Practical Pediatric تحفه
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Transcript of Practical Pediatric تحفه
Croup
Grades: Exertional stridor → only with exercise
At rest stridor
With retraction subcostal & intercostal
With Resp. failure “cyanosis”
1, 2 → outpatient treatment
3, 4 → hospitalization
Types: Bacterial: epiglottitis, tracheitis → high grade fever, anorexia, flushing, toxic, bad general
condition → organism is Staph. Aureus
Viral: laryngitis, lanyrgo-bronchitis → دي الذبحة ظهرت فجأة و برد و رشح شوية
Laryngo-tracheobronchitis → with wheezy chest
No tongue depressor in any case of croup → epiglottitis
Stridor is more common at night due to more congestion
Treatment
Humidify the vocal cords At the reception
Warm saline or
Epinephrine, racemic: 0.01 mg/kg/dose → (ampule 1mg/1ml) →
علي كيلوا 10احله لكل اديشرطة و سم
At home
Vapozol ( جاو يستنشقه ½ → (صبغة و ساخن ماء لتر علي معلقة
لمدة دافئة بخار حمامات دقائق 10او
β2 agonists are contraindicated → broncho-dilatation → ↑ dead space of bronchi → ↓ gas exchange in the alveoli
Antitussive is contraindicated
Corticosteroids Injection (at the hospital)
1
Dexamethasone
Trade name: apidone, Fortecortin, dexamethasone, decadron, epidron
Ampule: 8mg/2ml
Dose: 0.25-0.5 (0.4) mg/kg/dose → كيلو لكل شرطة
Takes 3-4 hours to work
Can be repeated
Hydrocortisone
Fast take ½ hour to work
Dose: 5-10 mg/kg/dose
Solu-Cortef (100mg/2ml) → لكل كيلوجرام 10امبول
Sigmacortin (500mg/5ml) → 1 لكل كيلوا 10سم
Oral (at home)
Oral steroids maximum for 3 days → if longer → gradual ↓
Dexamethasone
0.1-0.2 mg/kg/day
Trade name: apidone, vendexine, Orazone, phenadol (0.5mg/5ml)
1 علي يتقسم كجم لكل جرعات 3سم
Prednisone
Dose: 1-2 mg/kg/day
Trade name: Predsol, Xilone (5mg/5ml)
اليوم 1 في كجم لكل سم
Iron Deficiency anemia
Diagnosis and investigation Serum ferritin
HB electrophoresis
RDW → ↑↑ >20% in Fe def. anemia
→ ↓ or Normal in thalassemia
2
TreatmentOral iron 6mg/kg/day for at least 3 months
Ferose 50mg/5ml ( disadvantage Fe in the form of ferric require Gastric Hcl to be active
Sytron 27.5mg/5ml ( little amount per 1 ml)
Ferretal 35mg/5ml
Gastroenteritis (plan C)
Renal failure: Urine output 1ml/kg/hour
Blood pressure “pre renal failure”
Metabolic acidosis: cosmol breathing “D.D from grunting”
Investigation
Renal function tests
ABG
RBS → DKA
Chest x-ray
Aminoaciduria → metabolic acidosis
Oliguria challenge test10-20 mg/kg ringer IV
Or lasix 1-2 mg/kg → ساعة استني الضغط و متابعة مع
No → 5mg/kg/dose
Another 1 hour if still no → 10mg/kg/hour
Antibiotics
Macrolides Oral except azithromycin → بسغالية حقن ممكن
Taken for 7 days
Active against:
G +ve
3
E.Coli → Gastroenteritis
Klebsiella, mycoplasma → atypical pneumonia
Erythromycin Against G +ve → Upper airway (sore throat)
Dose 30-50 mg/kg/day ( average 40 mg )
Trade name: erythromycin, erythrocin, erythrin syrup ( 200mg/5 ml every 1 ml = 40 mg)
Dosage = 1 ml (1 cm3) / kg / day
Primomycin (erythromycin + sulpha) → 6-8 h
Clarithromycin Dose: 15 mg/kg/day divided over (/12 h)
Klacid : 125, 250 → 1cm = 25 mg => 3cm/5 kg
Klarimix: 125
Used in
Upper airway: bronchiolitis → خاصة Asthmatic
Atypical pneumonia: mycoplasma, Klebsiella, بتحصل A شهور 6عند غالبا , (febrile pneumonia)
Roxithromycin The only in form of suppositories
Dose: 5mg/kg/day
Used in upper airway
Azithromycin Used in
Sore throat
Otitis media
GE
UTI
Atypical pneumonia
Typhoid: dosage in typhoid is 20mg/kg/day for 7 days
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Eradication of post streptococcal GN: (Used for 10 days) (main symptom red urine, ↑ urea, ↑ creatine)
Used at least for 5 days
Used once daily, before meal by 1 hour or after meal by 2 hrs.
