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ESSENTIAL NEWBORN CARE PROTOCOL [from DOH]

What should be done immediately after birth is to dry the baby because
hypothermia can lead to several risks

APGAR SCORE

Delaying the cord clamping to 3 mins after birth (or waiting until the
umbilical cord has stopped pulsing)
Instead of immediately washing the NB, the baby should be placed on
the mothers chest or abdomen to provide warmth, increase the
duration of breastfeeding, and allow the good bacteria from the
mothers skin to infiltrate the NB
Washing should be delayed until after 6 hours because this exposes the
NB to hypothermia and remove vernix. Washing also removes the babys
crawling reflex.

NEWBORN CARE
Umbilical Cord
Cut 8 inches above abdomen after 30 sec

In nursery, cut the umbilical cord 1 inch above the abdomen


Healing should take place around 7 10 days
Eye Prophylaxis
1% silver nitrate drops [most effective against Neisseria]

Vaccine
BCG

PT: 0.5 mg
Hep B
Newborn Screening
Done on 16th hr of life . can be repeated after 2 weeks
Patients w/ CAH will die 7 14 days if not treated
Patient w/ CH will have permanent growth defect and MR if not
treated before 4 weeks
Disorder Screened

Effects Screened

Congenital
Hypothyroidism
Congenital Adrenal
Hyperplasia (CAH)
Galactosemia (Gal)

Severe MR

Effects if Screened &


treated
Normal

Death

Alive &Normal

Death of Cataract

Alive &Normal

Severe MR
Severe Anemia
Kernicterus

Normal
Normal

Phenylketonuria PKU
G6PD

HR
Reflex irritability
Activity
Respiration
The APGAR Score
8 10
47
03

BCG
DPT
OPV/IPV
Hep B

Measles
MMR
Hib
Pneumococcal
Rotavirus
Hep A
Varicella

Flu

# of
dose
1

Interval

Booster

4 wks

4 wks

18 mos
4 6 yo
Same as
DPT

6 wks from 1st


dose; 8 wks
from 2nd dose
-

15 mos

2, 4, 6 mos

18 mos

6 mos (PCV7)
2 yrs (PPV)
3 and 5 mos

18 mos
2

I month

1 yr and up

1st: 12 15 mos
2nd: 4 6 yo

6 12 mos
apart
Bet 1st & 2nd
dose: at least
3 mos
yearly

6 months

Good cardiopulmonary adaptation


Need for resuscitation, esp ventilatory support
Need for immediate resuscitation

NEONATAL JAUNDICE

Min age of 1st


dose
At birth
Before 1 mo
6 wks
(2, 4, 6 mos)
6 wks
2, 4, 6 mos)
At birth
(0, 1, 6 mos)
EPI (6, 10, 14)
6 9 mos

>100
Cough
Active
Good

Please admit under RI, LI, PD or AP


TPR q4H
May breastfeed if NSD; NPO x 2hrs if CS
Labs:
NBS at 24 hrs old, secure consent
CBC, BT (if w/ maternal illness, PROM or UTI
HGT now then 1, 3, 6, 12, 24, 48 hrs old (GDM)
HGT now (SGA or LGA)
Medications:
Erythromycin eye ointment both eyes
Vit K 1 mg IM (term); 0.5 mg (PT)
Hep B vaccine 0.5 ml IM, secure consent
BCG 0.05 ml ID (PT); 0.1 ml (term), secure onsent
SO
Routine NB care
Monitor VS q30 mins until stable
Thermoregulate at 36.5 to 37.5C
Place under droplight (NSD); isolette (CS)
Suction secretion prn
Will infrom AP /AP attended delivery

IMMUNIZATION
Vaccine

2
All pink

NICU

Erythromycin 0.5% [Chlamydia]


Tetracycline 1%
Povidone iodine 2.5%
Vitamin K
1 mg Vit K1

Color

Evaluates the need for resuscitation


Taken 1 and 5 minutes after birth
0
1
Blue, pale
Body pink,
extremities blue
0
<100
No response
Grimace
Limp
Some flexion
Absent
Slow, irregular

NEONATAL SEPSIS
Classification
Early: birth to 7th day of life
Late: 8th to 28th day of life
Risk factors:
Maternal infection during pregnancy
Prolongrupture of membranes (18 hrs)
Prematurity
Common organism:
Bacteria: GBS, E. coli & Listeria (early)
Viruses: HSV, enteroviruses
Signs & symptoms: Non-specific
Dx: CBC, CXR, blood and urine culture, lumbar tap for CSF studies
Treatment: Empiric antibiotics [Ampicillin + 3rd gen Cephalosporin or
Aminoglycoside) / Supportive

Risk Factors
Jaundice visible on first day of life
A sibling w/ neonatal jaundice or anemia
Unrecognized hemolysis
Non-optimal feeding
Deficiency: G6PD
Infection
Cephalhemaoma or bruising / Central hct >65%
East Asian/ Mediteranean in origin
PHYSIOLOGIC vs PATHOLOGIC
FACTORS
Onset
Rate of inc of TSB
Persistent

PHYSIOLOGIC
> 24 hrs of life
< 0.5mg/dl/hr
< 14 days

Total S. Bilirubn

FT: < 12 mg/dl


PT: < 14 mg/dl

Signs/Symptoms

ZONE
I
II
III
IV
V
Parameter
Onset

Pathophysiology
Mngt

PATHOLOGIC
< 24 hrs of life
> 0.5mg/dl/hr
FT: > 8 days
PT: > 14 days
Any level requiring
phototherapy
Vomiting, lethargy, poor
feeding, excess wt loss, apnea,
inc RR, temp instability

KRAMER CLASSIFICATION
JAUNDICE
Head/neck
Upper trunk
Lower trunk, thigh
Arms, leg, below knee
Hands/feet

mg/dl
68
9 12
12 16
15 18
> 15

BREAST FEEDING vs BREASTMILK JAUNDICE


BREASTFEEDING
BREASTMILK
3rd to 5th day
Late; start to rise on day 4; may reach
of life
20 30 mg/dl on day 14 then slowly
Normal by 4 12 weeks
milk intake
Unknown; Prob. due to glucoronidase
in BM which enterohepatic circulation
enterohepatic
Normal LFT; (-) hemolysis
circulation
Fluid and
If breastfeeding is stopped, rapid in
caloric
bilirubin level in 48 hrs, if resumed will
supplement
to 2 4 mg/dl but no precipitating
previous events

MILK FORMULAS
1:1 dilution
1:2 dilution
Mead-Johnson, Nestle, Glaxo,
Wyeth, Abbott, Unilab
Dumex, Milupa
0-6 months (20cal/oz)
Lactose free (0-6months)
Mead-johnson: Alacta , Enfalac
Nestle: NAN1, Nestogen
Glaxo: Frisolac
Dumex: Dulac
Abbott: Similac advance
Milupa: Alaptamil
Wyeth: S26, Bonna
Unilab: Mylac
6months onwards (20cal/oz)

Mead-johnson: Enfalac lacto-free


Nestle: AL110
Milupa: HN25
Wyeth: S26 Lacto-free

Mead-johnson: Enfapro
Nestle: NAN2, Nestogen 2
Glaxo: Frisomil
Dumex: Dupro
Abbott: Gain
Wyeth: Bonnamil. Promil
Unilab: Hi-nulac
1 year onwards (20 cal/oz)

Mead-johnson: Enfapro lacto-free

Mead-johnson: Enfagrow, Lactum


Nestle: NAN3, Neslac
Glaxo: Frisorow
Dumex: Dugrow
Abbott: Gainplus
Wyeth: Progress, Promil
Unilab: Enervon bright
Hypoallergenic (20cal/oz)

Mead-johnson: Enfaprem
Nestle: PreNAN
Abbott: Similac prem
Milupa: Preaptamil

Mead-johnson: Pregestimil
Nestle: Alfare, NAN HA1, NAN HA2

Mead-johnson: Prosoybee
Abbott: Isomil
Wyeth: Nursoy

Lactose free (6months onwards)

Premature Infant (24cal/oz)

Soy-Based (20cal/oz)

TPN for NEONATES


Wt 2kg
1. TFR = 100 ml/kg/day x 2 kg
2. Intralipid 20%
1 g/kg/day x 2kg = 2g/day
2 g = 20g
x
100ml

200 ml
10 ml

3. Compute for TFR 1


TFR1 = TFR Intralipid = 200 -10ml = 90 ml
4. Vamin 7%
1 g/kg/day x 2 kg = 2g
=
29 ml
2 g = 7g
x 100ml
5. Multivitamins Benutrex c 0.5 ml/100ml
0.5 ml = x
1 ml
100ml 190 ml
6. Ca gluc 10% 2ml/kg/day x 2 kg 4 ml
7. Dextrosity (D10) get d50w
TFR 1 x dextrosity factor (0.11)
21 ml
190 x 0.11
8 . D5IMB = TFR 1 (Vamin + MTV + Ca gluc + D50W)
190 (29 + 1+ 4+ 21) =
135 ml
9. IV rate = TFR 1 / 24H 190 ml/ 24H
8 ml/H

Order:
Start TPN as ff:
TFR= 100ml/kg/day
D5 IMB
135 ml
D50W
21 ml
Vamin 7%
29 ml
Ca Gluc
4 ml
MTV
1 ml
190 ml to run at 8 ml/h
Intralipid 20% 10 ml to run for 24H

TPN
Vamin 9% 0.67 cal/ml
Start 0.5 g/k/day inc by 0.5 g until 3 -3.5g/k/day
Compute = wt x dose x prep (100/9)
Intralipid 10% 20%
Start 0.5 g/k/day inc by 0.5 g until 3 g/k/day
Compute = wt x dose x prep (100ml/ 10) = ml/24H
Amino acids
Start 0.5 g/k/day inc by 0.5 g until 3 g/k/day
Compute = wt x dose x prep (100ml/g) = ml/24H
TPN shortcut computation
Wt 10 kg TFR= 100 ml/k/day

TFI = 1000ml/day

Vamin 7% 7 = 2 g/kg x 10kg


100
CaGluc 2ml/kg
D5IMB
D50W 0.11 x 1000ml

285 ml
20 ml
485 ml
110 ml
1000ml x 37 cc/h
TPN (PEDIATRICS)
Energy Requirment

AGE/WT
Neonates
Infants & Older Children
<10 kg
11-20 kg
>20
AGE/WT
Neonates: VLBW
( 1500 gm)

Caloric Rquirement
90-120 kcal/kg
10-120 kcal/kg
1000kcal + 50 kcal foe each kg > 10
1500 + 20 for each more than 20
Fluid Requirement
Fluid Rquirement
Initiate at 40 60 ml/kg/day and increase by 10
ml/kg/day till 120 ml/kg is reached

AGA & LBW

Initiate at 60 ml/kg/day and increase by 15 ml/


kg/day till 120 ml/kg is reached on the 5th day of
PN
Neonates under radiant heaters/on phototx an extra 30ml/kg/day of water
Infants & Older Children
<10 kg
11-20 kg
>20

100 120 ml/kg


1000ml + 50 ml foe each kg > 10
1500 + 20 for each more than 20

Protein Requirement
AGE/WT
Dosage (gm/kg/day)
VLBW ( 1500 gm)
2.25
0 12 months
2.50
1 8 yrs
1.50 2.0
8 yrs and above
1.00 1.50
With the initiation of PB|N, start w/ 0.5gm/kg/day and gradually increased
by 0.5gm/kg/day till recommended protein is reached.
Carbohydrate Requirement
% dextrose = gram dextrose x 100
Vol infused (ml
Should provide 50 60 % 0f total non-protein calories
Requirement ranges frm 10 to 25 gm/kg/day
Infusion should not exceed 12.5mg/kg/min
Should be decreased if urinary glucose 0.5% (2+) or blood sugar exceeds 7
mmol/L in neoanate or 9.7 mmol/L I above 1 mo of age
Fat Requirement
AGE
Dosage (gm/kg/day)
0 12 months
2
1 8 yrs
4
8 yrs and above
2.5
30 40 % of total calories shud b provided as fats
2 4% as EFA
Start at 0.5 gm/kg/day and gradually increase by 0.5 gm/kg/day till
recommended amt is reached
Daily Electrolyte Requirements
Elect.
(mmol/kg)

Neonates

NaCl
Potassium
Cal gluc

35
24
0.6 1.0

Phosphate
Magnesium

1.0
0.125-0.250

1-6 mos

6m-11yrs

34
23
0.25 1.2
(max of 4.7)
12
0.125-0.250

34
23
0.25 1.2
(max of 4.7)
12
0.125-0.250

Adolescents
60 100
80 120
4.7
30 45
48

Calcium gluconate contains 100 mg calcium gluconate or 9mg elemental


calcium/ml; 1 gm of Ca gluconate contains 4.7mEq or 2.35 mmol of Ca.

