MultiVitamins: Ascorbic acid !
! !
! !
Drops 100mg/mL:
Syrup: 100mg/ml
<3mos: 0.3ml/day 3-12mos: 0.6ml/day 1-2y/0: 1.2ml/day
2-6y/o: 5ml/day 7-12y/o: 10ml/day
Vit. B complex + hysine + beclizine (Appebon syrup) 2-6y/o: 1-2tsp OD 7-14y/o: 2-4tsp OD Iron wtx5/elem Fe 1mkday OD- prophylactic Hemarate 30/5 3-6mkday BID-therapeutic Iberet 26.25/5 Zinc RD – 10-20mg/day Incremin 30/5 10mgdrops- infant Sangobion 12/10 20mg- >2yo Ferlin 30/15 Folic acid 2.5g/ml 0.2 mkday Vitamin A 6-11mos: 100,000IU – 1 dose 12-71mos: 200,000IU <2yrs: drops 10mg/ml=1ml >2yrs: syrup 20mg/5ml= 5ml
Analgesics/Antipyretic Paracetamol (Q4h)
Mefenamic Acid (q6-8hr)
RD: 10-15mkdose PO 10mkdose IV 15mkdose-BFC Drops: 100mg/ml 60mg/0.6mk Syrup: 120mg/5ml 125mg/5ml 350mg/5ml Tab: 325mg/tab 250mg/tab 500mg/tab Amp: 150mg/ml 300mg/ml
RD: 5-8 mkdose Susp: 50mg/5ml 125mg/5ml Cap: 250mg/500 Aspirin (Q4-6H) RD: 10-15mg/kg/dose upto 60-80mg/kg/24h Anti-inflam:60-100mg/kg/ 24hPO Kawasaki: 80-100mkday Nimesulide (BID) RD: 2.5-5mkdose 100mg/tab
Ibuprofen RD: 5-10 mg/kg/dose PO Q6-8H Susp: 100mg/5ml Forte: 200ng/5ml Cap: 200mg Antacids Ranitidine (Q8h-12h)
Famotidine (Q12h/IV-Q8h)
RD: 0.75mkose PO 0.8-1mkdose IV Amp: 25mg/ml, 50mg/5ml Tab: 150mg/300mg
RD: 0.2mkdose Amp: 25mg/2ml Tab: 20mg/40
Cimetidine (Q4-6h)
Omeprazole
RD: 10-15mkday <1y.o: 20mkday 1-12y.o: 20-25mkday Liquid: 100mg/5ml Amp: 150mg/ml, 100mg/ml Tab: 200mg, 400mg
1mgkday
AlMg (Maalox) (Q6h)
Ursofalk
2-4 tabs max: 16tabs *take 30 minutes 1 hr after meal at bedtime Susp: 180ml; 355ml Tab: chewable c hewable Fw/flatulence-Almg+dimeticone (Maalox plus)
10-15mkday 200/5ml
Anti-emetic/ Anti-spasmodic Metoclopramine
Nifuroxide (Ercefuryl)
RD: 0.5mkdose PO 0.2mkdose IV Amp: 10mg/2ml, 5mg/2ml Syr: 5mg/5ml Tab: 10mg
<6mos- 10ml >6mos- 5ml Adult: 1cap Q6H Susp: 220mg/5ml Cap: 200mg
Dicycloverine HCL (Q8h)
Hyosciene N-Butyl (Bromide) Q6-8h
RD: 2.5-5mg/kg/day 6mos-2y.o: 0.5-1ml 2y.o-5y.o: 2y.o-5y.o: 2.5-5ml 2.5-5 ml Drops: 5mg/ml, 15mg/ml Syr: 2mg/ml, 10mg/ml Tab: 10mg
RD: 0.15mkdose Amp: 20mg/ml Tab: 10mg
Domperidone (Motilium)Q8h*15 RD: 0.3mkdose Dyspepsia: Adult: 1tab/2tsp Q8h Children: 2.5ml Q8h Suspension: 1mg/ml Tab: 10mg N/V: Adult: 2tab/4tsp Q6-8h Children: 5ml Q6-8h Dyspepsia N/V 10kg 2.5ml 5ml 20kg 5ml 10ml 30kg 7.5ml 15ml Anti-Diarrheals Paroromycin (Humagel)
Erceflora – Bacillus clausii
RD: 20-30mkday 3-4 dived dose 150mg/cap, 150 mg/5ml
>1mos: 1-2 vials/day 2-11y.o: 1-2 vials/day Adult: 2-3 vials/day
Racecadotril (Hidrasec)
Nifuroxamide (Ercefuryl)
1 mos onwards RD: 1.5mg/kg/day Q8h
<6mos: 1tsp BID >mos: 1tsp TID
BW Hidrasec Sachet <9kg 10mg 1 sachet 9-13kg 10mg 1 sachet 13-27kg 30mg 1 sachet >27kg 30mg 2 sachet Adult dose: 100mg/cap Q8h
Antihelminthics Mebendazole 500mg/tab single dose 100mg/tab or 5ml BIDx3 consecutive days 20mg/ml susp: 5ml BIDx3 consecutive days 50mg/ml susp: 10ml SD Enterobiasis (100mg or 5mg SDrpt 2 or 4 weeks) Susp: 20mg/ml, 50mg/ml Tab: 100mg; 500mg *deworm @2-4 yrs old Pyrantel Pamoate RD: 10-20 mkdose Susp: 125mg/5ml Tab: 125mg; 850mg Albendazole RD: 75mkday Susp: 200mg/5ml Tab: 400mg Quinolones Ciprofloxacin - BID Vial: 100mg/50ml, 200mg/100ml, 400mg/200ml Amebicide Metronidazole q6h
Furazolidone
RD: 30-50 mkday PO 7.5 mkdose IV 15mkdose – loading dose Vial: 5mg/ml IV: 500mg/100 Susp: 125mg/5ml 200mg/5ml Paramomycin RD: 20-30 mkday Susp: 150mg/15ml
RD: 4-7 mkday Liquid: 16.7 mg/5ml Susp: 50mg/ml
Etofamide (Kitnos) RD: 15-20mkayX3 days Q12H Susp: 100mg/5ml Tab: 200mg; 500mg
Antihistamine Hydroxyzine Hcl (Iterax) Q12h x 5 days RD: 1mg/kg/day or wt/4 Syrup: 2mg/ml Tab: 10mg; 25mg Amp: 5mg/ml
Chlorphenamine Maleate Q8h RD: 0.2mkdose Amp: 10mg/ml Vial: 10mg/ml Syrup: 2mg/5ml Tab: 4mg *20kg-1/2 amp IM >20kg-1amp IM
Desloratadine (Aerius) 6-11 mos: 2ml 1-5 y.o: 2.5 ml 6-11y.o: 5ml >/=12y.o: 10ml Syr: 2.5ml/5ml Tab: 5mg Diphenhydramine Hcl RD: 3-5 mkdose PO 1mkdose IV Syr: 12.5mg/5ml Cap: 25mg, 50 mg IV/IM: 50mg/ml
Cetirizine diHCL-OD-BID RD: 0.25-0.27 mkdose Drops: 10mg/ml 2.5mg/ml Soln: 1mg/ml Sry: 5mg/5ml Tab: 10mg
Levocetirizine 0.125mkdose
Mucolytic Carbocysteine (Q8-12h) RD: 30-50 mkday Drops: 50mg/5ml Syr: 100mg/5ml Cap: 500mg <3mos: 0.25ml 3-5mos: 0.5ml 6-8mos: 0.75ml 9-12mos: 1 ml 5y.o: 5ml
Erdosteine (Q12h) RD: 10mkday 10-20kg, 2-6y.o: 2.5ml 21-30kg, 7-12y.o: 5ml >30kg, >12y.o: 5mlTID/7.5ml BID Susp: 115mg/ml; cap: 300mg
Ambroxol (Q8h) D: 1.2-1.8 mkday Liq: 15mg/5ml; 30mg/ml Soln for inhalation: 15ml/2ml Amp: 15mg/2ml Ped drops: 6mg/ml Tab: 30mg; retard cap 75 Bronchodilators Salbutamol TID
Procaterol
RD: 0.13-0.15 mkdose Sry: 2mg/5ml 100mg/5ml Amp: 1mg/ml Tab: 2mg Terbutaline BID TID 1-15y.o: 2.5ml <3y.o: 0.075mkdose Syr: 1.5mg/5ml Soln: 2.5mg/5ml Amp: 0.5mg/ml Tab: 2.5mg