Dose: 10 mg/kg/day
Dosage
Syrup (30 ml – 60 ml – 90 ml) تركيزين منه يوجد
100mg/ 5 cm → as in zithrokan, unizithrin, zisrocin
WT/2 تركيز في علي 100يعني الوزن 2بنقسم
200mg/ 5cm → as in zithrokan, Zithromax, xithrone, aziwok, zithrodose
WT/4 تركيز في علي 200يعني الوزن 4بنقسم
Chloramphenicol: NOT used
Sulpha Not used before 2 years old
Active against E.Coli, G +ve
Dose: 1ml / 2kg/ day WT/2
Divided /12h
Bacteriostatic → used more than > 7 days
Uses
Sore throat
UTI
GE
Bacillary dysentery
Form and dosage
Syrup [not suspension, no injection]
Septazole, septrin, sutrim
Septazole tab: ساعة 12كل قرصين
5
Beta-lactamase Only in the form of injection, جدا غالية
Active against: G +ve, G –ve, anaerobes
فقط المستشفيات في الوالدة حديثي حاالت غالبا تسخدم
Mainly in neonates in hospitals
Names: imipenem, meropenem
Dose: 20 mg/kg/dose divided over /8h
½ gm. / 100cc
Uses
Severe neonatal sepsis
Meningitis: dose 40 mg/kg/day
Pseudomonas
Vancomycin Anti-staph
Only injection
Dose 15 mg/kg/dose divided over /8h
Trade name: vancomycin merk
Used in
Pneumonia
Pseudomembranous colitis → يشربه و األمبول يكسر
Anti-staph drugs
Ampicillin
Fluxacillin
Garamycin
ConvulsionsFirst time
Neonates→ most used phenytoin
Pediatric → first drug of choice is diazepam
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Diazepam Dose: 0.3-0.5 mg/kg/dose
Trade names: neuril, valpam => 5mg/ml
Dosage = كيلوا لكل شرطة
If febrile convulsions → المفروضابدأ rectal
IV over 10 minutes → منفعش
For 3 successive doses if no improvement → بعده الي خشعلي
Phenobarbitone Trade name: sominelatte
Dose
Loading dose: 15-20 mg/kg/dose
Maintenance dose: 5mg/kg → used when convulsions is controlled
Dosage:
Sominelatte = 40mg/1ml
فيه الميللي اخلي ميلليجرام 10عايز
علي االمبول ميللجرام 10سم / 1 --, سم 3احل
االول 2 هدي في كيلوا لكل سم
ب و علي دقائق 10بعدها الكيلوا 10هدي في ميللجرام
هدي دقائق 10 كل كيلوا 1سم / 1 يعني
For 3 successive doses if no improvement → بعده الي خشعلي
Phenytoin Dose: 15-20 mg/kg/dose
Trade name: epanutin → 250mg/5ml
Every 1ml = 50 mg
في 1احل سم 4سم
االول هدي بعدين كيلوا 2 و لكل دقائق 10 كل سم
مفيشتحسن لو بعدها كيلوا / 1 و دقائق 10 كل سم
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قبله الي زي
Maintenance → 5mg/kg
For 3 successive doses if NO improvement → بعده الي خشعلي
Midazolam Loading dose: 0.1-0.2 mg/kg/dose
Trade name: dormicum 5mg/1ml
Dosage:
اخلي فيه 1عايز ميللجرام 1سم
ال في 1 احل سم 4 سم
يكفي 1كدة كيلوا 10سم
الجرعة كيلوا = يبقي لكل شرطة
فيها الشرطة ميللجرام 0.1الن
عليشكل shots بيتاخد
If not → infusion = 0.05 mg/kg/hour
هي المعادلة
24 × الجرعة × الوزن
او
في احله و ملح 100امبول محلول سم
ساعة / / 1 وادي كيلو سم
First line therapy in convulsion is neuril but contraindicated in neonates
Antiepileptic
Depakine → first line in most of cases
بعد اال ابداء 2 → ال nd attack
EEG → prognostic value, determine site affected “frontal, temporal,…”
Depakine in all except
