Professional Documents
Culture Documents
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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.
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 O 2 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.
AGE
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.
BRONCHIAL ASTHMA
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.
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.
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.
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
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
ANTIVIRAL
Acyclovir (20 mkdose) q 4 6 h
Max 800mg/day x 5 days
Zovirax Susp: 200mg/5ml
Acevir 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 Cap: 50mg 150mg 200mg
Vial: 2mg/ml x 100 ml
ANTI-HELMINTHICS
Oxantel + Pyrantel pamoate (10 20 mkd) SD
Trichiuriasis: x 2 days Hookworm: x 3 days
Quantrel Susp : 125mg/5ml
Tab : 125mg 250mg
Mebendazole *not recommended below 2 yo
Antiox Susp: 50 mg/ml 100mg/ml
Tab: 125mg 250mg
100 mg BID x 3 days
500mg SD (>2 yo)
Albendazole <2 yo: 200mg SD
>2yo: 400mg SD
*may give x 3 days if with severe infestation
Zentel Susp: 200mg/5ml
Tab : 400mg
ANTIHISTAMINE
Diphenhydramine HCl (5mkd) q 6h
IM/IV/PO: 1 2 mkdose
Benadryl Syr: 12.5mg/5ml
Cap: 25mg 50mg
Inj: 50mg/ml
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
Oral soln: 1mg/ml
Tab: 10mg
Allerkid Drops: 2.5mg/ml
Syr: 5mg/5ml
Alnix Drops: 2.5mg/ml
Syr: 5mg/5ml
Tab: 10mg
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 Syr: 5mg/ml
Allerta Tab: 10mg
Loradex
Desloratadine 6 12 mos: 2ml OD
1 5 yo: 2.5ml OD
6 12 yo: 5ml OD
Aerius Syr: 2mg/5ml
Tab: 5mg
DECONGESTANT
Nasal
NaCl 2 4 drps/spray per nostril TID/QID
2 sprays/nostril then suction q6h x 3 days
Salinase Nasal spray
Muconase Nasal drops
Oxymetazoline HCl 2 5 yo: 2 3 drops/nostril BID
>5 yo: 2 3 sprays/nostril BID
Drixine Nasal spray: 0.05%
Nasal soln: 0.025%
Xylometazoline < 1 yo: 1 2 drps OD/BID
HCl 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
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
Solmux Capsule
Broncho Suspension
Solmux Tab: 500mg
Chewable tab 1 tab q 8h
Carbocisteine Infant Drops QID
MUCOLYTIC <3mos 0.25ml
3 5 mos 0.5ml
6 8 mos 0.75ml
9 12 mos 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 cao 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
Mucosolvan Infant drops 6mg/ml
Ped liquid 15mg/5ml
Adult liquid 30mg/5ml
Retard cap 75mg
Tab 30mg
Inhalation Soln 15mg/2ml
Ampule 15mg/2ml
Ambrolex Infant drops 7.5mg/ml
Zobrixol Ped liquid 15mg/5ml
Adult liquid 30mg/5ml
Tab 30mg
B2 AGONIST
Salbutamol (0.1 0.15 mkdose)
Theophylline 10 20 mkdose
3 5 mkdose
ANTITUSSIVES
Butamirate citrate 3 yo 5 ml TID
>6 yo 10ml TID
>12 yo 15ml TID
Adult 15ml QID
1 tab TID/QID
Sinecod Forte Syrup 7.5mg/5ml
Tab 50mg
Dextromethorphan + Guaifenesin
Robitussin DM 2 6 yo 2.5 5ml q 6 8h
6 12 yo 5ml q 6 8h
Adult 5 10ml q 6h
Syrup
INHALED STEROIDS
Budesonide
Budecort 250mcg q 12h
500mcg q 12h
500mcg OD for allergic rhinitis
250mcg /ml (2ml)
500mcg /ml (2ml)
Flexotide neb 250mcg /ml (2ml)
250mcg q 12h
MMR 15 mos 1
Na requirement : 2 4 meq/k/day
K requirement: 2 3 meq/k/day
KIR: 0.2 0.3 meq/k/hr max of 40 meq
COMPOSITION OF ORS
Na K Cl Glu
Glucolyte 60 20 50 100
Hydrite 90 20 80 111
WHO 75 20 65 75
Pedialyte 30 30 20 30
45 45 20 35
90 90 20 80
Gatorade 41 11 9/100
ASSESSMENT OF DEHYDRATION [CDD]
PARAMEeTER NO SIGN SOME SIGN SEVERE