Trace Elemental Requirements

VITAMINS

Trace
Elemental

Prematures
(ug/kg)

Infants & Children


(ug/kg)

Adolescents
(mg)

Stimulants
Buclizine (syrup)

Zinc
Copper
Chromium
Manganese
Iodine
Selenium
Flouride

400
50
0.3
10
8
4
57

100 500
20
0.14 0.2
2 10
8
4
57

2.5 4
0.5 1.5
0.01 0.04
0.15 0.5
0.2
0.3
0.9

w/ Folic acid
(Megaloblastic
Anemia)

In the absence of available prep of trace elements; weekly blood


transfusion may be given at 20 ml/kg

Iron: 2 mg/kg, with dose increased to 6 mg/kg if Fe def is documntd;


provided by adding iron dextran to amino acid soln
OSTERIZED FEEDING
TFR

Pizotifen
(drowsiness)
MTV w/ Iron

60 - 70% = 100/feeding q 6H
10 kg x 60%
TFR = 600
0.5 g/kg inc q other day by 0.5 , max of 2 g/kg
Dose x wt x prep (Vamin 7%, 9%)
0.5 x 10 kg x (100 /7) = 71 g/kg
CHON = 71 g/kg
If no prep = dose x wt x 4 = 20 g/kg
60%
(TFR CHON) x 0.6
(600- 71) x 0.6 = 317
CHO = 317
181 (the rest are fats , divided into 6 feedings)

CHON

CHO

Fats

w/ Serotonin (for
migraine + dec
wt)

COMPOSITION OF ORS
Na

Cl

Glu

Glucolyte

60

20

50

100

Hydrite

90

20

80

111

WHO
Pedialyte

75
30
45
90
41

20
20
20
20
11

65
30
35
80

75

ORS

30
45
90

Gatorade
Iron Deficiency
Anemia

9/100

Supplemental Iron =
Therapeutic Dose: 5 - 6 mkday for 3 mos
Maintenance Dose: 3 - 4 mkday
Elemental iron
20% of FeSo4
12% Fe gluconate
33% Fe fumarate
Wt x Dose x Prep
Ferlin drops15mg/ml
Fe 75 mg
Prophylactic dose
Term 1 mg/k/Day, start 4 mos-1y
PT 2 mkD, start 2 mos-1y
Therapeutic dose 3 mkD BID, QID for 4-6mos
Ferlin syrup 30mg/ml
Fe 149.3 mg
Supplemental dose 10-15 mg OD
Therapeutic dose 3 mkD TID, QID for 4-6mos
Sangobion syr (Fe gluc 250mg elem Fe 30mg)
Incremin with Iron
Syrup 30 mg elem Fe
ASSESSMENT OF DEHYDRATION [CDD]

PARAMETER

NO SIGN

SOME SIGN

SEVERE

Condition

Well, Alert

Restless
Irritable

Eyes

Normal

Sunken

Lethargic
Unconscious
Floppy
Very sunken
Dry

Tears

Present

Absent

Absent

Mouth/Togue

Moist

Dry

Very dry

Thirst

Drinks normally
Not thirsty

Thirsty
Drinks eagerly

Skin pinch

Goes back
quickly

Goes back
slowly

Drinks poorly
Not able to
drink
Goes back very
slowly

Severity

Mosegar Vita 0.25 mg/day prep 0.25 /5 ml


Appetens
Propan
Appebon
2 - 8yo 5 - 10 ml OD
7 - 14yo
10 - 20 ml OD
Molvite
7 - 12yo
10 - 15 ml OD
3 - 6yo 5 - 10 ml OD
1 - 2yo
2.5 - 5 ml OD
Iberet
Ferlin (10 mcg folic acid)
Macrobee
1 - 2yo
2.5 - 5 cc OD
3 - 6yo
5 - 10 cc OD
7 - 12yo
10 - 15 cc OD
Mosegor vita syr
Appetens
Propan w/ iron syr (Fe So4; elem fe 30mg)
Appebon w/ iron syr (FeSo4; elem fe 10mg)
Mosegor vita
Mosegor plain
Appeten
Jagaplex syrup
1-2yo
5ml OD
3-6yo
10 ml OD
7-12yo
15 ml OD
Clusivol Power syrup
syr
100mg/5ml
2-6yo
5 ml OD
7-12yo
10 ml OD
Zeeplus
<2yo
2.5 ml OD
2-6yo
5 ml OD
7-12yo
5-10 ml OD
Polynerv
1-2yo
2.5 ml OD
3-6yo
5 ml OD
7-12yo
10 ml OD
0-6mo
0.5 ml-1 ml OD
7mo-1yr
1-1.5 ml OD
1-2yrs
1.5-2ml OD
FLUID MANAGEMENT
Less than 2 yo

More than 2 yo

Mild
50cc/kg
30cc/kg
Moderate
100cc/kg
60cc/kg
Severe
150cc/kg
90cc/kg
To run for 6 8 hrs then refer
Usual fluid is D5 0.3 NaCl; if however more than 40 kg then D5 LR
ORAL REHYDRATION THERAPY
AGE
Amount ORS to give/loose stool
50 100 ml
100 200 ml
As much as wanted
Amount of ORS to give in 1st 24 hrs:Wt (kg) x 75ml/kg

PLAN A

PLAN B

30ml/kg
AGE
Infants (<1 yo)
1 hr
Children (>1 yo)
30 mins
In fluid resuscitation: use 20cc/kg as bolus. Usually PLR

PLAN C

70ml/kg
5 hrs
2.5 hrs

MAINTENANCE WATER
HOLLIDAY SEGAR METHOD
Weight [kg]
Daily Requirement [ml/kg]
3 10
100 ml
10 20
1000 + 50ml/kg for each kg >10
>20
1500 + 20ml/kg for each kg >20
Maintenance water rate
0 10
10 20
>20

4ml/kg/hr
40 mk/hr + 2ml/kg/hr x wt
60 mk/hr + 1ml/kg/hr x wt

COMPOSITION OF IV SOLUTION
Na
K
Cl
PNSS
154
154
0.45 NaCl
77
77
D5 0.3 NaCl
51
51
D5 LRS
130
4
109
D5 NM
40
13
40
D5 IMB
25
20
22
D5 NR
140
5
98
Na requirement: 2 4 meq/k/day
K requirement:
KIR: 0.2 0.3 meq/k/hr ; max 40 meq
KIR = Rate x incorporation / wt
Fluid

HCO3
Dxt
5
28
5
16
5
23
5
27
5
2 3 meq/k/day

CLINICAL FEATURES of PNEUMONIA


Bacterial

Fever >38.5C
Chest recession
Wheeze not a sign of primary bacterial URTI
Wheeze
Marked recession
Fever < 38.5
RR normal or increased

Viral
Mycoplasma

School children
Cough
wheeze
CXR in assessing CAP etiology

Alveolar infltrates

Bacterial pneumonia

Interstitial infiltrates
Both infiltrates

Viral pneumonia
Viral, Bacterial, or Mixed

Microbial causes of CAP according to Age


Birth to 20 days

Grp B Strep
Gram (-) enterobacteria

3 weeks to 3
months

RSV
B. pertussis
Parainfluenza virus
S. aureus
S. pneumonia
RSV, Parainfluenza virus
H. influenzae
Influenza virus, Adeno, Rhinovirus
M.tuberculosis
S. Pneumonia
M.pneumoniae
M.pneumoniae
S. pneumonia
C. Pneumoniae
M.tuberculosis

4 months to 4 yo

5 years to
15 years

CMV
L. monocytogenesis

Clinical Practice Guidelines in the Evaluation and Management of PCAP


Predictors of CAP in patients with cough
(3 mos to 5 yrs) tachypnea &/or chest retractions
(5 12 yrs) fever, tachypnea & crackles
(>12 yo) (a) fever, tachypnea & tachycardia; (b) at least 1 AbN CXR
WHO Age Specific classification for tachpynea
2 to 12 mos:
>50 RR
1 to 5 yrs:
>40 RR
>5 yrs:
>30 RR

THERAPEUTIC MANAGEMENT OF CAP


OPD MANAGEMENT
Birth to 20 days
Admit
3 weeks to 3 months
Afebrile: Oral Erythromycin (30-40mkd)
Oral Azithromycin (10 mg/kg/day) day 1
5 mkday for day 2 to 5
Admit: febrile or toxic
4 months to 4 yo
Oral Amoxicillin (90mkd/3doses)
Alternative: Amox-Clav, AZM, Cefaclor
Clarithromycin, Erythromycin
5 years to 15 years
Oral Erythromycin (30-40mkd)
Oral AZM 10mkday day 1, 5mkday day 2-5
Clarithromycin 15mkday/2 doses
Pneumococcal infxn: Amoxicillin alone
IN-PATIENT MANAGEMENT
Birth to 20 days
Ampicillin + Gentamicin w or w/o Cefotaxime
3 weeks to 3 months
Afebrile: IV Erythromycin (30-40mkd)
Febrile: add Cefotaxime 200mkd
Cefuroxime 150 mkd
4 months to 4 yo
If w/ pneumococcal infection:
IV Ampicillin (200mkd) Cefotaxime 200mkd
Cefuroxime 150 mkd
5 years to 15 years
Cefuroxime 150 mkd + Erythromycin 40mkd
IV or orally for 10-14 days
If pneumococcal is confirmed: Ampicillin 200mkd
VARIABLE

A (Min Risk)

PCAP
B (Low Risk)

C (Mod Risk)

D (High Risk)

Comorbid
Illness

None

Present

Present

Present

Compliant
caregiver

Yes

Yes

No

No

Possible

Possible

Not

Not

None
Able
>11 mos

Mild
Able
>11 mos

Moderate
Unable
<11 mos

Severe
Unable
<11 mos

>50/min
>40/min
>30/min

>50/min
>40/min
>30/min

>60/min
>50/min
>35/min

>70/min
>50/min
>35/min

Ability to
follow up
DHN
Feeding
Age
RR
2 12 m
1 5 yo
>5 yo

PCAP A/PCAP B
No diagnostic usually requested
PCAP C/PCAP D
The ff shud b routinely requested
CXR APL (patchy viral; consolidated bacterial)
WBC
C/S (blood, Pleural Fluid, tracheal aspirate on initial intubation)
Blood gas/Pulse oximeter
The ff may be requested: C/S sputum
The ff shud NOT be routinely requested: ESR & CRP
Antibiotic Recommendation
PCAP A/PCAP B and is beyond 2 yo & having fever w/o wheeze
PCAP C and is beyond 2 yo, having high grade fever, having alveolar
consolidation on CXR, having WBC >15,000
PCAP D refer to specialist
Antibiotic Recommendation
PCAP A/PCAP B w/o previous antibiotic
Amoxicillin (40 50 mkday) TID
PCAP C Pen G IV (100,000 IU/k/d) QID
PCAP C who had no HiB immunization
Ampicillin IV (100mkd) QID
PCAP D refer to specialist
What should be done if px is not responding to current antibiotics?
If PCAP A/PCAP B not responding w/n 72 hrs
Change initial antibiotic
Start oral Macrolide
Reevaluate dx
PCAP C no responding w/n 72 hrs consult w/ specialisr
PCN resistant S pneumonia
Complication
Other dx
PCAP D not responding w/n 72hrs, then immediate consultto a specialist is
warranted
Switch from IV to Oral Antibiotic done in 2 3 days after initiation in px who:
Respond to initial antibiotic
Is able to feed with intact GI tract
Does not have any pulmo or extra pulmo complication
Ancillary Treatments
O2 and Hydration
Bronchodilators, CPT, steam inhalation and Nebulization
Prevention
Vaccines
Zinc Supplementation (10mg for infants / 20mg for children > 2 yo)
Signs of Respiratory Failure
VARIABLE

A (Min Risk)

B (Low Risk)

C (Mod Risk)

D (High Risk)

Retractions

Head
bobbing
Cyanosis
Grunting
Apnea
Sensorium

Subcostal/
Intercostal
+

Subcostal/
Intercostal
+

None

Awake

+
Irritable

+
+
+
Lethargy /
Stupor
Coma/

None

None

Present

Present

OPD
f/u at end
of tx

OPD
f/u after 3
days

Admit to
regulat ward

Admit to
CCU; Refer
to specialist

Comp:
Effusion
Pneumo
-thorax
Action Plan

BRONCHIOLITIS
Acute inflammation of the small airways in children <2 yrs
Most commonly caused by RSV
Related to exposure to cigarette smoke
Risk factors for severe dse:
<6 mos
Heart or lung disease
Prematurity
Immunodeficiency
Signs/Symptoms
low grade fever, rhinorrhea, cough, wheezing
hyperresonance to percussion
CXR: hyperinflation, interstitial infiltrates
Treatment
Mild [at home]:
Increased fluids, trial of inhaled bronchodilators, aerosolized epinephrine
Severe:
Admit to hospital if: Marked respratory distress; Poor feeding; O2 sat <92%;
hx of prematurity < 34 wks; underlying cardiopulmonary dse;
unreliable caregivers
Manage with ventilatory and O2 support, hydration, inhaled
bronchodilators and ribavirin

