Pedia Idiot Notes

Partly Compensated Met Alkalosis Uncompensated Partly Compensated

WATERLOW CLASSIFICATION WASTING = Actual weight (kg) x 100 p50 weight for height STUNTING = actual height (cm) x 100 p50 height for age WASTING: >90 – normal 81-90 –mild 70-80 –moderate <70 –severe STUNTING: >95 –normal 90-95 –mild 85-89 –moderate <85 –severe IDEAL BODY WEIGHT (Filipino:3000 gms) < 6 mos = age (mos) x 600 + BW (gm) 6-12 mos = age (mos) x 500 + BW (gm) 1-6 yrs = age (yrs) x 2 + 8 7-12 yrs = age (yrs) x 7 – 5/2

↓ N

↓ ↓

↓ ↓

↓ ↓

↑ ↑ N

N ↑ ↑

↑ ↑ ↑

↑ ↑ ↑

GUIDELINES FOR BLOOD TRANSFUSION Cryopecipitate is administered using blood set/ macroset and transfused fast drip unless otherwise indicated Platelet Concentrate administered using platelet set and transfused fast drip unless otherwise indicated Pheresed Platelet I “U” is equivalent to six to fourteen (6-14) “U” of randomly collected platelet concentrate transfuse using platelet set PRBC/FWB is administered using blood set and transfused within 68 hrs FFP is administered using blood set/macroset and transfused for two hours unless otherwise indicated COMPUTATION FOR PRBC For: (Desired Hct – Actual Hct) x weight

USUAL CHANGES IN WT AT DIFF AGES 4-5 mos = 2 x BW 1 yr = 3 x BW 2 yrs = 4 x BW 3 yrs = 5 x BW 5 yrs = 6 x BW 7 yrs = 7 x BW 10 yrs = 10 x BW LENGTH/HEIGHT COMPUTATION At birth = 50 cm 0-3 mos = + 9 cm 3-6 mos = + 8 cm 6-9 mos = + 5 cm 9-12 mos = + 3 cm 2-12 yrs = Age x 5 + 80 HEAD CIRCUMFERENCE COMPUTATION At birth = 35 cm (13-18 inch) < 4 mos = 2 inch (1/2 inch / mos) 5-12 mos = 2 inch (1/4 inch / mos) 2 yrs = 1 inch 3-5 yrs = 1.5 inch (1/2 inch / yr) 6-20 yrs = 1.5 inch (1/2 inch / 5 yrs) TEMPERATURE Normal: 37 + / - 1.0-1.5 C Decrease: early morning Increase: late afternoon

BLOOD PRESSURE COMPUTATION SYSTOLIC DIASTOLIC 0-12 mos 110-90 mmHg 75-55 mmHg 1-2 yrs 110-90 mmHg 75-55 mmHg ≥ 3 yrs = age x 2 + 70 FONTANELS At Birth: 2 x 2 cm (anterior) Closes at: 9-18 mos (anterior) 6-8 mos (posterior) HEART RATE 120-170 100-150 90-120 80-120 70-110 65-110 60-95 55-85

ACID BASE BALANCE (ABG) Normal (N): normal acid base balance pH PaCO2 HCO3 Respiratory Acidosis Uncompensated ↓ ↑ N Partly ↓ ↑ ↑ Compensated N ↑ ↑ Respiratory Alkalosis Uncompensated ↑ ↓ N Partly ↑ ↓ ↓ Compensated N ↓ ↓ Met Acidosis Uncompensated ↓ N ↓

BLOOD GLUCOSE Normal: 70-110 mg/dl > 120 mg/dl: hyperglycemia Term infants: > 140 mg/dl normally Preterm: > 30 mg/dl normally

CLINICAL PRACTICE GUIDELINES IN THE EVALUATION OF PEDIATRIC COMMUNITY ACQUIRED PNEMONIA 2004 Predictors of CAP in a patient with cough 1. 3 mos to 5 yrs with tachypnea &/or chest retractions 2. 5-12 yrs with fever, tachypnea and crackles 3. > 12 yrs with the presence of the ff: a. Fever, tachypnea, tachycardia b. At least 1 abnormal chest findings (rales, wheezes, ronchi, dim BS) WHO age specific criteria for tachypnea 2-12 mos ≥ 50 1-5 yrs ≥ 40 >5 yrs ≥ 30

RESPIRATORY RATE (Harriet lane handbook 17 ed) NORMAL: 0.1 yr = 24-38 cpm 1-3 yrs = 22-30 cpm 4-6 yrs = 20-24 cpm 7-9 yrs = 18-24 cpm 10-14 yrs = 16-22 cpm 14-18 yrs = 14-20 cpm TACHYPNEA: 0.2 mos: >/= 60 2-12 mos: >/= 50

Premature 0-3 mos 3-6 mos 6-12 mos 1-3 yrs 3-6 yrs 6-12 yrs 12 yrs

Desired Hct = 40% for full correction 30% for WBC w/c are ↑ Content of PRBC RBC = 200 cc Anticoagulant = 50 cc 1 pack RBC= 250 cc (to be transfused in 4 hrs) Evidence Based Study Give diphenhydramine 30 min – 1 hr pre-BT

BE N ↑ ↑ N ↓ ↓ ↓

RISK CLASSIFICATION FOR PNEUMONIA RELATED MORTALITY Variables PCAP PCAP B PCAP C PCAP D A Low Mod High Risk Min. Risk Risk Risk 1.Comorbid None (+) (+) (+) illness 2.Compliant Yes Yes No No caregiver 3.Abilityto Possible Possible Not Not follow up Possible Possible 4.Presence of None Mild Mod Severe DHN 5.Ability to feed Able Able Unable Unable 6.Age >11 >11 <11 mos <11 mos mos mos 7.RR 2-12 mos ≥50/min >50/min >60/min >70/min 1-5 yrs ≥40/min >40/min >50/min >50/min >5 yrs ≥30/min >30min >35/min >35/min 8.Signs of resp distress a.Retraction None None Inter/ Supraclav/ Subcostal Int/subcoatal b.Head bobbing None None Present Present c.Cyanosis None None Present Present d.Grunting None None None Present e.Apnea None None None Present f.Sensorium Awake Awake Irritable Lethargic/ Stuporous/ comatose 9.Complications None None Present Present ACTION OPD OPD Admit to Admit to PLAN Ff up at Ff up regular PICU & end of after 3 ward Refer to tx days specialist

PCAP A or PCAP B No diagnostic aids are initially requested PCAP C or PCAP D 1. The ff should be routinely requested: a. CXR APL b. WBC c. Culture & sensitivity of i. blood for PCAP D ii. Pleural fluid iii. Tracheal aspirate upon initial intubation d. Blood gas &/or pulse oximetry 2. The ff may be requested: Culture and sensitivity of sputum for older children 3. The ff should not be requested a. ESR b. CRP An Antibiotic is recommended 1. For a px classified as either PCAP A or B and is a. Beyond 2 yrs b. Having high grade fever w/o wheeze 2. For a px classified as PCAP C and is a. Beyond 2 yrs of age b. Having high grade fever w/o wheeze c. Having alveolar consolidation in the CXR d. Having WBC > 15,000 3. For a px as PCAP D

Empiric Treatment 1. For PCAP A or B w/o previous antibiotic = Amoxicillin (40-50 mkD) oral TID 2. For PCAP C who completed Hib immunization = Pen G IV (100,000 U/k/D) QID PCAP C not completed Hib immunization = Ampicillin IV (100 mkD) QID 3. For PCAP D – consult specialist When can a px be considered as responding to current antibx? 1. Decrease in respiratory signs and defervescence w/in 72 hrs after initiation 2. Reevaluate if ssx persists beyond 72 hrs after antibiotics 3. End of tx, CXR, WBC, ESR, or CRP should not be done to assess therapeutic response to antibx

Suspension Drops Capsules Cefaclor (2nd gen) Suspension

Drops CD exten rel tab Cefuroxime (2nd gen) Suspension Sachet Tablet

125mg/5ml 250 mg/5 ml 100 mg/5 ml 250 mg; 500 mg 20-40 mkd q 8-12 h 125 mg/5 ml 187 mg/5 ml 250 mg/5 ml 375 mg/5ml 50 mg/ml 375 mg; 750 mg 20-40 mkd q 12 h 125 mg/5 ml 250 mg/5 ml 125 mg/ sachet 250 mg/ sachet 125 mg; 500 mg

Cefixime (3rd gen) Suspension Drops

6-12 mkd q 12h 100 mg/5 ml 20 mg/ml

Cefipime Vial

100 mkd q 12h 500 mg; 1 gram

Cotrimoxazole Suspension

(TM 5-8 mkd q 12h) 200 mg/40 mg/5 ml 400 mg/80 mg/5 ml 400 mg/80 mg/tab 800 mg/160 mg/tab

Tablet

MACROLIDES Erythromycin Suspension Drops

30-50 mld q 6h 200 mg/5 ml 400 mg/5 ml 100 mg/2.5 ml 100 mg/ml

Clarithromycin Suspension Tablet

7.5 mkdose q 12h 125 mg/5 ml 250 mg; 500 mg

What should be done if px is not responding to current antibx? 1. If PCAP A or PCAP B is not responding w/in 72 H a. Change initial antibx b. Start oral macrolide c. Reevaluate dx 2. If PCAP C is not responding w/in 72 H, consult w/ a specialist because of the ff possibilities a. PCN resistant Strep pneumonia b. Complications (pulmonary or extrapulmonary c. Other dx 3. If PCAP D is not responding w/in 72 H, consider immediate consult with a specialist

Roxithromycin

6-12 yrs: 100 mg/tab BID <6 yrs: 5-8 mkd BID 150 mg/tab 100 mg/tab

Switch from IV antibx to oral 2-3 days after initiation of antibx is recommended in a px who: a. Is responding to the initial antibx b. Is able to feed with intact GIT absorption c. Does not have any pulmo or extrapulmo complications

Clindamycin

Ancillary treatment 1. O2 and hydration 2. Bronchodilators, CPT, steam inhalation, NSS nebulization Prevention 1. Vaccines 2. Zinc supplementation for 4-6 months a. 10 mg for infants b. 20 mg for children > 2yrs

Amoxicillin Suspension Drops Capsules

OPD MEDS 30-50 mkd (50 mkd) q 8h 125 mg / 5 ml 250 mg / 5 ml 100 mg/ml 250 mg; 500 mg

Amoxicillin + clavulanic acid (amox 30-50 mkd) Suspension 125 mg/156.25mg/5 ml TID 200 mg/228.5 mg/5 ml BID 250 mg/312.5 mg/5 ml TID 400 mg/457 mg/5 ml BID Tablet 250mg/375 mg; 500 mg/625 mg Cloxacillin Suspension Capsules

50-100 mkd q 6h 125 mg/5 ml 250 mg/5 ml 250 mg; 500 mg

Chloramphenicol Suspension Capsules

50-75 mkd q 6h 125 mg/5 ml 250 mg; 500 mg

CEPHALOSPHORINS Cefalexin (1st gen)

25-100 mkd q 6-8h

Tablet Ped tab Azithromycin

Suspension Capsule

Suspension Capsule Ampoule

3 day regimen: 10 mld x 3 5 day regimen: 10 mkd on day 1 5mkd on days 2-5 Adult: 500 mg OD on day 1 250 mg OD on days 2-5 200 mg/5 ml 250 mg PO 20-30 mkd q 6-8h IV 25-40 mkd q 6h or 10-15 mkdose q 6h 75 mg/5 ml 150 mg; 300 mg 150 mg/ml

