Pedia Notes Revised
Pedia Notes Revised
Pedia Notes Revised
Please admit under RI, LI, PD or AP Please admit under the service of Dr.
TPR q4H TPR q4H and record
May breastfeed if NSD; NPO x 2hrs if CS NPO if dyspneic
Labs: Labs:
NBS at 24 hrs old, secure consent CBC
CBC, BT (if w/ maternal illness, PROM or UTI U/A (MSCC)
HGT now then 1, 3, 6, 12, 24, 48 hrs old (GDM) ABG* CXR APL*
HGT now (SGA or LGA) IVF:
Medications: D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
Erythromycin eye ointment both eyes D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
Vit K 1 mg IM (term); 0.5 mg (PT) D5LR 1L at 30cc/kg in 8hif >40 kg
Hep B vaccine 0.5 ml IM, secure consent Medications:
BCG 0.05 ml ID (PT); 0.1 ml (term), secure onsent Paracetamol prn q4h for T > 37.8C (10 15 mkdose)
SO USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses
Routine NB care Incorporate Budesonide 10 mkd LD (max 200mg IV); then
Monitor VS q30 mins until stable 5mkd q6h IV (max of 100 mg IV)
Thermoregulate at 36.5 to 37.5C Ranitidine IVTT at 1mkdose (if on NPO)
Place under droplight (NSD); isolette (CS) SO:
Suction secretion prn MIO q shift and record
Will infrom AP /AP attended delivery Monitor VS q2h and record
Refer for persistence of tachypnea, alar flaring and retractions
O2 at 2 lpm via NC, refer for desaturations <95%
DENGUE FEVER Will inform AP
Please admit under the service of Dr. Pls inform Dr _____ of this admission
TPR q4H and record Thank you.
DAT ( No dark colored foods)
Labs: HYPERSENSITIVITY REACTION
CBC, Plt (optional APTT and PT) Please admit under the service of Dr.
Blood typing TPR q4H and record
U/A (MSCC) Hypoallergenic diet
IVF: Labs:
D5 0.3 NaCl 1P/1L (<40 kg) at 3 5 cc/kg CBC
D5LR 1L (>40 kg) at 3 5 cc/kg U/A (MSCC)
Medications: IVF:
Paracetamol prn q4h for T > 37.8C D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
Omeprazole 1mkdose max 40 mg IVTT OD D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
SO: D5LR 1L at 30cc/kg in 8hif >40 kg
MIO q shift and record Medications:
Monitor VS q2h and record, to include BP *Epinephrine (1:1000) 0.1mg/kg/dose IM anterolateral thigh
Continue TSB for fever (max of 0.3 mg)
Refer for Hypotension, narrow pulse pressure (< 20mmHg) *Salbutamol neb x 3 doses q 20 mins
Refer for signs of active bleeding like epistaxis, gum bleeding, Diphenhydramine 10 mkdose LD (max of 200mg IV); thenmg IV)
melena, coffee ground vomitus 5mkdose q6h IV (max of 100
Will inform AP Ranitidine IVTT at 1mkdose q 12h
Pls inform Dr _____ of this admission SO:
Thank you. MIO q shift and record
Monitor VS q2h and record to include BP
Continue TSB for fever
FEBRILE SEIZURE O2 at 2 lpm via NC, or 6 lpm via facemask
Please admit under the service of Dr. Attach to pulse oximeter, refer for desaturations <95%
TPR q4H and record Will inform AP
DAT once fully awake Pls inform Dr _____ of this admission
Labs: Thank you.
CBC BPN
U/A (MSCC) Please admit under the service of Dr.
IVF: TPR q4H and record
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo) NPO if dyspneic
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo) Labs:
D5LR 1L at 30cc/kg in 8hif >40 kg CBC
Medications: U/A (MSCC)
Paracetamol prn q4h for T > 37.8C ABG* CXR APL*
IVF:
SO: D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo) OR
MIO q shift and record D5 IMB/D5 NM at MR if with NO losses
Monitor VS q2h and record D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
Monitor neurovital signs q4h and record D5LR 1L at 30cc/kg in 8hif >40 kg
Continue TSB for fever Medications:
Seizure precaution at bedside as ff: Paracetamol prn q4h for T > 37.8C (10 15 mkdose)
Suction machine at bedside USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses
O2 with functional gauge; if with active sz give O2 at 2lpm via NC then refer
Diazepam IVTT (0.3 mkd max of 5 mg IV) prn for seizure NaCl (Muconase) nasal spray, 2 sprays per nostrils, then suction
Will inform AP using bulb QID
Pls inform Dr _____ of this admission Ranitidine IVTT at 1mkdose (if on NPO)
Thank you. SO:
MIO q shift and record
Monitor VS q2h and record
Continue TSB for fever
AGE Refer for persistence of tachypnea, alar flaring and retractions
Please admit under the service of Dr. O2 at 2 lpm via NC, or 6 lpm via facemask
TPR q4H and record Attach to pulse oximeter, refer for desaturations <95%
DAT once fully awake; NPO x 2hrs if with vomiting Will inform AP
Labs: Pls inform Dr _____ of this admission
CBC Thank you.
