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7/25/2019 Pedia Small Notebook Edited
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ESSENTIAL NEWBORN CARE PROTOCOL [from DOH]
What should be done immediately after birth is to dry the baby because
hypothermia can lead to several risks
Delaying the cord clamping to 3 mins after birth (or waiting until the
umbilical cord has stopped pulsing)
Instead of immediately washing the NB, the baby should be placed on
the mothers chest or abdomen to provide warmth, increase theduration of breastfeeding, and allow the good bacteria from themothers skin to infiltrate the NB
Washing should be delayed until after 6 hours because this exposes the
NB to hypothermia and remove vernix. Washing also removes the babyscrawling reflex.
NEWBORN CARE
Umbilical Cord
Cut 8 inches above abdomen after 30 sec
In nursery, cut the umbilical cord 1 inch above the abdomen
Healing should take place around 7 10 days
Eye Prophylaxis
1% silver nitrate drops [most effective against Neisseria]
Erythromycin 0.5% [Chlamydia]
Tetracycline 1% Povidone iodine 2.5%
Vitamin K
1 mg Vit K1
PT: 0.5 mg
Vaccine
BCG
Hep B
Newborn Screening
Done on 16th hr of life . can be repeated after 2 weeks
Patients w/ CAH will die 7 14 days if not treated
Patient w/ CH will have permanent growth defect and MR if not
treated before 4 weeks
Disorder Screened Effects ScreenedEffects if Screened &
treated
Congenital
Hypothyroidism
Severe MR Normal
Congenital Adrenal
Hyperplasia (CAH)
Death Alive &Normal
Galactosemia (Gal) Death of Cataract Alive &Normal
Phenylketonuria PKU Severe MR Normal
G6PD Severe Anemia
Kernicterus
Normal
APGAR SCORE
Evaluates the need for resuscitation
Taken 1 and 5 minutes after birth
0 1 2
Color Blue, pale Body pink,
extremities blue
All pink
HR 0 100
Reflex irritability No response Grimace Cough
Activity Limp Some flexion Active
Respiration Absent Slow, irregular Good
The APGAR Score
81047
03
Good cardiopulmonary adaptationNeed for resuscitation, esp ventilatory support
Need for immediate resuscitation
NICU
Please admit under RI, LI, PD or AP
TPR q4H
May breastfeed if NSD; NPO x 2hrs if CS
Labs:
NBS at 24 hrs old, secure consent
CBC, BT (if w/ maternal illness, PROM or UTI
HGT now then 1, 3, 6, 12, 24, 48 hrs old (GDM)
HGT now (SGA or LGA)
Medications:
Erythromycin eye ointment both eyes
Vit K 1 mg IM (term); 0.5 mg (PT)
Hep B vaccine 0.5 ml IM, secure consent
BCG 0.05 ml ID (PT); 0.1 ml (term), secure onsent
SORoutine NB care
Monitor VS q30 mins until stable
Thermoregulate at 36.5 to 37.5C
Place under droplight (NSD); isolette (CS)
Suction secretion prn
Will infrom AP /AP attended delivery
IMMUNIZATION
Vaccine Min age of 1st
dose
# of
doseInterval Booster
BCG At birth
Before 1 mo
1 - -
DPT 6 wks
(2, 4, 6 mos)
3 4 wks 18 mos
46 yo
OPV/IPV 6 wks2, 4, 6 mos)
3 4 wks Same asDPT
Hep B At birth
(0, 1, 6 mos)
EPI (6, 10, 14)
3 6 wks from 1st
dose; 8 wks
from 2nd dose
Measles 69 mos 1 -
MMR 15 mos 1
Hib 2, 4, 6 mos 18 mos
Pneumococcal 6 mos (PCV7)
2 yrs (PPV)
18 mos
Rotavirus 3 and 5 mos 2 I month
Hep A 1 yr and up 2 612 mos
apart
Varicella 1st: 1215 mos
2nd: 46 yo
2 Bet 1st & 2nd
dose: at least
3 mos
Flu 6 months yearly
NEONATAL SEPSIS
Classification
Early:birth to 7th day of life Late:8th to 28th day of life
Risk factors:
Maternal infection during pregnancy
Prolongrupture of membranes (18 hrs)
Prematurity
Common organism:
Bacteria:GBS, E. coli& Listeria(early) Viruses:HSV, enteroviruses
Signs & symptoms: Non-specific
Dx: CBC, CXR, blood and urine culture, lumbar tap for CSF studies
Treatment: Empiric antibiotics [Ampicillin + 3rd gen Cephalosporin or
Aminoglycoside) / Supportive
NEONATAL JAUNDICE
Risk Factors
Jaundice visible on first day of life
Asibling w/ neonatal jaundice or anemia
Unrecognized hemolysis
Non-optimal feeding
Deficiency: G6PD
Infection
Cephalhemaoma or bruising / Central hct >65%
East Asian/ Mediteranean in origin
PHYSIOLOGIC vs PATHOLOGIC
FACTORS PHYSIOLOGIC PATHOLOGIC
Onset > 24 hrs of life < 24 hrs of life
Rate of inc of TSB < 0.5mg/dl/hr > 0.5mg/dl/hr
Persistent < 14 days FT: > 8 days
PT: > 14 days
Total S. Bilirubn FT: < 12 mg/dl
PT: < 14 mg/dl
Any level requiring
phototherapy
Signs/Symptoms Vomiting, lethargy, poor
feeding, excess wt loss, apnea,
inc RR, temp instability
KRAMER CLASSIFICATION
ZONE JAUNDICE mg/dl
I Head/neck 68
II Upper trunk 912
III Lower trunk, thigh 1216IV Arms, leg, below knee 1518
V Hands/feet > 15
BREAST FEEDING vs BREASTMILK JAUNDICE
Parameter BREASTFEEDING BREASTMILK
Onset 3rd to 5th day
of life
Late; start to rise on day 4; may reach
2030 mg/dl on day 14 then slowly
Normal by 412 weeks
Patho-
physiology
milk intake
enterohepatic
circulation
Unknown; Prob. due to glucoronidase
in BM which enterohepatic circulation
Normal LFT; (-) hemolysis
Mngt Fluid and
caloric
supplement
If breastfeeding is stopped, rapid in
bilirubin level in 48 hrs, if resumed will
to 24 mg/dl but no precipitating
previous events
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MILK FORMULAS
1:1dilution
Mead-Johnson, Nestle, Glaxo,
Dumex, Milupa
1:2dilution
Wyeth, Abbott, Unilab
0-6 months (20cal/oz) Lactose free (0-6months)
Mead-johnson: Alacta , Enfalac
Nestle: NAN1, Nestogen
Glaxo: Frisolac
Dumex: Dulac
Abbott: Similac advance
Milupa: AlaptamilWyeth: S26, Bonna
Unilab: Mylac
Mead-johnson: Enfalac lacto-free
Nestle: AL110
Milupa: HN25
Wyeth: S26Lacto-free
6months onwards (20cal/oz) Lactose free (6months onwards)
Mead-johnson: Enfapro
Nestle: NAN2, Nestogen 2
Glaxo: Frisomil
Dumex: Dupro
Abbott: Gain
Wyeth: Bonnamil. Promil
Unilab: Hi-nulac
Mead-johnson: Enfapro lacto-free
1 year onwards (20 cal/oz) Premature Infant (24cal/oz)
Mead-johnson: Enfagrow, Lactum
Nestle: NAN3, Neslac
Glaxo: Frisorow
Dumex: Dugrow
Abbott: Gainplus
Wyeth: Progress, Promil
Unilab: Enervon bright
Mead-johnson: Enfaprem
Nestle: PreNAN
Abbott: Similac prem
Milupa: Preaptamil
Hypoallergenic (20cal/oz) Soy-Based (20cal/oz)
Mead-johnson: Pregestimil
Nestle: Alfare, NAN HA1, NAN HA2
Mead-johnson: Prosoybee
Abbott: Isomil
Wyeth: Nursoy
TPN for NEONATESWt 2kg1.TFR = 100 ml/kg/day x 2 kg 200 ml
2.Intralipid 20%
1 g/kg/day x 2kg = 2g/day 10 ml
2 g = 20g
x 100ml
3. Compute for TFR 1TFR1 = TFRIntralipid = 200 -10ml = 90 ml
4. Vamin 7%
1 g/kg/day x 2 kg = 2g = 29 ml2 g = 7g
x 100ml5. Multivitamins Benutrex c 0.5 ml/100ml
0.5 ml = x 1 ml
100ml 190 ml
6. Ca gluc 10% 2ml/kg/day x 2 kg 4 ml
7.Dextrosity (D10) get d50wTFR 1 x dextrosity factor (0.11) 21 ml
190 x 0.118 . D5IMB= TFR 1(Vamin + MTV + Ca gluc + D50W)
190(29 + 1+ 4+ 21) = 135 ml
9. IV rate = TFR 1 / 24H 190 ml/ 24H 8 ml/H
Order:Start TPN as ff:
TFR= 100ml/kg/dayD5 IMB 135 mlD50W 21 mlVamin 7% 29 mlCa Gluc 4 mlMTV 1 ml
190 ml to run at 8 ml/hIntralipid 20% 10 ml to run for 24H
TPN
Vamin 9% 0.67 cal/ml
Start 0.5 g/k/day inc by 0.5 g until 3 -3.5g/k/day
Compute = wt x dose x prep (100/9)
Intralipid 10% 20%
Start 0.5 g/k/day inc by 0.5 g until 3 g/k/day
Compute = wt x dose x prep (100ml/ 10) = ml/24H
Amino acidsStart 0.5 g/k/day inc by 0.5 g until 3 g/k/day
Compute = wt x dose x prep (100ml/g) = ml/24H
TPN shortcut computation
Wt 10 kg TFR= 100 ml/k/day TFI = 1000ml/day
Vamin 7% 7 = 2 g/kg x 10kg 285 ml
100
CaGluc 2ml/kg 20 ml
D5IMB 485 ml
D50W 0.11 x 1000ml 110 ml
1000ml x 37 cc/h
TPN (PEDIATRICS)
Energy Requirment
AGE/WT Caloric Rquirement
Neonates 90-120 kcal/kg
Infants & Older Children
20
10-120 kcal/kg
1000kcal + 50 kcal foe each kg > 101500 + 20 for each more than 20
Fluid Requirement
AGE/WT Fluid Rquirement
Neonates: VLBW
( 1500 gm)
AGA & LBW
Initiate at 4060 ml/kg/day and increase by 10
ml/kg/day till 120 ml/kg is reached
Initiate at 60 ml/kg/day and increase by 15 ml/
kg/day till 120 ml/kg is reached on the 5 thday of
PN
Neonates under radiant heaters/on phototx an extra 30ml/kg/dayof water
Infants & Older Children
20
100120 ml/kg
1000ml + 50 ml foe each kg > 10
1500 + 20 for each more than 20
Protein Requirement
AGE/WT Dosage (gm/kg/day)
VLBW ( 1500 gm)
012 months
18 yrs
8 yrs and above
2.25
2.50
1.502.0
1.001.50
With the initiation of PB|N, start w/ 0.5gm/kg/day and gradually increased
by 0.5gm/kg/day till recommended protein is reached.
