FLUIDS
ORS
oresol Na- 50 K- 20 Cl- 50 HCO3- 30 Glucolyte Na- 50 Cl- 42 K- 20 Gluconate- 5 Mg- 5 HCO3- 28 Pedialyte Na- 30 Cl- 30 K- 20 Mg- 4
Hypoglycemia trt
= 0.61 x wt (kg) + 0.251
MAINTENANCE: (divide by 24)
FLUIDS (NEONATES)
1st 10 kg X 100 next 10 kg X 50 remaining kg X 20
(protein/amino acids) wt (dose) (prep 7-9%)
mild mod severe
<10kg 50 100 150
>10kg 30 60 90
mod: give ¼ in 1st hr ¾ in next 7 hr severe: give 1/3 in 1st hr 2/3 in next 7 hr MAINTENANCE (LUDANS)
NB 3-10kg 10-20 20-30 30-60
75 cc/kg/d 100cc/kd/d 5 cc/kg/d ‘50-60cc/kg/d 40-50cc/kg/d
emergency resuscitation resuscitation give glucose 250 -500mg/kg infused over 1-2min Diabetic Diet
bsa x35cal/k/d eg.70cal/k/d wt-7.5kg 7.5x70=525 60%cho-525 x.60= /4=80gms 20%chon-525x.20= 20%chon-525x.20= /4=20gms 20%fat-525x.20= 20%fat-525x.20= /9=12gms
TOTAL BODY WATER (L)
Full term = start at 60cc/kg/d Pre-term = 80cc/kg/d
TPN
TO CHECK IF ADEQUATE:
Inc. 10cc/kg/d to reach 150-180cc/kg/day
running rate X (8 or 24) /body wt.
ie: wt x 0.5 x 100 9 dose: start at 0.5 g/kg increase by 0.5 g/kg/day to reach max: 3.5g/kg
ASPHYXIATED INFANTS
FT: 40-50 cc/kg/d PT: 60-70cc/kg/d
INTRALIPID
1st 24hr- electrolyte free (D10W) >24 hr w/ urine output= D5IMB NB: TBW is 75-80% of his body wt Adult: 60%
DEGREE OF DHN
MILD Sunken eyes Depress ant fontanelle Dry skin lips and tongue Oliguria MODERATE Early shock Loss of skin elasticity (+ SKIN FOLD TEST) collapsed neck veins marked oliguria unstable v/s SEVERE Late shock-px is dying or moribund For every degree rise in temp add 12% of maintenance
Ideal body weight for the day
Wt x dose x prepn (10-20%)
birthweight - 10% of birthweight § -------------------corrected body weight [§ note: physiologic weight loss in 10 days]
Ie: wt x 0.5 x 100 20 dose: 0.5 g /kg--- 3g/kg order: intralipid 20%---- ml to run x 16 hrs
actual age in days - 10 days (for physiologic wt wt loss) -----------------corrected age in days * 10-30 grams/day weight gain -----------------ideal body weight gain + [corrected body weight] -----------------ideal body weight for the day Height
at birth 1 yr old 2-12 yr old
50 cm 75 cm (yr) x 6 + 77
Intralipid
prep: 10gms/100ml dose: starts at 1 gm/kg To compute: wt X gms needed X 100/10 /8 = ans. amt in ml to be given q 3 Richard's solution:
ex: wt: 0.9 kg. 1gm ÷ kg x 0.9 kg= 0.9gms. how many ml to be given: given: 0.9 gms.= 10gms ÷ 100ml=9 ml/day How should it be given in q 3 hrs? 9ml/day=1 day / 24 hrs= 0.375 ml/hr 0.375 ml x3 hrsw = 1.125 ml q hourly
DEXTROSITY :
For ex: D10 (desired) D50W (incorpo) Present IVF D5 0.3 Nacl
NEPHROLOGY NOTES
ACTIVE MAINTENANCE PHASE
Highest-desired Highest-desired = 50-10 = 40/45 = 0.89 0.89 Highest – lowest 50-5
MILD 5-10 liquid stools/day 25 ml/kg is added to mf MOD 10-15 liquid stools/day 50 cc/kg added to mf SEVERE >15 stools/day 75 ml/kg is added
to make 10% .89 +.11= 10% 500(fluid) x .89= 445= D5 500 x .11= 55 = D50
BSA: {(wt x 4) +7} /90 Oral fluid limitation : =(20 x wt) + ½ UO – IVF (24h)
= (BSA x 400) + ½ UO if w/ furosemide Estimated GFR: = (0.5)(ht cm) /
crea(Umol/L) x 100 incorporate 55cc of D50W D50W to 445cc of D5 0.3 Nacl to make D10W
Insensible loss:
BSA (500) + UO (24) + 10% IVF Composition
Na D5LR 130 D5 .3N 51 D5 .45N 75 D5 .9N 154 D5NR 140 D5NM 40 D5IMB 25
Glucose Infusion Rate
K 4 5 13 20
Cl 109 51 75 154 98 40 23
0.055 x 3 (q8 hrs.) x 38 total x 1000 / 1440 / wt. GIR = 4.6 TFI : 38 mL x 3 (q8 hrs.) / wt. : 120 cc/kg/day
Na limitation (2-3 meq/17)
= 2 x wt x 23 Total protein (mg/hr) [9/24 x 1000/24]/ BSA if>40, nephrotic
Hgt:
mmol/L to mg/dl divide by 0.055 mg/dl to mmol/L multiply by 0.055
Bladder capacity
=age yr x 2oz x 30 (N bladder residual; ,5cc or 10% bladder capacity; if increased, risk of UTI
Bicarbonate Replacement
CREATININE CLEARANCE
Sodium Deficit
a. Base deficit x wt. x 0.3 Give 1/2 initially then check ABG b. 1- 2 meq/kg and give 1/2 of computed dose
KL (IN GMS)/s. CREATINE (IN MG/DL) CONSTANT 0.55
Na Deficit: = ( desired - actual) x wt. x 0.6 Maintenance: Wt. x 2 Example: Wt. - 21 kg. D50.3NaCl - 5 cc/hr Actual Na - 113.9 meq Na deficit = (135 - 113.9) (21) (0.6) = 265.86 Maintenace = 21 x 2 = 42 Deficit = 265.86 + 42 = 307.8 meq
Fluid for AGN
D1 = 75% of TFI D2 = prev. 24 hr urine/2+400(BSA) Osmolality
(serum Na + K x 2) + glucose mg/dl ÷ 18+ BUN mg/dl ÷ 3 Dextrosity
0.05(%) x 32.5 mL = 1.625 0.10(%) x 5 mL = 0.5 --------------2.1 / 38 total 0.055 x 100 = 5.5 Dx Vamin Computation / Dx / GIR / TFI
Example : wt. 0.95 kgs. Formula : (Wt.) x (gm. needed) x 100 mL / cycle / 6 gm. : 0.95 x 1 gm. x 100 / 3 (q 8 hrs) / 6 gm. : 5.2 or 5 mL TFI : 120 cc/kg 120 x 0.95 / 3 (q8 hrs) 38 mL D5IMB - 32.5 mL Vamin 5 mL Ca Gluc - 0.5 mL -------------38 mL to run at 4-5 mL/hr
EX: 138 GMS S. CREA 572 mmol/L To convert mmol/L to mg/dL 572/88.4= 6.47 0.55(138 gms)/ 6.47= 11.7 Creatinine Clearance = (K) ( height in cm ) / m g/dl *answer is in ml/min normal value: 26- 78 ml/ min normal serum crea: 53- 115 mmol/L K - constant
LBW Infants 0.33 FT infants 0.45 Child 0.55 Adolescent girl 0.55 Adolescent boy 0. K DEFICIT
(desired-actual) x wt x 0.4 maintenance= wt x 3
SAMPLE COMPUTATION
EG . wt-2.3 kg tfi-70, dex-4 gir-8.2 ca d5w- 49 d50-4 ca-1 54 to run at 6-7cc/min q 8h cycle gir-dx/100xtfix 1000/1440/wt 82/100/3xtfi x1000/1440/2.3 Umbicath
shoulder-umbilicus distance 10cms - length of cath in uu 4.5cms 11cms - 7cms 12cms - 8cms 13cms - 8.9cms 14cms - 9.5cms 16cms - 11cms
