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Compensated
Met Alkalosis
Uncompensated
Partly
Compensated
WATERLOW CLASSIFICATION
WASTING = Actual weight (kg) x 100
p50 weight for height
STUNTING = actual height (cm) x 100
p50 height for age
WASTING: >90 normal
81-90 mild
70-80 moderate
<70 severe
STUNTING: >95 normal
90-95 mild
85-89 moderate
<85 severe
IDEAL BODY WEIGHT (Filipino:3000 gms)
< 6 mos = age (mos) x 600 + BW (gm)
6-12 mos = age (mos) x 500 + BW (gm)
1-6 yrs = age (yrs) x 2 + 8
7-12 yrs = age (yrs) x 7 5/2
N
Partly
Compensated
N
Respiratory Alkalosis
Uncompensated
N
Partly
Compensated
N
Met Acidosis
Uncompensated
BLOOD GLUCOSE
Normal: 70-110 mg/dl
> 120 mg/dl: hyperglycemia
Term infants: > 140 mg/dl normally
Preterm: > 30 mg/dl normally
RESPIRATORY RATE
(Harriet lane handbook 17 ed)
NORMAL:
0.1 yr = 24-38 cpm
1-3 yrs = 22-30 cpm
4-6 yrs = 20-24 cpm
7-9 yrs = 18-24 cpm
10-14 yrs = 16-22 cpm
14-18 yrs = 14-20 cpm
TACHYPNEA:
0.2 mos: >/= 60
2-12 mos: >/= 50
Premature
0-3 mos
3-6 mos
6-12 mos
1-3 yrs
3-6 yrs
6-12 yrs
12 yrs
BE
N
PCAP A or PCAP B
No diagnostic aids are initially requested
PCAP C or PCAP D
1. The ff should be routinely requested:
a.
CXR APL
b.
WBC
c.
Culture & sensitivity of
i. blood for PCAP D
ii. Pleural fluid
iii. Tracheal aspirate upon initial intubation
d.
Blood gas &/or pulse oximetry
2. The ff may be requested:
Culture and sensitivity of sputum for older children
3. The ff should not be requested
a.
ESR
b.
CRP
An Antibiotic is recommended
1. For a px classified as either PCAP A or B and is
a.
Beyond 2 yrs
b.
Having high grade fever w/o wheeze
2. For a px classified as PCAP C and is
a.
Beyond 2 yrs of age
b.
Having high grade fever w/o wheeze
c.
Having alveolar consolidation in the CXR
d.
Having WBC > 15,000
3. For a px as PCAP D
Empiric Treatment
1. For PCAP A or B w/o previous antibiotic
= Amoxicillin (40-50 mkD) oral TID
2. For PCAP C who completed Hib immunization
= Pen G IV (100,000 U/k/D) QID
PCAP C not completed Hib immunization
= Ampicillin IV (100 mkD) QID
3. For PCAP D consult specialist
When can a px be considered as responding to current antibx?
1. Decrease in respiratory signs and defervescence w/in 72 hrs
after initiation
2. Reevaluate if ssx persists beyond 72 hrs after antibiotics
3. End of tx, CXR, WBC, ESR, or CRP should not be done to
assess therapeutic response to antibx
Suspension
Drops
Capsules
Cefaclor (2nd gen)
Suspension
Drops
CD exten rel tab
Cefuroxime (2nd gen)
Suspension
Sachet
Tablet
125mg/5ml
250 mg/5 ml
100 mg/5 ml
250 mg; 500 mg
20-40 mkd q 8-12 h
125 mg/5 ml
187 mg/5 ml
250 mg/5 ml
375 mg/5ml
50 mg/ml
375 mg; 750 mg
20-40 mkd q 12 h
125 mg/5 ml
250 mg/5 ml
125 mg/ sachet
250 mg/ sachet
125 mg; 500 mg
Cefipime
Vial
Cotrimoxazole
Suspension
Tablet
MACROLIDES
Erythromycin
Suspension
Drops
30-50 mld q 6h
200 mg/5 ml
400 mg/5 ml
100 mg/2.5 ml
100 mg/ml
Clarithromycin
Suspension
Tablet
Roxithromycin
Clindamycin
Ancillary treatment
1. O2 and hydration
2. Bronchodilators, CPT, steam inhalation, NSS nebulization
Prevention
1. Vaccines
2. Zinc supplementation for 4-6 months
a.
10 mg for infants
b.
20 mg for children > 2yrs
Amoxicillin
Suspension
Drops
Capsules
OPD MEDS
30-50 mkd (50 mkd) q 8h
125 mg / 5 ml
250 mg / 5 ml
100 mg/ml
250 mg; 500 mg
50-100 mkd q 6h
125 mg/5 ml
250 mg/5 ml
250 mg; 500 mg
Chloramphenicol
Suspension
Capsules
50-75 mkd q 6h
125 mg/5 ml
250 mg; 500 mg
CEPHALOSPHORINS
Cefalexin (1st gen)
Tablet
Ped tab
Azithromycin
Suspension
Capsule
Suspension
Capsule
Ampoule
Metronidazole
Suspension
Tablet
30-50 mkd q 8h
125 mg/5 ml
250 mg; 500 mg
Diloxanide furoate
Suspension
Tablet
20 mkd q 8h x 10 days
125 mg/5 ml
500 mg
Miconazole
10-20 mkd SD
125 mg/5 ml
125 mg; 250 mg
Mebendazole
Suspension
Tablet
Albendazole
<2 yo 200 mg SD
>2 yo 400 mg SD
200 mg/5 ml
400 mg
Suspension
Tablet
Acyclovir
Suspension
Blue
Pink
Diphenhydramine
Syrup
Capsule
Ampoule
Doxofylline
Syrup
Tablet
6 mkdose TID
100 mg/5 ml
400 mg
20 mkdose diven q 6h
Max 800 mg/day
200 mg/5ml
400 mg
800 mg
Aminophylline
Prednisone
Syrup
Hydroxizine
Syrup
Tablet
Adult
1 mkd BID
2 mg/ml
10 mg; 25 mg
10 mg BID or 25 mg OD @ HS
Desloratadine
Syrup
6-11 mos
1-5 yrs
6-11 yrs
2.5 mg/5 ml
2 ml (1 mg) OD
2.5 ml (1.25 mg) OD
5 ml (2.5 mg) OD
Ceterizine
Oral drops
6-12 yo
2-6 yo
Tablet
Adult & >12 yo
6-12 yo
10 mg/ml
10 drops BID
5 drops BID
10 mg
1 tab OD
tab BID or 1 tab OD
Loaratadine
Syrup
Adult & 12 yo
2-12 yo (>30 kg)
(<30 kg)
1-2 yo
5 mg/5ml
10 ml OD
10 ml OD
5 ml OD
2.5 ml OD
Sodium chloride
Nasal drops
Nasal spray
Phenylpropanolamine HCL
Syrup
2-6 yo
7-12 yo
Drops
1-3 mos
4-6 mos
7-12 mos
1-2 yo
12.5 mg/5 ml q 6h
2.5 ml
5 ml
6.25 mg/ml q 6h
0.25 ml
0.5 ml
0.75 ml
1 ml
Tablet
Rexidol
Opigesic
10-20 mkdose q 4h
60 mg/0.6 ml
100 mg/ml
120 mg/5 ml
125 mg/5 ml
250 mg/5 ml
325 mg; 500 mg