Carbohydrate Requirement
% dextrose = gram dextrose x 100
Vol infused (ml
Should provide 5060 % 0f total non-protein calories
Requirement ranges frm 10 to 25 gm/kg/day
Infusion should not exceed 12.5mg/kg/min
Should be decreased if urinary glucose 0.5% (2+) or blood sugar exceeds 7
mmol/L in neoanate or 9.7 mmol/L I above 1 mo of age
Fat Requirement
AGE Dosage (gm/kg/day)
012 months
18 yrs
8 yrs and above
2
4
2.5
3040 % of total calories shud b provided as fats
24% as EFA
Start at 0.5 gm/kg/day and gradually increase by 0.5 gm/kg/day tillrecommended amt is reached
Daily Electrolyte Requirements
Elect.
(mmol/kg)Neonates 1-6 mos 6m-11yrs Adolescents
NaCl
Potassium
Cal gluc
Phosphate
Magnesium
35
24
0.61.0
1.0
0.125-0.250
34
23
0.251.2
(max of 4.7)
12
0.125-0.250
34
23
0.251.2
(max of 4.7)
12
0.125-0.250
60100
80120
4.7
3045
48
Calcium gluconate contains 100 mg calcium gluconate or 9mg elemental
calcium/ml; 1 gm of Ca gluconate contains 4.7mEq or 2.35 mmol of Ca.
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Trace Elemental Requirements
Trace
ElementalPrematures
(ug/kg)
Infants & Children
(ug/kg)
Adolescents
(mg)
Zinc
Copper
Chromium
Manganese
Iodine
Selenium
Flouride
400
50
0.3
10
8
4
57
100500
20
0.140.2
210
8
4
57
2.54
0.51.5
0.010.04
0.150.5
0.2
0.3
0.9
In the absence of available prep of trace elements; weekly blood
transfusion may be given at 20 ml/kg
Iron: 2 mg/kg, with dose increased to 6 mg/kg if Fe def is documntd;
provided by adding iron dextran to amino acid soln
OSTERIZED FEEDING
TFR 60 - 70% = 100/feeding q 6H10 kg x 60%
TFR = 600
CHON 0.5 g/kg inc q other day by 0.5 , max of 2 g/kgDose x wt x prep (Vamin 7%, 9%)
0.5 x 10 kg x (100 /7) = 71 g/kgCHON = 71 g/kg
If no prep = dose x wt x 4 = 20 g/kg
CHO 60%
(TFRCHON) x 0.6
(600- 71) x 0.6 = 317CHO = 317
Fats 181 (the rest are fats , div ided into 6 feedings)
COMPOSITION OF ORS
ORS Na K Cl GluGlucolyte 60 20 50 100
Hydrite 90 20 80 111
WHO 75 20 65 75
Pedialyte 30
45
90
30
45
90
20
20
20
30
35
80
Gatorade 41 11 9/100
VITAMINS
Stimulants Mosegar Vita 0.25 mg/day prep 0.25 /5 ml
Buclizine (syrup) Appetens
Propan
Appebon
2 - 8yo 5 - 10 ml OD
7 - 14yo 10 - 20 ml OD
w/ Folic acid
(Megaloblastic
Anemia)
Molvite
7 - 12yo 10 - 15 ml OD
3 - 6yo 5 - 10 ml OD
1 - 2yo 2.5 - 5 ml OD
Iberet
Ferlin (10 mcg folic acid)
Macrobee
1 - 2yo 2.5 - 5 cc OD3 - 6yo 5 - 10 cc OD
7 - 12yo 10 - 15 cc OD
Pizotifen
(drowsiness)Mosegor vita syr
Appetens
MTV w/ Iron Propan w/ iron syr (Fe So4; elem fe 30mg)
Appebon w/ iron syr (FeSo4; elem fe 10mg)
w/ Serotonin (for
migraine + dec
wt)
Mosegor vita
Mosegor plain
Appeten
Jagaplex syrup
1-2yo 5ml OD
3-6yo 10 ml OD
7-12yo 15 ml OD
Clusivol Power syrup
syr 100mg/5ml
2-6yo 5 ml OD
7-12yo 10 ml OD
Zeeplus
20
Daily Requirement [ml/kg]
100 ml
1000 + 50ml/kg for each kg >10
1500 + 20ml/kg for each kg >20
Maintenance water rate
010
1020
>20
4ml/kg/hr
40 mk/hr + 2ml/kg/hr x wt
60 mk/hr + 1ml/kg/hr x wt
COMPOSITION OF IV SOLUTION
Fluid Na K Cl HCO3 Dxt
PNSS 154 - 154 - -
0.45 NaCl 77 - 77 - -
D50.3 NaCl 51 - 51 - 5
D5LRS 130 4 109 28 5
D5NM 40 13 40 16 5
D5IMB 25 20 22 23 5
D5NR 140 5 98 27 5
Na requirement:24 meq/k/day K requirement: 23 meq/k/day
KIR: 0.20.3 meq/k/hr ; max 40 meq
KIR = Rate x incorporation/ wt
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CLINICAL FEATURES of PNEUMONIA
Bacterial Fever >38.5C
Chest recession
Wheeze not a sign of primary bacterial URTI
Viral Wheeze Marked recession
Fever < 38.5 RR normal or increased
Mycoplasma School children
Cough
wheeze
CXR in assessing CAP etiology
Alveolar infltrates Bacterial pneumonia
Interstitial infiltrates Viral pneumonia
Both infiltrates Viral, Bacterial, or Mixed
Microbial causes of CAP according to Age
Birth to 20 days Grp B Strep CMV
Gram (-) enterobacteria L. monocytogenesis
3 weeks to 3
months
RSV B. pertussis
Parainfluenza virus S. aureus
S. pneumonia
4 months to 4 yo RSV, Parainfluenza virus H. influenzae
Influenza virus, Adeno, Rhinovirus M.tuberculosis
S. Pneumonia M.pneumoniae
5 years to
15 years
M.pneumoniae S. pneumonia
C. Pneumoniae M.tuberculosis
Clinical Practice Guidelines in the Evaluation and Management of PCAP
Predictors of CAP in patients with cough
(3 mos to 5 yrs)tachypnea &/or chest retractions(512 yrs)fever, tachypnea & crackles
(>12 yo)(a) fever, tachypnea & tachycardia; (b) at least 1 AbN CXR
WHO Age Specific classification for tachpynea
2 to 12 mos: >50 RR
1 to 5 yrs: >40 RR
>5 yrs: >30 RR
PCAP A/PCAP B
No diagnostic usually requestedPCAP C/PCAP D
The ff shud b routinely requested
CXR APL (patchyviral; consolidatedbacterial)
WBC
C/S (blood, Pleural Fluid, tracheal aspirate on initial intubation)
Blood gas/Pulse oximeter
The ff may be requested: C/S sputum
The ff shud NOT be routinely requested: ESR & CRP
Antibiotic Recommendation
PCAP A/PCAP B and is beyond 2 yo & having fever w/o wheeze
PCAP C and is beyond 2 yo, having high grade fever, having alveolar
consolidation on CXR, having WBC >15,000
PCAP Drefer to specialist
Antibiotic Recommendation
PCAP A/PCAP B w/o previous antibiotic
Amoxicillin (4050 mkday) TID
PCAP CPen G IV (100,000 IU/k/d) QID
PCAP C who had no HiB immunization
Ampicillin IV (100mkd) QID
PCAP Drefer to specialist
What should be done if px is not responding to current antibiotics?