SEVERITY OF ASTHMA EXACERBATION


VIRAL CROUP vs EPIGLOTTITIS
VIRAL CROUP
Age group
3 mos to 3 yrs
Stridor
88%
Pathogen
Parainfluenza virus
Onset
Prodrome (1 7 days)
Fever Severity
Low grade
Associated symptom
Barking cough,
hoarseness
Respond to racemic
Stridor improves
epinephrine
CXR
steeple sign

EPIGLOTTITIS
3 7 yrs
8%
H. influenzae type B
Rapid (4 12 hrs)
High grade
Muffled voice,
Droolong
None

Breathless

MODERATE

SEVERE

Walking

Talking
Infant softer
shorter cry
Difficult
feeding

At rest
Infant
stops
feeding

BRONCHIAL ASTHMA

Talks in

Sentences

Prefers sitting
Phrases

Hunched
Words

Alertness

May be
agitated

Usually
agitated

Usually
agitated

Inc

>30/min

Usually

Usually

MANAGEMENT APPROACH BASED ON CONTROL


Step 2
Step 3
Step 4

RR

Inc
<60/min
<50/min
<40/min
<30/min
Usually
not

Wheeze

Moderate

Loud

Usually
loud

Paradoxical
Thoracoabd
movt
Absence of
wheeze

Pulse Rat
Normal PR
2-12 mo
1-2 y
2-8 y
Pulsus
paradoxus

<100

100-200

>120

Bradycardia

<10mmHg

Maybe
present
10-25mmHg

Present
20-40
mmHg

Absence
suggests resp
ms fatigue

>80%

60-80%

<60%

<160/min
<120/min
<110/min
Absent

PEF

Asthma education and Environmental control


As needed rapid acting B2 agonist

PRN B2
Agonist

C
O
N
T
R
O
L
L
E
R

Step 5

Select 1

Select 1

Add 1 or
more

Add 1 or
more

Low dose
ICS

Low dose ICS +


LABA

Oral
steroids

Leukotriene
modifier

Medium or Hi
dose ICS
Low dose
ICS +
Leukotriene
Modifier
Low dose
ICS +
Salbutamol
Release
theophylline

Med to Hi
dose
ICS + LABA
Leukotriene
Modifier
Sustained
Release
theophylline

Anti-IgE
treatment

LEVELS OF ASTHMA CONTROL [GINA GUIDELINES]


CONTROLLED

PARTLY

None [2x or
less/week]

More than 2x
a week

Limitation of
activities

None

Any

Nocturnal sx/
awakening

None

Any

Need for reliever/


recue tx

None

More than 2x
a week

Lung function
(PEF OR FEV1)

Normal

80% predicted

Exacerbation

None

One or more/
yr

Daytime symptom

UNCONTROLLED

Three or more
features of
partly controled
asthma present
in any week

One in any
week

Drowsy or
confused

Normal RR
<2 mo
2-12 mo
1-2 y
2-8 y
Accessory
ms

PaO2

Normal

>60 mmHg

<60 mmHg

PaCO2

<45 mmHg

<45 mmHg

>45 mmHg

O2 Sat

>95%

91-95%

<90%

ATOPIC DERMATITIS

Step 1

RESPIRATORY
ARREST
IMMINENT

Can lie

thumbprint sign

Please admit under the service of Dr. _____________


TPR q4H and record
NPO if dyspneic
Labs:
CBC
U/A (MSCC)
ABG*
CXR APL*
IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
Medications:
Paracetamol prn q4h for T > 37.8C (10 15 mkdose)
USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses
Incorporate Budesonide 10 mkd LD (max 200mg IV); then
5mkd q6h IV (max of 100 mg IV)
Ranitidine IVTT at 1mkdose (if on NPO)
SO:
MIO q shift and record
Monitor VS q2h and record
Refer for persistence of tachypnea, alar flaring and retractions
O2 at 2 lpm via NC, refer for desaturations <95%
Will inform AP
Pls inform Dr _____ of this admission
Thank you.

MILD

Hereditary, AR

hx of Asthma
thickened, shiny, red
exacerbated by dry
skin, contact sty, &
anxiety
tx:hydrocortisone or
fluocinolone
moisturizer

SEBORRHEIC
DERMATITS

CONTACT DERMATITIS

cloxa/cefalexin if with

Irritant strong chem.

excessive

e.g. diaper rash


remove reactant
Allergic
e.g. cosmetic,
perfume
tx: high/mod
potency steroid

infxn

sebum
accumulation
on scalp, face,
midchest,
perineum
greasy scalp
(cradle cap)
physiologic for
1st 6mos
tx: potency
steroid

HYPERSENSITIVITY REACTION
Please admit under the service of Dr. __________________
TPR q4H and record
Hypoallergenic diet
Labs:
CBC
U/A (MSCC)
IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
Medications:
*Epinephrine (1:1000) 0.1mg/kg/dose IM anterolateral thigh
(max of 0.3 mg)
*Salbutamol neb x 3 doses q 20 mins
Diphenhydramine 10 mkdose LD (max of 200mg IV); thenmg IV)
5mkdose q6h IV (max of 100
Ranitidine IVTT at 1mkdose q 12h
SO:
MIO q shift and record
Monitor VS q2h and record to include BP
Continue TSB for fever
O2 at 2 lpm via NC, or 6 lpm via facemask
Attach to pulse oximeter, refer for desaturations <95%
Will inform AP
Pls inform Dr _____ of this admission
Thank you.

ANAPHYLAXIS
A syndrome involving a rapid & generalized immunologically mediated rxn
After exposure to foreign allergens in previously sensitized individuals
A true emergency when cardio and respi system are involved
ED Management
O2

Aqueous Epinephrine 1:1000 IM (0.01ml/kg with 0.5ml max)


Prepare intubation if w/ stridor & if initial therapy of epi is not effective
Continuous monitor ECG and O2 sat & establish IV access
Antihistamine to prevent progression
H1 & H2 blocker
Diphenhydramine (1mg/kg) IM

Steroids may modify late phase or recurrent reaction (Hydrocortisone


5mg/kg/dose)
Epinephrine 1:10,000 IV (0.1ml/kg; 10ml max)
Epinephrine drip (0.01ml/kg/min)
Indication for Admission
Persistent bronchospasm

Hypotension requiring vasopressors


Significant hypoxia
Patient resides some distance from a hospital facility
SEIZURE
BENIGN FEBRILE SEIZURE CRITERIA

6 mos 6 yrs
< 15 mins
Febrile
Family history of febrile seizure
GTC
Not > 1 episode in 1 febrile episode; EEG done after 2 wks of seizure
episode
3% of general population develop epilepsy

1 2 % of BFS develop epilepsy


25% recurrence of seizure

HYPOVOLEMIC

CARDIOGENIC

DISTRIBUTIVE

SHOCK
CO is primarily maintained by changes in HR
Pump empty
Truma, hemorrhage,
DHN (diarrhea/
vomiting)
Metabolic dse (DM)
Excessive sweating
Weak/sick pump
CHF, cardiomegaly,
drug intoxication,
hypothermia,
after cardiac
surgery
Sepsis
Anaphylaxis
Barbiturate intox
CNS injury (SCI)
SIGNS OF SHOCK

EARLY
Narrowed pulse pressure
Orthostatic changes
Delayed capillary filling
Tachycardia
Hyperventilation
ED
MNGT

Duration
Recurrence

Simple

Complex

GTC

Focal then gen post ictal

< 15 min

> 15 min or may go into


status
Recurrent (w/in 24H)

None

CNS exam

Normal

Abnormal

Sequelae

None

Neurodev abnormalities

FEBRILE SEIZURE
Please admit under the service of Dr. ______________
TPR q4H and record
DAT once fully awake
Labs:
CBC
U/A (MSCC)
IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
Medications:
Paracetamol prn q4h for T > 37.8C
SO:
MIO q shift and record
Monitor VS q2h and record
Monitor neurovital signs q4h and record
Continue TSB for fever
Seizure precaution at bedside as ff:
Suction machine at bedside
O2 with functional gauge; if with active sz give O2 at 2lpm via NC
Diazepam IVTT (0.3 mkd max of 5 mg IV) prn for seizure
Will inform AP
Pls inform Dr _____ of this admission
Thank you.
BELLS PALSY

Acute unilateral facial nerve palsy that is not associated with other
cranial neuropathies or brainstem dysfunction

Seizure paroxysmal, time limited change in motor activity and/or behavior


that results from abnormal electrical activity in the brain
Epilepsy present when 2 or more unprovoked seizure/s occur at an interval
greater than 24 hrs apart

CO = HR x SV

SEIZURE
Type

MC in infant &children
Normal BV of children
80ml/kg

Compromise CO

Redistribution of fluid w/n


vascular space

LATE
Decrease systolic pressure
Decrease diastolic pressure
Cold, pale skin
Altered mental state
Diaphoresis
Decrease urine output

Position
Oxygen & Assisted ventilation
Intravenous access & Fluid (isotonic crystalloid)
Reassess (look for improvement in VS, skin signs, mental status;
insert foley cath & monitor UO)
Inotropes help stabilize BP
Epinephrine - (0.1 1 ug/kg/min) - Infusion of choice for
Hypotensive pxs
Dobutamine - (5 20 ug/kg/min)
Cardiogenic shock but not severely hypotensive
Dopamine [(5 20 ug/kg/min constrictor effect) [(10 15
ug/kg/min]
Distributive shock after successful fluid resuscitation
Cardiogenic shock
Diuretic pxs may get worse after fluid challenge
Adenosine / synchronize cardioversion SVT
Defibrillation Venticular fibrillation

Usually develops abruptly about 2 wks after SVI [EBV, HSV, mumps]
Upper and lower portions of the face are paretic; corner of the mouth
drops; unable to close the eye on the involved side

Protection of cornea with methylcellulose eye drops or an ocular


lubricant; excellent prognosis
CEREBRAL PALSY
Non-progressive disorder of posture & movement often associated with
epilepsy & abnormalities of speech, vision & intellect resulting from
defect or lesion of the developing brain
Etiology: infections, toxins, metabolic, ischemia
Classifications
Physiologic
Topogrphic
[major motor abnormality]
[involved extremities]
Spastic
Monoplegia [1 side/portion]
Athetoid worm like
Paraplegia
Rigid
Hemiplegia
Ataxic
Triplegia [3 limbs]
Tremor
Quadriplegia [all]
Atonic
Diplegia [LE/UE]
Mixed
Double hemiplegia
unclassified
Clinical Manifestations
Spastic
Arms > legs
hemiplegia
Dificulty in hand manipulation obviously by 1 yo
Delayed walking or walk on tiptoes
Spasticity apparent esp. in ankles
Seizure & cognitivr impairment
Spastic diplegia
Bilateral spasticity of the legs
Commando crawl
Increased DTRs & (+) Babinski sign
Normal intellect
Spastic
Most severe form, due to marked motor impairment
quadriplegia
of all extremities & high association with MR &
seizures
Swallowing difficulties
Management
Baseline EEG & cranial CT scan
Hearing & visual function tests
Multidisciplinary approach in the assessment & treatment
For tight heel cord: tenotomy of the Achilles tendon
CSF PATHWAY
Choroid plexus (lateral ventricle) Foramen of Monroe 3 rd ventricle
Aqueduct of sylvius 4th ventricle Foramina of Luschka (2 laterals)
& Magendie (median) SAS Absorbed in the arachnoid villi,
then in the Venous System

HYDROCEPHALUS
Result from impaired circulation & absorption of CSF or from inceased
production
Obstructive or Noncommunicating
Due to obstruction w/n ventricular system
Abnormality of the aqueduct or a lesion in the 4th venticle
(aqueductal stenosis)
Non-obstructive or Communicating
Obliteration of the subarachnoid cisterns or malfunction of the
arachnoid villi
Follows SAH that obliterates arachnoid villi; leukemic infiltrates
Clinical Manifestations
Infant: accelerated rate of enlargement of the head; wide anterior
fontanel & bulging [Normal fontanel size: 2 x 2 cm]
Eyes may deviate downward: due to impingement of the dilated
suprapineal recess on the tectum [setting sun sign]
Long tract sign: [brisk DTR, spasticity, clonus, Babinski sign]

Percussion of skull produce a crackedpot or Macewen sign

[separation of sutures]
Foreshortened occiput [Chiari malformation]
Prominent occiput [Dandy-Walker malformation]

Treatment
Depends on the cause

Extracranial shunt
Acetazolamide & Furosemide [provide temporary relief by reducing
the rate of CSF production]
MOTOR
Full resistance with gravity
Some resistance with gravity
Movement with gravity
Movement w/o gravity
Flicker
No movement

Very brisk
Brisker than average
Normal
Diminished
No response

Extend across midline

Occur 1-2 % cases

Edema disappears w/in 1st few days of life


Molding and overriding of parietal bones-frequent
Disappear during 1st wks of life