>/6: 5ml
Cephalosporins 1st generation Cefuroxime Q6-8h
Cefalexin Q6h RD: 30-50 mkday PO 50-100mkday IV Drops: 100mg/ml Susp: 125mg/ml 250mg/ml Cap: 250mg; 500mg Cefazolin RD: 50-100mkday IV x 3dose Vial: 250mg Inj: 500mg; 1g 2nd generation Cefaclor Q8h RD: 20-40mkday Drops: 50mg/ml Susp: 125mg/5ml 250mg/5ml Tab: 315mg; 750mg Cap: 500mg
RD: 20-40mkday PO; 50-100mkday IV Cefamandol RD: 50-100mkday Cefprozil RD: 20-4-mkday Powder: 125mg/5ml; 250mg/ 5ml Tab: 250mg; 500mg Cefotiam RD: 50-100mkday Tab: 200mg Vial: 0.5g; 1 gm Cefixime Q12h UTI: 8 TF: 20 RD: 3-6mkday PO, 15mkday Drops: 20mg/ml Susp: 100mg/5ml Cap: 100mg;200mg Cefdinir RD: 9-8mkday Cap: 100mg
3rd Generation
4th Generation
Cefoperazone RD: 100-150mkday IV Vial: 1.5g Ceftriaxone BID RD: 50-100mkday Vial: 500mg; 1 g; 250mg Ceftazidime RD: 30-50mkday IV Vial: 250mg; 500mg; 1g; 2g Cefpodoxime 3-10mkday Susp: 50mg/5ml Tab: 100mg
Cefepime OD-BID RD: 50-100 Vial: 500mg; 1g; 2g
Co-Amoxiclav: 228.5g/5ml; 457/5ml
Aminoglycosides
Antihypertensives
Gentamycin OD-BID 5-8mkday Amikacin OD-BID RD: 12-15mkday – 15mkdose OD \ Vancomycin
RD: 15mkday
Furosemide RD: 0.5-1mkdose Amp: 20mg/2ml Tab: 40mg Hydralazine RD: 0.1-0.2mkdose Amp: 20mg/ml Tab: 10mg; 15mg; 50mg Aspirin 75-100mkday Nifedipine Q4-6h RD: 10mkdose Max: 10mg/kg/24h Spironolactone 1.3-3mkday QID PO
Antifungal
Nystatin Q6h Adult & children: 4-6ml Infant: 2ml Tab: 500,000 U Susp:100, 000 U/ml
Amphothericin B RD: 0.3-0.7mkday Slow in Infusion *250mcg/kg/day-1mg/kg/day Vial: 50mg/5ml; 2mg/ml Cap: 50mg; 100mg; 200mg •
Fluconazole – OD RD: 3-6mkday Vial: 3mg/ml Cap: 50, 150, 300mg Griseofulvin Tab: 125mg/500mg Ketoconazole x 5 days OD Adult: 200mg/tab 5-12y.o: 100mg/tab 1-4y.o: 50mg/tab
Isoprinosine: 50-100mkday
Macrolides
Erythromycin q8h RD: 35-50mkday Granules: 200mg/5ml; 400mg/5ml Drops: 100mg/2.5ml Tab: 250-500mg Clarithromycin Q12h RD: 7.5mkdose; 15mkdose Susp: 125mg/5ml Tab: 250; 500mg Roxithromycin OD-BID Adult: 150mg/tab; 300mg/tab Q12h Children: >40kg Kiddie tab: 100mg
Azithromycin OD-BID RD: 15-20mkday Susp: 200mg/5ml Tab: 250mg; 500mg Vial: 500mg Chloramphenicol q6h RD: 50-100mkday; 75mkday (enteric fever) FT infant>/=2week: 25-50mg/kg/day Cotrimoxazole BID RD: 5-8mkday; 8 UTI; 10 BPN Susp: 200mg/40mg/5ml(40mg/5ml) (wt/2) 400mg/80mg/5ml-(80mg/5ml)(wt/4) Tab: 400mg/80mg; 800mg/ 100mg
Anti- TB drugs 1-10; R-15; S-20; E-35; P-30 Isoniazid RD: 5-10 Syr: 100mg/5ml; 200mg/5ml Tab: 100mg; 200mg; 300mg
Rifampicin: RD: 10-15mkday Drops: 100mg/ml Cap: 300; 45mg
Pyrazinamide RD: 15-30mkday Susp: 250mg/5ml Tab: 500mg
Ethambutol RD: 12-25mkday Syr: 125mg/5ml Tab: 400mg
Streptomycin RD: 15-20mg/kg/day Vial: 1gm
Amantadine HCL RD: 4.4-8.8mkday Syr: 50mg/5ml Tab: 100mg
Ribavirin RD: 10mkdose Syr: 50mg/5ml Tab: 100mg Anticonvulsants/ Sedatives Phenobarbital LD: 10mkday MD: 5mkdose (max 25mkdose) Diazepam RD: 0.2-0.8 mkdose
Midazolam RD: 0.2mkdose Tab: 15mg Amp: 5mg/ml, 5/5, 15/3
Phenytoin LD: 10mkdose MD: 5mkday Susp: 30/5, 12/5 Cap: 30, 100
Steroids Prednisone – BID RD: 1mkday BID; 2mkday OD Susp: 10mg/5ml Syr: 5mg/5ml; 20mg/5ml Tab: 1, 5, 10, 20, 30, 50mg
Dexamethasone RD: 0.5 – 1mkdose 0.3mkdose initial, then 0.1 mkdose 1-2mg/kg Q6h x 4 *xtubate on 3rd dose
Hydrocortisone RD: 5mkdose Q6-8h LB: 10mkdose MD: 5(max 100) Vial inj: 100mg; 250mg; 500mg
Procaterol (Meptin) BID-TID RD: 0.25mkdose or 0.25xwt Syr: 5meq/ml Tab: 25meq, 50meq
Erdosteine (Ectrin/Zertin) 175mg/5ml-10mkday BID; 300mg/cap BID
Aminophylline LD: 5-7mkdose MD: 3-5mkdose
Combivent: 200ug Ipatropium <2y.o: 5-8 drops; 2-3 y.o: 3 drops; >4y.o: 20 drops IVIG Dose: 2g/kg in 12H or 400mg/kg/dose x 5d 2.5g/vial, dilute w/ 50ml diluents to make 50mg/ml administer the ffL Test dose: NAHCO3 1. 0.5ml/kg/H x 15min BE x wt x 0.3 or 1meq/kg can be 2. 1ml/kg/H x 15min 4. 1.5ml/kg/H x 15min given IV push or drip 50mcg/kg 8. 2ml/kg/H x 15min NA>1-2 meq/kg 2.5ml/kg/H x 15min 3ml/kg/H x 15min 3.5ml/kg/H x 15min 4ml/kg/H x 15min *if tolerated in fuse the rest at ____cc/h for 10hr watch out for headache, flushing, hypotension, fever and chills Aminosteril 0.5/kg-inc until 3g/kg Wt x RD x 100/6%/24 or wt x RD/0.694 *start 1g x 48H then resume at 2g Conversion of Hyponatremia
1ml=2.5 meqs NaCL Wt: 1.8 kg S.Na: 131.4 D-A x wt x 0.6 (140-131.4 x 1.8 x 0.6 = 9.2 meqs)+ wt x 3= maintenance (1.8 x 3=5.4)
HYPONATREMIA D-A x wt x 0.6 ÷ (2-3) maintenance
! -
4.6 – 1.8 – 6.4 " - 2.3 – 1.8 – 4.1 " - 2.3 – 1.8 – 4.1
HYOPCALCEMIA K/K (?) – 0.1 to 0.3 meqs/k/H NK of Body= 50meqs
1st Shift D5W- 6.6 D5IMB- 50 NaCl- 2.5 (?) Hypokalemia D-A x wt x 0.3 + (Wt x 2) ?
