CSF ANALYSIS

Acute
bacterial
TB/fungal
Viral

Glucose

CHON

> 1000
99% PMN
25-5000
1000 lymph
25-5000
rarely
>1000 lym

< 10

100-500

10-25
mg/dL
N

Mod
50-100
mg/dL

Bacterial Meningitis
Neonatal
Ampicillin 150-200 mkd
+ Gentamycin 5-8 mkd
or Amikacin 50 mkd x 2 wks
Infancy ( 3mos-3 yrs)
AMpicillin 200-400 mkd
Chloramphenicol 100 mkd
X 2 wks

GLUC = CSF Gluc / HGT = ___

CSF Protein
NB
Child
Adolescent

NEONATAL
HYPERBILIRUBINEMIA

CNS DISEASES

Cells

45-100 mg/dL
10-20 mg/dL
15-30 mg/dL

Conditions associated w/ CSF glucose:

Leukemia
Sarcoidosis
SAH
Herpes
Mumps
Lymphocytic chorioretinitis

SEIZURE
Clonic jerking
Chaotic movement
weary, not sensitive
not stopped
associated with upward
rolling of eyeballs,
cyanosis
JITTERINESS
With passive flexion
To and fro; tremor
Stimulus sensitive
Will stop
Not associated with other
findings
BRONCHIAL ASTHMA
Hyperinflation/ use of
accessory muscles
Impaired expansion and
decreased fremitus
Hyperresonant/low diaphragm
Long expiration with wheezes

Children (>3 yrs)

Penicillin 20-400T u/kg/day
+ Chlramphenicol 400 mkd
x 2 wks
TB Meningitis
INH 10-20 mkd x 12-18 mos
Rif 15-20 mkd x 6-9 mos
PZA 20-30 mkd x 2-3 mos

TB

0.2-1

B1
B2

0.2 0.8
0.-0.2

5.1-17
umol/L
3.4 12
1.7-5.1

Birth Cord Bilirubin:

PT = 2.98 + 1.4 mg/dL
FT = 2.69 + 1.4 mg/dL
Visible Jaundice
7 mg/dL
bili accumulating
outside the vasc space

KRAMERS CLASSIFICATION
OF JAUNDICE

JAUNDICE
Onset
Inc in
total
Serum bili
Total
serum bili
Direct
serum bili
Duration
Time
Peak
Etiology
Mortality

Physiologic

Pathologic

3-4 days PT
4-7 days FT
Upto 5
mg/gL/day

24 hrs

15 PT
12.5 FT
1.5-2 mg/dL
FT/PT
2 wks PT
1 wk FT
Late Onset
> 5 days
> 7 days
20 days
S. pneu
S. aureus
Pseudomonas
20%

> 15
> 12.5
> 2mg/dL

>5
mg/dL/day

Early onset
< 5 days
20 hrs
H. influ
E. coli
Klebsiella
10-50%

Zone

Jaundice

Serum
Level

1
2
3

Head & Neck

Upper trunk
Lower trunk,
thigh
Arms and legs
Palms and soles

6-8
9-12
12-16

4
5

15-18
> 15

CAUSES OF JAUNDICE
1. dec. lifespan of RBC
2. Inc. enterohepatic circulation of
UCB
3. dec. glucoronyl transefease
4. immaturity of liver
5. breastmilk intolerance
6. metabolic disease
7. hematoma
8. polycythemia

PHOTOTHERAPHY &
EXCHANGE TRANSFUSION
Category

Photo
Exchange
PRETERM
< 1250
5-7
10-13
1250-1499
7-10
13-16
1500-1999
10-12
16-18
2000-2495 12-14
18-20
HEALTHY TERM
< 24 hrs
25-48 hrs
> 15
> 20
49-72 hrs
> 18
> 25
> 72 hrs
> 20
> 25
SICK TERM
< 24 hrs
10-14
20
> 24 hrs
15
20

Management of Jaundice
If B1 > 20 mg/dL -> Double volume
Exchange transfusion ( 160- 180
cc/day)
If bili is not rising rapidly :
a. Phenobarbital
Inc glucoronyl
transferase for
conjugation
Inc devt of
transport CHON
Mother : 30-60 mkd
2-3 wks prior t
delivery
Infants : after birth,
5 mkd
b. Phototherapy
photoisomerization
photooxidation