No specific tx
Cephalhematoma
Subperiosteal hemorrhage; limited to1 cranial bone
No discoloration of overlying scalp
Swelling not visible for several hours after birth (blding slow process)
Firm tense mass with palpable rim localized over 1 area of skull
Resorbed w/in 2wk- 3mos and calcify by end of 2nd wk
Few remain for years
10-25% cases underlying linear skull fracture
No tx but phototherapy in hyperbilirubinemia

Pre Lumbar Tap


NPO
RBS by gluco prior to lumbar tap
Prepare lumbar tap set
2% Lidocaine # 1
sterile bottles # 3
G 23 spinal needle
sterile gloves # 2
Mannitol 250 cc 1 bot - do not open Sterile gauze # 1
Solvent
Sterile gauze w/ Betadine #1
Diazepam 1 amp
Sterile towel w/ hole #1

3 cc syringe #2
2 manometers

DEEP TENDON REFLEXES


5/5
4/5
3/5
2/5
1/5
0/5

CRANIUM
Caput succedaneum
Diffuse edematous swelling of soft tissues of scalp

+4
+3
+2
+1
0

Sterile clamp #1
3-way stopcock #1
Post Lumbar Tap

NPO x 4H; Flat on bed


Monitor NVS to include BP q 30mins x 4H, then qH
CSF exams
Bottle # 1 Gm stain, AFB, India ink, KOH
Bottle # 2 Cell count, CHON, Sugar
Bottle # 3 C/S, save remaining specimen
Watch out for vomiting, HA and hypotension

Contraindications to LP

Evidence of Inc ICP


Severe CP compromise
Skin infection at site of puncture
DIAZEPAM

MIDAZOLAM

PHENOBARBITAL

ANTICONVULSANTS
0.2 0.3 mkdose
Drip: 1amp in 50cc D5 W
10mg/amp
0.15 mkdose prn 2 3 mins interval IV (1, 5mg/ml)
6 mos - 5 yo
0.05 - 0.10 max of 0.6 mg/kg
6 yo - 12 yo
0.25 - 0.05 max of 0.4 mg/kg
>12 yo
0.50 - 2 mg/dose over 2 mins
LD: 15 20 mkd
MD: 5 mkdose q 12h
(max load 20 mkday IV
Tabs: 15, 30, 60, 90, 100 mg
Caps: 16 mg
ELIXIR 20mg/5ml
Inj: 30, 60, 65, 130 mg/ml
MD: PO/ IV
Neonate:
3 - 5 mkD QID/ BID
Infant/child: 5 - 6 mkD
1 - 5 yo:
6 - 8 mkD
6 - 12 yo:
4 - 6 mkD
> 12 yo:
1 - 3 mkD
Hyperbil < 12 yo:
3 - 8 mkD BID/TID

PHENYTOIN

Dilantin

LD: 15 20 mg/kg/IV
MD:
Neonate:
5 mkD PO/ IV BID
Infant/child: 5 7mkD BID/ TID
6mos 3y: 8 10 mkD
4 6y:
7.5 9 mkD
7 9y:
7 8 mkD
10 16 y:
6 7 mkD
Tab: 50mg
100mg
TID
Extended release caps 30, 100, 200, 300 mg OD, BID
Inj: 50 mg/ml

Tegretol

< 6 yo
6 - 12 yo
> 12 y

CARBAMAZEPINE
Tab 200mg,
100mg
XR 100mg, 200mg,
Susp 100mg/ 5ml (QID)
Initial
Increment
10 - 20 mkD BID /TID q wkly til 35 mkD
10 mkD BID
100 mg/ 24H at
1 wk interval
200 mg BID
200 mg/ 24H at
1 wk interval

OXCARBAMAZEPINE

Trileptal
VALPROIC ACID

Depakene
Depacon
TOPIRAMATE

Topamax

chew
400mg
Maintenance
20 - 30 mkD BID/
QID
800 - 1200
mg/24H
BID/ QID

(8 - 10 mkd BID)
Initial: 8 -10 mkD PO BID then
Increment: increase over 2 week pd to
Maintenance doses:
20 -29 kg:
900 mg/24H PO BID
29.1 -39 kg: 1200 mg/24H PO BID
>39 kg:
1800 mg/24H PO BID
Tab
150 mg
300mg
600 mg
Susp 300mg/5ml
PO:
Initial :
10 - 15 mkD OD - TID
Increment:
10 mkD at wkly interval BID
Maintenance: 30 - 60 mkD BID/TID
IV: same dose as PO q 6H
Rectal : (syrup mix with water 1:1)
LD: 20 mkd
MD: 10 -15mkd TID
Tab 250 mg
Syr 250mg/5ml
IV 100mg/ml
2 - 16 yo
Initial: 1 - 3 mkd PO q HS x 7 days then Increment:
Increase by 1 - 3 mkday for 1 - 2 wks then
Maintenance: 5 -9 mkD BID
Caps: 15 mg, 25 mg
Tabs: 25, 50, 100, 200mg

Glasgow Coma Scale


Activity
Eye Opening
Spontaneous
To speech
To pain
None
Verbal
Oriented
Confused
Inappropriate words
Inappropriate sounds
None
Motor
Follows command
Localizes pain
Withdraws to pain
Abnormal flexion
Abnormal extension
None

GCS for Infants


Activity
4
3
2
1

Spontaneous
To speech
To pain
None

4
3
2
1

5
4
3
2
1

Coos, babbles
Irritable
Cries to pain
Moans to pain
None

5
4
3
2
1

6
5
4
3
2
1

N spontaneous movt
Withdraws to touch
Withdraws to pain
Abnormal flexion
Abnormal extension
None

6
5
4
3
2
1

CSF ANALYSIS
Diff
ct

Color

RBC

WBC

Sugar

CHON

Infant (Term)

Xantho

0100

0 -32

Infant (Preterm)

Clear

0100

0 -15

Older child

Clear

0 -10

Viral Meningitis

Clear

0 -20

TB/Fungal

Clear

20 500

L
100
%
L
100
%
L
100
%
L
100
%
L>
N

70 to
80%

60 150

70 to
80%

60 200

> 50%

10 - 20

40 to
60%

40 - 60

< 40%

> 100
g%

Bacterial
Meningitis

Purulent

>
1000

N>
L

< 50%

> 100
g%

Partially tx BM

Clear

100

L>
N

> 50%

Dec

ROSEOLA [HSV 6] Exanthem subitum


Age of onset
< 3 yo with peak at 6 15 months
High grade fever for 3 5 days but behave
normally
Rash
Appears 12 24 hrs of fever resolution fades in 1
3 days
HERPANGINA [Coxsackie A]
Sudden onset of fever with vomiting
Small vesicles & ulcers w/ red ring found in anterior tonsillar pillars, may also
seen on the soft palate, uvula & pharyngeal wall
VARICELLA [HSV]
MOT
Direct contact
IP
14 days
Prd of comm
1 2 days before the onset of the rash until 5 6
days after onset & all the lesions have crusted
Rash
Start from the trunk then spread to othe parts of the
body
All stages present; pruritic
Macule/papule vesicle crust
Complication
Secondary bacterial infection
Reye syndrome
Encephalitis or meningitis
GN
Pneumonia
Congenital
6 -12 wks AOG: maximal interruption w/ limb devt
Varicella
with cicatrix(ski lesion w/ zigzag scarring)
16 20 wks: eye and brain involvement
Tx
Acyclovir 15 30 mg/kg/day IV or 200 400 mg tab
q 4hrs minus midnight dose x 5 days: risk of severity
Post exposure
VZIg 1 dose up to 96 hrs after exposure
prophylaxis
Dose: 125 U/10 kg (max 625 U) IM
NB whos mother develop varicella 5 days before to 2
days after delivery shud recv 1 vial
Vaccine
Susceptible children >1 yo w/n 72 hrs
ERYTHEMA INFECTIOSUM [Parvovirus B 19] FIFTH DISEASE
MOT
Droplet spread & blood & blood products
IP
16 17 Days average
Prodrome
Low grade fever, headache, URTI
Rash
Erythematous facial flushing slapped cheek and
spreads rapidly to the trunk & proximal extremities as
a diffuse macular erythema; palms & soles spared
Resolves w/o desquamation but tend to wax and
wane in 1 3 wks

VIRAL INFECTIONS
MEASLES (Rubeola) [Paramyxoviridae]
MOT
Droplet spray
IP
10 12 days
Prd of comm
4 days before & 4 days after onset of rash
Enanthem
Koplik spots (opposite lower molars)
Prodrome
High grade fever, conjunctivitis, catharr (3 5 days)
Rash
Appear during height of fever
Cephalocaudal[1st along hairline, face, chest]
[+] brawny desquamation disappear w/n 7 10 days
Complication
Otitis media
Diarrhea
Pneumonia
Exacerbation of M tb infection
Encephalitis
Vit A SD 100,000 IU orally for 6 mos 1 yo / 200,000 IU >1 yo
Tx
Post exposure
Ig w/n 6 days of exposure
prophylaxis
(0.25ml/kg max 15 ml) IM
Vaccine
Susceptible children >1 yo w/n 72 hrs
SSPE
Chronic condition due to persistent measles infxn
Rare but found in 6 mo to >30 yrs of age
Subtle change in behavior & deterioration o schoolwork
followed by bizarre behavior
Elevated titers of Ab to measles virus(IgG, IgM)
Inosiplex (100mg/kg/day) may prolong survival
GERMAN OR 3 DAY MEASLES [RUBELLA] [Togaviridae]
MOT
Oral Droplet; transplacentally to fetus
IP
14 21 days
Prd of comm
7 days before &7 days after onset of rash
Enanthem
Forchheimer spots [soft palate] just b4 onset of rash
Rash
Cephalocaudal
Charac. sign
Retroauricular, posterior cervical & postoccipital LAD [24
hrs before rash & remains for 1 wk]
Vit A SD 100,000 IU orally for 6 mo 1 y / 200,000 IU >1 yo
Tx
Post exposure
Immunoglobulin [not routine]
prophylaxis
Considered if termination of preg is not an option
0.55ml/kg) IM
Vaccine
w/n 72 hrs of exposure
Congenital
Greatest during 1st trimester; IUGR
Rubella
Congenital cataract, microcephaly, PDA, blueberry
muffin skin lesions
Congenital or profound SNHL | Motor/mental retardation

MOT
IP
Period of
communicability
Prodrome
Parotid gland
swelling
Complications

Hx of
Absorbed TT
Unknown or
<3
>

MUMPS [Paramyxoviridae]
Direct contact, airborne droplets, fomites
contaminated by saliva
16 18 days
1 2 days before onset of parotid swelling until 5 days
after the onset of swelling
Fever, neck muscle pain, headache, malaise
Peak in 1 3 days
1st in the space between posterior border of mandible
& mastoid then extends being limited above zygoma
Meningoenephalitis - most frequent, 10 days; M>F
Orchitis & Epididymitis
Oophoritis
Dacryoadenitis or optic neuritis
Clean minor Wound

All other Wounds

Td

TIG

Td

TIG

Yes

No

Yes

Yes

No

No

No

No

< 7 yo Dtap is recommended


> 7 yo Td is recommended
If ony 3 doses of TT received, a 4th dose should be given
Give TT (clean minor wounds) if > 10 y since last dose
All other wounds (punctured wds, avulsions, burn)
Give TT (all clean wounds) if > 5 yrs since last dose
VERORAB
BERIRAB

Ig (Human)
Equine

RABIES VACCINE
0.5 cc/amp; 1 amp IM
Day: 0 3 7 14 and 28
RD: 20 iu/kg
300 iu/vial
1 vial = 2ml
at wound site
deep IM
Reqd amt in IU: wt x RD (20IU)
Amount in ml = wt x RD (20) x 2
300
20 iu/kg
Bayrab 300 iu/2ml | Berirab 300 iu/2ml
40 iu/kg
Favirab 200 400 iu/5ml
1000 2000 iu/5ml

BCG
DPT
OPV
IPV
MMR, Measles
Varicella
Hep B
Hep A
Hib
Typ
Pneumococcal
Influenza

VACCINES
Live attenuated M bovis
Diptheria and TT inactivated B pertussis
Sabin trivalent live attenuated virus
Salk inactivated virus
Live attenuated virus
Recombinant DNA, plasma derived
Inactivated virus
Capsular polysacc linked to carrier CHON
Live typhoid vaccine 3 doses x 2 days
IMSC Vi antigen typ vaccine
Capsular polysaccharide 0.5 ml
SC /IM 23 valent purified cap
Polysacc Antigen of 23 serotyp
Split or whole virus IM
DENGUE FEVER

Please admit under the service of Dr. ________________


TPR q4H and record
DAT (No dark colored foods)
Labs:
CBC, Plt (optional APTT and PT)
Blood typing
U/A (MSCC)
IVF:
D5 0.3 NaCl 1P/1L (<40 kg) at 3 5 cc/kg
D5LR 1L (>40 kg) at 3 5 cc/kg
Medications:
Paracetamol prn q4h for T > 37.8C
Omeprazole 1mkdose max 40 mg IVTT OD
SO:
MIO q shift and record
Monitor VS q2h and record, to include BP
Continue TSB for fever
Refer for Hypotension, narrow pulse pressure (< 20mmHg)
Refer for signs of active bleeding like epistaxis, gum bleeding,
melena, coffee ground vomitus
Will inform AP
Pls inform Dr _____ of this admission
Thank you.

