10-14 days
≥6 months: 20mg x 10-14 days
Pneumonia: <2 years old: 10mg OD po x 4-6 months
≥2 years old: 20mg OD po x 4-6 months
Drops: 10mg/mL = 27.5mg/mL

Syrup: 20mg/5mL = 55mg/5mL
IRON
Prophylaxis: 1-2 mkD
Treatment: 4-5 mkD
Ferlin: Drops 15 mg/mL
Syrup 30 mg/mL
FOLATE
AGE: 20 mkD OD
PCAP: >24 months: 20 mkD OD
<24 months: 10 mkD OD
Folart: Tablet: 5 mg tablet
Drops: 2.5 mg/mL

21
Syrup: 5 mg/mL
VITAMIN K
5-10 mg/dose
Children: 2-3 mg/24 hrs
Adolescents and adults: 5-10 mg/24hrs
RACECADOTRIL
1.5mkd tid
Hidrasec sachet: 10mg; 30mg
MIDAZOLAM DRIP
20mg + 50cc D5 water to make 0.4mg/cc
LD: 3.5 mkd

MD: 0.5mg/kg/hr via infusion pump
DOPAMINE/DOBUTAMINE
1-5µg/kg/min Increases renal and splanchnic
circulation
5-10µg/kg/min Inotropic; no effect on heart rate
10-20µg/kg/min Increases blood pressure
Preparation: 200mg/5mL

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Concentration Dopamine D5 Water
Single Strength 800 1mL 49mL
Double Strength 1600 2mL 48mL
Preparation of Dobutamine: 250mg/2mL

Concentration Dobutamine D5 Water
Single Strength 1000 4mL 46mL
Double Strength 2000 8mL 42mL
Computation:
Actual dose:
Rate x Concentration
Weight in kilograms x 60
Rate:
Recommended dose x weight in kilograms x 60
Concentration
DOPAMINE – DOBUTAMINE COCKTAIL

1.Get the rate of dopamine according to the desired dose
2.Get the volume of dobutamine to the desired dose using
this formula:
Weight in kilograms x Recommended dose x 60

Dopamine rate
Concentration (1000)

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3.In a soluset prepare the total volume of 50cc composed
of the following:
 Dopamine volume of 1cc
 Calculated Dobutamine volume
 D5 Water
4.Regulate to dopamine rate
NOREPINEPHRINE
0.1-2mg/kg/minute
Start at 0.5mg/kg/minute??
2mg + 48mL D5W
INSULIN DRIP
 Secure regular insulin at 100 IU/mL
 Prepare as follows:
 Aspirate 0.1mL from vial + 0.9mL of normal saline to
make 10 IU/mL
 Aspirate 0.1mL from the 10 IU/mL solution + 0.9mL of
normal saline to make 1 IU/mL
 Aspirate 0.6mL from the 1 IU/mL solution + 7.4mL D5Water
to make 8mL and run at 1mL/hr
 Flush syringe and tubing with regular insulin
 HGT one hour after (depends on physician’s preference)
(O.02-0.1) AD x wt x hrs
INTRALIPID

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Start with 10% at 0.5grams/kg/day
via infusion pump for 12 hours
Preparation:
10% = 10grams/100mL
20% = 20grams/100mL
NEWBORN SCREENING
Components:
 Congenital Adrenal Hyperplasia
 Congenital Hypothyroidism
 G6PD deficiency
 Galactosemia
 Phenylketonuria
Perform at 48 hrs old
 May be done ideally until 6 weeks old
 May be done theoretically from 24 hrs old until 6 months
old
Do not perform if the patient:
 Has received blood transfusion
Tests NOT affected:
 Congenital Adrenal Hyperplasia
 Galactosemia
 Placed on NPO
Test affected:
 Galactosemia

25
VITAL SIGNS
Heart rate:
< 2 months 140-160
2-12 months 120-140
1-2 years 100-120
2-8 years 90-110
Respiratory rate:
< 2 months up to 60
2 months - 1year 50
1-5 years 40
Blood pressure:
Systolic:
Upper limit = Age in years x 2 + 90
Lower limit = Age in years x 2 + 70
Diastolic:
30 mmHg lower than systolic BP
WEIGHT COMPUTATION
2-12 months
Weight in grams = age in months x 10
< 6 months
Weight in grams = age in months x 600 + birth weight
6-12 months
Weight in grams = age in months x 500 + birth weight
>2 years old
Weight in kilograms = age in years x 2 + 8

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4-5months Birth weight x 2
1 year Birth weight x 3
2 years Birth weight x 4
HEIGHT COMPUTATION
Height in centimeters = age in years x 5 + 80
Birth weight : 50cm
1st year : 25 cm
2nd year : 12.5 cm
3rd year : 6.25 cm
4th year : 3 cm
BLOOD PRESSURE
Systolic Blood Pressure
Age in years x 2 + 70
Diastolic Blood Pressure

Systolic Blood Pressure – 30
BLOOD PRESSURE 95TH P

Newborn to Day 7 > 95mmHg

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Day 8 to Day 30 >105mmHg
Infant to 2 years old > 115/75mmHg
2 years old to 5 years old >130/80mmHg
6 years old to 11 years old > 135/85mmHg
BODY SURFACE AREA

Weight in kilograms x 4 + 7
Weight in kilograms + 90
Renal BSA x 400

Meningitis BSA x 1500
Preterm BSA x 1200
CHF BSA x 800
Cardiac BSA x 200
MF < 2 years BSA x 1500
> 2 years BSA x 1200
Haematology BSA:
Weight in kilograms x Height in centimeters
Square root of
3600
Nephrology BSA:
0-5 kilograms Weight in kilograms x 0.05 + 0.05

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> 40 kilograms Weight in kilograms x 0.01 + 0.80
Dry weight:
= Actual weight – Estimated oedema
= Actual weight – (Actual weight x 0.80)
= Actual weight – [Actual weight – (Actual weight x 20%)]
BODY MASS INDEX