Calcium
-
ex: wt=13.5 serum K: 3 Normal= 3.5-5.2 (4-3) x 13.5 x 0.4= 5.4 13.5 x 3 = 40.5 total amt to b given 45.9 In IMB= 10 meq/500cc If IMB to run for 8hrs= 30cc You need 15.9 meq/l Order: may incorporate 5meq of KCl to present IVF (D5IMB) x 3 cycles (q8h)
Weight
3-12 mos. = (mos) + 9/2 1-6 yrs = (yrs.) x 2 + 8 7-12 yrs. = (yrs.) x 7 - 5/2
VF:D50.3NaCL at 5 cc/hr x 24 hrs = 120 cc/day D50.3NaCL = 51 meq/L D50.9NaCL = 154 meq/L Therefore 5 cc/hr = 40 cc / 8 hrs. 90 cc x 51 / 1000 = 4.59 meq 30 cc x 154 / 1000 = 4.62 meq ---------------9.21 meq / day
SODIUM DEFICIT
Normal: 135-145 {(desired-actual) x wt x 0.6} deficit: 140- actual (134) = 6 maintenance: 2-4 meq/kg 2 x 13.5(wt) = 27 Na deficit 33 Potassium Deficit
= (desired - actual) (wt.) (0.4) Maintenace K = wt. x 3 Example: Wt. 10 kgs. actual K - 2.44 Deficit = (4.5 - 2.44) (10) (0.4) = 8.4 meq Maintenance = 10 x 3 = 30 meq Total K = 38.4 meq K in D5IMB = 20 meq/1000 mL KCl in vials = 2 meq/mL K in present IVF: 45 cc/hr. x 24 hrs. 1080 cc/day 1080 cc x 20 meq/1000 mL = 21.6 meq = 38.4meq - 21.6meq = 16.8 meq needed MANALAYSAY
5
X
symptomatic hypocalcemia acute treatment: 10%calcium gluconate 100 to 200 mg/kg/dose (1 to 2 ml /kg/dose)
dilute in appropriate fluid , infuse IV over 0-30 mins while monitoring for bradycardia ( stop infusion once with bradycardia)
Maintenance treatment:
10% calcium gluconate (iv or po) 200 to 800mg/k/day ( 2-8 ml /kg/ day administer PO in 4 divided doses after diluting in feeding, or by continous IV infusion. Treat for 3-5 days and follow serum concentrations closely NELSON:
Contains 100 mg/ml of Ca Gluc – is equal to 8.9 mg/ml or 0.45 mEq/ml of Calcium Give 1-2 cc/k/dose or 0.45-0.90 mEq/dose daily dose may be as high as 2.7 mEq/kg/24hr Preparation: 10% injection: 9.3 mg/ml or 0.46 mEq/ml elemental calcium Osmolarity: 700 mOsm/L MURMUR GRADING
Grade I: only audible on listening carefully for some time Grade II: faint but immediately audible on placing the stethoscope on the chest Grade III: loud, readily audible but with no palpable thrill Grade IV: commonly accompanied by a thrill Grade V: so loud, audible with only the rim of the stethoscope touching the chest
WT = K deficit Grade VI: audible with the stethoscope not touching the chest but lifted just off it
DOPAMINE
Nutritional Management
FROZEN PLASMA
200MG IN 250 ML d5w: (60/800) 500mcg/ml 400mg in 250 mlD5W: (60/1600) 1600mcg/ml
Calories to maintain wt.= 50-60 cal/k/day
-
wt x #of mgm desired x 60/800= to run at ___mgtts/min dose: neonate: to BP: 0.5 -1 mcg/kg/min to SBP:1-2 mcg/kg/min to HR:2-3mcg/kg/min infant/child/adult: initial rate:2-5 mcg/kg/min to 5-10 mcg/kg/min upto 050mcg/kg/min low dose: 2-5mcg/kg/min IV int dose: 5-15 mcg/kg/min IV high dose : >20 mcg/kg/min IV (max dose) 20-50 mcg/kg/min IV drip : wt x 6/40 = cc +100ccD5W (1cc=1mcg) infusion:dopa= wt x 10 x 25 x 60/ (1000/40) = cc + 25D5W
to increase wt.= 100-120 cal/k/day(term) 110-140 cal/k/day(pret) Carbohydrates= 11-15g/kg/day (30-60% of total cal) Proteins= 2.25-4g/k/day (7-16% of total cal) should not be > 4g/k/day in low BW
Total Caloric Intake
BODY SURFACE AREA
Milk TCI = mL x 12 (e.g. q 2 hrs.)/ 30(cc) x
Wt x 4 + 9 100 or 0-5 kg= wt x 0.05 + 0.05 6-10kg= wt x 0.04 + 0.1 10-20kg= wt x 0.03 + 0.2 20-40 kg = wt x 0.02 + 0.4 or m2 = √ ht(cm x wt(kg) 3600
20 (cal) / wt.
if urine output not known = BSA x 800
D5IMB - 95.5 mL x 0.05 (%) x 4 = 19.1 D10W - 4 mL x 0.1(%) x 4 = 1.6 Total: 20.7 cal x 3 (q8 hrs.) = 62.1 cal/day
Ex: wt 15kg Wt x dose x prep/ 100cc (d5W) 0.2 x 15 x 150/ 100 = 4.5 cc/hr by infusion pump
10 ml/kBW blood loss <25% 250 ml/bagx matching
-
1 unit/7 kg plt ct <50,000 & there is significant bleeding plt ct <20,000 w/out bleeding 50 ml/bag no need x matching FD
-
* transfuse ___ units of plt conc type ___ properly typed & transfuse once available as FD; IVF off while on transfusion Blood Transfusion whole blood = plasma and rbc tored in
refrigerator BLOOD TRANSFUSION
Max: 10cc/kg/ alig (Normal) Anemia: depends on Hgb level Ie: hgb 5g/dl 5 cc/kg/alig plt conc: 15-20cc/kg/dose
FWB = extracted from donor 450 cc blood only with the 50 preservative 6 hrs only then ref FWB use only within 24 hrs with the platelets and coagulation factors PRBC
FFP: 15cc/kg/dose x 3 Cryoppt: 1U/6 kg/dose
Hb < 8 hct<24 or symptomatic regardless of Hgg level or with COPD ,sepsis
Exchange transfusion
Total bld vol: Preterm: 90cc/kg Term: 80cc/kg
Hypertensive crisis
Clonidine drip: 0.2mg- 0.4mg/kg mix with D5W 100 cc Prep: 150 mg
-
IVF TCI :
BP IN HYPERTENSIVE CHILDREN
Age x 2 + 70 Age x 2 +90
PACKED RBC
Human milk - 20 cal MIlk prep. - 24 cal
PRBC (DHct- AHct) x wt
BSA x 400 x UO BSA x 400 + ½ UO (if w/ furosemide) 1500ml/ m2
-
PLATELET CONC
Fats= 4-6g/k/day limit:less than 55% of total cal (ketosis may result)
Dobutamine : 25-15mcg/kg/min (max dose : 40 mg/kg/min)
TFR:
15 mg/Kg prolonged PTT (2x the control px w/ impending shock despite crystalloid infusion 250ml/bag no need x-matching FD (if stable-same rate w/IVF)
Exchange Transfusion/Phlebotomy
Volume of Exchange in mL = Total Blood Volume x kg x (Desired-actual Hct ) ÷ actual Hct
loss of over 15% BP < 20% 1liter loss+ give elec blood sol 2 lit= colloids and RBC whole blood= 517 cc PRBC 300cc only FWB
Total Blood Volume = Wt. x TFI
HAESTERIL