DENGUE HEMORRHAGIC FEVER


Serotype 1, 2, 3, & 4
Aedes egypti
IP: 4 6 days (min 3 days; max 10 days)
DHF SEVERITY GRADING
GRADE
MANIFESTATION
I
Fever, non-specific constitutional symptoms such as
anorexia, vomiting and abdominal pain (+) Torniquet
test
II
Grade I + spontaneous bleeding; mucocutaneous, GI
III
Grade II w/ more severe bleeding +
Evidence of circulatory failure: violaceous, cold &
clammy skin, restless, weak to imperceptible pulses,
narrowing of pulse pressure to < 20mmHg to
actualHPON
IV
Grade III but shock is usually refractory or irreversible
and assoc w/ massive bleeding
CRITERIA FOR CLINICAL DX (WHO)
DHF
DSS
Fever, acute onset, high, lasting 2 7
Above criteria
days
Plus
Hemorrhagic manif:
Hypotension or narrow pulse
(+) Torniquet test
pressure [SBP DBP]
Minor & Major bleeding
<20mmHg
phenomenon
Thrombocytopenia <100,000/mm3
Dengue Drips
Furosemide drip
Dose: 0.04 - 0.5
80 mg + 32 cc
Wt x dose = rate (cc/h)
2
Furo drip = 0.1 - 0.5mg/k/hr
Prep: 20mg/2ml (2mg/ml)
Rate: (wt x dose)/2 = cc/hr ex. 14.5kg x 0.45 = 3.2cc/hr
To order: 8ml Furo + 32ml D5W +40 cc to run at 3.2cc/hr

RHEUMATIC HEART DISEASE


JONES CRITERIA
Precedex drip
Dose: 0.2 - 0.7
1ml + 99cc D5W to run at cc/h
Wt x dose = rate (cc/h)
Noradrenaline (Levophed) 1mg/ml dose :(0.5 1 ml/kg)
Wt x dose ( each ml contains 4 mcg Noradrenaline)
4 mcg
( for acute hypotension)
2ml + 500cc D5W x 2cc/H (0.5 cc/H)
Dopamine ( 5 -20 mcg/kg/min)
200 mg/250ml Single strength
400 mg/250ml DS (div by 2)
Wt x dose x 0.075
Dobutamine
250 mg/5ml SS
500 mg/250ml DS(div by 2)
Wt x dose x 0.06
Terbutaline Bricanyl SC
Inj: 1 mg/ml
< 12y 0.005 0.01 mkd x 3 doses q 15
-20 min then q2-6H
> 12y 0.25 mkd
Terbutaline drip
LD: 2 10 mcg/kg
then
0.1 0.4 mcg/kg/min
Ketamine (Ketalar)
10, 50, 100 mg/ml
PO: 5mg/kg x 1
IV 0.25 - 0.5 mg/kg
IM 1.5 - 2 mg/kg x 1
Morphine IV
0.1 0.2 mkd q2-4H prn
Naproxen

250, 375, 500mg tab


125mg/5ml
> 2yo 5-7 mkd TID, BID PO

INFECTIVE ENDOCARDITIS
DUKE CRITERIA
Major Manifestation
Minor manifestation
Diagnosis
Highly probable: 2 major OR 1 major and 2 minor manifestation

Major Manifestations
Arthritis (70%)
Carditis (50%)
Tachycardia
Pericarditis
Heart murmur of valvulitis
Cardiomegaly
Signs of CHF [gallop rhythm, distant heart sounds, cardiomegaly]
Erythema marginatum (10%)
Subcutaneous nodules (2 10%)
Sydenhams chorea (15%)
Minor manifestations
Arthralgia
Fever at least 38.8C

Acute Phase Reactants (CRP & ESR)


Prolonged PR interval on the ECG

Diagnosis: Highly probable : 2 major OR 1 major and 2 minor manifestation


ACUTE GASTROENTERITIS
Please admit under the service of Dr. ________________
TPR q4H and record
DAT once fully awake; NPO x 2hrs if with vomiting
Labs:
CBC
U/A (MSCC)
F/A (Concentration Method)
IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
Medications:
Paracetamol prn q4h for T > 37.8C
Zinc (E Zinc)
Drops 10mg/ml 1ml OD (<6 mos) | 1ml BID (6 mos 2 yo)
Syrup 20 mg/5ml (>2 yo) 5ml OD
Ranitidine IVTT at 1mkdose (if with abdominal pain)
SO:
MIO q shift and record
Monitor VS q2h and record
Continue TSB for fever
Chart character, frequency and amount of GI losses and replace w/
PLR 1L/1P vol/vol
Will inform AP
Pls inform Dr _____ of this admission
Thank you.

BPN
Please admit under the service of Dr. ______________
TPR q4H and record
NPO if dyspneic
Labs:
CBC
U/A (MSCC)
ABG*
CXR APL*
IVF:
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo) OR
D5 IMB/D5 NM at MR if with NO losses
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
D5LR 1L at 30cc/kg in 8hif >40 kg
Medications:
Paracetamol prn q4h for T > 37.8C (10 15 mkdose)
USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses
then refer
NaCl (Muconase) nasal spray, 2 sprays per nostrils, then suction
using bulb QID
Ranitidine IVTT at 1mkdose (if on NPO)
SO:
MIO q shift and record
Monitor VS q2h and record
Continue TSB for fever
Refer for persistence of tachypnea, alar flaring and retractions
O2 at 2 lpm via NC, or 6 lpm via facemask
Attach to pulse oximeter, refer for desaturations <95%
Will inform AP
Pls inform Dr _____ of this admission
Thank you.
HENOCH SCHONLEIN PURPURA [HSP]
Most common cause of nonthrombocytopenic purpura in children
Typically follows URTI
2 8 years old
Hallmark
Rash palpable petechia or purpura, evolve from red to
brown; last from 3 10 days [LE and buttocks]
Arthritis of knees and ankles
Intermittent abdominal pain due to edema & damage to the
vasculatue of the GIT
Mngt
Symptomatic
Steroid for severe abdominal pain

ACUTE GLOMERULONEPHRITIS
Inflamm. process affecting the kidney, lesions predominate in glomerulus
Etiology: Infections:
Bacterial: Grp A hemolytic strep, S viridans, S pneumo, S. aureus, S
epidermidis, S typhi , T pallidum, Leptospira
Viral: HBV, Mumps, Measles, CMV, Enterovirus
Parasitic: Toxoplasm, Malaria, Schistosoma
Drugs: Toxins, Antisera, Vaccines (DPT)
Miscellaneous: Tumor Ag, Thyroglobulin
GABS Nephritogenic Strains
Sites: URT - pharyngitis - M1 2 4 12 18 25
Skin pyoderma - M49 55 57 60
Pathophysio Immune complex disease
Clinical & Lab
Hematuria
Hypocomplementenemia

Proteinuria
Edema
HPN 82%

JUVENILE RHEUMATOID ARTHRITIS [JRA]


Criteria

Clinical
Manifestations

Mngt

Age of onset <16 yo


Arthritis (swelling or effusion) or presence of 2 or more of:
limitation of range of motion, tenderness or pain on
motion
increased heat in one or more joints.
Duration: 6 wks or longer
Onset type defined in the 1st 6mos
Polyarthritis: (5 or more inflamed joints)
Oligoarthritis (<5)
Systemic arthritis w/ characteristic fever
Morning stiffness, ease of fatigue esp. after school in the
early afternoon, joint pain later in the day, joint
swelling
Pauci: LE, assoc w/ chronic uvietis
Poly: both large & small joints more severe if extensors of
elbow and Achilles tendon are involved
Systemic: quotidian fever w/ daily temp spikes of 39C
for 2 wks; faint red macular rash over the trunk &
proximal extremities
NSAIDS then Methotrexate
Seroid for overwhelming systemic illness
SYSTEMIC LUPUS ERYTHEMATOSUS [SLE]

Criteria

Dx

Mngt

Malar rash
Renal disorder
Discoid rash
Neurologic disorder
Photosensitivity
Hematologic disorder
Oral ulcers (painless)
Immunologic disorder
Nonerosive arthritis (2 or more joints)
ANA abormal titer
Serositis (pleuritis, serous pericarditis, Libman sacks endocarditis)
Presence of 4 of 11 criteria [ANA not required dx]
(+) ANA screening
Anti ds DNA more specific; reflects the degree of disease
activity
Decrease C3, C4 in active dse
Anti Sm Ab (most specific)
NSAIDS use w/ caution
Prednisone (1 2 mkday)
Severely ill: pulse IV steroid (30mkdose) max 1 gm over 60 mins
OD x 3 days
Severe dse: Pulse IV Cyclophosphamide to maintain renal fxn &
prevent progression

Computation for OFI (AGN & limiting OFI)


BSA x 400 + UO IVF (half if w/ Furo) = OFI (then divide to 3 shifts)
20cc x wt x UO IVF
BILIRUBIN METABOLISM

Oliguria
Nausea and Vomiting
Dull lumbar pain

Typical course
Latent: few days 3wks
Diuretic: 7 10 days
Oliguric: 7 10 days
Convalescent: 7 10 days
Normalization of urine sediment
Parameter
Resolved by
Gross hematuria
2 3 wks
Complement level
6 8 wks
Proteinuria
3 6 mos
Micro hematuria
6 12mos
Lab Dx:
U/A spec grav,cast, hematuria, chonuria
Serology culture of GABS, ASO, C3 ( dec in acute phase, rises during
convalescensce)
Renal fxn bun crea- normal, hyponat
Hematology dilutional anemia, transient hypoalbuminemia
Radiography CXR , renal utz
Management:
Bed rest
Fluid and salt restriction
Fluids: 400 600 ml/m2/day + UO 24H
NaCl < 2 g/day
K < 40 meq/day
Penicillin 50 100,000 u/kg/day TID/QID x 10 days
HPN, CHF - Furosemide 2 mg/k/dose
Prognosis complete resolution, 5 10 % progress to chronic state

Treatment of Hyperbilirubinemia
Phototherapy
Exchange
transfusion
IV Ig

Metalloporphyrins

Complications: met. acidosis, electrolyte abn,


hypoglycemia, hypocalcemia, thrombocytopenia, vol.
overload, arrhythmias, NEC, infection, GVHD, and death
Adjunctive treatment for hyperbilirubinemia due to
isoimmune hemolytic disease
(0.51.0 g/kg/dose; repeat in 12 hr) | Reducing hemolysis
Competitive enzymatic inhibition of the rate limiting
conversion of heme-protein to biliverdin (an intermediate
metabolite to the production of unconjugated bilirubin)
by heme-oxygenase
Patients with ABO inc or G6PD deficiency or when blood
products are discouraged (Jehovahs witness)

PHOTOTHERAPY
10 Bulbs; 20 watts; 200 hrs; 30 cms
Bilirubin in the skin absorbs light energy
Photo-isomerization reaction converting the toxic native unconjugated
4Z, 15Z-bilirubin into an unconjugated configurational isomer 4Z,15Ebilirubin, which can then be excreted in bile without conjugation
Major product from phototherapy is lumirubin, which is an irreversible
structural isomer converted from native bilirubin and can be excreted by
the kidneys in the unconjugated state
Complications
Loose stools, erythematous macular rash, purpuric rash associated with
transient porphyrinemia, overheating, dehydration (increased insensible
water loss, diarrhea), hypothermia from exposure, and a benign
condition called bronze baby syndrome dark, grayish-brown skin
discoloration in infants
Bilirubin (Total)
Cord
Preterm
Term
0 1 days
Preterm
Term
1 2 days
Preterm
Term
3 5 days
Preterm
Term
Older Infants
Preterm
Term
Adult
Neonate
Infants/Children

BICARB DEFICIT CORRECTION


Ex: wt 4.9kg
pH = 7.10
pCO2 = 9.1
pO2 = 36.5
HCO3 = 2.8
BE = -26.8
O2 Sat = 53.6%
BE x Wt x 0.3 = 26.8 x 4.9 x 0.3 = 39.39meqs
Half correction: 39.39/2 = 19.69 meqs
To order: Give 20 meqs NaHCO3 + equal amt of sterile water to be given
slow IVTT over 30mins.
Infuse another 20 meqs NaHCO3 + equal amt sterile water as drip for 1-2 hrs.
EMPIRIC: NaHCO3 1-2mkdose even w/o ABG.
HCO3 correction in ABG:
Half correction: Base xs x 0.3 x wt 2
(+ equal amount of sterile water)
Full correction: Base xs x 0.3 x wt 2
(1/2 via IV push, via IV drip)
Full correction: Base xs x 0.3 x wt 2
(1/2 via IV push, via IV drip)
BUN/ crea ratio
Normal 10 -20
> 20 suggest DHN, pre renal azotemia or GIB
< 5 liver disease, inborn error of metabolism