150 mg/5 ml syrup
600 mg tablet
125 mg; 250 mg
Mefenamic acid
Syrup
Capsule
6-8 mkdose q 6h
50 mg/5 ml
250 mg; 500 mg
Ibuprofen
5-10 mkdose q 6h
Max of 20 mkd
100 mg/5 ml
200 mg/5 ml
Suspension
Ampoule
1-2 mkd
10 mg/5 ml
20 mg/5 ml
1 mg; 5 mg; 10 mg; 20 mg
Tablet
Prednisolone
Syrup
1-2 mkd
15 mg/5 ml
Racecadotril
Sachet
Capsule
Tramadol
Ampoule
Capsule
Tablet
Famotidine
Ampoule
Tablet
Ranitidine
Entac
Pharex
1 mkdose q 8h
25 mg
75 mg
Zinc
Drops
Syrup
IV ANTIBIOTICS
Penicillin G
100,000 400,000 ukd q 4-6h
Ampicillin + sulbactam (unasyn) 50 100 mkd q 8-6 h
Chloramphenicol
50-100 mkd q 4-6h
Oxacillin (prostaphlin)
50-100 mkd q 6-8h
Flucloxacillin
50-100 mkd q 6-8h
Gentamycin (Tangyn)
5-7.5 mkd OD, q 8-12h
Netromycin
5 mkd q 12h
Amikacin + SO4 (Amikin)
15 mkd q 12h
Cefuroxime (Zegen)
50-100 mkd q 6-8h
Ceftriaxone
50-100 mkd OD, q 12h
Ceftazidine
50-100 mkd q 12h
Cefoxitin
20-40 mkd q 6-12h
Cefepime
100 mkd q 12h
Tienam
10-15 mkdose q 6h
Meropenem (Meronem)
20-40 mkd q 8h
Piper/tazo (Piptaz)
200-300 mkd q 6h
OTHER IV MEDS
Epinephrine
Diphenhydramine
Hydrocortisone
Max dose:
Nalbuphine (Nubain)
Phenobarbital
Diazepam
Rectal dose
2-5 yo
6-11 yo
12 yo
Ampoule
Oral soln
Tablet
Ped rectal gel
Salbutamol
Syrup
Tablet
0.1-0.15 mkdose
2 mg/5 ml
2 mg; 4 mg
Salbutamol + guaifenesin
Syrup
Tablet
STAGE
1
2
3
4
1 mg/50 mg/5 ml
2mg/50 mg
Terbutaline sulfate
Syrup
Tablet
0.075 mkdose
1.5 mg/5 ml
2.5 mg
Terbutaline + guaifenesin
Syrup
0.01 ml/kg
1-2 mkdose
4 mkdose q 6-8h
200 mg as LD
100 mg as MD
0.13-0.15 mkdose
10 mkdose LD
5 mkd MD q 12h OD HS
0.04-0.2 mkdose IM/IV
Max dose 0.6 mg/kg w/in 8h
0.12-0.8 mkd q 6-8h
0.5 mkdose ffd by
0.25 mkdose in 10 min PRN
0.5 mkdose
0.3 mkdose
0.2 mkdose
5 mg/ml
1 mg/ml; 5 mg/ml
2 mg; 5 mg; 10 mg
2.5 mg; 5 mg; 10 mg
STAGE
1
2
3
4
5
NEWBORN SCREENING
What is newborn screening?
Newborn screening is a simple procedure to find out if your
baby has a congenital metabolic disorder that may lead to
mental retardation and even death if left untreated.
Why is it important to have newborn screening?
Most babies with metabolic disorders look normal at birth.
One will never know that the baby has the disorder until the
onset of signs and symptoms and more often ill effects are
already irreversible.
When is newborn screening done?
Newborn screening is ideally done on the 48th hour or at
least 24 hours from birth. Some disorders are not detected if the
test is done earlier than 24 hours. The baby must be screened
again after 2 weeks for more accurate results.
Mumps
Hemophilus
influenza
Varicella
zoster
1 yr
2 mos 5
yrs
9 mos - up
1
3
0.5 ml IM
2 mos
0.5 ml SQ
2 mos
1 yr
2
1
6 wks
0.5 IM
1 ml SQ
EXTRA REQUIRED:
Fever (add 12% for each oC above 37.5)
Hypermetabolic States (thermal injury, thyrotoxicosis, resp.
distress) 25-75%
Abnormal H2O/electrolyte losses (diarrhea,/vomiting) depend
on degree of hydration
Sweating (10-35%)
LESS REQUIRED:
Hypothermia (subtract 12% for each oC < 37.5)
Very high humidity
Oliguria/anuria
Sedated/paralyzed patient (subtract 40%)
Edematous/ antidiuretic states (cardiac failure)
HALLIDAY-SEGAR METHOD
(Maintenance Fluid)
(Nelson 16th ed)
0-10 kg
11-20 kg
>20 kg
100 ml/kg/day
1000 + 50 ml/kg for each kg > 10 kg
1500 + 20ml/kg for each >20 kg
LUDANS METHOD
(del Mundo 2000)
0-3 kg
3-10 kg
11-20 kg
21-30 kg
31 kg
75 ml/kg/day
100 ml/kg/day
75 ml/kg/day
60 ml/kg/day
50 ml/kg/day
DOPAMINE DRIP
Prep: 200 mg/5ml (40 mg/ml)
Dose: 3-30 mcg/kg/min
Formula:
Amt/dose = wt x dose x K (6) prep 2(to make 50 ml prep)
to incorporate running dose
eg: 10 kg child, dopamine @ 5 mcg/kg/min @ 5 cc/hr
=10 kg (5mcg/kg/min) 6 40 mg/ml 2
5 cc/hr
= 0.75 ml of dopamine
To order:
Dopamine drip 0.75 ml plus
49.25 D5W @ 5 cc/hr
DOBUTAMINE DRIP
Prep: 250 mg/20 ml (12.5 mg/ml)
Dose: 3-30 mcg/kg/min
Formula:
Amt/dose to = wt (dose) (K) prep 2 (to make 50 ml prep)
incorporate running dose
eg: 10 kg child, dobutamine @ 5 mcg/kg/min @ 5 cc/hr
=10 kg (5mcg/kg/min) (6) 12.5 mg/ml 2
5 cc/hr
= 2.4 ml of dobutamine
To order:
Dobutamine 2.4 ml plus 47.6 ml D5W @ 5 cc/hr
To check:
(dose) X = prep x running rate x amt/dose incorporated x 2
Weight x 6
I
II
III
DHF GRADING
I
LYMPHADENOPATHY
1 cm
cervical & axillary LN
1.5 cm
inguinal LN
SPECIFIC GRAVITY
1.005- 1.020
rehydration is not enough
Adolescence 10-18 females
12-20 males
Childhood 2-12 years old
Infant to 2 years old
URINE OUTPUT
(1 cc/kg/hr)
Pedia: 1-3 cc/kg
Adult: 3 cc/kg/hr
ANEMIA
Hgb
10-12 g/dl = mild
8-10 g/dl = moderate
<8 g/dl = severe
CRYSTALLOIDS:
PLR
PNSS
D5 H2O
D5 0.3 NaCl
COLLOIDS:
Albumin
Voluven
Hesteril
DHF STAGING
Febrile stage (1-7 days)
Afebrile stage (3-4 days)
Convolescent Stage
APGAR
(1953 Invented by Virginia Apgar)
10 assess for the need for resuscitation
50 assessment of resuscitation/prognosis of patient
*APGAR does not predict neurological damage