If PCAP A/PCAP B not responding w/n 72 hrs
Change initial antibiotic
Start oral Macrolide
Reevaluate dx
PCAP C no responding w/n 72 hrs consult w/ specialisr
PCN resistant S pneumonia
Complication
Other dx
PCAP D not responding w/n 72hrs, then immediate consultto a specialist is
warranted
Switch from IV to Oral Antibiotic done in 2 3 days after initiation in px who:
Respond to initial antibiotic
Is able to feed with intact GI tract
Does not have any pulmo or extra pulmo complication
Ancillary Treatments
O2 and Hydration
Bronchodilators, CPT, steam inhalation and Nebulization
Prevention
Vaccines
Zinc Supplementation (10mg for infants / 20mg for children > 2 yo)
THERAPEUTIC MANAGEMENT OF CAP
OPD MANAGEMENT
Birth to 20 days Admit
3 weeks to 3 months Afebrile: Oral Erythromycin (30-40mkd)
Oral Azithromycin (10 mg/kg/day) day 1
5 mkday for day 2 to 5
Admit: febrile or toxic
4 months to 4 yo Oral Amoxicillin (90mkd/3doses)
Alternative: Amox-Clav, AZM, Cefaclor
Clarithromycin, Erythromycin
5 years to 15 years Oral Erythromycin (30-40mkd)
Oral AZM 10mkday day 1, 5mkday day 2-5
Clarithromycin 15mkday/2 doses
Pneumococcal infxn: Amoxicillin alone
IN-PATIENT MANAGEMENT
Birth to 20 days Ampicillin + Gentamicin w or w/o Cefotaxime
3 weeks to 3 months Afebrile: IV Erythromycin (30-40mkd)
Febrile: add Cefotaxime 200mkd
Cefuroxime 150 mkd
4 months to 4 yo If w/ pneumococcal infection:
IV Ampicillin (200mkd) Cefotaxime 200mkd
Cefuroxime 150 mkd
5 years to 15 years Cefuroxime 150 mkd + Erythromycin 40mkd
IV or orally for 10-14 days
If pneumococcal is confirmed: Ampicillin 200mkd
P C A PVARIABLE A(Min Risk) B(Low Risk) C(Mod Risk) D(High Risk)
Comorbid
IllnessNone Present Present Present
Compliant
caregiverYes Yes No No
Ability to
follow upPossible Possible Not Not
DHN None Mild Moderate Severe
Feeding Able Able Unable Unable
Age >11 mos >11 mos 50/min
>40/min
>30/min
>50/min
>40/min
>30/min
>60/min
>50/min
>35/min
>70/min
>50/min
>35/min
Signs of Respiratory Failure
VARIABLE A(Min Risk) B(Low Risk) C(Mod Risk) D(High Risk)
Retractions
Head
bobbing
Cyanosis
GruntingApnea
Sensorium
-
-
-
--
None
-
-
-
--
Awake
Subcostal/
Intercostal
+
+
--
Irritable
Subcostal/
Intercostal
+
+
++
Lethargy /
Stupor
Coma/
Comp:
Effusion
Pneumo
-thorax
None None Present Present
Action Plan OPD
f/u at end
of tx
OPD
f/u after 3
days
Admit to
regulat ward
Admit to
CCU; Refer
to specialist
BRONCHIOLITIS
Acute inflammation of thesmall airwaysin children
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VIRAL CROUP vs EPIGLOTTITIS
VIRAL CROUP EPIGLOTTITIS
Age group 3 mos to 3 yrs 37 yrs
Stridor 88% 8%
Pathogen Parainfluenza virus H. influenzaetype B
Onset Prodrome (17 days) Rapid (412 hrs)
Fever Severity Low grade High grade
Associated symptom Barking cough,
hoarseness
Muffled voice,
Droolong
Respond to racemic
epinephrineStridor improves None
CXR steeple sign thumbprint sign
BRONCHIAL ASTHMA
Please admit under the service of Dr. _____________
TPR q4H and record
NPO if dyspneic
Labs:
CBC
U/A (MSCC)
ABG* CXR APL*
IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if 2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
Medications:
Paracetamol prn q4h for T > 37.8C (10 15 mkdose)
USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses
Incorporate Budesonide 10 mkd LD (max 200mg IV); then
5mkd q6h IV (max of 100 mg IV)
Ranitidine IVTT at 1mkdose (if on NPO)
SO:MIO q shift and record
Monitor VS q2h and record
Refer for persistence of tachypnea, alar flaring and retractions
O2at 2 lpm via NC, refer for desaturations
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ANAPHYLAXIS
A syndrome involving a rapid & generalized immunologically mediated rxn
After exposure to foreign allergens in previously sensitized individuals
A true emergency when cardio and respi system are involvedED Management
O2
Aqueous Epinephrine 1:1000 IM (0.01ml/kg with 0.5ml max)
Prepare intubation if w/ stridor & if initial therapy of epi is not effective
Continuous monitor ECG and O2 sat & establish IV access
Antihistamine to prevent progression
H1 & H2 blocker
Diphenhydramine (1mg/kg) IM
Steroids may modify late phase or recurrent reaction (Hydrocortisone
5mg/kg/dose)
Epinephrine 1:10,000 IV (0.1ml/kg; 10ml max)
Epinephrine drip (0.01ml/kg/min)
Indication for Admission
Persistent bronchospasm
Hypotension requiring vasopressors
Significant hypoxia
Patient resides some distance from a hospital facility
SEIZURE
BENIGN FEBRILE SEIZURE CRITERIA
6 mos6 yrs
< 15 mins
Febrile
Family history of febrile seizure
GTC
Not > 1 episode in 1 febrile episode; EEG done after 2 w ks of seizure
episode
3% of general population develop epilepsy
12 % of BFS develop epilepsy
25% recurrence of seizure
Seizureparoxysmal, time limited change in motor activity and/or behavior
that results from abnormal electrical activity in the brain
Epilepsypresent when 2 or more unprovoked seizure/s occur at an interval
greater than 24 hrs apart
SEIZURE Simple Complex
Type GTC Focal then gen post ictal
Duration < 15 min > 15 min or may go into
status
Recurrence None Recurrent (w/in 24H)
CNS exam Normal Abnormal
Sequelae None Neurodev abnormalities
FEBRILE SEIZURE
Please admit under the service of Dr. ______________
TPR q4H and record
DAT once fully awake
Labs:
CBC
U/A (MSCC)IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if 2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
Medications:
Paracetamol prn q4h for T > 37.8C
SO:
MIO q shift and record
Monitor VS q2h and record
Monitor neurovital signs q4h and record
Continue TSB for fever
Seizure precaution at bedside as ff:
Suction machine at bedside
O2with functional gauge; if with active sz give O2at 2lpm via NC
Diazepam IVTT (0.3 mkd max of 5 mg IV) prn for seizure
Will inform AP
Pls inform Dr _____ of this admission
Thank you.