Weight in kilograms
Height in centimeters
Height in centimeters x 10,000
< 5th percentile Underweight

5th – 84th percentile Normal weight
85th – 94th percentile At risk for overweight
> 95th percentile Overweight
BASAL CALORIC EXPENDITURE

Newborn 45-50 cal/kg
3-10 kilos 60-80 cal/kg
>60 kilos 25-30 cal/kg

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Maintenance fluid computation: (cc/hr)
BCE x Weight in kilograms x 1.5
24
Fever + 12% for ever degree above 37.5oC

Hyperventillation + 25-50%
Bronchial Asthma + 50%
Bililight + 20%
Hypermetabolic + 25-50%
Burns + 14% for 1st degree
Sweating + 10-25%
RECOMMENDATIONS FOR DISCHARGE OF PRETERM

 Feeding per orem
 Weight gain of 10-30 grams/24 hrs
 Thermoregulated
 No apnea or bradycardia
 On PO meds
 Reached 1,800-2,100 grams
 Adequate home settings
DOUBLE VOLUME EXCHANGE TRANSFUSION

80cc/kg x 2
or
Body weight x 80% x 2

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 Divide by 10 or 20 to get volume for exchanges
 Put on NPO before and after DVET
 Pre DVET laboratory tests:
 Calcium
 Chloride
 Random Blood Sugar
 Sodium
 Potassium
 Arterial Blood Gas
 Total Bilirubin and Direct Bilirubin
MENINGITIS
Empirical:
Vancomycin 60 mkD q 6 hrs
S. pneumoniae, N. meningitides & H. influenzae:
Cefotaxime 200 mkD q 6 hrs
Ceftriaxone LD: 75 mkd
MD: 80-100 mkD
S. pneumonia:
Ceftriaxone, OR
Penicillin 400,000 units/kg/D q 4-6 hrs x 10-14 days
N. meningitides:
Penicillin 400,000 units/kg/D q 6 hrs x 5-7 days
H. influenza:
Ampicillin 100-200 mkD q 12 hrs
Steroids:

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Dexamethasone 0.15 mkd q 6 hrs x 2 days for patients
with HiB
Give 1-2 hrs prior to antibiotics
SEIZURES
Diazepam
IV: 0.2-0.4 mkd q 5 min
Rectal: 0.5 mkd
Phenobarbital
LD: 20-40 mkd, increase by increments of 10
MD: 5 mkD q 12 hrs, start 12 hrs after LD
CHOLERA
DOC: Tetracycline 50 mkD qid x 3 days
Contraindicated in <9years old. Instead, use:
 Co-Trimoxazole 8-10 mkD bid PO
 Erythromycin 40 mkD
Doxycycline 5mkD single dose
COUGH
Ambroxol
1.2-1.6 mkd bid
Mucosolvan: 15mg/5mL
Expel: 0.6mg/mL
Zobrixol: 15mg/5mL

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Carbocysteine
20-30 mkD
Loviscol: 50mg/mL; 100mg/mL
Solmux: 40mg/mL; 200mg/5mL
CARE OF ACUTE RESPIRATORY INFECTION

2 months - 2 years:
Mild Pneumonia:
 Send home
 Trimethoprim + Sulfomethoxazole
 Treat the fever
 Follow up in 2-4 days
Severe Pneumonia:
 Admit
 Intravenous or intramuscular Benzyl Penicillin
 Treat the fever and wheezing
 Supportive care
 Reassess daily
Very Severe Pneumonia:
 Admit
 Give oxygen inhalation
 Give Chloramphenicol
 Treat the fever and wheezing
 Reassess two times a day or every 15 minutes if
possible
< 2 months:
Severe Pneumonia:

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 Hospitalize
 Keep warm
 Give 1st dose antibiotics
 Benzyl Peicillin
 Garamycin; or
 Gentamycin
SHIGELLA
Ampicillin 100 mkD q 6 hrs
Ceftriaxone 50 mkD
Nalidixic Acid 55 mkD q 6 hrs
>19 years old: Ciprofloxacin 15-30mkD q 12 hrs
**Treat for 5 days
DENGUE FEVER
Grading:
Grade I Fever + non-specific signs and symptoms +
positive tourniquet test
Grade II Grade I + signs of spontaneous bleeding
Grade III Grade II + manifestations of circulatory
failure:
 Rapid, weak pulse
 Narrow pulse pressure
 Hypotension
 Cold, clammy extremities

34
Grade IV Profound shock with undetectable blood
pressure and pulse
Classical Dengue Fever:

 Thrombocytopenia not < 100K/µL
 Haemoconcentration not ≥ 20% of baseline
ANAPHYLAXIS
Epinephrine
IM: 0.01 mkd max of 0.5 mL
Preparation: 1:1000
Diphenhydramine
IM or IV: 1-2 mkd q 4-6 hrs
Maximum of 50mg
Ranitidine
IV: 1-2 mkD q 6 hrs
Maximum of 50mg
Hydrocortisone
IV: 5-10 mkd q 4-6 hrs
Maximum of 100-500mg
NORMAL ELECTROLYTE LEVELS

Sodium 135-145 mEq/L (RV = 136 mEq)
Potassium 4.5-6 mEq/L (RV = 4 mEq)
Calcium 8-10 mEq/L
Chloride 98-106 mEq/L

35
Deficit:
(Desired – Actual) x Weight in kilograms x 0.6
MAINTENANCE ELECTROLYTES
Sodium 3mEq/L
Potassium 2mEq/L
Chloride 2mEq/L
HYPERKALEMIA
Mild < 6.5mEq/L
Moderate 6.5 – 7.5mEq/L
Severe > 7.5mEq/L
Management:
 If with significant ECG abnormalities:
 Calcium gluconate 10% to stabilize myocardial cells;
given with patient attached to cardiac monitor
0.1-0.2 mkd administered over 5-10 minutes; or
1cc/kg/shift; or
30 x weight in kilograms
9
 For redistribution of potassium
 Sodium bicarbonate to correct acidosis and to induce
intracellular shift of potassium
1-2 mEq/kg IV push over 10-30 minutes

