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Partly

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

GUIDELINES FOR BLOOD TRANSFUSION


Cryopecipitate is administered using blood set/ macroset and
transfused fast drip unless otherwise indicated
Platelet Concentrate administered using platelet set and transfused
fast drip unless otherwise indicated
Pheresed Platelet I U is equivalent to six to fourteen (6-14) U of
randomly collected platelet concentrate transfuse using platelet
set
PRBC/FWB is administered using blood set and transfused within 68 hrs
FFP is administered using blood set/macroset and transfused for two
hours unless otherwise indicated
COMPUTATION FOR PRBC
For:
(Desired Hct Actual Hct) x weight

USUAL CHANGES IN WT AT DIFF AGES


4-5 mos = 2 x BW
1 yr = 3 x BW
2 yrs = 4 x BW
3 yrs = 5 x BW
5 yrs = 6 x BW
7 yrs = 7 x BW
10 yrs = 10 x BW
LENGTH/HEIGHT COMPUTATION
At birth = 50 cm
0-3 mos = + 9 cm
3-6 mos = + 8 cm
6-9 mos = + 5 cm
9-12 mos = + 3 cm
2-12 yrs = Age x 5 + 80
HEAD CIRCUMFERENCE COMPUTATION
At birth = 35 cm (13-18 inch)
< 4 mos = 2 inch (1/2 inch / mos)
5-12 mos = 2 inch (1/4 inch / mos)
2 yrs = 1 inch
3-5 yrs = 1.5 inch (1/2 inch / yr)
6-20 yrs = 1.5 inch (1/2 inch / 5 yrs)
TEMPERATURE
Normal: 37 + / - 1.0-1.5 C
Decrease: early morning
Increase: late afternoon

BLOOD PRESSURE COMPUTATION


SYSTOLIC
DIASTOLIC
0-12 mos
110-90 mmHg
75-55 mmHg
1-2 yrs
110-90 mmHg
75-55 mmHg
3 yrs = age x 2 + 70
FONTANELS
At Birth: 2 x 2 cm (anterior)
Closes at: 9-18 mos (anterior)
6-8 mos (posterior)
HEART RATE
120-170
100-150
90-120
80-120
70-110
65-110
60-95
55-85

ACID BASE BALANCE (ABG)


Normal (N): normal acid base balance
pH
PaCO2
HCO3
Respiratory Acidosis
Uncompensated

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

CLINICAL PRACTICE GUIDELINES IN THE


EVALUATION OF PEDIATRIC COMMUNITY ACQUIRED
PNEMONIA 2004
Predictors of CAP in a patient with cough
1. 3 mos to 5 yrs with tachypnea &/or chest retractions
2. 5-12 yrs with fever, tachypnea and crackles
3. > 12 yrs with the presence of the ff:
a.
Fever, tachypnea, tachycardia
b.
At least 1 abnormal chest findings
(rales, wheezes, ronchi, dim BS)
WHO age specific criteria for tachypnea
2-12 mos
50
1-5 yrs
40
>5 yrs
30

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

Desired Hct = 40% for full correction


30% for WBC w/c are
Content of PRBC
RBC =
200 cc
Anticoagulant = 50 cc
1 pack RBC= 250 cc (to be transfused in 4 hrs)
Evidence Based Study
Give diphenhydramine 30 min 1 hr pre-BT

BE
N

RISK CLASSIFICATION FOR PNEUMONIA RELATED


MORTALITY
Variables
PCAP
PCAP B PCAP C
PCAP D
A
Low
Mod
High Risk
Min.
Risk
Risk
Risk
1.Comorbid
None
(+)
(+)
(+)
illness
2.Compliant
Yes
Yes
No
No
caregiver
3.Abilityto
Possible Possible Not
Not
follow up
Possible
Possible
4.Presence of None
Mild
Mod
Severe
DHN
5.Ability to feed Able
Able
Unable
Unable
6.Age
>11
>11
<11 mos
<11 mos
mos
mos
7.RR
2-12 mos
50/min >50/min >60/min
>70/min
1-5 yrs
40/min >40/min >50/min
>50/min
>5 yrs
30/min >30min
>35/min
>35/min
8.Signs of resp
distress
a.Retraction
None
None
Inter/
Supraclav/
Subcostal Int/subcoatal
b.Head bobbing
None
None
Present
Present
c.Cyanosis
None
None
Present
Present
d.Grunting
None
None
None
Present
e.Apnea
None
None
None
Present
f.Sensorium
Awake
Awake
Irritable
Lethargic/
Stuporous/
comatose
9.Complications None
None
Present
Present
ACTION
OPD
OPD
Admit to Admit
to
PLAN
Ff up at Ff
up regular
PICU
&
end of after 3 ward
Refer
to
tx
days
specialist

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

Cefixime (3rd gen)


Suspension
Drops

6-12 mkd q 12h


100 mg/5 ml
20 mg/ml

Cefipime
Vial

100 mkd q 12h


500 mg; 1 gram

Cotrimoxazole
Suspension

(TM 5-8 mkd q 12h)


200 mg/40 mg/5 ml
400 mg/80 mg/5 ml
400 mg/80 mg/tab
800 mg/160 mg/tab

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

7.5 mkdose q 12h


125 mg/5 ml
250 mg; 500 mg

What should be done if px is not responding to current antibx?