U/A (MSCC)
F/A (Concentration Method)
IVF: ANTIBIOTICS
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo) Amoxicillin (30 50 mkday) TID
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo) Pediamox Susp : 250mg/5ml
D5LR 1L at 30cc/kg in 8hif >40 kg Drops : 100mg/ml
Medications: Himox Cap : 250mg, 500mg
Paracetamol prn q4h for T > 37.8C Moxicillin Susp : 125mg/5ml 250mg/5ml
Zinc (E Zinc) Harvimox Drops : 100mg/ml
Drops 10mg/ml 1ml OD (<6 mos) Novamox
1ml BID (6 mos 2 yo) Amoxil Susp : 125mg/5ml 250mg/5ml
Syrup 20 mg/5ml (>2 yo) 5ml OD Cap : 250mg 500mg
Ranitidine IVTT at 1mkdose (if with abdominal pain) Glamox Drops : 100mg/ml
SO: Globapen
MIO q shift and record Amoxicillin + Clavulanic acid (30 50 mkday)
Monitor VS q2h and record
Augmentin Tab: 375mg (250mg); 625 (500mg)
Continue TSB for fever
Amoclav Susp: 156.25mg/5ml (125mg) TID
Chart character, frequency and amount of GI losses and replace w/
228.5mg/5ml (200mg) BID
PLR 1L/1P vol/vol
312.5mg/5ml (250mg) TID
Will inform AP
457mg/5ml (400mg) BID
Pls inform Dr _____ of this admission
Thank you. Cloxacillin (50 100 mkday) q6h
Prostaphlin A Tab: 250mg 500mg
Orbinin Susp: 125mg/5ml
Flucloxacillin (50 100 mkday) q6h
Staphloxin Susp: 125mg/5ml
Cap : 250mg 500mg
Chloramphenicol (50 75 mkd) q6h
Pediachlor Susp: 125mg/5ml
Chloramol Tab : 250mg 500mg
Kemicetine
Chloromycetin
CEPHALOSPORINS ANTIVIRAL
1st Generation Acyclovir (20 mkdose) q 4 6 h
Cefalexin (25 100 mkd ) q 6-8 h Max 800mg/day x 5 days
Lexum Cap : 250mg; 500mg Zovirax Susp: 200mg/5ml
Cefalin Susp : 125mg/5ml 250mg/5ml Acevir Blue: 400mg
Keflex Drops : 100mg/ml Pink: 800mg
Ceporex Cap : 250mg 500mg
Selzef Caplet: 1 gm ORAL ANTIFUNGALS
Granules: 125mg/5ml 250mg/5ml Ketoconazole (6mkd) q 4 6h
Drops: 125mg/1.25ml Daktarin Adult & Child: tsp q 6h
2nd Generation Infant: tsp q 6 h
Cefaclor (20 40 mkd ) q 8 12 h Nystatin
Ceclor Pulvule: 250mg 500mg 375mg 750mg Mucostatin Susp: 100,000 u/5ml
Ceclor CD Susp: 125mg/5ml 187mg/5ml Ready mix susp Tab: 500,000 u
CD ext release 250mg/5ml 375mg/5ml Fluoconazole (3 6 mkd) OD x 2wks
Drops: 50mg/ml Diflucan Cap: 50mg 150mg 200mg
Xelent Cap : 250mg 500mg Vial: 2mg/ml x 100 ml
Vercef Susp : 125mg/5ml 250mg/5ml
ANTI-HELMINTHICS
Oxantel + Pyrantel pamoate (10 20 mkd) SD
Trichiuriasis: x 2 days Hookworm: x 3 days
Cefuroxime (20 40mkd) q 12h Quantrel Susp : 125mg/5ml
Zinnat Cap : 250mg 500mg Tab : 125mg 250mg
Sachet: 125mg/sat 250mg/sat Mebendazole *not recommended below 2 yo
Susp: 125mg/5ml Antiox Susp: 50 mg/ml 100mg/ml
Cefprozil (20 40mkd) q 12h Tab: 125mg 250mg
Procef Susp : 125mg/5ml 250mg/5ml 100 mg BID x 3 days
3rd Generation 500mg SD (>2 yo)
Cefixime (6 12 mkd) q 12h Albendazole <2 yo: 200mg SD
Tergecef Susp : 100mg/5ml >2yo: 400mg SD
Zefral Drops: 20mg/ml *may give x 3 days if with severe infestation
Ultrazime Zentel Susp: 200mg/5ml
Cefdinir (7mg/kg q 12h OR 14mg/kg OD) Tab : 400mg
Omnicef Cap : 100mg
Sachet/ Susp: mg/5ml ANTIHISTAMINE
COTRIMOXAZOLE (TM 5 8 mkd) q 12h Diphenhydramine HCl (5mkd) q 6h
Bactille TS Susp/5ml SMZ 400mg TM 80mg IM/IV/PO: 1 2 mkdose
Tab 800mg 160mg Benadryl Syr: 12.5mg/5ml
Bacidal Susp/5ml 400mg 80mg Cap: 25mg 50mg
Trizole Susp/5ml 400mg 80mg Inj: 50mg/ml
Globaxole Tab 800mg 160mg Hydroxyzine (1mkd) BID
Susp/5ml 400mg 80mg Adult: 10mg BID 25mg ODHS
Trimethoprim + Sulfadiazone (TM 5 8 mkd) Iterax Syr: 2mg/ml
Triglobe Tab Sdz 410mg TM 90mg Tab: 10mg 25mg 50mg
Forte 820mg 180mg Ceterizine (0.25mkdose)
Susp/5ml 205mg 45mg 6mos - <12mos : 1ml OD
AMINOGLYCOSIDES 12mos - <2 yo: 1ml OD/BID
Tetracycline 25 50 mkday q6h 2 5 yo: 2ml OD / 1ml BID
Doxycycline 5 mkday BID 6 12 yo: 10ml (2 tsp)OD/ 5ml BID
1 tab OD/ tab BID
Furaxolidone 5 8 mkday q6h
Adult & >12yo: 1 tab OD
MACROLIDES
Virlix Oral drops: 10mg/ml
Erythromycin (30 50 mkd) q 6h
Oral soln: 1mg/ml
Macrocin Susp: 200mg/5ml
Tab: 10mg
Ethiocin Drops: 100mg/2.5ml
Allerkid Drops: 2.5mg/ml
Erycin Cap : 250mg 500mg Syr: 5mg/5ml
Susp: 200mg/5ml
Alnix Drops: 2.5mg/ml
Drops: 100mg/2.5ml
Syr: 5mg/5ml
Erythrocin Film tab: 250mg 500mg Tab: 10mg
Granules: 200mg/5ml
Loratadine 1 2 yo: 2.5 ml BID
DS Granules: 400mg/5ml
2 12 yo (<30 kg): 5ml OD
Drops: 100mg/2.5ml
(>30 kg): 10ml OD
Ilosone/ Tab: 500mg Adult & > 12 y : 1 tab OD
Ilosone DS Pulvule: 250mg
Claritin Syr: 5mg/ml
Liquid: 125mg/5ml
Allerta Tab: 10mg
DS Liquid: 200mg/5ml
Loradex
Drops: 100mg/ml
Desloratadine 6 12 mos: 2ml OD
Clarithromycin (6 15 mkday OR 7.5 mkdose q12h)
1 5 yo: 2.5ml OD
Klaricid Susp : 125mg/5ml 50mg/5ml 6 12 yo: 5ml OD
Klaz Tab: 250mg 500mg
Aerius Syr: 2mg/5ml
Roxithromycin <6 yo 5 8 mkd BID Tab: 5mg
6 12 yo 100mg/tab BID
Macrol/Rulid Tab: 150mg
Ped Tab: 100mg
DECONGESTANT
Rulid dispensable Tab: 50mg
Nasal
NaCl 2 4 drps/spray per nostril TID/QID
Azithromycin 3 day regimen: 10 mkday x 3 days
2 sprays/nostril then suction q6h x 3 days
5 day regimen: 10 mkd on day 1
Salinase Nasal spray
5 mkd on day 2 to 5
Muconase Nasal drops
Adult: 500mg OD day 1
250mg OD day 2 to 5 Oxymetazoline HCl 2 5 yo: 2 3 drops/nostril BID
>5 yo: 2 3 sprays/nostril BID
Zithromax Susp: 250mg/5ml
Cap : 250mg Drixine Nasal spray: 0.05%
Sachet: 200mg/sachet Nasal soln: 0.025%
Clindamycin PO: 20 30 mkday q 6 8h Xylometazoline < 1 yo: 1 2 drps OD/BID
IV: 25 40vmkday q 6h HCl 1 6 yo: 1 2 drps OD/BID max TID
Susp: 75mg/5ml Adult: 2 3 drps / 1 squirt TID max QID
Cap: 150mg 300mg Otrivin
Amp: 150mg/ml Oral
Phenylpropanolamine HCl (0.3 0.5 mkdose)
AMOEBICIDES Disudrin 1 3 mos: 0.25 ml
Metronidazole PO: 30 50 mkday q 8h 4 6 mos: 0.5 ml
IV: 30 mkday q 8h 7 12 mos: 0.75 ml
1 2 yo: 1 ml
Anaerobia Susp : 125mg/5ml
2 6 yo: 2.5 ml
Tab : 250mg
7 12 yo: 5 ml