CONTROL OF DIARRHEAL
DISEASES
Treatment Plan A
Treat at home
Give more fluids
Give plenty of fod
Take child to health worker
Amount of ORS to give per BM
<24 mos -> 50-100 ml
2-10 yrs
-> 100-200 ml
10 and up -> as much as
wanted
Treatment Plan B
Treat dehydration
Amount of ORS to give 75 cc/kg/BW to
be given in 4 hours
Treatment Plan C
Treat severe dehydration
Start IVF immediately
100 ml/kg PLRS or PNSS
Age
1st 30 ml/kg
Then 70
ml/kg
<12 mos
1 hr
5 hrs
>1 yr
30 min
2.5 hrs

CONTROL OF DIARRHEAL
DISEASES

STAGES OF KERNICTERUS
1. initially hypotonia,
lethargy, nable to suck,
loss of moro reflex
2. spastic with
opisthotonus, seizure
frequent with accomp.
Fever
3. spasticity decreased
4. late sequelae

CONTROL OF DIARRHEAL
DISEASES
NO signs of Dehydration
Well, alert
Normal eyes
Tears present
Dry mouth and tongue
Drinks normally, not thirsty
Skin goes back quickly
TX Plan A
Some Dehydration
At least 2 or more signs
including at least 1 * sign
*restless, rritale
sunken eyes
absent tears
dry mouth and tongue
*thirsty, drinks eagerly
skin goes back slowly
Tx Plan B

Cholera
Tetracycline 500 mg QID x 5 days
Or Chloramphenicol, ampicillin,
Cotrimoxazole
Shigellosis
Ampicillin
Child : 50- 100 mkd
Adult:2g/kg in div doses x 5days
TM/SM ( if resistant to
ampicillin)
Child : TM 8 mkd
SM 40 mkd
Adult : 2 reg strength 2x OD x
5 days
Amoebiasis
Metronidazole
Child : 30-50 mkd
Adult : 750 mg PO or IV TID x
5-10 days

URINE OUTPUT
Normal
CONTROL OF DIARRHEAL
DISEASES
Severe Dehydration
At least 2 or more signs
including at least 1 * sign
lethargic, unconscious,
floppy
very dry and sunken eyes
absent tears
*very dry mouth and tongue
*drinks poorly or is not able
to drink
Tx Plan C

NB = 1-2 cc/kg/hr
Child = 20 cc/kg/day
Older = 15 cc/kg/day
Normal # of Urinations/day
1-2 days old = 2-6x
3 days old = 5-13 x
1 y/o = 8-14x

DIARRHEA
BLOOD PRESSURE
Persistent
Diarrhea

->

Prolonged

->

Protracted

->

Recurrent

->

Chronic

->

Of infectious
etiology lasting 2
wks
Any episode that
lasts for > 7 days
Passage of 4 or
more loose
stools/day for 2
wks with wt loss
or reduced wt
gain
Occurs
frequently at
least 1/mo for a
period of 3 mos
Lasts for 2 wks

CONTROL OF DIARRHEAL
DISEASES
treatment Plan C (cont)
per NGT 20 cc/kg for 6 hours,
reassess q1 2
or > 100 g
30 cc/kg <- 1st hr
40 cc/kg <- 2-4 hrs
40 cc/kg <- 4-8 hrs
FLUID CHALLENGE

< 10 mmHg
10 and up

BIOCHEMISTRY
Normal Values
TOTAL CHON
Albumin
Globulin
A/S ratio
BUN
CREA
AGE
< 4 yrs
5-8 yrs
9-12 yrs
Adolescents

Mean Sys
72 + 0.6
81.66 +0.6
87.3 + 0.8
88.2 + 1.2
87.47 + 1.8
87.37 + 1.2
93.9 + 1.2
93.84 + 1.2
96.56 + 1
98.5 + 1.2
97 + 1.2
98.95 + 2.2
98.8 + 2.6
101.55 + 1.8
106.05 + 3
108 + 1.2
114.05 + 1.8

Mean Dias

5.4 + 0.5
63.1 + 0.6
55.5 + 1.2
56.45 + 1.4
59.8 + 0.8
60.05 + 0.8
61.55 + 1
60.05 + 1
57.3 + 0.4
61.5 + 0.8
74.4 + 2.8
67.65 + 1.8
65.7 + 1
71.5 + 0.6
86.85 + 1.6