Wt x 0.2 x 8 x 3 x 2 x wt Sk- <3-5% -0.05 <2.5-10%-0.10 Wt X 0.05 x 50 /wt x (2/maintenance) RESPONSE TO PHOTOTHERAPY *check rebound B2 for 12-24H after discharge Bilirubin
Age
Action
<18
-
Wean to single photo
-
D/C home
49-7/2
D/C photo
>72’
D/C photo
Age in hours
TSB (mg/dl)
24-48H
<15
15-<20
20-<25
>/=25
49-72H
<18
18-<24
25-<30
>/=30
>72H
<20
20-<25
25-
>/=30
Tx/rec
OPD
PHOTO
INTENSIVE PHOTO
PHOTO/exc trans
IDEAL BODY WEIGHT At birth 3kg 3-12mo Age (mo)+ 9 /2 1-6 yrs Age (yrs)x 2 + 8 7-12 yrs [Age (yrs)x 7 – 5 ]/2 IDEAL BODY WEIGHT GIVEN BIRTH WIEGHT <6mo Age (mo) x 600 + BW in gm 6-12 mo Age (mo)x 500 + BW in gm Age
Conside r Photo
Photo
Exchange transfusion if extensive photo
Exchange transfusion if intensive photo
>/=12 (170)
>/=15 (260)
>/=20 (340)
>/=25 (430)
49-72
>/=15 (260)
>/=18 (310)
>/=25 (430)
>/=30 (510)
>72
>/=17 (290)
>/=20 (340)
>/=25 (430)
>/=30 (510)
EXPECTED BODY WEIGHT Term: EBW= (Age in days - 10) x 20 + BW in gm Preterm: EBW= (Age in days - 14) x 15 + BW in gm Where 10: # of days to recover over physiologic wt loss 20: g/day gained •
CARDIAC OUTPUT Newborn: 180-240ml/kg/min or 4ml/beat DOPAMINE DRIP (200mg/250-800conc) 0.0375/26.6 (400mg/250ml-1600conc) 0.075/13.3 Wt x RD x 60 (0.075)
SHORT CUT: wt x RD WT X 3(50) X dose (10mg/kg) 13.3 (800-conc) 6 (100) Wt x RD Rate (1cc/hr) 26.6 (1600-conc) 1.6 To check: AD: dose given x Prep/60/wt Or WT x RD X 140D/ 1600/24 Max: 20 LEVOPHED 4mg/4ml; 2mg/ml e.g 2ml/ml 2/100 x 1000= 20 conc (WT x dose x 60)= ml Conc To check: ml x conc/60/15= dose DRIP FORMULA
6 x wt (kg)x mcg/kg/min – mgin100ml of D5NSS MI/H ISOPROTERENOL/EPINEPHRINE/NOREPINEPHRINE 0.6 x wt (kg) = mgin100ml O *1ml/H will deliver 0.1 mcg/kg/min DOPAMINE/ DOBUTAMINE/ AMRINONE/ NITROPRUSSIDE 6 x wt (kg)= mg in 100ml *0.1 ml/H will deliver 1mcg/kg/min DOPAMINE/ DOBUTAMINE 6 x wt (kg) = # mg to add to diluents to make 100ml volume DOBUTAMINE DRIP 2.5 – 15mcg/kg/min (max: 40mcg/kg/min) Peak effect: 10-20min Prep: 12.5 mg /ml x 20ml/vial= 250mg/250ml (vial) Premix: 1000mcg/ml in 250= 250/250 (1mg/ml) 2000mcg/ml in 250 ml= 500mg/250 (2mg/ml) Dobu-premix 0.06-1000=250/250 D%W 0.03-2000 Wt x dose x 0.06/0.03
Wt x RD x 60 or wt x RD x 1400/12500 or 6 x wt in kg= ____mg in 2000 100ml(1mcg/kg/min) Ex: 250mg in D5W 250cc(1mg/ml) 500mg in D5W250cc(2mg/ml) Mcgtt/min= (Wt x DD)/16.6 ugtts/min=(wt x DD)/33.2 = Wt x DD x 0.06 = Wt x DD X 0.03 *to check: 7.5 – actual x 2000/ 60 /wt actual x conc/60/wt
FUROSEMIDE DRIP 20 mg/2ml **4ml + 20cc PNSS to run @ 1cc/h (wt)15 x (dose) 0.1 x 24 36 x 2/20 = 3.6 3.6/4ml = 0.9 or 1cc Prep: 10mg/ml amp (2m) Dose: infant and child: 0.05 mg/kg/H (titrate to clinical effect) Adult: 0.1 mg/kg/H (max: 0.4 mg/kg/H) •
•
Wt(kg)x dose x 24 = mg in 24 ml of NS to make: 1ml/H = 0.1mg/kg/H Wt(kg) x dose x 24 x 5= mg in 120ml NS to make 5ml/ H=0.1mg/kg/H
*20mg furo + 20cc distilled water to make conc of 1mg/ml Infusion rate: 0.05 x wt eg: 0.05 x mg x 1 = 4 cc EPINEPHRINE DRIP Wt x 0.6 mg = mg added to 100mgD5W 1cc/H = 0.1 ug/kg/min 5cc/H = 0.5 cc/min ml/H= wt x dose x 60 10cc/H = 1mg/kg/min conc 0.1mkd/0.1cc/kg/dose INSULIN DRIP 1. – 1 cc or ml/H Wt x 0.1 x 24 = # of ml/cc of insulin to be added to NSS to make 24 ml soln to run for 24H MIDAZOLAM DRIP Prep: 5mg/ml amp Dose: intermittent: 0.05 – 0.15mg/kg/dose Continuous: 1-2mcg/kg/dose
6 x wt(kg)x mcg/kg/min = mg in 100ml of D5W/NS mL/H Max total dose: 10mg (intermittent); can cause respiratory depression, hypotension, bradycardia AMIODARONE DRIP Prep: 50mg/ml amp Dose: infant and child: 5mg/kg over 30 min ff by infusion starting at 5mcg/kg/min Max dose: 10mcg/kg/min or 20 mg/kg/H must be diluted in D5W infusion concentration should not exceed 2 mg/ml wt(kg)x dose x 60 x 50 = mg in 50mlD5W 1000 To make: 1ml/H= 1mcg/kg/min INSULIN DRIP Prep: 1U/ml amp Dose: Infant and Child 0.1Ukg/H (titrate to clinical effect) Glucose drop: 80-110mg/dl/H Wt(kg)x dose x 24 = U in 24ml NS or Wt (kg)x dose x 24 x 5 = U in 120ml of NS *to make: 5ml/H= 0.1U/kg/H NICARDIPINE DRIP Prep: 2.5mg/ml= 5mg/10ml ampule Dose: Child: 0.5-5mcg/kg/min (titrate to clinical effect) Adult: start with 5mg/H, increase dose as needed by 2.5mg/H Q 5 -15 min (Max dose: 15mg/H) decreased by 3mg/H as needed to maintain desired response AMINOPHYLLINE DRIP LD: 5mg/kg BW in 30cc 5W in a soluset (if px is not maintained on oral theophylline) or 25mg/vial dilute 1ml + 4ml NSS to make 5 mg/ml so;ution. Aspirate ____mL give per iv infusion for 30 min as LD (5mg/kg)
D5W250cc + Aminophylline 250mg/amp at ____ugtts/min Main drip: 0.4 – 0.8mg/kg/H Formula ugtts/min = dose x BW Note: maintenance infusion rate must be induced to 0.2 – 0.3 mg /kg/ H for elderly px, pregnant px and those in CHF. Liver dse or cor pulmonale watch out for hypoglycemia and tachycardia. DUET (Double Volume Exchange Transfusion) Blood volume: 80cc/kg ABC: no correction if <10 E.g wt: 3kg B.D 3 x 80 x 74-60/74 = 3360/74 45cc to be exchanged 160-180cc/kg/FWB Mother’s Blood type – wt 80 x 2 INDICATIONS: Corrected WBC: Sepsis e.g RBC = 7500= 75000/500-15 S. Bilirubin >20mg/dl for every RBC = 1 WBC Hypoxia and acidosis WBC = 37-15=22 corrected RBC Hemolytic dose of NB ABO incompatibility Prematurity COMPLICATIONS: Vascular embolism Infection Cardiac arrhythmia vol overdose CP arrest Electrolyte imbalance FIO2: 100% target FiO2 X TRF (S) 79 ABDOMINAL UTZ Stomach – LUQ, directly under the L diaphragm Small Intestines- central abdomen, can have a random faceted/ tesseliated appearance
when air filled (but not dilated). Encircling valvulae connivantes visible depending on degree of air filling. Valvulae connivantes more widely spaced in ileum Large Intestines – circumferential, tends to frame the small intestines Feces of variable consistency Haustral folds interspaced w/ plicae semilunaris
Neurotoxicity • • •
Cisplatin – ototoxocity, p. neuropathy Paclitaxel – p. sensory, neuropathy Vinca Alkaloids- motor , sensory, autonomic neuropathy, adynamic ileus, urinary bladder atony
Cardiac Toxicity Doxorubicin, Daunomycin – cardiomyopathy •
Pulmonary Toxicity Bleomycin – interstitial Alkylating agent pneumonistis w pulmonary fibrosis • •
Gastrointestinal Toxicity Mathotraxate – hepatic fibrosis Vinca Alkaloids- adynamic ileus, urinary bladder atony • •
Genitourinary Toxicity Cisplatin – azotemia, Mg wasting Methotrexate – oliguria RF Cyclophosphamide/ Ifosfamide – chronic hemorrhagic cyctitis • • •
Dermatologic Toxicity
•
• •
Doxorubicin Skin necrosis, sloughing from Actinomycin – D drug extravasation Vincristine
Gonadal Dysfunction Azospermia recovery is uncommon •
Hematologic toxicity Granulocytopenia/neutropenuia 6-12 days after administration Recovery in 21-24 days ANC= (WBC count)(%segmenters) Must be ! 1500 for chemo to proceed Thrombocytopenia Recovers 4-5 days later than granulocytes ! 100,000/mm3 for chemo to proceed •
•
Fontanels – anterior closes at 18 mos (as early as 9=12 mos) Posterior 6-8 weeks Colostrum – 1st 2-4 days postpartum ! CHON, vitamins, salt, Ig " fat and sugar Absolute Contraindications to BF
Galactosemia Tyrosinemia Relative Contratindications to BF Psychosis Active TB • •
• •
WATERLOW CLASSIFICATION > 90 no PEM 75-90 MILD 60-74 MODERATE <60 SEVERE
WT for Age: Actual WT x 100% Wt at P50
HT for Age= Actual HT X 100 Ht at P50 Wt for HT = Actual wt X 100 Wt at P50 of HT at P50 HT >95 - no stunting 90-95 –mild 85-89- moderate <85- severe
WT >90 – no wasting 80-90- mild 70-80- moderate <70- severe
ET Tube Size
AOG
SIZE
<1000
<28
2.5
1000-2000
28-34
3.0
2000-3000
34-38
3.5
>3000
>38
3.5-4.0
ET SIZE BY AGE Premature
2.5mm
0-3 mo
3.0mm
3-7 mo
3.5mm
7-15 mo
4.0mm
15-24 mo
4.5mm
2-10 yrs
Age (yrs)+16/4 or Age(yrs)+ 4/4
10-20 yrs
6-8mm
ET level: size of tube x 3
Laryngoscope Blade Size Term/Newborn
Size 1
2-11 yrs
Size 2
>12yrs
Size 3
ET Tube Size & Depth Weight
Size
Depth
500-1000
2.5
7.0
1000-1400
3.0
7.5
1400-1900
3.0
8.0
1900-2200
3.5
8.5
2200-2600
3.5
9.0
2600-3000
3.5
9.5
3000-3400
3.5
10
3400-3700
3.5
10.5
3700-4100
4.0
11.0
4100-4500
4.0
11.5
>4500
4.0
12.0
BELL CLINICAL STAGING OF NEC 1. Suspect, Infant with suggestive clinical signs but x-ray non diagnostic 2. Definitive Infant w/ pneumatosis intestinalis 2a: mildly ill 2b: moderately ill (acidosis, thrombocytopenia/ ascites) 3. Advanced 3a: critilac w/ impending perforation 3b: critical w/ proven perforation MAXIMUM K that can be in cooperated per Liter IVF: Parenteral: 40meqs Central: 60-80meqs Electrolyte Computation: I. Potassium N= 4-5.6 meq N K deliuence: 0.1-0.4meq/kg Deficit = (KD - KA)x wt x 0.6 Maintenance K: 2 x wt Total K deficit: deficit + maintenance Full Incorporation: 40meq/L or 20 meq/500cc K infusion rate: N= 0.2meq – 0.4meq/kg IV rate x amt of K (meq) Vol of IVF x Wt Deficit: Wt x 50 x __K__ Maintence – 2 x wt • •
II.