Servizol Susp: 200mg/5ml
Drops: 6.25ml q6h
Tab : 250mg 500mg
Syr: 12.5mg/5ml q6h
Flagyl Susp : 125mg/5ml
Brompheniramine maleate + PPA
Tab : 250mg 500mg
Dimetapp 1 6 mos: 0.5ml TID/QID
Etofamide (15 20 mkd) TID
7 24 mos: 1ml TID/QID
Kitnos Susp : 125mg/5ml
2 4 yo: tsp
Tab : 200mg 500mg
4 12 yo: 5ml
Adult: 5 10 ml
1 tab BID
Diloxanide furoate (20mkd) q8h x 10 days Infant drops: (0.1mkdose)
Furamide Tab : 500mg Syr
Dilfur Susp: 125mg/5ml Extentab
Secnidazole Carbinoxamine maleate + Phenylephrine HCl
Flagentyl 2 tab now then 2 tabs after 4 hrs Rhinoport 1 5 yo: 5ml BID
Ercefuryl (20mkday) 6 12 yo: 10ml BID
Adult & > 12yo: 1 cap / 15ml BID
Syrup
Cap
Loratadine + PPA Theophylline 10 20 mkdose
Loraped <30 kg: 2.5ml BID 3 5 mkdose
>30 kg: 5ml BID
Syrup: 5mg/ml ANTITUSSIVES
MUCOLYTIC Butamirate citrate 3 yo 5 ml TID
Solmux Drops: 40mg/ml >6 yo 10ml TID
1 3 mos: 0.5ml TID/QID >12 yo 15ml TID
3 6 mos 0.75ml Adult 15ml QID
6 12 mos 1ml 1 tab TID/QID
1 2 yo 1.5 ml Sinecod Forte Syrup 7.5mg/5ml
Tab 50mg
Susp: 100mg/5ml 200mg/5ml
2 3 yo 5ml 2.5ml Dextromethorphan + Guaifenesin
4 7 yo 10ml 5 ml Robitussin DM 2 6 yo 2.5 5ml q 6 8h
8 12 yo 15ml 7.5ml 6 12 yo 5ml q 6 8h
Adult 5 10ml q 6h
Forte: 500mg/5ml Syrup
Cap: 500mg INHALED STEROIDS
Adult & >12 yo: 5 10ml Budesonide
1 cap
Budecort 250mcg q 12h
500mcg q 12h
500mcg OD for allergic rhinitis
250mcg /ml (2ml)
Solmux Capsule
500mcg /ml (2ml)
Broncho Suspension
Flexotide neb 250mcg /ml (2ml)
Solmux Tab: 500mg
Chewable tab 1 tab q 8h 250mcg q 12h
Carbocisteine Infant Drops QID
<3mos 0.25ml ORAL STEROIDS LD: 10mkdose 200mg
3 5 mos 0.5ml MD: 5mkdose
6 8 mos 0.75ml Prednisone 1 2 mkday
9 12 mos 1ml Prednisolone 1 2 mkday
Liquidpred Syrup 15mg/5ml
Ped Syr TID
1 3 yo 5 7.5ml 1 1 tsp ANTACIDS
4 7 yo 7.5 10ml 1 - 2 tsp Maalox 5ml/10kg
8 12 yo 10 15ml 2 3 tsp (plain, plus) Available in 180ml bottle
Simethicone
Adult Susp TID Restime < 2 yo 0.5ml qid
Adult & >12 yo 10 15ml 2 3 tsp 2 12 yo 4ml qid
Oral drops 40mg/ml
Capsule TID ANTISPASMODIC
Adult & >12 yo 1 cap Dicycloverine 6mos 2 yo 0.5 1ml TID
Relestal Drops 5mg/ml
Syrup 10mg/5ml
Lovsicol Infant drops 50mg/ml Domperidone 0.3 0.6 mkdose q 6 8 h
Ped Syrup 100mg/5ml 2.5 5ml/10kg BW TID
Adult Susp 250mg/5ml Dyspepsia: 2.5/10kg TID
Cap 500mg Nausea: 2.5 5ml/kg TID
Ambroxol Infant drops 6mg/ml 75mg/ml BID 0.3 0.6 ml/5kg BW TID/QID
< 6 mo 0.5ml 0.5ml Motilium Susp 1mg/ml
7 12 mo 1 ml 0.75ml Tab 10mg
13 24 mo 1.25ml 1ml
Vometa Oral drops 5mg/ml
Susp 5mg/5ml
Pedia Syrup
Tab 10mg
<2 yo 2.5ml BID
H2-BLOCKER
2 5 yo 2.5ml TID
Ranitidine 1 2 mkdose q 12h
5 10 yo 5ml TID
Zantac Tab 75mg 150mg 300mg
Adult Syrup Cimetidine Neonates: 5 20 mkday q6 12 h
Adult & >10 yo 5ml TID Infants: 10 20 mkday
Child; 20 40 mkday
Retard cap Adult: 300mkdose QID
Adult & >10 yo 1 cao OD 400mkdose BID
800mkdose QID
Tab Tagamet Susp: 300mg/5ml
Adult & >10 yo 1 tab TID Tab: 100mg 200mg 300mg 400mg 800mg
Famotidine PO: 0.5 mkdose q 12 h
Inhalation IV: 0.6 0.8 mkday q 8 12h
<5 yo 1 2 inhalation of 2ml soln daily
Adult & children >5 yo 1 2 inhalation of 2 3ml soln daily
Mucosolvan Infant drops 6mg/ml
Ped liquid 15mg/5ml ANTIPYRETIC
Adult liquid 30mg/5ml Paracetamol (10 20 mkdose) q 4h
Retard cap 75mg Tempra Drops: 60mg/0.6ml
Tab 30mg Syrup: 120mg/5ml
Inhalation Soln 15mg/2ml Forte : 250mg/5ml
Ampule 15mg/2ml Tablet: 325mg 500mg
Ambrolex Infant drops 7.5mg/ml Calpol Drops: 100mg/ml
Zobrixol Ped liquid 15mg/5ml Syrup: 120mg/5m
Adult liquid 30mg/5ml 250mg/5ml
Tab 30mg Defebrol Syrup: 120mg/5m
B2 AGONIST 250mg/5ml
Salbutamol (0.1 0.15 mkdose) Afebrin Drops: 60mg/0.6ml
Ventolin Tab 2mg Syrup: 120mg/5ml
Syr 2mg/5ml Forte : 250mg/5ml
Nebule 2.5mg/2.5ml Tablet: 600mg
Ventar Tab 2mg Tylenol Drops: 80mg/ml
Hivent Syrup Syr 2mg/5ml Syrup: 160mg/5ml
Salbutamol + Guaifenesin Naprex Drops: 60mg/0.6ml
Asmalin Tab Syrup: 250mg/5ml
Broncho 1 tab TID Inj: 300mg/2ml
Syrup Rexidol Drops: 60mg/0.6ml
Pulmovent 2 6 yo 5 10 ml BID/TID Syrup: 250mg/5ml
7 12 yo 10ml Tablet: 600mg
Biogesic Drops: 100mg/ml
Syrup: 120mg/5m
Terbutaline sulfate ( 0.075 mkdose) 250mg/5ml
Terbulin Tab 2.5mg Tablet: 500mg
Pulmoxel Tab 2.5mg Aeknil Ampule (2ml) 150mg/ml
Syr 1.5mg/5ml Opigesic Suppository: 125mg 250mg
Nebule 2.5mg/ml Mefenamic Acid (6 8mkdose) q 6h
Bricanyl Tab 2.5mg Ponstan Suspension: 50mg/5ml
Syr 1.5mg/5ml Cap SF: 250mg
Nebule 5mg/2ml Tab: 500mg
Expectorant Aspirin (60 100 mkd)
Doxophelline (6 8 mkdose) BID x 7 10 days Ibuprofen (5 10 mkday) q8h (max 20mkday)
Ansimar Syrup 100mg/5ml Dolan FP Suspension: 100mg/5ml
Tab 400mg Dolan Forte 200mg/5ml
Drops: 100mg/2.5ml
Procaterol HCl (0.25ml/kg) Advil 100mg/5
Meptin Syrup 5mcg/ml Tab: 200mg
Tab 25mcg
Nebuliser soln 100mcg/ml
IV ANTIBIOTICS
Penicillin 50,000 100,000 ukd q 6h ASSESSMENT OF DEHYDRATION [CDD]
Amoxicillin 50 100 mkd q 6 8 h PARAMEeTER NO SIGN SOME SIGN SEVERE
Ampicillin 50 100 mkd q 6 8 h Condition Well, Alert RestlessI Lethargic
Chloramphenicol 50 100 mkd q 4 6 h Irritable Unconscious
Ampi + Cloxa 50 100 mkd q 6 h Floppy
Oxacillin 50 100 mkd q 6 8 h Eyes Normal Sunkem Very sunken
Flucloxacillin 50 100 mkd q 6 8 h Dry
Gentamicin 5 7.5 mkd OD Tears Present Absent Absent
Netromycin 5mkd q 12 h Mouth/Togue Moist Dry Very dry
Amikacin 15mkd q 12 h Thirst Drinks normally Thirsty Drinks poorly
Cephalexin 50 100 mkd q 6 h Not thirsty Drinks eagerly Not able to drink
Cefuroxime 50 100 mkd q 6 8 h Skin pinch Goes back quicly Goes back slowly Goes back very
slowly
Ceftriazone 50 100 mkd OD
Ceftazidime 50 100 mkd q 12 h
HYDROCORTISONE LD: 10 mkdose
MD: 5 mkdose q 6, 8 or 12h
ORAL REHYDRATION THERAPY
*max dose: LD 200 MD 100