Condition Well, Alert RestlessI Lethargic
Irritable Unconscious
Floppy
Eyes Normal Sunkem Very sunken
Dry
Tears Present Absent Absent
Mouth/Togue Moist Dry Very dry
Thirst Drinks Thirsty Drinks poorly
normally Drinks Not able to
Not thirsty eagerly drink
Skin pinch Goes back Goes back Goes back very
quicly slowly slowly
FLUID MANAGEMENT
Severity 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
PCAP
VARIABLE PCAP A PCAP B PCAP C PCAP D
Minimal Low Risk Moderate High Risk
Risk Risk
Comorbid None Present Present Present
Illness
Compliant Yes Yes No No
caregiver
Ability to Possible Possible Not Not
follow up
Presence of None Mild moderate Severe
dehydration
Ability to feed Able Able Unable Unable
Age >11 mos >11 mos <11 mos <11 mos
RR
2 12 mos >50/min >50/min >60/min >70/min
1 5 yo >40/min >40/min >50/min >50/min
>5 yo >30/min >30/min >35/min >35/min
Signs of Respiratory Failure
Retractions - - Subcostal/ Subcostal/
Intercostal Intercostal
Head babbing - - + +
Cyanosis - - + +
Grunting - - - +
Apnea - - - +
Sensorium None Awake Irritable Lethargy /
Stupor
Coma/
Complication:
Effusion None None Present Present
Pneumothorax
Action Plan OPD OPD Admit to Admit to
f/u at f/u after regulat CCU
end of tx 3 days ward Refer to
specialist
Clinical Practice Guidelines in the Evaluation and Management of PCAP
2004
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 tachynea
2 12 mos: >50 RR
1 5 yrs: >40 RR
>5 yrs: >30 RR
PCAP A/PCAP B
No diagnostic usually requested
PCAP C/PCAP D
The ff shud b routinely requested
o CXR APL (patchy viral; consolidated bacterial)
o WBC
o C/S (blood, Pleural Fluid, tracheal aspirate on initial
intubation)
o Blood gas/Pulse oximeter
The ff may be requested: C/S sputum
The ff shud NOT be routinely requested
o ESR
o CRP
Antibiotic Recommendation
1. PCAP A/PCAP B and is beyond 2 yo & having fever w/o wheeze
2. PCAP C and is beyond 2 yo, having high grade fever, having
alveolar consolidation on CXR, having WBC >15,000
3. PCAP D refer to specialist
Antibiotic Recommendation
PCAP A/PCAP B w/o previous antibiotic
o Amoxicillin (40 50 mkday) TID
PCAP C
o Pen G IV (100,000 IU/k/d) QID
PCAP C who had no HiB immunization
o Ampicillin IV (100mkd) QID
PCAP D refer to specialist
What shud b done if px is not responding to current antibiotics
1. If PCAP A/PCAP B not responding w/n 72 hrs
a. Change initial antibiotic
b. Start oral Macrolide
c. Reevaluate dx
2. PCAP C no responding w/n 72 hrs consult w/ specialisr
a. PCN resistant S pneumonia
b. Complication
c. Other dx
3. 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
o 10mg for infants
o 20mg for children > 2 yo
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
hx of Asthma
chem. accumulation on
thickened, shiny,
e.g. diaper rash
scalp,
midchest,
face,
exacerbated by dry
greasy scalp
skin, contact sty, & Allergic
(cradle cap)
anxiety physiologic 1st
tx: hydrocortisone/ e.g. cosmetic,
6mos
fluocinolone perfume tx: low potency
moisturizer tx: high/mod
steroid
cloxa/cefalexin if
petency steroid
with infxn
SIGNS OF SHOCK
EARLY LATE
intoxication, (diarrhea/
hypothermia, vomiting),
after cardiac Metabolic
surgery dse (DM)
Excessive
sweating
SHOCK
&children
Normal BV
of children
80ml/kg
ED MNG
1. Position
2. Oxygen
3. Assisted ventilation
4. Intravenous access
5. Fluid (isotonic crystalloid)
6. Reassess (look for improvement in VS, skin signs, mental status; insert foley cath &
monitor UO)
7. Inotropes help stabilize BP
o Epinephrine - (0.1 1 ug/kg/min)