Partial complex seizures → tegretol [carbamazepine]
Infantile spasms (salaam attack) → ACTH
Rickets
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Definition: failure of mineralization of Ca in bone
Causes: Breast feeding: milk is deficient in Vit. D, Vit. K
From the 4th month → prophylactic dose of vitamin D
Cow milk:
Contraindicated in pediatric < less than 1 year
Cow milk allergy, ↑ type 1 D.M, ↑ bronchial asthma
High in phosphorus → ↓ Ca absorption
Micro-hemorrhage in intestine
Buffalo milk is contraindicated before 6 months
↓ Ultraviolet rays exposure
↑ phytates in foods → جاهز مطبوخ خضار
Clinical pictureيمسكه الذي االسمنت فيه يوجد ال العظم
Early Cupping, broadening: wrist joint
Craniotabes: ping pong skull
D.D from
Osteogenesis imperfecta→ all the skull ايده او رجله مكسور هتالقيه الواد و الدماغ كل
Rickets → Parietal bone
Rosary beads: at costochondral junction
Marfan sign
Late Box shaped skull
Pigeon chest
Harrison sulcus
Pot belly abdomen, visceroptosis , laxity of ligaments
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Kyphosis, kyphoscoliosis
Kyphoscoliosis → Co2 narcosis, congenital hypoventilation syndrome
Legs: bowing, coxa valga
InvestigationsX-Rays: on 2 wrists, 2 ankles
Active: cupping, frying, double periosteum, rarefaction
Healing
Healed
Serum Ca/ phosphorus level
Alkaline phosphatase
Treatment
Active Vitamin DTherapeutic:
Stooth therapy
Devarol once 600,000 unit
فهدي 200000الحقنة اليوم 3 وحدة نفس في حقن
+ Oral Ca with it or 1 day before it → الحقنة 15 لمدة بعد يوم
To prevent hypocalcemia
Dosage: Hical 50-70 mg/kg/day
اي ( و ) وبعدها تانية حقنة ادي مكنتشكويسة لو تانية عادية اشعة هعمل اسبوعين بعداسبوعين كمان استني
If good → healing rickets → oral Vitamin D
Therapeutic dose: 3000-5000 unit/day
Prophylactic dose: 400-600 unit/day
Trade name:
Decal 1000 unit/5ml → احسنهم ه
Vidrop: 100unit/drop
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Pedical: 400 unit/5ml
Dosage:
15cm decal = 3000 unit → 5cm/8h كل 5هدي ساعات 8سم
For 1 month واحد شهر لمدة
To avoid vitamin D toxicity [fever, rash, ↓ alertness, jaundice, flushing]
Prophylactic dosage: from 4th month to 1 ½ years
Decal 2cm/day
Pedical 5cm/day
Vidrop → 4 drops/day
{ المغربية وقت بساعة المغرب قبل و الشروق {يتعرضللشمسوقت
نستون جبنة و زبادي ياكل
بعده اللي نخشفي ما قبل صغيرة قصة
It is said that the famous sophist Protagoras took on a student, Euathlus, on the understanding that the student pay Protagoras for his instruction after he had won his first case (in some versions: if and only if Euathlus wins his first court case). Some accounts claim that Protagoras demanded his money as soon as Euathlus completed his education; others say that Protagoras waited until it was obvious that Euathlus was making no effort to take on clients and still others assert that Euathlus made a genuine attempt but that no clients ever came. In any case, Protagoras decided to sue Euathlus for the amount owed.
