Pedia Notes Compiled PDF

HANDY PEDIATRIC
NOTES
P e d i a t r i c N o t e s |2
TABLE OF CONTENTS
I. ADMITTING ORDERS
NEONATOLOGY
NICU....................................................................................... 11
NEUROLOGY
FEBRILE SEIZURES.................................................................... 12
LUMBAR TAP........................................................................... 13
PULMONOLOGY
BRONCHIAL ASTHMA.............................................................. 14
BPN......................................................................................... 15
GASTROENTEROLOGY
AGE......................................................................................... 16
IMMUNOLOGY
HYPERSENSITIVITY REACTION................................................. 17
INFECTIOUS DISEASES
DENGUE FEVER....................................................................... 18
II. MEDICATIONS
ANTIBACTERIAL
CELL WALL ACTIVE ANTIBIOTICS
PENICILLIN....................................................................... 20
Amoxicillin........................................................... 20
Cloxacillin............................................................ 20
Flucloxacillin........................................................ 20
PENICILLIN COMBINATIONS
Amx + CA............................................................. 20
CEPHALOSPORINS
1ST GEN
Cefalexin.............................................................. 21
2ND GEN
Cefaclor............................................................... 21
Cefuroxime.......................................................... 21
Cefrozil.............................................................. 21
3RD GEN
Cefixime.............................................................. 21
Cefdinir................................................................ 21
PROTEIN SYNTHESIS INHIBITOR

MACROLIDES
Erythromycin....................................................... 22
Clarithromycin..................................................... 22
Roxithromycin..................................................... 22
Azithromycin....................................................... 22
LINCOSAMIDES
Clindamycin......................................................... 23
CHLORAMPENICOL........................................................... 23
TETRACYCLINE................................................................. 23
Doxycycline......................................................... 23
DNA SYNTHESIS INHIBITOR
NITROFURAN
Furaxolidone....................................................... 23
Ercefuryl.............................................................. 23
ANTIBACTERIAL COMBINATIONS
TMP - SULFAMETHOXAZOLE
Cotrimoxazole..................................................... 24
TMP – SULFADIAZONE............................................................. 24
IV ANTIBIOTICS............................................................................... 24
ANTITUBERCULOSIS
Isoniazid.............................................................. 25
Rifampicin........................................................... 25
Pyrazinamide....................................................... 25
ANTIPROTOZOAN
AMOEBICIDES
Metronidazole..................................................... 26
Etofamide............................................................ 26
Diloxanide Furoate.............................................. 26
Secnidazole.......................................................... 26
Ercefuryl.............................................................. 26
ANTIHELMINTHICS
Oxantel + Pyrantel Pamoate................................ 27
Mebendazole....................................................... 27
Albendazole......................................................... 27
ANTIVIRAL
Acyclovir............................................................ 27
ANTIFUNGAL
Ketoconazole....................................................... 27
Nystatin............................................................... 27
Fluconazole......................................................... 27
NEUROLOGY
ANTICONVULSANT
Diazepam............................................................ 28
Midazolam........................................................... 28
Phenobarbital...................................................... 28
Phenytoin............................................................ 29
Carbamazepine.................................................... 29
Oxcarmazepine.................................................... 29
Valproic Acid....................................................... 30
Topiramate.......................................................... 30
RESPIRATORY DRUGS
NASAL
NaCl..................................................................... 32
Oxymetazoline..................................................... 32
Xylometazoline.................................................... 32
ORAL
Phenylpropanolamine......................................... 33
Bromphenamine Maleate + Pheylephrine............ 33
Carbinoxamine maleate + Phenylephrine HCl...... 33
Loratadine + PPA................................................. 33
MUCOLYTIC
Carbocisteine....................................................... 34
Ambroxol............................................................. 35
B2 AGONIST
Salbutamol.......................................................... 36
Terbutaline.......................................................... 36
Doxofylline.......................................................... 36
Procaterol........................................................... 37
Theophylline........................................................ 37
ANTI-TUSSIVES
Butamirate Citrate............................................... 37
Dextrometorphan................................................ 37
IMMNULOGY
ANTIHISTAMINE
Diphenhydarmine................................................ 38
Hydroxyzine......................................................... 38
Ceterizine............................................................ 38
Loratadine........................................................... 39
Desloratadine...................................................... 39
STEROIDS
INHALED
Budesonide.......................................................... 39
ORAL
Prednisone.......................................................... 39
Prednisolone........................................................ 39
INTRAVENOUS
Hydrocortisone.................................................... 39
IVIG INFUSION.................................................................... 40
CARDIOVASCULAR DRUGS
ANTIHYPERTENSIVE
Hydralazine................................................................. 41
Spirinolactone............................................................. 41
GASTROINTESTINAL DRUGS
ANTACIDS
MgOH + AlOH.............................................................. 43
Simethicone................................................................ 43
ANTISPASMODIC
Dicycloverine.............................................................. 43
Domperidone.............................................................. 43
H2-BLOCKER
Ranitidine................................................................... 44
Cimetidine.................................................................. 44
Famotidine.................................................................. 44
ANTI-DIARRHEAL
ENKEPHALINASE INHIBITOR
Racedotril............................................................ 44
OTHER GI DRUGS
PARENTERAL NUTRITIONAL PRODUCTS
LYSMIX................................................................ 44
SUPPLEMENTS & ADJUVANT THERAPY
PROBIOTICS
Prozinc............................................................ 45
Erceflora......................................................... 45
PRETOXIN............................................................ 45
ANTIPYRETIC/ANALGESIC
Paracetamol................................................................ 46
Mefenamic Acid.......................................................... 46
Aspirin........................................................................ 47
Ibuprofen.................................................................... 47
DRIPS
Dengue....................................................................... 48
Furosemide................................................................. 49
Noradrenaline............................................................. 49
Dopamine................................................................... 49
Dobutamine................................................................ 49
Terbutaline................................................................. 49
Precedex..................................................................... 50
Ketamine.................................................................... 50
Morphine.................................................................... 50
Naproxen.................................................................... 50
ELECTROLYTES
KCl.............................................................................. 50
NaHCO3...................................................................... 50
Ca GLUCONATE........................................................... 50
VITAMINS 51
III. CONDITIONS
NEONATOLOGY
Essential Newborn Care Protocol (DOH)............................. 54
Newborn Care.................................................................... 54
Apgar Score........................................................................ 56
Newborn Screening............................................................ 56
Nursery Notes
Dextrosity................................................................... 57
Electrolyte Requirements................................................... 59
Glucose Infusion Rate......................................................... 59
Emergency Intervention
Level of Umbillical Catheterization.............................. 59
ET Tube Determination............................................... 60
Total Flow Rate........................................................... 60
Extubation.................................................................. 60
Cows Milk Allergy............................................................... 61
Hyperbilirubinemia
Bilirubin Metabolism................................................... 61
Neonatal Jaundice....................................................... 62
Kramer Classification................................................... 62
Bilirubin Values........................................................... 63
Physiologic vs Pathologic Jaundice.............................. 63
Breastfeeding vs Breastmilk Jaundice.......................... 64
Treatment of Hyperbilirubinemia................................ 65
Neonatal Sepsis.................................................................. 66
NEUROLOGY
Glassgow Coma Scale......................................................... 67
Motor Assessment............................................................. 68
Deep Tendon Reflexes....................................................... 68
Cranium
Caput succedaneum.................................................... 68
Cephalhematoma........................................................ 68
Hydrocephalus................................................................... 69
Seizure
Bening Febrile Seizure................................................ 70
Simple vs Complex...................................................... 70
Cerebrspinal Fluid
CSF PATHWAY............................................................. 71
LUMBAR PUNCTURE.................................................... 71
CSF ANALYSIS.............................................................. 71
Hydrocephalus................................................................... 72
Bells Palsy.......................................................................... 73
Cerebral Palsy.................................................................... 74
Hypoxic Ischemic Enchepalopathy...................................... 75
PULMONOLOGY
PCAP
Clinical Features of Pneumonia................................... 77
Microbial Causes of CAP aacdg to Age......................... 77
CXR In Assessing CAP etiology..................................... 78
Therapeutic Mngt of CAP............................................ 78
CPG............................................................................. 80
ASTHMA
Severity of Asthma Exacerbation................................. 82
Levels of Asthma Control (GINA)................................. 83
Management Approach Based on Control................... 83
BRONCHIOLITIS.................................................................. 84
VIRAL CROUP VS EPIGLOTITIS............................................. 85
BICARBONATE DEFICIT CORRECTION.................................. 86
CARDIOVASCULAR
Transfusion Medicine
Blood Products........................................................... 87
Double Volume Exchange Therapy.............................. 88
SHOCK............................................................................... 89
Signs of Shock............................................................. 90
LABORATORY MEDICINE
HEMATOLOGY
Complete Blood Count................................................ 91
RBC INDICES................................................................ 91
ANC............................................................................. 92
CLINICAL CHEMISTRY
Glucose...................................................................... 92
GASTROENTEROLOGY
Assessment of Dehydration................................................ 93
Caposition of ORS............................................................... 93
Oral Rehydration Theraphy................................................ 94
Fluid Management............................................................. 94
Composition of IV Solution................................................. 95
Maintenance Water........................................................... 95
NEPHROLOGY
GFR Normal Values............................................................. 96
Computations
GFR............................................................................. 96
OFI.............................................................................. 96
BSA............................................................................. 96
AGN................................................................................... 97
GABS.................................................................................. 98
INTERPRETAtION OF BUN-CREA RATIO............................... 99
IMMUNOLOGY
Anaphylaxis........................................................................ 100
Dermatitis.......................................................................... 101
Atopic......................................................................... 101
Contact....................................................................... 101
Seborrheic.................................................................. 101
Juvenile Rheumatoid Arthritis............................................ 102
Systemic Lupus Erythematosus........................................... 103
Henoch-Schonlein Purpura................................................. 104
Immunization..................................................................... 105
Vaccines............................................................................. 106
Rabies Vaccine............................................................ 106
Tetanus Toxoid........................................................... 107
INFECTIOUS DISEASES
Rheumatic Heart Disease
Jones Criteria.............................................................. 108
Infective Endocarditis
Modified Duke Criteria................................................ 109
Paramyxoviridae (Mumps)................................................. 110
Rubella (German Measles)................................................. 111
Rubeola (Measles).............................................................. 112
P e d i a t r i c N o t e s | 10
Roseola (HSV 6).................................................................. 113