36
 Insulin to shift potassium intracellularly
1unit/10kilograms
D50 water to prevent hypoglycemia from insulin
administration
 Inhaled beta2 agonist to promote intracellular shift of
potassium
 For removal of potassium
 Dialysis
 Sodium Polystyrene Sulfonate (Kayexalate) cation
exchange resin to bind with potassium and to enable
excretion
 Loop diuretics
KAWASAKI’S DISEASE
Kumumi Score for IVIg resistance
< 6 months old 1 point
Before 4 days of illness 1 point
Platelet count < 30K/µL 1 point
CRP >8 mg/dL 1 point
ALT > 80 IU/L 2 points
 Score of > 3 indicates IVIg resistance with 78%
sensitivity and 76% specificity
Harada Score
Intravenous gamma globulin is given to children who fulfill
4 of the following criteria, assessed within 9 days of onset
of illness:

37
 White blood cell count >12 000/mm3
 Platelet count <350 000/mm3
 CRP > 3+
 Haematocrit <35%
 Albumin <3.5 g/dL
 Age ≤12 months
 Male sex
For children with < 4 risk factors but with continuing acute
symptoms, reassess daily.
Source: http://pediatrics.aappublications.org/content/114/6/1708.full
CREATININE CLEARANCE
K x height in centimeters
Serum Creatinine
Where K (Constant) is:

Preterm and Low birth weight 0.33
Term and > 1 year old 0.45
Child, female adolescent 0.55
Child, male adolescent 0.77
Interpretation:
80-120 normal
50-80 renal impairment
20-50 renal insufficiency
5-20 renal failure
<5 uremia

38
LUMBAR TAP
Post-LP orders:
 NPO until fully awake
 Flat on bed for 4 hrs
 Send tubes to lab:
Tube #1: Gm stain, culture, KOH and India ink, AFB
Tube #2: Glucose and CHON
Tube #3: Cell count and Differential count
 Do not forget to take opening pressure

 Do not forget HGT
Contraindications:
 Increased ICP
 Severe CP depression
 Infected skin
 Decreased platelet count or blood d/o
 Brain abscess
CSF: Colorless: 50-80 mmH20

WBC: 5/mm3
CHON: < 45 mg/dL
Glucose: 60-75% of HGT
CSF Normal Values:

Opening Pressure
Newborn 80-110 mm H2O

39
Infant < 200 mmH2O
Glucose
Premature 24-63 mg/dL (CSF: Blood ratio 55-105%)
Term 44-128 mg/dL (CSF: Blood ratio 44-158%)
Protein
Premature 65-150 mg/dL
Term 20-170 mg/dL
WBC Count
Premature 0-25 cells/mm3 (57% PMNs)
Term 0-22 cells/mm3 (61% PMNs)
WBC correction in traumatic tap:

Peripheral WBC x 1000 WBC
x1,000 =
5,000,000 1,000 RBC
ABSOLUTE NEUTROPHIL COUNT

Total WBC x % of neutrophils and bands
Mild neutropenia 1000-1500 /uL

Moderate 500-1000/uL
Severe <500/uL
CALORIC CONTENTS
VCO 8 kcal/mL
Aminosteril 650 kcal/1000mL
NAN 67 kcal/100mL

40
EBM 20 kcal/oz
Milk formula 30kcal/oz
Intralipid 650kcal/1000mL
D5 0.2 kcal/cc
D7.5 0.3 kcal/cc
D10 0.4 kcal/cc
LIGHT’S CRITERIA FOR PLEURAL EFFUSION

Exudates Transudates
LDH >0.5 <0.5
CHON >0.6 <0.6
Specimen for pleural fluid analysis:

Tube1: CHON, LDH
Tube 2: Differential count and cell count
Tube 3: Gram stain, AFB stain, Culture and Sensitivity
DO NOT FORGET to get
 Serum ODH
 Serum CHON
NELSON’S FLUID MANAGEMENT

Initial Fluid:
20cc/kg to be administered in 2 hrs
Regulated Fluid:
(Maintenance fluid + deficit) – 20cc/kg
24 hours

41
Maintenance fluid calculation use Holiday-Segar
Deficit:
Infant Children
< 2 years > 2 years
Mild 5% 3%
Moderate 10% 6%
Severe 15% 9%
MALCOLM-HOLIDAY
(¼ of the fluids in the 1st hour, ¾ in the next 7 hours)
Hydrite 1 tablet in 100cc water good for 8 hrs
Glucost 1 sachet in 100cc water good for 8 hrs
Oresol 1 sachet in 1L water good for 24 hrs
Glucolyte 1 sachet in 200cc water
FLUIDS AND ELECTROLYTES

Hypotonic:
 D5 Water
 D5 NM
 D5 0.3% NaCl
 D5 IMB
 Isolyte
 D5 Maintresol
Isotonic:
 D5LR
 D5 NSS
 PLR
42
 PNSS
Hypertonic:
 D50 Water
 D10 Water
NEW/REFORMULATED ORAL REHYDRATION SOLUTION

245 mmol/L
Sodium 75
Glucose 75
Chloride 65
Citrate 10
Potassium 20
IV FLUID COMPOSITION
Na K Cl HCO3 Ca PO4
IMB 25 20 22 23 3 3
NM 40 13 40 16 3 3
NSS 154 154
LR 130 4 109 28 3 3
NMR 40 30
IsolyteM 40 35 40
IsolyteP 25 20 20
0.3% 51 51
0.6% 102 102
0.45% 77 77