1. If PCAP A or PCAP B is not responding w/in 72 H
a. Change initial antibx
b. Start oral macrolide
c. Reevaluate dx
2. If PCAP C is not responding w/in 72 H, consult w/ a specialist
because of the ff possibilities
a. PCN resistant Strep pneumonia
b. Complications (pulmonary or extrapulmonary
c. Other dx
3. If PCAP D is not responding w/in 72 H, consider immediate
consult with a specialist

Roxithromycin

6-12 yrs: 100 mg/tab BID


<6 yrs: 5-8 mkd BID
150 mg/tab
100 mg/tab

Switch from IV antibx to oral 2-3 days after initiation of antibx is


recommended in a px who:
a. Is responding to the initial antibx
b. Is able to feed with intact GIT absorption
c. Does not have any pulmo or extrapulmo complications

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

Amoxicillin + clavulanic acid (amox 30-50 mkd)


Suspension
125 mg/156.25mg/5 ml TID
200 mg/228.5 mg/5 ml BID
250 mg/312.5 mg/5 ml TID
400 mg/457 mg/5 ml BID
Tablet
250mg/375 mg; 500 mg/625 mg
Cloxacillin
Suspension
Capsules

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)

25-100 mkd q 6-8h

Tablet
Ped tab
Azithromycin

Suspension
Capsule

Suspension
Capsule
Ampoule

3 day regimen: 10 mld x 3


5 day regimen: 10 mkd on day 1
5mkd on days 2-5
Adult: 500 mg OD on day 1
250 mg OD on days 2-5
200 mg/5 ml
250 mg
PO 20-30 mkd q 6-8h
IV 25-40 mkd q 6h or
10-15 mkdose q 6h
75 mg/5 ml
150 mg; 300 mg
150 mg/ml

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

adult & children tsp q 6h


Infants tsp q 6h

Oral gel 2% tube


Nystatin
NB <2000g = 200,000 400,000 u/day q 4-6h
>2000g = 200,000 400,000 u/day q 4-6h
Infant, Child = 400,000 800,000 u/day q 4-6h
Adult = 800,000 2 M u/day q 4-6 h
Fluconazole
Capsule
Vial

3-6 mkd OD x 2 weeks


50 mg; 150 mg; 200 mg
2 mg/ml x 100 ml

Oxantel + pyrantel pamoate


Suspension
Tablet
Tricuriasis x 2d
Hookworm x 3d

10-20 mkd SD
125 mg/5 ml
125 mg; 250 mg

Mebendazole
Suspension
Tablet

100mg BID x 3days or 500mg SD


50 mg/ml; 100 mg/5 ml
100 mg; 500 mg

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

5 mkdose (loading dose)


2.5 mkdose q 6h (maint.)
slow IVTT + equal amounts
of sterile water
25 mg/ml

1-2 mkdose IM/IV/PO


5 mkd q 6h
12.5 mg/5 ml
25 mg; 50 mg
50 mg/ml

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

2-4 drops or sprays per nostril


TID/QID
0.65%
0.65%

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

Phenylephrine + brompheneramine maleate


Syrup
Adult
5-10 ml TID/QID
4-12 yo
5 ml TID/QID
2-4 yo
tsp TID/QID
Drops (0.1 mkdose)
7-24 mos
1 ml TID/QID
1-6 mos
0.5 ml TID/QID
Paracetamol
Drops
Suspension/syrup

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

1.5 mkdose TID


10 mg; 30 mg
30 mg

Tramadol
Ampoule
Capsule
Tablet

IV: 1-2 mkd q 8h


50 mg/ml; 100 mg/2 ml
50 mg
100 mg

Famotidine
Ampoule
Tablet

0.6-0.8 mkdose q 12h


20 mg/2 ml
20 mg; 40 mg

Ranitidine
Entac
Pharex

1 mkdose q 8h
25 mg
75 mg

Zinc

<6 mos: 10 mg/kg


>6 mos: 20 mg/kg
<2 yo: 1 ml OD drops
>2 yo: 5 ml OD syrup
10 mg elemental Zn
20 mg elemental Zn

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

1.5 mg/50 mg/5 ml

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

SEXUAL MATURITY RATING IN BOYS


PUBIC HAIR
Prepubertal: no pubic hair, fine vellus hair
Sparse, long, straight, downy hair
Darker, coarser, curly, sparse over the entire pubis
Dark, curly, and abundant in pubic area; no growth on
thighs or up towards the umbilicus
Adult pattern