Coxsackie A (Herpangina)................................................... 113
Herpes Simplex Virus (Varicella)......................................... 114
Parvovirus B19 (Erythema Infectiosum/Fifth Disease)........ 115
Dengue Fever..................................................................... 116
NUTRITION
Waterloo Classification....................................................... 117
Growth & Caloric Requirements......................................... 117
Caloric & Protien Requirements......................................... 118
Estimated Catch Up Growth Requirement.......................... 118
Approximate Daily Water Requirement.............................. 118
Osterized Feeding.............................................................. 119
Milk Formulas.................................................................... 120
Total Parenteral Nutrition.................................................. 121
TPN in Pediatrics........................................................ 122
TPN for Neonates........................................................ 125
Sample Solving............................................................ 126
EMERGENCY MEDICINE
ET Tube Determination...................................................... 128
Laryngoscope Sizes............................................................. 128
Emergency Management.................................................... 128
Epinephrine
Amiodarone
Cardioversion
Albumin
Epinephrine Drip
Levophed
Dopamine
Anaphylaxis........................................................................ 130
O2 Supplementation.......................................................... 130
NORMAL VALUES
Ideal Body Weight.............................................................. 131
Head Circumference........................................................... 131
Length................................................................................ 131
Weight for Height .............................................................. 131
Height for age..................................................................... 131
ADMITTING ORDERS
NEONATOLOGY
NICU
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 37.5°C
Place under droplight (NSD); isolette (CS)
Suction secretion prn
Will infrom AP /AP attended delivery
NEUROLOGY
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 > 37.8°C
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.
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
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
PULMONOLOGY
BRONCHIAL ASTHMA
TPR q4H and record
NPO if dyspneic
Labs:
CBC CXR APL*
ABG* U/A (MSCC)
IVF:
Medications:
Paracetamol prn q4h for T > 37.8°C (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:
Refer for persistence of tachypnea, alar flaring and retractions
O2 at 2 lpm via NC, refer for desaturations <95%
Will inform AP
Thank you.
BPN
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
Medications:
Paracetamol prn q4h for T > 37.8°C (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:
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
Thank you.
GASTROENTEROLOGY
AGE
TPR q4H and record
DAT once fully awake; NPO x 2hrs if with vomiting
Labs:
CBC
U/A (MSCC)
F/A (Concentration Method)
IVF:
Medications:
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:
Chart character, frequency and amount of GI losses and replace w/
PLR 1L/1P vol/vol
Will inform AP
Thank you.
IMMUNOLOGY
HYPERSENSITIVITY REACTION
TPR q4H and record
Hypoallergenic diet
Labs:
CBC
U/A (MSCC)
IVF:
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:
Monitor VS q2h and record to include BP
O2 at 2 lpm via NC, or 6 lpm via facemask
Attach to pulse oximeter, refer for desaturations <95%
Will inform AP
Thank you.
INFECTIOUS DISEASES
DENGUE FEVER
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:
Omeprazole 1mkdose max 40 mg IVTT OD
SO:
Monitor VS q2h and record, to include BP
Refer for Hypotension, narrow pulse
pressure (<20mmHg)
Refer for signs of active bleeding like
epistaxis, gum bleeding, melena,
coffee ground vomitus
Will inform AP
Thank you.
MEDICATIONS
ANTIBACTERIALS
CELL WALL ACTIVE ANTIBIOTICS
PENICILLINS
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
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
PENICILLIN COMBINATIONS
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
642/5 (600mg)
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
Ceclor CD 375mg 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 : 300mg
Sachet/Susp: 125 mg/5ml 250mg/5ml
PROTEIN SYNTHESIS INHIBITOR

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
Ilosone DS Pulvule: 250mg
Liquid: 125mg/5ml
DS Liquid: 200mg/5ml
Drops: 100mg/ml
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 Tab: 150mg
Ped Tab: 100mg
Rulid dispensable Tab: 50mg
Azithromycin 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
Zithromax Susp: 250mg/5ml
Cap : 250mg
Sachet: 200mg/sachet
LINCOSAMIDES
Clindamycin PO: 20 – 30 mkday q 6 – 8h
IV: 25 – 40vmkday q 6h
Susp: 75mg/5ml
Cap: 150mg 300mg
Amp: 150mg/ml
CHLORAMPHENICOL
Chloramphenicol (50 – 75 mkd) q6h
Pediachlor Susp: 125mg/5ml
Chloramol Tab : 250mg 500mg
Kemicetine
Chloromycetin
TETRACYCLINES
Tetracycline 25 – 50 mkday q6h
Doxycycline 5 mkday BID
DNA SYNTHESIS INHIBITOR

NITROFURAN
Furazolidone 5 – 8 mkday q6h
NIFUROXAZIDE (20 mkday)
Ercefuryl Cap 200mg
Oral Susp 218mg/5ml
>2yo: max: 660mg/day TID

>6yo - Adult: max 800mg/day BID/QID
All treatment duration must not exceed 7 days

ANTIBACTERIAL COMBINATIONS
TRIMETHOPRIM + SULFAMETHOXAZOLE
COTRIMOXAZOLE (TM 5 – 8 mkd) q 12h
Bactille – TS Susp/5ml SMZ 400mg TM 80mg
Bacidal Tab 800mg 160mg
Globaxole
Trizole Susp/5ml SMZ 400mg TM 80mg
TRIMETHOPRIM + SULFADIAZONE
Triglobe Tab SDZ 410mg TM 90mg
Forte 820mg 180mg
Susp/5ml 205mg 45mg
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 50 – 100 mkd q 12 h
ANTI-TB MEDS
Isoniazid (10 – 12 mkd) ODAC or 2hrs PC
Comprilex Suspension:
Nicetal 200mg/5ml
Trisofort 100mg/5ml
Odinah 200mg/5ml
150mg/5ml
Tablet 400mg
Rifampicin (10 – 20 mkd) ODAC or 2hrs PC
Natricin 100mg/5ml
Rifadin 200mg/5ml
100mg/5ml
Rimactane 100mg/5ml
Rimaped 200mg/5ml
Tablet 300mg
450mg
Pyrazinamide (16 – 30 mkd) BID/TID
(PZA)
CIBA 250mg/5ml
Zcure
Zinaplex 500mg/5ml
Tablet 500mg
ANTIPROTOZOAN
AMOEBICIDES
Metronidazole 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)
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
ANTIVIRAL
Acyclovir (20 mkdose) q 4 – 6 h
Max 800mg/day x 5 days
Zovirax Susp: 200mg/5ml
Acevir Tab: (Blue) 400mg (Pink) 800mg
ORAL ANTIFUNGALS
Ketoconazole (6mkd) q 4 – 6h
Daktarin Adult & Child: ½ tsp q 6h
Infant: ¼ tsp q 6 h
Nystatin
Mucostatin Susp: 100,000 u/5ml
Ready mix susp Tab: 500,000 u
Fluconazole (3 – 6 mkd) OD x 2wks
Diflucan Cap: 50mg 150mg 200mg
Vial: 2mg/ml x 100 ml
NEUROLOGY
ANTICONVULSANT
DIAZEPAM 0.2 – 0.3 mkdose
Drip: 1amp in 50cc D5W
10mg/amp
MIDAZOLAM 0.05 - 0.2mkdose (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)
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 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 BID/ QID
1 wk interval
> 12 y 200 mg BID 200 mg/ 24H at 800 - 1200 mg/24H
1 wk interval BID/ QID
OXCARBAMAZEPINE (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
Trileptal Tab 150 mg 300mg 600 mg

