Pedia Notes

BCE 2-10 KG ---------60-80 10-15 KG---------45-65 15-25 KG---------40-45 25-35 KG---------35-40 35-60 KG---------30-35 >60 KG---------25-30 MF= BCE X WT X 15 24 = ugtts/min (: 4 = gtts/min) SURFACE AREA 0-5 kg= wt x 0.05 + 0.05 6.10 kg= wt x 0.04 + 0.1 10-15 kg= wt x 0.03 + 0.2 15-20 kg= wt x 0.02 + 0.4

K 20 4 4 13 20 30 35 20 20 20 20

Cl 20 51 102 77 154 154 109 109 40 80 40 20 22 80 36

Na+= 1 meq =23 mg K+ = 1 meq = 39.1 mg COMPOSITION OF FLUIDS Na K Cl HCO3 Gastric 50 10-15 150 0 Pancreas 140 5 50-100 100 Bile 130 5 100 40 Ileostomy 130 15-20 120 25-30 Diarrhea 50 35 40 50 Blood 140 4-5 100 25 Urine 0-100 20-100 70-100 0 ELECTROLYTE COMPUTATION N+ K+ deliverance = 0.1-0.4 meq/kg Deficit= (KD_KA) x wt x 0.6 Maintenance= 2 x wt  K 3 x wt  Na Total K def = deficit + maintenance Full incorporation: 40 meq/L or 20 meq/500 cc K incorporation: EX: wt =11.5 kg IVF= PLR at 100 ugtts/min 2 x ? 500 x 100 cc/hr ? = 0.4meq K /kg therefore 0.4 x 11.5 kg = 4.6 to incorporate to IVF or 5 meq in 500 cc PLR Order PLR 500 cc + 5 meq KCl at 100 cc/hr Therefore: PLR = 2 meq/500cc 2 + 5 meq = 7 meq x ? 500 x 100 ? = 1.4 meq/ hr 1.4 meq: wtof 11.5 kg = 0.12 meq/k/hr K+ deliverance K+ INFUSION RATE K+ delivery = 0.02 – 0.04/hr Not > 0.4/hr in ugtts/min mEq K+ Total vol IVF

X Rate / wt

0.5 x 6.3

ABG INTERPRETATION Rule #1: An acute change in PaCO2 of 1 mmHg is asso w/ an inc or a dec in pH of 0.008 units thus, when the PaCO2 increases by 10 mmHg will dec by 0.08 units (inversely proportional) > determine the resp component of acid-base balance

164 -1 140 (3.15) (1.18-1) =0.567 L = 567 cc No. of hours: At least 0.5 mEq dec in Na/hr Or 12 mEq dec in Na/2h4H

Plasma Osmolality: (Serum Na x 2) + (glucose mg/dL) 18

FLUIDS Na 25 51 102 77 154 154 130 130 40 90 40 40 25 25 90 45

WBC CORRECTION IN HEM TAP PERIPH WBC X 1000 5M = WBC 1000 RBC

164-140= 24 mEq = 48 0.5 mEq/hr → 567 = 11.8 cc/hr +(I H2O loss) 48 20cc =31.8 cc/hr

Renal = SA x 400 + 24H UO CHF/Cardiac = SA x 800 CNS = SA x 1,200 Meingitis = SA x 1,200 Fever : 12% Hyperventilation: 15% Phototherapy: 20%

D5IMB D50.3%NaCl D50.6%NaCl D50.45%NaCl D50.9%NaCl Plain NSS D5LR Plain LR D5NM ORESOL D5NR Isolyte M Isolyte P PLP 48 Pedialye 90 Pedialyte Plain

COMPUTATION FOR HYPERNATREMIA TBW X wt Actual serum Na – 1 Desired serum Na e.g. wt=6.3 ASNa=164 mEq TBW=50% DSNa=140 mEq

To asses the resp component of acid- base balance: 1. calculate the amount by which the reported PaCO2 either falls below or exceeds 40 mmHg. Subtract the patient’s PaCO2 from 40 mmHg 2. predict the pH based on the measured PaCO2 accdg to rule # 1 3. compare the measured pH w/ the predicted pH * if the predicted pH is equal to the measured pH, all change in the pH are resp in origin

Creatinine Clearance: K= 0.55 x pt Ht in cm Serum crea in mg/dL

* if the measured pH is > than the predicted pH, an asso. metabolic alkalosis is present

Crea ummol/L = mg/dL 88.4

* if the measured pH is < than that predicted from the PaCO2, an asso. metabolic acidosis is present.