STAGE
1
2
3
4
5

SEX MATURITY RATING IN GIRLS


PUBIC HAIR
Preadolescent
Sparse, lightly pigmented, straight, medical border of
labia
Darker, beginning to curl, increased amount
Coarse, curly, abundant, but amount less
Adult feminine triangle medical surface of thigh

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

FLUID COMPUTATION (FLUID HYDRATION)


<2 yrs / <10 kg = 50 cc/kg run @ 8h (D5 0.3 NaCl) - MILD
= 100 cc/kg run @ 1 h - MODERATE
run @ 6-7h (PNSS/PLR)
= 150 cc/kg run 1/3 @ 1h - SEVERE
run 2/3 @ 6-7h (PNSS/PLR)
>2 yrs/ >10 kg = 30 cc/kg run @ 8h (D5 0.3 NaCl) -MILD
= 60 cc/kg run @ 1h - MODERATE
run @ 6-8h
= 90 cc/kg run 1/3 @ 1h -SEVERE
run 2/3 @ 6-7 h
eg.: IV Fluids given ______ run @ 8h w/ 30cc/kg computed as
mild dehydration
*started w/ IVF ___ regulated at ______ computed as _____
dehydration in _____ hrs
Micro- cc/hr to macro cc/hr 4

FACTORS MODIFYING WATER REQUIREMENT


How is newborn screening done?
Newborn screening is a simple procedure. Using the heel
prick method, a few drops of blood are taken from the babys
heel and blotted on a special absorbent filter card. The blood is
dried for 4 hours and sent to the newborn screening laboratory
(NBS lab).
Who will collect the sample for newborn screening?
Newborn screening can be done by a physician, nurse,
midwife, or medical technologist.
Where is newborn screening available?
Newborn screening is available in participating health
institutions (Hospitals, lying-in, rural health units and health
centers). If babies are delivered at home, babies may be brought
to the nearest institution offering newborn screening.
When are newborn screening results available?
Newborn screening results are available within three weeks
after the NBS lab receives and tests the samples sent by the
institutions. Results are released by the NBS lab to the
institutions and are released to your attending birth attendants
or physicians. Parents may seek the results from institutions
where samples are collected.
What are the disorders included in the newborn screening
package?
The Philippine Newborn Screening program is currently
screening for five disorders and the following are:
1. Congenital Hypothyroidism (CH)
CH is the most common inborn metabolic disorder. CH
results from lack or absence of thyroid hormone which is
essential to growth of the brain and the body. If the disorder is
not detected and hormone replacement is not initiated within 4
weeks, the babys physical growth will be stunted and will start
losing IQ points and may become severely mentally retarded.
2. Congenital Adrenal Hyperplasia (CAH)
CAH is a rare but dangerous inborn metabolic disorder. This
causes severe salt loss, dehydration and abnormally high levels
of male sex hormones in both boys and girls. If not detected
and treated early, babies may die within 9-13 days.
3. Galactosemia (Gal)
GAL is a condition in which babies are unable to process
certain part of the milk called galactose. Accumulation of
excessive galactose in the body can cause many problems
including liver damage, brain damage, and cataracts.
4. Phenylketonuria (PKU)
PKU is a rare condition in which the baby cannot properly
use one the building blocks of protein called phenylalanine.
Excessive accumulation of phenylalanine in the blood causes
brain damage.
5. Glucose 6 Phosphate Dehydrogenase Deficiency (G6PD Def)
G6PD deficiency is a condition where the body lacks the
enzyme called G6PD. Babies with this deficiency are prone to
hemolytic anemia resulting from exposure to oxidative
substances found in drugs, foods and chemicals.

EXPANDED PROGRAM OF IMMUNIZATION (EPI)


Vaccine
1st dose
# of dose
Interval
Dose
BCG
Birth-up
1
0.05 ml ID
DPT
6 wks
3
4 wks
0.5 ml IM
OPV
6 wks
3
4 wks
0.5 ml oral
Hep B
6 wks
3
4 wks
0.5 ml IM
Measles
9 mos
1
0.5 SQ
TT
Rubella

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

+ volar area 1 inch distal to antecubital fossa of about


1 inch
+ petichial rashes of >20

ACTUAL DOSE = dose/wt


= dose x preparation
Wt
PEFR COMPUTATION
*for 100-170 cm (ht) only
Predicted PEFR
Females: ht (cm) 100 x 5 + 170
Males: ht (cm) 100 x 5 + 175
Actual PEFR:
% = actual PEFR
x 100
Predicted PEFR

I
II
III

DHF GRADING
I

RDA (RECOMMENDED DAILY ALLOWANCE)