Susp 300mg/5ml
VALPROIC ACID 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
Depakene Tab 250 mg
Syr 250mg/5ml
Depacon IV 100mg/ml
TOPIRAMATE 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
Topamax Cap 15 mg, 25 mg
Tabs 25 50 100 200mg
RESPIRATORY DRUGS
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
Brompheniramine maleate + Phenyleprine
Dimetapp 1 – 6 mos: 0.5ml TID/QID
7 – 24 mos: 1ml TID/QID
2 – 4 yo: ¾ tsp
4 – 12 yo: 5ml
Adult: 5 – 10 ml
1 tab BID
Infant drops: (0.1mkdose)
Syr/5ml: 2mg/5ml
Extentab
Carbinoxamine maleate + Phenylephrine HCl
Rhinoport 1 – 5 yo: 5ml BID
6 – 12 yo: 10ml BID
Adult & > 12yo: 1 cap / 15ml BID
Syrup
Cap
Loratadine + PPA
Loraped <30 kg: 2.5ml BID
>30 kg: 5ml BID
Syrup: 5mg/ml
MUCOLYTIC
Carbocisteine Infant Drops QID
<3mos 0.25ml
3 – 5 mos 0.5ml
6 – 8 mos 0.75ml
9 – 12 mos 1ml
Ped Syr TID

1 – 3 yo 5 – 7.5ml 1 – 1 ½ tsp
4 – 7 yo 7.5 – 10ml 1 ½ - 2 tsp
8 – 12 yo 10 – 15ml 2 – 3 tsp
Adult Susp TID

Adult & >12 yo 10 – 15ml 2 – 3 tsp
Capsule TID
Adult & >12 yo 1 cap
Carbocisteine Drops: 40mg/ml
(Solmux) 1 – 3 mos: 0.5ml TID/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
Adult & >12 yo

Forte: 500mg/5ml 5 – 10ml
Cap: 500mg 1 cap
Solmux Chewable tab Tab: 500mg 1 tab q 8h
Loviscol Infant drops 50mg/ml
Ped Syrup 100mg/5ml
Adult Susp 250mg/5ml
Cap 500mg
Salbutamol+Carbocisteine Capsule: (S)2mg/(C)500mg
(Solmux Broncho) Susp (/5ml): (S)2mg/(C)500mg
Ambroxol Infant Drops 6mg/ml 75mg/ml BID

<6mo 0.5ml 0.5ml
recommended 7-12mo 1ml 0.75ml
dose- 1.2mkd 13-24mo 1.25ml 1ml
Pedia Syr
<2yo 2.5ml BID
2 – 5 yo 2.5ml TID
5 – 10 yo 5ml TID
Adult Syr
>10yo & Adult 5ml TID
Retard Cap
>10yo & Adult 1cap OD
Tab
>10yo & Adult 1tab 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)
Ventolin Tab 2mg
Syr 2mg/5ml
Nebule 2.5mg/2.5ml
Ventar Tab 2mg
Hivent Syrup Syr 2mg/5ml
Salbutamol + Guaifenesin
Asmalin Tab: 1 tab TID
Broncho Syrup:
2 – 6 yo 5 – 10 ml BID/TID
Pulmovent 7 – 12 yo 10ml
Terbutaline sulfate ( 0.075 mkdose)
Terbulin Tab 2.5mg
Pulmoxel Tab 2.5mg
Syr 1.5mg/5ml
Nebule 2.5mg/ml
Bricanyl Tab 2.5mg
Syr 1.5mg/5ml
Nebule 5mg/2ml
Expectorant
Guaifenesin + Terbutaline Sulfate
Bricanyl Expectorant TID
Per 5ml 66.65mg/1.5mg
Doxofylline (6 – 8 mkdose) BID x 7 – 10 days
Ansimar Syrup 100mg/5ml
Tab 400mg
Procaterol HCl (1.25mcg/kdose)

Meptin Syrup 5mcg/ml
Tab 25mcg; 50mcg
Inhaler 10mcg/puff
Nebuliser soln 100mcg/ml
Theophylline (10 – 20 mkdose)
(3 – 5 mkdose)
Nuelin SR Tab: 125mg; 250mg
12-25kg: 125mg BID
>25kg: 250mg BID
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
IMMUNOLOGY
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/ ½ 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
STEROIDS
INHALED
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
ORAL LD: 10mkdose 200mg

MD: 5mkdose
Prednisone 1 – 2 mkday
Prednisolone 1 – 2 mkday
Liquidpred Syrup 15mg/5ml
INTRAVENOUS
HYDROCORTISONE LD: 10 mkdose
MD: 5 mkdose q 6, 8 or 12h
*max dose: LD 200 MD 100
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
16g IVIG 2. 5 g = 320 cc
X
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
CARDIOVASCULAR
ANTIHYPERTENSIVES
Hydralazine PO: 0.75 – 1.0 mkday q 6 – 12 h
Apresoline IV: 0.1 – 0.2 mkdose
Spirinolactone 1 – 3 mkday
GASTROENTEROLOGY
ANTACIDS
Maalox 5ml/10kg
(plain, plus) Available in 180ml bottle
Simethicone
Restime < 2 yo 0.5ml qid
2 – 12 yo 4ml qid
Oral drops 40mg/ml
ANTISPASMODIC
Dicycloverine 6mos – 2 yo 0.5 – 1ml TID
Relestal Drops 5mg/ml
Syrup 10mg/5ml
Domperidone 0.3 – 0.6 mkdose q6–8h
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
Motilium Susp 1mg/ml
Tab 10mg
Vometa Oral drops 5mg/ml
Susp 5mg/5ml
Tab 10mg
H2-BLOCKER
Ranitidine 1 – 2 mkdose q 12h
Zantac Tab 75mg 150mg 300mg
Cimetidine Neonates: 5 – 20 mkday q6 – 12h
Infants: 10 – 20 mkday
Child; 20 – 40 mkday
Adult: 300mkdose QID
400mkdose BID
800mkdose QID
Tagamet Susp: 300mg/5ml
Tab: 100mg 200mg 300mg
400mg 800mg
Famotidine PO: 0.5 mkdose q 12 h
IV: 0.6 – 0.8 mkday q 8 – 12h
ANTI-DIARRHEAL
Enkephalinase - Opiod Medication
Inhibitor - Reduce intestinal motility
- Antisecretory effect—it reduces the
secretion of water and electrolytes into the
intestine
Racecadotril 1.5 mg/kg for PRN (Max: 1 wk)
(Hidrasec) Cap: 100mg
Sachet: 10mg 30mg
< 9 kg 10 mg sachet 1 sach TID

9 – 13 kg 10 mg sachet 2 sach TID
13 – 27kg 30 mg sachet 1 sach TID
> 27 kg 30 mg sachet 2 sach TID
OTHER GI DRUGS
MULTIVITAMINS
LYSMIX 0.3 cc/k/dose TID Ceiling = 0.4
PROBIOTICS
Lactobacillus acidophilus, Bifidobacterium bifidum, Lactobacillus
casei, Bifidobacterium infantis, Bifidobacterium longum,
Lactococcus lactis, oligosaccharide, Zn, lactose, maltodextrin,
citric acid, sucralose
Prozinc Drops 10 mg/ml
< 6 mos 1 ml OD
< 6 mos – 2 yo 1 ml BID
Syrup 20 mg/5ml
> 2 yo 5ml OD
Sachet
Bacillus clausii
Erceflora Per vials: 2billion org/5ml
Max for 2 wks OD/Q4H
>1mos – 11yo: 1-2 vials /day
Adults: 2-3 vials/day
Always dilute with water, milk or juice

