NICU BRONCHIAL ASTHMA

Please admit under RI, LI, PD or AP Please admit under the service of Dr.
TPR q4H TPR q4H and record
May breastfeed if NSD; NPO x 2hrs if CS NPO if dyspneic
Labs: Labs:
NBS at 24 hrs old, secure consent CBC
CBC, BT (if w/ maternal illness, PROM or UTI U/A (MSCC)
HGT now then 1, 3, 6, 12, 24, 48 hrs old (GDM) ABG* CXR APL*
HGT now (SGA or LGA) IVF:
Medications: D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
Erythromycin eye ointment both eyes D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
Vit K 1 mg IM (term); 0.5 mg (PT) D5LR 1L at 30cc/kg in 8hif >40 kg
Hep B vaccine 0.5 ml IM, secure consent Medications:
BCG 0.05 ml ID (PT); 0.1 ml (term), secure onsent Paracetamol prn q4h for T > 37.8C (10 15 mkdose)
SO USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses
Routine NB care Incorporate Budesonide 10 mkd LD (max 200mg IV); then
Monitor VS q30 mins until stable 5mkd q6h IV (max of 100 mg IV)
Thermoregulate at 36.5 to 37.5C Ranitidine IVTT at 1mkdose (if on NPO)
Place under droplight (NSD); isolette (CS) SO:
Suction secretion prn MIO q shift and record
Will infrom AP /AP attended delivery Monitor VS q2h and record
Refer for persistence of tachypnea, alar flaring and retractions
O2 at 2 lpm via NC, refer for desaturations <95%
DENGUE FEVER Will inform AP
Please admit under the service of Dr. Pls inform Dr _____ of this admission
TPR q4H and record Thank you.
DAT ( No dark colored foods)
Labs: HYPERSENSITIVITY REACTION
CBC, Plt (optional APTT and PT) Please admit under the service of Dr.
Blood typing TPR q4H and record
U/A (MSCC) Hypoallergenic diet
IVF: Labs:
D5 0.3 NaCl 1P/1L (<40 kg) at 3 5 cc/kg CBC
D5LR 1L (>40 kg) at 3 5 cc/kg U/A (MSCC)
Medications: IVF:
Paracetamol prn q4h for T > 37.8C D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo)
Omeprazole 1mkdose max 40 mg IVTT OD D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
SO: D5LR 1L at 30cc/kg in 8hif >40 kg
MIO q shift and record Medications:
Monitor VS q2h and record, to include BP *Epinephrine (1:1000) 0.1mg/kg/dose IM anterolateral thigh
Continue TSB for fever (max of 0.3 mg)
Refer for Hypotension, narrow pulse pressure (< 20mmHg) *Salbutamol neb x 3 doses q 20 mins
Refer for signs of active bleeding like epistaxis, gum bleeding, Diphenhydramine 10 mkdose LD (max of 200mg IV); thenmg IV)
melena, coffee ground vomitus 5mkdose q6h IV (max of 100
Will inform AP Ranitidine IVTT at 1mkdose q 12h
Pls inform Dr _____ of this admission SO:
Thank you. MIO q shift and record
Monitor VS q2h and record to include BP
Continue TSB for fever
FEBRILE SEIZURE O2 at 2 lpm via NC, or 6 lpm via facemask
Please admit under the service of Dr. Attach to pulse oximeter, refer for desaturations <95%
TPR q4H and record Will inform AP
DAT once fully awake Pls inform Dr _____ of this admission
Labs: Thank you.
CBC BPN
U/A (MSCC) Please admit under the service of Dr.
IVF: TPR q4H and record
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo) NPO if dyspneic
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo) Labs:
D5LR 1L at 30cc/kg in 8hif >40 kg CBC
Medications: U/A (MSCC)
Paracetamol prn q4h for T > 37.8C ABG* CXR APL*
IVF:
SO: D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo) OR
MIO q shift and record D5 IMB/D5 NM at MR if with NO losses
Monitor VS q2h and record D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo)
Monitor neurovital signs q4h and record D5LR 1L at 30cc/kg in 8hif >40 kg
Continue TSB for fever Medications:
Seizure precaution at bedside as ff: Paracetamol prn q4h for T > 37.8C (10 15 mkdose)
Suction machine at bedside USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses
O2 with functional gauge; if with active sz give O2 at 2lpm via NC then refer
Diazepam IVTT (0.3 mkd max of 5 mg IV) prn for seizure NaCl (Muconase) nasal spray, 2 sprays per nostrils, then suction
Will inform AP using bulb QID
Pls inform Dr _____ of this admission Ranitidine IVTT at 1mkdose (if on NPO)
Thank you. SO:
MIO q shift and record
Monitor VS q2h and record
Continue TSB for fever
AGE Refer for persistence of tachypnea, alar flaring and retractions
Please admit under the service of Dr. O2 at 2 lpm via NC, or 6 lpm via facemask
TPR q4H and record Attach to pulse oximeter, refer for desaturations <95%
DAT once fully awake; NPO x 2hrs if with vomiting Will inform AP
Labs: Pls inform Dr _____ of this admission
CBC Thank you.
U/A (MSCC)
F/A (Concentration Method)
IVF: ANTIBIOTICS
D5 0.3 NaCl 1P (50cc/kg in 8 h if <2 yo) Amoxicillin (30 50 mkday) TID
D5 0.3 NaCl 1L (30cc/kg in 8 h if >2 yo) Pediamox Susp : 250mg/5ml
D5LR 1L at 30cc/kg in 8hif >40 kg Drops : 100mg/ml
Medications: Himox Cap : 250mg, 500mg
Paracetamol prn q4h for T > 37.8C Moxicillin Susp : 125mg/5ml 250mg/5ml
Zinc (E Zinc) Harvimox Drops : 100mg/ml
Drops 10mg/ml 1ml OD (<6 mos) Novamox
1ml BID (6 mos 2 yo) Amoxil Susp : 125mg/5ml 250mg/5ml
Syrup 20 mg/5ml (>2 yo) 5ml OD Cap : 250mg 500mg
Ranitidine IVTT at 1mkdose (if with abdominal pain) Glamox Drops : 100mg/ml
SO: Globapen
MIO q shift and record Amoxicillin + Clavulanic acid (30 50 mkday)
Monitor VS q2h and record
Augmentin Tab: 375mg (250mg); 625 (500mg)
Continue TSB for fever
Amoclav Susp: 156.25mg/5ml (125mg) TID
Chart character, frequency and amount of GI losses and replace w/
228.5mg/5ml (200mg) BID
PLR 1L/1P vol/vol
312.5mg/5ml (250mg) TID
Will inform AP
457mg/5ml (400mg) BID
Pls inform Dr _____ of this admission
Thank you. Cloxacillin (50 100 mkday) q6h
Prostaphlin A Tab: 250mg 500mg
Orbinin Susp: 125mg/5ml
Flucloxacillin (50 100 mkday) q6h
Staphloxin Susp: 125mg/5ml
Cap : 250mg 500mg
Chloramphenicol (50 75 mkd) q6h
Pediachlor Susp: 125mg/5ml
Chloramol Tab : 250mg 500mg
Kemicetine
Chloromycetin
CEPHALOSPORINS ANTIVIRAL
1st Generation Acyclovir (20 mkdose) q 4 6 h
Cefalexin (25 100 mkd ) q 6-8 h Max 800mg/day x 5 days
Lexum Cap : 250mg; 500mg Zovirax Susp: 200mg/5ml
Cefalin Susp : 125mg/5ml 250mg/5ml Acevir Blue: 400mg
Keflex Drops : 100mg/ml Pink: 800mg
Ceporex Cap : 250mg 500mg
Selzef Caplet: 1 gm ORAL ANTIFUNGALS
Granules: 125mg/5ml 250mg/5ml Ketoconazole (6mkd) q 4 6h
Drops: 125mg/1.25ml Daktarin Adult & Child: tsp q 6h
2nd Generation Infant: tsp q 6 h
Cefaclor (20 40 mkd ) q 8 12 h Nystatin
Ceclor Pulvule: 250mg 500mg 375mg 750mg Mucostatin Susp: 100,000 u/5ml
Ceclor CD Susp: 125mg/5ml 187mg/5ml Ready mix susp Tab: 500,000 u
CD ext release 250mg/5ml 375mg/5ml Fluoconazole (3 6 mkd) OD x 2wks
Drops: 50mg/ml Diflucan Cap: 50mg 150mg 200mg
Xelent Cap : 250mg 500mg Vial: 2mg/ml x 100 ml
Vercef Susp : 125mg/5ml 250mg/5ml
ANTI-HELMINTHICS
Oxantel + Pyrantel pamoate (10 20 mkd) SD
Trichiuriasis: x 2 days Hookworm: x 3 days
Cefuroxime (20 40mkd) q 12h Quantrel Susp : 125mg/5ml
Zinnat Cap : 250mg 500mg Tab : 125mg 250mg
Sachet: 125mg/sat 250mg/sat Mebendazole *not recommended below 2 yo
Susp: 125mg/5ml Antiox Susp: 50 mg/ml 100mg/ml
Cefprozil (20 40mkd) q 12h Tab: 125mg 250mg
Procef Susp : 125mg/5ml 250mg/5ml 100 mg BID x 3 days
3rd Generation 500mg SD (>2 yo)
Cefixime (6 12 mkd) q 12h Albendazole <2 yo: 200mg SD
Tergecef Susp : 100mg/5ml >2yo: 400mg SD
Zefral Drops: 20mg/ml *may give x 3 days if with severe infestation
Ultrazime Zentel Susp: 200mg/5ml
Cefdinir (7mg/kg q 12h OR 14mg/kg OD) Tab : 400mg
Omnicef Cap : 100mg
Sachet/ Susp: mg/5ml ANTIHISTAMINE
COTRIMOXAZOLE (TM 5 8 mkd) q 12h Diphenhydramine HCl (5mkd) q 6h
Bactille TS Susp/5ml SMZ 400mg TM 80mg IM/IV/PO: 1 2 mkdose
Tab 800mg 160mg Benadryl Syr: 12.5mg/5ml
Bacidal Susp/5ml 400mg 80mg Cap: 25mg 50mg
Trizole Susp/5ml 400mg 80mg Inj: 50mg/ml
Globaxole Tab 800mg 160mg Hydroxyzine (1mkd) BID
Susp/5ml 400mg 80mg Adult: 10mg BID 25mg ODHS
Trimethoprim + Sulfadiazone (TM 5 8 mkd) Iterax Syr: 2mg/ml
Triglobe Tab Sdz 410mg TM 90mg Tab: 10mg 25mg 50mg
Forte 820mg 180mg Ceterizine (0.25mkdose)
Susp/5ml 205mg 45mg 6mos - <12mos : 1ml OD
AMINOGLYCOSIDES 12mos - <2 yo: 1ml OD/BID
Tetracycline 25 50 mkday q6h 2 5 yo: 2ml OD / 1ml BID
Doxycycline 5 mkday BID 6 12 yo: 10ml (2 tsp)OD/ 5ml BID
1 tab OD/ tab BID
Furaxolidone 5 8 mkday q6h
Adult & >12yo: 1 tab OD
MACROLIDES
Virlix Oral drops: 10mg/ml
Erythromycin (30 50 mkd) q 6h
Oral soln: 1mg/ml
Macrocin Susp: 200mg/5ml
Tab: 10mg
Ethiocin Drops: 100mg/2.5ml
Allerkid Drops: 2.5mg/ml
Erycin Cap : 250mg 500mg Syr: 5mg/5ml
Susp: 200mg/5ml
Alnix Drops: 2.5mg/ml
Drops: 100mg/2.5ml
Syr: 5mg/5ml
Erythrocin Film tab: 250mg 500mg Tab: 10mg
Granules: 200mg/5ml
Loratadine 1 2 yo: 2.5 ml BID
DS Granules: 400mg/5ml
2 12 yo (<30 kg): 5ml OD
Drops: 100mg/2.5ml
(>30 kg): 10ml OD
Ilosone/ Tab: 500mg Adult & > 12 y : 1 tab OD
Ilosone DS Pulvule: 250mg
Claritin Syr: 5mg/ml
Liquid: 125mg/5ml
Allerta Tab: 10mg
DS Liquid: 200mg/5ml
Loradex
Drops: 100mg/ml
Desloratadine 6 12 mos: 2ml OD
Clarithromycin (6 15 mkday OR 7.5 mkdose q12h)
1 5 yo: 2.5ml OD
Klaricid Susp : 125mg/5ml 50mg/5ml 6 12 yo: 5ml OD
Klaz Tab: 250mg 500mg
Aerius Syr: 2mg/5ml
Roxithromycin <6 yo 5 8 mkd BID Tab: 5mg
6 12 yo 100mg/tab BID
Macrol/Rulid Tab: 150mg
Ped Tab: 100mg
DECONGESTANT
Rulid dispensable Tab: 50mg
Nasal
NaCl 2 4 drps/spray per nostril TID/QID
Azithromycin 3 day regimen: 10 mkday x 3 days
2 sprays/nostril then suction q6h x 3 days
5 day regimen: 10 mkd on day 1
Salinase Nasal spray
5 mkd on day 2 to 5
Muconase Nasal drops
Adult: 500mg OD day 1
250mg OD day 2 to 5 Oxymetazoline HCl 2 5 yo: 2 3 drops/nostril BID
>5 yo: 2 3 sprays/nostril BID
Zithromax Susp: 250mg/5ml
Cap : 250mg Drixine Nasal spray: 0.05%
Sachet: 200mg/sachet Nasal soln: 0.025%
Clindamycin PO: 20 30 mkday q 6 8h Xylometazoline < 1 yo: 1 2 drps OD/BID
IV: 25 40vmkday q 6h HCl 1 6 yo: 1 2 drps OD/BID max TID
Susp: 75mg/5ml Adult: 2 3 drps / 1 squirt TID max QID
Cap: 150mg 300mg Otrivin
Amp: 150mg/ml Oral
Phenylpropanolamine HCl (0.3 0.5 mkdose)
AMOEBICIDES Disudrin 1 3 mos: 0.25 ml
Metronidazole PO: 30 50 mkday q 8h 4 6 mos: 0.5 ml
IV: 30 mkday q 8h 7 12 mos: 0.75 ml
1 2 yo: 1 ml
Anaerobia Susp : 125mg/5ml
2 6 yo: 2.5 ml
Tab : 250mg
7 12 yo: 5 ml
Servizol Susp: 200mg/5ml
Drops: 6.25ml q6h
Tab : 250mg 500mg
Syr: 12.5mg/5ml q6h
Flagyl Susp : 125mg/5ml
Brompheniramine maleate + PPA
Tab : 250mg 500mg
Dimetapp 1 6 mos: 0.5ml TID/QID
Etofamide (15 20 mkd) TID
7 24 mos: 1ml TID/QID
Kitnos Susp : 125mg/5ml
2 4 yo: tsp
Tab : 200mg 500mg
4 12 yo: 5ml
Adult: 5 10 ml
1 tab BID
Diloxanide furoate (20mkd) q8h x 10 days Infant drops: (0.1mkdose)
Furamide Tab : 500mg Syr
Dilfur Susp: 125mg/5ml Extentab
Secnidazole Carbinoxamine maleate + Phenylephrine HCl
Flagentyl 2 tab now then 2 tabs after 4 hrs Rhinoport 1 5 yo: 5ml BID
Ercefuryl (20mkday) 6 12 yo: 10ml BID
Adult & > 12yo: 1 cap / 15ml BID
Syrup
Cap
Loratadine + PPA Theophylline 10 20 mkdose
Loraped <30 kg: 2.5ml BID 3 5 mkdose
>30 kg: 5ml BID
Syrup: 5mg/ml ANTITUSSIVES
MUCOLYTIC Butamirate citrate 3 yo 5 ml TID
Solmux Drops: 40mg/ml >6 yo 10ml TID