AGE
Wt(kg)
Cal/kg
P
F
VLBW
< 1500
2.25
0-6 mos
3-6
110-115
2.5
7-12 mos
7-9
110-115
2.3
2
1-3 yrs
10-12
110
1.5-2.5
4-6 yrs
14-18
90-100
1.5-2.25 4
7-9 yrs
22-24
80-90
1.5-2.0
10-12 yrs 28-32
70-80
1.5-2.0
2.5
CCU = IBW x ABW x caloric for age
ABW
= IBW x caloric for age
TCR = CCU x (50% - 60%)
CHON = ABW x RDA chon x 4
NPC TCR CHON
CHO = NPC x 60%
FATS = NPC CHO
TCR every other day starting day 3 (+ 10%)
To orders:
>start feeding based on the ff computation
Total caloric req. = 792 cal
Protein = 64 cal
Carbohydrate = 436 cal
Fats= 292 cal
-divided into 3 meals and 2 snacks
-pls provide sterile water after each feeding
*after 3 days
>Revise OTF/feeding based on the ff computation
Total caloric req = 871
Protein = 64
Carbohydrates = 464
Fats = 343
>Osteorized Feeding
- start osteorized feeding based on the ff computation (same)
- divided into 6 equal feeding
- please provide sterile H2O after each feeding
Eg: Px 8 y, 24.1 kg (ABW)
IBW 24 kg
Caloric req 7-9 yo = 80-90 cal/kg
CCU = 24 kg x 85 cal/kg = 2040 cal
3rd day = 2040 cal x 0.75 = 1530 ~ 1500

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

TORNIQUET TEST/ RUMPLL


MAP = > SYSTOLIC DIASTOLIC
Inflate for 5 minutes

DHF STAGING
Febrile stage (1-7 days)
Afebrile stage (3-4 days)
Convolescent Stage

Anorexia, vomiting, convulsion, restless


Flushes skin, + tourniquet test, abdominal pain, hepatomegaly
Pleural effusion (unilateral/bilateral), constipation, abdominal
distention

II Gum bleeding, epistaxis, petechiae on palate & axillae, rashes on


extremities
III Chest pain, cough, lethargy, violaceous skin, flushed face
Purpura, hematemesis, hemoptysis, melena
Cold clammy extremity, shock, ecchymosis
IV Profound shock

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

Score: 7-10 = vigorous infant


4-6 = mild-mod asphyxia 100% O2 face mask
<5 = severe asphyxia intubate

15 chest compression 2 puffs


32 chest compression 2 puffs
>5 min heart stops 50% chance survival
>10 min heart stops 0% chance survival

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

Tazobactam NA + Piperacillin NA (vigocid)


Zdorixol
6mg/ml syrup
Mucolvan
15 mg/3 ml susp

Ambroxol (expel)
1-2 yrs
2-6 yrs
7-12 yrs

15 mg/5 ml
tsp BID
tsp TID
1 tsp TID/BID

Multivitamins (Lugraplex Syrup)


2-6 yrs
1tsp
7-12 yrs
2 tsp
>12 yrs
1 tbsp
Cherifer forte Syrup
2-6 yrs
6-12 yrs

2.5 5 ml OD
1-2 tsp OD

Ascorbic acid (Geturs)


1 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

Infants and children require adequate fluid


and electrolyte intake to maintain fluid
balance. Calculation of maintenance fluids
based on the child's weight is required to
prevent under hydration or over hydration. To
weigh the child, use the same scale, at the
same time of day, before feeding, without
clothes.
First:
Obtain an accurate weight in
kilograms.
Second:

Apply the following table:

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

[10 kg x 100cc = 1000cc]


[5 kg x
50cc = 250cc] =
1250cc total over 24
hours
Divide 1250cc by 24 hours to calculate the
amount of fluids the child should receive each
hour:
1250cc
=
52cc/hr
24 hr.

OR
cc = (10kg x 100cc) (5kg x 50cc)=1000cc
250cc=1250cc x 1_ = 52cc/hr
hr
kg
24

3.
fluids.

kg

A 25 kg child requires maintenance


The child should receive:

10 kg x 100cc =
10 kg x 50cc =
5 kg x 20cc =

1000cc
500cc
100cc

16

Divide 1600 cc by 24 hours to calculate the


amount of fluids the child should receive each
hour:
1600cc = 67 cc/hr
24 hr.
OR
cc = (10kg x 100cc)
(10kg x 50cc)
(5kg x
20cc) = 1000cc
500cc
100cc = 1600cc x
1 = 67 cc/hr
hr
kg
kg
kg

B.

24

URINE OUTPUT

Normal urine output is:


A.
Infant: 2-3 ml/kg/hr
B.
Toddler/preschooler: 2 ml/kg/hr
C.
School-age child: 1 - 2cc/kg/hr
D.
Adolescent: 0.5-1 ml/kg/hr
First:
Obtain accurate wt. in kg
Second:
Measure urine output accurately.
Third:
Compute number of hours that patient
voided the above amount of urine.
Fourth:
Use formula:
Amt. of urine
divided by wt. in kg
divided by number of hours
Example:
At the end of your 8 hours shift, your 10 kg
infant voided 300cc. Is this sufficient urine
output for this patient?
cc =
300
kg/hr

300cc x 1
x
3.75 cc/kg/hr
10kg

1 =
8hr

This is sufficient urine output for this


patient.