Sodium 135-145 meq Maintence Na= 3 x Wt Na: 1 meq= 2.3mg/dl Max target/day: 10 meq K= 1 meq= 3.91mg/dl
NaHCO3= gr x = 650mg = 7.7meq gr v = 325 III. IV. V.
Calcium: 8-10 meq Chloride: 98-106 meq CO2 15meq Rate x 24= ___ ÷ 100= ____ x 4
Creatinine Clearance: 1. Based on ht *0.33 = pretem; lbw, <1 yr 0.45 = term, infant, <1yr 0.55 = children, adolescent female 0.7 = adolescent male * X ht (cm) Serum creatinine(mg/dl) 2.
Adult *male: 72 Female: 85 140-age x wt * x Creatinine (mg/dl)
Values: 80-120: normal 50-80: renal impairment 20-50: renal insufficiency 5-20: renal failure <5: uremia
GFR: 125ml/min (75-150) 24 urinary Creatinine M: 15-20mg/k F: 10-15mg/k ACTUAL RETICULOCYTE COUNT (ARC) Actual Hct x Reticulocyte ct Desired Hct Reticulocyte Index: ARC ÷ 2
= HCT/Ret Count x 2 >2= hemolysis <2= BM suppression IDEAL TRACHEAL ASPIRATE: EC < 25 PMNS> 10 2. “U”- increase HGB by 2: HCT by 3 BLOOD TRANSFUSION FWB 20cc/k (max) PRCB 10-15cc/K (15cc/k in neaonates) FWB: vol= desired-actual HB x 6 x wt = desired – actual Hct x wt Rate= volume x 12 gtts/ml = gtts/min 60min x 4H PRBC: vol = desired – actual HB x 2 x Wt = desired – actual hct x wt Desired Hct= vol/wt + actual hct Platelet Count: 1U /6KBW 1U=30-50 (raises platelet count by 10K) FFP= Fluid rate (5-20cc/k/h in 4h) PHOTOTHERAPY Indication: PT 10mg% Bilirubin PT 15mg% Bilirubin Complication: Osmotic diarrhea, Rashes Bronze baby syndrome, Dehydration
Kramer’s Classification ZONE 1
JAUNDICE Head/neck
EST. LEVELS 6-8mg/dl
2
Upper trunk
9-10mg/dl
3
Lower trunk to thigh
12-14mh/dl
4
Arms/legs/elbow/knees
15-18mg/dl
5
Hands/feet
>18mg/dl
B1 – uncongugated/ indirect B2 – conjugated/ direct Bilirubin CREATININE CLEARANCE* (140-age) (wt in kg) x 0.85 (F) 1(m) Creatinine (mg/dl) x 72 * ÷ 88.4 → mg/dl STAGING 1
Kidney damage with NGFR
>90
2
Mild " GFK
60-90
3
Moderate " GFK
30-59
4
Severe " GFK
15-24
5
Kidnet failure
<15
DEFICITS Na= 135-150/3-4meq/kg/day Na deficit= (Desired 140-actual) X TBW TBW (L)= 0.6 x BW (kg) + Maintenance BLOOD/ FFP TRANSFUSION Transfuse ____ “U” ( cc)TS x 4h Monitor VS q15mins @ 1st hr then Q 30min
Adjust IV rate to ___ cc/hr Ex: 369cc/4h = 92.25 → 92 IVF = 125 = 33 92 * " IVF rate to 33cc/hr How: 125-92=33cc/hr RBS (mmol/L) x 18 = ____ mg/dl N: 280-300 DKA: 300-320 HHS: 330-380 FFP- 20cc/k PLT conc- 1 uint/10kg TPR BP 02 stat SCE, CBS (-)DOB CP status assessed, may transfuse 1 unit PRBC, type-specific, after proper reverse typing x 4hrs. Monitor VS q 15mins on the 1st hr then q30mins thereafter once stable " IVF rate to ___ cc/hr (or KVO) watch out for any BT reactions Refer PRN Thank you PPE: awake, conscious, not in CPD, anicteric sclera, pinkish conjunctivae, non hyperemic, non-enlarged tonsils, (-) CLAD, (-)NVE SCE, CBS AP, NCRRR (-)murmur Flat, soft, NABS, Nontender, tympanitic, grossly N ext, full pulses CRT < 2 sec. TRANS-OUT ORDERS (SURGERY/OB) May transfer px back to room Monitor VS q15 until stable then q4h thereafter D/c o2 and pulse oximeter Monitor IO qhourly (if with FC) Refer if with UO " 30cc/hr or monitor IO qshift & record Refer PRN
Thank you Albumin Transfusion Wt x 1cc x 50% = amount in CC Kg 12.5 KAWASAKI DSE Fever= 5 days 1. Bilateral bulbar conjunctival injection with limbic sparing (-)exudates 2. Erythematous mouth and pharynx, strawberry tongue, red, cracked lips 3. Polymorphous, generalized erythematous rash 4. Changes in peripheral extremities consisting of induration of hands and feet 5. Acute nonsuppurative cervical lymphadenopathy (uni/ bilateral) ~1.5 cm
IVF: D10 – 1st24hrs of life D10IMB – after 24 hrs of life How to replace fluids: 1st 24HDL wt x 80cc/kg – if NPO Day 1
90 cc/kg
2
100 cc/kg
3
110 cc/kg
4
120 cc/kg
5
130 cc/kg
6
140 cc/kg
7
150 cc/kg
8
160 cc/kg (max)
D10IMB = Desired – Actual x volume Highest – Lowest Available: D5IMB; D50W, D10W D10IMB= 10-5 x volume (100) 50-5 = 5 x 100 45 11ccD50W 11→ D50W (subtract from the volume 100) + 89ccD5IMB 89→ D5IMB D10IMB UMBILICAL CATHETERIZATION Wt x 3 + 9 = answer + 1.2 cm 2 Allowable Blood loss in Preterm: 10% of BW Allowable Blood loss in infants/neonates: 20% of BW
H. Influenzae: 7-10days S. pneumonia: 10-14 days N. meningitides: 7 days E. coli, citrobacter, Senatia: ! 21 days Enterococcus: ! 14 days MENINGITIS •
•
<1mo: GBS, enterobacteriaceae, listeria, monocytogenes Tx: Ampicilin & Cefotaxime Alt: Ampicilin & gentamycin (nosocomial- Ampi + gentamycin) 1mo-3mo: GBS, S. Pneumoniae, Hi. Influenza, N. meningitides, Enterobacteriaceae
Tx: Ampiciliin, Cefotaxine •
>3mo & children – S. Pneumoniae, N. meningitides, H. influenza, neonatal pathogens Tx: Cefotaxime/Ceftiaxone, Vancomycin added for possible penicillin resistant S. Pneumoniae
AMINOSTERIL COMPUTATION Wt x 1gm x 100 = ___ cc to run for 22hrs, rest for 4hrs 6 EX. Wt: 900gms 0.9x 1gm x 100 = 15cc 6 1. Order: Aminosteril 6% 15cc to run for 22 hrs; rest for 4 hrs x 2 cycles (TFI 150- 1gm AA - FFP) ex: FFP x 2 units 18cc/unit 150-15cc-15cc-18cc+18cc x wt = 84 ÷ 24 = 3-4cc/hr IVF rate 24H PIP – 8 – 10 (Pacterm 12) PEEP – 4 100-FIO2 ÷ 79 x PEEP = level of compressed air PEEP – compressed air – level of pure air RESPIRATORY DISTRESS SYNDROME Deficiency of pulmonary surfactant, a phospholipid protein mixture that decreases surface tension & prevent alveolar collapse. Type II alveolar cells from 32 weeks AOG Risk of RDS is decreased in babies born >24hrs and <7days after maternal steroid administration APNEA – respiratory pause >20sec or a shorter pause assoc. w/ cyanosis, pallor, hypotonia or bradycardia Causes: Thermal instability, prematurity, infection (NEC, meningitis, neo sepsis), metabolic disorders, CNS problems (Seizures, malformations), drugs (maternal/fetal), decreased O2 delivery (anemia, hypoxemia, L to R shunt)