Protagoras argued that if he won the case he would be paid his money. If Euathlus won the case, Protagoras would still be paid according to the original contract, because Euathlus would have won his first case.
Euathlus, however, claimed that if he won then by the court's decision he would not have to pay Protagoras. If on the other hand Protagoras won then Euathlus would still not have won a case and therefore not be obliged to pay.
The question is: which of the two men is in the right?
يقول بالعربي ترجمة عايز اللي
مصر في كيو اي اعلي انتوا ده بسياجماعة
بعده الي خشعلي و سيبك
Antipyretic
Paracetamol Safe from 1st day of life
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Not effective if fever is > 38 c → as it work in peripheral PG
Dose: 10-15 mg/kg/dose for 3-4 times /day
Form/ trade names/dosage
Drops
Cetal, pyral 5mg/drop
نقطة 20سم = 1القطارة =
2 drops/kg/dose → الواحد المرة في كيلوا لكل ةنقطتين
Suppositories
Pyral 125
Cetal 125
Pyral 250
In 125 → تكفي تقسمها كيلوا 12اللبوسة ممكن و الواحدة المرة في
Syrup [PAC]
Pyral syrup:120 mg/5ml → 1cm = 2.5 kg → dosage= WT/2
Abimol syrup: 150mg/5ml → 30mg/1ml → 1cm = 3 kg → dosage= WT/3
Cetal syrup: 250mg/5ml → 50mg/1ml → 1cm = 5 kg → dosage = WT/5
Tablets: Cetal 500 mg → االطفال في استعماله نادر
Ibuprofen Not before 1 year old → سنة قبل ممنوع
Dose: 10-15mg/kg/dose
Forms/dosage/trade names
Drops Flabu الواحدة المرة في كيلو لكل نقطة
Brufen syrup: 100mg/5ml → 1 يكفي كيلوا 2سم → dosage = WT/2 ( ÷الوزن2)
Suppositories: macrofen 100mg ( for 10 kg) or 300 mg ( for 30 kg)
Paracetamol + ibuprofenCetafen, megafen: 100 mg ibuprofen + 162.5 paracetamol → علي 2الوزن (WT/2)
Acetyl salicylic acid Contraindicated in pediatric till 12 years old
Dose: 10-15 mg/kg/dose
Only used is → Aspegic → central effect → pass blood brain barrier → on Amino acid Alanine متركبعلي
Aspegic 500mg/5ml → 1ml/100 mg → 1ml = 10 kg → كيلوا لكل شرطة
Diclofenac Na Dose: 0.5-1 mg/kg/dose
Not safe before 1 year → سنة قبل ممنوع
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Dosage/ forms/ trade names
Drops: dolphin K → الواحدة المرة في كيلوا لكل نقطة
Suppositories: dolphin, baby relief, adwiflam
12.5 Or 25 or 50 mg
injection: voltaren, dolphin, epifenac 75mg/3ml
1cm = 25 kg
كيلو 2الشرطة =
شرطة 2 ÷ الوزن لكل
Olfen 75mg/2ml
جرعة 3÷ الوزن لكل شرطة لكل
ketoprofen dose: 0.5-1 mg/kg
trade name: ketofan syrup
nimesulide dose: 2-3 mg/kg/dose
trade names/ dosage
Nimesulide, nilsid, nimalox → 50mg/5ml → 1 لكل كيلو 2سم
Drug doses Antiemetic
Primperan (0.5 mg/kg/day)
Ampule 10mg/2ml → ال في كجم لكل ساعة 24شرطة
اليكرر
TTT of overdose → Avil 40 injection
→ Phenergan syrup
Drops: (drop = 0.1mg) → كل ساعات 8الوزن
Domperidone (1mg/kg/dose)
Motilium , Motinorm
Oral syrup→ 1 كيلوا لكل سم
Suppositories: 10mg, 20mg, 30mg