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

2-3 = severely depressed


4-6 = slow, irregular
7-10= vigorous

FORMULA FOR IDEAL BODY WEIGHT (NELSON)


AGE
At birth
3-12 months

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

250, 500 mg vial


*Cloxacillin Na (PO)
(Prostaphlin A) (50 100)
250, 500 mg cap
125 mg/5 ml susp
250, 500 mg vial
*Nafcillin Na (Vigopen)
(25 mg/k/D)
250 mg cap
500 mg cap
250 mg/5 ml soln
Fluocloxacillin Na (Stafloxin)
250, 500 mg cap
250, 500 mg, 1 g vial
E. Ampicillin
RD: 100 200 mg/k/D q 6H/8H IVTT
(meningitic : 200 400 mg/k/D)
Prep:
100 mg/ml drops
125, 250 mg/5 ml susp
250, 500 mg vial/cap

Ampicillin, Pensyn
Pentrexyl (with 125 mg vial)
Ampedia (with 100 mg vial)
Ampicillin/Cloxacillin

(Amplicox)

Adult cap/inj 500 mg


(250/250)

Ped cap/inj 250 mg


(125/125)
5 ml drops
(60/30)
Neonatal vial
(50/25)
Ampicillin/Cloxacillin

(Pensyclox)

500 mg cap/inj (250/250)


250 mg/5 ml susp (125/125)
100 500 mg/5 ml drops
Sultamicillin (Unasyn)
> 375 mg vial
Sulbactam Na 125 mg
Ampicillin 250 mg
> 750 mg vial
S = 250 mg
A = 500 mg
Sultamicillin (PO)
> 375 mg tab
< 30 kg : 50 mg/k/D q 12H
> 30 kg : 375 750 mg q 12H
(adult dose)
*Combination of drugs computed on the
basis of Ampicillin
F. Amoxicillin
RD: 40 -60 mg/k/D q 8H
Prep:
100 mg/ml drops
125, 250 mg/5 ml susp
250, 500 mg cap/vial*

Amoxil, Clearamox, Glamox, Himox*


Moxillin*, Pediamox* (250 mg vial)
Sumoxil*, Wyamox
Amoxicillin/Bromhexine

(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

400, 800 mg tab


H. Sulbenicillin
RD: 20 80 mg/k/D up to
80 180 mg/k/D q 4 6 H
Prep:
Kedacillin 1-2 g vial
I. Piperacillin
RD: 100 200 mg/k/D q 6 H
Severe infxn:
200 300 mg/k/D
Prep:
Cypercil 2 g vial
Tazocin * 2.25, 4.5 g vial
(2, 4 g Piperacillin/ .25 ,
.5 g Tazobactam)
* usual dose : 2.25 to 4.5 g/D q 6 12 H

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

250, 500 mg cap


125, 250 mg/5 ml susp
500 mg vial
5. Cefatrizine
RD: < 12 y.o.
20 14 mg/k/d q 8 12 H
For OM:
50 75 mg/k/D
Prep:

Zanitrin

250, 500 mg cap


250 mg/5 ml susp
6. Cefazolin
RD: 20 40 mg/k/D q 12 H
Severe infxn:
50 100 mg/k/D q 8 H
Prep:

Stancef, Lupex, zolival


Zolfef, Megacef
500 mg, 1 g vial

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 *

250, 750 mg vial *

Zinnat

125, 250 mg/5 ml susp


125, 250, 500 mg tab
2. Cefamandole
RD: 50 100 mg/k/d q 4 8 H
Prep:
Mandol 1 g vial
3. Cefaclor
RD: 20 40 mg/k//d q 8 H
Prep:

Ceclor

250, 500 mg pulvules


125, 187, 250 (DS)
375 mg/5 ml susp
50 mg/ml drops
375, 750 mg CD extended
release tab (BID)
4. Cefoxitin
RD: 40 160 mg/k/D q 6 12 H
Prep:

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 *

250, 500 mg, 1 g vial


2. Cefoperazone
RD: 50 200 mg/k/D q 12 H
Prep:
Cefobis 500 mg, 1 g vial
3. Ceftazidime
RD: 50 -100 mg/k/D q 8 H
< 2 mos.
25 60 mg/k/D q 12 H
> 2 mos.
30 100 mg/k/D q 8 12 H
Prep:
Fortum 250, 500 mg, 1g, 2 q vial
50 100 mg/k/D q 12 H
4. Ceftrixone
RD: 20 80 mg/k/D OD
50 100 mg/k/D q 12 H
Prep:
Rocephin 250, 500 mg, 1 g vial
5. Ceftizoxime
RD: 40 80 mg/k/D q 6 12 H
Up to 120 mg/k/D for severe infxn.
Prep:
Tergecin 500 mg, 1 g vial
6. Cefixime
RD: 8 10 mg/k/D q 12 H
Up to 12 mg/k/D for severe infxn.
Prep:

Tergecef

100, 200 mg cap


50 mg sachet
100 mg/5 ml susp
Zefral 120 mg/5 ml
7. Ceftibuten
RD: 9 mg/k/D OD
Prep:

Cedax

200, 400 mg cap


36 mg/ml susp

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

250, 500 mg tab


125, 250 mg/5 ml susp

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

Inc. to q 8 H severe infxn.