10cc/KG 500cc CRYOPRECIPITATE
1 unit/5kg FD FRESH WHOLE BLOOD
- 20 ml/KBW - gross bleeding 25% or > - Hct fall by 20%
exchange transfusion def of coag factors plt=1200 prbc 850 fwb= 850 only - FWB difficult to procure - lose 23 dpg by5-7 days - 23 dpg are easily replenished in 1-3 hrs after transfusion, so no problem with the patients - stored for 28 days= remainfor 90 days more - ok to give even 28 days old
Washed RBC
Blood volume
red cell washed with saline to remove leukocytes
vol desired hct preterm 90cc/kg 0.45 term 80 0.45 1month 75 0.40 1year 70 0.40 > 1year 74-82 0.40 adult 68-80 0.40
if with hx of reactions' if to transfuse type O
Interpretation of ABG
Platelet conc
1 unit -raises 5-10 survive to 5-10 days only may dev allo immunization if w repeated transfusion drop for plt <20,000 active bleeding in< 50000 or for surg within 8 hrs if critical surg give even at 100,000 or less eyes.,brain 30-50 cc in one unit may get from same donor at 3-5 days Fresh frozen plama
w all the coag factors' 15-20 cc/kbw maintenance; 1/2 of LD q 6 hrs
Body Surface Area
Wt. x 4 +9 / 100 TFI- BSA X 400 + total urine output
1. determine whether it is acidosis or alkalosis by looking at pH 2. determine cause of abnormality > metabolic- problem in HCO3 and BE > respiratory- problem in pCO2 > both 3. determine state of oxygenation > with no O2- hypoxemia pCO2 < 85 w/o hypoxemia >with O2 administration uncorrected pO2 <85 corrected pO2 85-100 overcorrected pO2 > 100
Double exchange Definition of Diff. Blood Gases :
wt x B.v. X 2 Double Volume exchange transfusion
1. Actual blood volume/kg x kg x 2 2. Volume per aliquot= 5 % single volume (not to exceed 2-3cc/k/min 3. Infusion/Extraction time= 1minute (not to exceed 3cc/k/min 4. No. Of exchanges= total vol/vol of aliquot 5. Use FWB blood type of mother
1. acidosis pH < 7.35 2. alkalosis pH > 7.45 3. resp. acidosis pCO2 > 45 4. resp. alkalosis pCO2 < 35 5. met. acidosis HCO3 < 24 w/ dec BE 6. met. alkalosis HCO3 > 24 w/ inc BE
Metabolic acidosis in LBM
Cryoprecipitate
I,VIII,XIII, VWF Cryosupernate
BT ORDERS
Give for bleeding due to liver dse.
____exchanges at ____cc/exchange
Autologous blood transfusions
donor is the recipient for rare blood type Rh neg Jehovah witness iron give within 6 months get usually take 450 cc in adults, may be taken every 3 days warm blood only if for newborn and 15ml/k/hr rate or 5 ml/min rate
monitor hgt and nvs while on exchange NPO X 4 hrs post exchange Prepare 3way stopcock. 2 10cc syringe 2 BT set 1 Ca Gluc Heparin sterile bottle gloves eye sheet cut down set 1 way bottle RDS SCORING
run prbc in3 hrs time only or standby for 3 hrs only , it may invite infection
RR Retrac Cyano . Perfus Air entry Grunt
0 <60 (-) (-)
1 60-80 mild (+) room good fair good fair none w/ stet score of 4-5 intubate
BT reaction
restart after 30 mins if another reaction again -do reaction study calcium gluc use only plain nss if with renal failure - give the freshest
ACIDOSIS
- dec. plasma HCO3 - inc. PCO2 - dec. pH (< 7.40) ALKALOSIS
To raise hgb/hct to a desired value:
desired hct = desired hct - actual xbv/ hct gf blood to transfuse babys bld vol: 80-100ml/kg x wt in kgs
NORMAL ANION GAP :
Net loss of bicarbonate from the kidneys or from diarrhea (Na) + (K) – {(Cl} + {HCO3}) – 12 meq/L range: 8-16 meq/L
use a blood warmer , not below 37C
prbc 2-4 hrs plt FD 30min FFP 2 h cryo fd fwb 3-4
Sx: deep sighing breathing Hepatomegaly (+)ketone bodies in urine ABG: dec. blood pO2, CO2, PCO2 Due to: loss of bases in stool Production of H ions from anaerobic metabolism Hydrogen ion retention d/t renal impairment Correction: Desired inc. in CO2 content x wt in kg x 0.7= total bicarb to be given
inc. plasma HCO3 - dec. PCO2 inc. pH (>7.4)
2 >80 severe (+) w/O2 poor poor w/o stet
METABOLIC ACIDOSIS
-
decreased pH inc.pCO2 – stimulate resp system to inc. excretion if CO2 – dec. level of PCO2 & carbonic acid Compensated: inc. HCO3, dec.PCO2 (respiratory) Anion gap
- tool in evaluating met acidosis - inc. d/t overprodxn of endogenous acids (ketoacids, lactic acids), undersecretions of acids in renal failure, ingestions of excess acids (salicylates)
RESPIRATORY ACIDOSIS
ET SIZE
d/t inadequate secretions of CO2 dec pH, inc pCO2 compensated: inc pCO2, inc HCO3 (renal)
<1000g 1000-2T 2T-3T >3000g
2.5 3 3.5 3.5-4
Term 1yo 2yr >2yr
3-3.5 4-4.5 4.5-5 age(yrs) + 4
METABOLIC ALKALOSIS
d/t excessive loss of H ion inc pH, inc HCO3 compensated: inc pCO2, inc HCO3 (resp) RESPIRATORY ALKALOSIS
-
excessive pulmonary losses of CO2 dec pCO2, inc pH compensated: dec pCO2, dec HCO3 CPAP
= 4 LPM CA x 21(%) = 0.84 + 2 LPM O2 = 2.84 / 6 (total 4 + 2) = 0.47 x 100 = 47% FiO2 O2 (100%) + CA (21%) ÷ TOTAL LMP ( usually 6) x 100= % of FIO2 given by CPAP ex: CA: 1 O2: 5 FIO2= 86.6% SUCTION CATHETER (F)
Premature Term 6-8 6 mos 8 1-2 y 8 4-8yo 10 10 and above
5-6
ET level ET size x 3 Age(yrs) +12 2 Neonate= wt +6 LARYNGOSCOPE SIZE
Premature Term 6mos 1 yo 2 yo 4-8 12 above
miller 0 miller 0-1 ½ 2 2 3
DISTANCE (DEPTH OF ET)
PREMATURE Term 6mos 1yo 2 yo 4 yo 6 yo 8 yo 10 yo 12 yo adolesc neonate= wt + 6 ET size x 3 Age(years)/2 + 12
8 9-10 10 11 12 14 15 16 17 18 20
1.olfactory 2. optic nerve & tract 3. oculomotor 4. trochlear 5. trigeminal 6. abducens 7. facial 8. acoustic 9. glossopharyngeal 10. vagus 11spinal accessory 12 hypoglossal 1-2 diencephalon 3-4 midbrain 5-8 pons 9-12 medulla NORMAL CSF FINDINGS