S H O C K
CO = HR x SV / CO is primarily maintained by changes in HR
HYPOVOLEMIC Pump empty
Truma, hemorrhage,
DHN (diarrhea/
vomiting)
Metabolic dse (DM)
Excessive sweating
MC in infant &children
Normal BV of children
80ml/kg
CARDIOGENIC Weak/sick pump
CHF, cardiomegaly,
drug intoxication,
hypothermia,
after cardiac
surgery
Compromise CO
DISTRIBUTIVE Sepsis
Anaphylaxis
Barbiturate intox
CNS injury (SCI)
Redistribution of fluid w/n
vascular space
SIGNS OF SHOCK
EARLY LATE
Narrowed pulse pressure
Orthostatic changes
Delayed capillary filling
Tachycardia
Hyperventilation
Decrease systolic pressure
Decrease diastolic pressure
Cold, pale skin
Altered mental state
Diaphoresis
Decrease urine output
EDMNGT
PositionOxygen & Assisted ventilation
Intravenous access & Fluid (isotonic crystalloid)
Reassess (look for improvement in VS, skin signs, mental status;
insert foley cath & monitor UO)
Inotropeshelp stabilize BPEpinephrine - (0.11 ug/kg/min)- Infusion of choice for
Hypotensive pxsDobutamine - (5 20 ug/kg/min)
Cardiogenic shock but not severely hypotensiveDopamine[(520 ug/kg/min constrictor effect) [(10 15
ug/kg/min]
Distributive shock after successful fluid resuscitation
Cardiogenic shock
Diureticpxs may get worse after fluid challenge
Adenosine / synchronize cardioversionSVT
DefibrillationVenticular fibrillation
BELLS PALSY
Acute unilateral facial nerve palsy that is not associated with other
cranial neuropathies or brainstem dysfunction
Usually develops abruptly about 2 wks after SVI [EBV, HSV, mumps]
Upper and lower portions of the face are paretic; corner of the mouth
drops; unable to close the eye on the involved side
Protection of cornea with methylcellulose eye drops or an ocular
lubricant; excellent prognosis
CEREBRAL PALSY
Non-progressive disorder of posture & movement often associated with
epilepsy & abnormalities of speech, vision & intellect resulting from
defect or lesion of the developing brain
Etiology: infections, toxins, metabolic, ischemia
Classifications
Physiologic
[major motor abnormality]
Topogrphic
[involved extremities]Spastic
Athetoidworm like
Rigid
Ataxic
Tremor
Atonic
Mixed
unclassified
Monoplegia [1 side/portion]
Paraplegia
Hemiplegia
Triplegia [3 limbs]
Quadriplegia [all]
Diplegia [LE/UE]
Double hemiplegia
Clinical Manifestations
Spastic
hemiplegia
Arms > legs
Dificulty in hand manipulation obviously by 1 yo
Delayed walking or walk on tiptoes
Spasticity apparent esp. in ankles
Seizure & cognitivr impairment
Spastic diplegia Bilateral spasticity of the legs
Commando crawl
Increased DTRs & (+) Babinski sign
Normal intellect
Spastic
quadriplegia
Most severe form, due to marked motor impairment
of all extremities & high association w ith MR &
seizures
Swallowing difficulties
Management
Baseline EEG & cranial CT scan
Hearing & visual function tests
Multidisciplinary approach in the assessment & treatment
For tight heel cord: tenotomy of the Achilles tendon
CSF PATHWAY
Choroid plexus (lateral ventricle) Foramen of Monroe 3rdventricle
Aqueduct of sylvius 4 thventricle Foramina of Luschka (2 laterals)
& Magendie (median) SAS Absorbed in the arachnoid villi,
then in the Venous System
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HYDROCEPHALUS
Result from impaired circulation & absorption of CSF or from inceased
production
Obstructive or Noncommunicating
Due to obstruction w/n ventricular system
Abnormality of the aqueduct or a lesion in the 4th venticle
(aqueductal stenosis)
Non-obstructive or Communicating
Obliteration of the subarachnoid cisterns or malfunction of the
arachnoid villi
Follows SAH that obliterates arachnoid villi; leukemic infiltrates
Clinical Manifestations Infant: accelerated rate of enlargement of the head; wide anterior
fontanel & bulging [Normal fontanel size: 2 x 2 cm]
Eyes may deviate downward: due to impingement of the dilated
suprapineal recess on the tectum [settingsun sign]
Longtract sign: [brisk DTR, spasticity, clonus, Babinski sign]
Percussion of skull produce a crackedpot or Macewen sign
[separation of sutures]
Foreshortened occiput [Chiari malformation]
Prominent occiput [Dandy-Walker malformation]
Treatment
Depends on the cause
Extracranial shunt
Acetazolamide & Furosemide [provide temporary relief by reducing
the rate of CSF production]
DEEP TENDON REFLEXESMOTOR
Full resistance with gravitySome resistance with gravity
Movement with gravity
Movement w/o gravity
Flicker
No movement
5/54/5
3/5
2/5
1/5
0/5
Very brisk
Brisker than average
Normal
Diminished
No response
+4
+3
+2
+1
0
CRANIUM
Caput succedaneum
Diffuse edematous swelling of soft tissues of scalp
Extend across midline
Edema disappears w/in 1stfew days of life
Molding and overriding of parietal bones-frequent
Disappear during 1stwks of life
No specific tx
Cephalhematoma
Subperiosteal hemorrhage; limited to1 cranial bone
Occur 1-2 % cases
No discoloration of overlying scalp
Swelling not visible for several hours after birth (blding slow process)
Firm tense mass with palpable rim localized over 1 area of skull
Resorbed w/in 2wk- 3mos and calcify by end of 2ndwk
Few remain for years
10-25% cases underlying linear skull fracture
No tx but phototherapy in hyperbilirubinemia
Pre Lumbar Tap
NPO
RBS by gluco prior to lumbar tap
Prepare lumbar tap set
2% Lidocaine # 1
G 23 spinal needle
Mannitol 250 cc 1 bot - do not open
Solvent
Diazepam 1 amp
3 cc syringe #2
2 manometers
sterile bottles # 3
sterile gloves # 2
Sterile gauze # 1
Sterile gauze w/ Betadine #1
Sterile towel w/ hole #1
Sterile clamp #1
3-way stopcock #1Post Lumbar Tap
NPO x 4H; Flat on bed
Monitor NVS to include BP q 30mins x 4H, then qH
CSF exams
Bottle # 1Gm stain, AFB, India ink, K OH
Bottle # 2Cell count, CHON, Sugar
Bottle # 3C/S, save remaining specimen
Watch out for vomiting, HA and hypotension
ANTICONVULSANTS
DIAZEPAM 0.20.3 mkdose
Drip: 1amp in 50cc D5W
10mg/amp
MIDAZOLAM 0.15 mkdose prn 23 mins interval IV (1, 5mg/ml)
6 mos - 5 yo 0.05 - 0.10 max of 0.6 mg/kg
6 yo - 12 yo 0.25 - 0.05 max of 0.4 mg/kg
>12 yo 0.50 - 2 mg/dose over 2 mins
PHENOBARBITAL LD: 15 20 mkd MD: 5 mkdose q 12h
(max load 20 mkday IV
Tabs: 15, 30, 60, 90, 100 mg
Caps: 16 mg
ELIXIR 20mg/5ml
Inj: 30, 60, 65, 130 mg/ml
MD: PO/ IV
Neonate: 3 - 5 mkD QID/ BID
Infant/child: 5 - 6 mkD
1 - 5 yo: 6 - 8 mkD
6 - 12 yo: 4 - 6 mkD
> 12 yo: 1 - 3 mkD
Hyperbil < 12 yo: 3 - 8 mkD BID/TID
PHENYTOIN LD: 1520 mg/kg/IV
MD:
Neonate: 5 mkD PO/ IV BID
Infant/child: 5 7mkD BID/ TID
6mos3y: 810 mkD
46y: 7.59 mkD
79y: 78 mkD
1016 y: 67 mkD
Dilantin Tab: 50mg 100mg TID
Extended release caps 30, 100, 200, 300 mg OD, BID
Inj: 50 mg/ml
Contraindications to LP
Evidence of Inc ICP
Severe CP compromise
Skin infection at site of puncture
CARBAMAZEPINE
Tegretol Tab 200mg, 100mg chew
XR 100mg, 200mg, 400mg
Susp 100mg/ 5ml (QID)
Initial Increment Maintenance
< 6 yo 10 - 20 mkD BID /TID q wkly til 35 mkD
6 - 12 yo 10 mkD BID 100 mg/ 24H at
1 wk interval
20 - 30 mkD BID/
QID
> 12 y 200 mg BID 200 mg/ 24H at
1 wk interval
800 - 1200
mg/24H
BID/ QID
OXCARBAMAZEPINE (8 - 10 mkd BID)
Initial: 8 -10 mkD PO BID then
Increment: increase over 2 week pd to
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
Trileptal Tab 150 mg 300mg 600 mg
Susp 300mg/5ml
VALPROIC ACID PO:
Initial : 10 - 15 mkD OD - TID
Increment: 10 mkD at wkly interval BID
Maintenance: 30 - 60 mkD BID/TIDIV: same dose as PO q 6H
Rectal : (syrup mix with water 1:1)
LD: 20 mkd
MD: 10 -15mkd TID
Depakene Tab 250 mg
Syr 250mg/5ml
Depacon IV 100mg/ml
TOPIRAMATE 2 - 16 yo
Initial: 1 - 3 mkd PO q HS x 7 days then Increment:
Increase by 1 - 3 mkday for 1 - 2 wks then
Maintenance: 5 -9 mkD BID
Topamax Caps: 15 mg, 25 mg
Tabs: 25, 50, 100, 200mg
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Glasgow Coma Scale GCS for Infants
Activity Activity
Eye Opening
Spontaneous
To speech
To pain
None
4
3
2
1
Spontaneous
To speech
To pain
None
4
3
2
1
Verbal
Oriented
Confused
Inappropriate words
Inappropriate sounds
None
5
4
3
2
1
Coos, babbles
Irritable
Cries to pain
Moans to pain
None
5
4
3
2
1
Motor
Follows commandLocalizes pain
Withdraws to pain
Abnormal flexion
Abnormal extension
None
65
4
3
2
1
N spontaneous movtWithdraws to touch
Withdraws to pain
Abnormal flexion