Pulse
Grimace
0
Blue, pale
ext & trunk
Absent
(-) response
1
Blue
ext,
pink trunk
< 100
Grimace
Activity
Limp
Respiration
absent
Some
flexion
of
extremity
Slow,
irregular
Appearance
2
Completely
pink
> 100
Cry, cough,
sneeze
Active motor
Good strong
cry
ECG
V3R Right, 5th ICS MCL
V4R - Right, 5th ICS, AAL
V7 Left, 5th ICS AL
PICCU INSTRUMENTS
1. Suction unit
2. Mechanical vent
3. Syringe pump
4. Pulse oximeter
5. Infusion pump
6. Soluset w/ microset
7. Macroset
8. Platelet set
9. Blood set
10. Billy light ( 20 W x 10 bulb x 20 inches)
11. Neovent/ infant ventilator
12. Cardiac monitor
13. IV stand
FEBRILE SEIZURE
Age: between 9 mos 5 yrs
Temp: 39 C above
Seizure: generalized, tonic-clonic
Duration: few seconds 10 min
Others: followed by postictal period of drowsiness
Rule out: meningitis by lumbar tap
Treatment: oral diazepam, 0.3 mg/kg q 8h
(1mg/kg/24hr) for 2-3 days
AMOEBIASIS
>Entamoeba histolytica (protozoan parasite)
Transmission: fecal contamination of food or hands, may also be
transmitted by anal intercourse
Pathologic feature: flask-shape ulcers in submucosa due to lytic
digestion
Diagnosis: E. histolytica in stool, tissues or aspirate, etc
Treatment: metronidazole
H. PYLORI INFECTION
- human, H2O, domestic cats & house flies (reservoir)
- ideal test:
Non invasive
Highly accurate
Inexpensive
Readily available
Endoscopy invasive
1.Biopsy & histopath
Definitive dx
Turns yellow +
Areas: antrum, body, transition zone
Drawbacks: invasive, risk of sedation
Anesthesia: absence of specialist
2.rapid urase testing for biopsy tissue
3.Bacterial culture
4. Polymerase Chain Reaction
-Non invasive
1.Immunoessay
2.Saliva & urine test
3. Stool test (monitoring eradication)
Immunoassay (ELISA)
- sensi: 60-70%
4. urea breath testing
- specificity & sensi: >95%
- difficult in smaller children
- primary goal of treatment: to dx the cause of clinical sx & not
presence of H. Pylori
- Eradication therapy
Both active H. pylori & symptomatic GI dse
Treated are:
Duodenal/gastric ulcer at endoscopy
Prior hx of duodenal or gastric ulcer
Noninvasive & invasive test +
Pathologic evidence of MALT lymphoma
Pathologically proven atrophic gastritis w/intestinal
metaplasia
OPTION 1
Amoxicillin 30 mkday up to 1 g BID for 2 wks
Clarithromycin 15 mkday 500 mg BID for 2 wks
PPI 1 mkday up to 2 mg BID for 4 wks
OPTION 2
Amoxicillin (same)
Metronidazole 20 mkday to 500 mg BID
PPI 1 mkday up to 20 mg BID
OPTION 3
Clarithromycin 2 wks
Metronidazole 2 wks
PPI 4 wks
OPTION 4
Bismuth Subsalicylate 1 tab (262 mg) QID or 15 ml (17.6
mg/ml QID)
Metronidazole
PPI
Plus add
Amox
Tetracycline (>12 yo) 50 mkday up to 1 gm BID
Clarithromycin
OPTION 5
Ranitidine 1 tab QID for 2 wks
Bismuth 1 tab QID for 2 wks
Citrate 1 tab QID for 2 wks
Clarithromycin same
Metronidazole same
Ambroxol (expel)
1-2 yrs
2-6 yrs
7-12 yrs
15 mg/5 ml
tsp BID
tsp TID
1 tsp TID/BID
2.5 5 ml OD
1-2 tsp OD
100 mg/5 ml
MFA (Medismon)
6 mos 1 yr
2-4 yrs
5-8 yrs
9-12 yrs
50 mg/5 ml
1 tsp
2 tsp
3 tsp
4 tsp
COMPLICATIONS OF PHOTOTHERAPY
(20 watts, 20 inches, 5 bulbs)
1.
DEHYDRATION
2.
BLINDNESS
3.
BRONZE BABY sun burn
BLOOD TRANSFUSION
PRBC - blood set
Desired Hct (40 or 30) actual Hct x Wt (kg)
Platelet Transfusion platelet set
1 unit platelet conc / 10 kg
PRBC - 20 cc q unit in 4 hrs (200 cc RBC; 50 cc
anticoagulants)
Platelet - 50 cc
Whole blood - 500 cc
Leukemia Pxs ANC (Absolute Neutrophil Count)
WBC x segmenters (%) x total diff ct (%)
Eg: WBC = 5000; segmenters = 50%
TDC (50%) = 1250
ADMITTING ORDERS
A admit
D diet or diagnostics
M meds
I IV
T therapeutics
Eg;
>admit under the service of.
>consent to care
>TPR w/ BP q 2
>Diet
>Problem: fever, pallor, SOB
>labs & diagnostics
>meds
Nursing orders: I & O
A.
MAINTENANCE FLUIDS
Child Weight:
Normal
Maintenance Fluid Requirements:
0 - 10 kg
100cc/kg/day
10.1 - 20 kg
50cc/kg/day
(1000cc for first
10 kg plus 50cc per kg
for each kg over
10 kg, total divided
by 24 hours)
20.1 kg and up
20cc/kg/day
(1500cc for first
20 kg plus 20cc per kg
for each kg over
20 kg, total divided
by 24 hours)
Examples:
1.
An 8.5 kg infant requires
maintenance fluids. The infant should receive
8.5 kg x 100cc = 850cc total over 24 hours.
Divide 850cc by 24 hours to calculate the
amount of fluids the infant should receive
each hour:
OR
cc = 8.5kg x
100cc
x
1
hr
kg
24 hrs.
24 hr
2.
A 15 kg child requires maintenance
fluids. The child should receive
(100cc per
OR
cc = (10kg x 100cc) (5kg x 50cc)=1000cc
250cc=1250cc x 1_ = 52cc/hr
hr
kg
24
3.
fluids.
kg
10 kg x 100cc =
10 kg x 50cc =
5 kg x 20cc =
1000cc
500cc
100cc
16
B.
24
URINE OUTPUT
300cc x 1
x
3.75 cc/kg/hr
10kg
1 =
8hr
80
HR
2 12 mos = < 160
1 2 yo
= < 120
2 8 yo
= < 110
RR
< 2 mos
= up to 60
2 mos 1yo = 50
1 5 yo
= 40
0
1
2
KILOGRAMS(Kg)
3.25
Age in months + 9
2
Age in yrs. x 2 + 8
Age in yrs. x 7 5
1-6 yrs.