43
Pedialyte90 90 20 80
PedialytePI 45 20 35
1mEq sodium = 23mg

1mEq potassium = 39.1mg
IV FLUID OF CHOICE
Maintenance < 2 years D5IMB
Maintenance > 2 years D5NM
Preterm Neonate Electrolyte free D5
LBM PLR
Vomiting D5 NSS
Bronchial Asthma D5 0.3% NaCl
Fever and Sweating D5 0.3% NaCl
Drowning D5 Water
Ascites D5 Water; D10 Water
CHF D5 NSS
Hypertension D5 0.3% NaCl
Heat Stroke D5 NSS
Burns PLR
Azotemia D5 Water
Increased BUN D10 Water
Bleeding D5 0.3% NaCl
UTI D5 NSS
Profuse Bleeding D5 0.3% NaCl
Dengue Fever D5 0.3% NaCl
Diabetes Mellitus PNSS
44
MAINTENANCE FLUID
Term 60cc/kg/day
Preterm 70cc/kg/day
 Increase by increments of 10cc/kg/day until a maximum of
150cc/kg/day
D10 BOLUS
HGT < 40 mg/dL
Volume to give: 2cc/kg

Volume of D50: Volume to give x 0.11
Volume of D5: Volume to give – Volume of D50
D10 = Volume of D50 + Volume of D5
REFILLING
 D5 is readily available
 How much D50 are you going to add to D5?
Amount of D50 = (Desided Dextrosity – Actual Dextrosity) – 45
Glucose Infusion Rate (GIR):

Rate in mL/hr x Dextrosity in mg/mL
Normal values: Peripheral lines: 4-6
As high as D12.5 in preterm
45
Central lines: 10-12
As high as D20 in preterm
Conversion: D10 0.11
D7.5 0.055
D12.5 0.16
D15 0.2
D20 0.3
AVERAGE ELECTROLYTE COMPOSITION OF LOSSES

Diarrhoea Emesis
Sodium 55 60
Potassium 25 10
Bicarbonate 15
Chloride 90
COMPOSITION OF BODY FLUIDS

Na K Cl HCO3
Gastric Fluid 50-60 10-15 90-150 0
Pancreatic Fluid 140 5 50-100 100
Bile 130 5 100 40
Ileal Fluid 130 15-20 120 25-30
Diarrhoea 50-55 25-35 0-40 15-50
Sweat 50 5 55 0
Blood 140 4-5 100 25
Urine 10-100 20-100 70-100 0
**mEq/L
46
MATERIALS FOR THORACENTESIS
 G18 ambucath
 Specimen bottles # 3
 Gauze
 Macro set
 Sterile bottle
 Normal Saline Solution
 Tongue depressor
 Gloves
 10cc syringe
Specimen:
Bottle # 1: CHON, LDH
Bottle # 2: Differential count and cell count
Bottle # 3: Gram stain, AFB stain, Culture and
Sensitivity
DO NOT FORGET to get
 Serum CHON
 Serum LDH
TYPHOID FEVER
Uncomplicated:
 Chloramphenicol
50-75 mkD x 14-21 days
 Amoxicillin

47
75-100 mkD x 14 days
 Quinolone
15 mkD x 15 day
 Cefixime
15-20 mkD x 7-14 days
 Ceftriaxone
75 mkD x 10-14 days
Severe:
 Ampicillin
100 mkD x 14 days
 Ceftriaxone
60-75 mkD x 15 days
 Quinolone
15 mkD x 15 days
RHEUMATIC FEVER
Major Criteria:
 Carditis
 Arthritis
 Sydenham’s chorea
 Erythema marginatum
 Subcutaneous nodules
Minor Criteria:
 Arthralgia
 Fever
 Laboratory test results:

48
 Elevated CRP and ESR
 Prolonged PR interval on ECG
 Positive ASO titer
 Positive Group A Streptococci culture
2 major criteria; or
1 major + 2 minor criterion
AMERICAN SOCIETY OF ANAESTHESIOLOGY

PHYSICAL STATUS CLASSIFICATION
Class I: Healthy patient, no systemic disease
Class II: Mild systemic disease without functional
limitations (mild CRF, IDA, mild asthma)
Class III: Severe systemic disease with functional
limitations
Class IV: Severe systemic disease that is a constant
threat to life (critically ill or acutely ill
pts with major systemic disease)
Class V: Moribund patient not expected to survive 24 hrs
with or without surgery
E: Emergency surgery
ALDRETE RECOVERY SCORE

Activity Able to move four extremities voluntarily or 2
on command
Able to move two extremities voluntarily or on 1
command
No motion 0
49
Respiration Able to breathe deeply and cough freely 2
Dyspnea or limited breathing 1
Apneic 0
Circulation BP ± 20% of pre-anaesthetic level 2
BP ± 20 – 40% of pre-anaesthetic level 1
BP ± 50% of pre-anaesthetic level 0
Pulse Rate Pulse ± 20 beats of pre-sedation rate 2
Pulse ± 50 to 21 beats of pre-sedation rate 1
Pulse > ± 51 beats of pre-sedation rate 0
Consciousness Fully awake 2
Arousable 1
Not responding 0
O2 Saturation Maintains baseline saturation on room air 2
Needs O2 to maintain >90% saturation 1
O2 saturation <90% with O2 supplement 0
Color Pink 2
Pale and blotchy 1
Cyanotic 0
Score of three points below baseline

 Maintain 1:1 surveillance and q 5 minute documentation
of vital signs
Score of two points below baseline
 q 15 minute surveillance and documentation of vital
signs
Score of one point below baseline
 q 15-30 minute surveillance and documentation of vital
signs depending on patient’s condition