Per 1 billion CFU/sachet Lactobacillus casei, Lactobacillus
rhamnosus, Streptococcus thermophilus, Bifidobacterium breve,
Lactobacillus acidophilus, Bifidobacterium infantis, Lactobacillus
bulgaricus, fructooligosaccharide (FOS)
Protexin 1billion CFU/sachet PRN (Max:7 days) OD
Restore >7mos: 1 sachet mix with milk
Lactobacillus casei, Lactobacillus rhamnosus, Streptococcus
thermophilus, Bifidobacterium breve, Lactobacillus acidophilus,
Bifidobacterium longum, Lactobacillus bulgaricus, allicin,
fructooligosaccharide (FOS)
Protexin 1-2 cap OD
Balance
ANALGESIC/ANTIPYRETIC
Paracetamol (10 – 20 mkdose) q 4h
Tempra 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)
Dolan FP Suspension: 100mg/5ml
Dolan Forte 200mg/5ml
Drops: 100mg/2.5ml
Advil 100mg/5
Tab: 200mg
DRIPS
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
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 -20 200 mg/250ml Single strength

mcg/kg/min) 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
DEXMEDETOMIDINE
Sedation of initially intubated and mechanically ventilated
patients during treatment in an intensive care setting.
Precedex drip Dose: 0.2 - 0.7
1ml + 99cc D5W to run at cc/h
Wt x dose = rate (cc/h)
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
KCl NaHCO3
IV 2 meq/ml Inj premixed: 5% (0.6
Child: 0.5 – 1meq/k/dose meq/ml)
infusion of 500ml
0.5 meq/k/h for 1-2 h Tabs: 325 mg (3.8 meq), 650
Tabs: 8, 10, 15, 20 meq mg (7.6 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: 84 – 840 mg (1- 10
1cc/k/dose x 3doses; meq)/kg/D PO QID
Max: 10cc/dose + equal amt
of sterile water
VITAMINS
Stimulants Mosegar Vita 0.25 mg/day prep 0.25 /5 ml
Buclizine (syrup) Appetens
Propan
Appebon
2 - 8yo 5 - 10 ml OD
7 - 14yo 10 - 20 ml OD
w/ Folic acid Molvite
(Megaloblastic 7 - 12yo 10 - 15 ml OD
Anemia) 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
Pizotifen Mosegor vita syr
(drowsiness) Appetens
MTV w/ Iron Propan w/ iron syr (Fe So4; elem fe 30mg)
Appebon w/ iron syr (FeSo4; elem fe 10mg)
w/ Serotonin (for Mosegor vita
migraine + dec wt) 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
Iron Deficiency Supplemental Iron =
Anemia 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
CONDITIONS
NEONATOLOGY
ESSENTIAL NEWBORN CARE PROTOCOL [from DOH]

1. Immediate Drying
– hypothermia can lead to several risks
2. Delayed Cord Clumping
– to 3 mins after birth (or waiting until the umbilical cord has
stopped pulsing)
3. Latched on
– Provide warmth
– Increase the duration of breastfeeding
– Allow the “good bacteria” from the mother’s skin to infiltrate the
NB
4. Breastfeeding
5. No suctioning
Washing should be delayed until after 6 hours because this exposes the NB to
hypothermia and remove vernix. Washing also removes the baby’s crawling reflex.
NEWBORN CARE
Umbilical Cord
 Cut 8 inches above abdomen after 30 sec
 In nursery, cut the umbilical cord 1 ½ 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% [Chlamydia]
 Tetracycline 1%
 Povidone iodine 2.5%
Vitamin K
 Term: 1 mg Vit K
 PreT: 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
NEWBORN CARE
Hypothermia
 hypoxia
 metabolic acidosis
 hyperglycemia
Erythromycin ointment
 should be given an hour after birth
 gonococcal/chlamydial conjunctivitis
Gonococcal Conjunctivitis
 within 7days
Chemical conjunctivitis
 disappears within 48H
Other bacterial conjunctivitis
 Chlamydial >10-14 days
 Staph 48H-5th day (2-5days)
 Herpes
 Pseudomonas-give Gentamycin
Umbilical stump - sloughed off <14 days
Alcohol - drying effect
APGAR SCORE
o Evaluates the need for resuscitation
o Taken 1 and 5 minutes after birth
0 1 2
Color Blue, pale Body pink, All pink
extremities blue
HR 0 <100 >100
Reflex irritability No response Grimace Cough
Activity Limp Some flexion Active
Respiration Absent Slow, irregular Good
The APGAR Score
8 – 10 Good cardiopulmonary adaptation
4–7 Need for resuscitation, esp ventilatory support
0–3 Need for immediate resuscitation
NEWBORN SCREENING
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
Maple Syrup Urine Dse
NURSERY NOTES
Dextrosity
(to get factor: Desired – D5

D50- D5
D 7.5 = 0.055
D10 = 0.11
D 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 prep’n 2.5 mg/ml
Ca: 100-200mkd prep’n 100mg/ml
K: 2-4 mkd prep’n 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)
EMERGENCY INTERVENTION
Level of Umbilical Cathetherization: (cm)
If arterial between T6-T9
Wt x 3 x 8
If venous: (wt x 3) + 8 +1
2
Determination of ET Tube Size

ET tube size: age in yrs +4
4
ET level:
o if >2yo: age(yrs) +12
2
o Or ET size x 3
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
o Nasopharyngeal cathether = Flow rate x 20 + 20
Ex. 1L Fio2 = 40
o Nasal catheter = Flow rate x 4 + 20
Ex. 1L FiO2 = 24
Extubation:
o Give Dexamethasone at 0.1 mkdose q 6 hours for 24 hours prior to
extubation
o USN with epinephrine 0.5 cc + 1.5 cc PNSS q 15 mins x 3 doses
then extubate then USN with Salbutamol ½ nebule + 1.5 cc PNSS q
6 hours x 24 hours
o O2 at 10 lpm then decrease as necessary
Cows milk allergy

 Onset- 3rd wk
 Rashes on cheeks → eyebrows → cradle cap
BILIRUBIN METABOLISM
RBC
↓ Hemeoxygenase
Heme +Globin
↓ Bilirubin Reductase
Biliverdin
↓
Uncomjugated bilirubin Enterohepatic Pathway
↓
Liver SER ß-Glucoronidase
Glucoronyl Transferase ↓
Conjugated bilirubin
Kidney Small Intestine
↓ Urobilinogen
Urobilin ↓ Stercobilinogen
Stercobilin
Urine Stool
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
KRAMER CLASSIFICATION
ZONE JAUNDICE mg/dl
I Head/neck 6–8
II Upper trunk 9 – 12
III Lower trunk, thigh 12 – 16
IV Arms, leg, below knee 15 – 18
V Hands/feet > 15
Bilirubin (Total)
Cord Preterm <2 mg/dl <34 µmol/L
Term <2 mg/dl <34 µmol/L
0 – 1 days Preterm <8 mg/dl <137 µmol/L
Term <8.7 mg/dl <149 µmol/L
Term <11.5 mg/dl <197µmol/L
Term <12 mg/dl <205µmol/L
Older Infants Preterm <2 mg/dl <34 µmol/L
Term <1.2 mg/dl <21 µmol/L
Adult 0.3 – 1.2 mg/dl 5 – 12 µmol/L
Bilirubin (Conjugated)
Neonate <0.6 mg/dl <10 µmol/L
Infants/Children <0.2 mg/dl <3.4 µmol/L
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
BREAST FEEDING vs BREASTMILK JAUNDICE

Parameter BREASTFEEDING BREASTMILK
Onset 3rd to 5th day of Late; start to rise on day 4; may reach 20 – 30
life mg/dl on day 14 then ↓ slowly
Normal by 4 – 12 weeks
Pathophysio Decrease milk Unknown
intake → Prob. due to β – glucoronidase in BM which ↑
↑enterohepatic enterohepatic circulation
circulation Normal LFT;
(-) hemolysis
Mngt Fluid and If breastfeeding is stopped, rapid decrease in
caloricsupplement bilirubin level in 48 hrs, if resumed will rise to 2
– 4 mg/dl but no precipitating previous events
Treatment of Hyperbilirubinemia
Phototherapy
o Complications: metabolic acidosis, electrolyte
Exchange abnormalities, hypoglycemia, hypocalcemia,
transfusion thrombocytopenia, volume overload, arrhythmias, NEC,
infection, graft versus host disease, and death
o Adjunctive treatment for hyperbilirubinemia due to

isoimmune hemolytic disease
IV Ig
o (0.5–1.0 g/kg/dose; repeat in 12 hr)
o Reducing hemolysis
o Competitive enzymatic inhibition of the rate limiting
conversion of heme-protein to biliverdin (an
intermediate metabolite to the production of
Metalloporphyrins unconjugated bilirubin) by heme-oxygenase
o Patients with ABO incompatibility or G6PD deficiency or
when blood products are discouraged as with Jehovah's
Witness patients
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
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
NEUROLOGY
Glasgow Coma Scale Infants