Antibiotic
Penicillin (100,000 unit/kg)
13
Penicillin G (3 L.E): vial 1,000,000 units for strept. Infection 10 times more potent than other penicillins
Tablets: ospen (1000)1000,000 (4.5 L.E) per tablet → كجم 10قرصلكل
Benzathine penicillin
Trade name: Durapen-S (5 L.E), lastipen (2.75 L.E), penadur (4.10 L.E), penicid L.A (1.50 L.E), retarpen (4.50 L.E), pencitard (3.75 L.E)
All are vial 1,200,000 IU
Dose
Less than 27 Kg → ½ vial every 2 weeks
More than 27 Kg → 1 vial every 2 weeks
Ampicillin (50-100 mg/kg/day)
Oral not effective → less than 40% are absorbed from GIT
Good with shigella infection
As injection
375Ampictam (3, 7.75, 11.75)Sulbin (4, 6.50, 9.25)Synerpen (4, 6.60, 9.75)Unasyn (8, 12, 17)Unictam (3.75, 6, 11)
Sulbactam 250 + ampicillin 125
750Sulbactam 500 + ampicillin 250
1500Sulbactam 1000 + ampicillin 500
Amoxicillin (50-100 mg/kg/day)
Oral syrup
156Augmentin (18, 28, 37)Curam (14, 21, 30)Emox-clav Hibiotic Klavox Magna-biotic
Amoxicillin 125mg/5ml
312Amoxicillin 250mg/5ml
625228+
MegamoxDeltaclavAmoxilanicAugmacillin
Amoxicillin 200mg/5ml
457Amoxicillin 400mg/5ml
Good for salmonella
Cephalosporin (50-100 mg/kg/day)
Ceftriaxone 3rd generation
14
Painful so with IM solvent is lidocaine
If IM is given IV it will lead to cardiac arrythemia, arrest
Gentamycin (5-7 mg/kg/day)
Amikacin (15mg/kg/day)
-ve and anti-staph
Erythromycin (30-50 mg/kg/day)
Erythrocin 200mg/5ml → 1 كجم لكل سم
Azithromycin (10mg/kg/day)
100mg/5ml → 1 لكل كجم 2سم
200 mg/5ml → 1 لكل كجم 4سم
Clarithromycin
125 mg/5ml→ 5 لكل كجم 8سم
250 mg/5ml → 5 لكل كجم 16سم
Flagyl
لكل 5 كجم 4سم
Antipyretic
Paracetamol (10 mg/kg/dose every 4-6 hours)
Cetal syrup (250 mg/5ml0
Cetal drops: 3 كجم لكل نقط
Ibuprofen (10-15 mg/kg/dose every 8-12 hours) maximum (40mg/kg/day)
Diclofenac (0.5-1 mg/kg/dose) maximum (2mg/kg/day)
No suppositories before 6 months
Paracetamol + ibuprofen
لكل 1 كجم 2سم
Steroids
Hydrocortisone (5-10 mg/kg/dose every 4-6 hours)
Dexamethasone (0.25-0.5 mg/kg/dose every 8-12 hours)
Contraindicated
Aspirin
15
Chloramphenicol
Tetracycline
Convulsions1st attack
Diazepam (0.5 mg/kg/dose)
Neuril 10 mg/2ml → كجم لكل شرطة
IV كانيوال في الزم يخففو ال
Rectal by insulin syringe → انسولين ادي 100سرنجة كجم 10و لكل
Cause
Febrile convulsions
6 months – 5 years
Once per disease
Recurrence 15% in another disease
In all not more than 2-3 times in all age: عن ماتزيد الولد 3عمرها عمر في مراتكله
EEG is normal
Atypical febrile convulsions
Treated as a case of epilepsy
Metabolic
Hypocalcemia
↓ feeding: بقري لبن او مخفف لبن
Endocrinal problem
Carpo-pedal spasm
Invest: Serum Ca
TTT: Ca gluconate 10% 1cm/kg over 10 minutes
Vit D orally 5000 unit/day
Hypo, hyper natermia
GE, dehydration
Hypoglycemia
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Serum glucose < 45