Metronidazole Suspension Tablet

30-50 mkd q 8h 125 mg/5 ml 250 mg; 500 mg

Diloxanide furoate Suspension Tablet

20 mkd q 8h x 10 days 125 mg/5 ml 500 mg

Miconazole

adult & children ½ tsp q 6h Infants ¼ tsp q 6h

Oral gel 2% tube Nystatin NB <2000g = 200,000 – 400,000 u/day q 4-6h >2000g = 200,000 – 400,000 u/day q 4-6h Infant, Child = 400,000 – 800,000 u/day q 4-6h Adult = 800,000 – 2 M u/day q 4-6 h Fluconazole Capsule Vial

3-6 mkd OD x 2 weeks 50 mg; 150 mg; 200 mg 2 mg/ml x 100 ml

Oxantel + pyrantel pamoate Suspension Tablet  Tricuriasis x 2d  Hookworm x 3d

10-20 mkd SD 125 mg/5 ml 125 mg; 250 mg

Mebendazole Suspension Tablet

100mg BID x 3days or 500mg SD 50 mg/ml; 100 mg/5 ml 100 mg; 500 mg

Albendazole

<2 yo 200 mg SD >2 yo 400 mg SD 200 mg/5 ml 400 mg

Suspension Tablet Acyclovir Suspension Blue Pink Diphenhydramine Syrup Capsule Ampoule

Doxofylline Syrup Tablet

6 mkdose TID 100 mg/5 ml 400 mg

20 mkdose diven q 6h Max 800 mg/day 200 mg/5ml 400 mg 800 mg

Aminophylline

5 mkdose (loading dose) 2.5 mkdose q 6h (maint.) slow IVTT + equal amounts of sterile water 25 mg/ml

1-2 mkdose IM/IV/PO 5 mkd q 6h 12.5 mg/5 ml 25 mg; 50 mg 50 mg/ml

Prednisone Syrup

Hydroxizine Syrup Tablet Adult

1 mkd BID 2 mg/ml 10 mg; 25 mg 10 mg BID or 25 mg OD @ HS

Desloratadine Syrup 6-11 mos 1-5 yrs 6-11 yrs

2.5 mg/5 ml 2 ml (1 mg) OD 2.5 ml (1.25 mg) OD 5 ml (2.5 mg) OD

Ceterizine Oral drops 6-12 yo 2-6 yo Tablet Adult & >12 yo 6-12 yo

10 mg/ml 10 drops BID 5 drops BID 10 mg 1 tab OD ½ tab BID or 1 tab OD

Loaratadine Syrup Adult & 12 yo 2-12 yo (>30 kg) (<30 kg) 1-2 yo

5 mg/5ml 10 ml OD 10 ml OD 5 ml OD 2.5 ml OD

Sodium chloride Nasal drops Nasal spray

2-4 drops or sprays per nostril TID/QID 0.65% 0.65%

Phenylpropanolamine HCL Syrup 2-6 yo 7-12 yo Drops 1-3 mos 4-6 mos 7-12 mos 1-2 yo

12.5 mg/5 ml q 6h 2.5 ml 5 ml 6.25 mg/ml q 6h 0.25 ml 0.5 ml 0.75 ml 1 ml

Phenylephrine + brompheneramine maleate Syrup Adult 5-10 ml TID/QID 4-12 yo 5 ml TID/QID 2-4 yo ¾ tsp TID/QID Drops (0.1 mkdose) 7-24 mos 1 ml TID/QID 1-6 mos 0.5 ml TID/QID Paracetamol Drops Suspension/syrup

Tablet Rexidol Opigesic

10-20 mkdose q 4h 60 mg/0.6 ml 100 mg/ml 120 mg/5 ml 125 mg/5 ml 250 mg/5 ml 325 mg; 500 mg 150 mg/5 ml syrup 600 mg tablet 125 mg; 250 mg

Mefenamic acid Syrup Capsule

6-8 mkdose q 6h 50 mg/5 ml 250 mg; 500 mg

Ibuprofen

5-10 mkdose q 6h Max of 20 mkd 100 mg/5 ml 200 mg/5 ml

Suspension

Ampoule

1-2 mkd 10 mg/5 ml 20 mg/5 ml 1 mg; 5 mg; 10 mg; 20 mg

Tablet Prednisolone Syrup

1-2 mkd 15 mg/5 ml

Racecadotril Sachet Capsule

1.5 mkdose TID 10 mg; 30 mg 30 mg

Tramadol Ampoule Capsule Tablet

IV: 1-2 mkd q 8h 50 mg/ml; 100 mg/2 ml 50 mg 100 mg

Famotidine Ampoule Tablet

0.6-0.8 mkdose q 12h 20 mg/2 ml 20 mg; 40 mg

Ranitidine Entac Pharex

1 mkdose q 8h 25 mg 75 mg

Zinc

<6 mos: 10 mg/kg >6 mos: 20 mg/kg <2 yo: 1 ml OD drops >2 yo: 5 ml OD syrup 10 mg elemental Zn 20 mg elemental Zn

Drops Syrup

IV ANTIBIOTICS Penicillin G 100,000 – 400,000 ukd q 4-6h Ampicillin + sulbactam (unasyn) 50 – 100 mkd q 8-6 h Chloramphenicol 50-100 mkd q 4-6h Oxacillin (prostaphlin) 50-100 mkd q 6-8h Flucloxacillin 50-100 mkd q 6-8h Gentamycin (Tangyn) 5-7.5 mkd OD, q 8-12h Netromycin 5 mkd q 12h Amikacin + SO4 (Amikin) 15 mkd q 12h Cefuroxime (Zegen) 50-100 mkd q 6-8h Ceftriaxone 50-100 mkd OD, q 12h Ceftazidine 50-100 mkd q 12h Cefoxitin 20-40 mkd q 6-12h Cefepime 100 mkd q 12h Tienam 10-15 mkdose q 6h Meropenem (Meronem) 20-40 mkd q 8h Piper/tazo (Piptaz) 200-300 mkd q 6h OTHER IV MEDS Epinephrine Diphenhydramine Hydrocortisone Max dose: Nalbuphine (Nubain) Phenobarbital Diazepam

Rectal dose 2-5 yo 6-11 yo ≥12 yo Ampoule Oral sol’n Tablet Ped rectal gel

Salbutamol Syrup Tablet

0.1-0.15 mkdose 2 mg/5 ml 2 mg; 4 mg

Salbutamol + guaifenesin Syrup Tablet

STAGE 1 2 3 4

1 mg/50 mg/5 ml 2mg/50 mg

5

Terbutaline sulfate Syrup Tablet

0.075 mkdose 1.5 mg/5 ml 2.5 mg

Terbutaline + guaifenesin Syrup

1.5 mg/50 mg/5 ml

0.01 ml/kg 1-2 mkdose 4 mkdose q 6-8h 200 mg as LD 100 mg as MD 0.13-0.15 mkdose 10 mkdose LD 5 mkd MD q 12h OD HS 0.04-0.2 mkdose IM/IV Max dose 0.6 mg/kg w/in 8h 0.12-0.8 mkd q 6-8h 0.5 mkdose ffd by 0.25 mkdose in 10 min PRN 0.5 mkdose 0.3 mkdose 0.2 mkdose 5 mg/ml 1 mg/ml; 5 mg/ml 2 mg; 5 mg; 10 mg 2.5 mg; 5 mg; 10 mg

SEXUAL MATURITY RATING IN BOYS PUBIC HAIR Prepubertal: no pubic hair, fine vellus hair Sparse, long, straight, downy hair Darker, coarser, curly, sparse over the entire pubis Dark, curly, and abundant in pubic area; no growth on thighs or up towards the umbilicus Adult pattern

STAGE 1 2 3 4 5

SEX MATURITY RATING IN GIRLS PUBIC HAIR Preadolescent Sparse, lightly pigmented, straight, medical border of labia Darker, beginning to curl, increased amount Coarse, curly, abundant, but amount less Adult feminine triangle medical surface of thigh

NEWBORN SCREENING What is newborn screening? Newborn screening is a simple procedure to find out if your baby has a congenital metabolic disorder that may lead to mental retardation and even death if left untreated. Why is it important to have newborn screening? Most babies with metabolic disorders look normal at birth. One will never know that the baby has the disorder until the onset of signs and symptoms and more often ill effects are already irreversible. When is newborn screening done? Newborn screening is ideally done on the 48th hour or at least 24 hours from birth. Some disorders are not detected if the test is done earlier than 24 hours. The baby must be screened again after 2 weeks for more accurate results.

Mumps Hemophilus influenza Varicella zoster

1 yr 2 mos – 5 yrs 9 mos - up

1 3

0.5 ml IM 2 mos

1

0.5 ml SQ

FLUID COMPUTATION (FLUID HYDRATION) <2 yrs / <10 kg = 50 cc/kg run @ 8h (D5 0.3 NaCl) - MILD = 100 cc/kg run ¼ @ 1 h - MODERATE run ¾ @ 6-7h (PNSS/PLR) = 150 cc/kg run 1/3 @ 1h - SEVERE run 2/3 @ 6-7h (PNSS/PLR) >2 yrs/ >10 kg = 30 cc/kg run @ 8h (D5 0.3 NaCl) -MILD = 60 cc/kg run ¼ @ 1h - MODERATE run ¾ @ 6-8h = 90 cc/kg run 1/3 @ 1h -SEVERE run 2/3 @ 6-7 h eg.: IV Fluids given ______ run @ 8h w/ 30cc/kg computed as mild dehydration *started w/ IVF ___ regulated at ______ computed as _____ dehydration in _____ hrs Micro- cc/hr to macro – cc/hr ÷ 4

FACTORS MODIFYING WATER REQUIREMENT How is newborn screening done? Newborn screening is a simple procedure. Using the heel prick method, a few drops of blood are taken from the baby’s heel and blotted on a special absorbent filter card. The blood is dried for 4 hours and sent to the newborn screening laboratory (NBS lab). Who will collect the sample for newborn screening? Newborn screening can be done by a physician, nurse, midwife, or medical technologist. Where is newborn screening available? Newborn screening is available in participating health institutions (Hospitals, lying-in, rural health units and health centers). If babies are delivered at home, babies may be brought to the nearest institution offering newborn screening. When are newborn screening results available? Newborn screening results are available within three weeks after the NBS lab receives and tests the samples sent by the institutions. Results are released by the NBS lab to the institutions and are released to your attending birth attendants or physicians. Parents may seek the results from institutions where samples are collected. What are the disorders included in the newborn screening package? The Philippine Newborn Screening program is currently screening for five disorders and the following are: 1. Congenital Hypothyroidism (CH) CH is the most common inborn metabolic disorder. CH results from lack or absence of thyroid hormone which is essential to growth of the brain and the body. If the disorder is not detected and hormone replacement is not initiated within 4 weeks, the baby’s physical growth will be stunted and will start losing IQ points and may become severely mentally retarded. 2. Congenital Adrenal Hyperplasia (CAH) CAH is a rare but dangerous inborn metabolic disorder. This causes severe salt loss, dehydration and abnormally high levels of male sex hormones in both boys and girls. If not detected and treated early, babies may die within 9-13 days. 3. Galactosemia (Gal) GAL is a condition in which babies are unable to process certain part of the milk called galactose. Accumulation of excessive galactose in the body can cause many problems including liver damage, brain damage, and cataracts. 4. Phenylketonuria (PKU) PKU is a rare condition in which the baby cannot properly use one the building blocks of protein called phenylalanine. Excessive accumulation of phenylalanine in the blood causes brain damage. 5. Glucose 6 Phosphate Dehydrogenase Deficiency (G6PD Def) G6PD deficiency is a condition where the body lacks the enzyme called G6PD. Babies with this deficiency are prone to hemolytic anemia resulting from exposure to oxidative substances found in drugs, foods and chemicals.