Color: sparkling clear Pressure: 80-180 mmH20 Cell count: 5 Type: mononuclear Smear/culture- negative Sugar: 2/3 of bld sugar Protein: 15-45 m CSF evaluation
Indications: -confusional states -inflam. Dses of brain -multiple sclerosis -unexplained seizure contraindications: -local infxn -inc intracranial pressure -complete spinal block Symptoms of inc. intracranial pressure
12
60sec ÷ 30= 2 secs/cycle give IT of 0.5
- headache -nausea/vomiting -papilledema -cranial nerve paralysis -visual disturbances -altered mental state - inc. BP - bradycardia -seizures
2 ÷ 0.5 = 4 so ratio is 1:3 = (1+3)
Cushing’s Triad
Endotracheal intubation
Initially: inc BP, dec HR dec RR Advanced: dec BP, dec HR, dec RR
I:E Ratio
given ENDOTRACHEAL TUBE SIZE
Premature Term 6mos 1 yo 2 yo 4 yo 6 yo 8 yo 10 yo 12yo adolescent
CRANIAL NERVES
2.5-3mm 3- 3.5 3.5-4 4-4.5 4.5-5 5-5.5 5.5 6 6.5 7 cuffed 7-8 cuffed
<1000g- 2.5 1000-2000- 3 2000-3000- 3.5 >3000- 3.5-4 Term 3-3.5 1 yo- 4 – 4.5 2yo 4.5-5 >2 yo age(years) +4/4
RR:30 IT:0.5
Formula: seconds ÷ IT
Neonates
below 1000g/below 28wk -use 2.5mm 1000-2000g/28-34wk -use 3mm 2000-3000g/34-38wk -use 3.5mm above 3000g /above 38wk -3.5-4mm Laryngoscope
-no.0 for preterm infants -no.1 for term infants Depth of Insertion
-adding 6 to infants wt.(kg) cut at 4cm from lip OLDER
AGE(YRS.)/2 + 12=ET level Age(yrs.)/4 + 4 = ET size
GLASGOW COMA SCALE
EYE OPENING Spontaneous To speech To pain None
Score 4 3 2 1
VERBAL Oriented Confused Inappropriate Nonspecific None
5 4 3 2 1
MOTOR Obeys command Localize pain Withdraws from pain Flexion (decorticate) Extension (decerebrate) None
6 5 4 3 2 1
MODIFIED GLASGOW COMA SCALE FOR INFANTS
EYE OPENING Spontaneous To speech To pain None
Score 4 3 2 1
VERBAL Coos, babbles Irritable cries Cries to pain Moans to pain None
5 4 3 2 1
Prothrombin time
Acyclovir
newborn 12-20 sec infant 12 -14 sec child 12-14 sec
(Zovirax) if above 2yrs old give 5ml q 4 hrs x 5 doses(omiting the nite time dose) x 5 days tab 200mg 400mg susp 200mg/5ml
Retic. Count
newborn 2.6-6.5 infant 0.5-3.1 child 0-2 adolescent 0-2
Adenosine
for SVT -0.1mg/kg as rapid IV bolus -max. Dose (single) -not > 12mg
S. Amylase
55.5-180U/L SGOT
M 10-35 U/L F 10-31 U/L
MOTOR 6 Withdraws from touch 5 Withdraws from pain 4 Flexion (decerebrate) 3 Extension (decorticate) 2 None 1
Ambroxol HCL
(Ambrolex, Zobrixol) Mucolytic Dosage: 1.2 - 1.6 mg/kg/day Infants (Drops 7.5mg/ml) under 6 mos: 0.5ml 2x a day 7-12 mos: 0.75 ml 2 x a day 13-24 mos: 1 ml 2 x a day Children (Syrup 15mg/5ml) 1-2 yrs: 1/2 tsp. 2 x a day 2-6 yrs: 1/2 tsp. 3 x a day 6-12 yrs: 1 tsp. 2-3 x a day
N spontaneous mov’t
SGPT
M 9-43 U/L F 9-36 U/L T3
euthyroid 0.95-2.5nmol/L hyperthyroid > 2.5 nmol/L LABORATORY VALUES
T4
euthyroid 60-120 nmol/L hypothyroid <60 nmol/L hyperthyroid >120 nmol/L
Bilirubin: D 0-8.5umol/L
T 0-25umol/L Bleeding time: newborn
infant child
1-5min 1-6min 1-6min
TSH
Aminophylline
euthyroid 0.25 - 5 uUI/ml hypothyroid >7 uUI/ml hyperthyroid< 0.15uUI/ml
4-5mg/kg IV over 20mins q 6° or mg/kg loading then drip 1-6mos=0.5mg/kg/hr 6-11mos=1 1-9yrs=1.2 - 1.5 >10yr=0.9 prep: 25mg/1ml
BUN: 3.57-7.14 mmol/L FT 4 C3: 938-1493mg/L
9.0-20 pmol
Clotting time: newborn 5-8min
infant child
5-8min 5-8min
Creatinine: M 44.2-150umol/L
F 44.2-150umol/L
TPAG
Total Protein 67-84gms/L Albumin M 35-50gms/L F38-80gms/L Globulin 18-32gms/L A/G ratio 15-24:10
Aminosteril 10
IgM (+) Acute typhoid fever
10gm/100cc eg.-2gm aminosteril. Wt-1.45 1.45 x2x100/10-9.6 -10cc q 8h 10gm/100cc.; x/10cc 1gm--4cal 4x3--12cal
IgM & IgG (+) Acute typhoid fever (in the middle stage of infx)
Amoxicillin
Serum Electrolytes
Na : 135 - 153 mmol/L K : 3.5 - 5.6 mmol/L Ca : 2.13 - 2.75 mmol/L CSF: Glucose - 2.75 to 5.5 mmol/L
Protein - 200 to 500 gms/L ESR: Male: 0 - 10 mm/hr
Female: 0 - 20 mm/hr Children: 0 - 20 mm/hr CRP: <6 – normal
Typhidot
IgG (+) relapse,reinfection of previous infection (in w/c case current fever may not be due to typhoid) IgM & IgG (-) probably not typhoid fever
CVP: 8-10 mmH2O
(Moxillin) antibacterial Dosage 20-40mg/kgBW/day given every 8 hrs. 250, 500mg capsule 125mg/5mL x 30 & 60 mL 250mg/5mL x 30 & 60 mL 100mg/mL x 10 mL
Detection of S.Typhi : Glucose: 3.1-6.4 mmol/L LDH: 230-380 U/L
1st week: Blood 2nd week: Urine 3rd week: Stool
Atropine
0. 01 mg/kg/dose as needed for bradycardia and/or hypotension
BILIRUBIN LEVEL
PT PHOTO <1250 5-7 1250-1499 7-10 1500-1999 10-12 2000-2495 12-14
DVET 10-13 13-16 16-18 18-20
Healthy Term <48hr >15 49-72hr >18 >72hrs >20
>20 >15 >25
Sick Term <24hrs >24 hrs
10-14 15
20 20
Azithromycin
(Zithromax) 10 mg/kg/day for 3 days, or alternatively, given for 5 days with a single 10 mg/kg dose on day 1, then 5 mg/kg on days 2- 5. Prep: 200/ 5 Bicarbonate Replacement
a. Base deficit x wt. x 0.3 Give 1/2 initially then check ABG b. 1- 2 meq/kg and give 1/2 of computed dose
CaGluc
Clarithromycin
Co- Amoxiclav
0.5-1ml/kg IV bolus 3 - 5mins. stop infusion if CR is < 60 once symptoms relieved 100mg elemental Ca/kg/24 added to IV solution
(Klaricid) macrolide Dosage 7.5 mg/kg BID for 5-10 days Suspension 125mg/5mL in 25 & 50mL 250mg/5mL in 25 & 50mL
(Augmentin, Amoclav) 30- 50 mg/kg/day BID Prep 156.25 mg/ 5 ml 228 mg/ 5 ml
Carbocisteine
(Mucodan) Prep: syrup 200 mg/5 ml Cefaclor
(Ceclor) 20- 40 mg/kg/day TID Prep: susp 125/5 187/5 250/5 375/5 drops 50/5 Cefipime