50
 Patients who have received reversal agents will require q
15 minute surveillance and documentation of vital signs
for a minimum of two hours post-reversal administration
 Patients with Aldrete score of two points or more below
baseline must be referred to the physician responsible for
the procedure for further evaluation.
 Patients equal to baseline post-procedure will be
discharged from the procedure area as in 5.0 of the
Sedation/ Analgesia Policy
RANSON’S CRITERIA FOR ACUTE PANCREATITIS

Pancreatitis:
On admission:
 Age > 55 years
 Leukocytosis > 16,000/µL
 Hyperglycemia > 200mg/dL (11mmol/L)
 Serum LDH > 400 IU/L
 Serum SGOT (AST) > 250 IU/L
At 48 hours:
 Haematocrit fall > 10%
 Fluid sequestration > 6,000mL
 Hypocalcemia < 8mg/dL (1.9mmol/L)
 Hypoxemia PO2 < 60mmHg)
 BUN rise > 5mg/dL (>1.8mmol/L) after IV fluid
hydration
 Hypoalbuminemia < 3.2g/dL (32g/L)

51
Gallstone pancreatitis:
On admission:
 Age in years > 70 years
 White blood cell count > 18000 cells/mm3
 Blood glucose > 12.2 mmol/L (> 220 mg/dL)
 Serum AST > 250 IU/L
 Serum LDH > 400 IU/L
At 48 hours:
 Calcium (serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
 Haematocrit fall > 10%
 Oxygen (hypoxemia PO2 < 60 mmHg)
 BUN increased by 1.8 or more mmol/L (5 or more
mg/dL) after IV fluid hydration
 Base deficit (negative base excess) > 5 mEq/L
 Sequestration of fluids > 4 L
Interpretation:
If the score ≥ 3, severe pancreatitis likely.
If the score < 3, severe pancreatitis is unlikely
or
Score 0 to 2: 2% mortality

52
CRITERIA FOR AMI
 Typical pain: retrosternal, severe, pain lasting >30min,
unrelieved by nitrates, cold, clammy perspiration
 Evolutionary ST elevation followed by Q wave formation
and ST segment inversion
 Elevation of serum CPK-MB
Test Onset Peak Duration

CPK-MB 4-6 hrs 12-24 hrs 24-48 hrs
SGOT 8-12 hrs 36-48 hrs 3-5 days
LDH 12-24 hrs 2-4 days 7-10 days
JAUNDICE
Clinical Jaundice:
Manifestation of color starting at serum bilirubin
levels of 5-7mg/dL
Criteria to rule out physiologic jaundice:

 Clinical jaundice in the 1st 24 hrs of life
 Increase in total serum bilirubin at > 5 mg/dL/day
(85µmol/L)
 Total serum bilirubin > 12mg/dL in full term, and >
15mg/dL in preterm
 Direct bilirubin > 1.5-2mg/dL (26-34µmol/L)
 Jaundice lasting for more than 1 week for term, 2 weeks
for preterm

53
TUBERCULOSIS NOTES
Class 1 3 months INH
Class 2 9 months INH
Class 3 2 months HRZ + 4 months HR
Extrapulmonary 2 months HRZ + E or S,
then 10 months HR ± E or S
Isoniazid
10 mkD OD ac breakfast
200mg/5mL
Rifampicin
5 mkD OD ac breakfast
200mg/5mL
Pyrazinamide
15 mkD bid pc meals
250mg/5mL
Ethambutol
20 mkD
Streptomycin
20-30 mkD OD IM
CARDIO NOTES
Chest x-ray findings:
Pericardial Effusion : Big heart with no lung
infiltrates
Heart Failure: Big heart with lung infiltrates

54
RESPIRATORY NOTES
Expected FEV1
Females: (height in centimeters - 100) x 5 +170
Males: (height in centimeters - 100) x 5 +175
Oxygen delivery:
FiO2 = O2 in liters per minute x 5 + 21
Expected PaO2 = FiO2 x 5
 If P/F ratio is <200 ARDS
 If P/F ratio is <300 Acute Lung Injury
Pulmonary volumes:
Total Volume (TV) = 500 mL
Volume inspired or expired with each normal breath
Inspiratory Reserve Volume (IRV) = 3.0 L
Volume that can be inspired over and above the TV
Expiratory Reserve Volume (ERV) = 1.1L
Residual Volume (RV) = 1.2 L
Volume that remains in the lungs after maximal
expiration
Dead Space = 150 mL
Anatomical: Volume of the conducting airways
Physiological functional measurement: Volume of the
lungs that does not eliminate CO2 (usually
greater in lung diseases with V/Q inequalities)

55
Signs of Acute Respiratory Distress
 Acute/sudden onset of hypoxemia
 PF ratio < 200 (ARDS)
 No cardiac lesion
 X ray of bilateral infiltrates
Alveolar-Arterial Oxygen Difference

PCO2
(713 x FiO2) - - PaO2
0.8
Normal: 10 to 20
 The smaller the number, the better the result
Indications for intubation:

 ABG
 Low PO2 (<60%)
 Increased PCO2 (>45)
 P/F ratio
 PaO2 < 80%
 Depressed neurologic status
 Increased work of breathing
 Hemodynamic status changes: HR, BP, decreased CRT
Endotracheal tube size: > 2 years old

Age in years
+ 4
4
Continuous Positive Airway Pressure

56
Total Flow Rate (TFR):
Weight x tidal volume (10-15) x respiratory rate x IE
ratio (2) + 2000 (2L) x
Formula for getting FiO2:

Compressed Air x 0.2 + O2 x 100
TFR
TFR of 6 is usually used
Compressed Air:
100 – FiO2 x TFR
79
1LPM = 4% FiO2
Continuous Positive Airway Pressure Guidelines

 Initially CPAP is set at 6 cm water. If there is no
increase in PO2 in 15 minutes, pressure must be
increased by 2cm increments to a maximum of 10 cm if by
endotracheal tube or by 12 cm in other methods.
 If there is an increase in PaO2, reduce pressure.
 If 10-12 cm water pressure is attained and if PaO2
remains under 50, FiO2 must be increased by 5-10%
increments.
 CPAP failure is evident if PaO2 remains less than 50 in
100% FiO2 with 10-12cm water.
 If CPAP fails under non invasive method, an ETT must be
inserted.