EXPANDED PROGRAM OF IMMUNIZATION (EPI) Vaccine 1st dose # of dose Interval Dose BCG Birth-up 1 0.05 ml ID DPT 6 wks 3 4 wks 0.5 ml IM OPV 6 wks 3 4 wks 0.5 ml oral Hep B 6 wks 3 4 wks 0.5 ml IM Measles 9 mos 1 0.5 SQ TT Rubella

2 mos 1 yr

2 1

6 wks

0.5 IM 1 ml SQ

EXTRA REQUIRED: Fever (add 12% for each oC above 37.5) Hypermetabolic States (thermal injury, thyrotoxicosis, resp. distress) 25-75% Abnormal H2O/electrolyte losses (diarrhea,/vomiting) depend on degree of hydration Sweating (10-35%) LESS REQUIRED: Hypothermia (subtract 12% for each oC < 37.5) Very high humidity Oliguria/anuria Sedated/paralyzed patient (subtract 40%) Edematous/ antidiuretic states (cardiac failure)

HALLIDAY-SEGAR METHOD (Maintenance Fluid) (Nelson 16th ed) 0-10 kg 11-20 kg >20 kg

100 ml/kg/day 1000 + 50 ml/kg for each kg > 10 kg 1500 + 20ml/kg for each >20 kg LUDAN’S METHOD (del Mundo 2000)

0-3 kg 3-10 kg 11-20 kg 21-30 kg ≥31 kg

75 ml/kg/day 100 ml/kg/day 75 ml/kg/day 60 ml/kg/day 50 ml/kg/day

DOPAMINE DRIP Prep: 200 mg/5ml (40 mg/ml) Dose: 3-30 mcg/kg/min Formula: Amt/dose = wt x dose x K (6) ÷ prep ÷ 2(to make 50 ml prep) to incorporate running dose eg: 10 kg child, dopamine @ 5 mcg/kg/min @ 5 cc/hr =10 kg (5mcg/kg/min) 6 ÷ 40 mg/ml ÷ 2 5 cc/hr = 0.75 ml of dopamine To order: Dopamine drip 0.75 ml plus 49.25 D5W @ 5 cc/hr

DOBUTAMINE DRIP Prep: 250 mg/20 ml (12.5 mg/ml) Dose: 3-30 mcg/kg/min Formula: Amt/dose to = wt (dose) (K) ÷ prep ÷ 2 (to make 50 ml prep) incorporate running dose eg: 10 kg child, dobutamine @ 5 mcg/kg/min @ 5 cc/hr =10 kg (5mcg/kg/min) (6) ÷ 12.5 mg/ml ÷ 2 5 cc/hr = 2.4 ml of dobutamine To order: Dobutamine 2.4 ml plus 47.6 ml D5W @ 5 cc/hr To check: (dose) X = prep x running rate x amt/dose incorporated x 2 Weight x 6

 + volar area 1 inch distal to antecubital fossa of about 1 ½ inch  + petichial rashes of >20

ACTUAL DOSE = dose/wt = dose x preparation Wt PEFR COMPUTATION *for 100-170 cm (ht) only Predicted PEFR Females: ht (cm) – 100 x 5 + 170 Males: ht (cm) – 100 x 5 + 175 Actual PEFR: % = actual PEFR x 100 Predicted PEFR

I II III

DHF GRADING I

RDA (RECOMMENDED DAILY ALLOWANCE) AGE Wt(kg) Cal/kg P F VLBW < 1500 2.25 0-6 mos 3-6 110-115 2.5 7-12 mos 7-9 110-115 2.3 2 1-3 yrs 10-12 110 1.5-2.5 4-6 yrs 14-18 90-100 1.5-2.25 4 7-9 yrs 22-24 80-90 1.5-2.0 10-12 yrs 28-32 70-80 1.5-2.0 2.5 CCU = IBW x ABW x caloric for age ABW = IBW x caloric for age TCR = CCU x (50% - 60%) CHON = ABW x RDA chon x 4 NPC TCR – CHON CHO = NPC x 60% FATS = NPC – CHO ↑ TCR every other day starting day 3 (+ 10%) To orders: >start feeding based on the ff computation Total caloric req. = 792 cal Protein = 64 cal Carbohydrate = 436 cal Fats= 292 cal -divided into 3 meals and 2 snacks -pls provide sterile water after each feeding *after 3 days >Revise OTF/feeding based on the ff computation Total caloric req = 871 Protein = 64 Carbohydrates = 464 Fats = 343 >Osteorized Feeding - start osteorized feeding based on the ff computation (same) - divided into 6 equal feeding - please provide sterile H2O after each feeding Eg: Px 8 y, 24.1 kg (ABW) IBW – 24 kg Caloric req 7-9 yo = 80-90 cal/kg CCU = 24 kg x 85 cal/kg = 2040 cal 3rd day = 2040 cal x 0.75 = 1530 ~ 1500

LYMPHADENOPATHY 1 cm cervical & axillary LN 1.5 cm inguinal LN

SPECIFIC GRAVITY 1.005- 1.020 ↑ rehydration is not enough Adolescence – 10-18 females 12-20 males Childhood – 2-12 years old Infant to 2 years old

URINE OUTPUT (1 cc/kg/hr) Pedia: 1-3 cc/kg Adult: 3 cc/kg/hr

ANEMIA Hgb 10-12 g/dl = mild 8-10 g/dl = moderate <8 g/dl = severe

CRYSTALLOIDS: PLR PNSS D5 H2O D5 0.3 NaCl COLLOIDS: Albumin Voluven Hesteril

TORNIQUET TEST/ RUMPLL MAP = > SYSTOLIC – DIASTOLIC  Inflate for 5 minutes

DHF STAGING Febrile stage (1-7 days) Afebrile stage (3-4 days) Convolescent Stage

Anorexia, vomiting, convulsion, restless Flushes skin, + tourniquet test, abdominal pain, hepatomegaly Pleural effusion (unilateral/bilateral), constipation, abdominal distention

II Gum bleeding, epistaxis, petechiae on palate & axillae, rashes on extremities III Chest pain, cough, lethargy, violaceous skin, flushed face Purpura, hematemesis, hemoptysis, melena Cold clammy extremity, shock, ecchymosis IV Profound shock

APGAR (1953 – Invented by Virginia Apgar) 10 – assess for the need for resuscitation 50 – assessment of resuscitation/prognosis of patient *APGAR does not predict neurological damage

Pulse Grimace

0 Blue, pale ext & trunk Absent (-) response

1 Blue ext, pink trunk < 100 Grimace

Activity

Limp

Respiration

absent

Some flexion of extremity Slow, irregular

Appearance

2 Completely pink > 100 Cry, cough, sneeze Active motor

Good strong cry

Score: 7-10 = vigorous infant 4-6 = mild-mod asphyxia – 100% O2 face mask <5 = severe asphyxia – intubate

15 chest compression – 2 puffs 32 chest compression – 2 puffs >5 min heart stops – 50% chance survival >10 min heart stops – 0% chance survival

ECG V3R – Right, 5th ICS MCL V4R - Right, 5th ICS, AAL V7 – Left, 5th ICS AL

PICCU INSTRUMENTS 1. Suction unit 2. Mechanical vent 3. Syringe pump 4. Pulse oximeter 5. Infusion pump 6. Soluset w/ microset 7. Macroset 8. Platelet set 9. Blood set 10. Billy light ( 20 W x 10 bulb x 20 inches) 11. Neovent/ infant ventilator 12. Cardiac monitor 13. IV stand

FEBRILE SEIZURE Age: between 9 mos – 5 yrs Temp: 39 C above Seizure: generalized, tonic-clonic Duration: few seconds – 10 min Others: followed by postictal period of drowsiness Rule out: meningitis by lumbar tap Treatment: oral diazepam, 0.3 mg/kg q 8h (1mg/kg/24hr) for 2-3 days

AMOEBIASIS >Entamoeba histolytica (protozoan parasite) Transmission: fecal contamination of food or hands, may also be transmitted by anal intercourse Pathologic feature: flask-shape ulcers in submucosa due to lytic digestion Diagnosis: E. histolytica in stool, tissues or aspirate, etc Treatment: metronidazole

H. PYLORI INFECTION - human, H2O, domestic cats & house flies (reservoir) - ideal test:  Non invasive  Highly accurate  Inexpensive  Readily available  Endoscopy – invasive 1.Biopsy & histopath  Definitive dx  Turns yellow +  Areas: antrum, body, transition zone  Drawbacks: invasive, risk of sedation  Anesthesia: absence of specialist 2.rapid urase testing for biopsy tissue 3.Bacterial culture 4. Polymerase Chain Reaction -Non invasive 1.Immunoessay 2.Saliva & urine test 3. Stool test (monitoring eradication) Immunoassay (ELISA) - sensi: 60-70% 4. urea breath testing - specificity & sensi: >95% - difficult in smaller children - primary goal of treatment: to dx the cause of clinical sx & not presence of H. Pylori - Eradication therapy Both active H. pylori & symptomatic GI dse  Treated are:  Duodenal/gastric ulcer at endoscopy  Prior hx of duodenal or gastric ulcer  Noninvasive & invasive test +  Pathologic evidence of MALT lymphoma  Pathologically proven atrophic gastritis w/intestinal metaplasia OPTION 1 Amoxicillin 30 mkday up to 1 g BID for 2 wks Clarithromycin 15 mkday 500 mg BID for 2 wks PPI 1 mkday up to 2 mg BID for 4 wks OPTION 2 Amoxicillin (same) Metronidazole 20 mkday to 500 mg BID PPI 1 mkday up to 20 mg BID OPTION 3 Clarithromycin – 2 wks Metronidazole – 2 wks PPI – 4 wks OPTION 4 Bismuth Subsalicylate 1 tab (262 mg) QID or 15 ml (17.6 mg/ml QID) Metronidazole PPI Plus add Amox Tetracycline (>12 yo) 50 mkday up to 1 gm BID Clarithromycin OPTION 5 Ranitidine 1 tab QID for 2 wks Bismuth 1 tab QID for 2 wks Citrate 1 tab QID for 2 wks Clarithromycin – same Metronidazole – same

Tazobactam NA + Piperacillin NA (vigocid) Zdorixol 6mg/ml syrup Mucolvan 15 mg/3 ml susp

Ambroxol (expel) 1-2 yrs 2-6 yrs 7-12 yrs

15 mg/5 ml ½ tsp BID ½ tsp TID 1 tsp TID/BID

Multivitamins (Lugraplex Syrup) 2-6 yrs 1tsp 7-12 yrs 2 tsp >12 yrs 1 tbsp Cherifer forte Syrup 2-6 yrs 6-12 yrs

2.5 – 5 ml OD 1-2 tsp OD

Ascorbic acid (Geturs) 1 tsp OD

100 mg/5 ml

MFA (Medismon) 6 mos – 1 yr 2-4 yrs 5-8 yrs 9-12 yrs

50 mg/5 ml 1 tsp 2 tsp 3 tsp 4 tsp

COMPLICATIONS OF PHOTOTHERAPY (20 watts, 20 inches, 5 bulbs) 1. DEHYDRATION 2. BLINDNESS 3. BRONZE BABY – sun burn

     

BLOOD TRANSFUSION PRBC - blood set Desired Hct (40 or 30) – actual Hct x Wt (kg) Platelet Transfusion – platelet set 1 unit platelet conc / 10 kg PRBC - 20 cc q unit in 4 hrs (200 cc RBC; 50 cc anticoagulants) Platelet - 50 cc Whole blood - 500 cc Leukemia Pxs – ANC (Absolute Neutrophil Count) WBC x segmenters (%) x total diff ct (%) Eg: WBC = 5000; segmenters = 50% TDC (50%) = 1250

ADMITTING ORDERS A – admit D – diet or diagnostics M – meds I – IV T – therapeutics Eg; >admit under the service of…. >consent to care >TPR w/ BP q 2 >Diet >Problem: fever, pallor, SOB >labs & diagnostics >meds Nursing orders: I & O A.