7-12 yrs.
POUNDS(lbs)
7
Age in months + 11
Age in yrs. x 5 + 17
Age in yrs. x 7 +5
none
slow, irregular
regular
CROUP SCORING
0
Insp. Breath
normal
Stridor
none
1
harsh w/ rhonchi
inspiratory
2
(ABW / IBW) x 100
N = 91 100 %
1st degree = 75 90 %
2nd degree = < 60
HEIGHT
cm
inches
at birth
50
20
at 1 yo
75
30
2-12yo age(yr)x6+77 age(yr)x2.5=30
Cough
Retractions
none
none
Cyanosis
none
hoarse cry
flaring, supraSternal retracn
none
2
delayed
inspiratory
w/ exp.
bark
(1) + subc.
interc. Retracn
in 40%O2
> 6 intubate
WATERLOW CLASSIFICATION
WASTING:
____ABW_____ _ X 100 = %
IBW for actual L.
Normal
= > 90 %
Mild
= 75 90 %
Moderate = 60 74 %
Severe
= < 60 %
STUNTING:
___Actual height___ X 100 = %
Ideal Ht. for age
Normal
= > 95 %
Mild
= 90 95 %
Moderate = 85 89 %
Severe
= < 85 %
PENICILLIN
A. Aqueous PNC (PCN G Na)
RD: 100 200 T U/k/D in 3-4 divided doses
or 50 100 mg/k/D (IV)
B. Benzathine (Penadur)
RD: 600 T 1.2M U IM q 28 days
Prep: 600 T, 1.2M, 2.4M U/vial
C. Phenoxymethyl PCN
RD: q 6-8 H po
25 T 50 T U/k/D; or
15 30 mg/k/D
625 mg
250 mg/5 ml
312.5 mg/5 ml
500 mg
=
=
=
=
1MU
400 T U
500 T U
800 T U
Prep:
IMMUNIZATIONS
BCG
.05 cc ID R deltoid @ birth;
.10 cc L deltoid for school entrant
A/R : subcutaneous abscess; LAD
Ostcitis, dessiminated dse. (rare)
DPT
5 cc IM upper outer thigh
A/R : (w/in 48 hrs.) high fever, hypotonic
Collapse or shock-like state,
inconsolable
Crying for 3 hrs., convulsion with or
Without fever within 3 days; erythema
Induration, palpable nodule, sterile
abscess
OPV
2 drops
A/F : paralysis (rare)
MEASLES .5 cc SQ outer part upper arm
A/F : (w/in 713 days) fever for 12 days,
Transient thrombocytopenia
Encephalopathy, encephalitis
Allergic rxn. , anaphylaxis, convulsions
TT
.5 cc IM, 2 doses @ least 4wks. Apart
HIB
.5 cc SC/IM
A/F : pain, redness, swelling, > 24 hrs. fever
HEP. B
IM
A/F : pain, fever, allergic rxn., anaphylaxis
VARICELLA .5 ml SC
A/F : fever, rashes
APGAR
ACTIVITY (muscle tone)
0
no activity
1
some flexion
2
very active
PULSE (HR)
0
none
1
<100 bpm
2
>100 bpm
GRIMACE
0
no response
1
grimace
2
good cry
APPEARANCE (color)
0
blue
1
pink, bluish extremity
2
pink all over
RESPIRATION
Centrapen
625 mg cap
312.5 mg/5ml susp
Megapen
625 mg cap
312.5 mg/5 ml, 50 T U/ml drops
Pentacillin
500 mg cap
250 mg/5 ml susp
Sumapen
250, 500 mg cap
125, 250 mg/5 ml susp
D. Isoxazole PCN
RD: q 6H IV/PO
100 200 mg/k/D except *
Prep:
Oxacillin Na (IV)
Prostaphlin
Ampicillin, Pensyn
Pentrexyl (with 125 mg vial)
Ampedia (with 100 mg vial)
Ampicillin/Cloxacillin
(Amplicox)
(Pensyclox)
(Bisolvomox, Mucomox)
Cap:
Amox = 500 mg
Brom HCl = 8 mg
Co-Amoxiclav
(Augmentin*, Amoclav)
RD:
< 12 y.o. 25 mg/k/D q 8H po
(for severe infxn. Up to 50 mg)
Prep:
375 mg tab 9250/125)
625 mg tab (500/125) *
1 g tab (875/125) *
156.25 mg/5 ml susp TID
(125/31.25)
228.5 mg/5 ml susp * BID
(200/28.5)
457 mg/5 ml susp * BID
(400/57)
312.5 mg/5 ml susp TID
(250/62.5)
300 mg vial (250/50) *
600 mg vial (500/100)
1.2 g vial (1g/200)
*po BID dosing prep.
G. Bacampicillin
RD: 25 50 mg/k/D q 8 12 H
Prep:
Bacacil, Bacamcillin
400 mg tab
Penglobe
CEPHALOSPHORIN
FIRST GENERATION
1. Cephalexin
RD: q 6 H
50 100 mg/k/D (IV) * / PO
40 60 mg/k/D (po)
Prep:
Cefalexin, Ceporex
Forexine, Keflex
Lexum, Selzef
Selvispor
250, 500 mg cap
125, 250 mg/5 ml susp
100 mg/ml drops
125 mg/1.25 ml drops *
500 mg, 1 g vial
Cefalin
500mg q6H
2. Cefadroxil
RD: 25 50 mg/k/D q 12 H
Prep:
Duracef *, Kefidrox
500 mg cap
250 mg/5 ml susp *
50 mg/ml drops *
3. Cephalothin
RD: 80 160 mg/k/D q 4 6 H
Prep:
Keflin 1 g vial
4. Cefradine
RD: 25 50 mg/k/D q 6 8 H po
50 100 mg/k/D q 6 H * IV
Prep:
Duphratex *, Sedinef *
Velosef
Zanitrin
SECOND GENERATION
1. Cefuroxime
RD: 20 40 mg/k/D BID (po)
20 40 mg/k/D
50 100 mg/k/D q 6 8 H (IV)
Prep:
PCAP 75 150
Zinacef, Lifurox *
Zinnat
Ceclor
Mefoxin 1 g vial
5. Ceradolan
RD: 40 80 mg/k/D q 6 8 H
Severe infxn:
Up to 160 mg/k/D
Prep:
Cefotiam
200 mg tab
500 mg, 1 g vial
THIRD GENERATION
1. Cefotaxime
RD: < 12 y.o.