(cepimax) 100mg/k/day-q° 12 dosage Cefixime
(Ultraxime, Zefral, Tergecef) 1.5 - 3 mg/kg/day (up to 6) BID Prep: drops 20 mg/ml 10 ml susp 100 mg/5 ml 30 ml 60 ml sachet 50 mg/g
Cetirizine
(Zyrtec, Virlix) anti-allergy Dosage A. 10mg tab adult and children 12 above: 10mg tab daily children 6-12yrs: 5mg (half tab) twice daily B. 10 mg/mL oral drops children 2-6yrs:10 drops daily or 5 drops twice daily children 6-12yrs: 20 drops daily or 10 drops twice daily adults and children 12yrs abv: 20 drops once daily C. 1 mg/mL oral solution children 2-6 yrs: 1 tsp. daily or 1/2 tsp. twice daily children 6-12 yrs: 2 tsp. daily or 1 tsp. twice daily adult and children 12 yrs abv: 2 tsp. once daily
Ceftriaxone
(Rocephin) 50- 100 mg/ kg/day IV OD/ BID Prep: 250 mg vial 500 mg 1 gram
Co-Amoxiclav
(Augmentin) antibacterial Dosage 156 and 312 susp. Oral: 25-50mg/kg/day q 8hrs. Under 1yr - 6yr 156.25mg/5mL (125mg amox. + 31.25 mg clavulanic) x 60mL Over 6yrs. 312.5mg/5mL (250 amox. + 62.5 clavulanic) x 60mL Dosage 228 and 457 susp. 25-45 mg/kg/day BID 228.5mg/5mL (200mg amox. + 28.5 clavulanic) x 70mL 457mg/5mL (400 amox. + 57 mg clavulanic) x 70mL Dosage Parenteral Children 0-3 months 30mg/kg every 12hrs. Children 3mos-12yrs. 30mg/kg every 8hrs. to 6hrs. Adults & 12yrs above 1.2gm every 8hrs. to 6hrs. Cotrimoxazole
Clonidine drip
0.2- 0.4 mcg/ kg/min, to be added to 100 ml D5W Prep: 150 mcg/ amp
(Trizole) 5- 8 mg/kg/day BID Prep: syrup 40 mg/5 ml 80 mg/5 ml
30, 60 ml
Crotamiton Clenbuterol HCL Cefuroxime
(Zinnat) 20- 30 mg/kg/day BID p.o. Prep: syrup 125 mg/5 ml 250 mg/5 ml 100 mg/kg/day IV TID/ QID Prep: 750 mg 1. 5 grams
(Spiropent) liquid(all doses BID) 6-12yr 15ml 4-6yr 10ml 2-4yr 7.5ml 1-2yr 5ml drops 6-24mos 2ml <6mos 1ml prep: tab 0.01mg liqd 0.005/5 drop 0.002/ml
Chloramphenicol
(Chloramol) antibacterial Dosage Infants 25 mg/kg/day q 6hrs. Children 50 mg/kg/day q 6hrs. 125mg/5mL susp. 250/500mg capsule Cimetidine
neonates 5-10mg/kg/day q 8-12hr oral,IM,IV infants 10-20mg/kg/day q 6-12hr children 20-40mg/kg/day q 6hr prep= liquid 300mg/5ml 150mg/ml Dr. Siasu 15 mg/kg/day q 8
Cocktail Nalbuphine 0.1mg/k/d Midazolam 0.15mg/k/d
Clindamycin
(Eurax) 10% cream & lotion anti-itch, anti-scabies Scabies: apply to body surface area in the evening and repeat for 3-5 days. Change linen. Pediculousis: single application on hair for 24 hrs. Wash and comb hair to remove nits. Dextromethorphan+ Phenylpropanplamine+ Carbinoxamine
(Coritussal) Antitussive, decongestant, antihistamine Children 1-5 yrs: 1 teaspoonful BID 6-12 yrs: 2 teaspoonful BID 12 yrs and adults: 1 tbsp. BID
5-7.5 mg/kg per dose IV infusion by syringe pump over 30 minutes or PO Diazepam
preparation: oral preparation( clindamycin palmitate) isreconstituted with sterile water for injection, yielding a 75 mg per 5 ml solution. do not refrigerate . Stable at room temp for 2 weeks
(Valium) 0.25 mg/kg/dose q 15 minutes per rectum or IVTT if in active seizure half life 43 + - 13
IV preparation is is available at 150mg/ml solution in 2 ml ,4 ml and 6 ml vials . It should be diluted using D5W , D10W, orLR to a concentratin of 6 mg/ml andinfused at a rate no greater than 5ml/min (30mg/min)
Dichlotride
(Hydrochlorothiazide) 2.5mkday-infants given BID Prep: 25mg 50mg
Dicycloverine
Epinephrine drip
Ferlin
(Relestal) 2.5- 5 ml TID Prep: drops syrup
0.6 x kg = + diluent to reach 100cc 1ml/hr is 0.1ug/kg/min
3-6 mg/kg/day drops: syrup:
15 mg/ml 15 ml 20 mg/5 ml 60 ml
Diloxanide Furoate
(Furamide) 20- 30 mg/kg/day TID Prep: syrup 125 mg/ 5 ml 250 mg/ 10 ml
long style wt x dose x 60/conc = cc/hr given: wt =17.5kc dose = 0.1ug cc/hr = 2
12mg/kg loading dose then 6 mg/kg/dose IV infusion over 30 minutes or PO
17.5 x 0.1 x 60/conc = 2 Conc = 52.5
Digitalization
Newborn 0.03 mg/kg/day Children 0.04 mg/kg/day Loading: 1/4th TDD q 6 hrs. x 4 doses Manitenance: 1/10th TDD q 12 hrs. Prep = Ped elixir 0.05mg/ml Tab 0.25mg Diphenylpropanolamine
( Disudrin) Prep: drops 6.25 mg/ml 10 ml syrup 12.5 mg/ml 60 ml
Trial and error ml of epi/diluent (1000) 2.5ml/45.5ml D5W=54.94 Actual dose wt x dose x 60/conc = cc/hr 17.5 (x) 60/54.94=2cc/hr x = (54.94)(2)/(17.5)(60) x = 0.1046ug ORDER 2.5cc epi 45.5cc D5W 48cc at 2cc/hr Epinephrine drip 2
wt x 0.6kg dilute resultant no. to total 100
Domperidone
(Motilium) 0.25 mg/kg/dose q 6 hrs Prep: susp 1 mg/ml tab 10 mg
Fluconazole
60 ml
Dobutamine
6mg x kg = + diluent to 100cc 5cc/hr is 5ug/kg/min 250mg/20ml
Dobutamine infusion :
6 mg dobutamine x Wt. = mg t o sufficient diluent to create a solution totalling 100 mL. Infusion of 1 mL/kg delivers 1 ug/kg/min Dopamine
= wt x dose x 60/concn
infusion rate 1ml/h equal to 0.1ug/kg/min adjusted every 5min until the desired clinical effect advisable to start at 20ml/hu,{2ug/kg} infusion is then reduced to 0.1 to 1ug/kg/min
Preparation: 200mg/100ml ,400mg/200ml (2mg/ml) Hidrasec
1-2mg/k/dose Hydrocortisone
(Solu- Cortef) 10 - 20 mg/kg loading dose IVTT bolus, then 5 - 6 mg/kg maintenance dose q 6 hrs, to start 6 hours after loading dose Hydroxyzine HCl
(Iterax) anxiolytic/antihistamine/antipruritic adults: 50-100 mg/day children: 1 mg/kg/day Preparation: 10 mg tab 25 mg tab 2 mg/ml syrup (60 ml) Imipenem/ Cilastatin
20-25 mg/kg per dose q 12 hrs IV infusion over 30 minutes preparation: 250 mg 500mg vials
EPINEPHRINE DRIP
Ibuprofen
1.