1 3 mos: 0.5ml TID/QID >12 yo 15ml TID
3 6 mos 0.75ml Adult 15ml QID
6 12 mos 1ml 1 tab TID/QID
1 2 yo 1.5 ml Sinecod Forte Syrup 7.5mg/5ml
Tab 50mg
Susp: 100mg/5ml 200mg/5ml
2 3 yo 5ml 2.5ml Dextromethorphan + Guaifenesin
4 7 yo 10ml 5 ml Robitussin DM 2 6 yo 2.5 5ml q 6 8h
8 12 yo 15ml 7.5ml 6 12 yo 5ml q 6 8h
Adult 5 10ml q 6h
Forte: 500mg/5ml Syrup
Cap: 500mg INHALED STEROIDS
Adult & >12 yo: 5 10ml Budesonide
1 cap
Budecort 250mcg q 12h
500mcg q 12h
500mcg OD for allergic rhinitis
250mcg /ml (2ml)
Solmux Capsule
500mcg /ml (2ml)
Broncho Suspension
Flexotide neb 250mcg /ml (2ml)
Solmux Tab: 500mg
Chewable tab 1 tab q 8h 250mcg q 12h
Carbocisteine Infant Drops QID
<3mos 0.25ml ORAL STEROIDS LD: 10mkdose 200mg
3 5 mos 0.5ml MD: 5mkdose
6 8 mos 0.75ml Prednisone 1 2 mkday
9 12 mos 1ml Prednisolone 1 2 mkday
Liquidpred Syrup 15mg/5ml
Ped Syr TID
1 3 yo 5 7.5ml 1 1 tsp ANTACIDS
4 7 yo 7.5 10ml 1 - 2 tsp Maalox 5ml/10kg
8 12 yo 10 15ml 2 3 tsp (plain, plus) Available in 180ml bottle
Simethicone
Adult Susp TID Restime < 2 yo 0.5ml qid
Adult & >12 yo 10 15ml 2 3 tsp 2 12 yo 4ml qid
Oral drops 40mg/ml
Capsule TID ANTISPASMODIC
Adult & >12 yo 1 cap Dicycloverine 6mos 2 yo 0.5 1ml TID
Relestal Drops 5mg/ml
Syrup 10mg/5ml
Lovsicol Infant drops 50mg/ml Domperidone 0.3 0.6 mkdose q 6 8 h
Ped Syrup 100mg/5ml 2.5 5ml/10kg BW TID
Adult Susp 250mg/5ml Dyspepsia: 2.5/10kg TID
Cap 500mg Nausea: 2.5 5ml/kg TID
Ambroxol Infant drops 6mg/ml 75mg/ml BID 0.3 0.6 ml/5kg BW TID/QID
< 6 mo 0.5ml 0.5ml Motilium Susp 1mg/ml
7 12 mo 1 ml 0.75ml Tab 10mg
13 24 mo 1.25ml 1ml
Vometa Oral drops 5mg/ml
Susp 5mg/5ml
Pedia Syrup
Tab 10mg
<2 yo 2.5ml BID
H2-BLOCKER
2 5 yo 2.5ml TID
Ranitidine 1 2 mkdose q 12h
5 10 yo 5ml TID
Zantac Tab 75mg 150mg 300mg
Adult Syrup Cimetidine Neonates: 5 20 mkday q6 12 h
Adult & >10 yo 5ml TID Infants: 10 20 mkday
Child; 20 40 mkday
Retard cap Adult: 300mkdose QID
Adult & >10 yo 1 cao OD 400mkdose BID
800mkdose QID
Tab Tagamet Susp: 300mg/5ml
Adult & >10 yo 1 tab TID Tab: 100mg 200mg 300mg 400mg 800mg
Famotidine PO: 0.5 mkdose q 12 h
Inhalation IV: 0.6 0.8 mkday q 8 12h
<5 yo 1 2 inhalation of 2ml soln daily
Adult & children >5 yo 1 2 inhalation of 2 3ml soln daily
Mucosolvan Infant drops 6mg/ml
Ped liquid 15mg/5ml ANTIPYRETIC
Adult liquid 30mg/5ml Paracetamol (10 20 mkdose) q 4h
Retard cap 75mg Tempra Drops: 60mg/0.6ml
Tab 30mg Syrup: 120mg/5ml
Inhalation Soln 15mg/2ml Forte : 250mg/5ml
Ampule 15mg/2ml Tablet: 325mg 500mg
Ambrolex Infant drops 7.5mg/ml Calpol Drops: 100mg/ml
Zobrixol Ped liquid 15mg/5ml Syrup: 120mg/5m
Adult liquid 30mg/5ml 250mg/5ml
Tab 30mg Defebrol Syrup: 120mg/5m
B2 AGONIST 250mg/5ml
Salbutamol (0.1 0.15 mkdose) Afebrin Drops: 60mg/0.6ml
Ventolin Tab 2mg Syrup: 120mg/5ml
Syr 2mg/5ml Forte : 250mg/5ml
Nebule 2.5mg/2.5ml Tablet: 600mg
Ventar Tab 2mg Tylenol Drops: 80mg/ml
Hivent Syrup Syr 2mg/5ml Syrup: 160mg/5ml
Salbutamol + Guaifenesin Naprex Drops: 60mg/0.6ml
Asmalin Tab Syrup: 250mg/5ml
Broncho 1 tab TID Inj: 300mg/2ml
Syrup Rexidol Drops: 60mg/0.6ml
Pulmovent 2 6 yo 5 10 ml BID/TID Syrup: 250mg/5ml
7 12 yo 10ml Tablet: 600mg
Biogesic Drops: 100mg/ml
Syrup: 120mg/5m
Terbutaline sulfate ( 0.075 mkdose) 250mg/5ml
Terbulin Tab 2.5mg Tablet: 500mg
Pulmoxel Tab 2.5mg Aeknil Ampule (2ml) 150mg/ml
Syr 1.5mg/5ml Opigesic Suppository: 125mg 250mg
Nebule 2.5mg/ml Mefenamic Acid (6 8mkdose) q 6h
Bricanyl Tab 2.5mg Ponstan Suspension: 50mg/5ml
Syr 1.5mg/5ml Cap SF: 250mg
Nebule 5mg/2ml Tab: 500mg
Expectorant Aspirin (60 100 mkd)
Doxophelline (6 8 mkdose) BID x 7 10 days Ibuprofen (5 10 mkday) q8h (max 20mkday)
Ansimar Syrup 100mg/5ml Dolan FP Suspension: 100mg/5ml
Tab 400mg Dolan Forte 200mg/5ml
Drops: 100mg/2.5ml
Procaterol HCl (0.25ml/kg) Advil 100mg/5
Meptin Syrup 5mcg/ml Tab: 200mg
Tab 25mcg
Nebuliser soln 100mcg/ml
 IV ANTIBIOTICS
Penicillin 50,000 100,000 ukd q 6h ASSESSMENT OF DEHYDRATION [CDD]
Amoxicillin 50 100 mkd q 6 8 h PARAMEeTER NO SIGN SOME SIGN SEVERE
Ampicillin 50 100 mkd q 6 8 h Condition Well, Alert RestlessI Lethargic
Chloramphenicol 50 100 mkd q 4 6 h Irritable Unconscious
Ampi + Cloxa 50 100 mkd q 6 h Floppy
Oxacillin 50 100 mkd q 6 8 h Eyes Normal Sunkem Very sunken
Flucloxacillin 50 100 mkd q 6 8 h Dry
Gentamicin 5 7.5 mkd OD Tears Present Absent Absent
Netromycin 5mkd q 12 h Mouth/Togue Moist Dry Very dry
Amikacin 15mkd q 12 h Thirst Drinks normally Thirsty Drinks poorly
Cephalexin 50 100 mkd q 6 h Not thirsty Drinks eagerly Not able to drink
Cefuroxime 50 100 mkd q 6 8 h Skin pinch Goes back quicly Goes back slowly Goes back very
slowly
Ceftriazone 50 100 mkd OD
Ceftazidime 50 100 mkd q 12 h
HYDROCORTISONE LD: 10 mkdose
MD: 5 mkdose q 6, 8 or 12h
ORAL REHYDRATION THERAPY
*max dose: LD 200 MD 100
PLAN A AGE Amount ORS to give/loose stool
ANTICONVULSANT
50 100 ml
Diazepam 0.2 0.3 mkdose
100 200 ml
Drip: 1amp in 50cc D5W
As much as wanted
10mg/amp
PLAN B Amount of ORS to give in 1st 24 hrs:
Midazolam 0.15 mkdose OR
Weight (kg) x 75ml/kg
0.05 0.2 mkdose
PLAN C AGE 30ml/kg 70ml/kg
Phenobarbital LD: 10 mkdose q 12h
MD: 5 mkdose q 12h Infants (<1 yo) 1 hr 5 hrs
Children (>1 yo) 30 mins 2.5 hrs
ANTIHYPERTENSIVES
Hydralazine PO: 0.75 1.0 mkday q 6 12 h
In fluid resuscitation: use 20cc/kg as bolus. Usually PLR
Apresoline IV: 0.1 0.2 mkdose
Spirinolactone 1 3 mkday
ANTI-TB MEDS
Isoniazid (10 12 mkd) ODAC or 2hrs PC
FLUID MANAGEMENT
Comprilex Suspension:
Severity Less than 2 yo More than 2 yo
Nicetal 200mg/5ml
Mild 50cc/kg 30cc/kg
Trisofort 100mg/5ml
Odinah 200mg/5ml Moderate 100cc/kg 60cc/kg
150mg/5ml Severe 150cc/kg 90cc/kg
Tablet 400mg To run for 6 8 hrs then refer
Rifampicin (10 20 mkd) ODAC or 2hrs PC Usual fluid is D5 0.3 NaCl; if however more than 40 kg then D5 LR
Natricin 100mg/5ml 200mg/5ml
Rifadin 100mg/5ml
100mg/5ml PCAP
Rimactane 200mg/5ml VARIAle BLE PCAP A PCAP B PCAP C PCAP D
Rimaped Tablet 300mg 450mg Minimal Risk Low Risk Moderate Risk High Risk
Pyrazinamide (PZA) (16 30 mkd) BID/TID Comorbid None Present Present Present
CIBA 250mg/5ml Illness
Zcure Compliant Yes Yes No No
Zinaplex 500mg/5ml caregiver
Tablet 500mg Ability to follow Possible Possible Not Not
up
Presence of None Mild moderate Severe
COMPOSITION OF ORS dehydration
Na K Cl Glu Ability to feed Able Able Unable Unable
Glucolyte 60 20 50 100 Age >11 mos >11 mos <11 mos <11 mos
Hydrite 90 20 80 111 RR
WHO 75 20 65 75 2 12 mos >50/min >50/min >60/min >70/min
Pedialyte 30 30 20 30 1 5 yo >40/min >40/min >50/min >50/min
45 45 20 35 >5 yo >30/min >30/min >35/min >35/min
90 90 20 80 Signs of Respiratory Failure
Gatorade 41 11 9/100 Retractions - - Subcostal/ Subcostal/
Intercostal Intercostal
Head babbing - - + +
Cyanosis - - + +
IMMUNIZATION Grunting - - - +
Apnea - - - +
Vaccine Min age 1st dose No of dose interval booster Sensorium None Awake Irritable Lethargy /
Stupor
BCG At birth 1 - - Coma/
Before 1 mo Complication:
DPT 6 wks 3 4 wks 18 mos Effusion None None Present Present
(2, 4, 6 mos) 4 6 yo Pneumothorax
OPV/IPV 6 wks 3 4 wks Same as Action Plan OPD OPD Admit to Admit to CCU
2, 4, 6 mos) DPT f/u at end of tx f/u after 3 days regulat ward Refer to
Hep B At birth 3 6 wks from 1st specialist
(0, 1, 6 mos) dose, 8
EPI (6, 10, 14) wksfrom 2nd
dose Clinical Practice Guidelines in the Evaluation and Management of PCAP 2004
Measles 6 9 mos 1 - Predictors of CAP in patients with cough
(3 mos to 5 yrs) tachypnea &/or chest retractions
MMR 15 mos 1 (5 12 yrs) fever, tachypnea & crackles
(>12 yo) (a) fever, tachypnea & tachycardia; (b) at least 1 AbN CXR
Hib 2, 4, 6 mos 18 mos
WHO Age Specific classification for tachynea
Pneumococcal 6 mos (PCV7) 18 mos 2 12 mos: >50 RR
2 yrs (PPV) 1 5 yrs: >40 RR
Rotavirus 3 and 5 mos 2 I month >5 yrs: >30 RR
PCAP A/PCAP B
Hep A 1 yr and up 2 6 12 mos No diagnostic usually requested
apart PCAP C/PCAP D
Varicella 1st: 12 15 mos 2 Bet 1st and 2nd The ff shud b routinely requested
2nd: 4 6 yo dose: at least 3 o CXR APL (patchy viral; consolidated bacterial)
mos o WBC
Flu 6 months yearly o C/S (blood, Pleural Fluid, tracheal aspirate on initial intubation)
o Blood gas/Pulse oximeter
The ff may be requested: C/S sputum
The ff shud NOT be routinely requested
COMPOSITION OF IV SOLUTION o ESR
Fluid Na K Cl HCO3 Dxt o CRP
PNSS 154 - 154 - -
0.45 NaCl 77 - 77 - - Antibiotic Recommendation
D5 0.3 NaCl 51 - 51 - 5 1. PCAP A/PCAP B and is beyond 2 yo & having fever w/o wheeze
2. PCAP C and is beyond 2 yo, having high grade fever, having alveolar consolidation on CXR,
D5 LRS 130 4 109 28 5
having WBC >15,000
D5 NM 40 13 40 16 5
3. PCAP D refer to specialist
D5 IMB 25 20 22 23 5
Antibiotic Recommendation
D5 NR 140 5 98 27 5 PCAP A/PCAP B w/o previous antibiotic
o Amoxicillin (40 50 mkday) TID
Na requirement : 2 4 meq/k/day PCAP C
K requirement: 2 3 meq/k/day o Pen G IV (100,000 IU/k/d) QID
KIR: 0.2 0.3 meq/k/hr max of 40 meq PCAP C who had no HiB immunization
o Ampicillin IV (100mkd) QID
KIR = Rate x incorporation PCAP D refer to specialist
wt
What shud b done if px is not responding to current antibiotics foley cath & monitor UO)
1. If PCAP A/PCAP B not responding w/n 72 hrs 7. Inotropes help stabilize BP
a. Change initial antibiotic o Epinephrine - (0.1 1 ug/kg/min)
b. Start oral Macrolide Infusion of choice for Hypotensive pxs
c. Reevaluate dx o Dobutamine - (5 20 ug/kg/min)
2. PCAP C no responding w/n 72 hrs consult w/ specialisr Cardiogenic shock but not severely hypotensive
a. PCN resistant S pneumonia o Dopamine [(5 20 ug/kg/min constrictor effect) [(10
b. Complication 15 ug/kg/min]
c. Other dx Distributive shock after successful fluid resuscitation
3. PCAP D not responding w/n 72hrs, then immediate consultto a specialist is warranted 8. Cardiogenic shock
Switch from IV to Oral Antibiotic done in 2 3 days after initiation in px who: o Diuretic pxs may get worse after fluid challenge
Respond to initial antibiotic o Adenosine / synchronize cardioversion SVT
Is able to feed with intact GI tract o Defibrillation Venticular fibrillation
Does not have any pulmo or extra pulmo complication
Ancillary Treatments
O2 and Hydration MUMPS [Paramyxoviridae]
Bronchodilators, CPT, steam inhalation and Nebulization MOT Direct contact, airborne droplets, fomites contaminated by saliva
Prevention IP 16 18 days
Vaccines Prd of comm 1 2 days before onset of parotid swelling until 5 days after the onset of
Zinc Supplementation swelling
o 10mg for infants Prodorme Fever, neck muscle pain, headache, malaise
o 20mg for children > 2 yo Parotid gland Peak in 1 3 days
swelling 1st in the space between posterior border of mandible & mastoid
then extends being limited above zygoma
DENGUE HEMORRHAGIC FEVER Complications Meningoenephalitis - most frequent, about 10 days; M>F
Serotype 1, 2, 3, & 4 Orchitis & Epididymitis
Aedes egypti Oophoritis
IP: 4 6 days (min 3 days; max 10 days) Dacryoadenitis or optic neuritis
DHF SEVERITY GRADING