Activiy Response Activity Response
Eye Opening
Spontaneous 4 Spontaneous 4
To speech 3 To speech 3
To pain 2 To pain 2
None 1 None 1
Verbal
Oriented 5 Coos, babbles 5
Confused 4 Irritable 4
Inappropriate 3 Cries to pain 3
words 2 Moans to pain 2
Inappropriate 1 None 1
sounds
None
Motor
Follows 6 Normal 6
command spontaneous
5 movement 5
Localizes pain 4 Withdraws to 4
Withdraws to 3 touch 3
pain 2 Withdraws to 2
Abnormal 1 pain 1
flexion Abnormal
Abnormal flexion
extension Abnormal
None extension
None
MOTOR DTR
full resistance with gravity 5/5 very brisk +4
some resistance with 4/5 brisker than average +3
gravity normal +2
movement with gravity 3/5 diminished +1
movement w/o gravity 2/5 no response 0
flicker 1/5
no movement 0/5
CRANIUM
Caput succedaneum
 diffuse edematous swelling of soft tses of scalp
 extend across midline
 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
 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
 calcify by end of 2nd wk
 few remain for years
 10-25% cases underlying linear skull fracture
 No tx but photo in hyperbil
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]
SEIZURE
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
SIMPLE COMPLEX
Type GTC Focal then gen post ictal
Duration < 15 min > 15 min or may go into

status
Recurrence None Recurrent (w/in 24H)
CNS exam Normal Abnormal
Sequelae None Neurodev abn
CSF PATHWAY
Choroid plexus (lateral ventricle) → Foramen of Monroe → 3rd ventricle
→ Aqueduct of sylvius → 4th ventricle →Foramina of Luschka (2 laterals)
→ & Magendie (median) → SAS → Absorbed in the arachnoid villi,
then in the Venous System
Contraindications to LP
 evidence of Inc ICP
 severe CP compromise
 Skin infection at site of puncture
CSF ANALYSIS
Color Rbc Wbc Diff ct Sugar CHON
Normal
Infant Xantho 0 -100 0 -32 L 100% 70 -80% 60 -
(Term) 150
Infant Clear 0 -100 0 -15 L 100% 70 -80% 60 -
(Preterm) 200
Older Clear 0 0 -10 L 100% > 50% 10-20
child
Viral Clear 0 0 -20 L 100% 40- 60% 40 -60
Mening
TB/Fungal Clear 0 20 - L>N < 40% > 100
500 g%
Bacterial Purulent 0 > 1000 N>L < 50% > 100
Mening g%
Partially Clear 0 100 L>N > 50% Dec
tx BM
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 side/portion]
2. Athetoid –worm like 2. Paraplegia
3. Rigid 3. Hemiplegia
4. Ataxic 4. Triplegia [3 limbs]
5. Tremor 5. Quadriplegia [all]
6. Atonic 6. Diplegia [LE/UE]
7. Mixed 7. Double hemiplegia
8. unclassified
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
Criteria for Hypoxic Ischemic Encephalopathy

 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
Prep’n : Single Strength: 200mg/250ml;
Double Strength: 400/250ml
if using double strength: wt x dose x 0.075÷2
(Dose = 5-20)
 Dobutamine: wt x dose x 0.06
Prep’n: 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
To make 50mg/50ml: Dobuject 1cc
D5 water 49cc
To make 50mg/20ml: Dobuject 1cc
D5 water 19cc
 Diflucan: 6 mkd OD prep’n 50mg/tab divide into pptabs and give 1 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
PULMONOLOGY
PCAP
CLINICAL FEATURES of PNEUMONIA
Bacterial o Fever >38.5C
o Chest recession
o Wheeze not a sign of primary bacterial URTI
Viral o Wheeze
o fever < 38.5
o marked recession
o RR normal or increased
Mycoplasma o School children
o Cough
o wheeze
Microbial causes of CAP accrdng to Age

Birth to 20 o Grp B Strep
days o Gram (-) enterobacteria
o CMV
o L. monocytogenesis
3 weeks to 3 o RSV
months o Parainfluenza virus
o S. pneumonia
o B. pertussis
o S. aureus
4 months to o RSV, Parainfluenza virus
4 yo o Influenza virus, Adeno, Rhinovirus
o S. pneumonia
o H. influenzae
o M.pneumoniae
o M.tuberculosis
5 years to o M.pneumoniae
15 years o C. pneumoniae
o S. pneumonia
o M.tuberculosis
CXR in assessing CAP etiology

Alveolar infltrates Bacterial pneumonia
Interstitial infiltrates Viral pneumonia
Both infiltrates Viral, Bacterial or mixed viral bacterial pneumonia
Therapeutic Mgt of CAP

OPD Mngt
Birth to 20 Admit
days
3 weeks to 3 Afebrile: Oral Erythromycin (30-40mkd)
months Oral Azithromycin (10 mg/kg/day) day 1
5mkday day2 to 5
Admit: febrile or toxic
4 months to Oral Amoxicillin (90mkd/3doses)
4 yo Alternative: Amox-Clav, AZM, Cefaclor
Clarithromycin, Erythromycin
5 years to Oral Erythromycin (30-40mkd)
15 years Oral AZM 10mkday day 1, 5mkday day 2-5
Clarithromycin 15mkday/2 doses
Pneumococcal infxn: Amoxicillin alone
IN-PATIENT
Birth to 20 Ampicillin + Gentamicin w or w/o Cefotaxime
days
3 weeks to 3 Afebrile: IV Erythromycin (30-40mkd)
months Febrile: add Cefotaxime 200mkd
Cefuroxime 150 mkd
4 months to If w/ pneumococcal infection:
4 yo IV Ampicillin (200mkd) Cefotaxime 200mkd
Cefuroxime 150 mkd
5 years to Cefuroxime 150 mkd + Erythromycin 40mkd
15 years IV or orally for 10-14 days
If pneumococcal is confirmed:
Ampicillin 200mkd
PCAP
VARIABLE PCAP A PCAP B PCAP C PCAP D
Minimal Risk Low Risk Moderate High 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
DHN
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
Subcosta/ Subcostal/
Retractions - - Intercostal Intercostal
Head Bobbing - - + +
Cyanosis - - + +
Grunting - - - +
Apnea - - - +
Lethargy/
Sensorium None Awake Irritable Stupor/
Coma
Complication:
Effusion None None Present Present
Pneumothora
x
Action Plan OPD OPD Admit (Ward) Admit (ICU)
f/u at end of f/u after 3 Refer to
tx days 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
ASTHMA
SEVERITY OF ASTHMA EXACERBATION
MILD MODERATE SEVERE RESPIRATORY
ARREST
IMMINENT
Breathless Walking Talking At rest
Infant –softer Infant stops
shorter cry feeding
Diff feeding
Can lie Prefers sitting Hunched

Talks in Sentences Phrases Words
Allertness May b agitated Usually agitated Usually agitated Drowsy or

confused
RR Inc Inc >30/min
Normal RR
<2 mo <60/min
2-12 mo <50/min
1-2 y <40/min
2-8 y <30/min
Acessory Usually Usually Usually Paradoxical
ms not Thoracoabd
movt
Wheeze Moderate Loud Usually loud Absence of
wheeze
Pulse <100 100-200 >120 Bradycardia
Normal PR
2-12 mo <160/min
1-2 y <120/min
2-8 y <110/min
Pulsus Absent Maybe present Often present Absence
paradoxus 10-25mmHg 20-40 mmHg suggests resp
<10mmHg ms fatigue
PEF >80% 60-80% <60%
PaO2 Normal >60 mmHg <60mmHg
PaCO2 <45 mmHg <45 mmHg >45 mmHg
O2 Sat >95% 91-95% <90%

LEVELS OF ASTHMA CONTROL [GINA GUIDELINES]

CONTROLLED PARTLY UNCONTROLLED
Daytime symptom None More than 2x a Three or more
[2x or less week features of
/week] partly controled
Limitation of None Any asthma present
activities in any week
Nocturnal None Any
sx/awakening
Need for None More than 2x a
reliever/recue tx week
Lung function Normal 80% predicted
(PEF OR FEV1)
Exacerbation None One or more/yr One in any week
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 more Add one or more
Low dose ICS Low dose ICS + Med to Hi dose Oral
C LABA ICS + LABA steroids
O Leukotriene Medium or Hi Leukotriene
N modifier dose ICS Modifier Anti
T Low dose Sustained IgE
R ICS + Release treatment
O Leukotriene theophylline
L Modifier
L Low dose
E ICS +
R Salbutamol
Release
theophylline
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:
o <6 mos
o Prematurity
o Heart or lung disease
o immunodeficiency
Signs /Symptoms
 low grade fever, rhinorrhea, cough, wheezing
 hyperresonance to percussion
CXR
 hyperinflation, interstitial infiltrates
Treatment
 Mild [at home]:
o Increased fluids, trial of inhaled bronchodilators, aerosolized
epinephrine
 Severe:
o Admit to hospital if: Marked respratory distress; Poor
feeding; O2 sat <92%; hx of prematurity < 34 wks; underlying
cardiopulmonary dse; unreliable caregivers
o Manage with ventilatory and O2 support, hydration, inhaled
bronchodilators and ribavirin
VIRAL CROUP vs EPIGLOTTITIS