57
 If CPAP fails with endotracheal tube, mechanical
ventilation is indicated.
Parameters to be met before weaning:

 Improvement in chest x-ray
 ABG showing PO2 ≥ 50 mmHg
 Blood pH ≥ 7.3
 PCO2 ≤ 55 mmHg
 Haemoglobin of 12-15 grams/dL or Haematocrit of 36-45%
Weaning from CPAP:

 Decrease FiO2 by 3-5% every time PaO2 reaches > 70
 With FiO2 of 40%, reduce pressure by increments of 2 cm
water every 2-4 hrs until pressure of 2-3 cm is
achieved.
 Transfer patient to oxygen hood with FiO2 of 15-50%
Indications for CTT insertion:

 Frank pus
 Positive Gram’s stain
 Parapneumonic effusion with evidence of loculation
 pH < 7.2
 Glucose load < 40 mg/dL
 LDH > 1000
 Massive effusion with overwhelming sepsis (Hib and
Staphylococcus)
Indications for CTT removal:

58
 Drainage < 30-50 cc/day
 Draining fluid is clear yellow
 Improved constitutional symptoms
 Non-functioning CTT
HAEMATOLOGY NOTES
Haematocrit Values:
1day 45-69%
2 days 48-75%
3 days 44-72%
2 months 28-42%
6 months – 12 years 35-45%
12 – 18 years Males: 37-49%
Females: 36-46%
18 – 49 years Males: 41-53%
Females: 36-46%
Hemoglobin Values
1 - 3 days 14.5-22.5
2 months 9-14
6months - 12 years 11.5-15.5
12 – 18 years Males: 13-16
Females: 12-16
18 – 49 years Males: 13.5-17.5
Females: 12-16
Reticulocyte Index (RI)

59
Patient’s Haematocrit
% Reticulocyte x
Normal Haematocrit
Reticulocyte Production Index (RPI)

Reticulocyte Index
Maturation Correction
% Haematocrit Maturation Correction

36-45 1.0
26-35 1.5
16-25 2.0
<15 2.5
Callman’s Equation for Desired Haematocrit

Age in years
Haemoglobin = + 11.1
10
Haematocrit = Haemoglobin x 3
Blood Transfusion
Fresh Whole Blood
10-15cc/kg
Maximum of 20cc/kg
Volume to be transfused:
Desired Haematocrit – Actual Haematocrit
Weight in kilograms
Packed Red Blood Cells
10-15 cc/kg
60
Neonates: 15cc/kg
Platelet concentrate
1unit for every 6 kilogram body weight
1 unit increases platelet by 10K/L
Fresh Frozen Plasma
10-15cc/kg at maintenance fluid rate
Cryoprecipitate
1 unit for every 7 kilogram body weight
Guidelines for RBC transfusion

Infants within the first four months of life:
Severe pulmonary and cardiac disease < 13g/dL
Moderate pulmonary major surgery < 10g/dL
Symptomatic anemia < 8g/dL
Children and Adolescents

Acute loss of > 25% circulating blood volume
Perioperative and symptomatic anemia <8g/dL
Severe cardiopulmonary disease <13g/dL
Cardio Patients
Volume needed for transfusion:
Hemoglobin x Weight
2
Expected hemoglobin for age:

Age in years
+ 11.1
10
61
Notes:
Administer Platelet at 10-15cc/hr
Administer PRBC:
If not congested, 2-4cc/kg/hr
If congested, 1-2cc/kg/hr
ALBUMIN
1gram/kg/dose
Formula:
Desired – Actual x 1.2 x Weight in kilograms
ARTERIAL BLOOD GASSES

Children Neonates
pH 7.35 – 7.45 7.3 – 7.4
pCO3 35 – 45 35 – 45
HCO3 22 – 26 24 - 26
O2 saturation
Normal > 80%
Mild Hypoxemia 60-80%
Moderate Hypoxemia 40-60%
Severe Hypoxemia < 40%
Acid base deficit:

Full incorporation for neonates:

62
0.3 x ABE x Weight in kilograms
Full incorporation for children:
0.6 x ABE x Weight in kilograms
Correction:
2cc/kg NaHCO3 IV bolus, give remaining in drip in 1 hr
Computation:
Metabolic Acidosis:
pCO2 = 1.5 (HCO3) + 8.4 ± 2
Metabolic Alkalosis:
0.6-0.7mmHg increase in pCO2 for every 1mEq/L increase
in HCO3
Respiratory Acidosis:
Acute: 1mEq/L increase in HCO3 for every 10mmHg
increase in pCO2
Chronic: 3-3.5mEq/L increase HCO3 for every 10mmHg
increase in pCO2
Respiratory Alkalosis:
Acute: 2-2.5 mEq/L decrease in HCO3 every 10mmHg
decrease in pCO2
Chronic: 4-5mEq/L decrease in HCO3 every 10mmHg
decrease in pCO2
Oxygen Delivery Index:

FiO2 x MAP
PaO2

63
GLASGOW COMA SCALE
CGS pCGS
Eye Opening Spontaneous 4 Spontaneous 4
Speech 3 Speech 3
Pain 2 Pain 2
None 1 None 1
Verbal Response Oriented 5 Coos, babbles 5
Confused 4 Irritable cries 4
Inappropriate 3 Cries to pain 3
Incomprehensible 2 Moans to pain 2
None 1 None 1
Motor Response Obeys commands 6 Spontaneous 6
movements
Localizes pain 5 Withdraws to touch 5
Withdraws to pain 4 Withdraws to pain 4
Decorticate 3 Abnormal flexion 3
Decerebrate 2 Abnormal extension 2
None 1 None 1
PHOTOTHERAPY
Indications:
Preterm: 10mg/dL bilirubin
Full term: 15mg/dL bilirubin
Complications:
 Osmotic diarrhea
 Rashes
 Bronze baby syndrome
64
 Dehydration
SMALL BOWEL OBSTRUCTION