WT X 0.6 mg # mg added to 100 ml D5W 1cc/hr= 0.1ug/kg/min 5cc/hr= 0.5 mg/kg/min 10cc/hr=1.0 mg/kg/min 2. Wt x dose x 60 = ml/hr Conc 10cc in 90 D5W = 100mg 20cc in 80 D5W = 200mg
(Dolan FP) antipyretic,analgesic Dosage Orally every 6-8 hrs. 5-10 mg/kg/dose
Epinephrine stat dose
Indomethacine
0.1 mg/ kg/ dose
0.2 mkdose q 12 prepn -25mgcap in 25cc vodka-to make 1mg/ml and giv 0.2cc/k/dose q 12 for 3doses
5-9 yrs: 5-10 mL 10-12 yrs: 10-15 mL 100 mg/5mL x 30mL & 60 mL
Dopamine Drip
(Dx of 5 because it is incorporated in D5W) Wt. x dose x 60 / conc. = cc/hr (where conc is usually 800)
Erythromycin ethylsuccinate
Example: Wt. - 1.8 kg Dopamine - 2.5 ug Rate - 5 cc/hr Computation: 1.8 x 2.5 x 60 / conc. = 5 cc/hr 270 / conc. = 5 cc/hr Conc. = 270 / 5 = 54 Wt. x dose x 480 / 800 = cc to be mixed in IVF Trial and Error: = mL of Dopa / diluent x 800 = 2.5 cc / 37.5 cc x 800 = 53.3 Conc. Actual Dose: = 1.8 (x) 60 / 53.3 = 5 cc/hr x = 5 (53.3) / 60 (1.8) = 2.47 ug
(Erythrocin) macrolide antibacterial Dosage 30-50 mg/kg/day divided in every 6 hrs. 200mg/5mL x 60mL 400mg/5mL x 50mL 100mg/2.5mL drops x 30mL 250mg TID /QID 500mg BID/QID 200mg/5ml 100mg/2.5ml Etofamide
(Kitnos) 20mg/kg/day prep:100/5
Inosiplex
(Immunosin) 250mg/5mL syrup immunostimulant, shorten course of illness and symptoms of chicken pox, hepatitis a, german measles,herpes zoster,measles, herpes simplex. Dosage: every 3-4 hrs. 0-6 mos: 1 mL 6-12 mos: 1.5 mL 1-2 yrs: 2 mL 2-6 yrs: 3 mL 6-12 yrs: 5 mL Initial dose: 100 mg/kg/day Maintenance: 50 mg/kg/day Duration: 3-14 days
Intralipid
Meropenem
Phenylephrine + Brompheniramine
prep: 10gms/100ml dose: starts at 1 gm/kg ex: wt: 0.9 kg. 1gm ÷ kg x 0.9 kg= 0.9gms. how many ml to be given: 0.9 gms.= 10gms ÷ 100ml=9 ml/day How should be given in q 3 hrs 9ml/day=1 day / 24 hrs= 0.375 ml/hr 0.375 ml x3 hrsw = 1.125 ml q hourly
sepsis: 20mg/kg per dose q 12 hrs . IV infusion over 30 minutes meningitis and infections caused by Pseudomonas sp: 40 mg/kg/dose q 8hrs preparation: 500mg, 1000mg vials
(Dimetapp) Decongestant, antihistamine Dosage Infant (Drops 1mg/0.8mg per ml) 1-3 mos: 0.75 to 1 ml 3-6 mos: 1-1.25 ml 6-12 mos: 1.25-1.5 ml 1-2 yrs: 1.5-2 ml 2-4 yrs: 2-2.5 ml 4-6 yrs: 2.5-3 ml Children (Syrup 5mg/2mg per 5ml) 2-4 yrs: 4 ml (0.8 tsp.) 5-6 yrs: 5 ml (1 tsp.) 7-12 yrs: 7.5 ml (1 1/2 tsp.) to be given every 6 to 8 hrs.
Iron Preparations Ferric pyrophosphate (Ferlin)
Prep: drops 15 ml syrup 120 ml Drops: Prophylactic dose: term infants 1 mg/kg/day, max of 15 mg/day; start no later than 4 months of age and continue for at least 1 year of life preterm infants 2 mg/kg/day, max of 15 mg/day; start no later than 2 months and continue for at least 1 year of life Therapeutic dose: 3 mg/kg in 3-4 divided doses, for 4- 6 months Syrup: Supplemental dose: 10- 15 mg daily Therapeutic dose: 3 mg/ kg/day in 3-4 divided doses, for 4- 6 months Fer-in-sol
Prep: syrup 90/5 drops 75/ 0.6 Prevention: 0.3 - 0.6 ml daily Therapy: 0.6 ml/dose older children: 5-7 times daily 2- 6 years: 3- 5 times daily infants: 2- 3 times daily
Metronidazole
(Flagyl, Servizol) Amebiasis Adult: 1.5gm daily in 3 divided doses Children: 30 to 40 mg/kg/day in 3 divided doses 500 mg tab 25 mg/ ml - flagyl 200 mg/ 5 ml - servizol
Piperacillin/Tazobactam Midazolam
0.1mg/kg/dose q 6° prep:5mg/5ml
Phenylpropanolamine MgSO4 DRIP
use if unresponsive to NaHCO3 DRIP prepn-500mg/ml- 2ml amp LD-200MG/KG X 1HR MD-30mg/k/hr eg.3.4kg newborn give 1.4cc + 15 d5w to be given n ..1hr(0.3cc/hr) as loading dose then 100mg/hr/ -0.2cc/hr(4.8cc+43.2cc=48 at 2cc/hr) Narcan
pedia (blue)=1/2 amp IM upto doses adult (orange)= 1/4 amp IM preparations: 4mg/ml 1mg/ml dose: 0.25ml/kg Nifuroxazide
(Zadec) >12yrs 1tab or tsp syr BID 6mos-3yrs=1/2 tsp BID
(Ercefuryl) intestinal infections, gastroenteritis, enterocolitis, chronic diarrhea, colitis. Dosage Below 6 mos: 3mL TID 6 mos and above: 5 mL TID
6mo.-3yr 0.5mg BID 3yr above 1mg BID syrup 1mg/5ml cap 1mg Liquipred
15mg/5ml
220mg/5mL x 30mL & 60 mL Paracetamol
(Naprex) 10- 15 mg/kg/dose Prep: drops 100 mg/ml 15 ml syrup 250 mg/5 ml 60 ml
Mannitol
Preparation: 20 gm/100 mL Dose: 0.5 - 1 gm/kg or 2.5 mL to 5 mL/kg q 6 hrs Levodropropizine
(Levopront) 30 mg/ 5mL antitussive Dosage 1 mg/kg/dose 10-20 kg: 3mL TID 20-30 kg: 5mL TID Adult: 10mL TID
(Disudrin) Nasal decongestant Dosage: Infants (6.25mg/ml drops) 1-3 mos: 0.25 ml q 6hrs. 4-6 mos: 0.50 ml q 6hrs. 7-12 mos: 0.75 ml q 6hrs. 1-2 yrs: 1 ml q 6hrs. Children (12.5mg/5ml syrup) 2-6 yrs: 2.5 ml q 6hrs. 7-12 yrs: 5 ml q 6hrs. Phenylpropanplamine + Bromphenamine
Ketotifen
Prep=syrup 1mg./5ml(60ml) oral infant drops 1mg/ml(30ml)
Brand: Tazocin Dosage: 80mkdose q 6hrs Preparation: 2gm vial 4gm vial
Pentoxyverine
(Toclase) 7.5 mg/5 mL syrup x 15 mL antitussive Dosage 1 mL (1.5mg) per kg body wt. per day in 3 divided doses. Phenobarbital
10 mg/kg as loading dose, then 5- 8 mg/kg q 12 hours as maintenance dose Propanolol
1-4mg/kg/24°