VIRAL CROUP EPIGLOTTITIS
Age group 3 mos to 3 yrs 3 – 7 yrs
Stridor 88% 8%
Pathogen Parainfluenza virus H. influenzae type B
Onset Prodrome (1 – 7 days) Rapid (4 – 12 hrs)
Fever Severity Low grade High grade
Associated symptoms Barking cough, Muffled voice,
hoarseness Droolong
Respond to racemic Stridor improves None
epinephrine
CXR “steeple sign” “thumbprint sign”
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 x’s x 0.3 x wt ÷ 2
(+ equal amount of sterile water)
Full correction: Base x’s x 0.3 x wt ÷ 2

(1/2 via IV push, ½ via IV drip)
Full correction: Base x’s x 0.3 x wt ÷ 2

(1/2 via IV push, ½ via IV drip)
CARDIOVASCULAR
TRANSFUSION MEDICINE
BLOOD PRODUCTS
FWB 10 - 20 cc/kg 3 – 4H
PRBC 5 - 10 3 – 4H
Plasma 10 - 15 1–2H
PRP 10 - 15 1–2H
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
PRBC to be transfused for correction = 40 – hct x wt
Double Volume Exchange Therapy (DVET)

Wt x 80 x 2 = Volume/ amt of fresh whole blood
(Use mother’s blood type)
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
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
SHOCK
 CO = HR x SV
 CO is primarily maintained by changes in HR
HYPOVOLEMIC  Pump empty  MC in infant &children
 Truma, hemorrhage, DHN  Normal BV of children
(diarrhea/vomiting) 80ml/kg
 Metabolic dse (DM)
 Excessive sweating
CARDIOGENIC  Weak/sick pump  Compromise CO
 CHF, cardiomegaly, drug
intoxication, hypothermia,
after cardiac surgery
DISTRIBUTIVE  Sepsis  Redistribution of fluid w/n
 Anaphylaxis vascular space
 Barbiturate intox
 CNS injury (SCI)
SIGNS OF SHOCK
EARLY LATE
 Narrowed pulse  Decrease systolic pressure
pressure  Decrease diastolic pressure
 Orthostatic changes  Cold, pale skin
 Delayed capillary filling  Altered mental state
 Tachycardia  Diaphoresis
 Hyperventilation  Decrease urine output
ED 1. Position
MNGT 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 αconstrictor 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
LABORATORY MEDICINE
HEMATOLOGY
COMPLETE BLOOD COUNT
1-3 1 mo 2mos 6 – 12y >12y
days
Hgb 14.5 – 9 -14 11.5 - 13-16
22.5 15.5
Hct .48 - .28 - .42 .35 - .45 .37 - .49
.69
Wbc 9 -30 5 – 19.5 6 -17.5 4.5 -
birth 13.5
Plt 84 – 478 NB After 1 wk, same as adult
150 - 400
Retic 0.4 - 0.6 < 1 -1.2 0.1 -2.9
BLOOD INDICES
MCV Hgb / rbc x 10 80 -94
MCH Hgb / rbc x 10 27 - 32
MCHC Hgb/ hct x 10 32 – 38
Absolute reticulocyte count = pt’s hct x retic %
N hct for age
Reticulocyte Index
Absolute Retic Ct > 2 hemorrhage
2 < 2 rbc production abn
ABSOLUTE NEUTROPHIL COUNT

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 fr sepsis
Anemia
< 10 g mild anemia
8-9g mod anemia
<8 g severe anemia
CLINICAL CHEMISTRY
GLUCOSE
PT : 20-60
NB: 30-60
1 d: 40-60
>1d: 50-90
Child: 60-100
Adult: 70-105
GASTROENTEROLOGY
AGE PROTOCOL
1. Continue Feeding
2. ORS – Electrolyte Replacement
3. Sedacious Use of Antibiotics -
4. Zn Supplementation – Aids in reepitheliazation of GI Tract
5. Probiotics – Aids in digestion
ASSESSMENT OF DEHYDRATION [CDD]

PARAMETER 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 normally Thirsty Drinks poorly
Not thirsty Drinks eagerly Not able to drink
Skin pinch Goes back quicly Goes back slowly Goes back very
slowly
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
ORAL REHYDRATION THERAPY

PLAN A AGE Amount ORS to give/loose stool
50 – 100 ml
100 – 200 ml
As much as wanted
PLAN B Amount of ORS to give in 1st 24 hrs:
Weight (kg) x 75ml/kg
PLAN C AGE 30ml/kg 70ml/kg
Infants (<1 yo) 1 hr 5 hrs
Children (>1 yo) 30 mins 2.5 hrs
In fluid resuscitation: use 20cc/kg as bolus. Usually PLR
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
COMPOSITION OF IV SOLUTION
Fluid Na K Cl HCO3 Dxt
PNSS 154 - 154 - -
0.45 NaCl 77 - 77 - -
D5 0.3 NaCl 51 - 51 - 5
D5 LRS 130 4 109 28 5
D5 NM 40 13 40 16 5
D5 IMB 25 20 22 23 5
D5 NR 140 5 98 27 5
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
KIR = Rate x incorporation

wt
MAINTENANCE WATER
HOLLIDAY – SEGAR METHOD
Weight [kg] Daily Requirement [ml/kg]
1 – 10 100 ml
10 – 20 1000 + 50ml/kg for each kg >10
>20 1500 + 20ml/kg for each kg >20
Maintenace water rate
0 – 10 4ml/kg/hr
10 – 20 40 mk/hr + 2ml/kg/hr x wt
>20 60 mk/hr + 1ml/kg/hr x wt
NEPHROLOGY
Age GFR Range
PT
2- 8 d 11 11 – 15
4 - 28 d 20 15 – 28
30 -90 d 50 40 – 65
Term
2- 8 d 39 17 – 60
4 - 28 d 47 26 – 68
30 - 90 d 58 30 – 86
1- 6mo 77 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
GFR (based on plasma creatinine and ht)

GFR = k x L = ml/min/1.73 m2 SA
sCr
L = body length (cm)
Scr = mg/dL ; divide by 88.4 if units in mmol/L
Computation for OFI (AGN & limiting OFI)

1. BSA x 400 + UO – IVF (half if w/ Furo) = OFI (then divide to 3 shifts)
2. 20cc x wt x UO – IVF
BSA
Weight in (kg)
0–5 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
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
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
o Fluids: 400 – 600 ml/m2/day + UO 24H
o NaCl < 2 g/day
o K < 40 meq/day
 Penicillin 50 – 100,000 u/kg/day TID/QID x 10 days
 HPN, CHF
o Furosemide 2 mg/k/dpse
Prognosis – complete resolution, 5 – 10 % progress to chronic state
BUN/ crea ratio

Normal 10 -20
> 20 suggest DHN, pre renal azotemia or GIB
< 5 – liver disease, inborn error of metabolism
IMMUNOLOGY
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
ATOPIC DERMATITIS CONTACT DERMATITIS SEBORRHEIC

DERMATITS
 Hereditary, AR  Irritant – strong  Excessive sebum
 Hx of Asthma chem. accumulation on
 Thickened, shiny,  Allergic scalp, face,
red  E.g. Diaper rash midchest, perineum
 Exacerbated by dry  E.g. Cosmetic,  Greasy scalp (cradle
skin, contact sty, & perfume cap)
anxiety  Physiologic 1st 6mos
Treatment: Treatment: Treatment:
 Hydrocortisone/  Remove reactant  Low potency
fluocinolone  High/mod potency steroid
 Moisturizer steroid
 Cloxa/cefalexin if
with infxn
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 39°C for 2
wks; faint red macular rash over the trunk & proximal
extremities
Mngt  NSAIDS then Methotrexate
 Seroid for overwhelming systemic illness
SYSTEMIC LUPUS ERYTHEMATOSUS [SLE]

Criteria  Serositis (pleuritis, serous pericarditis,Libman sacks
endocarditis
 Oral ulcers (painless)
SOAP  ANA abormal titer
BRAIN  Photosensitivity
MD
 Blood - Hematologic disorder
 Renal disorder
 Arthritis, Nonerosive (2 or more joints)
 Immunologic disorder
 Neurologic disorder