<2 mg/dl
<2 mg/dl

<34 mol/L
<34 mol/L

<8 mg/dl
<8.7 mg/dl

<137 mol/L
<149 mol/L

<12 mg/dl
<11.5 mg/dl

<205 mol/L
<197mol/L

<16 mg/dl
<12 mg/dl

<274 mol/L
<205mol/L

GFR = k x L = ml/min/1.73 m 2 SA
sCr
L = body length (cm)
Scr = mg/dL ; divide by 88.4 if units in mmol/L

<34 mol/L
<21 mol/L
5 12 mol/L

Dextrosity
to get factor:

<2 mg/dl
<1.2 mg/dl
0.3 1.2 mg/dl
Bilirubin (Conjugated)
<0.6 mg/dl
<0.2 mg/dl

<10 mol/L
<3.4 mol/L

GFR (based on plasma creatinine and ht)

NURSERY NOTES
Desired D5
D50- D5

D 7.5 = 0.055
D10 = 0.11D 12.5 = 0.166
D15 = 0.22
D 17.5 = 0.28
Limits of Dextrosity: Peripheral line = D12 | Central line = D20

Total Fluid Intake (TFI):


Preterm: start at 60 cckd
Term: start at 80 cckd
To check TFI = rate x 24 wt
ex. Preterm: wt: 1.129
Day 1: start IVF with D10 water
60 x 1.219 24 = 3.1 cc/hr x 24 hrs
Add Calcium gluconate at 200 mkd q8h
Ca gluc = 1.129 x 200 3 = 75mg q8hrs for 3 doses
Start antibiotics
Give ranitidine
HGT q 8/12 hrs
OGT, CBC
Na, K, Ca at 48 hrs
Blood c/s depends on AP
Day 2: increase TFI by 10-20 (depends on AP)
70 x 1.129 24 = 3.3 cc/hr x 24 hrs
incorporate ca gluc 200 mkd to IV
ex.
D10 water 80 cc
Ca gluc
2.2cc
82.2cc to run at 3.3ccx24hrs
Day 3: increase TFI by 10-20 (depends on AP)
If electrolytes are N, may use D10IMB
80 x 1.129 24 = rate
80 x 1.129 x factor to get value of D50 water (to make D10 use 0.11)
Cont Ca gluc incorporation (if feeding may discontinue)
D50 water 9.9cc
D5 IMB
77.9cc
= D10 IMB
Ca gluc
2.2cc (200mkd)
90 cc to run at 3.7cc/hrx24h
If feeding already:
Total volume of milk wt = cc/kg/day
Subtract this amount to TFI to get value for IV
(if Dr. Reinoso, divide by 2 before subtracting to TFI)
ex. MF 3cc q3hrs = 24 cc in 24 hrs
24 1.129 = 21.2 cckd from milk
80 21.2 = 58.8cckd (use this for IVF)
58.8 x 1.129 24 = rate
D50 water 7.3cc
D5 IMB
56.5cc
= D10 IMB
Ca gluc
2.2cc (200mkd)
66 cc to run at 2.7cc/hrx24h
Subsequent days depend on infants status.

Electrolyte requirements:
Na: 2-4 mkd
prepn 2.5 mg/ml
Ca: 100-200mkd
prepn 100mg/ml
K: 2-4 mkd
prepn 2mg/ml
Glucose Infusion Rate:
Dextrosity x IVF rate x 10 10
Wt
Ex. 10 kg; IVF D10 IMB at 40cc/h
GIR = 10 x 10 x 40 10 = 6.6mkmin
60
NV: Newborn & Infants 6-8 mg/kg/min
Children
4-6 mg/kg/min
If HGT <40 mg/dl, give D10 water slow IV push at 2cc/kg and
repeat HGT after 30 mins-1 hr (may do 3 boluses if still low, may inc dextrosity
or rate)
Level of Umbilical Cathetherization: (cm)
If arterial between T6-T9 = Wt x 3 x 8
If venous: (wt x 3) + 8 +1
2
ET tube size: age in yrs +4
4
ET level:
if >2yo: age(yrs) +12 or ET size x 3
2
Total Flow Rate = Tidal volume x wt x RR x I.E ratio + 2000
I.E = 2
Dead space = 2000
RR = 40-60
Tidal volume = Newborn: 6-10cck
Child:
10-15cck
Adult:
15cck
FiO2
Nasopharyngeal cathether = Flow rate x 20 + 20
Ex. 1L
Fio2 = 40
Nasal catheter = Flow rate x 4 + 20
Ex. 1L
FiO2 = 24
Extubation:
Give Dexamethasone at 0.1 mkdose q6h for 24 hours prior to extubation
USN with epinephrine 0.5 cc + 1.5 cc PNSS q15 mins x 3 doses then extubate
then USN with Salbutamol nebule + 1.5 cc PNSS q6h x 24 hours
O2 at 10 lpm then decrease as necessary

Double Volume Exchange Therapy (DVET)

Regular milk: 20 cal/oz


Preterm milk: 24 cal/oz

Wt x 80 x 2 = Volume/ amt of fresh whole blood


(Use mothers blood type)

Total Caloric Intake: rate x 24 x caloric content of IVF wt


To get factor:
Dextrosity x 0.04 = cal/cc

Volume
_
= # of exchange
aliquots per exchange

Caloric content of IVF


D5 = 0.2 cal/cc
D7.5 = 0.3 cal/cc
D10 = 0.4 cal/cc
D15 = 0.6 cal/cc
Caloric requirement & Protein requirement
Cal/kg
0-5mo
6-11mo
1-2 yo
3-6 yo
7-9 yo
10 12 yo
13-15 yo
16 19 yo

g/kg

115
110
110
90 100
80 90
70 80
55 65
45 50
Approximate Daily Water Requirement

0 3 do
10 do
1 5 mo
6 12 mo
1 3 yo

120cc/k/d
150cc/k/d
150cc/k/d
140cc/k/d
120cc/k/d

> 3 kg
2-3 kg
1-2 kg
850g-1kg
< 850 g

4 6 yo
7 9 yo
10 12 yo
13 15 yo
16 19 yo

3.5
3
2.5
2
1.5
1.5
1.5
1.5

CHON reqt = CHON reqt for age x IBW


Actual BW
Growth and Caloric requirements
RDA kcal/kg/day
115
110
100
100
100
90 100

Diflucan: 6 mkd OD prepn 50mg/tab divide into pptabs and give 1

Prepare the ff:


2 pcs 3 way stopcock
1 pc 5 cc syringe
1 pc BT set
1 pc IV tubing
1 pc empty bottle
Gloves
Calcium gluconate 100 mg every 10 exchanges
Criteria for Hypoxic Ischemic Encephalopathy

100 cc/k/d
90 cc/k/d
80 cc/k/d
70 cc/k/d
50 cc/k/d

Estimated Catch up Growth Requirement


= cal/k/day (age for wt) x IBW (wt for ht)
Actual BW

AGE
0 3 mos
3 6 mos
6 9 mos
9 12 mos
1 3 yo
4 6 yo

pptab OD x 2 weeks
Aminophylline: 5mkd (loading dose) then 1.6 mkd q 8 hrs
(maintenance)
Phenobarbital 20 mkd (loading dose) then 5 mkd (maintenance)
Dexamethasone 0.1 mkdose q6hrs x 24 hours

For other meds, please see NEOFAX

pH < 7 (profound met. Acidosis)


Apgar <3 more than 5 mins
Neurologic sequelae (coma; sz)
Multiorgan involvement
Difficult delivery

Medications
Dopamine: wt x dose x 0.075
Prepn : Single Strength: 200mg/250ml;
Double Strength: 400/250ml
if using double strength: wt x dose x 0.0752
(Dose = 5-20)
Dobutamine: wt x dose x 0.06
Prepn: 250mg/250 ml; Dobuject 50mg/ml
(Dose = 5-20)
If using Dobuject: Wt x dose x 60 concentration
Concentrations: 5mg/ml = 5000
50mg/50ml = 1000
50mg/20ml = 2500
To make 5mg/ml: Dobuject 5cc
D5 water 45cc

FWB
PRBC
Plasma
PRP
Plt conc
Cryoprecipitate

EMERGENCY
ET tube age in years + 4
4
ET diameter x 3
>10 yo cuffed

Factor 8
Laryngoscope sizes

PT

Miller 00 or 0

Term

Miller 0

0-6mos

Miller 1

6-24 mos

Miller 2

>24 mos

Miller 2 or Mac 2

NORMAL VALUES
AVERAGE WEIGHT (3,000 grams)
0 6 mos
Age in months x 600 + BW
7 12 mos
Age in months x 500 + BW
Children
1 6 yo
Age in years x 2+ 8
7 12
Age in years x 7 5 / 2
yo
HEAD CIRCUMFERENCE [35 cm (+ 2cm)]
1 4 months
inch per month
5 12 mos
inch per month
2 years old
1 inch per year
3 5 yo
inch per year
6 20 yo
inch per 5 years
LENGTH (50 cm)
0 3 months
9 cm
46
8 cm
79
5 cm
10 12
3cm

20 ml
15 ml
10 ml
5 ml
1-3 ml

1 - 3 days

BLOOD TRANSFUSION
10 - 20 cc/kg
5 - 10
10 - 15
10 - 15
1 u/ 7 -10 kg
1 u/kg
Hemophilia A 1 bag
(200mg fibrinogen)
VW dse 50 -100 mg/kg
Fibrinogen dse 100 cc
(2-5 kg)
Hemophilia A
50 u/kg
Hemophilia B
100 u/kg
1 mo

3 4H
3 4H
12H
12H
FD
FD

2mos

6 12y

>12y

Hgb

14.5 22.5

9 -14

11.5 -15.5

13-16

Hct

.48 - .69

.28 - .42

.35 - .45

.37 - .49

6 -17.5

4.5 -13.5

Wbc

9 -30 birth

Plt

84 478 NB

Retic

0.4 - 0.6

5 19.5

After 1 wk, same as adult


150 - 400
< 1 -1.2

0.1 -2.9

1 u FWB

(inch = 2.54cm)

= 200 cc PRBC
= 50 cc platelet concentrate
= 150 200cc PRP
= 150 cc FFP
MCV
Hgb / rbc x 10
80 -94
MCH
Hgb / rbc x 10
27 - 32
MCHC
Hgb/ hct x 10
32 38
Absolute reticulocyte count = pts hct
x retic %
N hct for age
Reticulocyte Index
Absolute Retic Ct
> 2 hemorrhage
2
< 2 rbc production abn
PRBC to be transfused for correction = 40 hct x wt

GLUCOSE

PT 20 -60
NB 30 60
1 d 40 -60
> 1d 50 -90

Child = 60 -100
Adult = 70-105

ANC - % of neutrophils & cells that become neutrophils multiplied by wbc


ANC = wbc x (% seg + % stabs + % meta)
Other formula: wbc x (seg + meta + stabs ) x 10
Ex 2.1 x 53 (seg) x 10 = 1113
ANC > 1000
Normal
ANC < 2000
Neutropenia
ANC 1000 -1500
Low risk of infection
ANC 500 -1000
Mod risk of infection
ANC < 500
High risk of infection
IT ratio
> 0.25 sepsis
> 0.80 higher risk of death from sepsis
Anemia
< 10 g
mild anemia
8-9g
mod anemia
<8 g
severe anemia
IVIG infusion
Preparation:
2.5g/50cc
500g/10cc
25g/100cc
5g/100cc
10g/250cc
Computation:
Wt x 2 g /kg IVIG
Ex wt: 7.2 kg
7.2 x 2 + 16 g IVIG
16 gIVIG
2. 5 g = 320 cc
Cc
50cc
# of vials = total cc
320cc = 6.4 vials
50cc
50cc
320cc x 0.03 = 9. 6 cc/h for 30 mins
Transfuse 9 10cc/h IVIG for the 1st 30mins if no reaction, run the remaining
volume for 12H
Refer for any infusion reactions
Close ML
Monitor v/s q 30 mins while on infusion
If after IVIG if still febrile, rpt IVIG after 3 D
If after 2nd IVIG still febrile start Prednisone
Aspirin 80 mkD QID (30 mg, 80, 100, 300 mg)

K (mean value)

KI

LBW < 1 yr

Age

0.33

29.17

FT < 1 yr

0.45

39.78

2-12 y

0.55

48.62

13-21 y (female)

0.55

48.62

13 -21 y (male)