50-60 : UTZ 25-50 : ACUTE RENAL FAILURE 10-25 : CHRONIC RF the diff bet calc pH & measured pH (ABG result) x 2/3 (0.66) mEq/L is equal to base excess

BLOOD VOLUME: Hb (DHb- AHb) x2 x wt Hct (DHct – AHct) x wt Packed RBC = 10cc/kg in 4 hours PRP = 10-15 cc/kg in 2-4 H Platelet con. = Fast drip 1u/10KBW 1 unit = 30cc will raise platelet by 10,000 Fresh Whole Blood = 20cc/ max. Volume: (D- AHb) x 2 x 3 x wt Or (D – Ahct) x wt Rate = vol. X 12 gtts/ml 60 min. x 4 H = gtts/min. Dextran : given not > 20cc/k/24H DOUBLE VOLUME EXCHANGE TRANSFUSION = KBW x EST. Blood vol. X 2 Materials: 1.NGT Fr. 5 #1 (umbilic cath.) Fr. 8#1 (for NGT) 2. three way stop cock 3. FWB 4. suture 5. 50 cc syringe 6. calcium gluconate 7. HGT strip PARTIAL EXCHANGE TRANSFUSION = KBW x EST. BLOOD VOL. X (AHct – DHct) Actual Hct * ( Arterial line) • may use Plain NSS or ideally, plasma CONVERTION o C= (oF-32) x 5/9 o F= (oC x 9/5) + 32 1 cc= 15 gtts 1 gtt = 4 ugtts 1 cc = 60 ugtts ABSOLUTE RETIC COUNT A Hct x retic D Hct Retic Index = ARC 2 > 2: Hemolysis < 2: BM suppresson

> if BE is >4 either +/- : AbN +4 : met. alkalosis - 4 : met. acidosis BD/BE calculated by multiplying the difference between the actual pH and predicted pH from the PaCO2 by 67 The predicted pH is always subtracted from the actual pH before multiplying the difference by 67. If the actual pH is lower than the predicted pH, the difference will be a number indicating a base deficit & the presence of metabolic acidosis. Rule # 3: The total body HCO3 deficit = base deficit x pt’s wt (kg) x 0.3 NORMAL ABG VALUES pH pCO2 NV 7.35-7.45 35-45 Acid < 7.35 > 45 Alk > 7.45 < 35

HCO3 22-26 < 22 > 26

Ex: pCO2 = 50 mmHg pH = 7.26 Rule # 1:

50 - 40 = 10 10 = 10 0.8 x x = 0.08

N pH : 7.40 – 0.08 = 7.32 Actual pH – measured pH 7.26 – 7.32 = - 0.06 BD/BE = 0.06 x 67 = 4.02 ( met acidosis) Total HCO3 deficit: 4.02 x wt x 0.03 = amt of HCO3 given as ½, ¼, ¼ correction METABOLIC ACIDOSIS Expected pCO2 = HCO3 x 1.5 + 8.4 Limit = 10 mmHG METABOLIC ALKALOSIS Expected pCO2 = each mEq inc in HCO3 will inc pCO3 by 0.5 – 1 mmHg limit = 55 mmHg RESPIRATORY ACIDOSIS Acute = HCO3 inc by 3-4 mEq/L Limit = 30 mmHg Chronic = each mmHg inc in pCO2 will inc HCO3 by 0.4 mEq/L RESPIRATORY ALKALOSIS Acute = HCO3 dec by 2-4 mEq/L Limit = 18 mmHg