Disturbance
Acute resp. Acidosis
Primary Change
PH
Compensatory Response ! HCO3 by 1 meq/l for
!PaCO2"
Acute Resp. Alkalosis
Chronic Resp. Acidosis
Chronic Resp. Alkalosis
"pH
each 10mmhg rise in PaCO2 " HCO3 by 1-3meq/L for
" PaCO2
! pH
each 10mmhg fall in PaCO2 ! HCO3 by 4meq/L for
!PaCO2"
" pH
each 10mmhg rise in PaCO2 " HCO3 by 2-5meq/L for
" PaCO2
! pH
Metabolic Acidosis
" HCO3
" pH
Metabolic Alkalosis
! HCO3
! pH
each 10mmhg fall in PaCO2 " PaCO2 by 1 – 1.5 x fall
in HCO3 ! PaCO2 by 0.25 – 1 x
rise in HCO3
EPINEPHRINE : 1:10, 000 (0.1mg/ml) Recommended IV does: 0.1-0.3 mg/kg of 1:10, 000 soln via umbilical vein 5. – 1mg/kg via ET FFP – 4cc/k/
CEFEPIME
→
!APTT by 1gm/dL
Term and preterm infants greater than 28 days of age: 50mg/kg per dose every 12 hrs Term and preterm infants 28 days of age and younger: 30 mg/kg per dose every 12 hrs Meningitis and severe infections due to Pseudomonas aeruginosa or Enterobacter spp: 50mg/kg per dose every 12 hrs Administer via IV infusion by syringe pump over 30 minutes or IM. To reduce pain at IM injection site, cefepime may be mixed with 1% Lidocaine without epinephrine CEFOTAXIME 50 mg/kg dose IV infusion on syringe pump over 30 minutes, or IM. Dosing Interval Chart •
•
•
•
•
PMA (Weeks)
PostNatal (day)
Interval (hours)
"29
0 to 28 > 28
12 8
30 to 36
0 to 14 > 14
12 8
37 to 44
0 to 7 >7
12 8
!45
All
6
Disseminated Gonococcal Infections: 25 mg/kg per dose IV over 30 minutes or IM every 12 hrs for 7 days with a duration of 10 to 14 days if meningitis is documented. CEFTAZIDIME 30 mg/kg per dose IV infusion by syringe pump over 30 minutes or IM. To reduce pain at IM injection site, Cfetazidime may be mixed with 1% Lidocaine without epinephrine. Dosing Interval Chart •
•
PMA (Weeks)
PostNatal (day)
Interval (hours)
"29
0 to 28 > 28
12 8
30 to 36
0 to 14 > 14
12 8
37 to 44
0 to 7 >7
12 8
!45
All
6
RANITIDINE Oral: 2mg/kg per dose every 8 hrs. IV: Term: 1.5 mg/kg per dose every 8 hours slow push Preterm: 0.5 mg/kg per dose every 12 hours slow push Continuous IV infusion: 0.0625 mg/kg per hour; dose range. 0.04 to 0.1 mg/kg per hour FLUCONAZOLE Invasive Candidiasis: 12 to 25 mg/kg loading dose, then 6 to 12 mg/kg per dose IV infusion by syringe pump over 30 minutes or orally. Consider the higher doses for treating severe infections or Candida strains with higher MICs (4 to 8 mcg/ml). Extended dosing intervals should be considered for neonates with renal insufficiency (serum Creatinine greater than 1.3 mg/dl) NOTE: the higher doses are based on recent pharmacokinetics data but have not been prospectively tested for efficiency or safety Prophylaxis: 3 mg/kg per dose via IV infusion twice weekly or orally. A dose of 6 mg/kg twice weekly may be considered if Candida strains with higher MICs (4 to 8mcg/ml). Consider prophylaxis only in VLBW infants at high risk for invasive fungal disease. Thrush: 6mg/kg on day 1 then 3mg/kg per dose every 24 hrs orally. •
•
•
•
•
INVASIVE CANDIDIASIS DOSING INTERVAL CHART Gestational age (weeks)
Post Natal (Days)
Interval (hours)
!29
0 to 4 >14
48 24
30 and Older
0 to 7 >7
48 24
OXACILLIN Usual Dosage: ____mg/kg per dose IV over at least 10 minutes Meningitis: 50 mg/kg per dose DOSING INTERVAL CHART PMA (Weeks)
PostNatal (day)
Interval (hours)
"29
0 to 28 > 28
12 8
30 to 36
0 to 14 > 14
12 8
37 to 44
0 to 7 >7
12 8
!45
All
6
MEROPENEM Sepsis: 20mg/kg per dose IV Less than 32 weeks GA: less than or equal to 14 days PNA, every 12 hrs, greater than 14 days PNA, every 8 hrs 32 weeks and older GA: less than or equal to 7 days PNA, every 12 hours; greater than 7 days PNA, every 8 hours
Meningitis and infections caused by Pseudomonas species, all ages: 40mg/kg per dose every 8 hours. Give an IV infusion over 30 minutes, longer infusion times (up to 4 hrs) may be associated with improved therapeutic efficacy.
METRONIDAZOLE Loading dose: 15mg/kg orally or IV infusion by syringe punp over 60 minutes Maintainance dose: 7.5 mg/kg per dose orally or IV infusion over 60 minutes. Begin one dosing interval after dose. DOSING INTERVAL CHART PMA (Weeks)
PostNatal (day)
Interval (hours)
"29
0 to 28 > 28
12 8
30 to 36
0 to 14 > 14
12 8
37 to 44
0 to 7 >7
12 8
!45
All
6
COMPOSITION OF AVAILABLE PARENTERAL FLUIDS IV
Na
Cl
K
Mg
Ca
HCO3
0.9NSS
154
154
-
-
-
-
0.3NSS
51
51
-
-
-
-
LR
130
109
4
-
1.5
NR
140
98
5
1.5
-
NM
40
40
13
1.5
1.5
Acetate
IMB
25
22
20
1.5
-
Acetate
Lactate Acetate/ Gluconate
Serum Anion Gap (AG)= Na – (Cl + HCO 3) Urine Anion Gap= (Na + K) – Cl Delta ActualIVF AGrate – 10once on Feeding HowGap= to Adjust 24-Actual HCO3 (90) Example: IVF: D5IMB WT: 2840gms Computations: 90 x 2.84kg ÷ 24H = 10-11cc/hr IVF rate Advance feeding to 10ccq 3 hrs x 3 feedings If tolerated, increase to 20cc every feeding until 30cc is reached. Adjust IVF rate accordingly " to 8cc/hr at 10cc feeding " to 6cc/hr at 15cc feeding " to 5cc/hr at 20cc feeding " to 1cc/hr at 30cc feeding •
•
•
10 x 8 ÷ 24 = 3 [IVF – 3 = 8] 15 x 8 ÷ 24 = 5 [IVF – 5 = 6] 20 x 8 ÷ 24 = 6 [IVF – 6 = 5] 30 x 8 ÷ 24 = 10 [IVF – 10 = 1] feeding q3H → 24h ÷ 3h = 8 DC CBG monitoring once 20cc feeding is tolerated.