First attack of epilepsy
Organic brain lesion: CP, encephalitis
Pediatric clinic 3 march 2011Antibiotics – PenicillinsNatural penicillinDose: 50,000unit/kg/day
Indications :Eradication of post strept. GN, ASO titer ≥ 444
Rheumatic feverTypesProcaine penicillin
Trade name and formula: Retarpen, Durapen, pencitard (1,000,000 units per vial)In meningitis dose is 100,000 – 200,000 units/kg/day
Unstable injection → used only onceUsed for 10 days) لمدة حقنة يوميا واحدة )ايام 10مرة
Benzathine penicillin (50,000 -100,000 units/kg/day)Penicillin G 1,200,000 unit per vial IM only
Painful in injectionPhenoxy methyl penicillin (25,000 – 50,000 units/kg/day)
Oral Penicillin VUsed in URI
If patient refuse injection or doesn’t tolerate injectionTrade name and dosageOspen 400,000 unit/5ml
كل بالسرنجة 5مللي = 5يعني فيهم = سم صغيرة وحدة 400معلقة الف كل فيه 1مللي = 1يعني بالسرنجة وحدة 80فيه 5÷400سم الف
Dose: 40,000 units/kg/day كل يكفي 1يبقي كيلوا 2سم
1 لكل اليوم 2سم في كجم ½/ الوزن او كجم لكل 2سم
علي تقسم كل ( 3الجرعة )ساعات 8مراتClacil 300,000 units/5mlEvery 1 ml = 60,000 units
علي اليوم 30احسب في كجم لكل وحدة الفDose: 30,000 units/kg/day
1 لكل كيلوا 2سم الوزن 2÷او مشموجود
Taste is very badSynthetic penicillins (broad spectrum)Ampicillin, amoxicillin (IV, IM, Oral)Ampicillin (dose 50 – 100 mg/kg/day)
Dose for injection (IM or IV): 100 mg/kg/dayDose for oral (suspension, caps): 50 mg/kg/day
InjectionTrade name and formula: ampicillin 250 mg / 50 mg / 1 g
17
OralTrade name and formula
Ampicillin125 mg/5ml2 كجم لكل سم
كجم 2501 لكل سم2÷ الوزن 500
Any antibiotic must be given for 7 days at leastTo calculate average weight for child by age (from 1 → 6 years): (age × 2) + 8
The half life time for synthetic penicillins is 6 – 8 hoursAll antibiotic injections are unstable except 3rd generation cephalosporin
For exampleTonsillitis in 1 years old kidWT= 1×2+8 = 4+8 = 10 kgFor injection = 1000 mg/day
Ampicillin 500 IM كل يومين 12حقنة لمدة ساعةFor oral: 500 mg/day
Ampicillin 250 Susp 3.5 كل بالفم لمدة 8سم ايام 7ساعاتAmoxicillin (25 – 50 mg/kg/day)
Trade name and formulaInjection: amoxicillin, E-Mox 250, 500, 1 g
Oral: amoxicillin, E-Mox (125mg/5ml, 250mg/5ml)Antistaph
Used mainly in pneumonia with pleural effusionAmpicillin + (Flucloxacillin, Dicloxacillin, Cloxacillin)
Amoxicillin + Flucloxacillin (Flumox, Amoflux, Famox, Flucamox) األموكسيسللين وكذلك عادي األمبيسلين جرعة علي بحسب
Flumox is very painful as IM injection and Very bad taste as suspension) يرجع الواد و )هياخده
Penicillin combinationAmpicillin + sulbactam (150 mg/kg/day for whole Combination)Injection
UnasynUnictamSulbin
375 mg750 mg1500 mg
Oral: Unasyn, Unictam 250 mg/5ml → 1 اليوم في كجم لكل سمAmoxicillin + clavulinic (40 - 50 mg/kg/day for amoxicillin concentration)Oral
