FLUIDS AND ELECTROLYTES MILD 50 30

 Maintenance D50.3NaCl
 <15 kg. = D5IMB MODERATE 100 60
 > 15 kg. = D5NM D50.3NaCl
Weight Fluid D5LRS
(kgs) requirement SEVERE 150 90
( cc/kg/day) PNSS
<3 75 PLRS
3 - 10 100 MILD hydration:
10 - 20 75  8 months old , 9 kgs.
20 - 30 60 9 x 50 = 450 / 8 hours
30 -40 50 = 56 – 57 uggts/min
> 40 40 IVF: D 50.3 NaCl 450 cc to run at 56
9 kg patient -57 ugtts/min for 8 hours then refer
9 kgs. x 100 = 900/24 for R/A
=37 to 38 uggts./min or
convert it to gtts divide by 4 Day term preterm SGA
= 9 -10 gtts/min 1 70 60 60
IVF: D5IMB 500 cc to run at 37 – 38 2 85 80 90
uggts/min 3 100 100 120
4 110 120 150
25 kgs patient 5 130 140 180
25 x 60 = 1500 cc/ 24 hours 6 140 160 210
= 62 – 63 uggts / min or 15 – 16 7 160 180 240
gtts/min 8 160 200 240
IVF: D5NM I L to run at 15 -16  1ST day of LIFE use D10 Water
gtts/min  2nd day of LIFE use D10 IMB
FLUID RESUSCITATION  if patient is feeding with good
< 2 y/o >2 y/o HGT may use D5IMB
< 10 kgs >10 kgs  D10IMB dextroxity
desired – actual 10 - 5 * if px is feeding regulate IVF at 10
------------------------------ = ------ ugtts/min
---- = 0.11 * if limit fluid intake by subtracting
D highest –D lowest 50 - 5 240 cc from TFR
Day 1 of life, term, wt = 3kgs = 750 – 240 = 510/3 = 170 cc
 Limit fluid intake to170 cc per
3kgs x 70 = 210 shift, pls. provide measuring
= 210/2 = 105 cup.
IVF : Hook to D10 water to release
105 cc/soluset to run at 8 – 9 ugtts  Day 2 = BSA x 400 + ½
/min for 12 hours x 2 doses urine output
Eg. UO = 600 cc
D2 of life , preterm wt.= 1.2 kgs = 0.5 x 400 + 300
TFR = 80 cc/kg/day = 500 cc to run at 20-21 ugtts/min
1.2 kgs x 80 = 96 cc
IVF = D10 IMB COMPUTATION OF MEDICATIONS
D5IMB 85.5 cc 1. Ampicillin (100-200 MKD)
D5050 10.5 cc  7 days = q 12 hours
------------  7 days = q 6 hours
96 cc/soluset to run at 4 Eg. 3 kgs Px, 3 days term
uggts/min for 24 hours 3 x 100 = 300/2 = 150 mg
q 12 hours
RENAL/CARDIAC PATIENTS Start ampicillin 150 mg q 12 hours
 BSA = square root of wt x ht
divided by 3600 2. Pen G Na (100-300 thousand
 Eg. Day 1 = BSA x 1500 cc u/kg/D)
= 0.5 x 1500 100T = Renal/Cardiac
= 750 cc in 24 hours at 31-32 200T = Pneumonia
ugtts/min 300 T = meningitic dose
eg. 10 kg patient
10 x 100,000 = 1,000,000 u/4 5. Amoxicillin (30-50 mkD)
= 250 T units q 6 hours Prep: 60mg/0.6ml
eg. Pen G Na 250,000 u q 100mg/ml
6 hours in a 10 kg px 125mg/ml
250,000 x 4 = 1,000,000 250mg/ml
u/10 kg = 100,000 UKD Eg. 10 kg Px