Abnormal extension
None
65
4
3
2
1
CSF ANALYSIS
Color RBC WBCDiff
ctSugar CHON
Infant (Term) Xantho 0 -
100
0 -32 L
100
%
70 to
80%
60 -
150
Infant (Preterm) Clear 0 -
100
0 -15 L
100
%
70 to
80%
60 -
200
Older child Clear 0 0 -10 L
100
%
> 50% 10 - 20
Viral Meningitis Clear 0 0 -20 L
100
%
40 to
60%
40 - 60
TB/Fungal Clear 0 20 -
500
L >
N
< 40% > 100
g%
Bacterial
MeningitisPurulent 0 >
1000
N >
L
< 50% > 100
g%
Partially tx BM Clear 0 100 L >
N
> 50% Dec
VIRAL INFECTIONS
MEASLES (Rubeola) [Paramyxoviridae]
MOT Droplet spray
IP 1012 days
Prd of comm 4 days before & 4 days after onset of rash
Enanthem Koplik spots (opposite lower molars)
Prodrome High grade fever, conjunctivitis, catharr (35 days)
Rash Appear during height of fever
Cephalocaudal[1st along hairline, face, chest]
[+] brawny desquamationdisappear w/n 710 days
Complication Otitis media Diarrhea
Pneumonia Exacerbation of M tb infection
Encephalitis
Tx Vit A SD 100,000 IU orally for 6 mos1 yo / 200,000 IU >1 yo
Post exposure
prophylaxis
Ig w/n 6 days of exposure
(0.25ml/kg max 15 ml) IM
Vaccine Susceptible children >1 yo w/n 72 hrs
SSPE Chronic condition due to persistent measles infxn
Rare but found in 6 mo to >30 yrs of age
Subtle change in behavior & deterioration o schoolwork
followed by bizarre behavior
Elevated titers of Ab to measles virus(IgG, IgM)
Inosiplex (100mg/kg/day) may prolong survival
GERMAN OR 3 DAY MEASLES [RUBELLA] [Togaviridae]
MOT Oral Droplet; transplacentally to fetus
IP 1421 days
Prd of comm 7 days before &7 days after onset of rash
Enanthem Forchheimer spots [soft palate] just b4 onset of rash
Rash Cephalocaudal
Charac. sign Retroauricular, posterior cervical & postoccipital LAD [24
hrs before rash & remains for 1 wk]
TxVit A SD 100,000 IU orally for 6 mo1 y / 200,000 IU >1 yo
Post exposure
prophylaxis
Immunoglobulin [not routine]
Considered if termination of preg is not an option
0.55ml/kg) IM
Vaccine w/n 72 hrs of exposure
Congenital
RubellaGreatest during 1st trimester; IUGR
Congenital cataract, microcephaly, PDA, blueberry
muffin skin lesions
Congenital or profound SNHL | Motor/mental retardation
ROSEOLA [HSV 6] Exanthem subitum
Age of onset < 3 yo with peak at 6 15 months
High grade fever for 35 days but behave
normally
Rash Appears 1224 hrs of fever resolution fades in 1
3 days
HERPANGINA [Coxsackie A]
Sudden onset of fever with vomitingSmall vesicles & ulcers w/ red ring found in anterior tonsillar pillars, may also
seen on the soft palate, uvula & pharyngeal wall
VARICELLA [HSV]
MOT Direct contact
IP 14 days
Prd of comm 12 days before the onset of the rash until 5 6
days after onset & all the lesions have crusted
Rash Start from the trunk then spread to othe parts of the
body
All stages present; pruritic
Macule/papule vesicle crust
Complication Secondary bacterial infection Reye syndrome
Encephalitis or meningitis GN
Pneumonia
Congenital
Varicella
6 -12 wks AOG: maximal interruption w/ limb devt
with cicatrix(ski lesion w/ zigzag scarring)
1620 wks: eye and brain involvement
Tx Acyclovir 1530 mg/kg/day IV or 200400 mg tabq 4hrs minus midnight dose x 5 days: risk of severity
Post exposure
prophylaxis
VZIg 1 dose up to 96 hrs after exposure
Dose: 125 U/10 kg (max 625 U) IM
NB whos mother develop varicella 5 days before to 2
days after delivery shud recv 1 vial
Vaccine Susceptible children >1 yo w/n 72 hrs
ERYTHEMA INFECTIOSUM [Parvovirus B 19] FIFTH DISEASE
MOT Droplet spread & blood & blood products
IP 1617 Days average
Prodrome Low grade fever, headache, URTI
Rash Erythematous facial flushing slapped cheekand
spreads rapidly to the trunk & proximal extremities as
a diffuse macular erythema; palms & soles spared
Resolves w/o desquamation but tend to wax and
wane in 13 wks
MUMPS [Paramyxoviridae]
MOT Direct contact, airborne droplets, fomites
contaminated by saliva
IP 1618 days
Period of
communicability
12 days before onset of parotid swelling until 5 days
after the onset of swelling
Prodrome Fever, neck muscle pain, headache, malaise
Parotid gland
swelling
Peak in 13 days
1st in the space between posterior border of mandible
& mastoid then extends being limited above zygoma
Complications Meningoenephalitis - most frequent, 10 days; M>F
Orchitis & Epididymitis
Oophoritis
Dacryoadenitis or optic neuritis
Hx of
Absorbed TTClean minor Wound All other Wounds
Td TIG Td TIG
Unknown or
No No No No
< 7 yo Dtap is recommended
> 7 yo Td is recommended
If ony 3 doses of TT received, a 4th dose should be given
Give TT (clean minor wounds) if > 10 y since last dose
All other wounds (punctured wds, avulsions, burn)
Give TT (all clean wounds) if > 5 yrs since last dose
RABIES VACCINE
VERORAB 0.5 cc/amp; 1 amp IM
Day: 0 3 7 14 and 28
BERIRAB RD: 20 iu/kg
300 iu/vial 1 vial = 2ml
at wound site
deep IM
Reqd amt in IU: wt x RD (20IU)
Amount in ml = wt x RD (20) x 2
300
Ig (Human)
Equine
20 iu/kg
Bayrab 300 iu/2ml | Berirab 300 iu/2ml
40 iu/kg
Favirab 200400 iu/5ml
10002000 iu/5ml
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VACCINES
BCG
DPT
OPV
IPV
MMR, Measles
Varicella
Hep B
Hep A
Hib
Typ
Pneumococcal
Influenza
Live attenuated M bovis
Diptheria and TTinactivated B pertussis
Sabin trivalent live attenuated virus
Salk inactivated virus
Live attenuated virus
Recombinant DNA, plasma derived
Inactivated virus
Capsular polysacc linked to carrier CHON
Live typhoid vaccine3 doses x 2 days
IMSCVi antigen typ vaccine
Capsular polysaccharide 0.5 ml
SC /IM23 valent purified capPolysacc Antigen of 23 serotyp
Split or whole virus IM
DENGUE FEVER
Please admit under the service of Dr. ________________
TPR q4H and record
DAT (No dark colored foods)
Labs:
CBC, Plt (optional APTT and PT)
Blood typing
U/A (MSCC)
IVF:
D5 0.3 NaCl 1P/1L (40 kg) at 35 cc/kg
Medications:
Paracetamol prn q4h for T > 37.8C
Omeprazole 1mkdose max 40 mg IVTT OD
SO:
MIO q shift and recordMonitor VS q2h and record, to include BP
Continue TSB for fever
Refer for Hypotension, narrow pulse pressure (< 20mmHg)
Refer for signs of active bleeding like epistaxis, gum bleeding,
melena, coffee ground vomitus
Will inform AP
Pls inform Dr _____ of this admission
Thank you.
DENGUE HEMORRHAGIC FEVER
Serotype 1, 2, 3, & 4
Aedes egypti
IP: 46 days (min 3 days; max 10 days)
DHF SEVERITY GRADING
GRADE MANIFESTATION
I Fever, non-specific constitutional symptoms such as
anorexia, vomiting and abdominal pain (+) Torniquet
test
II Grade I + spontaneous bleeding; mucocutaneous, GI
III Grade II w/ more severe bleeding +
Evidence of circulatory failure: violaceous, cold &
clammy skin, restless, weak to imperceptible pulses,
narrowing of pulse pressure to < 20mmHg to
actualHPON
IV Grade III but shock is usually refractory or irreversible
and assoc w/ massive bleeding
CRITERIA FOR CLINICAL DX (WHO)
DHF DSS
Fever, acute onset, high, lasting 27
days
Hemorrhagic manif:
(+) Torniquet test
Minor & Major bleeding
phenomenon
Thrombocytopenia 2yo5-7 mkd TID, BID PO
INFECTIVE ENDOCARDITISDUKE CRITERIA
Major ManifestationMinor manifestation
DiagnosisHighly probable: 2 major OR 1 major and 2 minor manifestation
RHEUMATIC HEART DISEASE
JONES CRITERIA
Major Manifestations
Arthritis (70%)
Carditis (50%)
Tachycardia Pericarditis
Heart murmur of valvulitis Cardiomegaly
Signs of CHF [gallop rhythm, distant heart sounds, cardiomegaly]
Erythema marginatum (10%)
Subcutaneous nodules (210%)
Sydenhams chorea (15%)
Minor manifestations
Arthralgia Acute Phase Reactants (CRP & ESR)
Fever at least 38.8C Prolonged PR interval on the ECG
Diagnosis: Highly probable : 2 major OR 1 major and 2 minor manifestation
ACUTE GASTROENTERITIS
Please admit under the service of Dr. ________________
TPR q4H and record
DAT once fully awake; NPO x 2hrs if with vomiting
Labs:
CBC
U/A (MSCC)
F/A (Concentration Method)
IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if 2 yo)D5LR 1L at 30cc/kg in 8hif >40 kg
Medications:
Paracetamol prn q4h for T > 37.8C
Zinc (E Zinc)Drops 10mg/ml 1ml OD (2 yo) 5ml OD
Ranitidine IVTT at 1mkdose (if with abdominal pain)
SO:
MIO q shift and record
Monitor VS q2h and record
Continue TSB for fever
Chart character, frequency and amount of GI losses and replace w/
PLR 1L/1P vol/vol
Will inform AP
Pls inform Dr _____ of this admission
Thank you.