PLAN A AGE Amount ORS to give/loose stool
ANTICONVULSANT
50 100 ml
Diazepam 0.2 0.3 mkdose
100 200 ml
Drip: 1amp in 50cc D5W
As much as wanted
10mg/amp
PLAN B Amount of ORS to give in 1st 24 hrs:
Midazolam 0.15 mkdose OR
Weight (kg) x 75ml/kg
0.05 0.2 mkdose
PLAN C AGE 30ml/kg 70ml/kg
Phenobarbital LD: 10 mkdose q 12h
MD: 5 mkdose q 12h Infants (<1 yo) 1 hr 5 hrs
Children (>1 yo) 30 mins 2.5 hrs
ANTIHYPERTENSIVES
Hydralazine PO: 0.75 1.0 mkday q 6 12 h
In fluid resuscitation: use 20cc/kg as bolus. Usually PLR
Apresoline IV: 0.1 0.2 mkdose
Spirinolactone 1 3 mkday
ANTI-TB MEDS
Isoniazid (10 12 mkd) ODAC or 2hrs PC
FLUID MANAGEMENT
Comprilex Suspension:
Severity Less than 2 yo More than 2 yo
Nicetal 200mg/5ml
Mild 50cc/kg 30cc/kg
Trisofort 100mg/5ml
Odinah 200mg/5ml Moderate 100cc/kg 60cc/kg
150mg/5ml Severe 150cc/kg 90cc/kg
Tablet 400mg To run for 6 8 hrs then refer
Rifampicin (10 20 mkd) ODAC or 2hrs PC Usual fluid is D5 0.3 NaCl; if however more than 40 kg then D5 LR
Natricin 100mg/5ml 200mg/5ml
Rifadin 100mg/5ml
100mg/5ml PCAP
Rimactane 200mg/5ml VARIAle BLE PCAP A PCAP B PCAP C PCAP D
Rimaped Tablet 300mg 450mg Minimal Risk Low Risk Moderate Risk High Risk
Pyrazinamide (PZA) (16 30 mkd) BID/TID Comorbid None Present Present Present
CIBA 250mg/5ml Illness
Zcure Compliant Yes Yes No No
Zinaplex 500mg/5ml caregiver
Tablet 500mg Ability to follow Possible Possible Not Not
up
Presence of None Mild moderate Severe
COMPOSITION OF ORS dehydration
Na K Cl Glu Ability to feed Able Able Unable Unable
Glucolyte 60 20 50 100 Age >11 mos >11 mos <11 mos <11 mos
Hydrite 90 20 80 111 RR
WHO 75 20 65 75 2 12 mos >50/min >50/min >60/min >70/min
Pedialyte 30 30 20 30 1 5 yo >40/min >40/min >50/min >50/min
45 45 20 35 >5 yo >30/min >30/min >35/min >35/min
90 90 20 80 Signs of Respiratory Failure
Gatorade 41 11 9/100 Retractions - - Subcostal/ Subcostal/
Intercostal Intercostal
Head babbing - - + +
Cyanosis - - + +
IMMUNIZATION Grunting - - - +
Apnea - - - +
Vaccine Min age 1st dose No of dose interval booster Sensorium None Awake Irritable Lethargy /
Stupor
BCG At birth 1 - - Coma/
Before 1 mo Complication:
DPT 6 wks 3 4 wks 18 mos Effusion None None Present Present
(2, 4, 6 mos) 4 6 yo Pneumothorax
OPV/IPV 6 wks 3 4 wks Same as Action Plan OPD OPD Admit to Admit to CCU
2, 4, 6 mos) DPT f/u at end of tx f/u after 3 days regulat ward Refer to
Hep B At birth 3 6 wks from 1st specialist
(0, 1, 6 mos) dose, 8
EPI (6, 10, 14) wksfrom 2nd
dose Clinical Practice Guidelines in the Evaluation and Management of PCAP 2004
Measles 6 9 mos 1 - Predictors of CAP in patients with cough
(3 mos to 5 yrs) tachypnea &/or chest retractions
MMR 15 mos 1 (5 12 yrs) fever, tachypnea & crackles
(>12 yo) (a) fever, tachypnea & tachycardia; (b) at least 1 AbN CXR
Hib 2, 4, 6 mos 18 mos
WHO Age Specific classification for tachynea
Pneumococcal 6 mos (PCV7) 18 mos 2 12 mos: >50 RR
2 yrs (PPV) 1 5 yrs: >40 RR
Rotavirus 3 and 5 mos 2 I month >5 yrs: >30 RR
PCAP A/PCAP B
Hep A 1 yr and up 2 6 12 mos No diagnostic usually requested
apart PCAP C/PCAP D
Varicella 1st: 12 15 mos 2 Bet 1st and 2nd The ff shud b routinely requested
2nd: 4 6 yo dose: at least 3 o CXR APL (patchy viral; consolidated bacterial)
mos o WBC
Flu 6 months yearly o C/S (blood, Pleural Fluid, tracheal aspirate on initial intubation)
o Blood gas/Pulse oximeter
The ff may be requested: C/S sputum
The ff shud NOT be routinely requested
COMPOSITION OF IV SOLUTION o ESR
Fluid Na K Cl HCO3 Dxt o CRP
PNSS 154 - 154 - -
0.45 NaCl 77 - 77 - - Antibiotic Recommendation
D5 0.3 NaCl 51 - 51 - 5 1. PCAP A/PCAP B and is beyond 2 yo & having fever w/o wheeze
2. PCAP C and is beyond 2 yo, having high grade fever, having alveolar consolidation on CXR,
D5 LRS 130 4 109 28 5
having WBC >15,000
D5 NM 40 13 40 16 5
3. PCAP D refer to specialist
D5 IMB 25 20 22 23 5
Antibiotic Recommendation
D5 NR 140 5 98 27 5 PCAP A/PCAP B w/o previous antibiotic
o Amoxicillin (40 50 mkday) TID
Na requirement : 2 4 meq/k/day PCAP C
K requirement: 2 3 meq/k/day o Pen G IV (100,000 IU/k/d) QID
KIR: 0.2 0.3 meq/k/hr max of 40 meq PCAP C who had no HiB immunization
o Ampicillin IV (100mkd) QID
KIR = Rate x incorporation PCAP D refer to specialist
wt
What shud b done if px is not responding to current antibiotics foley cath & monitor UO)
1. If PCAP A/PCAP B not responding w/n 72 hrs 7. Inotropes help stabilize BP
a. Change initial antibiotic o Epinephrine - (0.1 1 ug/kg/min)
b. Start oral Macrolide Infusion of choice for Hypotensive pxs
c. Reevaluate dx o Dobutamine - (5 20 ug/kg/min)
2. PCAP C no responding w/n 72 hrs consult w/ specialisr Cardiogenic shock but not severely hypotensive
a. PCN resistant S pneumonia o Dopamine [(5 20 ug/kg/min constrictor effect) [(10
b. Complication 15 ug/kg/min]
c. Other dx Distributive shock after successful fluid resuscitation
3. PCAP D not responding w/n 72hrs, then immediate consultto a specialist is warranted 8. Cardiogenic shock
Switch from IV to Oral Antibiotic done in 2 3 days after initiation in px who: o Diuretic pxs may get worse after fluid challenge
Respond to initial antibiotic o Adenosine / synchronize cardioversion SVT
Is able to feed with intact GI tract o Defibrillation Venticular fibrillation
Does not have any pulmo or extra pulmo complication
Ancillary Treatments
O2 and Hydration MUMPS [Paramyxoviridae]
Bronchodilators, CPT, steam inhalation and Nebulization MOT Direct contact, airborne droplets, fomites contaminated by saliva
Prevention IP 16 18 days
Vaccines Prd of comm 1 2 days before onset of parotid swelling until 5 days after the onset of
Zinc Supplementation swelling