0.70
Age

Range

11
20
50

11 15
15 28
40 65

39
47
58
77

17 60
26 68
30 86
39 -114

6 - 12 mo

103

49 157

2 - 19mo

127

62 191

2 - 12y

127

89 165

Adult males

131

88 174

Adult females

117

87 147

Preterm
2- 8 d
4 - 28 d
30 -90 d
Term
2- 8 d
4 - 28 d
30 - 90 d
1- 6mo

Age
(months)
0

Ht (cm)
boys
50.5

Ht (cm)
girls
49.9

Wt for Ht
(cm)
49

Boys
(kg)
3.1

Girls
(kg)
3.3

54.6

53.5

50

3.3

3.4

58.1

56.8

51

3.5

3.5

61.1

59.5

52

3.7

3.7

63.7

62.0

53

3.9

3.9

65.9

64.1

54

4.1

4.1

67.8

65.9

55

4.3

4.3

69.5

67.6

56

4.6

4.5

71.0

69.1

57

4.8

4.8

BSA
0 5 kg
6 10 kg
11 20 kg
20 40 kg
>40 kg

wt x 0.05 + 0.05
wt x 0.04 + 0.10
wt x 0.03 + 0.20
wt x 0.02 + 0.40
wt x 0.01 + 0.80

Age
(months)
9

Ht (cm)
boys
72.3

Ht (cm)
girls
70.4

Wt for Ht
(cm)
58

Boys
(kg)
5.1

Girls
(kg)
5.0

10

73.6

71.8

59

5.4

11

74.9

73.1

60

5.7

12

76.1

74.3

61

5.9

13

77.2

75.5

62

6.2

14

78.3

76.7

63

15

79.4

77.8

16

80.4

17
18

61.88

GFR

Age
(months)
35

Ht (cm)
boys
95.8

Ht (cm)
girls
94.9

Wt for Ht
(cm)
84

Boys
(kg)
11.7

Girls
(kg)
11.4

5.3

36

96.5

95.6

85

11.9

11.6

5.5

3.5 yo

98.4

97.3

86

12.3

11.8

5.8

102.9

101.6

87

12.3

11.9

6.1

4.5

106

104.5

88

12.5

12.2

6.5

6.4

109.9

108.4

89

12.8

12.4

64

6.8

6.7

5.5

112.6

111.0

90

13.0

12.6

78.9

65

7.1

7.0

116.1

114.6

91

13.2

12.8

81.4

79.9

66

7.4

7.3

6.5

118.5

117.1

92

13.4

13.0

82.4

80.9

67

7.7

7.5

121.7

120.6

93

13.7

13.3

19

83.3

81.9

68

8.0

7.8

7.5

123.9

123.0

94

13.9

13.5

20

84.2

82.9

69

8.3

8.1

127.0

126.4

95

14.1

13.8

21

85.1

83.8

70

8.5

8.4

8.5

129.1

128.8

96

14.4

14.0

22

86.0

84.7

71

8.8

8.6

132.2

132.2

97

14.7

14.3

23

86.8

85.6

72

9.1

8.9

9.5

134.4

134.7

98

14.9

14.6

24

87.6

86.5

73

9.3

9.1

10

137.5

138.3

99

15.2

14.9

25

88.5

87.3

74

9.6

9.4

10.5

139.9

140.9

100

15.5

15.2

26

89.2

88.2

75

9.8

9.6

11

143.3

144.8

101

101.0

15.5

27

90.0

89.0

76

10.0

9.8

11.5

145.8

147.6

102

16.1

15.9

28

90.8

89.8

77

10.3

10.0

12

149.7

151.5

103-105

16.5-17.1

16.2-16.7

29

91.6

90.6

78

10.5

10.2

12.5

152.5

154.1

106-108

17.4-18.0

17.0-17.6

30

92.3

91.3

79

10.7

10.4

13

156.5

157.1

109-111

18.3-19.0

17.9-18.6

31

93.0

92.1

80

10.9

10.6

13.5

159.3

158.8

112-114

19.3-20.0

18.9-19.5

32

93.7

92.8

81

11.1

10.8

14

163.1

160.4

115-117

20.3-21.1

19.9-20.6

33

94.5

93.5

82

11.3

11.0

14.5

165.7

161.1

118-120

21.4-22.2

21.0-21.8

34

95.2

94.2

83

11.5

11.2

15

169.0

161.8

121-123

22.6-23.4

22.2-23.1

Age
(months)
15.5

Ht (cm)
boys
171.1

Ht (cm)
girls
162.1

Wt for Ht
(cm)
124-126

Boys
(kg)
23.9-24.8

Girls
(kg)
23.6-24.6

16

173.5

162.4

127-129

25.2-26.2

25.1-26.2

16.5

174.9

162.7

130-132

26.8-27.8

26.8-28.0

17

176.2

163.1

133-135

28.4-29.6

28.7-30.1

17.5

176.7

163.3

136-140

30.2-33.0

30.8-32

18

176.8

163.7

141-145

33.7-36.9

Weight for Height = Actual BW (kg)


P50 Wt for Ht (kg)
Waterloo
Classification
Normal
Mild
Moderate
Severe
Epinephrine
Amiodarone
Cardioversion
Albumin

Height for Age = Actual Height (cm)


P50 Ht for Age

Wasting
(Wt for Ht)
>90
81 90
70 80
<70

Stunting
(Ht for Age)
>95
90 95
85 89
<85

EMERGENCY MEDS
(bradycardia, asystole) (1:1000) 0.1 ml/kg q 3- 5 mins
5 mg/kg rapid IV push
2 J/kg then 4 J/kg then rpt 2x
1gm x wt given in 2-4hrs.
Prep: 12.5g/50ml
Vol expander: 20ml/kg
HypoCHONemia 1gm/k/dose x 4H

Epinephrine Drip

0.1 1mg/k/min; 1amp = 1mg/ml


Rate = (wt x dose x 60)/desired
Ex: (18kg x 0.1 x 60)/100 = 2cc/hr
To order: 5 amps Epi + 50cc D5W to rum at 2cc/hr
(0.1mg/k/min)

Levophed

0.3-2mcg/k/min
Prep: 4mg/amp (1mg/ml)
Rate = (wt x dose x 60)/desired
Ex. Dose 0.5
1mg/20 = 0.05 x 1000 = 50mcg/ml
(18kg x 0.5 x 60)/50 = 10.8cc/hr
To order: 1 amp levophed + 80 cc D5W to run at
11cc/hr

CEPHALOSPORINS
1st Generation
Cefalexin (25 100 mkd ) q 6-8 h
Lexum
Cap : 250mg; 500mg
Cefalin
Susp : 125mg/5ml
250mg/5ml
Keflex
Drops : 100mg/ml
Ceporex
Cap : 250mg
500mg
Selzef
Caplet: 1 gm
Granules: 125mg/5ml
250mg/5ml
Drops: 125mg/1.25ml
2nd Generation
Cefaclor (20 40 mkd ) q 8 12 h
Ceclor
Pulvule: 250mg 500mg
375mg
Ceclor CD
750mg
CD ext release
Susp: 125mg/5ml
187mg/5ml
250mg/5ml
375mg/5ml
Drops: 50mg/ml
Xelent
Cap : 250mg
500mg
Vercef
Susp : 125mg/5ml
250mg/5ml
Cefuroxime (20 40mkd) q 12h
Zinnat
Cap : 250mg
500mg
Sachet: 125mg/sat
250mg/sat
Susp: 125mg/5ml
Cefprozil (20 40mkd) q 12h
Procef
Susp : 125mg/5ml
250mg/5ml
3rd Generation
Cefixime (6 12 mkd) q 12h
Tergecef
Susp : 100mg/5ml
Zefral
Drops: 20mg/ml
Ultrazime
Cefdinir (7mg/kg q 12h OR 14mg/kg OD)
Omnicef
Cap : 100mg
Sachet/ Susp:
mg/5ml
COTRIMOXAZOLE (TM 5 8 mkd) q 12h
Bactille TS
Susp/5ml
SMZ 400mg
TM 80mg
Tab
800mg
160mg
Bacidal
Susp/5ml
400mg
80mg
Trizole
Susp/5ml
400mg
80mg
Globaxole

Tab
Susp/5ml

800mg
400mg

160mg
80mg

Dopamine

Renal dose
Pressor
alpha effect

3-5
>5 - <15
>15

ANAPHYLAXIS
0. 01ml/kg max of 0.5 mg/dose SC
< 30 kg 0.15 mg
> 30 kg 0.3 mg
Diphen = 50mg IM (1mkdose)
USN w/ Salbu x 3 doses
Epinephrine
(1:1000)

ANTIBIOTICS
Amoxicillin (30 50 mkday) TID
Pediamox
Susp : 250mg/5ml
Drops : 100mg/ml
Himox
Cap
: 250mg, 500mg
Moxicillin
Susp : 125mg/5ml
250mg/5ml
Harvimox
Drops : 100mg/ml
Novamox
Amoxil
Susp : 125mg/5ml
250mg/5ml
Cap
: 250mg
500mg
Glamox
Drops : 100mg/ml
Globapen
Amoxicillin + Clavulanic acid (30 50 mkday)
Augmentin
Tab: 375mg (250mg); 625 (500mg)
Amoclav
Susp: 156.25mg/5ml (125mg) TID
228.5mg/5ml (200mg) BID
312.5mg/5ml (250mg) TID
457mg/5ml
(400mg) BID
Cloxacillin (50 100 mkday) q6h
Prostaphlin A
Tab: 250mg
500mg
Orbinin
Susp: 125mg/5ml
Flucloxacillin (50 100 mkday) q6h
Staphloxin
Susp: 125mg/5ml
Cap : 250mg
500mg
Chloramphenicol (50 75 mkd) q6h
Pediachlor
Susp: 125mg/5ml
Chloramol
Tab : 250mg
500mg
Kemicetine
Chloromycetin

Trimethoprim + Sulfadiazone (TM 5 8 mkd)


Triglobe
Tab
Sdz 410mg
TM 90mg
Forte
820mg
180mg
Susp/5ml
205mg
45mg
AMINOGLYCOSIDES
Tetracycline
25 50 mkday q6h
Doxycycline
5 mkday BID
Furaxolidone
5 8 mkday q6h
MACROLIDES
Erythromycin (30 50 mkd) q 6h
Macrocin
Susp: 200mg/5ml
Ethiocin
Drops: 100mg/2.5ml
Erycin
Cap : 250mg
500mg
Susp: 200mg/5ml
Drops: 100mg/2.5ml
Erythrocin
Film tab: 250mg
500mg
Granules: 200mg/5ml
DS Granules: 400mg/5ml
Drops: 100mg/2.5ml
Ilosone/
Tab: 500mg
DS Liquid: 200mg/5ml
Ilosone DS
Pulvule: 250mg
Drops:
100mg/ml
Liquid: 125mg/5ml
Clarithromycin (6 15 mkday OR 7.5 mkdose q12h)
Klaricid
Susp : 125mg/5ml
50mg/5ml
Klaz
Tab:
250mg
500mg
Roxithromycin
<6 yo
5 8 mkd
BID
6 12 yo
100mg/tab
BID
Macrol/Rulid
Rulid dispensable
Azithromycin

Zithromax
Clindamycin

Tab:
150mg
Ped Tab: 100mg
Tab:
50mg
3 day regimen: 10 mkday x 3 days
5 day regimen: 10 mkd on day 1
5 mkd on day 2 to 5
Adult: 500mg OD day 1/250mg OD day 2 to 5
Susp: 250mg/5ml
Sachet: 200mg/sachet
Cap : 250mg
PO: 20 30 mkday q 6 8h
IV: 25 40vmkday q 6h
Susp: 75mg/5ml
Cap: 150mg 300mg
Amp: 150mg/ml

Oxantel + Pyrantel pamoate


Trichiuriasis: x 2 days
Quantrel

IV ANTIBIOTICS
Penicillin

50,000 100,000 ukd q 6h

Amoxicillin

50 100 mkd q 6 8 h

Ampicillin

50 100 mkd q 6 8 h

Chloramphenicol

50 100 mkd q 4 6 h

Ampi + Cloxa

50 100 mkd q 6 h

Oxacillin

50 100 mkd q 6 8 h

Flucloxacillin

50 100 mkd q 6 8 h

Gentamicin

5 7.5 mkd OD

Netromycin

5mkd q 12 h

Amikacin

15mkd q 12 h

Cephalexin

50 100 mkd q 6 h

Cefuroxime

50 100 mkd q 6 8 h

Ceftriazone

50 100 mkd OD

Ceftazidime
HYDROCORTISONE

50 100 mkd q 12 h

Acyclovir
Zovirax
Acevir

Mebendazole
Antiox

Albendazole

Zentel

AMOEBICIDES
PO: 30 50 mkday q 8h
IV: 30 mkday q 8h
Anaerobia
Susp : 125mg/5ml
Tab : 250mg
Servizol
Susp: 200mg/5ml
Tab : 250mg
500mg
Flagyl
Susp : 125mg/5ml
Tab : 250mg
500mg
Etofamide
(15 20 mkd) TID
Kitnos
Susp : 125mg/5ml
Tab : 200mg
500mg
Diloxanide furoate (20mkd) q8h x 10 days
Furamide
Tab : 500mg
Dilfur
Susp: 125mg/5ml
Secnidazole
Flagentyl
2 tab now then 2 tabs after 4 hrs
Ercefuryl (20mkday)
Metronidazole