GRADE MANIFESTATION
I Fever, non-specific constitutional symptoms such as anorexia, vomiting ANAPHYLAXIS
and abdominal pain (+) Torniquet test A syndrome involving a rapid & generalized immunologically mediated rxn
II Grade I + spontaneous bleeding; mucocutaneous, GI After exposure to foreign allergens in previously sensitized individuals
III Grade II w/ more severe bleeding + A true emergency when cardio and respi system are involved
Evidence of circulatory failure: violaceous, cold & clammy skin, restless, ED Management
weak to imperceptible pulses, narrowing of pulse pressure to < 20mmHg o O2
to actualHPON o Aqueous Epinephrine 1:1000 IM (0.01ml/kg with 0.5ml max)
IV Grade III but shock is usually refractory or irreversible and assoc w/ o Prepare intubation if w/ stridor & if initial therapy of epi is not effective
massive bleeding o Continuous monitor ECG and O2 sat & establish IV access
o Antihistamine to prevent progression
o H1 & H2 blocker
CRITERIA FOR CLINICAL DX (WHO) o Diphenhydramine (1mg/kg) IM
DHF DSS o Steroids may modify late phase or recurrent reaction (Hydrocortisone
Fever, acute onset, high, lasting 2 7 Above criteria 5mg/kg/dose)
days Plus o Epinephrine 1:10,000 IV (0.1ml/kg; 10ml max)
Hemorrhagic man: Hypotension or narrow pulse o Epinephrine drip (0.01ml/kg/min)
o (+) Torniquet test pressure [SBP DBP] <20mmHg Indication for Admission
o Minor & Major bleeding o Persistent bronchospasm
phenomenon o Hypotension requiring vasopressors
Thrombocytopenia <100,000/mm3 o Significant hypoxia
o Patient resides some distance from a hospital facility