AugmentinCuramEmox-clav
156 =125mg/5ml2 كجم لكل سم
312 =250 mg/5ml1 كجم لكل سم
MegamoxDeltaclavAugmacillin
228.5 =200mg/5ml1 اليوم في كجم لكل سم
457 = 400 mg/5ml ½اليوم في كجم لكل سم
Hibiotic - N230 = 200 mg/5ml1 اليوم في كجم لكل سم460 = 400 mg/5ml÷اليوم 2الوزن في600 = 600 mg/5ml÷اليوم 3الوزن في
18
Giardia lamblia
Macrolides
Nifuroxazide
Flagyl: سنتين قبل Constipation, GIT upset → ممنوع
Milk types
حاجة 6قبل Bebelac 1 زي 1شهور
حاجة 6بعد bebelac 2زي 2شهور
ممنوع 6قبل cow milkشهور
من اقل صغير وزنة الواد كيلو 2لو
حاجة AS26أو Bebelac PTزي PTبندي
عالية ← 30مكيال / كالوري كمية
كل علي درة رضعات 4زيت
↑free fatty acids → 1gm = 9 calories
↑ Appetite
Lactose intolerance
Bebelac FL → المصري السوق في نوع انظف ده
Pneumonia
DefinitionLower respiratory tract + lung parenchyma
Causes Bacterial: staph, strept, pneumococci, haemophilus influenza, Klebsiella,
mycoplasma
Viral: Para-influenza viruses, adenovirus, RSV
Fungal: rare
Stages: 3 stages Inflammation: edema + secretion " red"
19
Consolidation: fibrin deposition "grey"
Resolution: lipotropic factors
Symptoms
General: High grade fever
Severe bronchospasm
Respiratory distress grade 4
Severe cough: spasmodic cough esp. if atypical pneumonia
Chest ↓ Air entry
Adventitious sounds: sibilant or sonorous rhonchi
Stage of consolidation → bronchial breathing
Fine crepitation
Types: According to Chest X-Ray Patchy pneumonia
Lobar pneumonia
Perihilar pneumonia → cotton fluffy appearance
X-ray: normal in 4 months child→ interstitial pneumonitis → no consolidation patches → mostly viral infection
Other investigations ABG for respiratory failure
H.R
Urea & creatinine
Treatment Cyanosis → respiratory failure = oxygenation
Nebulizer: ملح as mucolytic → محلول
±Atrovent if severe bronchospasm: Side effects: tachycardia
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There is no limited number for nebulizer sessions (in status asthmaticus: جلسات اربع ادي ممكن ساعة اول في
IV fluids: Maintenance therapy
كجم 100كجم ← 10اول لكل ميللي
كجم 50كيلو ← 10تاني لكل ميللي
كجم 20كيلو ← 10تات لكل ميللي
علي 4بقسم
ملح ¼ محلول المحلول
جلوكوز ¾ 5المحلول %
بدي لكل 1 و بوتاسيوم محاليل 100سم سم
To avoid volume overload → heart failure, pulmonary congestion, brain Edema
Fluid restriction by 20% or 30%: واضربها عايزها انا الي الكمية 0.8 × احسب
الرضاعة feeding اوقف
Respiratory distress → tachypnea → aspiration
Tubal feeding → شوية يهدي صدره لما
Antibiotics
Against G +ve: Penicillins انواعها بكل : ampicillin, amoxicillin
G –ve: 3rd generation cephalosporins
3-4 months → atypical pneumonia "mycoplasma & Klebsiella"
Macrolides & Aminoglycosides :مجموعتين
علي Protein synthesis : بتشتغل
Flagyl for anaerobic bacteria
بسغالية كله علي بتشتغل حاجات فيه
Imipenem: االطفال رعاية في اال يعطي خالصوال برة مشموجود