MAINTENANCE FLUIDS

Infants and children require adequate fluid and electrolyte intake to maintain fluid balance. Calculation of maintenance fluids based on the child's weight is required to prevent under hydration or over hydration. To weigh the child, use the same scale, at the same time of day, before feeding, without clothes. First: Obtain an accurate weight in kilograms. Second:

Apply the following table:

Child Weight: Normal Maintenance Fluid Requirements: 0 - 10 kg 100cc/kg/day 10.1 - 20 kg 50cc/kg/day (1000cc for first 10 kg plus 50cc per kg for each kg over 10 kg, total divided by 24 hours) 20.1 kg and up 20cc/kg/day (1500cc for first 20 kg plus 20cc per kg for each kg over 20 kg, total divided by 24 hours) Examples: 1. An 8.5 kg infant requires maintenance fluids. The infant should receive 8.5 kg x 100cc = 850cc total over 24 hours. Divide 850cc by 24 hours to calculate the amount of fluids the infant should receive each hour: OR cc = 8.5kg x 100cc x 1 hr kg 24 hrs. 24 hr 2. A 15 kg child requires maintenance fluids. The child should receive

(100cc per

=

[10 kg x 100cc = 1000cc] [5 kg x 50cc = 250cc] = 1250cc total over 24 hours Divide 1250cc by 24 hours to calculate the amount of fluids the child should receive each hour: 1250cc = 52cc/hr 24 hr.

OR cc = (10kg x 100cc) (5kg x 50cc)=1000cc 250cc=1250cc x 1_ = 52cc/hr hr kg 24

3. fluids.

kg

A 25 kg child requires maintenance The child should receive:

10 kg x 100cc = 10 kg x 50cc = 5 kg x 20cc =

1000cc 500cc 100cc

16

Divide 1600 cc by 24 hours to calculate the amount of fluids the child should receive each hour: 1600cc = 67 cc/hr 24 hr. OR cc = (10kg x 100cc) (10kg x 50cc) (5kg x 20cc) = 1000cc 500cc 100cc = 1600cc x 1 = 67 cc/hr hr kg kg kg

B.

24

URINE OUTPUT

Normal urine output is: A. Infant: 2-3 ml/kg/hr B. Toddler/preschooler: 2 ml/kg/hr C. School-age child: 1 - 2cc/kg/hr D. Adolescent: 0.5-1 ml/kg/hr First: Obtain accurate wt. in kg Second: Measure urine output accurately. Third: Compute number of hours that patient voided the above amount of urine. Fourth: Use formula: Amt. of urine divided by wt. in kg divided by number of hours Example: At the end of your 8 hours shift, your 10 kg infant voided 300cc. Is this sufficient urine output for this patient? cc = 300 kg/hr

=

300cc x 1 x 3.75 cc/kg/hr 10kg

1 = 8hr

This is sufficient urine output for this patient.

80

HR 2 – 12 mos = < 160 1 – 2 yo = < 120 2 – 8 yo = < 110

RR < 2 mos = up to 60 2 mos – 1yo = 50 1 – 5 yo = 40

0 1 2

2-3 = severely depressed 4-6 = slow, irregular 7-10= vigorous

FORMULA FOR IDEAL BODY WEIGHT (NELSON) AGE At birth 3-12 months

KILOGRAMS(Kg) 3.25 Age in months + 9 2 Age in yrs. x 2 + 8 Age in yrs. x 7 – 5

1-6 yrs. 7-12 yrs.

POUNDS(lbs) 7 Age in months + 11 Age in yrs. x 5 + 17 Age in yrs. x 7 +5

none slow, irregular regular

CROUP SCORING 0 Insp. Breath normal Stridor none

1 harsh w/ rhonchi inspiratory

2 (ABW / IBW) x 100 N = 91 – 100 % 1st degree = 75 – 90 % 2nd degree = < 60

HEIGHT cm inches at birth 50 20 at 1 yo 75 30 2-12yo age(yr)x6+77 age(yr)x2.5=30

Cough Retractions

none none

Cyanosis

none

hoarse cry flaring, supraSternal retrac‟n none

2 delayed inspiratory w/ exp. bark (1) + subc. interc. Retrac‟n in 40%O2

> 6 intubate WATERLOW CLASSIFICATION WASTING: ____ABW_____ _ X 100 = % IBW for actual L. Normal = > 90 % Mild = 75 – 90 % Moderate = 60 – 74 % Severe = < 60 % STUNTING: ___Actual height___ X 100 = % Ideal Ht. for age Normal = > 95 % Mild = 90 – 95 % Moderate = 85 – 89 % Severe = < 85 %

PENICILLIN A. Aqueous PNC (PCN G Na) RD: 100 – 200 T U/k/D in 3-4 divided doses or 50 – 100 mg/k/D (IV) B. Benzathine (Penadur) RD: 600 T – 1.2M U IM q 28 days Prep: 600 T, 1.2M, 2.4M U/vial C. Phenoxymethyl PCN RD: q 6-8 H po 25 T – 50 T U/k/D; or 15 – 30 mg/k/D 625 mg 250 mg/5 ml 312.5 mg/5 ml 500 mg

= = = =

1MU 400 T U 500 T U 800 T U

Prep: IMMUNIZATIONS BCG .05 cc ID R deltoid @ birth; .10 cc L deltoid for school entrant A/R : subcutaneous abscess; LAD Ostcitis, dessiminated dse. (rare) DPT 5 cc IM upper outer thigh A/R : (w/in 48 hrs.) high fever, hypotonic Collapse or shock-like state, inconsolable Crying for 3 hrs., convulsion with or Without fever within 3 days; erythema Induration, palpable nodule, sterile abscess OPV 2 drops A/F : paralysis (rare) MEASLES .5 cc SQ outer part upper arm A/F : (w/in 7–13 days) fever for 1–2 days, Transient thrombocytopenia Encephalopathy, encephalitis Allergic rxn. , anaphylaxis, convulsions TT .5 cc IM, 2 doses @ least 4wks. Apart HIB .5 cc SC/IM A/F : pain, redness, swelling, > 24 hrs. fever HEP. B IM A/F : pain, fever, allergic rxn., anaphylaxis VARICELLA .5 ml SC A/F : fever, rashes APGAR ACTIVITY (muscle tone) 0 no activity 1 some flexion 2 very active PULSE (HR) 0 none 1 <100 bpm 2 >100 bpm GRIMACE 0 no response 1 grimace 2 good cry APPEARANCE (color) 0 blue 1 pink, bluish extremity 2 pink all over RESPIRATION

Centrapen

625 mg cap 312.5 mg/5ml susp

Megapen

625 mg cap 312.5 mg/5 ml, 50 T U/ml drops Pentacillin 500 mg cap 250 mg/5 ml susp Sumapen 250, 500 mg cap 125, 250 mg/5 ml susp

D. Isoxazole PCN RD: q 6H IV/PO 100 – 200 mg/k/D except * Prep:

Oxacillin Na (IV) Prostaphlin

250, 500 mg vial *Cloxacillin Na (PO) (Prostaphlin A) (50 – 100) 250, 500 mg cap 125 mg/5 ml susp 250, 500 mg vial *Nafcillin Na (Vigopen) (25 mg/k/D) 250 mg cap 500 mg cap 250 mg/5 ml sol‟n Fluocloxacillin Na (Stafloxin) 250, 500 mg cap 250, 500 mg, 1 g vial E. Ampicillin RD: 100 – 200 mg/k/D q 6H/8H IVTT (meningitic : 200 – 400 mg/k/D) Prep: 100 mg/ml drops 125, 250 mg/5 ml susp 250, 500 mg vial/cap

Ampicillin, Pensyn Pentrexyl (with 125 mg vial) Ampedia (with 100 mg vial) Ampicillin/Cloxacillin

(Amplicox)

Adult cap/inj 500 mg (250/250)

Ped cap/inj 250 mg (125/125) 5 ml drops (60/30) Neonatal vial (50/25) Ampicillin/Cloxacillin

(Pensyclox)

500 mg cap/inj (250/250) 250 mg/5 ml susp (125/125) 100 – 500 mg/5 ml drops Sultamicillin (Unasyn) > 375 mg vial Sulbactam Na 125 mg Ampicillin 250 mg > 750 mg vial S = 250 mg A = 500 mg Sultamicillin (PO) > 375 mg tab < 30 kg : 50 mg/k/D q 12H > 30 kg : 375 – 750 mg q 12H (adult dose) *Combination of drugs computed on the basis of Ampicillin F. Amoxicillin RD: 40 -60 mg/k/D q 8H Prep: 100 mg/ml drops 125, 250 mg/5 ml susp 250, 500 mg cap/vial*

Amoxil, Clearamox, Glamox, Himox* Moxillin*, Pediamox* (250 mg vial) Sumoxil*, Wyamox Amoxicillin/Bromhexine

(Bisolvomox, Mucomox) Cap:

Amox = 500 mg Brom HCl = 8 mg

Co-Amoxiclav

(Augmentin*, Amoclav)

RD: < 12 y.o. 25 mg/k/D q 8H po (for severe infxn. Up to 50 mg) Prep: 375 mg tab 9250/125) 625 mg tab (500/125) * 1 g tab (875/125) * 156.25 mg/5 ml susp TID (125/31.25) 228.5 mg/5 ml susp * BID (200/28.5) 457 mg/5 ml susp * BID (400/57) 312.5 mg/5 ml susp TID (250/62.5) 300 mg vial (250/50) * 600 mg vial (500/100) 1.2 g vial (1g/200) *po BID dosing prep. G. Bacampicillin RD: 25 – 50 mg/k/D q 8 – 12 H Prep:

Bacacil, Bacamcillin 400 mg tab

Penglobe

400, 800 mg tab H. Sulbenicillin RD: 20 – 80 mg/k/D up to 80 – 180 mg/k/D q 4 – 6 H Prep: Kedacillin 1-2 g vial I. Piperacillin RD: 100 – 200 mg/k/D q 6 H Severe infxn: 200 – 300 mg/k/D Prep: Cypercil 2 g vial Tazocin * 2.25, 4.5 g vial (2, 4 g Piperacillin/ .25 , .5 g Tazobactam) * usual dose : 2.25 to 4.5 g/D q 6 – 12 H