3. Paracetamol (10-20Mkd) dose = wt x TD x

Prep: denominator/numerator/freq. of
60mg/0.6 ml drop giving
100mg/ml = 10x50x5ml/125mg /3 = 6.6 ml
120mg/5ml
125mg/5ml TD = ml given x frequency of giving
150mg/5ml xnumerator/denominator/wt
250mg/5ml = 6.6ml x 3 x 125mg/5mg/10
Eg. 5 mos., 6 kg = 49.5 mkD
Dose = wt x TD x 1/100
= 6 x 10 x 1/100 6. Cotrimoxazole (5-8 MKD)
= 0.6ml Prep: 200mg/40mg/5ml
TD = ml given x numerator x 400mg/80mg/5ml susp
denominator/weight 400mg/80mg tab
= 0.6 x 100/1/6= 800mg/1680mg tab
10 MKD
EG Px is 10 kgs.
4. Diazepam (0.2 – 0.8 MKd) dose = wt x TD x 5/40/freq.
Prep: 10mg/2ml; 10 mg tab ofgiving
Eg. Px is 10 kg = 10 x 8 x 5/40/2
IV = 10 x 0.2 = 2 mg IM/IV = 5 ml
Rectal = 10 x 0.5 = 5 mg / rectum
TD = ml given x freq of giving x
40/5/wt
= 5 x2 x 40 / 5 / 10
PROCATEROL
• 0.25 mg/kg/ dose
• Eg. 8kgs.
8 x .25 = 2 ml BID
AMIKACIN
 15mkd q8, q12, OD
 250mg, 500mg/vial
AMINOPHYLLINE
 LD 8m/kg IV infusion x
30mins
 MD 3ml dose q8
 25mg/ml amp
 26.7 mg/5ml, 80mg/5ml
syr
ALLOPURINOL
 10mkd; TID
 300mg/tab
AMPICILLIN
 100mkd q6, q12
 500mg, 1g/vial
AMPICILLIN SULBACTAM
 50-100 mkd q6-q8 (IV)
 500mg=250mg; 750mg =
500mg
 50MKD q12 PO < 30kgs
 >30 kgs; adult dose
 250mh/5ml; 375 mg;
750mg/tab
AMOXICILLIN
 50MKD
 100mg/ml, 125/5, 250/5;
500mg/cap
AMOXICILLIN-CLAVULANIC ACID
 50MKd q 8-12 hours
ASPIRIN
 100mkd QID
 10-15 MKd q4-6 hours
 30mg, 80mg, 100mg/tab
AZITHROMYCIN
 10mkd x 3 days PO OD
 200/5, 250mg, 500mg/tab
 10mkd on 1st day then 5
mkd on D2-D5
BENZATHINE PEN G
 600,000 u if <27 kgs
 1.2 mu if <27 kgs

