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
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
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
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
NEONATAL JAUNDICE
>100
Cough
Active
Good
IMMUNIZATION
Vaccine
2
All pink
NICU
Color
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
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
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: 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: Enfaprem
Nestle: PreNAN
Abbott: Similac prem
Milupa: Preaptamil
Mead-johnson: Pregestimil
Nestle: Alfare, NAN HA1, NAN HA2
Mead-johnson: Prosoybee
Abbott: Isomil
Wyeth: Nursoy
Soy-Based (20cal/oz)
200 ml
10 ml
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
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
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
VITAMINS
Trace
Elemental
Prematures
(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)
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
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
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
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
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
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
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
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
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
PARTLY
None [2x or
less/week]
More than 2x
a week
Limitation of
activities
None
Any
Nocturnal sx/
awakening
None
Any
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
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
excessive
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
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
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
< 15 min
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
CO = HR x SV
SEIZURE
Type
MC in infant &children
Normal BV of children
80ml/kg
Compromise CO
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
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]
[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
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
3 cc syringe #2
2 manometers
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
Contraindications to LP
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
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
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
Td
TIG
Td
TIG
Yes
No
Yes
Yes
No
No
No
No
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
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
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%
Clinical
Manifestations
Mngt
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
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
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
<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
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
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
Volume
_
= # of exchange
aliquots per exchange
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
100 cc/k/d
90 cc/k/d
80 cc/k/d
70 cc/k/d
50 cc/k/d
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
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
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
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
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
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
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
IV ANTIBIOTICS
Penicillin
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
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
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)