Infusion of choice for Hypotensive pxs
o Dobutamine - (5 20 ug/kg/min)
Cardiogenic shock but not severely hypotensive
o Dopamine [(5 20 ug/kg/min constrictor effect) *(10 15 ug/kg/min]
Distributive shock after successful fluid resuscitation
8. Cardiogenic shock
o Diuretic pxs may get worse after fluid challenge
o Adenosine / synchronize cardioversion SVT
o Defibrillation Venticular fibrillation
MUMPS [Paramyxoviridae]
MOT Direct contact, airborne droplets, fomites
contaminated by saliva
IP 16 18 days
Prd of comm 1 2 days before onset of parotid swelling until 5
days after the onset of swelling
Prodorme Fever, neck muscle pain, headache, malaise
Parotid gland Peak in 1 3 days
swelling 1st in the space between posterior border of
mandible & mastoid then extends being
limited above zygoma
Complications Meningoenephalitis - most frequent, about
10 days; M>F
Orchitis & Epididymitis
Oophoritis
Dacryoadenitis or optic neuritis
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
o O2
o Aqueous Epinephrine 1:1000 IM (0.01ml/kg with
0.5ml max)
o Prepare intubation if w/ stridor & if initial therapy
of epi is not effective
o Continuous monitor ECG and O2 sat & establish IV
access
o Antihistamine to prevent progression
o H1 & H2 blocker
o Diphenhydramine (1mg/kg) IM
o Steroids may modify late phase or recurrent
reaction (Hydrocortisone 5mg/kg/dose)
o Epinephrine 1:10,000 IV (0.1ml/kg; 10ml max)
o Epinephrine drip (0.01ml/kg/min)
Indication for Admission
o Persistent bronchospasm
o Hypotension requiring vasopressors
o Significant hypoxia
o Patient resides some distance from a hospital
facility
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 1. Otitis media
2. Pneumonia
3. Encephalitis
4. Diarrhea
5. Exacerbation of M tb infection
Tx Vit A SD 100,000 IU orally for 6 mos 1 yo
200,000 IU >1 yo
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
Characteristic Retroauricular, posterior cervical & postoccipital
sign LAD [24 hrs before rash & remains for 1 wk]
Tx Vit A SD 100,000 IU orally for 6 mos 1 yo
200,000 IU >1 yo
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
Rubella IUGR
Congenital cataract, microcephaly, PDA,
blueberry muffin skin lesions
Congenital or profound SNHL
Motor or mental retardation
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
Encephalitis or meningitis
Pneumonia
Reye syndrome
GN
Congenital 6 -12 wks AOG: maximal interruption w/ limb
Varicella devt 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: increased risk
o 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 are spared
Resolves w/o desquamation but tend to wax and
wane in 1 3 wks
Dengue insert
Rabies
JUVENILE RHEUMATOID ARTHRITIS [JRA]
Criteria 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
o Polyarthritis: (5 or more inflamed
joints)
o Oligoarthritis (<5)
o Systemic arthritis w/ characteristic
fever
CM 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
Mngt NSAIDS then Methotrexate
Seroid for overwhelming systemic illness
IN-PATIENT
Birth to 20 days Ampicillin + Gentamicin w or w/o Cefotaxime
PHOTOTHERAPY
o 10 Bulbs
o 20 watts
o 200 hrs
o 30 cms
o Bilirubin in the skin absorbs light energy
o Photo-isomerization reaction converting the toxic native
unconjugated 4Z, 15Z-bilirubin into an unconjugated
configurational isomer 4Z,15E-bilirubin, which can then be
excreted in bile without conjugation
o 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
o Complications