BENZYL PEN G
 100,000 – 200,000 ukd q6
 400,000 ukd q6 =
meningitic dose
 1MU/2MU
 Max: 2 MU q6
BUTAMIRATE CITRATE
 0.5mkd q8
 7.5 mkd q8
 7.5mg/5 ml syr, 50mg/tab
CAPTOPRIL
 1-5 MKD Q8-Q12
 25 mg/tab, 50mg/tab
CEFALEXIN
 30-50 mkd q8
CEFEPIME
 100-150 mkd q8-q12 IV
 500mg, 1g, 2g vial
CEFIXIME
 8 mkd q12, OD PO
 Susp: 20 mg/ml, 50mg/ml,
100mg/5ml
 Cap 100mg, 200mg
CEFUROXIME
 40mkd q12 PO
 100mkd q8 IV
 250/5, 500mgtab,
750mg/vial
CEFACLOR
 20-40 mkd q8, q12, PO
 50/ml, 125/5, 250/5
CEFTRIAXONE
 50 mkd OD IV = sepsis
 100mkd OD = meningitis
 500mg/1g/vial
CEFTAZIDIME
 30mkd q8
 500mg, 1g, 2g /vial
CLINDAMYCIN
 10-25 mkd q5 PO
 150 & 300mg; 75 mg/5ml
 10-40 mkd q6 IV/IM via S/P
x 30 mins
 150mg/ml vial
CHLORAMPHENICOL
 100mkd q6 PO, IV
 125 mg/5ml susp, 1g/vial
CEFOTAXIME
  50 mkd q12
 100-200 mkd q6-q8
 1g/vial
CETIRIZINE
 0.25 mkd BID
 1mg/ml, 10mg/ml, 10
mg/tab
CLARITHROMYCIN
 7.5 mkd q12
 125/5, 250/5, 250mgtab,
500mgtab, 500mg vial
CHLORAMPHENICOL
 100mkd q6 PO IV
 125 mg/5ml susp, 1g/vial
CLOXACILLIN/OXACILLIN
 100mkd q6 PO/IV
 125/5; 250/5;
 Cap 250mg, 500mg
 Vial 250 mg, 500mg
CO-TRIMOXAZOLE
 5.8 mkd q12 PO
 Susp: 200mg/40mg/5ml;
400mg/80mg/5ml
 Tab 400mg, 800mg
DIAZEPAM
 0.3 mkd
 10mg/2ml amp; 5 mg tab
DIPHENHYDRAMINE
 5mkd q6-8 hrs
 Max 300/day
 1mkd; 1 mk IM
 Cap: 25, 50mg
 12.5/5 susp, 50mg/ml amp
DIGOXIN
 0.004 MKD Q12
 0.25 mg/tab; 0.05 mg/ml
elixir; 0.25mg/2ml amp
 Rapid Digitalization:
Total Digitalizing Dose IV
 Wt x dose x 75% = mcg
 ½ of TDD at 1st
hour
 ¼ of TDD at 8th
hour
 ¼ of TDD at 16th
hour
Maintenance Dose
 Wt x dose = mcg q12
 NB: 0.03-0.04
mg/kg
 0.02-0.025 mg/kg
  <2 y/o: 0.03-0.05
mg/kg
 >2 y/o: 0.02-0.03
mg/kg
DOPAMINE DRIP
 10-20mg/kg/min
 Cc/hr = dose x wt x 60
/ug/cc
 Single conc: 200 mg/250
cc (800ug/cc)
 Double Con: 400mg/250cc
(1600 ug/cc)
 Penta Conc: 1000mg/50 cc
(400 ug/cc)
DOBUTAMINE DRIP
 10-20 UG/KG/MIN
 Cc/hr = dose x wt x 60 /
ug/cc
 Single Conc: 200mg/250cc
(1000ug/cc)
 Double Conc 500mg/250cc
(2000ug/cc)
 Penta Conc: 1250
mg/250cc (5000ug/cc)
DEXAMETHASONE
CROUP
 0.6 mkd single dose IM
Airway Edema/Prior Extubation
Neonates
 0.25mkd IV q12 x 3-4
doses
 Give >4hours before
extubation
Children
 0.5-2 mkd q6 x 4-6 doses
 Give 24 hrs before
extubation and continue 4-
6 doses post extubation
(IV,PO,IM)
Bacterial Meningitis
 0.6mkd q6 IV D1-4 of
antibiotics
Cerebral Edema
 1.2 mkd as LD then 1-
1.5mkd q4-6 hrs then taper
over 1-6 weeks
ERYTHROMYCIN
 10mkd q6-8H PO; 5-10mkd
q6H IV
 100mg/ml, 125mg/5ml,
200mg/5ml; 400mg/5ml,
500mg/vial
HYDRALAZINE
 0.5mkd q4-6H
 20mg/ml, 25mg/tab