FLUID
10 ml/kg or 200
ml over 10 mins
5 ml/kg or 100 ml
over 10 mins
3 ml/kg or 50 ml
over 10 mins

60-70
40-55
15-34
2:1
3-7.2 mol/dL
20.7 176.7
mol/dL
< 65 mmHg
< 75
< 85
< 95

Present Temp- 37.5 = ___ x 10 x wt

= _____
BSA x 1500 + _____ / 24 = ______
Amikacin ( aminoglycoside)
50, 250 mg/ml
DOSE : (15-22.5 mg/kg/24 hr )
q8 IV/IM
Adults : 15 mg/kg/24 hr
Q8-12
Aminophylline ( Bronchodilator,
MethylSo4)
25 mg/mL
Loading dose : 5-6 mg/kg/IV NPO
Maintenance dose : 1-2 mg/kg/dose q6-8
IV Loading : 6 mg/kg/IV over 20 min
Amoxicillin
50 mg/ml & 125 ; 250mg/5 ml; 200,
400mg/ 5 ml
DOSE : 25-50 mkd
BID TID

URINARY TRACT INFECTION

Criteria for Significant Bacteremia
100,000 CFU = UTI
10,000 CFU = s/sx
10,000 CFU non coliform/ml
1000 CFU + s/sx = bacteriuria (male)
100 CFU = catheterized
10,000 CFU + s/sx in 2 consecutive
occasions
SEPSIS
Definite :
(+) blood culture
(+) urine culture
(+) CSF culture
Highly probable :
(+) bacterial Ag in bloodCSF, urine ELISA

For Pxs in Shock

CVP
< 6 mmHg

Age
0-1
2-11
1 yr
2
3
4
5
6
7
8
9
10
11
12
13
14
15

ASPIRIN
80-100 mg/kg/day q6-8

Probable:
Inc. ESR
Inc. CRP
Inc. serum IgG
Thrombocytopenia < 100000 cells/mm3
Possible
Pulmonary infiltrates in CXR
Inc CRP
Inc ESR on 3rd day of antibiotic tx

Immunoglobulin Infusion (IVIg)

Dose : 2 g/kg/dose to run for 12 hrs
How to order :
Start IVIg
Test Dose : Reconstitute 2.5 gm
IVIg in 50 ml diluent through
infusion pump at 0.5 m/kg/kr x 2
hrs
1 cc/k/hr x 1 hrs
2 cc/k/hr x 1 hr then infuse
the remaining for 8 hrs

Amoxicillin- Clavulanic Acid

( augmentin)
Aminopenicillin W/ Bet Lacta Inhibit
TID
156.25 mg/5ml (125 mg)
312.25 mg/5 ml (250 mg)
BID
228.5 mg/5 ml (200)
457 mg/5ml (410)
DOSE
> 3 mos : 20-40 kd 25-45 mkd
< 3 mos : 30 mg/kg/24
BID PO
Ampicillin
IV : 125, 250, 500 mg; 1,2, 10 g
Neonate (< 7 days) : > 2 kg 75150 mg/kg/24 q8 hrs
>7 days : > 2 kg 100-200
mg/kg/d q6
INF & Child : 100-200 mkd q6

Ampicillin/ Sulbactam (Unasyn)

Injxn : 1.5 g 0.3 g
Infant =/> 1 mo : 100-150 mkd q6
Child 100-200 mkd
6
Aspirin
80 mg, 325 mg, 500 mg
Analgesic/antipyretic : 10-15 kdose
q6
Anti inflammatory : 60-100 mkd /
q6-8
Kawasaki Dis : 80-100 mkd / q6
then decrease to 3-5 nkd qam
Azithromycin ( Macrolide)
100 mg/5 ml, 200 mg/5 ml
DOSE : 10 mg/kg/dose OD
Betaethasone ( Corticosteroid)
Diprolene cream qid-bid

Bisacodyl ( Laxative, stimulant)

Dulcolax
Tab : 5 mg upp: 10 mg Enem : 10mg/30ml
Rectal : < 2 yr : 5 mg
2-11 yr : 5-10 mg
> 11 yr : 10 mg