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BPN
Please admit under the service of Dr. ______________
TPR q4H and record
NPO if dyspneic
Labs:
CBC
U/A (MSCC)
ABG* CXR APL*
IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if 2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
Medications:
Paracetamol prn q4h for T > 37.8C (10 15 mkdose)
USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses
then refer
NaCl (Muconase) nasal spray, 2 sprays per nostrils, then suction
using bulb QID
Ranitidine IVTT at 1mkdose (if on NPO)
SO:
MIO q shift and record
Monitor VS q2h and record
Continue TSB for fever
Refer for persistence of tachypnea, alar flaring and retractions
O2at 2 lpm via NC, or 6 lpm via facemask
Attach to pulse oximeter, refer for desaturations
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PHOTOTHERAPY
10 Bulbs; 20 watts; 200 hrs; 30 cms
Bilirubin in the skin absorbs light energy
Photo-isomerizationreaction converting the toxic native unconjugated
4Z, 15Z-bilirubin into an unconjugated configurational isomer 4Z,15E-
bilirubin, which can then be excreted in bile without conjugation
Major product from phototherapy is lumirubin, which is an irreversible
structural isomer converted from native bilirubin and can be excreted by
the kidneys in the unconjugated stateComplications
Loose stools, erythematous macular rash, purpuric rash associated with
transient porphyrinemia, overheating, dehydration (increased insensiblewater loss, diarrhea), hypothermia from exposure, and a benign
condition called bronze baby syndromedark, grayish-brown skin
discoloration in infants
Bilirubin (Total)
Cord
Preterm
Term
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Regular milk: 20 cal/oz
Preterm milk: 24 cal/oz
Total Caloric Intake: rate x 24 x caloric content of IVF wt
To get factor: Dextrosity x 0.04 = cal/cc
Caloric content of IVF
D5 = 0.2 cal/cc
D7.5 = 0.3 cal/cc
D10 = 0.4 cal/cc
D15 = 0.6 cal/cc
Caloric requirement & Protein requirement
Cal/kg g/kg
0-5mo
6-11mo1-2 yo
3-6 yo
7-9 yo
1012 yo
13-15 yo
1619 yo
115
110110
90100
8090
7080
5565
4550
3.5
32.5
2
1.5
1.5
1.5
1.5
Approximate Daily Water Requirement
03 do
10 do
15 mo
612 mo
13 yo
120cc/k/d
150cc/k/d
150cc/k/d
140cc/k/d
120cc/k/d
46 yo
79 yo
1012 yo
1315 yo
1619 yo
100 cc/k/d
90 cc/k/d
80 cc/k/d
70 cc/k/d
50 cc/k/d
Estimated Catch up Growth Requirement
= cal/k/day (age for wt) x IBW (wt for ht)
Actual BW
CHON reqt = CHON reqt for age x IBW
Actual BW
Growth and Caloric requirements
AGE RDA kcal/kg/day
03 mos
36 mos
69 mos
912 mos
13 yo
46 yo
115
110
100
100
100
90100
Double Volume Exchange Therapy (DVET)
Wt x 80 x 2 = Volume/ amt of fresh whole blood
(Use mothers blood type)
Volume _ = # of exchange
aliquots per exchange
> 3 kg 20 ml
2-3 kg 15 ml
1-2 kg 10 ml
850g-1kg 5 ml
< 850 g 1-3 ml
Prepare the ff:
2 pcs 3 way stopcock
1 pc 5 cc syringe
1 pc BT set
1 pc IV tubing
1 pc empty bottle
Gloves
Calcium gluconate 100 mg every 10 exchanges
Criteria for Hypoxic Ischemic Encephalopathy
pH < 7 (profound met. Acidosis)
Apgar 10 yo cuffed
Laryngoscope sizes
PT Miller 00 or 0
Term Miller 0
0-6mos Miller 1
6-24 mos Miller 2
>24 mos Miller 2 or Mac 2
NORMAL VALUES
AVERAGE WEIGHT (3,000 grams)
06 mos Age in months x 600 + BW
712 mos Age in months x 500 + BW
Children16 yo
712
yo
Age in years x 2+ 8
Age in years x 75 / 2
HEAD CIRCUMFERENCE [35 cm (+ 2cm)] (inch = 2.54cm)
14 months
512 mos
2 years old
35 yo
620 yo
inch per month
inch per month
1 inch per year
inch per year
inch per 5 years
LENGTH (50 cm)
03 months
46
79
1012
9 cm
8 cm
5 cm
3cm
BLOOD TRANSFUSION
FWB 10 - 20 cc/kg 34H
PRBC 5 - 10 34H
Plasma 10 - 15 12 H
PRP 10 - 15 12 H
Plt conc 1 u/ 7 -10 kg FD
Cryoprecipitate 1 u/kg
Hemophilia A 1 bag(200mg fibrinogen)
VW dse 50 -100 mg/kg
Fibrinogen dse 100 cc
(2-5 kg)
FD
Factor 8 Hemophilia A 50 u/kg
Hemophilia B 100 u/kg
1 - 3 days 1 mo 2mos 612y >12y
Hgb 14.522.5 9 -14 11.5 -15.5 13-16
Hct .48 - .69 .28 - .42 .35 - .45 .37 - .49
Wbc 9 -30 birth 519.5 6 -17.5 4.5 -13.5
Plt 84478 NB After 1 wk, same as adult
150 - 400
Retic 0.4 - 0.6 < 1 -1.2 0.1 -2.9
1 u FWB = 200 cc PRBC
= 50 cc platelet concentrate
= 150200cc PRP
= 150 cc FFP
MCV Hgb / rbc x 10 80 -94
MCH Hgb / rbc x 10 27 - 32
MCHC Hgb/ hct x 10 3238
Absolute reticulocyte count= pts hct x retic %
N hct for age
Reticulocyte Index
Absolute Retic Ct > 2 hemorrhage
2 < 2 rbc production abn
PRBC to be transfused for correction= 40hct x wt
GLUCOSE
PT 20 -60
NB 3060
1 d 40 -60
> 1d 50 -90
Child = 60 -100
Adult = 70-105
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ANC - % of neutrophils & cells that become neutrophilsmultiplied by wbc
ANC = wbc x (% seg + % stabs + % meta)
Other formula: wbc x (seg + meta + stabs ) x 10
Ex 2.1 x 53 (seg) x 10 = 1113
ANC > 1000 Normal
ANC < 2000 Neutropenia
ANC 1000 -1500 Low risk of infection
ANC 500 -1000 Mod risk of infection
ANC < 500 High risk of infection
IT ratio > 0.25 sepsis
> 0.80 higher risk of death from sepsis
Anemia
< 10 g mild anemia
8 - 9 g mod anemia
40 kg
wt x 0.05 + 0.05
wt x 0.04 + 0.10
wt x 0.03 + 0.20
wt x 0.02 + 0.40
wt x 0.01 + 0.80
Age K (mean value) KI
LBW < 1 yr 0.33 29.17
FT < 1 yr 0.45 39.78
2-12 y 0.55 48.62
13-21 y (female) 0.55 48.62
13 -21 y (male) 0.70 61.88
Age GFR Range
Preterm
2- 8 d
4 - 28 d
30 -90 d
11
20
50
1115
1528
4065
Term
2- 8 d
4 - 28 d
30 - 90 d
39
47
58
1760
2668
3086
1- 6mo 77 39 -114
6 - 12 mo 103 49157
2 - 19mo 127 62191
2 - 12y 127 89165
Adult males 131 88174
Adult females 117 87147
Age
(months)
Ht (cm)
boys
Ht (cm)
girls
Wt for Ht
(cm)
Boys
(kg)
Girls
(kg)
0 50.5 49.9 49 3.1 3.3
1 54.6 53.5 50 3.3 3.4
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
5 65.9 64.1 54 4.1 4.1
6 67.8 65.9 55 4.3 4.3
7 69.5 67.6 56 4.6 4.5
8 71.0 69.1 57 4.8 4.8
Age
(months)
Ht (cm)
boys
Ht (cm)
girls
Wt for Ht
(cm)
Boys
(kg)
Girls
(kg)
9 72.3 70.4 58 5.1 5.0
10 73.6 71.8 59 5.4 5.3
11 74.9 73.1 60 5.7 5.5
12 76.1 74.3 61 5.9 5.8