Chronic = each mmHg dec in pCO2 will dec HCO3 by 0.5 mEq/L Limit = 12-15 mmHg CPAP TFR = wt x TV (10-15) x RR x I:E Ratio (2) + 2000 (2L) FiO2 = CA (0.2) + O2(I) x 100 TFR CA = 100 – FiO2 x TFR 79 O2 = FR – CA Materials needed: Cardence y-tubing rubber tubings glass tubings 1L bottle w/ calibration w/ glass tubing inserted into the cover Compressed air Pulse oximeter

Trouble shooting: 1. poor entry – inc flow rate 2. Retaining CO2 – cannot tolerate CPAP - ambubag to blow off excess O2 - always suction before CPAP, ABG Weaning from CPAP 1. dec FiO2 by 3-5% every time PaO2 >70 2. with FiO2 of 40%, reduce pressure by increments of 2 cm water every 2-4H until pressure of 2-3 cm is achieved 3. transfer patient to oxygen hood w/ FiO2 of 15-50% Parameters to be Met Before Weaning 1. improvement in CXR 2. ABG showing PO2 >/= 50 mmHg 3. Blood pH >/= 7.3 4. PCO2 100: dec FiO2 gradually while checking patient – rpt BGs after 15-30 min GUIDELINES 1. initially CPAP is set at 6 cm water. If there is no inc in PO2 in 15 min pressure must be increased in 2 cm increments to a maximum of 10 cm (if by ETT) or by 12 cm (in other method 2. I there is an inc in PaO2, reduce pressure. 3. If 10-12 cm wter pressure is attained and if PaO2 remains under 50, FiO2 must be increased by 5-10% increments 4. CPAP failure is evident if PaO2 remains less than 50 in 100% FiO2 with 10-12 cm water * If CPAP fails under noninvasivemethod, an ETT must be inserted * If CPAP fails w/ ETT, mechanical ventilation is indicated

8 10 12 2:6 2.5:7.5 3:9 3:5 4:6 4.5:7.5 4:4 5:5 6:6 5:3 6:4 7.5:4.5 6:2 7:2.5 4:3 7:1 9:1 10.5:1.5

Arrangement of CPAP Compressed air \________ / | \ O2

Patient

Bottle

EMERGENCY MEDS Atropine IV/IM: 0.01-0.03 MKd Q 10-15 min Max dose 0.04MKd ETT: 0.01-0.03MKd ff’d by 1 cc NSS PO: 0.02-0.09 MKd q 4-6H Naloxone 0.1 MKd Plain 0.4/1 Neonatal 0.02/1 Captopril 0.01-0.05 MKd PO Q 12H - administer 1H before feeding Capoten 25 mg/tab L-Carnitine 30-40 MKd q8H Carnicor PO: 1g/10 cc; 330 IV: 1g/5 Hydralazine IV: 0.1-0.5 MKd q6-8H Max 2 MKd q6H PO: 0.25-1 MKd q6-8H Admin w/ food Apresoline IV 20/amp PO 10,25/tab Lidocaine Initial: 0.5-1MKd IV push x 5 min Sld not exceed 5MKd Maintenance IV infusion: 10-15 mcg/kg/min Urecholine 2.9 mg/m2/d q8H PO Nifedipine 0.5-1 MKd Na Nitroprusside Initial: 0.25-0.5 ug/k/min IV infusion Maintenance: 8 D = 0.25 mk