CEPHALOSPHORIN

FIRST GENERATION

1. Cephalexin RD: q 6 H 50 – 100 mg/k/D (IV) * / PO 40 – 60 mg/k/D (po) Prep:

Cefalexin, Ceporex Forexine, Keflex Lexum, Selzef

Selvispor 250, 500 mg cap 125, 250 mg/5 ml susp 100 mg/ml drops 125 mg/1.25 ml drops * 500 mg, 1 g vial

Cefalin

500mg q6H

2. Cefadroxil RD: 25 – 50 mg/k/D q 12 H Prep:

Duracef *, Kefidrox

500 mg cap 250 mg/5 ml susp * 50 mg/ml drops * 3. Cephalothin RD: 80 – 160 mg/k/D q 4 – 6 H Prep: Keflin 1 g vial 4. Cefradine RD: 25 – 50 mg/k/D q 6 – 8 H po 50 – 100 mg/k/D q 6 H * IV Prep:

Duphratex *, Sedinef * Velosef

250, 500 mg cap 125, 250 mg/5 ml susp 500 mg vial 5. Cefatrizine RD: < 12 y.o. 20 – 14 mg/k/d q 8 – 12 H For OM: 50 – 75 mg/k/D Prep:

Zanitrin

250, 500 mg cap 250 mg/5 ml susp 6. Cefazolin RD: 20 – 40 mg/k/D q 12 H Severe infxn: 50 – 100 mg/k/D q 8 H Prep:

Stancef, Lupex, zolival Zolfef, Megacef 500 mg, 1 g vial

SECOND GENERATION

1. Cefuroxime RD: 20 – 40 mg/k/D BID (po) 20 – 40 mg/k/D 50 – 100 mg/k/D q 6 – 8 H (IV) Prep: PCAP 75 – 150

Zinacef, Lifurox *

250, 750 mg vial *

Zinnat

125, 250 mg/5 ml susp 125, 250, 500 mg tab 2. Cefamandole RD: 50 – 100 mg/k/d q 4 – 8 H Prep: Mandol 1 g vial 3. Cefaclor RD: 20 – 40 mg/k//d q 8 H Prep:

Ceclor

250, 500 mg pulvules 125, 187, 250 (DS) 375 mg/5 ml susp 50 mg/ml drops 375, 750 mg CD extended release tab (BID) 4. Cefoxitin RD: 40 – 160 mg/k/D q 6 – 12 H Prep:

Mefoxin 1 g vial 5. Ceradolan RD: 40 – 80 mg/k/D q 6 – 8 H Severe infxn: Up to 160 mg/k/D Prep: Cefotiam 200 mg tab 500 mg, 1 g vial THIRD GENERATION 1. Cefotaxime RD: < 12 y.o. 50 – 100 mg/k/D q 6 – 12 H 150 – 200 mg/k/D severe infxn >12yo/adults 1gm BID Prep:

Claforan, Clavacef *

250, 500 mg, 1 g vial 2. Cefoperazone RD: 50 – 200 mg/k/D q 12 H Prep: Cefobis 500 mg, 1 g vial 3. Ceftazidime RD: 50 -100 mg/k/D q 8 H < 2 mos. 25 – 60 mg/k/D q 12 H > 2 mos. 30 – 100 mg/k/D q 8 – 12 H Prep: Fortum 250, 500 mg, 1g, 2 q vial 50 – 100 mg/k/D q 12 H 4. Ceftrixone RD: 20 – 80 mg/k/D OD 50 – 100 mg/k/D q 12 H Prep: Rocephin 250, 500 mg, 1 g vial 5. Ceftizoxime RD: 40 – 80 mg/k/D q 6 – 12 H Up to 120 mg/k/D for severe infxn. Prep: Tergecin 500 mg, 1 g vial 6. Cefixime RD: 8 – 10 mg/k/D q 12 H Up to 12 mg/k/D for severe infxn. Prep:

Tergecef

100, 200 mg cap 50 mg sachet 100 mg/5 ml susp Zefral 120 mg/5 ml 7. Ceftibuten RD: 9 mg/k/D OD Prep:

Cedax

200, 400 mg cap 36 mg/ml susp

8. Cefdinir RD: 14 mg/k/D OD or BID Prep:

Omnicef

100 mg cap 50 mg/500 mg granules 125/5 syrup 250/5 (USA) 9. Cefetamet RD: BID < 12 y.o. 20 mg/k/D > 12 y.o. 500 mg Prep:

Globocef

500 mg tab 250 mg/5 ml susp 10. Cefprozil RD: 20 – 30 mg/k/D BID Prep:

Procef

250, 500 mg tab 125, 250 mg/5 ml susp

FOURTH GENERATION 1. Cefepime RD: 50 mg/k/D q 12 H IV drip > 2 mos. , < 40 kg 100 mg/k/D q 12 H

Inc. to q 8 H severe infxn. Prep:

Cepimax 500 mg, 1, 2 g 2. Cefpirome RD: not for < 12 y.o. 1 – 2 g q 12 H Prep: Cefrom 1, 2 g AMINOGLYCOSIDES 1. Amikacin RD: 10 – 15 mg/k/D q 12 H (IV) Prep:

Amikacide, Amikin, Pediakin, Bilkin

100, 250, 500 mg 2. Kanamycin RD: 15 mg/k/D q 12 H (IV) Prep: Kanamycin Meiji 1 g 3. Gentamycin RD: 5 – 8 mg/k/D q 8 H (IV) Prep:

Garamycin

20 mg/ml, 60 mg/1.5 ml 80 mg/2 ml Servigenta 80 mg/2 ml 4. Tobramycin RD: 6 – 8 mg/k/D q 6-8 H (IV) Prep: Nebcin 20, 80 mg/2 ml 5. Netilmycin RD: 6 – 8 mg/k/D q 8 H (IV) Prep:

Netromycin

50, 100 mg/2 ml 150 mg/1.5 ml 6. Streptomycin (Anti-TB) RD: 20 mg/k/D q 12 H (IV) Prep: 1 g vial 7. Neomycin RD: 50 mg/k/D q 6 H PO (ETEC)

MACROLIDES 1. Erythromycin RD: q 6 H 30 – 50 mg/k/D po 20 mg/k/D (IV) Prep:

Erymax

250 mg cap 40 mg/ml susp

Erycin

250, 500 mg tab 200 mg/5 ml susp 100 mg/2.5 ml drops

Erythrocin

400 mg/5 ml DS 500 mg vial

Ethiocin, Macrocin Ilosone / DS 500 250 125 250 100

mg tab mg pulvules mg/5 ml liq mg/5 ml DS mg/ml drops Servitrocin (no drops) 2. Spiramycin RD: 2 – 3 tabs daily (adults only) Prep: Rova 3 3 MIU tab 3. Roxithromycin RD: 5 – 8 mg/k/D * or > 40 kg 150 mg tab BID 24 – 40 kg 100 mg tab BID Prep:

Macrol / Macrol Kiddie

150 mg tab/100 mg tab

Rulid 100, 150 mg tab

4. Clarithromycin RD: 15 mg/k/D BID (max 500 BID) Prep:

Klaricid

125 mg/5 ml susp 250, 500 mg tab 5. Dirithromycin RD: 500 mg OD (adults only) Prep:

Dynabac, Onzayt

250 mgtab 6. Azithromycin RD: 10 mg/k/D (for 3 D); or 10 mg/k/D in D1, 5 mg/K in D2-4 Prep:

Zithromax

250 mg cap 200 mg/5 ml susp

TETRACYCLINE C/I : < 8 y.o.

Microbid

tab 160/800 Cap 80/400 5 ml susp 40/200

Septrin Forte

tab 160/800 Cap 80/400 5 ml susp 40/200

Triglobe Forte

tab 180/820 Tab 90/410 5 ml susp 45/180 CHLORAMPHENICOL RD: Prep:

1. Doxycycline RD: 5 mg/k/D BID/QID Prep:

Atrax, Biocolyn, Doryx, Doxin, Servidoxyne, Vibramycin *, Doxicon 50 *, 100 mg cap

2. Oxytetracycline RD: 25 – 50 mg/k/D q 6 H po Prep:

Leydoxycycline *, Terramycin

250, 500 mg cap 125 mg/5 ml susp * 3. Tetracycline RD: 25 – 50 mg/k/D q 6 H po Prep:

Hostacycline, Unimycin *

500 – 100 mg/k/D q 6 H IV/po Meningitis : 100 – 200 mg/k/D q 6 H

Biomycetin (no 250 cap) Chloramol, Chloramycetin Pediachlor (no cap) *, Plivacol (no susp) * Kimicetine * 250, 500 mg cap 125 mg/5 ml susp 1 g vial

CLINDAMYCIN RD: Prep:

20 – 40 mg/k/D q 6 – 8 H (IV/IM) 10 – 25 mg/k/D TID/QID po

Dalacin C

150, 300 mg cap 75 mg/5 ml granules 150 mg/ml amp.

LINCOMYCIN (For PCN allergy)

250 *, 500 mg cap

RD: QUINOLONE 1. Nalidixic acid RD: 33 – 55 mg/k/D q 6H Prep:

Wintomylon

500 mg tab 250 mg/5 ml susp 2. Ciprofloxacin RD: 10 mg/k/D q 12 H (IV) 12 mg/k/D q 8 – 12 H po Prep:

Ciprobay

250, 500 mg tab 100 mg/50 ml, 100 mg/100 ml 400 mg/200 ml infusion 3. Ofloxacin RD: q 12 H 5 mg/k/D IV 10 mg/k/D po Prep:

Inoflox Qinolon

200, 400 mg tab 200 mg/100 ml inj.