 Malar rash
 Discoid rash
Dx  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)
Mngt  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
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
IMMUNIZATION
Vaccine Min age 1st No of interval booster
dose dose
BCG At birth 1 - -
Before 1 mo
DPT 6 wks 3 4 wks 18 mos
(2, 4, 6 mos) 4 – 6 yo
OPV/IPV 6 wks 3 4 wks Same as
2, 4, 6 mos) DPT
Hep B At birth 3 6 wks from 1st dose,
(0, 1, 6 mos) 8 wks from 2nd dose
EPI (6, 10, 14)
Measles 6 – 9 mos 1 -
MMR 15 mos 1
Hib 2, 4, 6 mos 18 mos
Pneumococcal 6 mos (PCV7) 18 mos
2 yrs (PPV)
Rotavirus 3 and 5 mos 2 I month
Hep A 1 yr and up 2 6 – 12 mos apart
Varicella 1st: 12 – 15 2 Bet 1st and 2nd dose:
mos at least 3 mos
2nd: 4 – 6 yo
Flu 6 months yearly
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
½ at wound site
½ 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
TETANUS TOXOID
Hx of Clean minor Wound All other Wounds
Absorbed TT
Td TIG Td TIG
Unknown or Yes No Yes Yes
<3
> 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 wds) if > 5 yrs since last dose
INFECTIOUS DISEASES
RHEUMATIC HEART DISEASE

JONES CRITERIA
Major Manifestation (FEArP CPC Every Saturday)
1. Carditis (50%)
a. Tachycardia
b. Heart murmur of valvulitis
c. Pericarditis
d. Cardiomegaly
e. Signs of CHF [gallop rhythm, distant heart sounds,
cardiomegaly]
2. Polyarthritis (70%)
3. Chorea, Sydenham’s (15%)
4. Erythema marginatum (10%)
5. Subcutaneous nodules (2 – 10%)
Minor manifestation
1. Fever at least 38.8°C
2. Elevated Acute Phase Reactants (CRP & ESR)
3. Arthralgia
4. Prolonged PR interval on the ECG
Diagnosis
1. Highly probable : 2 major OR 1 major and 2 minor manifestation
INFECTIVE ENDOCARDITIS
Modified DUKE CRITERIA
Major Manifestation
1. Blood Culture Positive
– IE organism isolated from two separate blood cultures (1hour
apart)
– (+) Coxiella Burnetti isolate in one culture + IgG Ab Titer for Q
Fever Phase 1 Ag >1:8000
2. (+) Evidence of Endocardial Involvement (2D-ECHO)
– Oscillating intracardiac mass on valve or supporting structures
– Abscess
– New partial dehiscence of prosthetic valve or new valvular
regurgitation (worsening or changing of preexisting murmur not
sufficient)
Minor manifestation
1. Predisposing factor:
– Known cardiac lesion,
– Recreational drug injection
2. Fever >38°C
3. Embolism evidence:
– Arterial Emboli, Pulmonary Infarcts, Janeway
Lesions,Conjunctival Hemorrhage
4. Immunological problems:
– Glomerulonephritis, Osler's Nodes, Roth's Spots, Rheumatoid
Factor
5. Microbiologic evidence:
– Positive blood culture (that doesn't meet a major criterion)
– serologic evidence of infection with organism consistent with IE
but not satisfying major criterion
6. Positive echocardiogram (that doesn't meet a major criterion) (this
criterion has been removed from the modified Duke criteria)
Diagnosis
Definite
– Histology (Vegetation) or Culture Positive
– 2 Major
– 1 Major and 3 Minor
– 5 Minors
Possible
– 1 Major + 1 Minor
– 3 Minors
VIRAL INFECTIONS
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
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 LAD [24
sign hrs before rash & remains for 1 wk]
Tx Vit A SD 100,000 IU orally for 6 mo –1 y
200,000 IU >1 yo
Post Immunoglobulin [not routine]
exposure Considered if termination of preg is not an option
prophylaxis 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
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 Ig w/n 6 days of exposure
exposure (0.25ml/kg max 15 ml) IM
prophylaxis
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
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 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: increased risk o severity
Post VZIg 1 dose up to 96 hrs after exposure
exposure Dose: 125 U/10 kg (max 625 U) IM
prophylaxis 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 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
Pathogenesis of Dengue Hemorrhagic Fever
DENGUE VIRUS
↓ ↓ ↓
Liver Lymphoblast Platelet
/Plasma Cell
↓ ↓ ↓
Liver Injury Ag-Ab reaction Decr Maturation (MEG)
Incr Platelet Destruction
↓ ↓ ↓
Decreased Coagulation Increased Vascular
Factors Permeability Thrombocytopenia
↓ ↓ ↓
Increased Bleeding Hypoalbuminemia Bleeding
Tendency Hemoconcentration
Pleural Effusion
↓
Hypotension
CRITERIA FOR CLINICAL DX (WHO)

DHF DSS
 Fever, acute onset, high, lasting 2 – 7  Above criteria
days Plus
 Hemorrhagic man:  Hypotension or narrow pulse
o (+) Torniquet test pressure [SBP – DBP] <20mmHg
o Minor & Major bleeding
phenomenon
 Thrombocytopenia <100,000/mm3
NUTRITION
Waterloo Wasting Stunting

Classification (Wt for Ht) (Ht for Age)
Normal >90 >95
Mild 81 – 90 90 – 95
Moderate 70 – 80 85 – 89
Severe <70 <85
Growth and Caloric requirements

AGE RDA kcal/kg/day
0 – 3 mos 115
3 – 6 mos 110
6 – 9 mos 100
9 – 12 mos 100
1 – 3 yo 100
4 – 6 yo 90 – 100
Regular milk: 20 cal/oz
Preterm milk: 24 cal/oz
Total Caloric Intake: rate x 24 x caloric content of IVF ÷ wt
To get factor: Dextrosity x 0.04 = cal/cc
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 g/kg
0-5mo 115 3.5
6-11mo 110 3
1-2 yo 110 2.5
3-6 yo 90 – 100 2
7-9 yo 80 – 90 1.5
10 – 12 yo 70 – 80 1.5
13-15 yo 55 – 65 1.5
16 – 19 yo 45 – 50 1.5
Estimated Catch up Growth Requirement

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

Actual BW
Approximate Daily Water Requirement

0 – 3 do 120cc/k/d 4 – 6 yo 100 cc/k/d
10 do 150cc/k/d 7 – 9 yo 90 cc/k/d
1 – 5 mo 150cc/k/d 10 – 12 yo 80 cc/k/d
6 – 12 mo 140cc/k/d 13 – 15 yo 70 cc/k/d
1 – 3 yo 120cc/k/d 16 – 19 yo 50 cc/k/d
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)
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
Milupa: Alaptamil
Abbott: Similac advance
Wyeth: S26, Bonna
Unilab: Mylac
6months onwards (20cal/oz) Lactose free (6months onwards)
Mead-johnson: Enfapro Mead-johnson: Enfapro lacto-free
Nestle: NAN2, Nestogen 2
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 Milupa: Preaptamil
Dumex: Dugrow Abbott: Similac prem
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
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 285 ml

100
CaGluc 2ml/kg 20 ml
D5IMB 485 ml
D50W 0.11 x 1000ml 110 ml
1000ml x 37 cc/h
TPN in Pediatrics
A. Energy Requirment
AGE/WT Caloric Rquirement
Neonates 90-120 kcal/kg
Infants & Older
Children 10-120 kcal/kg
<10 kg 1000kcal + 50 kcal foe each kg > 10
11-20 kg 1500 + 20 for each more than 20
>20
B. Fluid Requirement
AGE/WT Fluid Rquirement
Neonates
VLBW (≤ 1500 Initiate at 40 – 60 ml/kg/day and increase by 10
gm) ml/kg/day till 120 ml/kg is reached
Initiate at 60 ml/kg/day and increase by 15

AGA & LBW ml/kg/day till 120 ml/kg is reached on the 5th day
of PN
 Neonates under radiant heaters or on phototx an extra 30ml/kg/day of

water
Infants & Older
Children 100 – 120 ml/kg
<10 kg 1000ml + 50 ml foe each kg > 10
11-20 kg 1500 + 20 for each more than 20
>20
C. 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.
D. Carbohydrate Requirement
% dextrose = gram dextrose x 100
Vol infused (ml
 Shud provide 50 – 60 % 0f total non-protein calories
 Requirement ranges frm 10 to 25 gm/kg/day
 Infusion shud not exceed 12.5mg/kg/min
 Shud b 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
E. 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
F. Daily Electrolyte Requirements
Electrolytes Neonates 1-6 mos 6 mo -11 Adolescents
(mmol/kg) (mmol/kg) yr (mmol/kg)
(mmol/kg)
NaCl 3–5 3–4 3–4 60 – 100
Potassium 2–4 2–3 2–3 80 – 120
Cal gluc 0.6 – 1.0 0.25 – 1.2 0.25 – 1.2 4.7
(max of (max of
Phosphate 1.0 4.7) 4.7) 30 – 45
Magnesium 0.125- 1–2 1–2 4–8
0.250 0.125- 0.125-
0.250 0.250
 Calcium gluconate contains 100 mg calcium gluconate or 9 mg
elemental calcium/ml
 1 gm of calcium gluconate contains 4.7 mEq or 2.35 mmol of Ca.
G. Trace Elemental Requirements