BICARBONATE CORRECTION (15 – initial HCO3) x Vol x Kg BW
Serum HCO3 level (meq/L)
Volume of Distribution (Vol)
>10 5-10 <5
0.5 0.75 1.0
TOTAL PROTEIN SPILLAGE (TPS) TPS= Total Protein (mg) BSA (m2) x 24H
FLUID LIMITATION Volume in 24H = 400-500ml x BSA + Urine output in 24H Length: inches to cm, multiply by 2.54 Weight: lbs to kg, divide by 2.2 EPINEPHRINE DRIP: 6 X Wt in Kg x mcg/K/min = ____mg in 100ml of D5W/NS mL/Hr Set your own rate: ex: 4ml/hr 6 x wt x 0.1 mcg/kg/min 4ml/h If wt is 40 kg: 6 x 40 x 0.1 = 6mg in 100ml D5W 4 Order: Start epinephrine drip: 6mg epinephrine + 100cc D5w x 4cc/Hr (0.1 mcg/k/min) •
BEVV BEVV x 0.6 x Wt (1/2 push then ! to run for _____) or Desired –actual x 0.3 x wt
DRUGS
RD
Ambroxol
1.2 – 1.6 mkdose(BIDTID)
Tab: 30mg, Syr: 15mg/ml Drops: 6mg/ml
Amikacin (Amikin, Amikacide, Onikin)
10mkdose (LD) 15mkdose (MD) 15mg/kg/day (BID)
Amp/Vial: 50mg/ mlx2ml 250mg/mlx2ml
Amoxicillin (Pediamox)
30-50 mkday (TID)
Cap: 250mg; 500mg Syr: 250mg/5ml, Ped drops: 125mg/ 1.25ml, 100mg/ml Vial: 500mg
Amphotericin B
50-100mkday (IV), 30-50mkday (PO), 1mg/ kgBW (alternate day)
Ampicillin (Ampicin, Pensyn)
50-100mkday (IV), 30-50mkday (PO), 1mg/ kgBW (alternate day)
PREPARATION
Vial: 50mg/10ml
Cap: 250mg; 500mg Syr: 125mg/5ml, Forte Syr: 250mg/ 5ml, Ped Drops: 125mg/1.25ml, 100mg/ml Vial: 500mg
Antamin
Augmentin
0.2-0.3mkdose
Tab: 4mg, Amp: 5mg/ml Vial: 5mg/mlx10ml Syr: 2mg/5ml
20-40mkday (BID-TID)
Tab: 375mg; 625mg Susp: 156.25/5ml; 228.5/5ml; 312.5mg/5ml; 457mg/5ml, IV Vial: 300mg; 600mg Tab: 1g
ASA
75-100mkday (TID)
Aztreonam
30-50mkday
Benadryl
3-5mdose (PO TID-QID) 1mkdose (IV OD)
Buscopan
0.01mkdose q6h 0.02-1.5mkday
Carbocisteine
10-20mkday(infant) (TID-QID)
Caterizine
0.25mkday
Tab: 250mg. 500mg Enema: 4mg Susp: 250mg
Cap: 25mg, 50mg Syr: 12.5mg/5ml Inj: 50mg/ml Tab: 10mg Amp: 20mg Cap: 500mg, Syr: 100mg/5ml Susp: 250mg/ml
Cefaclor
20-40mkday (TID)
Cap: 250mg, 500mg Susp: 125mg/5ml, 250mg/5ml
Cefadroxil
25-50mkday (TID)
Cap: 500mg Syr: 125mg/5ml
Cefetamet
20mkday (BID)
Cefotaxime
50-100mkday (BID)
Cefepime
50mkday q 8h
Vial: 500mg; 2g
Ceftazidime
50-100mkday
Vial: 500mg; 1g
Cefazolin
50-100mkday
Vial: 500mg; 1g
Ceftriaxone
Cefuroxime
Cefalexin
Vial: 1g
50-100mkday (TID-QID)
Vial: 250mg, 500mg, 1mg plus 10ml diluent
50-100mkday (IV); 20-40mkday(oral)
Tab: 500mg/ 500mg Susp: 125mg/5ml, 250mg/5ml Vial: 250mg, 750mg, 1.5g
30-50mkday (PO), 50-100mkday (IV)
Cap: 250mg, 500mg Susp: 125mg/5ml Drpos: 100mg/ml
50-100mkday
Cap: 250mg, 500mg Susp: 125mg/5ml Vial: 1g
50-100mkday
Cap: 250mg, 400mg Syr: 100mg/5ml Amp: 200mg/2ml, 300mg/2ml
7.5mkday (BID)
Tab: 250mg, 500mg Susp: 125mg/5ml
50-100mkday (BID)
Cap: 250mg, 500mg Oral soln powder: 125mg/5ml
Cotrimoxazole
8-12mkday (BID)
Tab: 400mg/80mg; 800mg/180mg Susp: 200mg/ 40mg/5ml
Diazepam
0.2mkdose
Tab: 2mg, 5mg Amp: 10mg/ 2ml
Diflucan
6-13mkday
Cap: 50mg; 150mg; 250mg Vial: 2mg/ml
Diloxanide
20mkday (TID)
Doxycyxline
204mkday
Chloramphenic ol
Cimetidine
Ciprofloxacin (Klaricid)
Cloxacillin (Pharex)
Tab: 500mg Susp: 125mg/5ml Cap: 100mg
Erythromycin
30-50mkday
Ethambutol
15mkday
Ferrous Sulfate
1mkday (MRD)4-6mkday (Txc)
Fluconazole
LD:12-20mkday MD: 6-12mkday
Furazolindone
4-7mkday
Furosemide
0.5-1mkdose
Gentamycin
5-8mkday
Hydralazine
0.15mkdose (IV)
Cap: 250mg; 500mg Susp: 200mg/5ml; 400mg/5ml Drpos: 100mg/ 2.5ml Tab: 400mg; 200mg Cap: 250mg Syr: 220mg/5ml Drops: 75mg/0.6ml
Tab: 100mg Amp: 50mg/5ml
Tab: 20mg, 40mg Amp: 10mg/ml Vial: 40mg/ml; 80mg/2ml Tab: 25mg Amp: 20mg/2ml
Hydrocortisone
5mkdose
Vial: 259mg Amp: 100mg, 250mg, 500mg
Hyoscine
0.01mkdose; 0.02-0.15mkday
Tab: 100mg; Amp: 20mg
Ibuprofen
5-10mkdose
Tab: 200mg; 400mg; 600mg Syr: 100mg/5ml
INH
5-10mkday (Premeal)
Tab: 300mg Syr: 100ml/5ml
Isoprinosine
50mkday
Tab: 500mg Syr: 250mg/5ml
Meclizine
12.5-50mkday
Mefenamic Acid
6.5mkdose (Q6h)
Meperidine
6mkday; 0.5mkdose
Metoclopramid e
0.25mkdose (IV, IM) 1mkday(PO)
Metronidazole
30-50mkday TID
Nafcillin
50-100mkday TID
Nalbuphine
0.1-0.2mkdose
Cap: 250mg, 500mg Susp: 50mg/5ml
Syr: 5mg/5ml Amp: 5mg/ml, 10mg/ml
Tab: 250mg, 500mg Susp: 125mg/5ml Inj: 500mg Infusion: 500mg/ 100ml Vial: 5mg/ml
10mg/ml
Nifedipine
0.25mkdose (IV, IM) 1mkday (OP)
Nystatin
400,000U/day NB 1.2M U/day
Ofloxacin
20-30mkday
Paracetamol
5-25mkdose q4h
Penicillin G (Penadur)
50-100,00U/mkday, 200,000-400,000U/ mkday (meningitic dose)
Phenobarbital
10mkdose (LD) 5nkdose (MD)
Phenoxymethyl penicillin K
Adult: 250-500mg QID Child: 50mkd QID
Piperacillin (Tazocin)
100-300mkday
Prednisone (Oracort, Orasone, Prolix)
1-2mkday
Tab: 5mg, 10mg, 20mg, 30mg, 60mg Oint: 5g Tab:200mg, 400mg IV Soln: 200mg/100ml Tab: 500mg Susp: 120mg/5ml, 250mg/5ml Drops: 100mg/ml
1.2M U
Tab: 15mg, 30mg, 60mg, 90mg Amp: 130mg/ml
Vial: 2.25, 4.5g
Tab: 5mg, 10mg, 20mg Susp: 10mg/5ml
Pyrazinamide
Ranitidine
Rifampicin
15-30mkday
Tab: 500mg Susp: 500mg/5ml, 250mg/5ml
1-2mkdose BID q8-12h
Tab: 150mg, 300mg Amp: 25mg/ml; 50mg/2ml
10-15mkday (premeal)
Cap: 300mg; 450mg; 600mg Susp: 200mg/5ml
Salbutamol (Ventolin, Asmalin, Combivent)
0.15mkdose TID-QID
Tab: 2mg Syr: 2mg/5ml MDI: 100mcg/dose Nebule: 2.5mg/ 5ml, 5mg/ml
Spironolactone
1-3mkday
Tab: 25mg, 50mg, 100mg
Streptomycin
20-40mkday
Sucralfate (Iselpin)
1g/dose QID
Terbutalin (Bricanyl, Terbulin, pulmoxcel)
0.075mkdose BID-TID
Tetracycline
20-50mkday QID
Vial: 1g
Tab: 1g
Tab: 2 2.5mg, .5mg, 5mg Syr: 1.5mg/5ml Neb: 5mg/2ml Cap: 250mg
Theopylline
20mkday q6h
Tab: 125mg SR tab: 250mg Syr: 80mg/15
DOPAMINE Wt x ug/min ÷26.6 Ex: 40kg x 15ug/min or 10ug/min ÷ 26 DOBUTAMINE Wt x ug/min ÷ 16.6 DOPAMINE DOPAMINE DRIP (5-8mg/k/min) 100cc 6 x wt x dose = 21mg of Dopamine Rate___ 1.6 79cc D5W + 21mg of Dopamine •
•
25cc 1.5 x wt x dose = 5mg of Dopamine Rate___ 1.6 5mg of Dopamine in 20cc D5W
HEMODIALYSIS HEMODIALYSIS PRESCRIPTION PRESCRIPT ION Blood Flow Rate: 5ml/kg/min Dialyzer: F4: BSA 0.7 F5: BSA 1.0 F6: BSA 1.3 NSS Flushing 100ml q 15min or Heparin LD: 10-20IU/kg MD: 10-20IU/kg Ultrafiltrate 0.2ml/kg/min 0.2ml/kg/min x ____ hrs Duration: initial 1.5 – 2 hrs 2nd day: 3hrs 3rd day: maintemance – 4hrs
Bicarbonate bath: prime solution with NSS 120ml • • •
• • •
•
• • •
•
Weigh pt pre & post HD and record Monitor VS q15mins while on HD Watch out for Headache, nausea, disorientation, hypotension, seizure, muscle cramps & vomiting Labs: pre & post HD Intradialytic transfusion (if any ) Initial HD: Mannitol 0.5-1.0g/kg to decrease disequilibrium syndrome in pt w/ elevated BUN (>35mmol/L) Refer accordingly. MGH orders for KD Repeat CBC, Plt, ESR, after 2 weeks Repeat 2D echo after 6 weeks Home meds: ASA ASA 80mg/tab 80mg/tab 1 tab OD x 6 weeks take on full stomach No live attenuated vaccine for at least 11 months
KAWASAKI DISEASE Febrile, examthematous, multisystem vasculitis Fever for at least 4 days + clinical features (at least 4/5) 1. Bilateral bu bulbar co conjuctival in injection w/ w/o ex exudates w/ w/ lumbar sparing 2. Erythematous mouth & pharynx, strawberry tto o ng ue and red, cracked lips 3. Polymorphous, generalized erythematous rash (morbilliform, (morbilliform, maculopaular or scarlatiniform ) 4. Changes in in pe peripheral ex extremities (i (induration of of ha hands and feet w/ erythematous palm & soles later w/ periungual desquamation) 5. Acute, nonsuppurative, unilateral cervical lymphadenopathy at least 1.5cm in diameter or if w/ coronary actery aneurysims