o 10mg for infants Prodorme Fever, neck muscle pain, headache, malaise
o 20mg for children > 2 yo Parotid gland Peak in 1 3 days
swelling 1st in the space between posterior border of mandible & mastoid
then extends being limited above zygoma
DENGUE HEMORRHAGIC FEVER Complications Meningoenephalitis - most frequent, about 10 days; M>F
Serotype 1, 2, 3, & 4 Orchitis & Epididymitis
Aedes egypti Oophoritis
IP: 4 6 days (min 3 days; max 10 days) Dacryoadenitis or optic neuritis
DHF SEVERITY GRADING
GRADE MANIFESTATION
I Fever, non-specific constitutional symptoms such as anorexia, vomiting ANAPHYLAXIS
and abdominal pain (+) Torniquet test A syndrome involving a rapid & generalized immunologically mediated rxn
II Grade I + spontaneous bleeding; mucocutaneous, GI After exposure to foreign allergens in previously sensitized individuals
III Grade II w/ more severe bleeding + A true emergency when cardio and respi system are involved
Evidence of circulatory failure: violaceous, cold & clammy skin, restless, ED Management
weak to imperceptible pulses, narrowing of pulse pressure to < 20mmHg o O2
to actualHPON o Aqueous Epinephrine 1:1000 IM (0.01ml/kg with 0.5ml max)
IV Grade III but shock is usually refractory or irreversible and assoc w/ o Prepare intubation if w/ stridor & if initial therapy of epi is not effective
massive bleeding o Continuous monitor ECG and O2 sat & establish IV access
o Antihistamine to prevent progression
o H1 & H2 blocker
CRITERIA FOR CLINICAL DX (WHO) o Diphenhydramine (1mg/kg) IM
DHF DSS o Steroids may modify late phase or recurrent reaction (Hydrocortisone
Fever, acute onset, high, lasting 2 7 Above criteria 5mg/kg/dose)
days Plus o Epinephrine 1:10,000 IV (0.1ml/kg; 10ml max)
Hemorrhagic man: Hypotension or narrow pulse o Epinephrine drip (0.01ml/kg/min)
o (+) Torniquet test pressure [SBP DBP] <20mmHg Indication for Admission
o Minor & Major bleeding o Persistent bronchospasm
phenomenon o Hypotension requiring vasopressors
Thrombocytopenia <100,000/mm3 o Significant hypoxia
o Patient resides some distance from a hospital facility
SEIZURE
BENIGN FEBRILE SEIZURE CRITERIA
6 mos 6 yrs
< 15 mins
Febrile
Family history of febrile seizure
GTC
Not > 1 episode in 1 febrile episode; EEG done after 2 wks of seizure episode
3% of general population develop epilepsy
1 2 % of BFS develop epilepsy
25% recurrence of seizure
Seizure paroxysmal, time limited change in motor activity and/or behavior
that results from abnormal electrical activity in the brain
Epilepsy present when 2 or more unprovoked seizure s occur at an interval
greater than 24 hrs apaet
HYDROCEPHALUS NEWBORN CARE
Result from impaired circulation & absorption of CSF or from inceased production Umbilical Cord
Obstructive or Noncommunicating Cut 8 inches above abdomen after 30 sec
o Due to obstruction w/n ventricular system In nursery, cut the umbilical cord 1 inch above the abdomen
o Abnormality of the aqueduct or a lesion in the 4th venticle (aqueductal Healing should take place around 7 10 days
stenosis) Eye Prophylaxis
Non-obstructive or Communicating 1% silver nitrate drops [most effective against Neisseria]
o Obliteration of the subarachnoid cisterns or malfunction of the Erythromycin 0.5% [Clamydia]
arachnoid villi Tetracycline 1%
o Follows SAH that obliterates arachnoid villi; leukemic infiltrates Povidone iodine 2.5%
Clinical Manifestation Vitamin K
Infant: accelerated rate of enlargement of the head; wide anterior fontanel & bulging 1 mg Vit K1
[Normal fontanel size: 2 x 2 cm] PT: 0.5 mg
Eyes may deviate downward: due to impingement of the dilated suprapineal recess Vaccine
on the tectum [setting sun sign] BCG
Long tract sign: [brisk DTR, spasticity, clonus, Babinski sign] Hep B
Percussion of skull produce a crackedpot or Macewen sign [separation of sutures] Newborn Screening
Foreshortened occiput [Chiari malformation] Done on 16th hr of life . can be repeated after 2 weeks
Prominent occiput [Dandy-Walker malformation] Patients w/ CAH will die 7 14 days if not treated
Treatment Patient w/ CH will have permanent growth defect and MR if not treated before 4
Depends on the cause weeks
Extracranial shunt Disorder Screened Effects Screened Effects if Screened &
Acetazolamide & Furosemide [provide temporary relief by reducing the rate of CSF treated
production] Congenital Hypothyroidism Severe MR Normal
(CH)
BELLS PALSY Congenital Adrenal Death Alive &Normal
Acute unilateral facial nerve palsy that is not associated with other cranial Hyperplasia (CAH)
neuropathies or brainstem dysfunction Galactosemia (Gal) Death of Cataract Alive &Normal
Usually develops abruptly about 2 wks after SVI [EBV, HSV, mumps] Phenylketonuria PKU Severe MR Normal
Upper and lower portions of the face are paretic G6PD Severe Anemia Normal
Corner of the mouth droops Kernicterus
Unable to close the eye on the involved side
Protection of cornea with methylcellulose eye drops or an ocular lubricant
Excellent prognosis
NEONATAL JAUNDICE
Risk Factors
CEREBRAL PALSY o Jaundice visible on first day of life
Non-progressive disorder of posture & movement often associated with epilepsy & o A sibling w/ neonatal jaundice or anemia
abnormalities of speech, vision & intellect resulting from defect or lesion of the o Unrecognized hemolysis
developing brain o Non-optimal feeding
Etiology: infections, toxins, metabolic, ischemia o Deficiency: G6PD
Classification o Infection
Physiologic Topogrphic o Cephalhemaoma or bruising / Central hct >65%
[major motor abnormality] [involved extremities] o East Asian/ Mediteranean in origin