LD: 10 mkdose
MD: 5 mkdose q 6, 8 or 12h
*max dose: LD 200
MD 100

ANTIVIRAL
(20 mkdose) q 4 6 h
Max 800mg/day x 5 days
Susp: 200mg/5ml
Blue: 400mg
Pink: 800mg
ORAL ANTIFUNGALS

Ketoconazole (6mkd) q 4 6h
Daktarin

Adult & Child: tsp q 6h


Infant: tsp q 6 h

Nystatin
Mucostatin
Susp: 100,000 u/5ml
Ready mix susp
Tab: 500,000 u
Fluoconazole (3 6 mkd) OD x 2wks
Diflucan

Isoniazid
Comprilex
Nicetal
Trisofort
Odinah

Rifampicin
Natricin
Rifadin
Rimactane
Rimaped
Pyrazinamide (PZA)
CIBA
Zcure
Zinaplex

Solmux

Solmux
Broncho
Solmux
Chewable tab

Cap: 50mg
150mg
Vial: 2mg/ml x 100 ml

ANTI-HELMINTHICS
(10 20 mkd) SD
Hookworm: x 3 days
Susp : 125mg/5ml
Tab : 125mg
250mg
*not recommended below 2 yo
Susp: 50 mg/ml
100mg/ml
Tab: 125mg
250mg
100 mg BID x 3 days
500mg SD (>2 yo)
<2 yo: 200mg SD
>2yo: 400mg SD
*may give x 3 days if with severe infestation
Susp: 200mg/5ml
Tab : 400mg

Diazepam

Midazolam

200mg

Phenobarbital

ANTI-TB MEDS
(10 12 mkd) ODAC or 2hrs PC
Suspension:
200mg/5ml
100mg/5ml
200mg/5ml
150mg/5ml
Tablet
400mg
(10 20 mkd) ODAC or 2hrs PC
100mg/5ml
200mg/5ml
100mg/5ml
100mg/5ml
200mg/5ml
Tablet
300mg
450mg
(16 30 mkd)
BID/TID
250mg/5ml

Carbocisteine

500mg/5ml
Tablet 500mg

Ambroxol

MUCOLYTIC
Drops: 40mg/ml
1 3 mos:
0.5ml
QID
3 6 mos
0.75ml
6 12 mos
1ml
1 2 yo
1.5 ml
Susp:
100mg/5ml
200mg/5ml
2 3 yo
5ml
2.5ml
4 7 yo
10ml
5 ml
8 12 yo
15ml
7.5ml
Forte: 500mg/5ml
Cap:
500mg
Adult & >12 yo:
5 10ml
1 cap
Capsule
Suspension
Tab: 500mg
1 tab q 8h

Lovsicol

TID/

Mucosolvan

Ambrolex
Zobrixol

ANTICONVULSANT
0.2 0.3 mkdose
Drip: 1amp in 50cc D5 W
10mg/amp
0.15 mkdose
OR
0.05 0.2 mkdose
LD: 10 mkdose q 12h
MD: 5 mkdose q 12h
Infant Drops
<3mos
3 5 mos
6 8 mos
9 12 mos
Ped Syr
1 3 yo
4 7 yo
8 12 yo
Adult Susp
Adult & >12 yo
Capsule
Adult & >12 yo

QID
0.25ml
0.5ml
0.75ml
1ml
TID
5 7.5ml
7.5 10ml
10 15ml
TID
10 15ml
TID
1 cap

1 1 tsp
1 - 2 tsp
2 3 tsp
2 3 tsp

Infant drops
50mg/ml
Ped Syrup
100mg/5ml
Adult Susp
250mg/5ml
Cap
500mg
Infant drops
6mg/ml
75mg/ml
BID
< 6 mo
0.5ml
0.5ml
7 12 mo
1 ml
0.75ml
13 24 mo
1.25ml
1ml
Pedia Syrup
<2 yo
2.5ml
BID
2 5 yo
2.5ml
TID
5 10 yo
5ml
TID
Adult Syrup: Adult & >10 yo = 5ml TID
Retard cap: Adult & >10 yo = 1 cap OD
Tab: Adult & >10 yo = 1 tab TID
Inhalation
<5 yo
1 2 inhalation of 2ml soln daily
Adult & children >5 yo = 1 2 inhalation of
2 3ml soln daily
Infant drops
6mg/ml
Ped liquid
15mg/5ml
Adult liquid
30mg/5ml
Retard cap
75mg
Tab
30mg
Inhalation Soln 15mg/2ml
Ampule
15mg/2ml
Infant drops
7.5mg/ml
Ped liquid
15mg/5ml
Adult liquid
30mg/5ml
Tab
30mg

Salbutamol
Ventolin

Ventar
Hivent Syrup
Salbutamol + Guaifenesin
Asmalin
Broncho
Pulmovent
Terbutaline sulfate
Terbulin
Pulmoxel
Bricanyl
Doxophelline
Ansimar
Procaterol HCl
Meptin

Theophylline
Ranitidine
Zantac
Cimetidine

Tagamet

Famotidine

Butamirate citrate

B2 AGONIST
(0.1 0.15 mkdose)
Tab
2mg
Syr
2mg/5ml
Nebule
2.5mg/2.5ml
Tab
2mg
Syr
2mg/5ml

DECONGESTANT
Nasal
NaCl
Salinase
Muconase
Oxymetazoline HCl

Tab
1 tab TID
Syrup
2 6 yo
5 10 ml BID/TID
7 12 yo
10ml
( 0.075 mkdose)
Tab 2.5mg
Tab
2.5mg
Nebule 2.5mg/ml
Syr
1.5mg/5ml
Tab
2.5mg
Nebule
5mg/2ml
Syr
1.5mg/5ml
Expectorant
(6 8 mkdose) BID x 7 10 days
Syrup
100mg/5ml
Tab
400mg
(0.25ml/kg)
Syrup
5mcg/ml
Tab
25mcg
Nebuliser soln
100mcg/ml
10 20 mkdose
3 5 mkdose
H2-BLOCKER
1 2 mkdose q 12h
Tab 75mg
150mg
300mg
Neonates: 5 20 mkday q6 12 h
Infants:
10 20 mkday
Child;
20 40 mkday
Adult:
300mkdose QID
400mkdose BID
800mkdose QID
Susp: 300mg/5ml
Tab: 100mg
200mg 300mg 400mg
800mg
PO: 0.5 mkdose q 12 h
IV: 0.6 0.8 mkday q 8 12h
ANTITUSSIVES
3 yo
>6 yo
>12 yo
Adult

Sinecod Forte
Dextromethorphan + Guaifenesin
Robitussin DM

5 ml
TID
10ml
TID
15ml
TID
15ml
QID
1 tab TID/QID
Syrup 7.5mg/5ml
Tab 50mg
2 6 yo
6 12 yo
Adult
Syrup

2.5 5ml
5ml
5 10ml

q 6 8h
q 6 8h
q 6h

ANTIHISTAMINE
Diphenhydramine HCl (5mkd) q 6h | IM/IV/PO: 1 2 mkdose
Benadryl
Syr: 12.5mg/5ml
Inj: 50mg/ml
Cap: 25mg
50mg
Hydroxyzine
(1mkd) BID
Adult: 10mg BID
25mg ODHS
Iterax
Syr: 2mg/ml
Tab: 10mg
25mg
50mg
Ceterizine
(0.25mkdose)
6mos - <12mos : 1ml OD
12mos - <2 yo:
1ml OD/BID
2 5 yo:
2ml OD / 1ml BID
6 12 yo:
10ml (2 tsp)OD/ 5ml BID
1 tab OD/ tab BID
Adult & >12yo:
1 tab OD
Virlix
Oral drops: 10mg/ml
Tab: 10mg
Oral soln: 1mg/ml
Allerkid
Drops: 2.5mg/ml
Syr: 5mg/5ml
Alnix
Drops: 2.5mg/ml
Tab: 10mg
Syr: 5mg/5ml
Loratadine
1 2 yo:
2.5 ml BID
2 12 yo (<30 kg): 5ml
OD
(>30 kg): 10ml OD
Adult & > 12 y :
1 tab OD
Claritin/Allerta/Loradex
Syr: 5mg/ml
Tab: 10mg
Desloratadine
6 12 mos: 2ml
OD
1 5 yo:
2.5ml OD
6 12 yo:
5ml OD
Aerius
Syr: 2mg/5ml
Tab: 5mg

Drixine
Xylometazoline
HCl

2 4 drps/spray per nostril TID/QID


2 sprays/nostril then suction q6h x 3 days
Nasal spray
Nasal drops
2 5 yo: 2 3 drops/nostril
BID
>5 yo: 2 3 sprays/nostril
BID
Nasal spray: 0.05%
Nasal soln: 0.025%
< 1 yo: 1 2 drps
OD/BID
1 6 yo: 1 2 drps OD/BID max TID
Adult: 2 3 drps / 1 squirt TID max QID

Otrivin
Oral Phenylpropanolamine HCl (0.3 0.5 mkdose)
Disudrin
1 3 mos:
0.25 ml
4 6 mos:
0.5 ml
7 12 mos: 0.75 ml
1 2 yo:
1 ml
2 6 yo:
2.5 ml
7 12 yo:
5 ml
Drops: 6.25ml q6h
Syr: 12.5mg/5ml q6h
Brompheniramine maleate + PPA
Dimetapp
1 6 mos:
0.5ml TID/QID
7 24 mos:
1ml
TID/QID
2 4 yo:
tsp
4 12 yo:
5ml
Adult:
5 10 ml
1 tab BID
Infant drops: (0.1mkdose)
Syr
Extentab
Carbinoxamine maleate + Phenylephrine HCl
Rhinoport
1 5 yo:
5ml
6 12 yo:
10ml
Adult & > 12yo:
1 cap / 15ml
Syrup
Cap
Loratadine + PPA
Loraped
<30 kg: 2.5ml
BID
>30 kg:
5ml
BID
Syrup: 5mg/ml
ANTIPYRETIC
(10 20 mkdose) q 4h
Drops: 60mg/0.6ml
Syrup: 120mg/5ml
Forte : 250mg/5ml
Tablet: 325mg
500mg
Calpol
Drops: 100mg/ml
Syrup: 120mg/5m
250mg/5ml
Defebrol
Syrup: 120mg/5m
250mg/5ml
Afebrin
Drops: 60mg/0.6ml
Syrup: 120mg/5ml
Forte : 250mg/5ml
Tablet: 600mg
Tylenol
Drops: 80mg/ml
Syrup: 160mg/5ml
Naprex
Drops: 60mg/0.6ml
Syrup: 250mg/5ml
Inj:
300mg/2ml
Rexidol
Drops: 60mg/0.6ml
Syrup: 250mg/5ml
Tablet: 600mg
Biogesic
Drops: 100mg/ml
Syrup: 120mg/5m
250mg/5ml
Tablet: 500mg
Aeknil
Ampule (2ml) 150mg/ml
Opigesic
Suppository: 125mg
250mg
Mefenamic Acid
(6 8mkdose) q 6h
Ponstan
Suspension: 50mg/5ml
Cap SF:
250mg
Tab:
500mg
Aspirin
(60 100 mkd)
Ibuprofen
(5 10 mkday) q8h (max 20mkday)
Paracetamol
Tempra

Dolan FP
Dolan Forte
Advil

Suspension: 100mg/5ml
200mg/5ml
Drops:
100mg/2.5ml
100mg/5
Tab:
200mg

BID
BID
BID

Dicycloverine
Relestal
Domperidone

Motilium
Vometa

ANTISPASMODIC
6mos 2 yo
0.5 1ml
Drops 5mg/ml
Syrup 10mg/5ml
0.3 0.6 mkdose q 6 8 h
2.5 5ml/10kg BW
TID
Dyspepsia: 2.5/10kg TID
Nausea:
2.5 5ml/kg TID
0.3 0.6 ml/5kg BW TID/QID
Susp 1mg/ml
Tab
Oral drops
Susp

5mg/ml
5mg/5ml

Tab

TID

10mg
10mg

INHALED STEROIDS
Budesonide
Budecort

Flexotide neb
ORAL STEROIDS
Prednisone
Prednisolone
Liquidpred
Maalox
(plain, plus)
Simethicone
Restime

Hydralazine
Apresoline
Spirinolactone

250mcg q 12h
500mcg q 12h
500mcg OD for allergic rhinitis
250mcg /ml (2ml)
500mcg /ml (2ml)
250mcg /ml (2ml)
250mcg q 12h
LD: 10mkdose
200mg
MD: 5mkdose
1 2 mkday
1 2 mkday
Syrup
15mg/5ml
ANTACIDS
5ml/10kg
Available in 180ml bottle
< 2 yo
2 12 yo
Oral drops

0.5ml
4ml
40mg/ml

qid
qid

ANTIHYPERTENSIVES
PO: 0.75 1.0 mkday q 6 12 h
IV: 0.1 0.2 mkdose
1 3 mkday

Edited by:
frankydinks (2015)