FLUCONAZOLE
 12mg/kg x 30 min via ISP
 6mg/kg x 30mins via ISP
 50, 150, 200 mg/cap;
2mg/ml vial
FLUCLOXACILLIN
 25-50 mkd q6
 125/5, 250mg, 500mg
GENTAMYCIN
 0.5mkd OD
 80mg/2ml
HYDROCORTISONE
 4mkd TID QID q4
 100,200, 500mg/vial
IBUPROFEN
 10-15 mkd q6
 100/5, 200/5, 200mg/cap
LAGUNDI
 15 mkd TID
 300mg/5ml syr
 300mg, 600 mg tab
MEROPENEM
 20mkd q12 IV = sepsis
 40mkd q8 = meningitis
 500mg, 1 g vial
MANNITOL
 LD 0.5-1g/kg; MD 0.25-
0.5g/kg q4-6H
 Not to exceed 5 days 20%
IV solution
 0.5 g/kg = 2.5ml/kg
 0.25 g/kg = 1.25 ml/kg
METHYPREDNISOLONE
 20mkd IV q6 x2-3days; 2
mkd/PO
 15-30 mkd OD x 2 hours q
other day x 3 doses (Pulse
tx AGN)
 500mg, 1g/vial, 4mg, 16mg
tab
METOPROLOL
 1.5mkd BID
 50mg, 100mg, 200mg/tab
METRONIDAZOLE
 Amoebiasis: 35-50mkd q8
PO x 10 days
  Anaerobic Infection: 30  0.1-0.2 mkd
mkd q6 hours IV/PO 0r  20mcg/ml, 400mcg/ml
7.5mkd IV q 8
MEBENDAZOLE PREDNISONE
 >2yo: 5ml BID x 3 days  1-2 mkd BID
 <2yo: 2.5 ml BID x 3days  1-2 mkd BID-TID or 40-60
 100/5, 500mg/tab mg/day in cardiac patients
 10mg/5ml
METOCLOPROMIDE  2.3, 5, 10, 20, 30 mg/tab
 0.1 mkd PO/IV q8
 5mg/5ml syrup, 10mg/tab, PHYTOMENADIONE
10mg/2ml amp  Infants = 1-2 mkd q4-6
 Child = 0.6 mkd
NIFEDIPINE  10 mg/ml amp
 0.6-0.9 mkd q6-8h
 5, 10, 20 mg/cap PREDNISOLONE
 Same dose
NALBUPHINE  15mg/5ml; 20mg/5ml
 0.1 mkd syrup
 10mg/ml amp PYRANTEL pAMOATE
 11mk as single dose
NALOXONE  125/5 susp, 125mg. 250mg
 0.1-0.2 mkd q 6-8 hours tab
 1mg/ml, 20 mcg/ml,
400mcg/ml PANCURONIUM
 0.1 mkd
NETILMICIN  4mg/2ml
 9mkd OD
 100mg/2ml, 150mg/1.5ml PIPERACILLIN TAZOBACTAM
NALOXONE  50mkd q12
  1g/2g
 Via Infusion syringe pump
over 30 minutes
PARACETAMOL
 10-20mkd q4
 100mg/ml, 120/5, 125/5,
250/5, 325mg, 500mg/tab
 150mg/ml amp
POTASSIUM CHLORISE
 1-2 mkD OD/BID
 750mg/tab = 10 meqs
PROCATEROL
 0.25 ml/kg BID
 5 mcg/ml, 25 mcg/ml,
50mcg/tab
PHENOBARBITAL
 LD = 10-40 mkd; MD = 5-8
mkd q12
 130mg/ml amp; 15mg,
30mg,60mg tab
PNENYTOIN
 LD: 20-40 mkd; MD: 5mkd
q12
 10mg/2ml amp; 30mg,
100mg, 30mg/5ml, 15
mg/5ml syrup
PREDNISONE
 1-2 mkD BID
 1-2 mkd BID-TID or 40-60
mg/day in cardiac patients
 10mg/5ml, 20mg/5ml syr
 2.5,5,10,20,30 mg tab
ROXITHROMYCIN
 5-8 mkd q12 PO
 50, 100, 150, 300 mg/tab
RANITIDINE
 1-2 mkd
 50mg/2ml amp
 75, 150, 300 mg/tab
SODIUM BICARBONATE
Acidosis
 1-2 mk + equal vol of DW
SIVP
PPHN
 Full Strength: 0.15 x TFR /3
= ml/shift
 Half Strength: 0.075 x
TFR/3ml q shift
  Full Correction: BD x wt x
0.3/2
 Add equal volume of DW,
give 1st half SIVP, then 2nd
half x 2 hours via infusion
pump
 325mg, 650mg/tab; 40
meq/amp
SALBUTAMOL
 0.15 mkd TID
 2.5 mg/tab, 15mg/ml syrup
STATUS ASTHMATICUS
 TERBUTALINE: 0.01 mkdSQ
 EPINEPHRINE: 1: 10,000
prep give 0.01 mk SQ
TERBUTALINE DRIP
 0.1-0.4 mcg/kg/hr
 6 x doses x wt /RR = mg
terbutaline in 100c D5W @
____cc/hr
 Running Rate (RR) = 2
cc/hr
 RR x 24H = _____ml of
terbu/day
VANCOMYCIN
 10-15 mkd via SIP x 1 hr
 40-60 mkd q6-12 via SIP x
1hr q 10-20 ml
 500 mg tab
BLOOD TRANSFUSION
 PRBC 10 cc/kg
 FWB 20 cc/kg
 Plasma 15-20 cc/kg
 PC 1 “u” /10 kg
 Dextran 10 cc/kg
Desired Amount of BT
 Ideal HCT – present hct x wt
 Rate of transfusion should not
exceed 5 cc/kg/hr
DVET
 Blood vol (80) x 2x weight
PHLEBOTOMY
Criteria
 Plethora
 Headache sec to Ischemia
 Hct >65%
Use
 PNSS, Fresh Plasma, FFP
Vol of blood to Remove & plasma ABG’S
vol to give p PCO HCO
H 2 3
 Actual Hct – Desired HCT / Metaboli Uncompens ↓ N ↓
c ated
actual Hct x blood vol x wt Acidosis
Compensate N ↓ ↓
d
PNEUMONIA Respirat Uncompens ↓ ↑ N
ory ated
1. PNEUMONIA – Cough, Acidosis
Tachypnea, rales Compensate N ↑ ↑
d
 DOC: Amoxicillin, Co- Respirat Uncompens ↑ ↓ N
ory ated
Trimoxazole Alkalosis
 Alternative: Co-Amoxiclav, Compensate N ↓ ↓
d
Clarithromycin,  When to correct Metabolic
Roxithromycin Acidosis
2. PNEUMONIA SEVERE – o HCO# <15
Pneumonia with chest o BC excess >10
indrawing  Wt + BE x -.3 (0.6 in newborn) /
 Admit 2
 DOC: PenG ; 3months o Give ½ of the
Ampi/Genta computed correction
 Nebulize with PNSS + now then repeat ABG
Salbutamol/Terbutamol o Give the ½ if repeat
 If not responding give ABG still with
cefuroxime, ceftriaxone, metabolic acidosis
azithromycin
3. PNEUMONIA VERY SEVERE - ET TTUBES
Pneumonia Severe + Cyanosis,  ET Size = Age (years) +4 / 4
failure to feed, seizure,  ET level – ET size x 3
malnutrition  Insertion Distance + Wt + 6
 DOC: Chloramphenicol
 <3months: Ampi/Genta
Tube size Wt (g) AOG
 (wks)  Maintain patient flat on bed for
2.5 <1000 <28 4 hours
3.0 1000- 28-34  NPO temporarily x4
2000  Pressure pack at puncture site
3.5 2000- 34-38  WOF any untoward s/s
3000  Send Specimen for CSF analysis