o 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
Treatment of Hyperbilirubinemia
Phototherapy
Exchange o Complications: metabolic acidosis,
transfusion electrolyte abnormalities, hypoglycemia,
hypocalcemia, thrombocytopenia, volume
overload, arrhythmias, NEC, infection, graft
versus host disease, and death
VACCINES
BCG Live attenuated M bovis
DPT Diptheria and TT inactivated B pertussis
OPV Sabin trivalent live attenuated virus
IPV Salk inactivated virus
MMR, Measles Live attenuated virus
Varicella
Hep B Recombinant DNA, plasma derived
Hep A Inactivated virus
Hib Capsular polysacc linked to carrier CHON
Typ Live typhoid vaccine 3 doses x 2 days
IMSC Vi antigen typ vaccine
Pneumococcal Capsular polysaccharide 0.5 ml
SC /IM 23 valent purified cap
Polysacc Antigen of 23 serotyp
Influenza Split or whole virus IM
RABIES VACCINE
VERORAB 0.5 cc/amp; 1 amp IM
Day: 0 3 7 14 and 28
BERIRAB 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
Ig (Human) 20 iu/kg
Bayrab 300 iu/2ml
Equine Berirab 300 iu/2ml
40 iu/kg
Favirab 200 400 iu/5ml
1000 2000 iu/5ml
Heme +Globin
Heme oxygenase
Biliverdin
Bilirubin reductase
Unconjugated bilirubin
Enterohepatic pathway
Liver SER
Glucoronyl transferase B-glucoronidase
Conjugated bilirubin
Dengue Virus
Hypotension
MANAGEMENT APPROACH BASED ON CONTROL
Step 1 Step 2 Step 3 Step 4 Step 5
PRN B2 Asthma education and Environmental control
agonist As needed rapid acting B2 agonist
Select one Select one Add one or Add one
more or more
C Low dose Low dose Med to Hi Oral
O ICS ICS + LABA dose steroids
N ICS + LABA
T Leukotriene Medium or Leukotriene
R modifier Hi dose ICS Modifier Anti
O Low dose Sustained IgE
L ICS + Release treatment
L Leukotriene theophylline
E Modifier
R Low dose
ICS +
Salbutamol
Release
theophylline
SEVERITY OF ASTHMA EXACERBATION
MILD MODERATE SEVERE RESPIRAT
ORY
ARREST
IMMINEN
T
Breathless Walking Talking At rest
Infant Infant stops
softer feeding
shorter cry
Diff
Can lie feeding Hunched
Prefers
sitting
Talks in Sentences Phrases Words
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
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 apaet
HYDROCEPHALUS
Result from impaired circulation & absorption of CSF or from
inceased production
Obstructive or Noncommunicating
o Due to obstruction w/n ventricular system
o Abnormality of the aqueduct or a lesion in the 4th
venticle (aqueductal stenosis)
Non-obstructive or Communicating
o Obliteration of the subarachnoid cisterns or
malfunction of the arachnoid villi
o Follows SAH that obliterates arachnoid villi;
leukemic infiltrates
Clinical Manifestation
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]
BELLS PALSY
Acute unilateral facial nerve palsy that is not associated with
other cranial neuropathies or brainstem dysfunction
Usually develops abruptly about 2 wks after SVI [EBV, HSV,
mumps]
Upper and lower portions of the face are paretic
Corner of the mouth droops
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
Classification
Physiologic Topogrphic
[major motor abnormality] [involved extremities]
1. Spastic 1. Monoplegia [1
2. Athetoid worm like side/portion]
3. Rigid 2. Paraplegia
4. Ataxic 3. Hemiplegia
5. Tremor 4. Triplegia [3 limbs]
6. Atonic 5. Quadriplegia [all]
7. Mixed 6. Diplegia [LE/UE]
8. unclassified 7. Double hemiplegia
Clinical Manifestaion
Spastic hemiplegia Arms > legs
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 quadriplegia Most severe form, due to marked motor