• •
ATYPICAL KD – KD – common in <12 mo old
•
•
•
Coronary artery ectasia/dilatation: confirms diagnosis (1-4 wks DOI) Labs: CRP > 3.0mg/dl 1st 2 weeks of illness ESR > 40mm/h ! PLT ct >450 on days 10-12 of illness “without aspirin & IVIg, fever can last upto 2 weeks or longer. After fevr resolves, pt can remain notablefor 2-3 weeks. Desquamation of groin, finger, toes after 2-3 weeks may occur. ” Labs normalizes w/in 6-8 weeks
Treatment IVIg high dose within 10 days Aspirin IVIg: 2g/kg as single dose over 10-12hrs Aspirin: 80-100mg/kg/day x 4 doses After fever is controlled, " Aspirin to 3-5 mg/kg/day, discontinue after 6-8 weeks if no heart problems • • • • •
Recommended Dosage and Drip Rate for Kawasaki Patient Dosage: 2g/kg/12hrs EX: Pt: 10kg Patient total needs: 20g of Immunorel Total Volume need: 400ml to be divide by 12 hrs = 33.33ml Initial Test drip: 33.33ml/4= 8.33ml for 1st hour Succeeding Drip Rate 2nd hour: 8.33ml x 16.67ml Total Volume left: 375ml/10hrs=37.5ml/hr * Courtesy of Dr. Ana Marie Morelos, Dr. James Angtuaco and Dr. Edison Ty GUIDELINES FOR PEDIATRIC PLATELET TRANSFUSION Children/Adolescents <50 x 109/L and bleeding <50 x 109/L and invasive procedure <20 x 109/L and bone marrow failure with age risk factor <10 x 109/L and bone marrow failure w/o age risk factor
Infants within the 1st 4mos of life <100 x 109/L and bleeding <50 x 109/L and invasive procedure <20 x 109/L and clinically stable <100 x 109/L and clinically unstable WHO GRADING OF DHF I. Hemocencentration, fever, & constitutional sx; + TT II. Spontaneous bleeding + grade 1 III. Circulatiry failure, pulse pressure <20mmhg SBP normal DSS IV. Profound shock, hypotension/unrecordable BP NORMAL HEMATOCRIT VALUES FOR AGE Age 2 weeks 3 months 6 months – 6 yrs 7 yrs – 12 yrs Adult: Male Female
Range (%)
Mean (%)
42-66 31-41 33-42 34-40
50 36 37 38
42-52 37-47
47 42
Source: Nelson textbook of Pediatrics, 15 th edition p. 1379 WHO CASE DEFINITION OF DHF (WHO 1975, 1986) All of the ff criteria nust be present: 1. Fever (high and continuous of 2-7 days’ duration) 2. Hemorrhagic diathesis (at least a positive tourniquest test except in shock) 3. Thrombocytopenia (less than 100,000/mm3) 4. Hemoconcentration (20% or more relative to baseline or evidence of increased capillary permeability) or evidence of plasma leakage (i.e. pleural effusion, ascites and/or hypoproteinemia) OTHER CLINICAL MANIFESTATIONS SUGGESTIVE OF DHF ARE:
1. 2.
Hepatomegaly (which may be tender) Circulatory disturbances (restlessness, cool extremities), capillary refill time >2 sec., tachycardia) 3. A fall in hematocrit following volume relacememnt ~ These along with a platelet count below 100,000/mm3 can justify notification of the case as DHF ~ Hematoconcentration may be absent during earlt fluid replcemnt or in cases where bleeding has occurred.
Unstable VS, " urine output Signs of shock Immediate rapid volume replacement 10-20ml/kg (or rapid bolus)normal saline or LR solution
Improvement
Adjust IVT
O2 to Correct Acidosis
Hematocrit ""
No Improvement
Hematocrit !!
Colloid infusion 10-20 ml/kg IV Blood transfusion 10ml/kg SCABIES Plasma/Hemaccel ®/ 5% Albumin/ ~ Tr eatment for dengue shock syndrome grades and 4 Dextran3 40 Crotamion (Eurax)lotion apply from neck down x 24h then rinse
DOPAMINE DRIP 200mg in D5W 200cc mcgtt/mins = wt x DD/13.3 = wt x DD x 0.75 400mg in D5W 250cc mgtt/min = wt x DD/26.6
= wt x DD x 0.375 6 x wt in kg = ___ mg in 100ml (1ml/hr = 1mcg/k/min) CRANIAL NERVE EXAMINATION LIST Rapport with patient
!
Introductions
Sit on edge of bed General inspection
$ Diagnostic
facies $ IVC $
NGT $ IDC $ Facial asymmetry $ Pupil symmetry $ Scars $ Ptosis $ eye patch $ eye glasses $ Hearing aide 1.
Ask for change in smell
2.
Test visual acquity
$ Snellen
chart $ Left eye $
Right eye Test visual fields
$ Hat
pin $ Left eye $ Right eye
Test light reflexes
$ Direct $ Consensual $
Swinging torch Test accommodation Fundoscopy
$ Hat
pin
$ Optic
disc $ Retinopathy
3, 4, 6. Test ocular movements ; ask if diplopia occur
$ Dysconjugate
5. Trigeminal Sensory & Motor
$ Pin
gaze (MLF) $ H pattern testing $ Diplopia $ Nystagmus $ Vertical $ Horizontal $ Test Intorsion (if CN3 palsy) prick testing
$V1 $V2
$V3 $ Light
touch testing $ Corneal
reflex $ Clench teeth & palpation of masseter muscle $ Open jaw & ptyerygoid resistance $ Jaw jerk 7. Test Facial Muscles
$ Forehead
wrinkling $ Eye
closure $ Blowing of cheeks $ Smiling $ Ear $ Mastoid $ Parotid $ Palate 8. Test Hearing and Balance
$ Inspection
9, 10. Deviation to Normal side
$ Dysphonia $ Swallowing
of ear and
tympanum $ whisper $ High tone 68 $ Low tone 100 $ Rinne’s $ R $ L $ W e b e r ’ s ( 2 5 6 H z ) $ Nystagmus $ Hallpike’s +/- Epley’s
$ Coughing $ Uvual $ Gag
reflex
deviation
11. test shoulder & neck movements
$ Trapezius
12. Tongue Protrusion; deviation to affected side
$ Wasting $ Fasiculation
mm: Shoulder
shrug $ SCM mm: Head turning
$ Dysarthria
Ask for BSL $ Peripheral
If relevant assess other neurological system
nervous system $ Cerebellar system
Summary & interpretation
HEART RATE
MEAN
NB- 3MOS
85-205
140
3MOS-2YRS
100-190
130
2YRS-10 YRS
60-140
80
>10YRS
60-100
75
WEIGHT 6MOS-12MOS
AGE in mos + 9 ÷ 2
1 YR-6YRS
Yrs x 2 + 8
7YRS-12YRS
Yrs x 7 - 5
HEIGHT Ht in cm
AGE in yrs x 5 + 80
Ht in inches
AGE in yrs x 2 + 32
Light index D2 diameter of collapsed lung DH diameter of hemithorax on the collapsed side % of pneumothorax= 100-(D23/DH3 x 100)
DOBUTAMINE DRIP 6 X WT in Kg = ______mg in 100ml 250mg in D5W 250cc (1mg/ml) Mcgtt/min= wt x DD/16.6 = wt x DD x 0.06 500mg in D5W 250cc (2mg/ml) Mgtts/min = wt x DD/33.2 = wt x DD x 0.03 EPINEPHRINE/NOREPINEPHRINE DRIP 0.6 X WT = ______mg in 100ml 1ml/hr will deliver 0.1mcg/kg/min Treatment for Chicken Pox Children: 800mg/tag, 1tab QID >40mg (3, 200mg PO in 4 divided doses) Nasal Cannula Oxygen Flow rate
Est. FIO2 in %
1
24%
2
28%
3
32%
4
36%
5
40%
6
44%
SIMPLE FACE MASK 5-6
40%
6-7
50%
7-8
60%
Anion gap (serum)= Na- (Cl + HCO 3) Corrected Ca= Actual Ca + [(40-alb)x 0.02] Sodium deficit= DNa-Ana x BW x 0.6 Potassium deficit = DK – AK /0.27 x 100% Sodium • •
•
•
Methylmed
The needed to infuse DNa-Ana 0.5 meqs / hr L Amount of PNSS needed = Computed Na deficiency ÷ 154 Drip rate = amount of PNSS needed Time needed to infuse
30mkdose + 100cc D5W x 2h q 24H via infusion pump x 3 doses
SCLEREMA NEONATORUM In an infant, fat has higher saturated-to-unsaturated fatty acid ration compared to adult fat and thus a higher melting point. Prematurity, hypothermia, shock and metabolic abnormalities have been postulated to further increase this ratio, possibly as a result of enzymatic alteration allowing precipitation of fatty acid crystals within the lipocytes. This condition has been suggested to result in the dramatic clinical findings in affected skin. X-ray diffraction techniques have confirmed that infants with sclerema neonatorum have an increase in saturated fats and that the crystals within the fat cells are composed of triglycerides.