3.5-4.0 >3000 >38 o Tube 1 – Cell count, diff

count, SG, LDH

BRONCHIAL ASTHMA o Tube 2 – CHON, Gluc,

 Nebulize with o Tube 3 – AFB, GS, CS,

salbutamol/terbutaline; 1 India Ink

nebule q15 minutes x 3 doses

 If improved, MGH with IV FLUIDS & ELECTROLYTE

bronchodilator oral/inhalation CONTENTS

 If the cause of exacerbation is IV FLUID Na K Glucos Cl

infection like e

cough/pneumonia, give D5NR 14 5 50

antibiotics 0
 May give prednisone x 3 days D5LRS 13 4 50
 If without improvement, admit 0
and give hydrocortisone, neb, D50.9Na 15 0 50
O2, inhalation and antibiotics if Cl 4
needed. D50.3Na 50 0 50
 Home meds: Bronchodilator Cl
(PO/Inhalation) with or without D5IMB 25 2 50
steroid inhalation 0
(Flixotide/Budecort)/oral D5NM 40 13 50
prednisone PLRS 13 4
0
POST LUMBAR PUNCTURE PNSS 15 0 15
 4 4

IMMUNIZATION SCHEULE
 Hepa B1 & BCG – at birth or
any time after birth
 DPT1 OPV1, HepaB2 – 6
weeks after birth (1month & 2
weeks)
 DPT2, OPV2 – 10 weeks after
birth (2months & 2 weeks) or
4 weeks after the 1st dose
 DPT3, OPV3, Hepa B3 – 14
weeks after birth (3months & 2
weeks) or 4 weeks after the 2nd
dose
 Measles – 6-9 months
 Measles booster – 15 months
(1 year and 3 months)
 DPT4,OPV4 – 18 months (1
year and 6 months)
 DPT5, OPV5 – 4-5 years old
 BCG Booster – before school
entrance