impairment 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
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 yo Age in years x 7 5 / 2
HEAD CIRCUMFERENCE [35 cm (+ 2cm)] (inch =
2.54cm)
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
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]
Erythromycin 0.5% [Clamydia]
Tetracycline 1%
Povidone iodine 2.5%
Vitamin K
1 mg Vit K1
PT: 0.5 mg
Vaccine
BCG
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 Effects if Screened
& treated
Congenital Severe MR Normal
Hypothyroidism (CH)
Congenital Adrenal Death Alive &Normal
Hyperplasia (CAH)
Galactosemia (Gal) Death of Cataract Alive &Normal
Phenylketonuria PKU Severe MR Normal
G6PD Severe Anemia Normal
Kernicterus
NEONATAL JAUNDICE
Risk Factors
o Jaundice visible on first day of life
o A sibling w/ neonatal jaundice or anemia
o Unrecognized hemolysis
o Non-optimal feeding
o Deficiency: G6PD
o Infection
o Cephalhemaoma or bruising / Central hct >65%
o East Asian/ Mediteranean in origin
PHYSIOLOGIC vs PATHOLOGIC
FACTORS PHYSIOLOGIC PATHOLOGIC
Onset > 24 hrs of life < 24 hrs of life
Rate of inc of TSB < 0.5mg/dl/hr > 0.5mg/dl/hr
Persistent < 14 days FT: > 8 days
PT: > 14 days
Total S. Bilirubn FT: < 12 mg/dl Any level requiring
PT: < 14 mg/dl phototherapy
Sign/ Symptom Vomiting, lethargy,
poor feeding, excess
wt loss, apnea, inc
RR, temp instability
KRAMER CLASSIFICATION
ZONE JAUNDICE mg/dl
I Head/neck 68
II Upper trunk 9 12
III Lower trunk, thigh 12 16
IV Arms, leg, below knee 15 18
V Hands/feet > 15
BREAST FEEDING vs BREASTMILK JAUNDICE
Parameter BREASTFEEDING BREASTMILK
Onset 3rd to 5th day of life Late; start to rise on
day 4; may reach 20
30 mg/dl on day 14
then slowly
Normal by 4 12
weeks
Pathophysio Decrease milk intake Unknown
enterohepatic Prob. due to
circulation glucoronidase in BM
which
enterohepatic
circulation
Normal LFT;
(-) hemolysis
Mngt Fluid and If breastfeeding is
caloricsupplement stopped, rapid
decrease in bilirubin
level in 48 hrs, if
resumed will rise to 2
4 mg/dl but no
precipitating previous
events
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 & symptom
Non-specific
Dx:
CBC, CXR, blood and urine culture, lumbar tap for CSF studies
Treatment
Empiric antibiotics [Ampicillin + 3rd gen Cephalosporin or
Aminoglycoside)
supportive
Diagnosis
2. Highly probable : 2 major OR 1 major and 2 minor manifestation
NURSERY NOTES
Dextrosity
Limits of Dextrosity:
Peripheral line = D12
Central line = D20
Total Fluid Intake (TFI):
Preterm: start at 60 cckd
Term: start at 80 cckd
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)
If venous: (wt x 3) + 8 +1
2
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 q 6 hours for 24 hours prior
to extubation
USN with epinephrine 0.5 cc + 1.5 cc PNSS q 15 mins x 3 doses
then extubate then USN with Salbutamol nebule + 1.5 cc PNSS q
6 hours x 24 hours
O2 at 10 lpm then decrease as necessary
Regular milk: 20 cal/oz
Preterm milk: 24 cal/oz
Volume _ = # of exchange
aliquots per exchange
> 3 kg 20 ml
2-3 kg 15 ml
1-2 kg 10 ml
850g-1kg 5 ml
< 850 g 1-3 ml
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)
CRANIUM
Caput succedaneum
diffuse edematous swelling of soft tses of scalp
extend across midline
st
edema disappears w/in 1 few days of life
molding and overriding of parietal bones-frequent
st
disappear during 1 wks of life
no specific tx
Cephalhematoma
subperiosteal hemorrhage
limited to1 cranial bone
occur 1-2 % cases