Brompheniramine +
pseudoephedrine
( antihistamine + decongestant)
DIMETAPP
Oral drops :
1-3 mos : 0.25 mg qid
> 3-6 mos : 0.5 mg qid
=/> 6-12 mos : 0.75 mg qid
=/> 12-24 mos : 1 mg qid
Oral
Children 6-11 yr : 2 mg q4
=/> 12 yr & adult : 4 mg q4

Cefaclor (2nd gen cephalosporin)

Ceftriaxone (3rd gen)

Dose : 50-75 mkd/ q12-24

Cefuroxime ( 2nd gen)

IV: Sinacef, Zegen PO : Zinnet
750 mg/50 ml, 125, 250 mg/5ml
IM/IV
Neonate: 20-60 mkd/q12
Infant (> 3mos) /child : 75-150 mkd/q8

Age
0-1
wk
1wk1m

HR
> 180
< 100
> 180
< 100

RR
> 50

WBC
> 34

SBP
< 65

> 40

< 75

1m1y

> 180
< 90

> 34

2-5 y

> 140
NA

>32

6-12
y

> 130
NA

> 18

13<18

> 110
NA

> 14

>
19.5
or < 5
>
17.5
or < 5
>
15.5
or < 6
>
13.5
or <
4.5
>
11.5
or <
4.5

Cephalexin (1st gen)

125 mg/5 ml, 250 mg/5 ml
Dose : 25-100 mkd/q6

Cetirizine (2nd gen)

Zyrtec
5 mg/ml; 5,10 mg tab
Dose : 6 mos - < 2yr 2.5 mg PO qid
2-5 yr : 2.5 mg PO qid
=/> 6 yr : 5-10 mg PO qid

< 100
< 94
< 105

< 117

125mg/5 ml, 250/5ml, 375/5ml 50 mg/ml

DOSE : 20-40 mg/kg/d
8

Cefadroxil (1st gen cephalosporin)

SEPSIS

( Drozid)
125,250,500 mg/5ml
DOSE : 30 mkd q12

Clinical syndrome that complicates severe

infection

Cefazolin (1st gen) Stancef

Characterized by systemic inflammation and wide

spread tissue injury

0.5, 1,5 10,20 g

Dose : 50-100 mkd q8

CEfepime (4th gen)

Dose : 100 mkd /q12
rd

Cefixime (3 gen)
100 mg/5ml
Dose : 8mkdose q12-24

Cefotaxime (3rd Gen)

0.5,1,2,10 g
Dose : 100-200 mkd/q6-8 < 50 kg
1-2 g/dose q6-8 > 50 kg
nd

Cefoxitin (2 gen)
80-160 mkd q4-8

Ceftazidime (3rd gen)

Dose : 90-150 mkd/q8

In this syndrome, tissues remote from the original

insult display the cardinal signs of inflammation ,
including vasodilation, increased microvascular
permeability and leukocyte accumulation
SYSTEMIC INFLAMMATORY RESPONSE
SYNDROME
- a widespread inflammatory response that may or
may not be associated with infection
1. core temperature : 38.5 or < 36 measured
by rectal , oral or bladder or central probe
2. tachycardia defined as a mean heart rate > 2
standard deviations above normal for age
*** or for children < 1yr : bradycardia defined
as a mean heart rate < 10 percentile for age
Mean respiratory rate > 2 standard deviations
above normal for age
3. leucocyte count elevated or depressed for
age or > 10 percentile immature neutrophils

RESPIRATORY
Pao2/Fi02 < 300 in absence of cyanotic hearg
disease or pre existing lung disease or
PaCo2 > 65 torr or 20 mmHg over baseline
PaCo2 or
Proven need > 50% Fi02 to maintain saturation
of > 92% or
Need for nonelective invasive or noninvasive
mechanical ventilation
NEUROLOGIC
Glasgow coma score < 11 or
Acute changes in mental status with a decrease
Glasgow coma Score > 3 points from abnormal
baselin
HEmatologic
Platelet count < 80000 or a decline of 50% in
platelet count from highest value recorded over
past 3 days ( for chronic heme- onco patients) or
International normalized ratio > 2
RENAL
Serum creatinine

HYPOKALEMIA
TK+R
Deficit +
Maintenance
Deficit
Desired
Actual x wt x
0.1 x 50
Maintenance 2 meqs/kg
KIR
(N= 0.2-0.3)

meqs x rate
Wt____
100

Total K
Delivered in
24 hrs (y)

meqs =
Y______
100
rate x 24
y/24 = meqs/h

Correction