Trace Prematures Infants & Adolescents
Elemental (ug/kg) Children (mg)
(ug/kg)
Zinc 400 100 – 500 2.5 – 4
Copper 50 20 0.5 – 1.5
Chromium 0.3 0.14 – 0.2 0.01 – 0.04
Manganese 10 2 – 10 0.15 – 0.5
Iodine 8 8 0.2
Selenium 4 4 0.3
Flouride 57 57 0.9
 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
TPN for NEONATES

Wt 2kg
1. TFR = 100 ml/kg/day x 2 kg 200 ml
2. Intralipid 20%
1 g/kg/day x 2kg = 2g/day 10 ml
2 g = 20g
x 100ml
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
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 x
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

EMERGENCY MEDICINE
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
6-24 mos Miller 2
>24 mos Miller 2 or Mac 2
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 0.1 – 1mg/k/min; 1amp = 1mg/ml
Drip 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
O2 SUPPLEMENTATION
Peak Flow (6 – 7 yo)
(Ht cm – 100) x 5 + 170 female
+ 175 male
Nasopharyngeal catheter = flow rate x 20 + 20
Nasal cannula = flow rate X 4 + 21
TFR= TV x RR x IE ratio + dead space (2000)

TV= 10 ml x wt
TFR Short cut: wt x 10 + 40 ml divide by 0.5
16.77
NORMAL VALUES
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 Mos ½ inch per month
5 – 12 mos ¼ inch per month
2 years old 1 inch per year
3 – 5 yo ½ inch per year
6 – 20 yo ½ inch per 5 years
LENGTH (50 cm)
0 – 3 mos 9 cm
4–6 8 cm
7–9 5 cm
10 – 12 3cm
Weight for Height = Actual BW (kg)

P50 Wt for Ht (kg)
Height for Age = Actual Height (cm)

P50 Ht for Age
Age Ht (cm) Ht (cm) Wt for Ht Boys Girls

mo boys girls (cm) (kg) (kg)
0 50.5 49.9 49 3.1 3.3
1 54.6 53.5 50 3.3 3.4
2 58.1 56.8 51 3.5 3.5
3 61.1 59.5 52 3.7 3.7
4 63.7 62.0 53 3.9 3.9

5 65.9 64.1 54 4.1 4.1
6 67.8 65.9 55 4.3 4.3
7 69.5 67.6 56 4.6 4.5
8 71.0 69.1 57 4.8 4.8
9 72.3 70.4 58 5.1 5.0
10 73.6 71.8 59 5.4 5.3
11 74.9 73.1 60 5.7 5.5
12 76.1 74.3 61 5.9 5.8
13 77.2 75.5 62 6.2 6.1
14 78.3 76.7 63 6.5 6.4
15 79.4 77.8 64 6.8 6.7
16 80.4 78.9 65 7.1 7.0
17 81.4 79.9 66 7.4 7.3
18 82.4 80.9 67 7.7 7.5
19 83.3 81.9 68 8.0 7.8
20 84.2 82.9 69 8.3 8.1
21 85.1 83.8 70 8.5 8.4
22 86.0 84.7 71 8.8 8.6
23 86.8 85.6 72 9.1 8.9
24 87.6 86.5 73 9.3 9.1
25 88.5 87.3 74 9.6 9.4
26 89.2 88.2 75 9.8 9.6
27 90.0 89.0 76 10.0 9.8
28 90.8 89.8 77 10.3 10.0
29 91.6 90.6 78 10.5 10.2
30 92.3 91.3 79 10.7 10.4
31 93.0 92.1 80 10.9 10.6
32 93.7 92.8 81 11.1 10.8
33 94.5 93.5 82 11.3 11.0
34 95.2 94.2 83 11.5 11.2
35 95.8 94.9 84 11.7 11.4
36 96.5 95.6 85 11.9 11.6
yo
3.5 98.4 97.3 86 12.3 11.8
4 yo 102.9 101.6 87 12.3 11.9
4.5 106 104.5 88 12.5 12.2
5 109.9 108.4 89 12.8 12.4

5.5 112.6 111.0 90 13.0 12.6
6 116.1 114.6 91 13.2 12.8
6.5 118.5 117.1 92 13.4 13.0
7 121.7 120.6 93 13.7 13.3
7.5 123.9 123.0 94 13.9 13.5
8 127.0 126.4 95 14.1 13.8
8.5 129.1 128.8 96 14.4 14.0
9 132.2 132.2 97 14.7 14.3
9.5 134.4 134.7 98 14.9 14.6
10 137.5 138.3 99 15.2 14.9
10.5 139.9 140.9 100 15.5 15.2
11 143.3 144.8 101 101.0 15.5
11.5 145.8 147.6 102 16.1 15.9
12 149.7 151.5 103-105 16.5-17.1 16.2-16.7
12.5 152.5 154.1 106-108 17.4-18.0 17.0-17.6
13 156.5 157.1 109-111 18.3-19.0 17.9-18.6
13.5 159.3 158.8 112-114 19.3-20.0 18.9-19.5
14 163.1 160.4 115-117 20.3-21.1 19.9-20.6
14.5 165.7 161.1 118-120 21.4-22.2 21.0-21.8
15 169.0 161.8 121-123 22.6-23.4 22.2-23.1
15.5 171.1 162.1 124-126 23.9-24.8 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
Age K (mean value) KI

LBW < 1 yr 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 61.88

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HANDY PEDIATRIC

PROTEIN SYNTHESIS INHIBITOR

Roseola (HSV 6).................................................................. 113

Pre Lumbar Tap

PROTEIN SYNTHESIS INHIBITOR

Azithromycin 3 day regimen: 10 mkday x 3 days

DNA SYNTHESIS INHIBITOR

>2yo: max: 660mg/day TID

All treatment duration must not exceed 7 days

Tabs: 15, 30, 60, 90, 100 mg

PHENYTOIN LD: 15 – 20 mg/kg/IV

OXCARBAMAZEPINE (8 - 10 mkd BID)

Trileptal Tab 150 mg 300mg 600 mg

VALPROIC ACID PO:

Ped Syr TID

Adult Susp TID

Adult & >12 yo

Ambroxol Infant Drops 6mg/ml 75mg/ml BID

Procaterol HCl (1.25mcg/kdose)

Loratadine 1 – 2 yo: 2.5 ml BID

ORAL LD: 10mkdose 200mg

< 9 kg 10 mg sachet 1 sach TID

Always dilute with water, milk or juice

Mefenamic Acid (6 – 8mkdose) q 6h

Noradrenaline (Levophed) 1mg/ml dose :(0.5 – 1 ml/kg)

Dopamine ( 5 -20 200 mg/250ml Single strength

Terbutaline Bricanyl SC Inj: 1 mg/ml

Ketamine (Ketalar) 10, 50, 100 mg/ml

Naproxen 250, 375, 500mg tab

Ferlin syrup 30mg/ml

Sangobion syr (Fe gluc 250mg elem Fe 30mg)

ESSENTIAL NEWBORN CARE PROTOCOL [from DOH]

(to get factor: Desired – D5

To check TFI = rate x 24 ÷ wt

Day 1: start IVF with D10 water

Day 3: increase TFI by 10-20 (depends on AP)

Subsequent days depend on infants status…..

Determination of ET Tube Size

Cows milk allergy

Kidney Small Intestine

BREAST FEEDING vs BREASTMILK JAUNDICE

o Adjunctive treatment for hyperbilirubinemia due to

Glasgow Coma Scale Infants

Duration < 15 min > 15 min or may go into

Criteria for Hypoxic Ischemic Encephalopathy

If using Dobuject: Wt x dose x 60÷ concentration

Microbial causes of CAP accrdng to Age

CXR in assessing CAP etiology

Therapeutic Mgt of CAP

Clinical Practice Guidelines in the Evaluation and Management of PCAP 2004

What shud b done if px is not responding to current antibiotics

Can lie Prefers sitting Hunched

Allertness May b agitated Usually agitated Usually agitated Drowsy or

PaCO2 <45 mmHg <45 mmHg >45 mmHg

O2 Sat >95% 91-95% <90%

LEVELS OF ASTHMA CONTROL [GINA GUIDELINES]

MANAGEMENT APPROACH BASED ON CONTROL

VIRAL CROUP vs EPIGLOTTITIS

BICARB DEFICIT CORRECTION:

Full correction: Base x’s x 0.3 x wt ÷ 2

Full correction: Base x’s x 0.3 x wt ÷ 2

1 u FWB = 200 cc PRBC

Double Volume Exchange Therapy (DVET)