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
nd
calcify by end of 2 wk
few remain for years
10-25% cases underlying linear skull fracture
No tx but photo in hyperbil
seizure
Simple Complex
ANTICONVULSANT
DIAZEPAM 0.2 0.3 mkdose
Drip: 1amp in 50cc D5W
10mg/amp
MIDAZOLAM 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
PHENOBARBITAL LD: 15 20 mkd MD: 5 mkdose
q 12h
(max load 20 mkday IV
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 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
Dilantin Tab: 50mg 100mg TID
Extended release caps 30, 100, 200, 300 mg
OD, BID ; Inj: 50 mg/ml
CARBAMAZEPINE
Tegretol Tab 200mg, 100mg chew
XR 100mg, 200mg, 400mg
Susp 100mg/ 5ml (QID)
Initial Increment Maintenance
< 6 yo 10 - 20 mkD BID /TID q wkly til 35 mkD
6 - 12 yo 10 mkD BID 100 mg/ 24H at 20 - 30 mkD
1 wk interval BID/ QID
> 12 y 200 mg BID 200 mg/ 24H at 800 - 1200 mg/24H
1 wk interval BID/ QID
Bilirubin (Total)
Cord
Preterm <2 mg/dl <34 mol/L
Term <2 mg/dl <34 mol/L
0 1 days
Preterm <8 mg/dl <137 mol/L
Term <8.7 mg/dl <149 mol/L
1 2 days
Preterm <12 mg/dl <205 mol/L
Term <11.5 mg/dl <197mol/L
3 5 days
Preterm <16 mg/dl <274 mol/L
Term <12 mg/dl <205mol/L
Older Infants
Preterm <2 mg/dl <34 mol/L
Term <1.2 mg/dl <21 mol/L
Adult 0.3 1.2 mg/dl 5 12 mol/L
Bilirubin (Conjugated)
Neonate <0.6 mg/dl <10 mol/L
Infants/Children <0.2 mg/dl <3.4 mol/L
Pre Lumbar Tap
NPO
RBS by gluco prior to lumbar tap
Prepare lumbar tap set
2% Lidocaine # 1
G 23 spinal needle
Mannitol 250 cc 1 bottle - do not open
Solvent
Diazepam 1 amp
3cc syringe #2
2 manometers
sterile bottles # 3
sterile gloves # 2
Sterile gauze # 1
Sterile gauze w/ Betadine #1
Sterile towel w/ hole #1
Sterile clamp #1
3-way stopcock #1
Contraindications to LP
evidence of Inc ICP
severe CP compromise
Skin infection at site of puncture
CSF ANALYSIS
Color Rbc Wbc Diff sugar CHON
ct
Normal
Infant Xantho 0- 0 -32 L 70 - 60 -
(Term) 100 100% 80% 150
Infant Clear 0- 0 -15 L 70 - 60 -
(Preterm) 100 100% 80% 200
Older Clear 0 0 -10 L > 10-20
child 100% 50%
Viral Clear 0 0 -20 L 40- 40 -60
Mening 100% 60%
TB/Fungal Clear 0 20 - L>N < > 100
500 40% g%
Bacterial Purulent 0 > N>L < > 100
Mening 1000 50% g%
Partially Clear 0 100 L>N > Dec
tx BM 50%
CSF PATHWAY
rd
Choroid plexus (lateral ventricle) Foramen of Monroe 3
th
ventricle Aqueduct of sylvius 4 ventricle Foramina of
Luschka (2 laterals) & Magendie (median) SAS Absorbed in
the arachnoid villi, then in the Venous System
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
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)
KCl NaHCO3
IV 2 meq/ml Inj premixed: 5% (0.6 meq/ml)
Child: 0.5 1meq/k/dose infusion 500ml
of Tabs: 325 mg (3.8 meq), 650 mg
0.5 meq/k/h for 1-2 h (7.6 meq)
Tabs: 8, 10, 15, 20 meq
Oral soln
10% ( 6.7 meq/5ml)
15% (10 meq/5ml)
20% (13.3 meq/5ml)
PO : 1-4 meq/kg/24H QID
IV: 0.5 1meq/k/dose
Urine alkalinization
Ca Gluc = Children: 1cc/k/dose x 84 840 mg (1- 10 meq)/kg/D PO
3doses; QID
Max: 10cc/dose + equal amt of
sterile water
FWB 10 - 20 cc/kg 3 4H
PRBC 5 - 10 3 4H
Plasma 10 - 15 12H
PRP 10 - 15 12H
Plt conc 1 u/ 7 -10 kg FD
Cryoprecipitate 1 u/kg FD
Hemophilia A 1 bag
(200mg fibrinogen)
VW dse 50 -100 mg/kg
Fibrinogen dse 100 cc
(2-5 kg)
Factor 8 Hemophilia A 50 u/kg
Hemophilia B 100 u/kg
1 u FWB = 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
Anemia
< 10 g mild anemia
8-9g mod anemia
<8 g severe anemia
EMERGENCY
ET tube age in years + 4
4
ET diameter x 3
>10 yo cuffed