LEVELS OF ASTHMA CONTROL [GINA GUIDELINES] VIRAL INFECTIONS

CONTROLLED PARTLY UNCONTROLLED MEASLES (Rubeola) [Paramyxoviridae]
Daytime symptom None [2x or More than 2x a week Three or more MOT Droplet spray
less/week] features of partly IP 10 12 days
Limitation of activities None Any controled asthma Prd of comm 4 days before & 4 days after onset of rash
Nocturnal None Any present in any Enanthem Koplik spots (opposite lower molars)
sx/awakening week Prodrome High grade fever, conjunctivitis, catharr (3 5 days)
Need for None More than 2x a week Rash Appear during height of fever
reliever/recue tx Cephalocaudal[1st along hairline, face, chest]
Lung function Normal 80% predicted [+] brawny desquamation disappear w/n 7 10 days
(PEF OR FEV1) Complication 1. Otitis media
Exacerbation None One or more/yr One in any week 2. Pneumonia
3. Encephalitis
4. Diarrhea
ATOPIC DERMATITIS CONTACT DERMATITIS SEBORRHEIC 5. Exacerbation of M tb infection
DERMATITS Tx Vit A SD 100,000 IU orally for 6 mos 1 yo
Hereditary, AR Irritant strong excessive sebum 200,000 IU >1 yo
hx of Asthma chem. accumulation on Post exposure Ig w/n 6 days of exposure
thickened, shiny, e.g. diaper rash scalp, face, prophylaxis (0.25ml/kg max 15 ml) IM
red remove reactant midchest, perineum Vaccine Susceptible children >1 yo w/n 72 hrs
exacerbated by dry greasy scalp (cradle SSPE Chronic condition due to persistent measles infxn
skin, contact sty, & Allergic cap) Rare but found in 6 mo to >30 yrs of age
anxiety physiologic 1st Subtle change in behavior & deterioration o schoolwork followed
tx: hydrocortisone/ e.g. cosmetic, 6mos by bizarre behavior
fluocinolone perfume tx: low potency Elevated titers of Ab to measles virus(IgG, IgM)
moisturizer tx: high/mod steroid Inosiplex (100mg/kg/day) may prolong survival
cloxa/cefalexin if petency steroid GERMAN OR 3 DAY MEASLES [RUBELLA] [Togaviridae]
with infxn MOT Oral Droplet; transplacentally to fetus
IP 14 21 days
Prd of comm 7 days before &7 days after onset of rash
Enanthem Forchheimer spots [soft palate] just b4 onset of rash
Rash Cephalocaudal
SHOCK Characteristic Retroauricular, posterior cervical & postoccipital LAD [24 hrs before rash &
CO = HR x SV sign remains for 1 wk]
CO is primarily maintained by changes in HR Tx Vit A SD 100,000 IU orally for 6 mos 1 yo
HYPOVOLEMIC Pump empty MC in infant &children 200,000 IU >1 yo
Truma, hemorrhage, DHN Normal BV of children Post exposure Immunoglobulin [not routine]
(diarrhea/vomiting), 80ml/kg prophylaxis Considered if termination of preg is not an option
Metabolic dse (DM) 0.55ml/kg) IM
Excessive sweating Vaccine w/n 72 hrs of exposure
CARDIOGENIC Weak/sick pump Compromise CO Congenital Greatest during 1st trimester
CHF, cardiomegaly, drug Rubella IUGR
intoxication, hypothermia, Congenital cataract, microcephaly, PDA, blueberry muffin skin
after cardiac surgery lesions
DISTRIBUTIVE Sepsis Redistribution of fluid w/n Congenital or profound SNHL
Anaphylaxis vascular space Motor or mental retardation
Barbiturate intox ROSEOLA [HSV 6] Exanthem subitum
CNS injury (SCI)
Age of onset < 3 yo with peak at 6 15 months
SIGNS OF SHOCK
High grade fever for 3 5 days but behave normally
EARLY LATE
Rash Appears 12 24 hrs of fever resolution fades in 1 3 days
Narrowed pulse pressure Decrease systolic pressure
HERPANGINA [Coxsackie A]
Orthostatic changes Decrease diastolic pressure
Sudden onset of fever with vomiting
Delayed capillary filling Cold, pale skin
Small vesicles & ulcers w/ red ring found in anterior tonsillar pillars, may also
Tachycardia Altered mental state
seen on the soft palate, uvula & pharyngeal wall
Hyperventilation Diaphoresis
Decrease urine output
ED MNGT 1. Position
2. Oxygen
3. Assisted ventilation
4. Intravenous access
5. Fluid (isotonic crystalloid)
6. Reassess (look for improvement in VS, skin signs, mental status; insert
VARICELLA [HSV] Microbial causes of CAP accrdng to Age
MOT Direct contact Birth to 20 days o Grp B Strep
IP 14 days o Gram (-) enterobacteria
Prd of comm 1 2 days before the onset of the rash until 5 6 days after onset & all the o CMV
lesions have crusted o L. monocytogenesis
Rash Start from the trunk then spread to othe parts of the body 3 weeks to 3 o RSV
All stages present; pruritic months o Parainfluenza virus
Macule/papule vesicle crust o S. pneumonia
Complication Secondary bacterial infection o B. pertussis
Encephalitis or meningitis o S. aureus
Pneumonia 4 months to 4 o RSV, Parainfluenza virus
Reye syndrome yo o Influenza virus, Adeno, Rhinovirus
GN o S. pneumonia
Congenital 6 -12 wks AOG: maximal interruption w/ limb devt with cicatrix(ski o H. influenzae
Varicella lesion w/ zigzag scarring) o M.pneumoniae
16 20 wks: eye and brain involvement o M.tuberculosis
Tx Acyclovir 15 30 mg/kg/day IV or 200 400 mg tab q 4hrs minus midnight 5 years to o M.pneumoniae
dose x 5 days: increased risk o severity 15 years o C. pneumoniae
Post exposure VZIg 1 dose up to 96 hrs after exposure o S. pneumonia
prophylaxis Dose: 125 U/10 kg (max 625 U) IM o M.tuberculosis
NB whos mother develop varicella 5 days before to 2 days after delivery
shud recv 1 vial
Vaccine Susceptible children >1 yo w/n 72 hrs Therapeutic Mgt of CAP
ERYTHEMA INFECTIOSUM [Parvovirus B 19] FIFTH DISEASE OPD Mngt
MOT Droplet spread & blood & blood products Birth to 20 days Admit
IP 16 17 Days average
Prodrome Low grade fever, headache, URTI 3 weeks to 3 Afebrile: Oral Erythromycin (30-40mkd)
Rash Erythematous facial flushing slapped cheek and spreads rapidly to the months Oral Azithromycin (10 mg/kg/day) day 1
trunk & proximal extremities as a diffuse macular erythema 5mkday day2 to 5
Palms & soles are spared Admit: febrile or toxic
Resolves w/o desquamation but tend to wax and wane in 1 3 wks
4 months to 4 yo Oral Amoxicillin (90mkd/3doses)
Dengue insert Alternative: Amox-Clav, AZM, Cefaclor
Rabies Clarithromycin, Erythromycin
5 years to Oral Erythromycin (30-40mkd)
JUVENILE RHEUMATOID ARTHRITIS [JRA] 15 years Oral AZM 10mkday day 1, 5mkday day 2-5
Criteria Age of onset <16 yo Clarithromycin 15mkday/2 doses
Arthritis (swelling or effusion or presence of 2 or more of: Pneumococcal infxn: Amoxicillin alone
limitation of range of motion, tenderness or pain on motion,
increased heat in one or more joints. IN-PATIENT
Duration: 6 wks or longer Birth to 20 days Ampicillin + Gentamicin w or w/o Cefotaxime
Onset type defined in the 1st 6mos
o Polyarthritis: (5 or more inflamed joints)
o Oligoarthritis (<5) 3 weeks to 3 Afebrile: IV Erythromycin (30-40mkd)
o Systemic arthritis w/ characteristic fever months Febrile: add Cefotaxime 200mkd
Cefuroxime 150 mkd
CM Morning stiffness, ease of fatigue esp. after school in the early
afternoon, joint pain later in the day, joint swelling 4 months to 4 yo If w/ pneumococcal infection:
Pauci: LE, assoc w/ chronic uvietis IV Ampicillin (200mkd) Cefotaxime 200mkd
Poly: both large & small joints more severe if extensors of elbow Cefuroxime 150 mkd
and Achilles tendon are involved
Systemic: quotidian fever w/ daily temp spikes of 39C for 2 wks; 5 years to Cefuroxime 150 mkd + Erythromycin 40mkd
faint red macular rash over the trunk & proximal extremities 15 years IV or orally for 10-14 days
If pneumococcal is confirmed:
Mngt NSAIDS then Methotrexate
Ampicillin 200mkd
Seroid for overwhelming systemic illness

SYSTEMIC LUPUS ERYTHEMATOSUS [SLE]

Criteria Malar rash
Discoid rash
Photosensitivity
Oral ulcers (painless)
Nonerosive arthritis (2 or more joints)
Serositis (pleuritis, serous pericarditis,Libman sacks endocarditis
Renal disorder
Neurologic disorder CLINICAL FEATURES of PNEUMONIA
Hematologic disorder Bacterial o Fever >38.5C
Immunologic disorder o Chest recession
ANA abormal titer o Wheeze not a sign of primary bacterial URTI
Dx Presence of 4 of 11 criteria [ANA not required dx] Viral o Wheeze
(+) ANA screening o fever < 38.5
Anti ds DNA more specific; reflects the degree of disease activity o marked recession
Decrease C3, C4 in active dse o RR normal or increased
Anti Sm Ab (most specific) Mycoplasma o School children
Mngt NSAIDS use w/ caution o Cough
Prednisone (1 2 mkday) o wheeze
Severely ill: pulse IV steroid (30mkdose) max 1 gm over 60 mins OD CXR in assessing CAP etiology
x 3 days Alveolar infltrates Bacterial pneumonia
Severe dse: Pulse IV Cyclophosphamide to maintain renal fxn &
Interstitial infiltrates Viral pneumonia
prevent progression
Both infiltrates Viral, Bacterial or mixed viral bacterial
HENOCH SCHONLEIN PURPURA [HSP]
pneumonia
Most common cause of nonthrombocytopenic purpura in children
Typically follows URTI
2 8 years old
PHOTOTHERAPY
Hallmark Rash palpable petechia or purpura, evolve from red to brown;
o 10 Bulbs
last from 3 10 days [LE and buttocks]
o 20 watts
Arthritis of knees and ankles
o 200 hrs
Intermittent abdominal pain due to edema & damage to the
o 30 cms
vasculatue of the GIT
o Bilirubin in the skin absorbs light energy
Mngt Symptomatic
o Photo-isomerization reaction converting the toxic native unconjugated 4Z,
Steroid for severe abdominal pain
15Z-bilirubin into an unconjugated configurational isomer 4Z,15E-bilirubin,
which can then be excreted in bile without conjugation
o major product from phototherapy is lumirubin, which is an irreversible
MAINTENANCE WATER structural isomer converted from native bilirubin and can be excreted by the
HOLLIDAY SEGAR METHOD kidneys in the unconjugated state
Weight [kg] Daily Requirement [ml/kg] o Complications
3 10 100 ml o loose stools, erythematous macular rash, purpuric rash associated with
10 20 1000 + 50ml/kg for each kg >10 transient porphyrinemia, overheating, dehydration (increased insensible
>20 1500 + 20ml/kg for each kg >20 water loss, diarrhea), hypothermia from exposure, and a benign condition
Maintenace water rate called bronze baby syndrome dark, grayish-brown skin discoloration in
0 10 4ml/kg/hr infants
10 20 40 mk/hr + 2ml/kg/hr x wt
>20 60 mk/hr + 1ml/kg/hr x wt
Treatment of Hyperbilirubinemia
Phototherapy Pathogenesis of Dengue Hemorrhagic Fever
Exchange transfusion o Complications: metabolic acidosis, electrolyte
abnormalities, hypoglycemia, hypocalcemia, Dengue Virus
thrombocytopenia, volume overload, arrhythmias,
NEC, infection, graft versus host disease, and
death Liver Lymphoblast/plasma Platelet
Cell
IV Ig o Adjunctive treatment for hyperbilirubinemia due
to isoimmune hemolytic disease
o (0.51.0 g/kg/dose; repeat in 12 hr) Liver injury Ag-Ab reaction Dec maturation
o Reducing hemolysis Megakaryocyte
Metalloporphyrins o Competitive enzymatic inhibition of the rate Inc plt destruction
limiting conversion of heme-protein to biliverdin
(an intermediate metabolite to the production of
unconjugated bilirubin) by heme-oxygenase Dec coagulation Inc Vascular Thrombocytopenia
o Patients with ABO incompatibility or G6PD Factors Permeability
deficiency or when blood products are
discouraged as with Jehovah's Witness patients
Inc. Bleeding Hypoalbuminemia Bleeding
VACCINES Tendency Hemoconc.
BCG Live attenuated M bovis Pleural Effusion
DPT Diptheria and TT inactivated B pertussis
OPV Sabin trivalent live attenuated virus
IPV Salk inactivated virus Hypotension
MMR, Measles Live attenuated virus
Varicella
Hep B Recombinant DNA, plasma derived
Hep A Inactivated virus
Hib Capsular polysacc linked to carrier CHON
Typ Live typhoid vaccine 3 doses x 2 days
MANAGEMENT APPROACH BASED ON CONTROL
IMSC Vi antigen typ vaccine
Step 1 Step 2 Step 3 Step 4 Step 5
Pneumococcal Capsular polysaccharide 0.5 ml
PRN B2 Asthma education and Environmental control
SC /IM 23 valent purified cap
agonist As needed rapid acting B2 agonist
Polysacc Antigen of 23 serotyp
Influenza Split or whole virus IM Select one Select one Add one or Add one
more or more
C Low dose ICS Low dose ICS Med to Hi Oral
O + LABA dose steroids
RABIES VACCINE
N ICS + LABA
VERORAB 0.5 cc/amp; 1 amp IM
T Leukotriene Medium or Hi Leukotriene
Day: 0 3 7 14 and 28
R modifier dose ICS Modifier Anti
BERIRAB RD: 20 iu/kg O Low dose Sustained IgE
300 iu/vial 1 vial = 2ml L ICS + Release treatment
at wound site L Leukotriene theophylline
deep IM E Modifier
Reqd amt in IU: wt x RD (20IU) R Low dose
Amount in ml = wt x RD (20) x 2
ICS +
300
Salbutamol
Ig (Human) 20 iu/kg
Release
Bayrab 300 iu/2ml
theophylline
Equine Berirab 300 iu/2ml
40 iu/kg
Favirab 200 400 iu/5ml
1000 2000 iu/5ml
SEVERITY OF ASTHMA EXACERBATION
Hx of Clean minor Wound All other Wounds
MILD MODERATE SEVERE RESPIRATO
Absorbed TT
RY
Td TIG Td TIG
ARREST
Unknown or Yes No Yes Yes IMMINENT
<3
Breathless Walking Talking At rest
> No No No No Infant softer Infant
< 7 yo Dtap is recommended shorter cry stops
> 7 yo Td is recommended Diff feeding feeding
If ony 3 doses of TT received, a 4th dose should be given
Give TT (clean minor wounds) if > 10 y since last dose Can lie Prefers sitting
All other wounds (punctured wds, avulsions, burn) Hunched
Give TT (all clean wds) if > 5 yrs since last dose Talks in Sentences Phrases Words

