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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
NEONATAL
HYPERBILIRUBINEMIA
CNS DISEASES
Cells
45-100 mg/dL
10-20 mg/dL
15-30 mg/dL
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
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
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
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
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
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
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
< 100
< 94
< 105
< 117
SEPSIS
( Drozid)
125,250,500 mg/5ml
DOSE : 30 mkd q12
Cefixime (3 gen)
100 mg/5ml
Dose : 8mkdose q12-24
Cefoxitin (2 gen)
80-160 mkd q4-8
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