Anti-staph
Ampicillin + flucloxacillin
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Gentamycin
Vancomycin dose: 12mg/kg/dose
Heart failure: transient except if congenital heart disease
Tachycardia, tachypnea, tender enlarged liver
Treatment
Frusemide: Lasix 1mg/kg/day
Lasix 20mg/2ml
في السم اليوم 9بحل في كيلو لكل سم واحد ادي و سم
كيلوا لكل شرطة ادي ماحله غير من او
كل اقسمة ساعة 12و
To decrease afterload: Capoten: dose 0.5-5mg/kg/day
علي 2 → بندي mg/kg/day
علي 25قرص ملح 12.5يحل محلول سم
فيه سم كل ميلليجرام 2يبقي
كل 1يبقي اقسمة و اليوم في كيلوا لكل ساعة 12سم
Digitalis:
Loading dose: 0.05mg/kg or (50μg /kg)
Maintenance dose: 0.01mg/kg/day or (10μg/kg/day)
Digitalizing dose: 50μg/kg
علي ½ الكمية ساعات 8هدي
علي ¼ الكمية ادي ساعات 8ثم
علي ¼ اخر ساعات 8ثم
Digitalis is contraindicated in: obstructive lesions as in M.S
Don't tire tired horse
Pulmonary stenosis
Cardiomyopathy
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H ypertrophic Obstructive Cardiomyopathy (HOCM) → infant of diabetic mother (As ↑ insulin → ↑ deposition of phospholipids in the septum) → هيشيع النوكسين خد لو دي → ده الحالة ايه عالجها → Inderal
Any neonate with cough in the first 4 months is considered pneumonia until proved otherwise
Treated as pneumonia in the outpatient: بسفي الرئوي االلتهاب زي هيتعالجالحارجية العيادة
Antibiotics course for 7-10 days at least
G-ve injection
G +ve
Oral macrolides: azithromycin or erythromycin
Amoxicillin + clavulinic acid
Cough depressant Herbal سنة اول في نهائي حاجة ممنوعة ممكن
Active respiratory infection حاالت في ممنوع
After 1 year Cough sedative for dry cough or pertussis
All doses are: 1-2mg/kg/day except 1 drug
2P 2B 1C DONE
2P P holcodine 0.5-1 mg/kg/day
Cyrinol 4mg/5ml → 0.7mg/1ml → 0.7mg/kg/day → 1ml/kg/day 1 سماليوم في كيلوا لكل
P ipazethate 1-2mg/kg/day
Selgon
Suppositories 10mg → تقضي سنة ( 10اللبوسة قبل ممنوع )كيلوا
Drops 40mg/1ml every 1 ml =20 drops → 40mg/20drops → 2mg/drop → 2mg/kg/day → 1drop/kg/day اليوم في كيلوا لكل نقطة
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2B B utamirate 1-2mg/kg/day
Sinecod فيهم واحد اقوي ده
Syrup 7.5mg/5ml → 1.5mg/1ml → 1.5mg/kg/day → 1ml/kg/day 1 سماليوم في كيلوا لكل
Drops: 0.5mg/drop → 4 كيلوا لكل نقطتين او كيلوا لكل نقط
Other trade name: Cough cut syrup: 1 اليوم في كيلوا لكل سم
B enproperine 1-2mg/kg/day
Pectipro syrup 10mg/5ml → 2mg/1ml → 2mg/kg/day → 1 كيلو لكل سماليوم في
1C C olbutinol 1-2mg/kg/day
Silomat (drops, syrup, injection) مشموجود
DON D extromethorphan 1-2mg/kg/day
Codilar 7.5mg/5ml → 1 اليوم في كجم لكل سم
Pulmonal-N → 1 اليوم في كجم لكل سم
O xeladine
Oxeladine syrup 10mg/5ml →1 اليوم في كجم لكل سم
Paxeladine → مشموجود
N oscapine
Tusscapine syrup → 1 اليوم في كجم لكل سم
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