1. Spastic 1. Monoplegia [1 side/portion] PHYSIOLOGIC vs PATHOLOGIC
2. Athetoid worm like 2. Paraplegia FACTORS PHYSIOLOGIC PATHOLOGIC
3. Rigid 3. Hemiplegia Onset > 24 hrs of life < 24 hrs of life
4. Ataxic 4. Triplegia [3 limbs] Rate of inc of TSB < 0.5mg/dl/hr > 0.5mg/dl/hr
5. Tremor 5. Quadriplegia [all]
Persistent < 14 days FT: > 8 days
6. Atonic 6. Diplegia [LE/UE]
PT: > 14 days
7. Mixed 7. Double hemiplegia
Total S. Bilirubn FT: < 12 mg/dl Any level requiring
8. unclassified
PT: < 14 mg/dl phototherapy
Clinical Manifestaion
Sign/ Symptom Vomiting, lethargy, poor
Spastic hemiplegia Arms > legs
feeding, excess wt loss,
Dificulty in hand manipulation obviously by 1 yo
apnea, inc RR, temp
Delayed walking or walk on tiptoes
instability
Spasticity apparent esp. in ankles
KRAMER CLASSIFICATION
Seizure & cognitivr impairment
ZONE JAUNDICE mg/dl
Spastic diplegia Bilateral spasticity of the legs
Commando crawl I Head/neck 68
Increased DTRs & (+) Babinski sign II Upper trunk 9 12
Normal intellect III Lower trunk, thigh 12 16
Spastic quadriplegia Most severe form, due to marked motor impairment of all IV Arms, leg, below knee 15 18
extremities & high association with MR & seizures V Hands/feet > 15
Swallowing difficulties
Management BREAST FEEDING vs BREASTMILK JAUNDICE
Baseline EEG & cranial CT scan Parameter BREASTFEEDING BREASTMILK
Hearing & visual function tests Onset 3rd to 5th day of life Late; start to rise on day 4; may
Multidisciplinary approach in the assessment & treatment reach 20 30 mg/dl on day 14
For tight heel cord: tenotomy of the Achilles tendon then slowly
Normal by 4 12 weeks
ESSENTIAL NEWBORN CARE PROTOCOL [from DOH] Pathophysio Decrease milk intake Unknown
o What should be done immediately after birth is to dry the baby because hypothermia enterohepatic circulation Prob. due to glucoronidase
can lead to several risks in BM which enterohepatic
o Delaying the cord clamping to 3 mins after birth (or waiting until the umbilical cord circulation
has stopped pulsing) Normal LFT;
o Instead of immediately washing the NB, the baby should be placed on the mothers (-) hemolysis
chest or abdomen to provide warmth, increase the duration of breastfeeding, and Mngt Fluid and caloricsupplement If breastfeeding is stopped,
allow the good bacteria from the mothers skin to infiltrate the NB rapid decrease in bilirubin level
o Washing should be delayed until after 6 hours because this exposes the NB to in 48 hrs, if resumed will rise to
hypothermia and remove vernix. Washing also removes the babys crawling reflex. 2 4 mg/dl but no precipitating
previous events
APGAR SCORE
o Evaluates the need for resuscitation NEONATAL SEPSIS
o Taken 1 and 5 minutes after birth Classification
0 1 2 Early: birth to 7th day of life
Color Blue, pale Body pink, extremities All pink Late: 8th to 28th day of life
blue Risk factors
HR 0 <100 >100 Maternal infection during pregnancy
Reflex irritability No response Grimace Cough Prolongrupture of membranes (18 hrs)
Activity Limp Some flexion Active Prematurity
Respiration Absent Slow, irregular Good Common organism:
The APGAR Score Bacteria: GBS, E. coli & Listeria (early)
8 10 Good cardiopulmonary adaptation Viruses: HSV, enteroviruses
47 Need for resuscitation, esp ventilatory support Signs & symptom
03 Need for immediate resuscitation Non-specific
Dx:
NORMAL VALUES CBC, CXR, blood and urine culture, lumbar tap for CSF studies
AVERAGE WEIGHT (3,000 grams) Treatment
Empiric antibiotics [Ampicillin + 3rd gen Cephalosporin or Aminoglycoside)
0 6 mos Age in months x 600 + BW
supportive
7 12 mos Age in months x 500 + BW
Children
1 6 yo Age in years x 2+ 8
VIRAL CROUP vs EPIGLOTTITIS
7 12 yo Age in years x 7 5 / 2
VIRAL CROUP EPIGLOTTITIS
HEAD CIRCUMFERENCE [35 cm (+ 2cm)] (inch = 2.54cm)
Age group 3 mos to 3 yrs 3 7 yrs
1 4 months inch per month
5 12 mos inch per month Stridor 88% 8%
2 years old 1 inch per year Pathogen Parainfluenza virus H. influenzae type B
3 5 yo inch per year Onset Prodrome (1 7 days) Rapid (4 12 hrs)
6 20 yo inch per 5 years Fever Severity Low grade High grade
LENGTH (50 cm) Associated sympto Barking cough, Muffled voice,
0 3 months 9 cm hoarseness Droolong
46 8 cm Respond to racemic Stridor improves None
79 5 cm epinephrine
10 12 3cm CXR steeple sign thumbprint sign
RHEUMATIC HEART DISEASE
JONES CRITERIA
BRONCHIOLITIS Major Manifestation
Acute inflammation of the small airways in children <2 yrs 1. Arthritis (70%)
Most commonly caused by RSV 2. Carditis (50%)
Related to exposure to cigarette smoke a. Tachycardia
Risk factors for severe dse: b. Heart murmur of valvulitis
o <6 mos c. Pericarditis
o Prematurity d. Cardiomegaly
o Heart or lung disease e. Signs of CHF [gallop rhythm, distant heart sounds,
o immunodeficiency cardiomegaly]
Signs /Symptoms 3. Erythema marginatum (10%)
low grade fever, rhinorrhea, cough, wheezing 4. Subcutaneous nodules (2 10%)
hyperresonance to percussion 5. Sydenhams chorea (15%)
CXR Minor manifestation
hyperinflation, interstitial infiltrates 1. Arthralgia
Treatment 2. Fever at least 38.8C
Mild [at home]: 3. Elevated Acute Phase Reactants (CRP & ESR)
o Increased fluids, trial of inhaled bronchodilators, aerosolized 4. Prolonged PR interval on the ECG
epinephrine Diagnosis
Severe: 1. Highly probable : 2 major OR 1 major and 2 minor manifestation
o Admit to hospital if: Marked respratory distress; Poor
feeding; O2 sat <92%; hx of prematurity < 34 wks;
underlying cardiopulmonary dse; unreliable caregivers INFECTIVE ENDOCARDITIS
o Manage with ventilatory and O2 support, hydration, inhaled DUKE CRITERIA
bronchodilators and ribavirin Major Manifestation
1.