SULFONAMIDE RD: BID TMP 8 – 10 mg/k/D * SMZ 40 – 50 mg/D (or 1 cc/k/D; prep = 40/200) Prep:

Cotrimoxazole Bacidal Forte

tab 160/180 5 ml susp 80/400

Bactrim

tab 80/400, 160/800 5 ml susp 40/200 40/5

Cotrimazine Forte tab 180/820

Prep:

30 – 60 mg/k/D TID po 10 mg/k/D q 24 H IV

Lincocin

250, 500 mg cap 250 mg/5 ml susp 600 mg/2 ml inj

NITROFURANTOIN RD: 5 – 7 mg/k/D q 6 H Prep:

Macrodantin

50, 150 mg cap

LORACARBEF RD: 15 – 30 mg/k/D q 12 H Prep:

Lorabid

100, 200 mg/5 ml susp 200 mg pulvule

IMEPENEM / CILASTIN RD: 60 mg/k/D q 6 H Prep: Tienam (500/500) 1 g vial VANCOMYCIN RD: 40 – 60 mg/k/D q 6 -12 H Prep: 500 mg vial MEROPENEM RD: 60 – 120 mg/k/D q 8 H Prep: Meronem 500 mg, 1 g vial

5 ml susp 45/205

ANTI - TUBERCULOSIS

Globec

tab 80/820 5 ml susp 45/205

Globaxol

cap 80/400 5 ml susp 40/200

Lipadrim Forte

tab 160/800 5 ml susp 40/200

1. INH RD: OD/BID Px : 10 mg/k/D Tx : 10 – 20 mg/k/D Adults : 5 mg/k/D max 300 mg Prep: Nicetal Forte tab 400 mg 100 mg/5 ml susp

Odinah

tab 400 mg 150 mg/5 ml susp * Comprilex 200 mg/5 ml susp Trisofort tab 400 mg 200 mg/5 ml liq Trisovit tab 100 mg 50 mg/5 ml liq 2 kit : Curazid 200/5 2. Ethambutol RD: OD < 12 y.o. : 10 – 15 mg/k/D > 12 y.o. : 15 – 25 mg/k/D Max 2500 mg/D Prep:

Ebutol

400 mg E-200 mg INH tab 125 mg – 100 mg/5 ml syr

Ethambin – INH

200 mg – 100 mg tab 125 mg – 150 mg tab

Ethamizid

400 mg – 200 mg tab 3. Rifampicin RD: 10 – 20 mg/k/D OD Adults : 10 – 20 mg/k/D OD (max 600 mg/D) Meningo px. < 1 mo. 10 mg/k/D OD for 4 days Others : 20 mg/k/D OD up to 600 mg/D for 4 days Prep: * Natricin 300, 450 mg cap 100, 200 mg/5ml susp Rimaped 100 mg/5ml syr

* Rimactane Forte

Rifadin

150, 300 mg cap 450, 600 mg tab 100, 200 mg/5 ml syr 150, 300, 450, 600 mg cap 100 mg/5 ml susp

4. PZA RD: 15 – 40 mg/k/D OD/BID (max 2 g/D) 2 cure = kidz kit 250/5 Prep:

PZA-Ciba

500 mg tab 250 mg/5 ml susp 5. Streptomycin RD: 20 – 30 mg/K/D OD IM - ototoxic

100 mg/5 ml susp 4. Diloxanirde furoate RD: 20 mg/k/D TID x 10 days Prep:

Furamide

500 mg tab, 125 mg/5 ml susp 5. Tinidazole RD: 50 – 60 mg/k/D OD x 3 days Prep:

Fasigyn

300, 500 mg tab

FOR AGE 1. Furazolidone RD: 5 – 7 mg/k/D QID Prep:

Furoxone

100 mg tab 16.7 mg/5 ml liq

Diafuran, F-Zolidone

100 mg tab 50 mg/5 ml susp 2. Nifuroxazide RD: < 6 mos. – 1 tsp BID > 6 mos. – 1 tsp TID Adult - cap QID Prep:

Ercefuryl

200 mg cap 220 mg/5 ml susp 3. Infloran Berna 1 cap TID ANTI – HELMINTHICS 1. Piperazine citrate RD: 75 – 100 mg/k OD x 2 days Prep:

Tabeel

1.25 g/5 ml syr 2. Pyrantel pamoate RD: 10 – 20 mg/k SD (q 3 mos) Prep:

Combantrin

125, 250 mg tab 125 mg/5 ml susp

Quantrel

100 mg tab, 20 mg/ml susp 3. Mebendazole (not for < 2 y.o.) RD: 100 mg/D BID for 3 days Prep:

Antiox

ANTI – AMOEBICS 1. Metronidazole RD: 40 – 50 mg/k/D TID or q 8 H (IV/PO) IV drip = 7.5 mg/k/D q 8 H Prep:

100, 500 mg tab 20, 50 mg/ml susp 4. Tetramisole RD: 2.5 mg/k SD Prep:

TMZ

50, 100 mg tab 12.5 mg/5 ml syr

Anaerobia

250, 500 mg tab 125 mg/5 ml susp 500 mg inj

Flagyl, Triconex, Rodazid

500 mg forte tab 125 mg/5 ml susp 500 mg inj Metroxyn 500 mg tab Servizole 250, 500 mg tab 200 mg/5 ml susp 500 mg inj 2. Secnidazole RD: 30 mg/k SD or in 2 divided doses w/in 4 hrs. 3D treatment 1 tab TID (adult) 25 mg/k/D (child) Prep:

Flagentyl

500 mg tab 500 mg/15 ml susp 25 mg/20 ml susp 3. Etofamide RD: 15 – 20 mg/k/D TID for 3D Prep:

Kinox

200, 500 mg tab

ANTI - FUNGAL 1. Nystatin RD: infant : 2 ml QID Adult / children : 4 – 6 ml QID 1 – 2 tab TID Prep:

Mycostatin

500 T U tab 100 T U/ml susp 2. Amphotericin B RD: 250 ug/k with grad. inc. to total 1 – 1.5 mg/k/D Prep:

Fungizone

50 mg/10 ml vial 3. Griseofulvin RD: 10 mg/k/D 4. Fluconazole RD: Px : 3 mg/k/D OD x 1 wk. Tx : 6 mg/k/D OD Prep:

Diflucan

50, 150, 200 mg cap 2 mg/ml vial 5. Terbinafine

RD: OD > 40 kg 20 – 40 mg < 20 mg Prep:

250 mg 125 mg 62.5 mg

Lamisil

250 mg tab 6. Ketoconazole RD: OD > 30 kg 200 mg 15 – 30 mg 100 mg < 15 mg 5 mg/day Prep:

Nizoral

200 mg tab

ANTI – VIRAL 1. Methisoprinol RD: 50 – 100 mg/k/D TID or QID Prep:

Isopronosine

500 mg tab 250 mg/5 ml syr 2. Amantadine RD: 5 – 8 mg/k/D BID (max 150 mg/D) Adult – 200 mg/D Prep:

Symmetrel

100 mg tab 50 mg/5 ml syr 3. Acyclovir RD: 20 mg/k/D q 4 H (5x/D, miss mn dose) Prep:

Zovirax

200, 400, 800 mg tab 250 mg vial 4. Inosiplex RD: 50 mg/k/D q 6 H Prep:

Immunosin

500 mg tab 250 mg/5ml syr

MUCOLYTICS 1. Carbicisteine RD: 20 – 30 mg/k/D TID/QID Prep:

Loviscol

500 mg cap 100, 250 mg/5 ml syr 50 mg/ml drops 2. Ambroxol RD: 1.2 – 1.6 mg/k/D q 12 H Prep:

Ambrolex *, Salvotran Mucosolvan ** 30 mg tab 15, 30 mg/5 ml syr 7.5 mg/ml drops *

6 mg/ml drops ** Inhalation sol‟n 15 mg/2 ml ** 15 mg/2 ml amp **

ANTI – HISTAMINE 1. Diphenhydramine RD: 5 mg/k/D q 6 H 1 – 2 mg/k/D q 6 H Prep:

Benadryl

25.5 mg cap 125 mg/5 ml syr 50 mg/ml amp 2. Chlorpheniramine RD: 0.35 mg/k/D q 6 H Prep: Cohistan 4 mg tab 2 mg/5 ml syr Histacort (2 mg C - 2mg Prednisone)

Naafarin A, Tuseran, Myracof AF/F, Sinutab, Neozep

> 12 y.o. 1 – 2 tab or 2 tsp 7 – 12 y.o ½ tab or 1 tsp 2 – 6 y.o. ½ tsp TID/QID 3. Loratadine RD: 0.16 mg/k/D OD or 1 – 2 y.o. 2.5 ml 2 – 12 y.o., < 30 kg 5 ml > 30 kg 10 ml Adult 1 tab or 10 ml Prep:

Claitin, Loradex

10 mg tab 5 mg/5 ml syr 4. Astemizole RD: OD < 6 y.o. 2 mg/10 kg 6 – 12 y.o. ½ tab, 5 ml > 12 y.o. 1 tab Prep:

Hismanal

10 mg tab 1 mg/ml susp 5. Clemastine RD: 0.05 mg/k/D q 12 H Prep: Tavegyl 1 mg tab .5 mg/5 ml syr Tavist 1 mg tab .5 mg/5 ml syr 6. Cetirizine RD: 0.25 mg/k/D OD or Adult, > 12 y.o. 1 tab OD 6 – 12 y.o. ½ tab BID or 1 tab OD or 10 drops BID or 10 ml OD or 5 ml BID Prep:

Virlix, Zyrtec *

10 mg/ml drops 10 mg tab 1 mg/ml sol‟n * Anerkid 2.5 mg/ml Atnix 2.5 mg/ml 7. Hydroxyzine RD: 1 mg/k/D OD or 1 – 5 y.o. 5 – 10 mg 6 – 10 y.o. 20 – 30 mg Adults 25 – 50 mg Prep:

Iterax

10, 25 mg tab 2 mg/ml syr

DECONGESTANT 1. Loratadine / Pseudoephedrine RD: BID > 12 y.o. 1 tab > 30 kg 5 ml < 30 kg 2.5 ml Prep: Clarinase tab 5/120 Syr 5 – 60/5 ml 2. Brompheniramine / Phenylephrine Phenylpropanolamine Prep: Dimetapp TID/QID Syrup 4 – 12 y.o. 1 tsp 2 – 3 y.o ¾ tsp Drops 7 – 24 mos. 1 ml 1 – 6 mos. .5 ml

ANTI – ASTHMATICS 1. Epinephrine RD: 0.1 – 0.2 cc/kg/D 1 : 10,000 - 1 cc/k/D SQ/IVTT 1 : 1,00 - 0.01 cc/k/D SQ 2. Terbutaline RD: .005 mg/k/D rpt prn after 20 min. SQ (onset 30 min) .075 * - .1 mg/k/D TID po (onset 2 – 3 min) (wt x .25 = cc) Prep:

Bricanyl / expectorant * (with Guaifenesin), Pulmoxel * 2.5 mg tab, 5 mg ER tab .3 mg/ml syr .25 mg/D misthaler, inhaler

500 ug/D turbuhaler 5 mg/2 ml neb sol‟n .5 mg/ml amp 1.5 mg/5 ml syr * 3. Salbutamol RD: 0.12 – 0.15 mg/k/D q 6 H (wt x .375 = cc) Prep:

Ventolin, Librentin, Asmalin

2 mg tab 2 mg/5 ml syr 2.5 mg/2.5 ml, 5 mg/2.5 ml neb 4. Aminophylline RD: children LD 5 – 10 mg/k MD 3 – 5 mg/k/D q 8 H Slow IVTT in 20 min Apnea of prematurity: LD 5 – 6 mg/k MD 2 mg/k/D Drip : .4 - .9 mg/k/H Eg: 5kg @ .4 mg/k/H in 8 H If IVF rate is 5cc/H, fill Soluset w/ 40cc IVF + Amino 16 mg (.64 ml) Prep: 25 mg/ml amp 5. Bambuterol RD: not for < 2 y.o. , OD A : 10 mg B : 5 mg Prep: Bambec 10 mg tab, 1 mg/ml sol‟n 6. Theophylline RD: 3 – 5 mg/k/D q 6 H po Prep: Brondil 130 mg tab 25 mg/5 ml elixir Nuelin 125 mg tab 175 mg SR tab 80 mg/15 ml syr 7. Ketotifen RD: BID > 3 y.o. / A 1 mg 6 mos – 3 y.o. 1 drop or .1 mg/k/D Prep:

Zadec / SRO, Zaditen / SRO 1 2 1 1

mg tab mg SRO tab mg/5 ml syr mg/ml drops

ANTIPYRETICS / ANALGESICS 1. Paracetamol RD: 10 – 15 mg/k/D q 4 H Prep: 100mg/ml (drops) 120mg/5ml or 250mg/5ml (syr) 500mg tab Calpol ,Tempra, Biogesic 2. Ibuprofen / Paracetamol RD: 5 – 10 mg/k/D q 6-8 H Prep: Dolan FR 100mg/5ml, 200/5 (syr) 3. Aspirin RD: 10 – 20 mg/k/D (Gr 1 = 65 mg) Prep: Aspilet 80 mg tab Cor 30 30 mg tab Ascriptin 325 mg tab (w/ Al(OH)3, Mg(OH)2) For: RF : 65 – 130 mg/k/D Arthritis : 40 – 60 mg/k/D KD : 80 – 100 mg/k/D (febrile stage) 3 – 5 mg/k/D (afebrile stage) 4. Indomethacin RD: fever : 1 mg/k/D TID anti - inflam. : 2 – 4 mg/k/D TID PDA closure : .2 - .3 mg/k/D q12 – 24 H x 3 doses Prep: Indocid 25 mg cap Infree 100 mg cap 5. Mefenamic Acid RD: 3 – 5 mg/k/D

5 – 8 mg/k/D q 6 – 8 H PDA closure : 2 mg/k/D q 8 H x 3 doses Prep:

Ponstan / SF

250 mg, 500 mg cap 50 mg / 5 ml susp

NARCOTIC ANALGESIC 1. Meperidine RD: I/C .8 – 1.3 mg/k/D q 3 – 4 H (IM / SC) 1 – 2 mg/k/D q 2 H (IV) adult : 50 -150 mg q 3 – 4 H Prep:

Demerol 50 mg vial

100 mg/2 ml 2. Nalbuphine RD: SC, IM, IV q 3 – 6 H prn C : .1 - .2 mg/k/D A : .15 - .2 mg/k/D Max : 10 mg Prep: Nubain 10 mg/ml amp 3. Morphine RD: .1 - .2 mg/k/D q 2 – 4 H (IM / SC / IV) .01 - .1 mg/k/H cont. infu. Prep: 16 mg/ml amp (add 15 ml dose H2O to make 1 mg/ml prep.) 4. Fentanyl RD: for analgesia .5 – 2 ug/k/dose q 1 – 2 H IV for anesthesia N 10 ug/k/D I 15 – 50 ug/k/D C 50 – 100 ug/k/D Prep: Sublimaze .05 mg/2 ml 10 ml amp Other drugs for Sedation 1. Midazolam RD: 0.1 mg/k/D Prep:

Dormicum

15 mg tab 5 mg/ml, 5 mg/5 ml 15 mg/3 ml amp 2. Ketamine RD: 1 – 2 mg/k/D (IM) 0.5 – 1.5 mg/k/D (IV) 6 – 10 mg/k/D (po) Prep: Ketalar 50 mg/ml inj ANTACIDS 1. Cimetidine RD: q 4 – 6 H (pc meals) N 10 – 15 mg/k/D < 1 y.o. 20 mg/k/D 1 – 12 y.o. 20 – 40 mg/k/D A 200 mg BID po (max 800 mg q HS) 200 mg q 4 – 6 H IV Prep:

Tagamet

200 , 400, 800 mg tsb 100 mg/5 ml liq 200, 300 mg/2 ml amp 2. Famotidine RD: q 12 H C .7 mg/k/D A 20 – 40 mg Prep:

H2Bloc, Pepcidine

20, 40 mg tab 20 mg/2 ml amp 3. Sucralfate RD: QID (1 H ac meals, HS) C : < 6 y.o. .5 g/D > 6 y.o. 1 g/D A : 1 g/D Prep: Iselpin 500 mg, 1 g

4. Omeprazole RD: OD C : .5 mg/k/D A : 20 – 40 mg Prep: Losec 10, 20 mg cap 40 mg/10 ml inj 5. Ranitidine RD: C: 1.5 mg/k/D q 6 H (IV) 2 mg/k/D q 6 – 8 H (po) A: 50 mg q 6 – 8 H (IV) 150 mg q 8 – 12 H (po) Prep: Pylorid 400 mg tab

Ranix, Zantac */FR

150, 300 mg tab 150 mg/10 ml syr * 50 mg/2 ml amp 6. Al (OH)3 / Mg (OH)2 RD: QID (pc meals & at HS) 2 – 4 tabs, 1 – 2 tsp Prep:

Mucaine, Novaluzid Simeco, Mylanta Tab, susp

ANTISPASMODICS 1. Hyosine RD: PO A / > 6 y.o. 1 – 2 tabs 3 – 5x / D 10 – 20 ml 3 – 5x / D < 5 y.o. 5 – 10 ml TID Infant 5 ml TID IV / IM / SC A : 1 – 2 amp (max 100 mg/D) C : ¼ amp TID Prep: Buscopan (plus w/ para) 10 mg tab 5 mg/5 ml liq 20 mg amp

Spasmolysin

10 mg tab 20 mg/ml amp 2. Dicycloverine / Dicyclomine RD: 15 min. ac meals : TID / QID Not for 6 mos. C : 2 – 12 y.o. 10 mg 6 mos – 2 y.o. 5 – 10 mg or .5 – 1 ml drops < 6 mos. 3 mg/k/D Prep:

Bentyl *, Relestal ** 10 mg tab * 10 mg/5 ml syr 5 mg/ml drops **

OTHER GIT REGULATOR 1. Cisapride RD: ac meals, TID C .6 - .9 mg/k/D or 5 mg/D A 15 – 40 mg/D Prep: Prepulsid 5 mg tab 1 mg/ml susp 2. Metoclopramide RD: q 8 H C .1 - .5 mg/k/D A 1 tab Prep: Plasil 10 mg tab 5 mg/5 ml syr 10 mg/2 ml amp 3. Domperidone RD: TID / QID Dyspepsia A : 1 tab or 2 tsp C : 7.5 mg/k/D Nausea / Vomiting A : 2 tabs or 4 tsp

C : 15 – 20 ml/10 kg/ Prep: Molitium 10 mg tab 1 mg/ml susp EMERGENCY MEDICINES Atropine 0.02 – 0.03 Mkd Naloxone 0.1 Mkd Plain 0.4 / 1 Neonatal 0.02 / 1 Captopril 0.3 – 1 Mkd q 12 H Capoten 25 mg tab L-Carnitine 30 – 40 Mkd Carnicor po 1 g / 10; 330 IV 1 g / 5 Hydralazine 0.1 – 0.5 Mkd Apresoline IV 20 / amp; Tab 10, 25 Lidocaine 1 Mkd bolus 10 – 50 ugKm Adenocard initial 6 mg then 12 mg Adenosine 6/2 10% Ca Gluconate 0.1 – 0.2 Mkd Mannitol 20% 0.25 – 0.5 Mkd NaHCO3 1.5 – 2 Mkd Prep 1.2% sol‟n (1 med/ml) DOPAMINE RD: 1 – 5 ug/k/min = VD, inc renal and splanchic circ. 5 – 10 ug/k/min = inc cardiac contractions w/o effect on HR 10 – 20 ug/k/min = inc BP  Rule of 6 (Docard 40 mg/ml) Wt. x 6 = mg of Dopa to make 100cc Mg div. 40 = ml of Docard + D5W Rate = dose (1cc/H = 1 ug/k/min)  Pre mixed (200 mg/250 ml) Rate (cc/H) = wt. x dose 13.3  3 mg/k + 50 ml D5W or 15 mg/k + 250 ml D5W Ug/k/min = cc/hr  15 mg/k + 50 ml Ug/k/min = 5 x cc/hr DOBUTAMINE RD: 2 – 20 ug/k/min Prep: 250 mg/20 ml inj > to make sol‟n for desired rate and Conc. – same with Dopa DIURETICS Furosemide

1 – 2 MKD 20/2; 40 20/2; 20; 40 Diazoxide 5 – 10 MKD 300/2 Acerazolamide 20 – 30 MKD Diamox 250/tab Spironolactone 1.5 – 3 MKD Aldactone 25/tab Hydrochlorothiazide 1 – 2 MKD Dichlotride 25, 50/tab Mannitol 20% 1.5 – 2g/k/D or 5 cc/k/D 200 g/L 1 g = 5 cc 0.5 – 1 g/k/D

Lasix Frusema

ANTICONVULSANTS Diazepam 0.2 – 0.4 Mkd (max 2 – 5 mg) Valium 10/2 ; Trazopam 10/2 Phenobarbital LD 15 – 20 Mk MD 5 MkD q 8 H Luminal IV 130/1 Po 20/5 (Gr 1 = 65 mg) Gr 1, ½ , ¼ Carbamazepine 10 – 20 MKD Tegretol 100/5; 200 Phenytoin LD 15 – 20 MK MD 5 – 8 MkD Dilantin IV 100/2 Po 30/5, 125/5, 30, 100 Clonazepam 0.01 – 0.03 MKD For Bael LD 0.03 MK MD 0.08 MKD q 12 H Rivotril 2/tab Valproic acid 15 MKD Depakene 250/5 Epival 250/ta

Lorazepam 0.05 – 0.1 MKD (max 0.4 MK) Midazolam (Dormicum) 0.1 – 0.2 MKD DIAZEPAM DRIP 0.3 MKH dilute in NSS to make 0.1 mg/ml

every 1 mEq/L inc. HCO3 RESPIRATORY ACIDOSIS Acute : 1 mEq/L inc. HCO3 for every 10 mmHg inc pCO2 Chronic : 3 – 5 mEq/L inc. HCO3 for Every 10 mmHg inc. pCO2

Conc. = mg/ total vol (ml) Rate = RD x wt x 60 Conc. AD = rate x conc. Wt. x 60

RESPIRATORY ALKALOSIS Acute : 2 – 2.5 mEq/L dec HCO3 for Every 10 mmHg dec pCO2 Chronic : 4 – 5 mmHg dec HCO3 for Every 10 mmHg dec pCO2 FLUIDS AND ELECTROLYTES

LUMBAR TAP Pressure (in cm H2O) G 22 (1 & ½ ) = gtts in 21 sec G22 (3 & ½ ) = gtss in 39 sec G20 (3 & ½ ) = gtss in 12 sec

IMB NM NSS LR .3 Na .45Na

WBC correction in Hemorrhagic tap : Periph WBC x 1000 = WBC 5,000,000 1000 RBC C/I : 1. Increase ICP 2. severe Cp compression 3. infected skin (absolute) 4. decrease plt or bld d/o 5. brain abscess ANTIDERMATOSIS Hydrocortisone 1% TID 2 wks.