(Nasatapp) Allergic rhinitis, nasal congestion, coryza Dosage Infant (Drops) 0-6 mos: 0.5 ml q 8-6hrs 7mos-2yrs: 1ml q 8-6hrs Children (Syrup) 1-6 mos: 1/4 tsp. (1.25ml) 7mos-2 yrs: 1/2 tsp. (2.5ml) 2-4 yrs: 3/4 tsp. (3.75ml) 4-12 yrs: 1 tsp. (5ml) Procaterol HCL
(Meptin) syrup: 5 mcg/mL bronchial asthma, chronic bronchitis, asthmatic bronchitis Dosage <5 yrs: 0.25 mL/kg BID-TID 6 yrs: 5 mL BID Ranitidine
(Zantac) neonate= 1.5-2mg/kg/24 PO,IV q 12 0.04mg/kg/hr max of 1mg/kg/24hr infusion children= 1-5mg/kg/24 PO, IM,IV g 6-8hr 2-5mg/kg/24hr IV infusion Prep=syrup 15mg/ml injection 25mg/ml tab 150mg,300mg
Salbutamol + Guaifenesin
(Ventolin Expectorant, Pulmovent) beta 2 agonist, anti-asthma expectorant Dosage: Adult & Children over 12 yrs. 2-4 teaspoonfuls (10-20 ml) 2 or 3 times a day Children 6-12 yrs. 2 teaspoonfuls (10ml) 2 or 3 times a day Children 2-6 yrs. 1-2 teaspoonfuls (5-10ml) 2 or 3 times a day Capsules Syrup 60 and 120ml
Theophylline
< 1yr 1-16yr > 16
Types Of IVF
mg/kg/24 hrs 5+0.2 x age in weeks 16 12 -13
Neonates LD 6-10mg/kg MD 2-4mg/kg/dose q 12 hrs 6wk-6mo=10mg/kg/day 6mo-1yr=12-18mg/kg/day 1-9yr=20-24mg/kg/day 12-16yr=13mg/kg/day prep=80mg/15
Spironolactone
Vamin
1m/k/dose tabs 25mg
wt x 0.5 x 100/6/3 50mg Vancomycin
Spiropent
(Clenbuterol HCL) liquid(all doses BID) 6-12yr 15ml 4-6yr 10ml 2-4yr 7.5ml 1-2yr 5ml drops 6-24mos 2ml <6mos 1ml prep: tab 0.01mg liqd 0.005/5 drop 0.002/ml
38-44wks AOG : 15MKdose q 8° >45wks: 10 mkdose q 6° IV infusion by syringe pump over 60minutes give BENADRYL 1HR BEFORE May cause red mans syndrome
Approximate weight gain for infants
Terbutaline drip
gestational age 24-28wk 29-32wk 33-36wk 37-40wk
30ug/däy (30)wt /x = 1000/1 ex: 4.6 terbutaline s.q.-0.05mg SQ D5W 23.8CC TERB 0.2 cc total 24cc at 1cc /hr
corrected age 40wk-3mos 3-6mos 6-9mos 9-12mos 12-24mos
g/kg/d 15-20 17-21 14-15 7-9
-
g/d 30 20 15 10 6
Terbutaline sulfate + Guaifenesin
(Bricanyl expectorant) Anti-asthma, expectorant Dosage Under 2 yrs 0.075 mg/kg/dose or .25 ml/kg/dose 2-6 yrs 2.5 ml (1/2 tsp.) q 8 hrs. 7-12 yrs 5 ml (1 tsp.) q 8 hrs. Adults 10-15 ml (2 tsp.-1 tbsp.) q 8 hrs.
Hyperglycemia
Risks: 1.mmaturity-less than 30wks and 1kg bw 2.age-less than 3 days most often 1day 3 gir-exceed 8mg/kg/min (eguiualent to 10% glucose at 100mg/kg/24h) 4.septicemia-fungal and bacteria TR T INSULIN 2-6UNITS daily diabetic state resolves in a few days to weeks;,glucose metabolism is subseguently normal and prognosis is good
1.5 mg/66.65 mg per 5 ml trt-insulin infusion 0.001 to 0.01U/KG /MIN Tegretol
10-20mg/kg/day prep: 100mg/5ml 200mg/5ml
TRANSIENT NEONATAL DIABETES
rare disorder most infants are at or near term with marked intrauterine m alnutrition symptoms: wt loss dehydration hyperglycemia occasional ketosis appear within a few days of age
1) Hypotonic > D5NM, D5W, D5 0.3NaCL, D5Maintresol, D5IMB, Isolyte 2) Isotonic > D5LR, D5NSS, RL, PNSS 3) Hypertonic > D50W, D10W IVF OF CHOICE:
LBM - D5LR vomiting - D5NSS Maintenance - D5NM BA - D5 0.3 NaCL Fever & sweating - D5 0.3NaCL Drowning - D5W Ascitis - D5W, D10W CHF - D5W HPN - D5W, D5LR (watch BP) CHF (NPO) - D5NSS 2ndary to HPN - D5W Heat Stroke - D5NSS Burns - D5LR Azotemia - D5W Inc. BUN - D10W Bleeding - D5LR UTI - D5NSS profuse bleed - D5LR DF - D5 0.3 NaCL DM - plain NSS D5 0.3NaCl = used initially if unsure of status of kidney. = contains no K hence will avoid hyperkalemia ( cardiac problems ) DENGUE WITH WARNING SIGNS
Please admit under the service of Dr.__(PC/HC) Secure consent for admission DAT except dark colored food VS q 4hrs to include BP and record Labs CBC Blood typing U/A PT,APTT (if with bleeding) Start IVF with PLR (wt x 10cc/kg) as fast drip now then shift to D5LR (wt x 3cc/kg) Meds 1.Paracetamol (prep) (dose) q 4hrs PRN for fever 2.Domperidone (prep) (dose) q 6hrs PRN for vomiting I & O q shift and record Hydration rounds q 4hrs (if with vomiting) Refer any signs of hypotension (SBP=agex2+70), cold and clammy extremities, weak pulses, CRT>2secs, no U/O within 6hrs and any signs of bleeding Refer for any unusualities Will inform AP / PROD of this admission Refer accordingly
DENGUE SEVERE
Cardio-Pulmonary Arrest
Post- Lumbar Tap Orders:
Admit to PICU NPO Monitor vs q 1hr DX: CBC, plt,, BT, APTT, PT (optional f w/ bldg) FD Plain LR 10cc/kg if still w/ ¯BP & FFP is not available Start Dopa at 5mgtts/min Haesteril 10% at 10cc/kg
Intubate Continuous CPR Continuous ambu-bagging with 100% O2 Epinephrine 0.1 mg/kg IVTT Plain LR 10 cc/kg IV bolus NaHCO3 1- 2 meq + equal amount of diluent slow IVTT *or if ABG is available, correct metabolic acidosis by the ff. computation: Weight X Base Excess X 0.3= ¬¬__ meq given slow IVTT + equal amount of diluent Dopamine =wtxdosex60/concn
*use gauge 23 needle in babies 1. flat on bed x 4 hours 2. NPO x 4 hours 3. VS q hourly 4. send specimens to lab as follows: bot 1- wbc cell count, diff count bot 2- protein and sugar bot 3- GS/ CS bot 4- AFB, india ink bot 5- bacterial antigen 5. watch out for bleeding on LP site, changes in sensorium and other unusualities.