Age Ht (cm) Ht (cm) Wt for Ht Boys Girls Minor manifestation
mo boys girls (cm) (kg) (kg)
0 50.5 49.9 49 3.1 3.3 Diagnosis
1 54.6 53.5 50 3.3 3.4 2. Highly probable : 2 major OR 1 major and 2 minor manifestation
2 58.1 56.8 51 3.5 3.5
3 61.1 59.5 52 3.7 3.7
4 63.7 62.0 53 3.9 3.9 NURSERY NOTES
5 65.9 64.1 54 4.1 4.1 Dextrosity
6 67.8 65.9 55 4.3 4.3
7 69.5 67.6 56 4.6 4.5 (to get factor: Desired D5
8 71.0 69.1 57 4.8 4.8 D50- D5
9 72.3 70.4 58 5.1 5.0 D 7.5 = 0.055
10 73.6 71.8 59 5.4 5.3 D10 = 0.11
11 74.9 73.1 60 5.7 5.5 D 12.5 = 0.166
D15 = 0.22
12 76.1 74.3 61 5.9 5.8
D 17.5 = 0.28
13 77.2 75.5 62 6.2 6.1
14 78.3 76.7 63 6.5 6.4
Limits of Dextrosity:
15 79.4 77.8 64 6.8 6.7 Peripheral line = D12
16 80.4 78.9 65 7.1 7.0 Central line = D20
17 81.4 79.9 66 7.4 7.3 Total Fluid Intake (TFI):
18 82.4 80.9 67 7.7 7.5 Preterm: start at 60 cckd
19 83.3 81.9 68 8.0 7.8 Term: start at 80 cckd
20 84.2 82.9 69 8.3 8.1
21 85.1 83.8 70 8.5 8.4 To check TFI = rate x 24 wt
22 86.0 84.7 71 8.8 8.6
23 86.8 85.6 72 9.1 8.9 ex. Preterm: wt: 1.129
24 87.6 86.5 73 9.3 9.1
25 88.5 87.3 74 9.6 9.4 Day 1: start IVF with D10 water
26 89.2 88.2 75 9.8 9.6 60 x 1.219 24 = 3.1 cc/hr x 24 hrs
27 90.0 89.0 76 10.0 9.8 Add Calcium gluconate at 200 mkd q8h
28 90.8 89.8 77 10.3 10.0 Ca gluc = 1.129 x 200 3 = 75mg q8hrs for 3 doses
29 91.6 90.6 78 10.5 10.2 Start antibiotics
30 92.3 91.3 79 10.7 10.4 Give ranitidine
HGT q 8/12 hrs
31 93.0 92.1 80 10.9 10.6
OGT
32 93.7 92.8 81 11.1 10.8
CBC
33 94.5 93.5 82 11.3 11.0
Na, K, Ca at 48 hrs
34 95.2 94.2 83 11.5 11.2
Blood c/s depends on AP
35 95.8 94.9 84 11.7 11.4
Day 2: increase TFI by 10-20 (depends on AP)
36 96.5 95.6 85 11.9 11.6
70 x 1.129 24 = 3.3 cc/hr x 24 hrs
3.5 98.4 97.3 86 12.3 11.8
incorporate ca gluc 200 mkd to IV
4 yo 102.9 101.6 87 12.3 11.9 ex.
4.5 106 104.5 88 12.5 12.2 D10 water 80 cc
5 109.9 108.4 89 12.8 12.4 Ca gluc 2.2cc
5.5 112.6 111.0 90 13.0 12.6 82.2cc to run at 3.3ccx24hrs
6 116.1 114.6 91 13.2 12.8
6.5 118.5 117.1 92 13.4 13.0 Day 3: increase TFI by 10-20 (depends on AP)
7 121.7 120.6 93 13.7 13.3 If electrolytes are N, may use D10IMB
7.5 123.9 123.0 94 13.9 13.5 80 x 1.129 24 = rate
8 127.0 126.4 95 14.1 13.8 80 x 1.129 x factor to get value of D50 water (to make D10 use 0.11)
8.5 129.1 128.8 96 14.4 14.0 Cont Ca gluc incorporation (if feeding may discontinue)
9 132.2 132.2 97 14.7 14.3 D50 water 9.9cc
9.5 134.4 134.7 98 14.9 14.6 D5 IMB 77.9cc = D10 IMB
10 137.5 138.3 99 15.2 14.9 Ca gluc 2.2cc (200mkd)
90 cc to run at 3.7cc/hrx24h
10.5 139.9 140.9 100 15.5 15.2
If feeding already:
11 143.3 144.8 101 101.0 15.5
Total volume of milk wt = cc/kg/day
11.5 145.8 147.6 102 16.1 15.9
Subtract this amount to TFI to get value for IV
12 149.7 151.5 103-105 16.5-17.1 16.2-16.7 (if Dr. Reinoso, divide by 2 before subtracting to TFI)
12.5 152.5 154.1 106-108 17.4-18.0 17.0-17.6 ex. MF 3cc q3hrs = 24 cc in 24 hrs
13 156.5 157.1 109-111 18.3-19.0 17.9-18.6 24 1.129 = 21.2 cckd from milk
13.5 159.3 158.8 112-114 19.3-20.0 18.9-19.5 80 21.2 = 58.8cckd (use this for IVF)
14 163.1 160.4 115-117 20.3-21.1 19.9-20.6 58.8 x 1.129 24 = rate
14.5 165.7 161.1 118-120 21.4-22.2 21.0-21.8 D50 water 7.3cc
15 169.0 161.8 121-123 22.6-23.4 22.2-23.1 D5 IMB 56.5cc = D10 IMB
15.5 171.1 162.1 124-126 23.9-24.8 23.6-24.6 Ca gluc 2.2cc (200mkd)
16 173.5 162.4 127-129 25.2-26.2 25.1-26.2 66 cc to run at 2.7cc/hrx24h
16.5 174.9 162.7 130-132 26.8-27.8 26.8-28.0
17 176.2 163.1 133-135 28.4-29.6 28.7-30.1 Subsequent days depend on infants status..