BILIRUBIN METABOLISM Allertness May b Usually Usually Drowsy or

RBC agitated agitated agitated confused

Heme +Globin RR Inc Inc >30/min

Heme oxygenase Normal RR
<2 mo <60/min
Biliverdin 2-12 mo <50/min
Bilirubin reductase 1-2 y <40/min
2-8 y <30/min
Unconjugated bilirubin Acessory Usually Usually Usually Paradoxical
ms not Thoracoabd
Enterohepatic pathway movt
Liver SER Wheeze Moderate Loud Usually Absence of
Glucoronyl transferase B-glucoronidase loud wheeze
Pulse <100 100-200 >120 Bradycardia
Conjugated bilirubin Normal PR
2-12 mo <160/min
1-2 y <120/min
Kidney Small intestine 2-8 y <110/min
Urobilinogen Stercobilinogen Pulsus Absent Maybe Often Absence
Urobilin Stercobilin paradoxus present present suggests
Urine Stool <10mmHg 10-25mmHg 20-40 resp ms
mmHg fatigue
PEF >80% 60-80% <60%
PaO2 Normal >60 mmHg <60mmHg

PaCO2 <45 mmHg <45 mmHg >45 mmHg

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

SEIZURE
BENIGN FEBRILE SEIZURE CRITERIA
6 mos 6 yrs
< 15 mins
Febrile
Family history of febrile seizure
GTC
Not > 1 episode in 1 febrile episode; EEG done after 2 wks of seizure episode
3% of general population develop epilepsy
1 2 % of BFS develop epilepsy
25% recurrence of seizure
Seizure paroxysmal, time limited change in motor activity and/or behavior
that results from abnormal electrical activity in the brain
Epilepsy present when 2 or more unprovoked seizure s occur at an interval
greater than 24 hrs apaet
 HYDROCEPHALUS NEWBORN CARE
Result from impaired circulation & absorption of CSF or from inceased production Umbilical Cord
Obstructive or Noncommunicating Cut 8 inches above abdomen after 30 sec
o Due to obstruction w/n ventricular system In nursery, cut the umbilical cord 1 inch above the abdomen
o Abnormality of the aqueduct or a lesion in the 4th venticle (aqueductal Healing should take place around 7 10 days
stenosis) Eye Prophylaxis
Non-obstructive or Communicating 1% silver nitrate drops [most effective against Neisseria]
o Obliteration of the subarachnoid cisterns or malfunction of the Erythromycin 0.5% [Clamydia]
arachnoid villi Tetracycline 1%
o Follows SAH that obliterates arachnoid villi; leukemic infiltrates Povidone iodine 2.5%
Clinical Manifestation Vitamin K
Infant: accelerated rate of enlargement of the head; wide anterior fontanel & bulging 1 mg Vit K1
[Normal fontanel size: 2 x 2 cm] PT: 0.5 mg
Eyes may deviate downward: due to impingement of the dilated suprapineal recess Vaccine
on the tectum [setting sun sign] BCG
Long tract sign: [brisk DTR, spasticity, clonus, Babinski sign] Hep B
Percussion of skull produce a crackedpot or Macewen sign [separation of sutures] Newborn Screening
Foreshortened occiput [Chiari malformation] Done on 16th hr of life . can be repeated after 2 weeks
Prominent occiput [Dandy-Walker malformation] Patients w/ CAH will die 7 14 days if not treated
Treatment Patient w/ CH will have permanent growth defect and MR if not treated before 4
Depends on the cause weeks
Extracranial shunt Disorder Screened Effects Screened Effects if Screened &
Acetazolamide & Furosemide [provide temporary relief by reducing the rate of CSF treated
production] Congenital Hypothyroidism Severe MR Normal
(CH)
BELLS PALSY Congenital Adrenal Death Alive &Normal
Acute unilateral facial nerve palsy that is not associated with other cranial Hyperplasia (CAH)
neuropathies or brainstem dysfunction Galactosemia (Gal) Death of Cataract Alive &Normal
Usually develops abruptly about 2 wks after SVI [EBV, HSV, mumps] Phenylketonuria PKU Severe MR Normal
Upper and lower portions of the face are paretic G6PD Severe Anemia Normal
Corner of the mouth droops Kernicterus
Unable to close the eye on the involved side
Protection of cornea with methylcellulose eye drops or an ocular lubricant
Excellent prognosis
NEONATAL JAUNDICE
Risk Factors
CEREBRAL PALSY o Jaundice visible on first day of life
Non-progressive disorder of posture & movement often associated with epilepsy & o A sibling w/ neonatal jaundice or anemia
abnormalities of speech, vision & intellect resulting from defect or lesion of the o Unrecognized hemolysis
developing brain o Non-optimal feeding
Etiology: infections, toxins, metabolic, ischemia o Deficiency: G6PD
Classification o Infection
Physiologic Topogrphic o Cephalhemaoma or bruising / Central hct >65%
[major motor abnormality] [involved extremities] o East Asian/ Mediteranean in origin
1. Spastic 1. Monoplegia [1 side/portion] PHYSIOLOGIC vs PATHOLOGIC
2. Athetoid worm like 2. Paraplegia FACTORS PHYSIOLOGIC PATHOLOGIC
3. Rigid 3. Hemiplegia Onset > 24 hrs of life < 24 hrs of life
4. Ataxic 4. Triplegia [3 limbs] Rate of inc of TSB < 0.5mg/dl/hr > 0.5mg/dl/hr
5. Tremor 5. Quadriplegia [all]
Persistent < 14 days FT: > 8 days
6. Atonic 6. Diplegia [LE/UE]
PT: > 14 days
7. Mixed 7. Double hemiplegia
Total S. Bilirubn FT: < 12 mg/dl Any level requiring
8. unclassified
PT: < 14 mg/dl phototherapy
Clinical Manifestaion
Sign/ Symptom Vomiting, lethargy, poor
Spastic hemiplegia Arms > legs
feeding, excess wt loss,
Dificulty in hand manipulation obviously by 1 yo
apnea, inc RR, temp
Delayed walking or walk on tiptoes
instability
Spasticity apparent esp. in ankles
KRAMER CLASSIFICATION
Seizure & cognitivr impairment
ZONE JAUNDICE mg/dl
Spastic diplegia Bilateral spasticity of the legs
Commando crawl I Head/neck 68
Increased DTRs & (+) Babinski sign II Upper trunk 9 12
Normal intellect III Lower trunk, thigh 12 16
Spastic quadriplegia Most severe form, due to marked motor impairment of all IV Arms, leg, below knee 15 18
extremities & high association with MR & seizures V Hands/feet > 15
Swallowing difficulties
Management BREAST FEEDING vs BREASTMILK JAUNDICE
Baseline EEG & cranial CT scan Parameter BREASTFEEDING BREASTMILK
Hearing & visual function tests Onset 3rd to 5th day of life Late; start to rise on day 4; may
Multidisciplinary approach in the assessment & treatment reach 20 30 mg/dl on day 14
For tight heel cord: tenotomy of the Achilles tendon then slowly
Normal by 4 12 weeks
ESSENTIAL NEWBORN CARE PROTOCOL [from DOH] Pathophysio Decrease milk intake Unknown
o What should be done immediately after birth is to dry the baby because hypothermia enterohepatic circulation Prob. due to glucoronidase
can lead to several risks in BM which enterohepatic
o Delaying the cord clamping to 3 mins after birth (or waiting until the umbilical cord circulation
has stopped pulsing) Normal LFT;
o Instead of immediately washing the NB, the baby should be placed on the mothers (-) hemolysis
chest or abdomen to provide warmth, increase the duration of breastfeeding, and Mngt Fluid and caloricsupplement If breastfeeding is stopped,
allow the good bacteria from the mothers skin to infiltrate the NB rapid decrease in bilirubin level
o Washing should be delayed until after 6 hours because this exposes the NB to in 48 hrs, if resumed will rise to
hypothermia and remove vernix. Washing also removes the babys crawling reflex. 2 4 mg/dl but no precipitating
previous events
APGAR SCORE
o Evaluates the need for resuscitation NEONATAL SEPSIS
o Taken 1 and 5 minutes after birth Classification
0 1 2 Early: birth to 7th day of life
Color Blue, pale Body pink, extremities All pink Late: 8th to 28th day of life
blue Risk factors
HR 0 <100 >100 Maternal infection during pregnancy
Reflex irritability No response Grimace Cough Prolongrupture of membranes (18 hrs)
Activity Limp Some flexion Active Prematurity
Respiration Absent Slow, irregular Good Common organism:
The APGAR Score Bacteria: GBS, E. coli & Listeria (early)
8 10 Good cardiopulmonary adaptation Viruses: HSV, enteroviruses
47 Need for resuscitation, esp ventilatory support Signs & symptom
03 Need for immediate resuscitation Non-specific
Dx:
NORMAL VALUES CBC, CXR, blood and urine culture, lumbar tap for CSF studies
AVERAGE WEIGHT (3,000 grams) Treatment
Empiric antibiotics [Ampicillin + 3rd gen Cephalosporin or Aminoglycoside)
0 6 mos Age in months x 600 + BW
supportive
7 12 mos Age in months x 500 + BW
Children
1 6 yo Age in years x 2+ 8
VIRAL CROUP vs EPIGLOTTITIS
7 12 yo Age in years x 7 5 / 2
VIRAL CROUP EPIGLOTTITIS
HEAD CIRCUMFERENCE [35 cm (+ 2cm)] (inch = 2.54cm)
Age group 3 mos to 3 yrs 3 7 yrs
1 4 months inch per month
5 12 mos inch per month Stridor 88% 8%
2 years old 1 inch per year Pathogen Parainfluenza virus H. influenzae type B
3 5 yo inch per year Onset Prodrome (1 7 days) Rapid (4 12 hrs)
6 20 yo inch per 5 years Fever Severity Low grade High grade
LENGTH (50 cm) Associated sympto Barking cough, Muffled voice,
0 3 months 9 cm hoarseness Droolong
46 8 cm Respond to racemic Stridor improves None
79 5 cm epinephrine
10 12 3cm CXR steeple sign thumbprint sign
 RHEUMATIC HEART DISEASE
JONES CRITERIA
BRONCHIOLITIS Major Manifestation
Acute inflammation of the small airways in children <2 yrs 1. Arthritis (70%)
Most commonly caused by RSV 2. Carditis (50%)
Related to exposure to cigarette smoke a. Tachycardia
Risk factors for severe dse: b. Heart murmur of valvulitis
o <6 mos c. Pericarditis
o Prematurity d. Cardiomegaly
o Heart or lung disease e. Signs of CHF [gallop rhythm, distant heart sounds,
o immunodeficiency cardiomegaly]
Signs /Symptoms 3. Erythema marginatum (10%)
low grade fever, rhinorrhea, cough, wheezing 4. Subcutaneous nodules (2 10%)
hyperresonance to percussion 5. Sydenhams chorea (15%)
CXR Minor manifestation
hyperinflation, interstitial infiltrates 1. Arthralgia
Treatment 2. Fever at least 38.8C
Mild [at home]: 3. Elevated Acute Phase Reactants (CRP & ESR)
o Increased fluids, trial of inhaled bronchodilators, aerosolized 4. Prolonged PR interval on the ECG
epinephrine Diagnosis
Severe: 1. Highly probable : 2 major OR 1 major and 2 minor manifestation
o Admit to hospital if: Marked respratory distress; Poor
feeding; O2 sat <92%; hx of prematurity < 34 wks;
underlying cardiopulmonary dse; unreliable caregivers INFECTIVE ENDOCARDITIS
o Manage with ventilatory and O2 support, hydration, inhaled DUKE CRITERIA
bronchodilators and ribavirin Major Manifestation
1.
Age Ht (cm) Ht (cm) Wt for Ht Boys Girls Minor manifestation
mo boys girls (cm) (kg) (kg)
0 50.5 49.9 49 3.1 3.3 Diagnosis
1 54.6 53.5 50 3.3 3.4 2. Highly probable : 2 major OR 1 major and 2 minor manifestation
2 58.1 56.8 51 3.5 3.5
3 61.1 59.5 52 3.7 3.7
4 63.7 62.0 53 3.9 3.9 NURSERY NOTES
5 65.9 64.1 54 4.1 4.1 Dextrosity
6 67.8 65.9 55 4.3 4.3
7 69.5 67.6 56 4.6 4.5 (to get factor: Desired D5
8 71.0 69.1 57 4.8 4.8 D50- D5
9 72.3 70.4 58 5.1 5.0 D 7.5 = 0.055
10 73.6 71.8 59 5.4 5.3 D10 = 0.11
11 74.9 73.1 60 5.7 5.5 D 12.5 = 0.166
D15 = 0.22
12 76.1 74.3 61 5.9 5.8
D 17.5 = 0.28
13 77.2 75.5 62 6.2 6.1
14 78.3 76.7 63 6.5 6.4
Limits of Dextrosity:
15 79.4 77.8 64 6.8 6.7 Peripheral line = D12
16 80.4 78.9 65 7.1 7.0 Central line = D20
17 81.4 79.9 66 7.4 7.3 Total Fluid Intake (TFI):
18 82.4 80.9 67 7.7 7.5 Preterm: start at 60 cckd
19 83.3 81.9 68 8.0 7.8 Term: start at 80 cckd
20 84.2 82.9 69 8.3 8.1
21 85.1 83.8 70 8.5 8.4 To check TFI = rate x 24 wt
22 86.0 84.7 71 8.8 8.6
23 86.8 85.6 72 9.1 8.9 ex. Preterm: wt: 1.129
24 87.6 86.5 73 9.3 9.1
25 88.5 87.3 74 9.6 9.4 Day 1: start IVF with D10 water
26 89.2 88.2 75 9.8 9.6 60 x 1.219 24 = 3.1 cc/hr x 24 hrs
27 90.0 89.0 76 10.0 9.8 Add Calcium gluconate at 200 mkd q8h
28 90.8 89.8 77 10.3 10.0 Ca gluc = 1.129 x 200 3 = 75mg q8hrs for 3 doses
29 91.6 90.6 78 10.5 10.2 Start antibiotics
30 92.3 91.3 79 10.7 10.4 Give ranitidine
HGT q 8/12 hrs
31 93.0 92.1 80 10.9 10.6
OGT
32 93.7 92.8 81 11.1 10.8
CBC
33 94.5 93.5 82 11.3 11.0
Na, K, Ca at 48 hrs
34 95.2 94.2 83 11.5 11.2
Blood c/s depends on AP
35 95.8 94.9 84 11.7 11.4
Day 2: increase TFI by 10-20 (depends on AP)
36 96.5 95.6 85 11.9 11.6
70 x 1.129 24 = 3.3 cc/hr x 24 hrs
3.5 98.4 97.3 86 12.3 11.8
incorporate ca gluc 200 mkd to IV
4 yo 102.9 101.6 87 12.3 11.9 ex.
4.5 106 104.5 88 12.5 12.2 D10 water 80 cc
5 109.9 108.4 89 12.8 12.4 Ca gluc 2.2cc
5.5 112.6 111.0 90 13.0 12.6 82.2cc to run at 3.3ccx24hrs
6 116.1 114.6 91 13.2 12.8
6.5 118.5 117.1 92 13.4 13.0 Day 3: increase TFI by 10-20 (depends on AP)
7 121.7 120.6 93 13.7 13.3 If electrolytes are N, may use D10IMB
7.5 123.9 123.0 94 13.9 13.5 80 x 1.129 24 = rate
8 127.0 126.4 95 14.1 13.8 80 x 1.129 x factor to get value of D50 water (to make D10 use 0.11)
8.5 129.1 128.8 96 14.4 14.0 Cont Ca gluc incorporation (if feeding may discontinue)
9 132.2 132.2 97 14.7 14.3 D50 water 9.9cc
9.5 134.4 134.7 98 14.9 14.6 D5 IMB 77.9cc = D10 IMB
10 137.5 138.3 99 15.2 14.9 Ca gluc 2.2cc (200mkd)
90 cc to run at 3.7cc/hrx24h
10.5 139.9 140.9 100 15.5 15.2
If feeding already:
11 143.3 144.8 101 101.0 15.5
Total volume of milk wt = cc/kg/day
11.5 145.8 147.6 102 16.1 15.9
Subtract this amount to TFI to get value for IV
12 149.7 151.5 103-105 16.5-17.1 16.2-16.7 (if Dr. Reinoso, divide by 2 before subtracting to TFI)
12.5 152.5 154.1 106-108 17.4-18.0 17.0-17.6 ex. MF 3cc q3hrs = 24 cc in 24 hrs
13 156.5 157.1 109-111 18.3-19.0 17.9-18.6 24 1.129 = 21.2 cckd from milk
13.5 159.3 158.8 112-114 19.3-20.0 18.9-19.5 80 21.2 = 58.8cckd (use this for IVF)
14 163.1 160.4 115-117 20.3-21.1 19.9-20.6 58.8 x 1.129 24 = rate
14.5 165.7 161.1 118-120 21.4-22.2 21.0-21.8 D50 water 7.3cc
15 169.0 161.8 121-123 22.6-23.4 22.2-23.1 D5 IMB 56.5cc = D10 IMB
15.5 171.1 162.1 124-126 23.9-24.8 23.6-24.6 Ca gluc 2.2cc (200mkd)
16 173.5 162.4 127-129 25.2-26.2 25.1-26.2 66 cc to run at 2.7cc/hrx24h
16.5 174.9 162.7 130-132 26.8-27.8 26.8-28.0
17 176.2 163.1 133-135 28.4-29.6 28.7-30.1 Subsequent days depend on infants status..
17.5 176.7 163.3 136-140 30.2-33.0 30.8-32 Electrolyte requirements:
18 176.8 163.7 141-145 33.7-36.9 Na: 2-4 mkd prepn 2.5 mg/ml
Ca: 100-200mkd prepn 100mg/ml
K: 2-4 mkd prepn 2mg/ml
Weight for Height = Actual BW (kg)
P50 Wt for Ht (kg) Glucose Infusion Rate:

Height for Age = Actual Height (cm) Dextrosity x IVF rate x 10 10

P50 Ht for Age Wt
Ex. 10 kg; IVF D10 IMB at 40cc/h
Waterloo Wasting Stunting
Classification (Wt for Ht) (Ht for Age) GIR = 10 x 10 x 40 10 = 6.6mkmin
60
Normal >90 >95
NV: Newborn & Infants 6-8 mg/kg/min
Mild 81 90 90 95
Children 4-6 mg/kg/min
Moderate 70 80 85 89
Severe <70 <85
If HGT <40 mg/dl, give D10 water slow IV push at 2cc/kg and
repeat HGT after 30 mins-1 hr (may do 3 boluses if still low, may inc dextrosity
or rate)
Level of Umbilical Cathetherization: (cm) if using double strength: wt x dose x 0.0752
If arterial between T6-T9 (Dose = 5-20)
Wt x 3 x 8 Dobutamine: wt x dose x 0.06
Prepn: 250mg/250 ml; Dobuject 50mg/ml
If venous: (wt x 3) + 8 +1 (Dose = 5-20)
2
If using Dobuject: Wt x dose x 60 concentration
ET tube size: age in yrs +4 Concentrations: 5mg/ml = 5000
4 50mg/50ml = 1000
ET level: 50mg/20ml = 2500
if >2yo: age(yrs) +12 To make 5mg/ml: Dobuject 5cc
2 D5 water 45cc
Or ET size x 3 To make 50mg/50ml: Dobuject 1cc
Total Flow Rate = Tidal volume x wt x RR x I.E ratio + 2000 D5 water 49cc
I.E = 2 To make 50mg/20ml: Dobuject 1cc
Dead space = 2000 D5 water 19cc
RR = 40-60 Diflucan: 6 mkd OD prepn 50mg/tab divide into pptabs and give 1 pptab
Tidal volume = Newborn: 6-10cck OD x 2 weeks
Child: 10-15cck Aminophylline: 5mkd (loading dose) then 1.6 mkd q 8 hrs (maintenance)
Adult: 15cck Phenobarbital 20 mkd (loading dose) then 5 mkd (maintenance)
Dexamethasone 0.1 mkdose q6hrs x 24 hours
FiO2 For other meds, please see NEOFAX
Nasopharyngeal cathether = Flow rate x 20 + 20 NEWBORN CARE
Ex. 1L Fio2 = 40 Hypothermia
Nasal catheter = Flow rate x 4 + 20 hypoxia
Ex. 1L FiO2 = 24 metabolic acidosis
Extubation: hyperglycemia
Give Dexamethasone at 0.1 mkdose q 6 hours for 24 hours prior to Erythromycin ointment
extubation should be given an hour after birth
USN with epinephrine 0.5 cc + 1.5 cc PNSS q 15 mins x 3 doses then gonococcal/chlamydial conjunctivitis
extubate then USN with Salbutamol nebule + 1.5 cc PNSS q 6 hours x Gonococcal Conjunctivitis
24 hours within 7days
O2 at 10 lpm then decrease as necessary Chemical conjunctivitis
Regular milk: 20 cal/oz disappears within 48H
Preterm milk: 24 cal/oz Other bacterial conjunctivitis
Chlamydial >10-14 days
Total Caloric Intake: rate x 24 x caloric content of IVF wt Staph 48H-5th day (2-5days)
Herpes
To get factor: Dextrosity x 0.04 = cal/cc Pseudomonas-give Gentamycin
Umbilical stump - sloughed off <14 days
Caloric content of IVF Alcohol - drying effect
D5 = 0.2 cal/cc Cows milk allergy
D7.5 = 0.3 cal/cc Onset- 3rd wk
D10 = 0.4 cal/cc Rashes on cheeks eyebrows cradle cap
D15 = 0.6 cal/cc
Caloric requirement & Protein requirement
Cal/kg g/kg
0-5mo 115 3.5
6-11mo 110 3 CRANIUM
1-2 yo 110 2.5 Caput succedaneum
3-6 yo 90 100 2 diffuse edematous swelling of soft tses of scalp
7-9 yo 80 90 1.5 extend across midline
10 12 yo 70 80 1.5 edema disappears w/in 1st few days of life
13-15 yo 55 65 1.5 molding and overriding of parietal bones-frequent
16 19 yo 45 50 1.5 disappear during 1st wks of life
Approximate Daily Water Requirement no specific tx
0 3 do 120cc/k/d 4 6 yo 100 cc/k/d Cephalhematoma
10 do 150cc/k/d 7 9 yo 90 cc/k/d subperiosteal hemorrhage
1 5 mo 150cc/k/d 10 12 yo 80 cc/k/d limited to1 cranial bone
6 12 mo 140cc/k/d 13 15 yo 70 cc/k/d occur 1-2 % cases
1 3 yo 120cc/k/d 16 19 yo 50 cc/k/d no discoloration of overlying scalp
Estimated Catch up Growth Requirement swelling not visible for several hours after birth ( blding slow
= cal/k/day (age for wt) x IBW (wt for ht) process)
Actual BW firm tense mass with palpable rim localized over 1 area of skull
resorbed w/in 2wk- 3mos
CHON reqt = CHON reqt for age x IBW calcify by end of 2nd wk
Actual BW few remain for years
10-25% cases underlying linear skull fracture
Growth and Caloric requirements No tx but photo in hyperbil
AGE RDA kcal/kg/day
0 3 mos 115 seizure
3 6 mos 110 Simple Complex
6 9 mos 100
Type GTC Focal then gen post ictal
9 12 mos 100
1 3 yo 100
4 6 yo 90 100 Duration < 15 min > 15 min or may go into status
Recurrence None Recurrent (w/in 24H)
CNS exam Normal Abnormal
Sequelae None Neurodev abn

ANTICONVULSANT
DIAZEPAM 0.2 0.3 mkdose
Double Volume Exchange Therapy (DVET) Drip: 1amp in 50cc D5W
Wt x 80 x 2 = Volume/ amt of fresh whole blood 10mg/amp
(Use mothers blood type) MIDAZOLAM 0.15 mkdose prn 2 3 mins interval IV (1, 5mg/ml)
6 mos - 5 yo 0.05 - 0.10 max of 0.6 mg/kg
Volume _ = # of exchange 6 yo - 12 yo 0.25 - 0.05 max of 0.4 mg/kg
aliquots per exchange >12 yo 0.50 - 2 mg/dose over 2 mins
PHENOBARBITAL LD: 15 20 mkd MD: 5 mkdose q 12h
> 3 kg 20 ml (max load 20 mkday IV
2-3 kg 15 ml
1-2 kg 10 ml Tabs: 15, 30, 60, 90, 100 mg
850g-1kg 5 ml Caps: 16 mg
< 850 g 1-3 ml ELIXIR 20mg/5ml
Inj: 30, 60, 65, 130 mg/ml
Prepare the ff:
2 pcs 3 way stopcock MD: PO/ IV
1 pc 5 cc syringe Neonate: 3 - 5 mkD QID/ BID
1 pc BT set Infant/child: 5 - 6 mkD
1 pc IV tubing 1 - 5 yo: 6 - 8 mkD
1 pc empty bottle 6 - 12 yo: 4 - 6 mkD
Gloves > 12 yo: 1 - 3 mkD
Calcium gluconate 100 mg every 10 exchanges Hyperbil < 12 yo: 3 - 8 mkD BID/TID
Criteria for Hypoxic Ischemic Encephalopathy PHENYTOIN LD: 15 20 mg/kg/IV
pH < 7 (profound met. Acidosis) MD:
Apgar <3 more than 5 mins Neonate: 5 mkD PO/ IV BID
Neurologic sequelae (coma; sz) Infant/child: 5 7mkD BID/ TID
Multiorgan involvement 6mos 3y: 8 10 mkD
Difficult delivery 4 6y: 7.5 9 mkD
7 9y: 7 8 mkD
Medications 10 16 y: 6 7 mkD
Dopamine: wt x dose x 0.075 Dilantin Tab: 50mg 100mg TID
Prepn : Single Strength: 200mg/250ml; Extended release caps 30, 100, 200, 300 mg OD, BID
Double Strength: 400/250ml Inj: 50 mg/ml
CARBAMAZEPINE
Tegretol Tab 200mg, 100mg chew Post Lumbar Tap
XR 100mg, 200mg, 400mg NPO x 4H
Susp 100mg/ 5ml (QID) Flat on bed
Initial Increment Maintenance Monitor NVS to include BP q 30mins x 4H, then qH
< 6 yo 10 - 20 mkD BID /TID q wkly til 35 mkD CSF exams
6 - 12 yo 10 mkD BID 100 mg/ 24H at 20 - 30 mkD BID/ QID Bottle # 1 Gm stain, AFB, India ink, KOH
1 wk interval Bottle # 2 Cell count, CHON, Sugar
> 12 y 200 mg BID 200 mg/ 24H at 800 - 1200 mg/24H Bottle # 3 C/S, save remaining specimen
1 wk interval BID/ QID Watch out for vomiting, HA and hypotension