Proximal/High SBO Distal/Low SBO
Onset Acute Less acute
Vomiting Prominent Less prominent
Vomitus Non-faecaloid Faecaloid
Pain Frequent Less frequent
Distension Minimal Prominent
SEPSIS
Infection: Suspected or proven infection or a clinical
syndrome associated with high probability of infection
SIRS: 2 out of 4 criteria, 1 of which must be abnormal

temperature or abnormal leukocyte count
 Core temperature >38.5°C or <36°C (rectal, bladder,
oral, or central catheter)
 Tachycardia: mean heart rate >2 SD above normal for age
in absence of external stimuli, chronic drugs or painful
stimuli;
OR
 Unexplained persistent elevation over 0.5–4 hrs;
OR
 Persistent bradycardia in children <1 yr old over
0.5 hr (mean heart rate <10th percentile for age in
65
absence of vagal stimuli, β blocker drugs, or
congenital heart disease)
 Respiratory rate >2 SD above normal for age or acute
need for mechanical ventilation not related to
neuromuscular disease or general anesthesia
 Leukocyte count elevated or depressed for age (not
secondary to chemotherapy) or >10% immature neutrophils
Sepsis: SIRS plus a suspected or proven infection
Severe Sepsis: Sepsis plus one of the following

 Cardiovascular organ dysfunction defined as
- Despite >40mL/kg of isotonic intravenous fluid in 1 hr
- Hypotension <5th percentile for age, systolic blood
pressure <2 SD below normal for age
OR
- Need for vasoactive drug to maintain blood pressure
OR
- Two of the following
 Unexplained metabolic acidosis: base deficit >5
mEq/L
 Increased arterial lactate >2 times upper limit of
normal
 Oliguria: urine output <0.5 mL/kg/hr
 Prolonged capillary refill 5 sec
 Core to peripheral temperature gap >3°C
 Acute respiratory distress syndrome (ARDS) as defined by
the presence of a PaO2/FiO2 ratio ≤300 mm Hg, bilateral

66
infiltrates on chest radiograph, and no evidence of left
heart failure
OR
Sepsis plus 2 or more organ dysfunctions (respiratory,
renal, neurologic, hematologic, or hepatic)
Septic Shock: Sepsis plus cardiovascular organ dysfunction

defined as defined above
Multiple Organ Dysfunction Syndrome (MODS): Presence of

altered organ function such that homeostasis cannot be
maintained without medical intervention
MOTOR GRADING
0 No movement
1 Flicker of contraction with no associated movement
at a joint
2 Movement present but can’t sustain against gravity
3 Movement against gravity but not with resistance
4 Movement against some resistance
5 Movement against full resistance
CALORIC REQUIREMENTS
< 1 month 110-140 cal/kg/day
1-11 months 110-115 cal/kg/day
1-2 years 100-110 cal/kg/day

67
RECOMMENDED DIETARY ALLOWANCE FOR PROTEIN

0-5 months 2.5 grams/kg/day
6-11 months 2.5-3.0 grams/kg/day
1-6 years 2.0-2.5 grams/kg/day
13-15 years 1.5 grams/kg/day
NEWBORN ADMITTING ORDERS

Date of birth:
Time of birth:
AS: BW: HC: AG:
BS: BL: CC: T:
 Please admit patient under the Department of Paediatrics
under the service of Dr. .
 Please secure consent to care
 TPR q 4 hrs
 Problem: A live, term or preterm, gender, neonate,
delivered via NSDV or Caesarean Section, AS: ,

68
weeks by Ballard’s Score, BW: , AGA, LGA,
SGA, with or without microcephaly
 Diet: Exclusive breastfeeding
 Laboratory tests:
o Newborn screening at 48 hours old
o Cord blood typing if mother is type O
o Others as needed
 Medications:
o Oxytertacycline 1 squirt per eye, OU
o Vitamin K 0.1mL intramuscularly on the left thigh,
single dose
o Hepatitis B vaccine 0.5mL intramuscularly on the
right thigh, single dose
o BCG vaccine 0.05mL intradermally on the right
deltoid (right gluteus if under Dr. Bullo)
 Thermoregulate between 36.5-37.5oC
 Monitor vital signs every 15 minutes for the first hour,
every 30 minutes for the second hour and every hour
thereafter until stable
 Refer for the following:
o Temperature of < 36.5oC or > 37.5oC
o Heart rate of < 120 bpm or > 160 bpm
o Respiratory rate of < 40 cpm or > 60 cpm
 Do routine newborn care
o Daily bath with mild soap and water
o Daily cord care with 70% alcohol. (use soap and
water if under Dr. Amatong)

69
o Daily early morning sunlight exposure for 10-15
minutes between 6AM to 8AM. (not done if under Dr.
Amatong)
 Please refer accordingly
 Will inform attending physician of delivery
 Thank you
SILVERMAN – ANDERSON SCORING

FOR RESPIRATORY DISTRESS SYNDROME
Feature Score 0 Score 1 Score 2
Chest Equal Respiratory Seesaw
Movement lag respiration
Intercostal None Minimal Marked
Retraction
Xyphoid None Minimal Marked
Retraction
Nasal Flaring None Minimal Marked
Expiratory None Audible with Audible
Grunt stethoscope
Scoring: 3-4 give oxygen
> 7 intubate
ASTHMA CLASSIFICATION
Based on severity:
Persistent
Intermittent Mild Moderate Severe