50 100 mg/k/D q 6 12 H
150 200 mg/k/D severe infxn
>12yo/adults
1gm BID
Prep:
Claforan, Clavacef *
Tergecef
Cedax
8. Cefdinir
RD: 14 mg/k/D OD or BID
Prep:
Omnicef
100 mg cap
50 mg/500 mg granules
125/5 syrup
250/5 (USA)
9. Cefetamet
RD: BID
< 12 y.o. 20 mg/k/D
> 12 y.o. 500 mg
Prep:
Globocef
500 mg tab
250 mg/5 ml susp
10. Cefprozil
RD: 20 30 mg/k/D BID
Prep:
Procef
FOURTH GENERATION
1. Cefepime
RD: 50 mg/k/D q 12 H IV drip
> 2 mos. , < 40 kg
100 mg/k/D q 12 H
Garamycin
20 mg/ml, 60 mg/1.5 ml
80 mg/2 ml
Servigenta 80 mg/2 ml
4. Tobramycin
RD: 6 8 mg/k/D q 6-8 H (IV)
Prep:
Nebcin 20, 80 mg/2 ml
5. Netilmycin
RD: 6 8 mg/k/D q 8 H (IV)
Prep:
Netromycin
MACROLIDES
1. Erythromycin
RD: q 6 H
30 50 mg/k/D po
20 mg/k/D (IV)
Prep:
Erymax
250 mg cap
40 mg/ml susp
Erycin
Erythrocin
400 mg/5 ml DS
500 mg vial
Ethiocin, Macrocin
Ilosone / DS
500
250
125
250
100
mg tab
mg pulvules
mg/5 ml liq
mg/5 ml DS
mg/ml drops
Servitrocin (no drops)
2. Spiramycin
RD: 2 3 tabs daily (adults only)
Prep:
Rova 3 3 MIU tab
3. Roxithromycin
RD: 5 8 mg/k/D * or
> 40 kg
150 mg tab BID
24 40 kg
100 mg tab BID
Prep:
4. Clarithromycin
RD: 15 mg/k/D BID
(max 500 BID)
Prep:
Klaricid
Dynabac, Onzayt
250 mgtab
6. Azithromycin
RD: 10 mg/k/D (for 3 D); or
10 mg/k/D in D1,
5 mg/K in D2-4
Prep:
Zithromax
250 mg cap
200 mg/5 ml susp
TETRACYCLINE
C/I : < 8 y.o.
Microbid
tab 160/800
Cap 80/400
5 ml susp 40/200
Septrin Forte
tab 160/800
Cap 80/400
5 ml susp 40/200
Triglobe Forte
tab 180/820
Tab 90/410
5 ml susp 45/180
CHLORAMPHENICOL
RD:
Prep:
1. Doxycycline
RD: 5 mg/k/D BID/QID
Prep:
2. Oxytetracycline
RD: 25 50 mg/k/D q 6 H po
Prep:
Leydoxycycline *, Terramycin
Hostacycline, Unimycin *
CLINDAMYCIN
RD:
Prep:
20 40 mg/k/D q 6 8 H (IV/IM)
10 25 mg/k/D TID/QID po
Dalacin C
LINCOMYCIN
(For PCN allergy)
RD:
QUINOLONE
1. Nalidixic acid
RD: 33 55 mg/k/D q 6H
Prep:
Wintomylon
500 mg tab
250 mg/5 ml susp
2. Ciprofloxacin
RD: 10 mg/k/D q 12 H (IV)
12 mg/k/D q 8 12 H po
Prep:
Ciprobay
Inoflox Qinolon
SULFONAMIDE
RD: BID
TMP 8 10 mg/k/D *
SMZ 40 50 mg/D
(or 1 cc/k/D; prep = 40/200)
Prep:
Cotrimoxazole
Bacidal Forte
tab 160/180
5 ml susp 80/400
Bactrim
Prep:
30 60 mg/k/D TID po
10 mg/k/D q 24 H IV
Lincocin
NITROFURANTOIN
RD: 5 7 mg/k/D q 6 H
Prep:
Macrodantin
LORACARBEF
RD: 15 30 mg/k/D q 12 H
Prep:
Lorabid
IMEPENEM / CILASTIN
RD: 60 mg/k/D q 6 H
Prep:
Tienam (500/500) 1 g vial
VANCOMYCIN
RD: 40 60 mg/k/D q 6 -12 H
Prep:
500 mg vial
MEROPENEM
RD: 60 120 mg/k/D q 8 H
Prep:
Meronem 500 mg, 1 g vial
5 ml susp 45/205
ANTI - TUBERCULOSIS
Globec
tab 80/820
5 ml susp 45/205
Globaxol
cap 80/400
5 ml susp 40/200
Lipadrim Forte
tab 160/800
5 ml susp 40/200
1. INH
RD: OD/BID
Px : 10 mg/k/D
Tx : 10 20 mg/k/D
Adults : 5 mg/k/D max 300 mg
Prep:
Nicetal Forte tab 400 mg
100 mg/5 ml susp
Odinah
tab 400 mg
150 mg/5 ml susp
* Comprilex
200 mg/5 ml susp
Trisofort
tab 400 mg
200 mg/5 ml liq
Trisovit
tab 100 mg
50 mg/5 ml liq
2 kit : Curazid 200/5
2. Ethambutol
RD: OD
< 12 y.o. : 10 15 mg/k/D
> 12 y.o. : 15 25 mg/k/D
Max 2500 mg/D
Prep:
Ebutol
Ethambin INH
Ethamizid
* Rimactane Forte
Rifadin
4. PZA
RD: 15 40 mg/k/D OD/BID
(max 2 g/D)
2 cure = kidz kit 250/5
Prep:
PZA-Ciba
500 mg tab
250 mg/5 ml susp
5. Streptomycin
RD: 20 30 mg/K/D OD IM - ototoxic
Furamide
Fasigyn
FOR AGE
1. Furazolidone
RD: 5 7 mg/k/D QID
Prep:
Furoxone
100 mg tab
16.7 mg/5 ml liq
Diafuran, F-Zolidone
100 mg tab
50 mg/5 ml susp
2. Nifuroxazide
RD: < 6 mos. 1 tsp BID
> 6 mos. 1 tsp TID
Adult
- cap QID
Prep:
Ercefuryl
200 mg cap
220 mg/5 ml susp
3. Infloran Berna
1 cap TID
ANTI HELMINTHICS
1. Piperazine citrate
RD: 75 100 mg/k OD x 2 days
Prep:
Tabeel
Combantrin
Quantrel
Antiox
ANTI AMOEBICS
1. Metronidazole
RD: 40 50 mg/k/D TID or q 8 H (IV/PO)
IV drip = 7.5 mg/k/D q 8 H
Prep:
TMZ
Anaerobia
Flagentyl
500 mg tab
500 mg/15 ml susp
25 mg/20 ml susp
3. Etofamide
RD: 15 20 mg/k/D TID for 3D
Prep:
Kinox
ANTI - FUNGAL
1. Nystatin
RD: infant : 2 ml QID
Adult / children :
4 6 ml QID
1 2 tab TID
Prep:
Mycostatin
500 T U tab
100 T U/ml susp
2. Amphotericin B
RD: 250 ug/k with grad. inc. to
total 1 1.5 mg/k/D
Prep:
Fungizone
50 mg/10 ml vial
3. Griseofulvin
RD: 10 mg/k/D
4. Fluconazole
RD: Px : 3 mg/k/D OD x 1 wk.