OXCARBAMAZEPINE
Contraindications to LP
(8 - 10 mkd BID) evidence of Inc ICP
Initial: 8 -10 mkD PO BID then severe CP compromise
Increment: increase over 2 week pd to Skin infection at site of puncture
Maintenance doses:
20 -29 kg: 900 mg/24H PO BID
29.1 -39 kg: 1200 mg/24H PO BID
>39 kg: 1800 mg/24H PO BID

Trileptal Tab 150 mg 300mg 600 mg

Susp 300mg/5ml CSF ANALYSIS
VALPROIC ACID PO: Color Rbc Wbc Diff ct sugar CHON
Initial : 10 - 15 mkD OD - TID Normal
Increment: 10 mkD at wkly interval BID Infant Xantho 0 -100 0 -32 L 70 - 60 -150
Maintenance: 30 - 60 mkD BID/TID
(Term) 100% 80%
IV: same dose as PO q 6H
Rectal : (syrup mix with water 1:1) Infant Clear 0 -100 0 -15 L 70 - 60 -200
LD: 20 mkd (Preterm) 100% 80%
MD: 10 -15mkd TID Older child Clear 0 0 -10 L > 50% 10-20
Depakene Tab 250 mg 100%
Syr 250mg/5ml Viral Clear 0 0 -20 L 40- 40 -60
Depacon IV 100mg/ml
Mening 100% 60%
TOPIRAMATE 2 - 16 yo
Initial: 1 - 3 mkd PO q HS x 7 days then Increment: TB/Fungal Clear 0 20 - L>N < 40% > 100
increase by 1 - 3 mkday for 1 - 2 wks then 500 g%
Maintenance: 5 -9 mkD BID Bacterial Purulent 0 > 1000 N>L < 50% > 100
Topamax Cap 15 mg, 25 mg Mening g%
Tabs 25 50 100 200mg Partially tx Clear 0 100 L>N > 50% Dec
BM
Glasgow Coma Scale Infants
Activiy Response Activity Response
CSF PATHWAY
Eye Opening
Choroid plexus (lateral ventricle) Foramen of Monroe 3rd ventricle Aqueduct
Spontaneous 4 Spontaneous 4
of sylvius 4th ventricle Foramina of Luschka (2 laterals) & Magendie (median)
To speech 3 To speech 3
SAS Absorbed in the arachnoid villi, then in the Venous System
To pain 2 To pain 2
None 1 None 1
Verbal Dengue Drips
Oriented 5 Coos, babbles 5 Furosemide drip
Confused 4 Irritable 4 Dose: 0.04 - 0.5
Inappropriate words 3 Cries to pain 3 80 mg + 32 cc
Inappropriate sounds 2 Moans to pain 2 Wt x dose = rate (cc/h)
None 1 None 1 2
Motor Furo drip = 0.1 - 0.5mg/k/hr
Follows command 6 Normal spontaneous 6 Prep: 20mg/2ml (2mg/ml)
movement Rate: (wt x dose)/2 = cc/hr ex. 14.5kg x 0.45 = 3.2cc/hr
Localizes pain 5 Withdraws to touch 5 To order: 8ml Furo + 32ml D5W +40 cc to run at 3.2cc/hr
Withdraws to pain 4 Withdraws to pain 4 Precedex drip
Abnormal flexion 3 Abnormal flexion 3 Dose: 0.2 - 0.7
Abnormal extension 2 Abnormal extension 2 1ml + 99cc D5W to run at cc/h
None 1 None 1 Wt x dose = rate (cc/h)
Noradrenaline (Levophed) 1mg/ml dose :(0.5 1 ml/kg)
MOTOR DTR Wt x dose ( each ml contains 4 mcg Noradrenaline)
full resistance with gravity 5/5 very brisk +4 4 mcg ( for acute hypotension)
some resistance with gravity 4/5 brisker than average +3 2ml + 500cc D5W x 2cc/H (0.5 cc/H)
movement with gravity normal +2
movement w/o gravity 3/5 diminished +1 Dopamine ( 5 -20 mcg/kg/min) 200 mg/250ml Single strength
flicker 2/5 no response 0 400 mg/250ml DS (div by 2)
no movement 1/5 Wt x dose x 0.075
0/5 Dobutamine 250 mg/5ml SS
500 mg/250ml DS(div by 2)
Bilirubin (Total) Wt x dose x 0.06
Terbutaline Bricanyl SC Inj: 1 mg/ml
Cord < 12y 0.005 0.01 mkd x 3 doses q 15
Preterm <2 mg/dl <34 mol/L -20 min then q2-6H
Term <2 mg/dl <34 mol/L > 12y 0.25 mkd
0 1 days Terbutaline drip LD: 2 10 mcg/kg then
0.1 0.4 mcg/kg/min
Preterm <8 mg/dl <137 mol/L
Ketamine (Ketalar) 10, 50, 100 mg/ml
Term <8.7 mg/dl <149 mol/L
PO: 5mg/kg x 1
1 2 days IV 0.25 - 0.5 mg/kg
Preterm <12 mg/dl <205 mol/L IM 1.5 - 2 mg/kg x 1
Term <11.5 mg/dl <197mol/L Morphine IV 0.1 0.2 mkd q2-4H prn
3 5 days Naproxen 250, 375, 500mg tab
Preterm <16 mg/dl <274 mol/L 125mg/5ml
> 2yo 5-7 mkd TID, BID PO
Term <12 mg/dl <205mol/L
Older Infants
IVIG infusion
Preterm <2 mg/dl <34 mol/L Preparation:
Term <1.2 mg/dl <21 mol/L 2.5g/50cc 500g/10cc 25g/100cc
Adult 0.3 1.2 mg/dl 5 12 mol/L 5g/100cc 10g/250cc
Bilirubin (Conjugated) Computation:
Neonate <0.6 mg/dl <10 mol/L Wt x 2 g /kg IVIG
Ex wt: 7.2 kg
Infants/Children <0.2 mg/dl <3.4 mol/L
7.2 x 2 + 16 g IVIG
16 gIVIG 2. 5 g = 320 cc
Pre Lumbar Tap Cc 50cc
NPO # of vials = total cc 320cc = 6.4 vials
RBS by gluco prior to lumbar tap 50cc 50cc
Prepare lumbar tap set 320cc x 0.03 = 9. 6 cc/h for 30 mins
2% Lidocaine # 1 Transfuse 9 10cc/h IVIG for the 1st 30mins if no reaction, run the remaining
G 23 spinal needle volume for 12H
Mannitol 250 cc 1 bottle - do not open Refer for any infusion reactions
Solvent Close ML
Diazepam 1 amp Monitor v/s q 30 mins while on infusion
3cc syringe #2 If after IVIG if still febrile, rpt IVIG after 3 D
2 manometers If after 2nd IVIG still febrile start Prednisone
sterile bottles # 3 Aspirin 80 mkD QID
sterile gloves # 2 30 mg, 80, 100, 300 mg
Sterile gauze # 1
Sterile gauze w/ Betadine #1
KCl NaHCO3
Sterile towel w/ hole #1
IV 2 meq/ml Inj premixed: 5% (0.6 meq/ml)
Sterile clamp #1
Child: 0.5 1meq/k/dose infusion of 500ml
3-way stopcock #1
0.5 meq/k/h for 1-2 h Tabs: 325 mg (3.8 meq), 650 mg (7.6 meq)
Tabs: 8, 10, 15, 20 meq Amiodarone 5 mg/kg rapid IV push
Oral soln Cardioversion 2 J/kg then 4 J/kg then rpt 2x
10% ( 6.7 meq/5ml) Albumin 1gm x wt given in 2-4hrs.
15% (10 meq/5ml) Prep: 12.5g/50ml
20% (13.3 meq/5ml) Vol expander: 20ml/kg
PO : 1-4 meq/kg/24H QID HypoCHONemia 1gm/k/dose x 4H
IV: 0.5 1meq/k/dose Epinephrine Drip 0.1 1mg/k/min; 1amp = 1mg/ml
Urine alkalinization Rate = (wt x dose x 60)/desired
Ca Gluc = Children: 1cc/k/dose x 3doses; 84 840 mg (1- 10 meq)/kg/D PO QID Ex: (18kg x 0.1 x 60)/100 = 2cc/hr
Max: 10cc/dose + equal amt of sterile To order: 5 amps Epi + 50cc D5W to rum at 2cc/hr
water (0.1mg/k/min)
Levophed 0.3-2mcg/k/min
LYSMIX 0.3 cc/k/dose TID Ceiling = 0.4 Prep: 4mg/amp (1mg/ml)
Prozinc drops 10 mg/ml Rate = (wt x dose x 60)/desired
< 6 mos 1 ml OD Ex. Dose 0.5
< 6 mos 2 yo 1 ml BID 1mg/20 = 0.05 x 1000 = 50mcg/ml
syrup 20 mg/5ml (18kg x 0.5 x 60)/50 = 10.8cc/hr
> 2 yo 5ml OD To order: 1 amp levophed + 80 cc D5W to run at 11cc/hr
Ercefuryl 20 mkday Dopamine Renal dose 3-5
Erceflora 1-2 vials/day OD for 2 wks Pressor >5 - <15
mix with water, milk or juice alpha effect >15
ANAPHYLAXIS
Protexin Restore 1 sachet mix with milk OD Epinephrine (1:1000) 0. 01ml/kg max of 0.5 mg/dose SC
Racecadotril (Hidrasec) 1.5 mg/kg for 1 wk < 30 kg 0.15 mg
> 30 kg 0.3 mg
< 9 kg 10 mg sachet 1 sachet TID Diphen = 50mg IM (1mkdose)
9 13 kg 10 mg sachet 2 sachets TID USN w/ Salbu x 3 doses
13 27kg 30 mg sachet 1 sachet TID
> 27 kg 30 mg sachet 2 sachets TID BICARB DEFICIT CORRECTION:
Ex: wt 4.9kg
pH = 7.10
pCO2 = 9.1
FWB 10 - 20 cc/kg 3 4H pO2 = 36.5
PRBC 5 - 10 3 4H HCO3 = 2.8
BE = -26.8
Plasma 10 - 15 12H
O2 Sat = 53.6%
PRP 10 - 15 12H
BE x Wt x 0.3 = 26.8 x 4.9 x 0.3 = 39.39meqs
Plt conc 1 u/ 7 -10 kg FD
Half correction: 39.39/2 = 19.69 meqs
Cryoprecipitate 1 u/kg FD To order: Give 20 meqs NaHCO3 + equal amt of sterile water to be given slow IVTT over
Hemophilia A 1 bag 30mins.
(200mg fibrinogen) Infuse another 20 meqs NaHCO3 + equal amt sterile water as drip for 1-2 hrs.
VW dse 50 -100 mg/kg
EMPIRIC: NaHCO3 1-2mkdose even w/o ABG.
Fibrinogen dse 100 cc
HCO3 correction in ABG:
(2-5 kg)
Half correction: Base xs x 0.3 x wt 2
Factor 8 Hemophilia A 50 u/kg
(+ equal amount of sterile water)
Hemophilia B 100 u/kg
Full correction: Base xs x 0.3 x wt 2
1 u FWB = 200 cc PRBC (1/2 via IV push, via IV drip)
= 50 cc platelet concentrate
= 150 200cc PRP Full correction: Base xs x 0.3 x wt 2
= 150 cc FFP (1/2 via IV push, via IV drip)
MCV Hgb / rbc x 10 80 -94
BUN/ crea ratio
MCH Hgb / rbc x 10 27 - 32
Normal 10 -20
MCHC Hgb/ hct x 10 32 38
> 20 suggest DHN, pre renal azotemia or GIB
Absolute reticulocyte count = pts hct x retic %
< 5 liver disease, inborn error of metabolism
N hct for age
GFR (based on plasma creatinine and ht)
Reticulocyte Index
GFR = k x L = ml/min/1.73 m2 SA
Absolute Retic Ct > 2 hemorrhage
sCr
2 < 2 rbc production abn
L = body length (cm)
Scr = mg/dL ; divide by 88.4 if units in mmol/L
PRBC to be transfused for correction = 40 hct x wt
Age K (mean value) KI
1 - 3 days 1 mo 2mos 6 12y >12y
LBW < 1 yr 0.33 29.17
Hgb 14.5 22.5 9 -14 11.5 -15.5 13-16
FT < 1 yr 0.45 39.78
Hct .48 - .69 .28 - .42 .35 - .45 .37 - .49
2-12 y 0.55 48.62
Wbc 9 -30 birth 5 19.5 6 -17.5 4.5 -13.5
13-21 y (female) 0.55 48.62
Plt 84 478 NB After 1 wk, same as adult
13 -21 y (male) 0.70 61.88
150 - 400
Retic 0.4 - 0.6 < 1 -1.2 0.1 -2.9
Age GFR Range
Glucose PT 20 -60 Child Adult
NB 30 60 60 -100 70 -105 PT
1 d 40 -60 2- 8 d 11 11 15
> 1d 50 -90 4 - 28 d 20 15 28
30 -90 d 50 40 65
ANC - % of neutrophils & cells that become neutrophils multiplied by wbc Term
ANC = wbc x (% seg + % stabs + % meta) 2- 8 d 39 17 60
Other formula: wbc x (seg + meta + stabs ) x 10 4 - 28 d 47 26 68
Ex 2.1 x 53 (seg) x 10 = 1113 30 - 90 d 58 30 86
ANC > 1000 Normal 1- 6mo 77 39 -114
ANC < 2000 Neutropenia 6 - 12 mo 103 49 157
ANC 1000 -1500 Low risk of infection 2 - 19mo 127 62 191
ANC 500 -1000 Mod risk of infection 2 - 12y 127 89 165
ANC < 500 High risk of infection Adult males 131 88 174
IT ratio > 0.25 sepsis Adult females 117 87 147
> 0.80 higher risk of death fr sepsis
BSA
Anemia Weight in (kg)
< 10 g mild anemia 05 wt x 0.05 + 0.05
8-9g mod anemia 6 10 wt x 0.04 + 0.10
<8 g severe anemia 11 20 wt x 0.03 + 0.20
20 40 wt x 0.02 + 0.40
EMERGENCY >40 wt x 0.01 + 0.80
ET tube age in years + 4
4 Computation for OFI (AGN & limiting OFI)
ET diameter x 3 1. BSA x 400 + UO IVF (half if w/ Furo) = OFI (then divide to 3 shifts)
>10 yo cuffed 2. 20cc x wt x UO IVF