To secure FFP of px’s bld type & properly
xmatched IVF to FF D5LR 1L (5cc/kg- to include dopa in TFI) Transfuse the FFP at rate __(rate of D5W) & off main IVF while transfusion is going on Monitor I & O q shift (cc/cc) Hook px to pulse oximeter maintain 90% •O2 inhalation at 6lpm by mask •No arterial bld extraction •Refer for BP <80/60 (5yrs & above), narrow pulse pressure, cyanosis Bronchial Asthma in Acute Exacerbation
Please admit Hypoallergenic diet Monitor VS q 4 hrs and record Labs: CBC, platelet, Hct, Urinalysis Start venoclysis with D5 0.3NaCl computed at mild dehydration Meds: Salbutamol nebulization q 4 hrs Incorporate Budesonide q 12 hrs. *or instead of Budesonide,start Solu-Cortef at 10 mg/kg as loading dose IVTT now, then 5- 6 mg/kg q 6 hrs maintenance. O2 inhalation prn Moderate- high backrest Refer for signs of respiratory distress (eg. dyspnea, alar flaring, circum-oral and peripheral cyanosis, subcostal and intercostal retractions) Inform AP Refer accordingly
BACTERIAL PNEUMONIA
NB: grp B Strep G (-) bacilli Chlamydia Children: Strep pneumoniae H. influenzae M. catarrhalis Adolescents: Strep pneumoniae Mycoplasma pneumoniae Moraxella catarrhalis Hospital acquired : Gram negative—pseudomonas Klebsiella, E. coli Enterobacter Lobar pneumonia: Strep pneumoniae Pneumatocoele: S. aureus, K. pneumoniae
Dengue Hemorrhagic Fever
Please admit DAT except dark- colored foods Monitor VS, esp BP, q 4 hrs and record please Labs: CBC, platelet, Hct Urinalysis *tourniquet test Start venoclysis with D5LR 500 cc computed at mild dehydration * if in shock, fast drip 10 cc/kg with Plain LR or D5LR, then regulate at mild dehydration Meds: Paracetamol (10 mkdose) for fever prn I and O q shift Refer for signs of bleeding (eg. epistaxis, gum bleeding, melena) and impending shock (eg. low BP, pallor, cold and clammy skin) Inform AP Refer accordingly
A 4yr oid intubated Fio2=100% RR=30 PEEP=2 IT=0.7 TV=130
Post- Thoracentesis Orders:
*get BP prior to tap *note character and amount of fluid aspirated 1. flat on bed X 6 hours 2. NPO X 6 hours 3. Repeat CXR after 6 hours 4.Send specimen to lab as follows: * if serous bot 1 - GS/CS bot 2 - AFB bot 3 - LDH bot 4 - protein * if purulent bot 1 - GS/CS bot 2 - AFB 5. Serum protein, serum LDH Instructions for Thoracentesis: younger older nipple line
Newborn, Potentially Septic
(delivered from outside) To PICU NPO temporarily Monitor CR, RR, Temp q hourly and record please Start venoclysis: fast drip 10 cc/kg Plain LR via solu-set, then shift to D5 0.3NaCl computed at mild- moderate dehydration Labs: CBC, platelet, Hct Urinalysis Fecalysis Blood Culture/ Sensitivity ABG now Hgt now, then q 6 hours Serum electrolytes Thermoregulate at all times Provide droplight at bedside O2 inhalation via cone/hood at 6 lpm Refer for tachypnea, fever, cyanosis and other unusualities Inform AP and PRIC of this admission Refer accordingly
lower border of scapula mid- axillary line (superior border of the rib) lying supine sitting
Preterm, Intubatable
BENIGN FEBRILE CONVULSION
NEWBORN WITH INFECTION
Admit under the service of NPO temporarily, insert OGT Fr. 5, open end to BSB Monitor VS q 15 minutes until stable, then q hourly & record pls. RDS monitoring q hourly Labs: CBC, platelet, central hct, BT Urinalysis, Blood C/S Meds: Ampicillin 100 mkday q 12 IVTT Amikacin 15 mkday q 12 IVTT (or Netil, Genta) Start venoclysis TFI- 80 D10W + Ca gluc (or D5W if <1 kg) Intubate with ET size 3, maintain at level 8 and hook to ventilator with the ff. set-up: FiO2 100% RR 50- 60 P/P 15- 16/ 2-4 IT 0.5 ABG 1 hour after ventilator set-up Umbilical catheterization Tthermoregulate at all times (36.5- 37.5) Routine newborn care Crede's prophylaxis cord care Vit K 1 mg IM Refer for any unusualities Will inform AP Refer accordingly
Please admit under the service of Dr.__ (PC/HC) Secure consent for admission DAT VS q 4hrs Start IVF with D5 0.3NaCl @ (mild/moderate/severe) rate (wt x 30 for >10kgs, x 50 for <10kgs) (compute cc/kg/8hrs= rate x 8/wt) Labs CBC U/A Serum electrolytes Hgt Meds 1.Diazepam wt x .2) mg IVTT for active sizures 2. Paracetamol (wt x 10mkd,suppository) Incfease OFI Hydration rounds q 4hrs Seizure precaution 1.raise siderails 2.padded tongue depressors 3.O2 inhalation via face mask 4.side lying position 5.suction secretions 6.give diazepam Refer for unusualities Will inform AP / PROD of this admission Refer accordingly
Admit to __ under the service of Dr.__ (PC/HC) Secure consent to care Exclusive breastfeeding Labs CBC CRP Blood CS (include antibiotics to be used in sensitivity test) Hgt monitoring @ 2hrs of life t hen q 6hrs, refer if <50 or >125mg/dl Routine newborn care Vit. K 1mg IM Eye ointment (Terramycin) apply to both eyes Heap B 0.5ml IM within 12hrs of life BCG 0.05ml ID Newborn screening after 24hrs of life Hearing screening prior to discharge Meds 1.Ampicillin (wt x 100mkd) mg IVTT q 12hrs 2.Gentamycin (wt x 5mkd) mg IVTT q 24hrs Monitor VS q 30mins for 2hrs then q 4hrs thereafter Refer for cyanosis, poor suck, tachypnea, tachycardia, hyperthermia Keep thermoregulated at all times Remove cord clamp once dry Refer for unusualities Will inform AP of this admission Refer accordingly
ACUTE GASTROENTERITIS PCAP-C
Please admit under the service of Dr.__(PC/HC) Secure consent for admission DAT/Diet for age VS q 4hrs Start IVF with D5 0.3NaCl @ (mild/moderate/severe) rate (wt x 30 for >10kgs, x 50 for <10kgs) (compute cc/kg/8hrs= rate x 8/wt) Labs CBC U/A CXR-PAL or APL Meds 1.Cefuroxime (wt x 100mkd / 3) q 8hrs ANST 2.Paracetamol (prep) (dose) q 4hrs PRN for fever 3.Salbutamol nebulization 1 neb q8hrs I & O q shift and record Increase OFI Hydration rounds q 4hrs Chest physiotherapy every after nebulization Refer for unusualities Will inform AP / PROD of this admission Refer accordingly
Please admit under the service of Dr.__ (PC/HC) Secure consent for admission NPO temporarily for 2hrs then may have small frequent feeding Start IVF with D5 0.3NaCl @ (mild/moderate/severe) rate (wt x 30 for >10kgs, x 50 for <10kgs) (compute cc/kg/8hrs= rate x 8/wt) Labs CBC (6hrs after vomiting) U/A Stool exam Meds 1.Domperidone (prep) (dose) q 6hrs PRN for vomiting 2.Paracetamol (prep) (does) q 4hrs PRN for fever 3.Erceflora polyamp 1polyamp BID x 5days 4.Zinc syrup (<6mos: zinc drops 1ml; >6mos: zinc syrup 5ml or zinc drops 2ml) OD x 2weeks 5.ORS vol/vol replacement I & O q shift Hydration rounds q 4hrs Increase OFI Stool charting at bedside c/o watcher Refer for unusualities Will inform AP / PROD of this admission Refer accordingly
Acute Lymphocytic Leukemia
Please admit NPO Monitor VS q 4 hours and record Labs: CBC, platelet, Hct now CXR- AP-L Blood CS X 1 site Serum electrolyes Urinalysis ECG- 12 lead w/ long lead II Start venoclysis with D5 0.3NaCl computed at mild dehydration Meds: I and O q shift Moderate- high back rest Avoid unnecessary trauma Reverse isolation Neuro VS q 4 hours O2 inhalation via mask with reservoir Refer for unusualities Will inform AP of this admission Refer accordingly