Tx : 6 mg/k/D OD
Prep:
Diflucan
RD: OD
> 40 kg
20 40 mg
< 20 mg
Prep:
250 mg
125 mg
62.5 mg
Lamisil
250 mg tab
6. Ketoconazole
RD: OD
> 30 kg
200 mg
15 30 mg
100 mg
< 15 mg
5 mg/day
Prep:
Nizoral
200 mg tab
ANTI VIRAL
1. Methisoprinol
RD: 50 100 mg/k/D TID or QID
Prep:
Isopronosine
500 mg tab
250 mg/5 ml syr
2. Amantadine
RD: 5 8 mg/k/D BID
(max 150 mg/D)
Adult 200 mg/D
Prep:
Symmetrel
100 mg tab
50 mg/5 ml syr
3. Acyclovir
RD: 20 mg/k/D q 4 H
(5x/D, miss mn dose)
Prep:
Zovirax
Immunosin
500 mg tab
250 mg/5ml syr
MUCOLYTICS
1. Carbicisteine
RD: 20 30 mg/k/D TID/QID
Prep:
Loviscol
500 mg cap
100, 250 mg/5 ml syr
50 mg/ml drops
2. Ambroxol
RD: 1.2 1.6 mg/k/D q 12 H
Prep:
Ambrolex *, Salvotran
Mucosolvan **
30 mg tab
15, 30 mg/5 ml syr
7.5 mg/ml drops *
6 mg/ml drops **
Inhalation soln 15 mg/2 ml **
15 mg/2 ml amp **
ANTI HISTAMINE
1. Diphenhydramine
RD: 5 mg/k/D q 6 H
1 2 mg/k/D q 6 H
Prep:
Benadryl
25.5 mg cap
125 mg/5 ml syr
50 mg/ml amp
2. Chlorpheniramine
RD: 0.35 mg/k/D q 6 H
Prep:
Cohistan 4 mg tab
2 mg/5 ml syr
Histacort (2 mg C - 2mg Prednisone)
> 12 y.o.
1 2 tab or 2 tsp
7 12 y.o tab or 1 tsp
2 6 y.o.
tsp TID/QID
3. Loratadine
RD: 0.16 mg/k/D OD or
1 2 y.o. 2.5 ml
2 12 y.o., < 30 kg
5 ml
> 30 kg
10 ml
Adult
1 tab or 10 ml
Prep:
Claitin, Loradex
10 mg tab
5 mg/5 ml syr
4. Astemizole
RD: OD
< 6 y.o.
2 mg/10 kg
6 12 y.o.
tab, 5 ml
> 12 y.o.
1 tab
Prep:
Hismanal
10 mg tab
1 mg/ml susp
5. Clemastine
RD: 0.05 mg/k/D q 12 H
Prep:
Tavegyl
1 mg tab
.5 mg/5 ml syr
Tavist
1 mg tab
.5 mg/5 ml syr
6. Cetirizine
RD: 0.25 mg/k/D OD or
Adult, > 12 y.o. 1 tab OD
6 12 y.o.
tab BID or 1 tab OD
or 10 drops BID or 10 ml
OD or 5 ml BID
Prep:
Virlix, Zyrtec *
10 mg/ml drops
10 mg tab
1 mg/ml soln *
Anerkid 2.5 mg/ml
Atnix 2.5 mg/ml
7. Hydroxyzine
RD: 1 mg/k/D OD or
1 5 y.o.
5 10 mg
6 10 y.o.
20 30 mg
Adults
25 50 mg
Prep:
Iterax
10, 25 mg tab
2 mg/ml syr
DECONGESTANT
1. Loratadine / Pseudoephedrine
RD: BID
> 12 y.o.
1 tab
> 30 kg
5 ml
< 30 kg
2.5 ml
Prep:
Clarinase tab 5/120
Syr 5 60/5 ml
2. Brompheniramine / Phenylephrine
Phenylpropanolamine
Prep:
Dimetapp TID/QID
Syrup
4 12 y.o.
1 tsp
2 3 y.o
tsp
Drops
7 24 mos.
1 ml
1 6 mos.
.5 ml
ANTI ASTHMATICS
1. Epinephrine
RD: 0.1 0.2 cc/kg/D
1 : 10,000 - 1 cc/k/D SQ/IVTT
1 : 1,00
- 0.01 cc/k/D SQ
2. Terbutaline
RD: .005 mg/k/D rpt prn after
20 min. SQ (onset 30 min)
.075 * - .1 mg/k/D TID po
(onset 2 3 min)
(wt x .25 = cc)
Prep:
2 mg tab
2 mg/5 ml syr
2.5 mg/2.5 ml, 5 mg/2.5 ml neb
4. Aminophylline
RD: children
LD 5 10 mg/k
MD 3 5 mg/k/D q 8 H
Slow IVTT in 20 min
Apnea of prematurity:
LD 5 6 mg/k
MD 2 mg/k/D
Drip : .4 - .9 mg/k/H
Eg: 5kg @ .4 mg/k/H in 8 H
If IVF rate is 5cc/H, fill
Soluset w/ 40cc IVF +
Amino 16 mg (.64 ml)
Prep:
25 mg/ml amp
5. Bambuterol
RD: not for < 2 y.o. , OD
A : 10 mg
B : 5 mg
Prep:
Bambec 10 mg tab, 1 mg/ml soln
6. Theophylline
RD: 3 5 mg/k/D q 6 H po
Prep:
Brondil 130 mg tab
25 mg/5 ml elixir
Nuelin 125 mg tab
175 mg SR tab
80 mg/15 ml syr
7. Ketotifen
RD: BID
> 3 y.o. / A
1 mg
6 mos 3 y.o. 1 drop or .1 mg/k/D
Prep:
mg tab
mg SRO tab
mg/5 ml syr
mg/ml drops
ANTIPYRETICS / ANALGESICS
1. Paracetamol
RD: 10 15 mg/k/D q 4 H
Prep:
100mg/ml (drops)
120mg/5ml or 250mg/5ml (syr)
500mg tab
Calpol ,Tempra, Biogesic
2. Ibuprofen / Paracetamol
RD: 5 10 mg/k/D q 6-8 H
Prep:
Dolan FR 100mg/5ml, 200/5 (syr)
3. Aspirin
RD: 10 20 mg/k/D
(Gr 1 = 65 mg)
Prep:
Aspilet
80 mg tab
Cor 30
30 mg tab
Ascriptin 325 mg tab
(w/ Al(OH)3, Mg(OH)2)
For:
RF
: 65 130 mg/k/D
Arthritis
: 40 60 mg/k/D
KD
: 80 100 mg/k/D (febrile stage)
3 5 mg/k/D (afebrile stage)
4. Indomethacin
RD:
fever
: 1 mg/k/D TID
anti - inflam. : 2 4 mg/k/D TID
PDA closure : .2 - .3 mg/k/D
q12 24 H x 3 doses
Prep:
Indocid 25 mg cap
Infree
100 mg cap
5. Mefenamic Acid
RD: 3 5 mg/k/D
5 8 mg/k/D q 6 8 H
PDA closure : 2 mg/k/D q 8 H x 3 doses
Prep:
Ponstan / SF
NARCOTIC ANALGESIC
1. Meperidine
RD: I/C
.8 1.3 mg/k/D q 3 4 H (IM / SC)
1 2 mg/k/D q 2 H (IV)
adult : 50 -150 mg q 3 4 H
Prep:
Demerol 50 mg vial
100 mg/2 ml
2. Nalbuphine
RD: SC, IM, IV q 3 6 H prn
C : .1 - .2 mg/k/D
A : .15 - .2 mg/k/D
Max : 10 mg
Prep:
Nubain 10 mg/ml amp
3. Morphine
RD: .1 - .2 mg/k/D q 2 4 H
(IM / SC / IV)
.01 - .1 mg/k/H cont. infu.