3rd < 48 H = 0.1 mk 2-7 D = 0.2 mk > 8 H = 0.25 mk ANTICONVULSANT Diazepam 0.2-0.4 MKd Max 2-5 mg Valium 10/2 Trazepam 10/2 Phenobarbital LD 15-20 MKd MD 5 MKD Luminal IV 130/ml PO 20/5 Gr I : 65 mg ½, ¼ Phynetoin LD 15-20 MKd MD 5-8 MKD Dilantin IV 100/2 PO 30/5; 125/5; 30; 100 *to be diluted w/ equal amt of dist water, to be given very slow IVTT while monitoring the heart rate. Hold if w/ arrythmias. Flush dist Water prior to & after giving Dilantin. Carbamazepine 10-20 MKD Tegretol 100/5; 200 Clonazepam 0.01-0.03 MKD For Bael: LD 0.08 MKd MD 0.08 MKD q12H Rivotril 2/tab Valproic Acid 15MKD Depakene 250/5 Epival 250/tab Lorazepam 0.05-0.1 MKd Max 0.4 MK Midazolam IV: 0.05-0.15 MKd q 2-4H IV infusion: 0.01-0.06 m/k/H (10-60ug/k/H) Intranasal: 0.2-0.3 MKd; 5mg/ml Sublingual: 0.2-0.3 MKd; 5mg/ml Oral: 0.3-0.5 MKd Morphine 0.05-0.2 MKd q4H IV infusion: LD 100 ug/k x 1H MD 10-15 ug/k/H Neostigmine Myasthenia gravis: 0.1 mg IM (give 30 min before feeding) 1 mg PO ( give 2H before feeding) Reversal of neuromuscular blockade: 0.04-0.08 m/k IV, in addition to atropine 0.02 m/k Chloral hydrate 25-75 MKd 50 mg/ml; 100 mg/ml 324; 500; 648 Pentobarbital 2-6 MKd 50 mg/ml PARACETAMOL 15-20 MKd Afebrin 120/5; 325;500 Bigesic 100/ml;250/5;500 Calpol 120/5;250/5 Crocin 125/5;500 Defebrol 60/0.6;120/5 Naprex 250/5;300/2 Rexidol 150/5;600 Tempra 120/5;250/5 Tylenol 120/5 Winadol 120/5;500 Aeknil 300/2 Opegesic 125;250 supp SALICYLATES Anti-rheumatic: 65-130 MKD Asaped: 81 Ascpitin: 325 Neo-Novaldin: 325 Superin: 180/5; 3 g Aspirin: Gr V (1g = 65 mg) ANALGESICS Mefenamic acid 3-5 MKd Ponstan 50/5 Nalbuphine 0.1-0.15 MKd Nubain 10/ml Pancuronium 0.04-0.15 MKd q1-2H Fentanyl low: 2ug/k/d mod: 2-20 ug/k/d high: 20-50 ug/k/d Infusion rate: 1-5 ug/k/H Anesthesia 5-50 ug/k/d Sublimaze (Janseen) 60 ug/2 Promethazine Phenergan IV 50/2 PO i/I;10 Meperidine 0.5-1.5 MKd Max 2 MKd IV; 4 MKd PO