Fluids and Electrolytes
> 5 years old (>20kgs)D5LR > 3 years old (<15kg)D50.3Nacl/ D5IMB (>15kg)D5NM Deficit
<10 kg
>10kg
Mild
50
30
Moderate
100
60
Severe
150
90
Maintenance (24 H) 0-3 kg
75cc/kg
3-10 kg
100cc/kg
10-20kg
75cc/kg
20-30kg
60cc/kg
30-40kg
50cc/kg
>40kg
40cc/kg
Newborn 0-1 day old
80cc/kg/hr
2
90cc/kg/hr
3
100cc/kg/hr
4
110cc/kg/hr
5
120cc/kg/hr
6
130cc/kg/hr
7
140cc/kg/hr
8
150cc/kg/hr
Mild Dehydration 30-50cc/kg/6h D50.3Nacl Moderate Dehydration 60-90cc/kg/6h " of computed deficit give D5LRX2hrs then % to be given for the next 6hrs D50.6Nacl Severe Dehydration >100cc/kg/6h 1/3 with D5LRX2H then 2/3 with D50.3Nacl X 6H Medical Prophylaxis Diphtheria – update DPT immunization status for all age groups and Erythromycin 4-050mkd in 4 days divided doses X 10 days (max 2g/day). Alternative: Benzathine Pen G IM single dose <30kg – 600,000 units >30kg – 1.2 Million units • •
NOTE: Close contact should be observed for 7 days for evidence of the disease. Endocarditis – prophylaxis given 30-60 mins after procedure Oral: Amoxicillin 50mg/kg Unable to tolerate PO Ampicillin 50mkdose IM/IV or Cefazolin/Ceftriaxone 50mg/kg Allergic to Penicillin Cephalexin 50mg/kg or CLindamycin 20mg/kg or Azithromycin/Clarithromycin 15mg/kg Allergic & unable to tolerate PO: Cefazolin/ceftriaxone 50mg/kg IM or IV or Clindamycin 20mg/kg IM or IV • •
•
•
•
Note: No prophylaxis for procedures ________ Respiratory, GI or Genitourinary Tract
Hepatitis B Newborn with HBsAg (+) mother HBIG 0.5mL and Hep B vaccine 0.5ml IM at birth or w/in 12 hrs followed by Hep B vaccine at 6 weeks after and after 6 months. Premature & HbsAg (-) mother Hep B vaccine delayed until child ! 2000 gm Sexual contact with HBsAg (+) partner, exposure to blood/ body fluids •
•
•
-
Hep B vaccine + HBIG 0.06ml/kg IM (not later than 14 days from exposure from sexual contact and with in 7 days for percutaneous exposure) Household/Sexual Contact with Chronic Causes Hap B vaccine only
•
Malaria Mefloquine (250mg/tab) to start 1 week before travel then weekly until 4 weeks after leaving endemic area as ff: < 45kg = 5mg/kg (max: 250mg) ! >45kg = 1 tab once a week ! Doxycycline daily to start 2-3 days before travel then daily until 4 weeks after leaving endemic area 8 years old = 2mg/kg up to adult dose of ! 100mg/day •
•
•
Note: Contraindicated for < 8years and pregnant women
Meningococcemia Rifampicin in 2 divided doses X 2days " 1 month – 5mkdose every 12 hrs ! 1 month – 10mkdose every 12 hrs (max 600mg) Alternative: Ceftriaxone single IM dose < 15 years old – 125mg ! 15 years old – 250mg or •
•
Ceprofloxacin (not for "18 years old)
! 18
years old: 20mk PO as SD (max 500mg)
Rheumatic Fever Benzathine Penicillin 1.2 Million U IM every 4 weeks <27kg (60lbs)- 600,000 U IM or Penicillin V 250mg PO twice daily for patients allergic to Penicillin: Erythromycin 250mg PO BID Duration: RF, (-) carditis: 5 years since last episode ao ARF or until 21 years old whichever is longer RF, (+) carditis w/o residual heart disease (no valvular disease): 10 years or until 21 years old whichever is longer RF, (+) carditis, (+) residual heart disease: 10 years since last episode or at least until 40 years old whichever is longer •
•
•
Note: Consider lifelong prophylaxis for people with severe valvular disease
VACCINATION Absolute Contraindications Severe anaphylactic/allergic reaction to previous vaccine Moderate – severe illness ± fever Encephalopathy within 7 days of vaccine (pertussis) Immunodeficiency (Congenital – all live vaccines ) or households contact (OPV) Pregnancy (MMR, OPV/IPV ) •
• • •
•
Relative Contraindications Immunosuppressive therapy (all live vaccines) Egg allergy (MMR) Seizure w/in 3 days of last dose (Pertussis) Shock w/in 48 hrs of last dose (Pertussis) Fever >40.5°C w/in 48hrs of last dose (Pertussis) Not Contraindications Mild illness ± low grade fever Current antibiotic therapy Positive PPD Prematurity • • • • •
• • • •
Nursery Please admit to NICU under the service of Dr. _____ TPR Q15minutes until stable Breastfeeding Labs: CBC, APC, BT, RH typing, NBS at 24h old Medications: 1. Terramycin ophthalmic ointment OU 2. Vit. K 1mg IM 3. Hep B vaccine 0.5mL IM S/O: Routine newborn care Gastric lavage Suction secretion PRN Thermoregulate at 36.5-37.5°C Daily cord care w/70% IPA Watch out for tachypnea, tachycardia, alar flaring, retractions Refer PRN • • • •
Newborn Final Diagnosis: Fullterm (__wks), AGA, BW=__kg, cephalic via NSVD, Live, Bb.Girl/Boy AS 9,10; Neonatal sepsis; Uninvestigated physiologic jaundice
IVF: TFR x wt/24h/20% (if with phototherapy) TFR x wt/24h-fdg-Aminosteril (use formula if w/ Aminosteril & fdg) eg: wt: 3kg TFR: 80 80x3/24/20%= 20 or 80x3=240x0.2= 48, next 240/48= 288/24h= 12cc/hr • •
1st 24h D10w, then D10IMB D5IMB Preterm Please admit TPR q15 minutes until stable NPO D10W 250ccx7cc/hr Labs: CBC, APC @24HDL Blood & RH typing Na, K, Ca BUN, Creatinine 24HDL • • • • •
NBS
ABG, Blood C/S, CBG q6H CXR, APL Vit. K 1mg IM now Hep B 0.5 ml Im now Terramycin/Erythromycin ophthalmic ointment Ampicillin – q12h Oxygen Attach to pulse oximeter
• • • • • •
HBsAg Reactive Mother Give HBIg 0.5ml deep IM w/in 12HOL CRP at 24HOL Blood C/S anytime after birth Normal CBG: 60-140 Bilirubin: B1B2: ÷ 17.1 (start phototherapy if !15) WBC: !20,000 start meds IT Ratio- stabs/juvenile/total neutrophils = !0.2 (+) infection • Reticulocyte – actual Hct/0.40 (desired Hct)X Reticulocyte = N 1-1.5 ! 1.0 = hemolysis " 1 = bone marrow failure (CRT ÷ 2) • • • •
Seizure Disorder Please admit TPR q4h and record NPO temporarily Labs: CBS, APC, Urinalysis, fecalysis, CBG now then q6h while on NPO
•
IVF: D50.3Nacl 500cc+2meq KCL/150ccIVF post voiding Meds: S/O: MIO qshift & record ! Monitor VS q4h & NVS qhour & record ! Seizure precaution at bedside ! Standby O2, padded tongue depressor at ! bedside Replace GI loses volume/volume w/ PLR ! as sidedrip Refer PRN !
Benign Febrile Seizure Please admit TPR q4h & record NPO temporarily Labs: CBC, APC, Urinalysis, Fecalysis, CBC now then q6h while on NPO IVF: D50.3Nacl 50cc+ 2meq KCl/100cc IVF IVF post voiding Meds: Paracetamol, Ibuprofen, Diazepam (0.2mkdose) S/O: MIO qshift & record ! Monitor VS q4h, neuroVS qhour & record ! Seizure precaution ! Standby O2, tongue depressor at bedside ! Replace GI losses V/V w/ PLR as sidedrip ! Refer PRN !
Status Post Lumbar Puncture Orders Flat on Bed x 4h NPO x 4h Send the following specimen to lab as ff: TT#3 – CSF cell ct, diff ct ! TT#2 – CSF, sugar & protein ! TT#1 – CSF GS/CS, AFB, KOH ! RBS now Monitor VSq15min until stable Refer patient for any untoward s/sx Status Post Extubation Orders Nebulizer with Racemic epinephrine now Extubate patient now Nebulize w/ Racemic epinephrine q15minx3doses Nebulize w/ Salbutamol 1nebule q6h NPO x 6h CXR, APG 6h post extubation O2 6-10LPM Watch out for secretions, tachypnea, etc. Note: Racemic Epi: PNSS: 4.7ml Epi: 0.3ml Body Surface Area =
! ! ! ! !
ANC= WBC x Differentials x 10 IT = stabs ÷ seg >0.2 bacterial BMI = wt (kg)÷ ht (m)2 MIO + intake – output = +/- balance Output + output ÷ wt ÷24h = ____cc/k (Output of chemo px: output ÷24h÷BSA = _____cc/m2)