Prep:
16 mg/ml amp
(add 15 ml dose H2O to make 1 mg/ml prep.)
4. Fentanyl
RD: for analgesia
.5 2 ug/k/dose q 1 2 H IV
for anesthesia
N 10 ug/k/D
I
15 50 ug/k/D
C 50 100 ug/k/D
Prep:
Sublimaze .05 mg/2 ml
10 ml amp
Other drugs for Sedation
1. Midazolam
RD: 0.1 mg/k/D
Prep:
Dormicum
15 mg tab
5 mg/ml, 5 mg/5 ml
15 mg/3 ml amp
2. Ketamine
RD: 1 2 mg/k/D (IM)
0.5 1.5 mg/k/D (IV)
6 10 mg/k/D (po)
Prep:
Ketalar 50 mg/ml inj
ANTACIDS
1. Cimetidine
RD: q 4 6 H (pc meals)
N
10 15 mg/k/D
< 1 y.o.
20 mg/k/D
1 12 y.o. 20 40 mg/k/D
A
200 mg BID po
(max 800 mg q HS)
200 mg q 4 6 H IV
Prep:
Tagamet
H2Bloc, Pepcidine
20, 40 mg tab
20 mg/2 ml amp
3. Sucralfate
RD: QID (1 H ac meals, HS)
C : < 6 y.o. .5 g/D
> 6 y.o. 1 g/D
A : 1 g/D
Prep:
Iselpin 500 mg, 1 g
4. Omeprazole
RD: OD
C : .5 mg/k/D
A : 20 40 mg
Prep:
Losec 10, 20 mg cap
40 mg/10 ml inj
5. Ranitidine
RD:
C:
1.5 mg/k/D q 6 H (IV)
2 mg/k/D q 6 8 H (po)
A:
50 mg q 6 8 H (IV)
150 mg q 8 12 H (po)
Prep:
Pylorid 400 mg tab
Mucaine, Novaluzid
Simeco, Mylanta
Tab, susp
ANTISPASMODICS
1. Hyosine
RD:
PO A / > 6 y.o.
1 2 tabs 3 5x / D
10 20 ml 3 5x / D
< 5 y.o.
5 10 ml TID
Infant
5 ml TID
IV / IM / SC
A : 1 2 amp
(max 100 mg/D)
C : amp TID
Prep:
Buscopan (plus w/ para)
10 mg tab
5 mg/5 ml liq
20 mg amp
Spasmolysin
10 mg tab
20 mg/ml amp
2. Dicycloverine / Dicyclomine
RD: 15 min. ac meals : TID / QID
Not for 6 mos.
C : 2 12 y.o.
10 mg
6 mos 2 y.o. 5 10 mg or
.5 1 ml drops
< 6 mos.
3 mg/k/D
Prep:
Bentyl *, Relestal **
10 mg tab *
10 mg/5 ml syr
5 mg/ml drops **
C : 15 20 ml/10 kg/
Prep:
Molitium 10 mg tab
1 mg/ml susp
EMERGENCY MEDICINES
Atropine
0.02 0.03 Mkd
Naloxone
0.1 Mkd
Plain
0.4 / 1
Neonatal
0.02 / 1
Captopril
0.3 1 Mkd q 12 H
Capoten
25 mg tab
L-Carnitine
30 40 Mkd
Carnicor
po 1 g / 10; 330
IV 1 g / 5
Hydralazine
0.1 0.5 Mkd
Apresoline
IV 20 / amp;
Tab 10, 25
Lidocaine
1 Mkd bolus
10 50 ugKm
Adenocard initial
6 mg then 12 mg
Adenosine 6/2
10% Ca Gluconate 0.1 0.2 Mkd
Mannitol 20%
0.25 0.5 Mkd
NaHCO3
1.5 2 Mkd
Prep 1.2% soln
(1 med/ml)
DOPAMINE
RD: 1 5 ug/k/min = VD, inc renal
and splanchic circ.
5 10 ug/k/min = inc cardiac
contractions w/o effect on HR
10 20 ug/k/min = inc BP
Rule of 6 (Docard 40 mg/ml)
Wt. x 6 = mg of Dopa to make 100cc
Mg div. 40 = ml of Docard + D5W
Rate = dose (1cc/H = 1 ug/k/min)
Pre mixed (200 mg/250 ml)
Rate (cc/H) = wt. x dose
13.3
3 mg/k + 50 ml D5W or
15 mg/k + 250 ml D5W
Ug/k/min = cc/hr
15 mg/k + 50 ml
Ug/k/min = 5 x cc/hr
DOBUTAMINE
RD: 2 20 ug/k/min
Prep: 250 mg/20 ml inj
> to make soln for desired rate and
Conc. same with Dopa
DIURETICS
Furosemide
1 2 MKD
20/2; 40
20/2; 20; 40
Diazoxide
5 10 MKD 300/2
Acerazolamide
20 30 MKD
Diamox
250/tab
Spironolactone
1.5 3 MKD
Aldactone
25/tab
Hydrochlorothiazide 1 2 MKD
Dichlotride
25, 50/tab
Mannitol 20%
1.5 2g/k/D or 5 cc/k/D
200 g/L 1 g = 5 cc 0.5 1 g/k/D
Lasix
Frusema
ANTICONVULSANTS
Diazepam
0.2 0.4 Mkd (max 2 5 mg)
Valium 10/2 ; Trazopam 10/2
Phenobarbital LD 15 20 Mk
MD 5 MkD q 8 H
Luminal
IV 130/1
Po 20/5
(Gr 1 = 65 mg)
Gr 1, ,
Carbamazepine
10 20 MKD
Tegretol
100/5; 200
Phenytoin
LD 15 20 MK
MD 5 8 MkD
Dilantin
IV 100/2
Po 30/5, 125/5, 30, 100
Clonazepam
0.01 0.03 MKD
For Bael
LD 0.03 MK
MD 0.08 MKD q 12 H
Rivotril
2/tab
Valproic acid
15 MKD
Depakene
250/5
Epival
250/ta
Lorazepam
0.05 0.1 MKD
(max 0.4 MK)
Midazolam (Dormicum)
0.1 0.2 MKD
DIAZEPAM DRIP
0.3 MKH dilute in NSS to make 0.1 mg/ml
RESPIRATORY ALKALOSIS
Acute : 2 2.5 mEq/L dec HCO3 for
Every 10 mmHg dec pCO2
Chronic : 4 5 mmHg dec HCO3 for
Every 10 mmHg dec pCO2
FLUIDS AND ELECTROLYTES
LUMBAR TAP
Pressure (in cm H2O)
G 22 (1 & ) = gtts in 21 sec
G22 (3 & ) = gtss in 39 sec
G20 (3 & ) = gtss in 12 sec
IMB
NM
NSS
LR
.3 Na
.45Na
Hytone, Eczacort
Elica
Clobetasole Propionate
Dermovate
Kenacort A, Ladecort A
BLOOD TRANSFUSION
FWB in 6 H
= (des act Hct) x wt.