Hytone, Eczacort

Betamethasone BID – TID

Betnovate, Diprolene, Diprosone

Fluocinolone Acetonide BID – TID Aplosyn 10, 25, HP Synalar 10, 25, HP Mometasone Furoate OD

Elica

Clobetasole Propionate

Dermovate

Triamcinolone Acetonide BID – TID

Kenacort A, Ladecort A

BLOOD TRANSFUSION FWB – in 6 H = (des – act Hct) x wt. = (des – act Hb) x wt. x 2 x 3 = 20 cc/kg pRBC – in 4-6 H = (des – act Hct) x ractions = (des – act Hct) x P (VC) = (des – act Hb) x 2 X wt. = 10 cc/kg Plt conc – in MFD = 1 „U‟ / 6 KBW 1 „U‟ = 30 – 50 cc will raise plt by 10T Plt rich plasma – in 4 H Actual Retic ct. (ARC) : Actual Hct x retic ct. Desired HCt Retic Index : ARC or Hct x 2 2 retic > 2 hemolysis < 2 RBC suppression Double Vol. Exchange transfusion : = KBW x est. body vol. x 2 Partial Exchange Transfusion = KBW x est. vol. x (A-D Hct) Actual Hct A B G NORMAL VALUES pH = 7.35 - 7.45 = 7.4 pCO2 = 35 – 45 = 40 HCO3 = 22 – 26 = 24 O2 = 80 – 100 % METABOLIC ACIDOSIS (HCO3) pCO2 = 1.5 (HCO3) + 8 + 2 METABOLIC ALKALOSIS 0.6 – 0.7 mmHg inc. pCO2 for

Na K Cl HCO3 25 20 22 23 40 13 40 16 154 154 130 4 109 28 51 51 77 77

Ca 3 3 3 -

PO4 3 3 3 -

Types of IV Fluids : 1. HYPO - D5W, D5NM, D50, .3 NaCl, D5 IMB Isolyte, D5 maintesol 2. ISO - D5LR, D5NSS, D5NK, LR, NSS 3. HYPER – D50W, D10W

IVF OF CHOICE : LBM D5LR Vomiting D5 NSS Maintenance D5 NM BA D50 .3 NaCl fever & Sweating D50 .3 NaCl / D5W Drowning D5W Ascitis D5W / D10W CHF D5 NSS HPN D5W / D5LR watch BP Heart stroke D5NSS Burns D5LR Azotemia D5W Inc Burn D10W Bleeding D5LR UTI D5NSS Profuse Bleeding D5LR DF D5 0.3% NaCl DM PNSS MAINTENANCE FLUID =(BCE) (wt.) (1.5 ml/k) NB 45 – 50 cal/k/D 3 – 10 m 60 – 80 10 – 15 m 45 – 65 15 – 25 m 40 – 45 25 – 35 m 35 – 40 34 – 60 m 30 – 35 > 60 m 25 – 30 < 10 kg : 100 cc/k/D > 10 kg : 50 cc/k in excess of 10 k + 1000 > 20 kg : 20 cc/k in excess of 20 k + 1500 = + 12% for q degree rise in temp (fever) = + 15% for hyperventilation/dyspnea = + 50% for BA = + 20% for photo tx Renal px : SA x 400 + UO in 24 H Cardiac px : SA x 800 Surface area : 0 – 5 kg = 6 – 10 kg = 10 – 15 kg = 15 – 20 kg =

wt. wt. wt. wt.

x x x x

.05 .04 .03 .02

+ .05 + .10 + .20 + .40

FLUID PLAN > w/o electrolytes Deficit : Na K Cl/k Mild 4 3 3 Mod 8 6 6 Severe 12 9 9 Maintenance : 3 2 2 > w/ electrolytes Deficit : (desired – actual) x wt. x .6

Maintenance : 3 mEq/k for Na 2 m Eq/k for K

60 x 24 x wt. IV rate x conc. wt. x 60

Deficit + Maintenance = total req’t. Na req‟t given in 2 days K req‟t given in 3 days * full K incorporation = 40 mEq/L Na : 1 mEq = 23 mg K : 1 mEq = 39.1 mg FLUID REQ’T FOR NB’S Day 1 term 65 cc/k/D Preterm 75 – 85 2 80 3 80 – 100 4 110 -120 5 130 – 140 6 150 7 120 8 100 CALORIC REQ’T <1m 1 – 11 m 1 – 2 y.o. 3 – 6 y.o. 7 – 9 y.o. 10 -12 y.o 13 – 15 y.o. 16 – 19 y.o.

110 – 140 cal/k/D 110 – 115 100 – 110 90 – 100 80 – 90 70 – 80 55 – 65 45 – 50

Total Caloric req’t – div into 50% CHO div 4 = gm 15 % fats div 9 = gm 35% CHON div 4 = gm Nestle (1:1) Nan / HA 1 & 2

Prenan, Neslac (> 1 y.o.), Nestogen 1 & 2 Lactogen 2, Primolac (> 6 m), Al 110 (lac intol) Alfare (sev diar) Wyeth (1:2) Bonna, Bonamil, S 26 / LBW Promil, Nursoy (lac intol) Abott (1:2) Similac Avd / PM 60/40 Gain, Grow (> 1 y.o.), Pediasure (1-10 y.o.) Isomil (allergy) VAMIN RD: SD .5 g/k/D CHON (up to max 2.5 – 3 g/k/D) 5 – 9 mg/k/D gluc Prep: (per liter) CHON 60 gm Gluc 100 gm Cal 650 cal E.g: wt 1 kg 1 kg x .5 g/k/D x 100 = cc of Vamin 6 Cc o Vamin x .65 = cal/Day AMINOSTERIL Prep: (per liter) Infant 6% 240 kcal, 60 gm CHON 100% 400 kcal, 100 gm CHON Wt. x RD x 100 = cc of Amino 6% 6 cc of Amino x .24 = cal/D INTRALIPID RD: .5 – 2 g/k/D Prep: 10% = 100 gm/L = 1100 cal/L 20% = 200 gm/L Wt. x RD x 100 = cc of Intra 10% 10 Cc of Intra x 1.1 = cal/D LIPOVENOUS Prep: 10% = 100 gm/L = 1080 cal/L GLUOSE DELIVERY RATE N = 5- 8 mg/k/min. IV rate x conc. x 24 H

OR

Concentration (Dextrosity) D5 = 50 mg D10 = 100 mg D7.7 = 75 mg D50 = 500 mg Preparation of desired Dextrosity: Desired conc. – present conc. x 2 100 = product X total volume needed Eg. D10 – D5 x 2 = 1 100 If total vol. needed is 100cc : 100 cc x .1 = 10 cc D50 W + 90 cc D5 IVF to make a 100 cc of D10 IVF DEHYDRTION (CDD) Pediatrics None vol/vol replacement < 1 y.o. 50 – 100 cc/LBM > 2 y.o. 100 – 200 cc/LBM Some : 75 ml x wt(kg) for 4 H Assess q 4 H; IV = 8 H Severe : < 1 y.o. > 1 y.o. Kg x 30 1 hr. 30 min. Kg x 70 5 hrs. 2.5 hrs. Adults: Mild Moderate Severe Kg x 30 (50) kg x 60 (100) kg x 90 (150) In 8 hrs. ¼ in 1st hr. 1/3 in 1st hr. ¾ in 7 H 2/3 in 7 H Computed deficit / 4 = gtts/min 1 macrodrop = 4 udrop MALCOLM HOLIDAY Mild Moderate Severe < 2 y.o. 50 100 150 > 2 y.o. 30 60 90 (1/4 tab in 1st H, ¾ in 7 H) Hydrite Glucost Oresol Glucolyte

-

ORS 90 Pedialyte 90 Pedialyte 45 Hydrite 90

1 tab in 100 cc water - 8H 1 sachet in 100 cc water - 8 H 1 sachet in 1 L water - 24 H 1 sachet in 200 cc water 20

80

90

20

45 20

20 80

30

(gluc 20) (citrate 30) 80 dext 25 (citrate 30) 35 dext 20 30 gluc 111

TREATMENT OF PNEUMONIA CARI 2 mos – 5 y.o. MILD PNEUMONIA Send home, Cotrimoxazole, tx fever, Check child back 2 – 4 days after SEVERE PNEUMONIA Admit, give IV/IM Benzyl PCN, tx fever, Tx wheezing, supportive care Reassess daily VERY SEVERE PNEUMONIA Admit, give O2, Chloramphenicol, tx fever And wheezing prn, reassess 2x daily (q 15 min. if possible) < 2 mos. SEVERE PNEUMONIA Hospitalize Keep warm Give first dose of Antibiotic Benzyl PCN Garamycin Gentamycin CPAP TFR = wt. x TV (10 – 15) x RR x IE ratio (2) = 2000 (2L) FIO2 = CA (0.2) + O2 (1) x 100 TFR

CA O2

= 100 – FIO2 x TFR 79 = FR – CA

ET size

> 2 y.o. = age(yrs) + 16 4

STAGES OF DHF I. Febrile II. Afebrile III. Convalescent Grading of Fever I. fever w/ no specific constitutional s/sx (+) Tourniquet test II. (+) Spont. Bleeding of skin III. Circulatory failure manifestations: - rapid & weak pulse, narrow pulse pressure/ hypotension w/ presence of cold clammy extremities IV. Profound Shock w/ undetectable blood pressure and pulse DAY 1 – 5 = PETECHIAE, FEVER DAY 5 – 7 = BLEEDING DAY 8 = SHOCK

DEVELOPMENTAL MILESTONES Gross Motor : Mos Head steady in sitting Pull to sit, no head lag Hands together in midline Asymmetric tonic neck Neck reflex gone Sits w/o support Rolls back to stomach Walks alone Runs Fine Motor : Grasps rattle Reaches for object Palmar grasp gone Transfers obj. hand to hand Thumb finger grasp Turn pages of a book Scribbles Builds tower of 2 cubes Builds tower of 6 cubes

2 3 3 4 6 6.5 12 16 Mos 3.5 4 4 5.5 8 12 13 15 22

CLASSICAL FEVER

Communication & Language :

DIGITALIZATION TDD : 0.04 = 0.06 Mk 1st dose : ½ of TDD 2nd dose : ¼ of TDD (8 H) 3rd dose : ¼ of TDD (6 H) 2 H after, start MD – ½ of TDD OD ½ of TDD BID Adult : TDD 0.5 – 1.5 MkD MD 0.125 – 0.25 Md

Smiles in response to face, voice Monosyllabic babble Inhibits to “no” Follows 1 step command w/ gesture follows 1 step command w/o gesture Speaks 1st real word Speaks 4 – 6 words Speaks 10 – 15 words Speaks 2 word sentences

- Thrombocytopenia not < 100T - Hemoconcentration not > 20% of baseline

Caffeine Na Benzoate 0.1 – 0.2 cc IM Prep: 5/ml; 10/ml Furosemide 1 -2 MKD Lasix 40/tab; 20/2 inj Atropine Sulfate Pedia : 1 – 2 mEq SQ q 20 min 0.2 MKD q 3 – 5 min Adult : 2 mg q 10 min IV/IM 0.5 mg (5ml) 3 – 5 min 0.01 MKD prn after 24 H Digitalis 0.04 – 0.06 Mk (TDD) Pedia Elixer .05/ml; 0.25/ml Tab 0.25 mg/tab Inj 0.50 mg/2 amp DOPAMINE DRIP 1 – 5 ug/k/min = VD, inc. renal & splanchnic circulation 5 – 10 ug/k/min = inc. heart contraction w/o effect on HR 10 – 20 ug/k/min = inc. BP Prep: DOPAMINE 200/5 Conc Dopa D5W S 800 1 cc 49 cc DS 1600 2 cc 48 cc QS 3200 3 cc 46 cc Prep: DOBUTAMINE 250/2 Conc Dobu D5W S 1000 4 cc 46 cc DS 2000 8 cc 42 cc QS 4000 16 cc 34 cc AD = rate x conc. Wt. x 60 Rate = RD x wt. x 60 Conc. KVO = ugtt = 3.5 gtt = 10

1.5 6 7 7 10 12 15 18 19

Cognitive : Stares momentarily at spot where object disapperead Stares at own hand Bangs 2 cubes Uncovers toys Egocentric pretend play Uses stict to reach toy Pretend play w/ doll

2 4 8 8 12 17 17