OSTERIZED FEEDING
TFR 60 - 70% = 100/feeding q 6H
Laryngoscope sizes 10 kg x 60%
PT Miller 00 or 0 TFR = 600
Term Miller 0 CHON 0.5 g/kg inc q other day by 0.5 , max of 2 g/kg
Dose x wt x prep (Vamin 7%, 9%)
0-6mos Miller 1 0.5 x 10 kg x (100 /7) = 71 g/kg
CHON = 71 g/kg
6-24 mos Miller 2 If no prep = dose x wt x 4 = 20 g/kg
>24 mos Miller 2 or Mac 2 CHO 60%
(TFR CHON) x 0.6
(600- 71) x 0.6 = 317
CHO = 317
EMERGENCY MEDS Fats 181 (the rest are fats , divided into 6 feedings)
Epinephrine (bradycardia, asystole)
(1:1000) 0.1 ml/kg q 3- 5 mins TPN
Vamin 9% 0.67 cal/ml Sites: URT - pharyngitis - M1 2 4 12 18 25
Start 0.5 g/k/day inc by 0.5 g until 3 -3.5g/k/day Skin pyoderma - M49 55 57 60
Compute = wt x dose x prep (100/9) Pathophysio Immune complex disease
Clinical & Lab
Intralipid 10% 20% -hematuria -hypocomplementenemia
Start 0.5 g/k/day inc by 0.5 g until 3 g/k/day -proteinuria -oliguria
Compute = wt x dose x prep (100ml/ 10) = ml/24H -edema -n & v
Amino acids -hpn 82% -dull lumbar pain
Start 0.5 g/k/day inc by 0.5 g until 3 g/k/day Typical course
Compute = wt x dose x prep (100ml/g) = ml/24H Latent: few days 3wks
Oliguric: 7 10 days
TPN shortcut computation Diuretic: 7 10 days
Wt 10 kg TFR= 100 ml/k/day TFI = 1000ml/day Convalescent: 7 10 days

Vamin 7% 7 = 2 g/kg x 10kg 285 ml Normalization of urine sediment

100 Parameter Resolved by
CaGluc 2ml/kg 20 ml Gross hematuria 2 3 wks
D5IMB 485 ml Complement level 6 8 wks
D50W 0.11 x 1000ml 110 ml Proteinuria 3 6 mos
1000ml x 37 cc/h Micro hematuria 6 12mos
Lab Dx:
U/A spec grav,cast, hematuria, chonuria
TPN for NEONATES Serology culture of GABS, ASO, C3 ( dec in acute phase, rises during
Wt 2kg convalescensce)
1. TFR = 100 ml/kg/day x 2 kg 200 ml Renal fxn bun crea- normal, hyponat
2. Intralipid 20% Hematology dilutional anemia, transient hypoalbuminemia
1 g/kg/day x 2kg = 2g/day 10 ml Radiography CXR , renal utz
2 g = 20g Management:
x 100ml Bed rest
Fluid and salt restriction
3. Compute for TFR 1 o Fluids: 400 600 ml/m2/day + UO 24H
TFR1 = TFR Intralipid = 200 -10ml = 90 ml o NaCl < 2 g/day
4. Vamin 7% o K < 40 meq/day
1 g/kg/day x 2 kg = 2g = 29 ml Penicillin 50 100,000 u/kg/day TID/QID x 10 days
2 g = 7g HPN, CHF
x 100ml o Furosemide 2 mg/k/dpse
5. Multivitamins Benutrex c 0.5 ml/100ml Prognosis complete resolution, 5 10 % progress to chronic state
0.5 ml = x 1 ml
100ml 190 ml VITAMINS
6. Ca gluc 10% 2ml/kg/day x 2 kg 4 ml Stimulants Mosegar Vita 0.25 mg/day prep 0.25 /5 ml
7. Dextrosity (D10) get d50w Buclizine (syrup) Appetens
TFR 1 x dextrosity factor (0.11) 21 ml Propan
190 x 0.11 Appebon
8 . D5IMB = TFR 1 (Vamin + MTV + Ca gluc + D50W) 2 - 8yo 5 - 10 ml OD
190 (29 + 1+ 4+ 21) = 135 ml 7 - 14yo 10 - 20 ml OD
9. IV rate = TFR 1 / 24H 190 ml/ 24H 8 ml/H w/ Folic acid Molvite
(Megaloblastic 7 - 12yo 10 - 15 ml OD
Order: Anemia) 3 - 6yo 5 - 10 ml OD
Start TPN as ff: 1 - 2yo 2.5 - 5 ml OD
TFR= 100ml/kg/day Iberet
D5 IMB 135 ml Ferlin (10 mcg folic acid)
D50W 21 ml Macrobee
Vamin 7% 29 ml 1 - 2yo 2.5 - 5 cc OD
Ca Gluc 4 ml 3 - 6yo 5 - 10 cc OD
MTV 1 ml 7 - 12yo 10 - 15 cc OD
190 ml to run at 8 ml/h Pizotifen (drowsiness) Mosegor vita syr
Intralipid 20% 10 ml to run for 24H Appetens
MTV w/ Iron Propan w/ iron syr (Fe So4; elem fe 30mg)
Appebon w/ iron syr (FeSo4; elem fe 10mg)
w/ Serotonin (for Mosegor vita
Peak Flow (6 7 yo) migraine + dec wt) Mosegor plain
(Ht cm 100) x 5 + 170 female Appeten
+ 175 male Jagaplex syrup
Nasopharyngeal catheter = flow rate x 20 + 20 1-2yo 5ml OD
Nasal cannula = flow rate X 4 + 21 3-6yo 10 ml OD
7-12yo 15 ml OD
TFR= TV x RR x IE ratio + dead space (2000) Clusivol Power syrup
TV= 10 ml x wt syr 100mg/5ml
TFR Short cut: wt x 10 + 40 ml divide by 0.5 2-6yo 5 ml OD
16.77 7-12yo 10 ml OD
Zeeplus
MILK FORMULAS <2yo 2.5 ml OD
1:1 dilution 1:2 dilution 2-6yo 5 ml OD
Mead-Johnson, Nestle, Glaxo, Wyeth, Abbott, Unilab 7-12yo 5-10 ml OD
Dumex, Milupa Polynerv
0-6 months (20cal/oz) Lactose free (0-6months) 1-2yo 2.5 ml OD
Mead-johnson: Alacta , Enfalac Mead-johnson: Enfalac lacto-free 3-6yo 5 ml OD
Nestle: NAN1, Nestogen Nestle: AL110 7-12yo 10 ml OD
Glaxo: Frisolac Milupa: HN25 0-6mo 0.5 ml-1 ml OD
Dumex: Dulac Wyeth: S26 Lacto-free 7mo-1yr 1-1.5 ml OD
Abbott: Similac advance 1-2yrs 1.5-2ml OD
Milupa: Alaptamil Iron Deficiency Supplemental Iron =
Wyeth: S26, Bonna Anemia Therapeutic Dose: 5 - 6 mkday for 3 mos
Unilab: Mylac Maintenance Dose: 3 - 4 mkday
6months onwards (20cal/oz) Lactose free (6months onwards) Elemental iron
Mead-johnson: Enfapro Mead-johnson: Enfapro lacto-free 20% of FeSo4
Nestle: NAN2, Nestogen 2 12% Fe gluconate
Glaxo: Frisomil 33% Fe fumarate
Dumex: Dupro Wt x Dose x Prep
Abbott: Gain
Wyeth: Bonnamil. Promil Ferlin drops15mg/ml
Unilab: Hi-nulac Fe 75 mg
1 year onwards (20 cal/oz) Premature Infant (24cal/oz) Prophylactic dose
Mead-johnson: Enfagrow, Lactum Mead-johnson: Enfaprem Term 1 mg/k/Day, start 4 mos-1y
Nestle: NAN3, Neslac Nestle: PreNAN PT 2 mkD, start 2 mos-1y
Glaxo: Frisorow Abbott: Similac prem Therapeutic dose 3 mkD BID, QID for 4-6mos
Dumex: Dugrow Milupa: Preaptamil
Abbott: Gainplus Ferlin syrup 30mg/ml
Wyeth: Progress, Promil Fe 149.3 mg
Unilab: Enervon bright Supplemental dose 10-15 mg OD
Hypoallergenic (20cal/oz) Soy-Based (20cal/oz) Therapeutic dose 3 mkD TID, QID for 4-6mos
Mead-johnson: Pregestimil Mead-johnson: Prosoybee
Sangobion syr (Fe gluc 250mg elem Fe 30mg)
Nestle: Alfare, NAN HA1, NAN HA2 Abbott: Isomil
Incremin with Iron
Wyeth: Nursoy
Syrup 30 mg elem Fe
AGN
inflam process affecting the kidney, lesions predom in the glomerulus
Etiology
Infections:
a. Bacterial: Grp A B hemolytic strep, S viridans, S pneumo, Staph
aureus, S epidermidis, S typhi , T pallidum, Leptospira
b. Viral: HBV, Mumps, Measles, CMV, Enterovirus
c. Parasitic: Toxoplasm, Malaria, Schistosoma
Drugs: Toxins, Antisera, Vaccines (DPT)
Miscellaneous: Tumor Ag, Thyroglobulin
GABS Nephritogenic Strains