Laryngoscope sizes
PT Miller 00 or 0
Term Miller 0
0-6mos Miller 1
EMERGENCY MEDS
Epinephrine (bradycardia, asystole)
(1:1000) 0.1 ml/kg q 3- 5 mins
Amiodarone 5 mg/kg rapid IV push
Cardioversion 2 J/kg then 4 J/kg then rpt 2x
Albumin 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
Dopamine Renal dose 3-5
Pressor >5 - <15
alpha effect >15
ANAPHYLAXIS
Epinephrine 0. 01ml/kg max of 0.5 mg/dose SC
(1:1000) < 30 kg 0.15 mg
> 30 kg 0.3 mg
Diphen = 50mg IM (1mkdose)
USN w/ Salbu x 3 doses
BSA
Weight in (kg)
05 wt x 0.05 + 0.05
6 10 wt x 0.04 + 0.10
11 20 wt x 0.03 + 0.20
20 40 wt x 0.02 + 0.40
>40 wt x 0.01 + 0.80
OSTERIZED FEEDING
TFR 60 - 70% = 100/feeding q 6H
10 kg x 60%
TFR = 600
CHON 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
CHO 60%
(TFR CHON) x 0.6
(600- 71) x 0.6 = 317
CHO = 317
Fats 181 (the rest are fats , divided into 6 feedings)
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)
MTV 1 ml
190 ml to run at 8 ml/h
Intralipid 20% 10 ml to run for 24H
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 Mead-johnson: Enfalac lacto-free
Nestle: NAN1, Nestogen Nestle: AL110
Glaxo: Frisolac Milupa: HN25
Dumex: Dulac Wyeth: S26 Lacto-free
Abbott: Similac advance
Milupa: Alaptamil
Wyeth: S26, Bonna
Unilab: Mylac
6months onwards (20cal/oz) Lactose free (6months onwards)
Mead-johnson: Enfapro Mead-johnson: Enfapro lacto-
Nestle: NAN2, Nestogen 2 free
Glaxo: Frisomil
Dumex: Dupro
Abbott: Gain
Wyeth: Bonnamil. Promil
Unilab: Hi-nulac
1 year onwards (20 cal/oz) Premature Infant (24cal/oz)
Mead-johnson: Enfagrow, Lactum Mead-johnson: Enfaprem
Nestle: NAN3, Neslac Nestle: PreNAN
Glaxo: Frisorow Abbott: Similac prem
Dumex: Dugrow Milupa: Preaptamil
Abbott: Gainplus
Wyeth: Progress, Promil
Unilab: Enervon bright
Hypoallergenic (20cal/oz) Soy-Based (20cal/oz)
Mead-johnson: Pregestimil Mead-johnson: Prosoybee
Nestle: Alfare, NAN HA1, NAN Abbott: Isomil
HA2 Wyeth: Nursoy
AGN
inflam process affecting the kidney, lesions predom in the
glomerulus
Etiology
Infections:
a. Bacterial: Grp A B hemolytic strep, S viridans, S pneumo,
Staph
aureus, S epidermidis, S typhi , T pallidum, Leptospira
b. Viral: HBV, Mumps, Measles, CMV, Enterovirus
c. 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 -oliguria
-edema -n & v
-hpn 82% -dull lumbar pain
Typical course
Latent: few days 3wks
Oliguric: 7 10 days
Diuretic: 7 10 days
Convalescent: 7 10 days
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
Neonates
VLBW ( 1500 gm) Initiate at 40 60 ml/kg/day and increase by
10 ml/kg/day till 120 ml/kg is reached
Sample Solving:
Wt 15 80kcal/kg
A. Energy: 15 x 80 = 1, 200 kcal/day
B. TFR: 1,250 ml/day
C. CHON: (1gm/day) 15 x 1
Prep: Aminosteril 6% (6gms/100ml)
6gms x 15 gms = 250 ml
100 x
D. CHO: % = gm x 100 10% x = 125 gms
Vol 1250
Prep: D50W
50 gm = 125gm
100 ml x
E. Lipids: ( 1 gm) 15 x 1 =15
Prep: 10% Intralipid (10gms/100ml)
10 gms x 15 gm = 150
100 ml
F. Sodium: (3 mmol/kg) 15 x 3 = 45 mmol/kg
Prep: 2.5 mmol/ml
2.5 mmol x 45 = 18 ml
ml x
G. Potassium: (2 mmol/kg) 15 x 2 = 30 mmol/kg
Prep; 2 mmol/ml
2.0mmol x 30 = 15 ml
ml x
H. Calcium gluc: (0.25 mmol/kg) 15 x 0.25 = 3.75
Prep: 10% Cal gluc
0.25 mmol x 3.75 = 15 ml
ml x
I. Magnesium: (0.25 mmol/kg) 15 x 0.25 = 3.75
Prep: 25% MgSO4
2 mmol x 3.75 = 1.9 ml x 2 = 4 ml
ml x
J. Total Mixture:
24 hrs 12 hrs
Aminostril 250 125
D50W 250 125
Na 18 9
K 15 7.5
Cal gluc 15 7.5
MgSO4 4 ml 2 ml
Total 552 276
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