70
Symptomatic
< 1/week > 1/week Daily Daily
days
Symptomatic
< 2/month > 2/month > 1/week > 1/week
nights
PEFR
> 80 > 80 60-79 < 60
expiratory
PEFR variable < 20 20-30 > 30 > 30
FEV1 > 80 > 80 60-79 < 60
Wood’s Score:
Score 0 Score 1 Score 2
Cyanosis 50-100 < 70 in room < 70 in 40%
air FiO2
Breath sounds Normal Unequal Absent
Accessory None Moderate Maximum
muscles
Expiratory None Moderate Extreme
wheeze
Cerebral Normal Depresses/ Agitated
function Coma
Scoring: 1-3 Mild asthma attack
4-6 Moderate, bedside treatment
> 7 Severe; intubate
FREQUENT PATHOGENS
Age Group Pathogens in order of frequency
Neonates  Group B streptococcus
(< 1month)  Escherichia coli
71
 Other gram-negative bacilli
 Streptococcus pneumonia
 Haemophilus influenzae (type b,
nontypable)
1-3 months Febrile pneumonia
 Respiratory syncytial virus
 Other respiratory viruses (parainfluenza
viruses, influenza viruses, adenoviruses)
nontypable)
Afebrile pneumonia
 Chlamydia trachomatis
 Mycoplasma hominis
 Ureaplasma urealyticum
 Cytomegalovirus
3-12 months  Respiratory syncytial virus
 Other respiratory viruses (parainfluenza
nontypable)
 Chlamydia trachomatis
 Mycoplasma pneumonia
 Group A streptococcus
2-5 years  Respiratory viruses (parainfluenza

72
 Streptococcus pneumoniae
nontypable)
 Mycoplasma pneumonia
 Chlamydophila pneumonia
 Staphylococcus aureus
 Group A streptococcus
5-18 years  Mycoplasma pneumonia
 Chlamydia pneumoniae
nontypable)
 Influenza viruses
 Adenoviruses
 Other respiratory viruses
≥ 18 years  Mycoplasma pneumonia
 Chlamydia pneumoniae
nontypable)
 Influenza viruses
 Adenoviruses
 Legionella pneumophila
NEONATAL ASSESSMENT and PLAN MNEMONICS

Fluids
Respiratory System

73
Infection
Cardiovascular System/Circulation/Perfusion
Haematologic Status
Metabolism
Output
Neurologic Status
Diet – to include amount of calories
NEONATAL SUPPLEMENTATION
Calicum Gluconate (30mg/kg)
Ca Gluconate mL in 24 hours =
9.4
Preparation: 100mg/mL/10mL ampoule
Aminosteril 6%
Start with 0.5grams/kg/24 hours initially
Increase by 0.5grams/kg/day
May start at 2.5grams/kg/day
Maximum of__________________
Aminosteril mL in 24 hours = RD x Weight in kilograms x 0.6
Intralipid
2-3 grams/kg/24 hours
POTASSIUM REPLACEMENT
ORAL
One medium sized banana 10 mEq/banana
One serving of grapes 15mEq/serving
74
One serving of Prunes 15mEq/serving
One watermelon 15 mEq/watermelon
Kalium durule 10mEq/durule
Give as high as 2 tablets three times a day pc
PARENTERAL
KCl Incorporation
One litre
Maximum of 40mEq at 30gtts/minute
One pint
Maximum of 20mEq at maintenance fluid rate
KCl infusion
In a soluset, mix 90ccPNSS and 10-20mEq KCl with a
preparation of 1mEq/mL to make a concentration
of 0.1mEq/mL then regulate to a rate of
30cc/hour or to as high as 100cc/hour
Actual dose = Rate x Concentration
Maximum of 15mEq/hour
Potassium infusion rate (KIR)

Infusion rate x Actual Dose
Volume x Weight in kilograms
Care has been taken to confirm the accuracy of the information presented and
to describe generally accepted practices. However, the authors and/or
editors are not responsible for errors or omissions or of any consequences
expressed or implied with respect to the currency, completeness or accuracy
of the contents of the publication. Application of this information in a
particular situation remains the professional responsibility of the
practitioner.
75
76

Clerkship Pediatrics Medication Orders 1

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Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

OTHER BETA LACTAMS

FIRST GENERATION CEPHALOSPORINS

Department of Paediatrics 2011 and jed_steven1987

SECOND GENERATION CEPHALOSPORINS

THIRD GENERATION CEPHALOSPORINS

Department of Paediatrics 2011 and jed_steven1987

FOURTH GENERATION CEPHALOSPORINS

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Other options for asthma:

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Drops: 10mg/mL = 27.5mg/mL

Department of Paediatrics 2011 and jed_steven1987

LD: 3.5 mkd

Department of Paediatrics 2011 and jed_steven1987

Preparation of Dobutamine: 250mg/2mL

DOPAMINE – DOBUTAMINE COCKTAIL

Weight in kilograms x Recommended dose x 60

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Diastolic Blood Pressure

BLOOD PRESSURE 95TH P

Department of Paediatrics 2011 and jed_steven1987

BODY SURFACE AREA

Renal BSA x 400

Department of Paediatrics 2011 and jed_steven1987

BODY MASS INDEX

< 5th percentile Underweight

BASAL CALORIC EXPENDITURE

Department of Paediatrics 2011 and jed_steven1987

Fever + 12% for ever degree above 37.5oC

RECOMMENDATIONS FOR DISCHARGE OF PRETERM

DOUBLE VOLUME EXCHANGE TRANSFUSION

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

CARE OF ACUTE RESPIRATORY INFECTION

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Classical Dengue Fever:

NORMAL ELECTROLYTE LEVELS

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Department of Paediatrics 2011 and jed_steven1987

Where K (Constant) is:

Department of Paediatrics 2011 and jed_steven1987

 Do not forget to take opening pressure