= (des act Hb) x wt. x 2 x 3
= 20 cc/kg
pRBC in 4-6 H
= (des act Hct) x ractions
= (des act Hct) x P (VC)
= (des act Hb) x 2 X wt.
= 10 cc/kg
Plt conc in MFD
= 1 U / 6 KBW
1 U = 30 50 cc will raise plt by 10T
Plt rich plasma in 4 H
Actual Retic ct. (ARC) :
Actual Hct
x retic ct.
Desired HCt
Retic Index :
ARC
or
Hct
x 2
2
retic
> 2 hemolysis
< 2 RBC suppression
Double Vol. Exchange transfusion :
= KBW x est. body vol. x 2
Partial Exchange Transfusion
= KBW x est. vol. x (A-D Hct)
Actual Hct
A B G NORMAL VALUES
pH
= 7.35 - 7.45 = 7.4
pCO2
= 35 45
= 40
HCO3
= 22 26
= 24
O2
= 80 100 %
METABOLIC ACIDOSIS (HCO3)
pCO2 = 1.5 (HCO3) + 8 + 2
METABOLIC ALKALOSIS
0.6 0.7 mmHg inc. pCO2 for
Na K
Cl HCO3
25 20 22
23
40 13 40
16
154 154
130 4 109
28
51
51
77
77
Ca
3
3
3
-
PO4
3
3
3
-
Types of IV Fluids :
1. HYPO - D5W, D5NM, D50, .3 NaCl, D5 IMB
Isolyte, D5 maintesol
2. ISO
- D5LR, D5NSS, D5NK, LR, NSS
3. HYPER D50W, D10W
IVF OF CHOICE :
LBM
D5LR
Vomiting
D5 NSS
Maintenance
D5 NM
BA
D50 .3 NaCl fever
& Sweating
D50 .3 NaCl / D5W
Drowning
D5W
Ascitis
D5W / D10W
CHF
D5 NSS
HPN
D5W / D5LR watch BP
Heart stroke
D5NSS
Burns
D5LR
Azotemia
D5W
Inc Burn
D10W
Bleeding
D5LR
UTI
D5NSS
Profuse Bleeding
D5LR
DF
D5 0.3% NaCl
DM
PNSS
MAINTENANCE FLUID
=(BCE) (wt.) (1.5 ml/k)
NB
45 50 cal/k/D
3 10 m
60 80
10 15 m
45 65
15 25 m
40 45
25 35 m
35 40
34 60 m
30 35
> 60 m
25 30
< 10 kg : 100 cc/k/D
> 10 kg : 50 cc/k in excess of 10 k + 1000
> 20 kg : 20 cc/k in excess of 20 k + 1500
= + 12% for q degree rise in temp (fever)
= + 15% for hyperventilation/dyspnea
= + 50% for BA
= + 20% for photo tx
Renal px : SA x 400 + UO in 24 H
Cardiac px : SA x 800
Surface area :
0 5 kg
=
6 10 kg =
10 15 kg =
15 20 kg =
wt.
wt.
wt.
wt.
x
x
x
x
.05
.04
.03
.02
+ .05
+ .10
+ .20
+ .40
FLUID PLAN
> w/o electrolytes
Deficit :
Na
K
Cl/k
Mild
4
3
3
Mod
8
6
6
Severe 12
9
9
Maintenance :
3
2
2
> w/ electrolytes
Deficit : (desired actual) x wt. x .6
Maintenance :
3 mEq/k for Na
2 m Eq/k for K
60 x 24 x wt.
IV rate x conc.
wt. x 60
OR
Concentration (Dextrosity)
D5 = 50 mg
D10 = 100 mg
D7.7 = 75 mg
D50 = 500 mg
Preparation of desired Dextrosity:
Desired conc. present conc.
x 2
100
= product X total volume needed
Eg. D10 D5 x 2 = 1
100
If total vol. needed is 100cc :
100 cc x .1 = 10 cc D50 W +
90 cc D5 IVF to make a
100 cc of D10 IVF
DEHYDRTION (CDD)
Pediatrics
None
vol/vol replacement
< 1 y.o.
50 100 cc/LBM
> 2 y.o.
100 200 cc/LBM
Some : 75 ml x wt(kg) for 4 H
Assess q 4 H; IV = 8 H
Severe :
< 1 y.o.
> 1 y.o.
Kg x 30
1 hr.
30 min.
Kg x 70
5 hrs.
2.5 hrs.
Adults:
Mild
Moderate
Severe
Kg x 30 (50) kg x 60 (100) kg x 90 (150)
In 8 hrs.
in 1st hr.
1/3 in 1st hr.
in 7 H
2/3 in 7 H
Computed deficit / 4 = gtts/min
1 macrodrop = 4 udrop
MALCOLM HOLIDAY
Mild
Moderate
Severe
< 2 y.o. 50
100
150
> 2 y.o. 30
60
90
(1/4 tab in 1st H, in 7 H)
Hydrite
Glucost
Oresol
Glucolyte
ORS
90
Pedialyte
90
Pedialyte
45
Hydrite 90
80
90
20
45
20
20
80
30
(gluc 20)
(citrate 30)
80
dext 25
(citrate 30)
35
dext 20
30
gluc 111
CA
O2
ET size
STAGES OF DHF
I. Febrile
II. Afebrile
III. Convalescent
Grading of Fever
I. fever w/ no specific constitutional s/sx
(+) Tourniquet test
II. (+) Spont. Bleeding of skin
III. Circulatory failure manifestations:
- rapid & weak pulse, narrow pulse pressure/
hypotension w/ presence of cold clammy
extremities
IV. Profound Shock w/ undetectable blood
pressure and pulse
DAY 1 5 = PETECHIAE, FEVER
DAY 5 7 = BLEEDING
DAY 8
= SHOCK
DEVELOPMENTAL MILESTONES
Gross Motor :
Mos
Head steady in sitting
Pull to sit, no head lag
Hands together in midline
Asymmetric tonic neck
Neck reflex gone
Sits w/o support
Rolls back to stomach
Walks alone
Runs
Fine Motor :
Grasps rattle
Reaches for object
Palmar grasp gone
Transfers obj. hand to hand
Thumb finger grasp
Turn pages of a book
Scribbles
Builds tower of 2 cubes
Builds tower of 6 cubes
2
3
3
4
6
6.5
12
16
Mos
3.5
4
4
5.5
8
12
13
15
22
CLASSICAL FEVER
DIGITALIZATION
TDD : 0.04 = 0.06 Mk
1st dose : of TDD
2nd dose : of TDD (8 H)
3rd dose : of TDD (6 H)
2 H after, start MD of TDD OD
of TDD BID
Adult : TDD 0.5 1.5 MkD
MD 0.125 0.25 Md
1.5
6
7
7
10
12
15
18
19
Cognitive :
Stares momentarily at spot where
object disapperead
Stares at own hand
Bangs 2 cubes
Uncovers toys
Egocentric pretend play
Uses stict to reach toy
Pretend play w/ doll
2
4
8
8
12
17
17