Prep:

Cepimax 500 mg, 1, 2 g


2. Cefpirome
RD: not for < 12 y.o.
1 2 g q 12 H
Prep:
Cefrom 1, 2 g
AMINOGLYCOSIDES
1. Amikacin
RD: 10 15 mg/k/D q 12 H (IV)
Prep:

Amikacide, Amikin, Pediakin, Bilkin

100, 250, 500 mg


2. Kanamycin
RD: 15 mg/k/D q 12 H (IV)
Prep:
Kanamycin Meiji 1 g
3. Gentamycin
RD: 5 8 mg/k/D q 8 H (IV)
Prep:

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

50, 100 mg/2 ml


150 mg/1.5 ml
6. Streptomycin (Anti-TB)
RD: 20 mg/k/D q 12 H (IV)
Prep:
1 g vial
7. Neomycin
RD: 50 mg/k/D q 6 H PO (ETEC)

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

250, 500 mg tab


200 mg/5 ml susp
100 mg/2.5 ml drops

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:

Macrol / Macrol Kiddie

150 mg tab/100 mg tab

Rulid 100, 150 mg tab

4. Clarithromycin
RD: 15 mg/k/D BID
(max 500 BID)
Prep:

Klaricid

125 mg/5 ml susp


250, 500 mg tab
5. Dirithromycin
RD: 500 mg OD (adults only)
Prep:

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:

Atrax, Biocolyn, Doryx,


Doxin, Servidoxyne,
Vibramycin *, Doxicon
50 *, 100 mg cap

2. Oxytetracycline
RD: 25 50 mg/k/D q 6 H po
Prep:

Leydoxycycline *, Terramycin

250, 500 mg cap


125 mg/5 ml susp *
3. Tetracycline
RD: 25 50 mg/k/D q 6 H po
Prep:

Hostacycline, Unimycin *

500 100 mg/k/D q 6 H IV/po


Meningitis : 100 200 mg/k/D q 6 H

Biomycetin (no 250 cap)


Chloramol, Chloramycetin
Pediachlor (no cap) *, Plivacol (no susp) *
Kimicetine *
250, 500 mg cap
125 mg/5 ml susp
1 g vial

CLINDAMYCIN
RD:
Prep:

20 40 mg/k/D q 6 8 H (IV/IM)
10 25 mg/k/D TID/QID po

Dalacin C

150, 300 mg cap


75 mg/5 ml granules
150 mg/ml amp.

LINCOMYCIN
(For PCN allergy)

250 *, 500 mg cap

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

250, 500 mg tab


100 mg/50 ml, 100 mg/100 ml
400 mg/200 ml infusion
3. Ofloxacin
RD: q 12 H
5 mg/k/D IV
10 mg/k/D po
Prep:

Inoflox Qinolon

200, 400 mg tab


200 mg/100 ml inj.

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

tab 80/400, 160/800


5 ml susp 40/200
40/5

Cotrimazine Forte tab 180/820

Prep:

30 60 mg/k/D TID po
10 mg/k/D q 24 H IV

Lincocin

250, 500 mg cap


250 mg/5 ml susp
600 mg/2 ml inj

NITROFURANTOIN
RD: 5 7 mg/k/D q 6 H
Prep:

Macrodantin

50, 150 mg cap

LORACARBEF
RD: 15 30 mg/k/D q 12 H
Prep:

Lorabid

100, 200 mg/5 ml susp


200 mg pulvule

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

400 mg E-200 mg INH tab


125 mg 100 mg/5 ml syr

Ethambin INH

200 mg 100 mg tab


125 mg 150 mg tab

Ethamizid

400 mg 200 mg tab


3. Rifampicin
RD: 10 20 mg/k/D OD
Adults : 10 20 mg/k/D OD
(max 600 mg/D)
Meningo px.
< 1 mo. 10 mg/k/D OD for 4 days
Others : 20 mg/k/D OD up to
600 mg/D for 4 days
Prep:
* Natricin 300, 450 mg cap
100, 200 mg/5ml susp
Rimaped 100 mg/5ml syr

* Rimactane Forte

Rifadin

150, 300 mg cap


450, 600 mg tab
100, 200 mg/5 ml syr
150, 300, 450, 600 mg cap
100 mg/5 ml susp

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

100 mg/5 ml susp


4. Diloxanirde furoate
RD: 20 mg/k/D TID x 10 days
Prep:

Furamide

500 mg tab, 125 mg/5 ml susp


5. Tinidazole
RD: 50 60 mg/k/D OD x 3 days
Prep:

Fasigyn

300, 500 mg tab

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

1.25 g/5 ml syr


2. Pyrantel pamoate
RD: 10 20 mg/k SD (q 3 mos)
Prep:

Combantrin

125, 250 mg tab


125 mg/5 ml susp

Quantrel

100 mg tab, 20 mg/ml susp


3. Mebendazole (not for < 2 y.o.)
RD: 100 mg/D BID for 3 days
Prep:

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:

100, 500 mg tab


20, 50 mg/ml susp
4. Tetramisole
RD: 2.5 mg/k SD
Prep:

TMZ

50, 100 mg tab


12.5 mg/5 ml syr

Anaerobia

250, 500 mg tab


125 mg/5 ml susp
500 mg inj

Flagyl, Triconex, Rodazid

500 mg forte tab


125 mg/5 ml susp
500 mg inj
Metroxyn 500 mg tab
Servizole
250, 500 mg tab
200 mg/5 ml susp
500 mg inj
2. Secnidazole
RD: 30 mg/k SD or in 2 divided doses w/in 4 hrs.
3D treatment
1 tab TID (adult)
25 mg/k/D (child)
Prep:

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

200, 500 mg tab

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

50, 150, 200 mg cap


2 mg/ml vial
5. Terbinafine

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

200, 400, 800 mg tab


250 mg vial
4. Inosiplex
RD: 50 mg/k/D q 6 H
Prep:

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)

Naafarin A, Tuseran, Myracof


AF/F, Sinutab, Neozep

> 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:

Bricanyl / expectorant * (with


Guaifenesin), Pulmoxel *
2.5 mg tab, 5 mg ER tab
.3 mg/ml syr
.25 mg/D misthaler, inhaler

500 ug/D turbuhaler


5 mg/2 ml neb soln
.5 mg/ml amp
1.5 mg/5 ml syr *
3. Salbutamol
RD:
0.12 0.15 mg/k/D q 6 H
(wt x .375 = cc)
Prep:

Ventolin, Librentin, Asmalin

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:

Zadec / SRO, Zaditen / SRO


1
2
1
1

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

250 mg, 500 mg cap


50 mg / 5 ml susp

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

200 , 400, 800 mg tsb


100 mg/5 ml liq
200, 300 mg/2 ml amp
2. Famotidine
RD: q 12 H
C
.7 mg/k/D
A
20 40 mg
Prep:

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

Ranix, Zantac */FR

150, 300 mg tab


150 mg/10 ml syr *
50 mg/2 ml amp
6. Al (OH)3 / Mg (OH)2
RD: QID (pc meals & at HS)
2 4 tabs, 1 2 tsp
Prep:

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 **

OTHER GIT REGULATOR


1. Cisapride
RD: ac meals, TID
C .6 - .9 mg/k/D or
5 mg/D
A
15 40 mg/D
Prep:
Prepulsid 5 mg tab
1 mg/ml susp
2. Metoclopramide
RD: q 8 H
C
.1 - .5 mg/k/D
A
1 tab
Prep:
Plasil
10 mg tab
5 mg/5 ml syr
10 mg/2 ml amp
3. Domperidone
RD: TID / QID
Dyspepsia
A : 1 tab or 2 tsp
C : 7.5 mg/k/D
Nausea / Vomiting
A : 2 tabs or 4 tsp

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

every 1 mEq/L inc. HCO3


RESPIRATORY ACIDOSIS
Acute : 1 mEq/L inc. HCO3 for every
10 mmHg inc pCO2
Chronic : 3 5 mEq/L inc. HCO3 for
Every 10 mmHg inc. pCO2

Conc. = mg/ total vol (ml)


Rate = RD x wt x 60
Conc.
AD = rate x conc.
Wt. x 60

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

WBC correction in Hemorrhagic tap :


Periph WBC x 1000 = WBC
5,000,000
1000 RBC
C/I : 1. Increase ICP
2. severe Cp compression
3. infected skin (absolute)
4. decrease plt or bld d/o
5. brain abscess
ANTIDERMATOSIS
Hydrocortisone 1% TID 2 wks.

Hytone, Eczacort

Betamethasone BID TID

Betnovate, Diprolene, Diprosone

Fluocinolone Acetonide BID TID


Aplosyn 10, 25, HP
Synalar 10, 25, HP
Mometasone Furoate OD

Elica

Clobetasole Propionate

Dermovate

Triamcinolone Acetonide BID TID

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

Deficit + Maintenance = total reqt.


Na reqt given in 2 days
K reqt given in 3 days
* full K incorporation = 40 mEq/L
Na : 1 mEq = 23 mg
K : 1 mEq = 39.1 mg
FLUID REQT FOR NBS
Day
1 term
65 cc/k/D
Preterm
75 85
2
80
3
80 100
4
110 -120
5
130 140
6
150
7
120
8
100
CALORIC REQT
<1m
1 11 m
1 2 y.o.
3 6 y.o.
7 9 y.o.
10 -12 y.o
13 15 y.o.
16 19 y.o.