13 77.2 75.5 62 6.2 6.1
14 78.3 76.7 63 6.5 6.4
15 79.4 77.8 64 6.8 6.7
16 80.4 78.9 65 7.1 7.0
17 81.4 79.9 66 7.4 7.3
18 82.4 80.9 67 7.7 7.5
19 83.3 81.9 68 8.0 7.8
20 84.2 82.9 69 8.3 8.1
21 85.1 83.8 70 8.5 8.4
22 86.0 84.7 71 8.8 8.6
23 86.8 85.6 72 9.1 8.9
24 87.6 86.5 73 9.3 9.1
25 88.5 87.3 74 9.6 9.4
26 89.2 88.2 75 9.8 9.6
27 90.0 89.0 76 10.0 9.8
28 90.8 89.8 77 10.3 10.0
29 91.6 90.6 78 10.5 10.2
30 92.3 91.3 79 10.7 10.4
31 93.0 92.1 80 10.9 10.6
32 93.7 92.8 81 11.1 10.8
33 94.5 93.5 82 11.3 11.0
34 95.2 94.2 83 11.5 11.2
Age
(months)
Ht (cm)
boys
Ht (cm)
girls
Wt for Ht
(cm)
Boys
(kg)
Girls
(kg)
35 95.8 94.9 84 11.7 11.4
36 96.5 95.6 85 11.9 11.6
3.5 yo 98.4 97.3 86 12.3 11.8
4 102.9 101.6 87 12.3 11.9
4.5 106 104.5 88 12.5 12.2
5 109.9 108.4 89 12.8 12.4
5.5 112.6 111.0 90 13.0 12.6
6 116.1 114.6 91 13.2 12.8
6.5 118.5 117.1 92 13.4 13.0
7 121.7 120.6 93 13.7 13.3
7.5 123.9 123.0 94 13.9 13.5
8 127.0 126.4 95 14.1 13.8
8.5 129.1 128.8 96 14.4 14.0
9 132.2 132.2 97 14.7 14.3
9.5 134.4 134.7 98 14.9 14.6
10 137.5 138.3 99 15.2 14.9
10.5 139.9 140.9 100 15.5 15.2
11 143.3 144.8 101 101.0 15.5
11.5 145.8 147.6 102 16.1 15.9
12 149.7 151.5 103-105 16.5-17.1 16.2-16.7
12.5 152.5 154.1 106-108 17.4-18.0 17.0-17.6
13 156.5 157.1 109-111 18.3-19.0 17.9-18.6
13.5 159.3 158.8 112-114 19.3-20.0 18.9-19.5
14 163.1 160.4 115-117 20.3-21.1 19.9-20.6
14.5 165.7 161.1 118-120 21.4-22.2 21.0-21.8
15 169.0 161.8 121-123 22.6-23.4 22.2-23.1
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Height for Age= Actual Height (cm)
P50 Ht for Age
Age
(months)
Ht (cm)
boys
Ht (cm)
girls
Wt for Ht
(cm)
Boys
(kg)
Girls
(kg)
15.5 171.1 162.1 124-126 23.9-24.8 23.6-24.6
16 173.5 162.4 127-129 25.2-26.2 25.1-26.2
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
17.5 176.7 163.3 136-140 30.2-33.0 30.8-32
18 176.8 163.7 141-145 33.7-36.9
Weight for Height = Actual BW (kg)
P50 Wt for Ht (kg)
WaterlooClassification
Wasting(Wt for Ht)
Stunting(Ht for Age)
Normal
Mild
Moderate
Severe
>90
8190
7080
95
9095
8589
5 - 15
ANAPHYLAXIS
Epinephrine
(1:1000)0. 01ml/kg max of 0.5 mg/dose SC
< 30 kg 0.15 mg
> 30 kg 0.3 mg
Diphen = 50mg IM (1mkdose)
USN w/ Salbu x 3 doses
ANTIBIOTICS
Amoxicillin (30 50 mkday) TID
Pediamox Susp : 250mg/5ml
Drops : 100mg/ml
Himox Cap : 250mg, 500mg
Moxicillin Susp : 125mg/5ml 250mg/5ml
Harvimox
Novamox
Drops : 100mg/ml
Amoxil Susp : 125mg/5ml 250mg/5ml
Cap : 250mg 500mg
Glamox
Globapen
Drops : 100mg/ml
Amoxicillin + Clavulanic acid (30 50 mkday)
Augmentin Tab: 375mg (250mg); 625 (500mg)
Amoclav Susp: 156.25mg/5ml (125mg) TID
228.5mg/5ml (200mg) BID
312.5mg/5ml (250mg) TID457mg/5ml (400mg) BID
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
Chloramol
Kemicetine
Chloromycetin
Susp: 125mg/5ml
Tab : 250mg 500mg
CEPHALOSPORINS
1st Generation
Cefalexin (25 100 mkd ) q 6-8 h
Lexum Cap : 250mg; 500mg
Cefalin Susp : 125mg/5ml 250mg/5ml
Keflex Drops : 100mg/ml
Ceporex Cap : 250mg 500mg
Selzef Caplet: 1 gmGranules: 125mg/5ml 250mg/5ml
Drops: 125mg/1.25ml
2nd Generation
Cefaclor (20 40 mkd ) q 8 12 h
Ceclor
Ceclor CD
CD ext release
Pulvule: 250mg 500mg 375mg
750mg
Susp: 125mg/5ml 187mg/5ml
250mg/5ml 375mg/5ml
Drops: 50mg/ml
Xelent
Vercef
Cap : 250mg 500mg
Susp : 125mg/5ml 250mg/5ml
Cefuroxime (20 40mkd) q 12h
Zinnat Cap : 250mg 500mg
Sachet: 125mg/sat 250mg/sat
Susp: 125mg/5ml
Cefprozil (20 40mkd) q 12h
Procef Susp : 125mg/5ml 250mg/5ml
3rd GenerationCefixime (6 12 mkd) q 12h
Tergecef
Zefral
Ultrazime
Susp : 100mg/5ml
Drops: 20mg/ml
Cefdinir (7mg/kg q 12h OR 14mg/kg OD)
Omnicef Cap : 100mg
Sachet/ Susp: mg/5ml
COTRIMOXAZOLE (TM 5 8 mkd) q 12h
BactilleTS
Bacidal
Susp/5ml SMZ 400mg TM 80mg
Tab 800mg 160mg
Susp/5ml 400mg 80mg
Trizole Susp/5ml 400mg 80mg
Globaxole Tab 800mg 160mg
Susp/5ml 400mg 80mg
Trimethoprim + Sulfadiazone (TM 5 8 mkd)
Triglobe Tab Sdz 410mg TM 90mg
Forte 820mg 180mg
Susp/5ml 205mg 45mg
AMINOGLYCOSIDES
Tetracycline 2550 mkday q6h
Doxycycline 5 mkday BID
Furaxolidone 58 mkday q6hMACROLIDES
Erythromycin (30 50 mkd) q 6h
Macrocin Susp: 200mg/5ml
Ethiocin Drops: 100mg/2.5ml
Erycin Cap : 250mg 500mg
Susp: 200mg/5ml
Drops: 100mg/2.5ml
Erythrocin Film tab: 250mg 500mg
Granules: 200mg/5ml
DS Granules: 400mg/5ml
Drops: 100mg/2.5ml
Ilosone/
Ilosone DS
Tab: 500mg DS Liquid: 200mg/5ml
Pulvule: 250mg Drops: 100mg/ml
Liquid: 125mg/5ml
Clarithromycin (6 15 mkday OR 7.5 mkdose q12h)
Klaricid
Klaz
Susp : 125mg/5ml 50mg/5ml
Tab: 250mg 500mg
Roxithromycin
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IV ANTIBIOTICS
Penicillin 50,000100,000 ukd q 6h
Amoxicillin 50100 mkd q 68 h
Ampicillin 50100 mkd q 68 h
Chloramphenicol 50100 mkd q 46 h
Ampi + Cloxa 50100 mkd q 6 h
Oxacillin 50100 mkd q 68 h
Flucloxacillin 50100 mkd q 68 h
Gentamicin 57.5 mkd OD
Netromycin 5mkd q 12 h
Amikacin 15mkd q 12 h
Cephalexin 50100 mkd q 6 h
Cefuroxime 50100 mkd q 68 h
Ceftriazone 50100 mkd OD
Ceftazidime 50100 mkd q 12 h
HYDROCORTISONE LD: 10 mkdose
MD: 5 mkdose q 6, 8 or 12h
*max dose: LD 200 MD 100
ANTIVIRAL
Acyclovir (20 mkdose) q 4 6 h
Max 800mg/day x 5 days
Zovirax
Acevir
Susp: 200mg/5ml
Blue: 400mg
Pink: 800mg
ORAL ANTIFUNGALS
Ketoconazole (6mkd) q 4 6h
Daktarin Adult & Child: tsp q 6h
Infant: tsp q 6 h
Nystatin
Mucostatin
Ready mix susp
Susp: 100,000 u/5ml
Tab: 500,000 u
Fluoconazole (3 6 mkd) OD x 2wks
Diflucan Cap: 50mg 150mg 200mg
Vial: 2mg/ml x 100 ml
ANTI-HELMINTHICS
Oxantel + Pyrantel pamoate (10 20 mkd) SD
Trichiuriasis: x 2 days Hookworm: x 3 days
Quantrel Susp : 125mg/5ml
Tab : 125mg 250mg
Mebendazole *not recommended below 2 yo
Antiox Susp: 50 mg/ml 100mg/ml
Tab: 125mg 250mg
100 mg BID x 3 days
500mg SD (>2 yo)
Albendazole 2yo: 400mg SD
*may give x 3 days if with severe infestation
Zentel Susp: 200mg/5ml
Tab : 400mgAMOEBICIDES
Metronidazole PO: 30 50 mkday q 8h
IV: 30 mkday q 8h
Anaerobia Susp : 125mg/5ml
Tab : 250mg
Servizol Susp: 200mg/5ml
Tab : 250mg 500mg
Flagyl Susp : 125mg/5ml
Tab : 250mg 500mg