17.5 176.7 163.3 136-140 30.2-33.0 30.8-32 Electrolyte requirements:
18 176.8 163.7 141-145 33.7-36.9 Na: 2-4 mkd prepn 2.5 mg/ml
Ca: 100-200mkd prepn 100mg/ml
K: 2-4 mkd prepn 2mg/ml
Weight for Height = Actual BW (kg)
P50 Wt for Ht (kg) Glucose Infusion Rate:
ANTICONVULSANT
DIAZEPAM 0.2 0.3 mkdose
Double Volume Exchange Therapy (DVET) Drip: 1amp in 50cc D5W
Wt x 80 x 2 = Volume/ amt of fresh whole blood 10mg/amp
(Use mothers blood type) MIDAZOLAM 0.15 mkdose prn 2 3 mins interval IV (1, 5mg/ml)
6 mos - 5 yo 0.05 - 0.10 max of 0.6 mg/kg
Volume _ = # of exchange 6 yo - 12 yo 0.25 - 0.05 max of 0.4 mg/kg
aliquots per exchange >12 yo 0.50 - 2 mg/dose over 2 mins
PHENOBARBITAL LD: 15 20 mkd MD: 5 mkdose q 12h
> 3 kg 20 ml (max load 20 mkday IV
2-3 kg 15 ml
1-2 kg 10 ml Tabs: 15, 30, 60, 90, 100 mg
850g-1kg 5 ml Caps: 16 mg
< 850 g 1-3 ml ELIXIR 20mg/5ml
Inj: 30, 60, 65, 130 mg/ml
Prepare the ff:
2 pcs 3 way stopcock MD: PO/ IV
1 pc 5 cc syringe Neonate: 3 - 5 mkD QID/ BID
1 pc BT set Infant/child: 5 - 6 mkD
1 pc IV tubing 1 - 5 yo: 6 - 8 mkD
1 pc empty bottle 6 - 12 yo: 4 - 6 mkD
Gloves > 12 yo: 1 - 3 mkD
Calcium gluconate 100 mg every 10 exchanges Hyperbil < 12 yo: 3 - 8 mkD BID/TID
Criteria for Hypoxic Ischemic Encephalopathy PHENYTOIN LD: 15 20 mg/kg/IV
pH < 7 (profound met. Acidosis) MD:
Apgar <3 more than 5 mins Neonate: 5 mkD PO/ IV BID
Neurologic sequelae (coma; sz) Infant/child: 5 7mkD BID/ TID
Multiorgan involvement 6mos 3y: 8 10 mkD
Difficult delivery 4 6y: 7.5 9 mkD
7 9y: 7 8 mkD
Medications 10 16 y: 6 7 mkD
Dopamine: wt x dose x 0.075 Dilantin Tab: 50mg 100mg TID
Prepn : Single Strength: 200mg/250ml; Extended release caps 30, 100, 200, 300 mg OD, BID
Double Strength: 400/250ml Inj: 50 mg/ml
CARBAMAZEPINE
Tegretol Tab 200mg, 100mg chew Post Lumbar Tap
XR 100mg, 200mg, 400mg NPO x 4H
Susp 100mg/ 5ml (QID) Flat on bed
Initial Increment Maintenance Monitor NVS to include BP q 30mins x 4H, then qH
< 6 yo 10 - 20 mkD BID /TID q wkly til 35 mkD CSF exams
6 - 12 yo 10 mkD BID 100 mg/ 24H at 20 - 30 mkD BID/ QID Bottle # 1 Gm stain, AFB, India ink, KOH
1 wk interval Bottle # 2 Cell count, CHON, Sugar
> 12 y 200 mg BID 200 mg/ 24H at 800 - 1200 mg/24H Bottle # 3 C/S, save remaining specimen
1 wk interval BID/ QID Watch out for vomiting, HA and hypotension
Contraindications to LP
OXCARBAMAZEPINE (8 - 10 mkd BID) evidence of Inc ICP
Initial: 8 -10 mkD PO BID then severe CP compromise
Increment: increase over 2 week pd to Skin infection at site of puncture
Maintenance doses:
20 -29 kg: 900 mg/24H PO BID
29.1 -39 kg: 1200 mg/24H PO BID
>39 kg: 1800 mg/24H PO BID
OSTERIZED FEEDING
TFR 60 - 70% = 100/feeding q 6H
Laryngoscope sizes 10 kg x 60%
PT Miller 00 or 0 TFR = 600
Term Miller 0 CHON 0.5 g/kg inc q other day by 0.5 , max of 2 g/kg
Dose x wt x prep (Vamin 7%, 9%)
0-6mos Miller 1 0.5 x 10 kg x (100 /7) = 71 g/kg
CHON = 71 g/kg
6-24 mos Miller 2 If no prep = dose x wt x 4 = 20 g/kg
>24 mos Miller 2 or Mac 2 CHO 60%
(TFR CHON) x 0.6
(600- 71) x 0.6 = 317
CHO = 317
EMERGENCY MEDS Fats 181 (the rest are fats , divided into 6 feedings)
Epinephrine (bradycardia, asystole)
(1:1000) 0.1 ml/kg q 3- 5 mins TPN
Vamin 9% 0.67 cal/ml Sites: URT - pharyngitis - M1 2 4 12 18 25
Start 0.5 g/k/day inc by 0.5 g until 3 -3.5g/k/day Skin pyoderma - M49 55 57 60
Compute = wt x dose x prep (100/9) Pathophysio Immune complex disease
Clinical & Lab
Intralipid 10% 20% -hematuria -hypocomplementenemia
Start 0.5 g/k/day inc by 0.5 g until 3 g/k/day -proteinuria -oliguria
Compute = wt x dose x prep (100ml/ 10) = ml/24H -edema -n & v
Amino acids -hpn 82% -dull lumbar pain
Start 0.5 g/k/day inc by 0.5 g until 3 g/k/day Typical course
Compute = wt x dose x prep (100ml/g) = ml/24H Latent: few days 3wks
Oliguric: 7 10 days
TPN shortcut computation Diuretic: 7 10 days
Wt 10 kg TFR= 100 ml/k/day TFI = 1000ml/day Convalescent: 7 10 days