110 140 cal/k/D


110 115
100 110
90 100
80 90
70 80
55 65
45 50

Total Caloric reqt div into


50% CHO div 4 = gm
15 % fats div 9 = gm
35% CHON div 4 = gm
Nestle (1:1) Nan / HA 1 & 2

Prenan, Neslac (> 1 y.o.), Nestogen 1 & 2


Lactogen 2, Primolac (> 6 m), Al 110 (lac intol)
Alfare (sev diar)
Wyeth (1:2) Bonna, Bonamil, S 26 / LBW
Promil, Nursoy (lac intol)
Abott (1:2) Similac Avd / PM 60/40
Gain, Grow (> 1 y.o.), Pediasure (1-10 y.o.)
Isomil (allergy)
VAMIN
RD: SD .5 g/k/D CHON
(up to max 2.5 3 g/k/D)
5 9 mg/k/D gluc
Prep: (per liter)
CHON
60 gm
Gluc
100 gm
Cal
650 cal
E.g: wt 1 kg
1 kg x .5 g/k/D x 100 = cc of Vamin
6
Cc o Vamin x .65 = cal/Day
AMINOSTERIL
Prep: (per liter)
Infant 6%
240 kcal, 60 gm CHON
100% 400 kcal, 100 gm CHON
Wt. x RD x 100 = cc of Amino 6%
6
cc of Amino x .24 = cal/D
INTRALIPID
RD:
.5 2 g/k/D
Prep:
10% = 100 gm/L = 1100 cal/L
20% = 200 gm/L
Wt. x RD x 100 = cc of Intra 10%
10
Cc of Intra x 1.1 = cal/D
LIPOVENOUS
Prep:
10% = 100 gm/L = 1080 cal/L
GLUOSE DELIVERY RATE
N = 5- 8 mg/k/min.
IV rate x conc. x 24 H

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

1 tab in 100 cc water


- 8H
1 sachet in 100 cc water - 8 H
1 sachet in 1 L water
- 24 H
1 sachet in 200 cc water
20

80

90

20

45
20

20
80

30

(gluc 20)
(citrate 30)
80
dext 25
(citrate 30)
35
dext 20
30
gluc 111

TREATMENT OF PNEUMONIA CARI


2 mos 5 y.o.
MILD PNEUMONIA
Send home, Cotrimoxazole, tx fever,
Check child back 2 4 days after
SEVERE PNEUMONIA
Admit, give IV/IM Benzyl PCN, tx fever,
Tx wheezing, supportive care
Reassess daily
VERY SEVERE PNEUMONIA
Admit, give O2, Chloramphenicol, tx fever
And wheezing prn, reassess 2x daily
(q 15 min. if possible)
< 2 mos.
SEVERE PNEUMONIA
Hospitalize
Keep warm
Give first dose of Antibiotic
Benzyl PCN
Garamycin
Gentamycin
CPAP
TFR = wt. x TV (10 15) x RR x
IE ratio (2) = 2000 (2L)
FIO2 = CA (0.2) + O2 (1) x 100
TFR

CA
O2

= 100 FIO2 x TFR


79
= FR CA

ET size

> 2 y.o. = age(yrs) + 16


4

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

Communication & Language :

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

Smiles in response to face, voice


Monosyllabic babble
Inhibits to no
Follows 1 step command
w/ gesture
follows 1 step command
w/o gesture
Speaks 1st real word
Speaks 4 6 words
Speaks 10 15 words
Speaks 2 word sentences

- Thrombocytopenia not < 100T


- Hemoconcentration not > 20% of baseline

Caffeine Na Benzoate 0.1 0.2 cc IM


Prep: 5/ml; 10/ml
Furosemide 1 -2 MKD
Lasix
40/tab; 20/2 inj
Atropine Sulfate
Pedia :
1 2 mEq SQ q 20 min
0.2 MKD q 3 5 min
Adult :
2 mg q 10 min IV/IM
0.5 mg (5ml) 3 5 min
0.01 MKD prn after 24 H
Digitalis
0.04 0.06 Mk (TDD)
Pedia Elixer .05/ml; 0.25/ml
Tab 0.25 mg/tab
Inj 0.50 mg/2 amp
DOPAMINE DRIP
1 5 ug/k/min = VD, inc. renal &
splanchnic circulation
5 10 ug/k/min = inc. heart contraction
w/o effect on HR
10 20 ug/k/min = inc. BP
Prep: DOPAMINE 200/5
Conc
Dopa
D5W
S
800
1 cc
49 cc
DS 1600
2 cc
48 cc
QS 3200
3 cc
46 cc
Prep: DOBUTAMINE 250/2
Conc
Dobu
D5W
S
1000
4 cc
46 cc
DS 2000
8 cc
42 cc
QS 4000
16 cc
34 cc
AD = rate x conc.
Wt. x 60
Rate = RD x wt. x 60
Conc.
KVO = ugtt = 3.5 gtt = 10

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