Etofamide (15 20 mkd) TID
Kitnos Susp : 125mg/5ml
Tab : 200mg 500mg
Diloxanide furoate (20mkd) q8h x 10 days
Furamide Tab : 500mg
Dilfur Susp: 125mg/5ml
Secnidazole
Flagentyl 2 tab now then 2 tabs after 4 hrsErcefuryl (20mkday)
ANTICONVULSANT
Diazepam 0.20.3 mkdose
Drip: 1amp in 50cc D5W
10mg/amp
Midazolam 0.15 mkdose OR
0.050.2 mkdose
Phenobarbital LD: 10 mkdose q 12h
MD: 5 mkdose q 12h
ANTI-TB MEDS
Isoniazid (1012 mkd) ODAC or 2hrs PC
Comprilex
Nicetal
Trisofort
Odinah
Suspension:
200mg/5ml
100mg/5ml
200mg/5ml
150mg/5ml
Tablet 400mg
Rifampicin (1020 mkd) ODAC or 2hrs PC
Natricin
Rifadin
Rimactane
Rimaped
100mg/5ml 200mg/5ml
100mg/5ml
100mg/5ml
200mg/5ml
Tablet 300mg 450mg
Pyrazinamide (PZA) (1630 mkd) BID/TID
CIBA
Zcure
Zinaplex
250mg/5ml
500mg/5ml
Tablet 500mg
MUCOLYTIC
Solmux Drops: 40mg/ml
13 mos: 0.5ml TID/
QID
36 mos 0.75ml
612 mos 1ml
12 yo 1.5 ml
Susp: 100mg/5ml200mg/5ml
23 yo 5ml
2.5ml
47 yo 10ml
5 ml
812 yo 15ml
7.5mlForte: 500mg/5ml
Cap: 500mg
Adult & >12 yo: 510ml
1 cap
Solmux
Broncho
Capsule
Suspension
Solmux
Chewable tab
Tab: 500mg
1 tab q 8h
Carbocisteine Infant Drops QID
12 yo 1015ml 23 tspCapsule TID
Adult & >12 yo 1 cap
Lovsicol Infant drops 50mg/ml
Ped Syrup 100mg/5ml
Adult Susp 250mg/5ml
Cap 500mg
Ambroxol Infant drops 6mg/ml 75mg/ml BID
< 6 mo 0.5ml 0.5ml
712 mo 1 ml 0.75ml
1324 mo 1.25ml 1mlPedia Syrup
10 yo = 5ml TID
Retard cap: Adult & >10 yo = 1 cap OD
Tab: Adult & >10 yo = 1 tab TID
Inhalation
5 yo = 1 2 inhalation of
23ml soln daily
Mucosolvan Infant drops 6mg/ml
Ped liquid 15mg/5ml
Adult liquid 30mg/5ml
Retard cap 75mg
Tab 30mg
Inhalation Soln 15mg/2ml
Ampule 15mg/2ml
Ambrolex
Zobrixol
Infant drops 7.5mg/ml
Ped liquid 15mg/5ml
Adult liquid 30mg/5ml
Tab 30mg
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B2 AGONIST
Salbutamol (0.10.15 mkdose)
Ventolin Tab 2mg
Syr 2mg/5ml
Nebule 2.5mg/2.5ml
Ventar
Hivent Syrup
Tab 2mg
Syr 2mg/5ml
Salbutamol + Guaifenesin
Asmalin
Broncho
Pulmovent
Tab
1 tab TID
Syrup
26 yo 510 ml BID/TID
712 yo 10ml
Terbutaline sulfate ( 0.075 mkdose)
Terbulin Tab 2.5mgPulmoxel Tab 2.5mg Nebule 2.5mg/ml
Syr 1.5mg/5ml
Bricanyl Tab 2.5mg Nebule 5mg/2ml
Syr 1.5mg/5ml Expectorant
Doxophelline (68 mkdose) BID x 710 days
Ansimar Syrup 100mg/5ml Tab 400mg
Procaterol HCl (0.25ml/kg)
Meptin Syrup 5mcg/ml
Tab 25mcg
Nebuliser soln 100mcg/ml
Theophylline 1020 mkdose 35 mkdose
DECONGESTANT
NasalNaCl 24 drps/spray per nostril TID/QID
2 sprays/nostril then suction q6h x 3 days
Salinase
Muconase
Nasal spray
Nasal drops
Oxymetazoline HCl 25 yo: 23 drops/nostril BID
>5 yo: 23 sprays/nostril BID
Drixine Nasal spray: 0.05%
Nasal soln: 0.025%
Xylometazoline
HCl< 1 yo: 12 drps OD/BID
16 yo: 12 drps OD/BID max TID
Adult: 23 drps / 1 squirt T ID max QID
Otrivin
OralPhenylpropanolamine HCl (0.3
0.5 mkdose)Disudrin 13 mos: 0.25 ml
46 mos: 0.5 ml
712 mos: 0.75 ml
12 yo: 1 ml
26 yo: 2.5 ml
712 yo: 5 ml
Drops: 6.25ml q6h
Syr: 12.5mg/5ml q6h
Brompheniramine maleate + PPA
Dimetapp 16 mos: 0.5ml TID/QID
724 mos: 1ml TID/QID
24 yo: tsp
412 yo: 5ml
Adult: 510 ml
1 tab BID
Infant drops: (0.1mkdose)
Syr
Extentab
Carbinoxamine maleate + Phenylephrine HCl
Rhinoport 15 yo: 5ml BID
612 yo: 10ml BID
Adult & > 12yo: 1 cap / 15ml BID
Syrup Cap
Loratadine + PPA
Loraped 30 kg: 5ml BID
Syrup: 5mg/ml
ANTITUSSIVES
Butamirate citrate 3 yo 5 ml TID
>6 yo 10ml TID
>12 yo 15ml TID
Adult 15ml QID
1 tab TID/QID
Sinecod Forte Syrup 7.5mg/5ml Tab 50mg
Dextromethorphan + Guaifenesin
26 yo 2.55ml q 68h
612 yo 5ml q 68h
Adult 510ml q 6h
RobitussinDM
Syrup
ANTIHISTAMINE
Diphenhydramine HCl (5mkd) q 6h | IM/IV/PO: 12 mkdose
Benadryl Syr: 12.5mg/5ml Inj: 50mg/ml
Cap: 25mg 50mg
Hydroxyzine (1mkd) BID
Adult: 10mg BID 25mg ODHS
Iterax Syr: 2mg/ml
Tab: 10mg 25mg 50mg
Ceterizine (0.25mkdose)
6mos - 12 y : 1 tab OD
Claritin/Allerta/Loradex Syr: 5mg/ml Tab: 10mg
Desloratadine 612 mos: 2ml OD
15 yo: 2.5ml OD
612 yo: 5ml OD
Aerius Syr: 2mg/5ml Tab: 5mg
ANTIPYRETIC
Paracetamol (1020 mkdose) q 4h
Tempra Drops: 60mg/0.6ml
Syrup: 120mg/5ml
Forte : 250mg/5ml
Tablet: 325mg 500mg
Calpol Drops: 100mg/ml
Syrup: 120mg/5m
250mg/5ml
Defebrol Syrup: 120mg/5m
250mg/5ml
Afebrin Drops: 60mg/0.6ml
Syrup: 120mg/5ml
Forte : 250mg/5ml
Tablet: 600mg
Tylenol Drops: 80mg/ml
Syrup: 160mg/5ml
Naprex Drops: 60mg/0.6ml
Syrup: 250mg/5ml
Inj: 300mg/2ml
Rexidol Drops: 60mg/0.6ml
Syrup: 250mg/5ml
Tablet: 600mg
Biogesic Drops: 100mg/ml
Syrup: 120mg/5m
250mg/5mlTablet: 500mg
Aeknil Ampule (2ml) 150mg/ml
Opigesic Suppository: 125mg 250mg
Mefenamic Acid (6 8mkdose) q 6h
Ponstan Suspension: 50mg/5ml
Cap SF: 250mg
Tab: 500mg
Aspirin (60 100 mkd)
Ibuprofen (5 10 mkday) q8h (max 20mkday)
Dolan FP
Dolan Forte
Advil
Suspension: 100mg/5ml
200mg/5ml
Drops: 100mg/2.5ml
100mg/5
Tab: 200mg
H2-BLOCKER
Ranitidine 12 mkdose q 12h
Zantac Tab 75mg 150mg 300mg
Cimetidine Neonates: 520 mkday q612 h
Infants: 1020 mkday
Child; 2040 mkday
Adult: 300mkdose QID
400mkdose BID
800mkdose QID
Tagamet Susp: 300mg/5ml
Tab: 100mg 200mg 300mg 400mg
800mg
Famotidine PO: 0.5 mkdose q 12 h
IV: 0.60.8 mkday q 812h
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ANTISPASMODIC
Dicycloverine 6mos2 yo 0.51ml TID
Relestal Drops 5mg/ml
Syrup 10mg/5ml
Domperidone 0.30.6 mkdose q 68 h
2.55ml/10kg BW TID
Dyspepsia: 2.5/10kg TID
Nausea: 2.55ml/kg TID
0.30.6 ml/5kg BW TID/QID
Motilium Susp 1mg/ml Tab 10mg
Vometa Oral drops 5mg/ml Tab 10mg
Susp 5mg/5ml
INHALED STEROIDS
Budesonide Budecort 250mcg q 12h
500mcg q 12h
500mcg OD for allergic rhinitis
250mcg /ml (2ml)
500mcg /ml (2ml)
Flexotide neb 250mcg /ml (2ml)
250mcg q 12h
ORAL STEROIDS LD: 10mkdose 200mg
MD: 5mkdose
Prednisone 12 mkday
Prednisolone
Liquidpred
12 mkday
Syrup 15mg/5ml
ANTIHYPERTENSIVES
Hydralazine
Apresoline
PO: 0.751.0 mkday q 612 h
IV: 0.10.2 mkdose
Spirinolactone 13 mkday
ANTACIDS
Maalox
(plain, plus)
5ml/10kg
Available in 180ml bottle
Simethicone
Restime < 2 yo 0.5ml qid
212 yo 4ml qid
Oral drops 40mg/ml
Edited by:
frankydinks (2015)