Demerol Ibuprofen10-15 MKD TID Dolan 100/5 ANTI-ASTHMA Aminophylline LD 4-6 MKd MD 1.5-3 MKd Q8-12H very slow IVTT to be diluted w/ equal amount of dist water. For older infant, dosage may be inc to 25-30 MKD q4-8H *if changing IV to PO aminophylline, inc dose by 20% *from IV to PO Theophylline, no adjustment DRIP: 0.4-0.9 MKH How to drip: e.g. 5kg at 0.4 MKH in 8H drip 5 x 0.4 x 8 = 16 mg in 8H if IVF rate is 5 cc/H, fill SS w/ 40 cc IVF + 16 mg Amino (0.64 ml) Theophylline 3-5 MKd q8H Neullin 80/15; 50; 125;250 Terbutaline SQ 0.005 MKd PO 0.075 MKd Drip 0.003 MKH Bricanyl IV 0.5/ml PO 1.5/5; 2.5 Neb 5 mg/2 Salbutamol 0.15 MKd Ventolin 2/5 syr; 1.2/5 exp; 2/tab Neb 2.5 mg/2.5 ml Librentin 2/5; 2/tab Prox-S 2/5 Atrovent 4 gtts/ml NSS 0.4-1 ml TID-QID Berodual neb 4-10 gtts + 3 cc NSS alternate w/ Tertbutaline even up to q 2H Bodecort neb q 12H COUGH Ambroxol 1.2-1.6 MKD q 12H Mucosolvan 15/5; 7.5/5 Zobrixol 15/5; 6/1; 7.5/1.5 Ambrolex 15/5 Bromhexine 7-12 yo: 1 tsp TID 2-6 yo: ½ tsp TID Bromulex 4/5; 8mg/tab Bisolvon 0.8 mg/ml elixir 2 mg/ml soln 4 mg amp SCMC 20-30 MKD Loviscol 50/ml drops 100/5 250/5 Solmux 40/ml drops 200/5 susp Diphenhydramine 3-5 MKD Benadryl 12.5/5 syr 50/ml amp 25 mg; 50 mg/tab Phenylpropanolamine Disudrin 6.25 g/ml drops 12.5/5 syr RD: 1-3 mo: ¼ ml 4-6 mo: ½ ml 7-12mo: ¾ ml 1-2 yo: 1 ml 2-6 yo: ½ tsp 7-12 yo: 1 tsp Nafarin A 12.5/ml RD: 2-6 yo: ½ tsp 7-12 yo: 1 tsp Brompheneramine Dimetapp 4/5ml syr 2/ml drops RD: 0.1 ml/k/dose TID-QID 1-6 mo: 0.5 ml 7-24 mo: 1 tsp 3-12 yo: 1-2 tsp ANTIBIOTICS PCN G NB: 50-100 T U q12 beyond NB: 100-200 T U q6H Meningitis: 200-400 T U q6H Congenital Syphillis: 50 TU 625 mg= 1M U 250/5 = 400TU 312.5/5= 500 TU 500 mg= 800 TU Oral PCN 50-100 MKD Pentacillin 50/5; 500 Sumapen 25/5; 250; 500 Megapen 50/ml drops 312/5 625 Amoxicillin 60-90 MKD q8H Pediamox

Glamox Himox Moxillin Amox/Clavulanic Acid 40-60 MKD Augmentin 312.5/5 TID 228.5/5 BID Amoclav 312.5/5 Nafcillin 100-200 MKD q 6H 25-50 MKd ≤29 wks (0-28days): q12H (>28 days): q8H 30-36 wks (0-14 days): q12H (>14 days): q8H 37-44 wks (0-7 days): q12H (>7 days): q8H ≥45 wks: q6H Stafloxin 100-200 MKD Ampicillin 100-200 MKD Bacampicillin 25-50 MKD Penglobe 200/5 Vancomycin 40-60 MKD ≤29 wks: 20 MKd q24H 30-33 wks: 20 MKd q18H 34-37 wks: 20 MKd q12H 38-44 wks: 15 MKd q8H ≥45 wks: 10 MKd q6H * reconstitute 500 mg vial w/ 10 cc sterile water for injection to make a final conc of 50mg/ml. Soln is stable for 14 days. Oxacillin 50-100 MKD 25-50 MKd ≤29 wks (0-28 days): q12H (>28 days): q8H 30-36 wks (0-14 days): q12H (>14 days): q8H 37-44 wks (0-7 days): q12H (>7 days): q8H ≥45 wks: q6H * Reconstitute 1 g vial w/ 5.7 cc sterile water to make a final conc of 167 mg/ml. Soln is stable for 3 days at room temp, 7 days ref Prostaphlin 125/5 Orbenin 125/5; 250; 500 CEPHALOSPHORINS First Gen Cephalexin 50-100 MKD Ceporex 125/5; 250/5 Selzef; Keflex Cefradoxil 25-50 MKD BID Cefazolin 50-100 MKD q6-8H Stancef 500 mg, 1 g vial Cefradine 25-50 MKD q6H Second Gen Cefuroxime 50-100 MKD q8H IV 20 MKD q12 PO Zinnat 125/5; 250/5 Zinacef 250; 750; 1.5 g Cefamandole 50-100 MKD QID Mandol 500 mg; 1 g vial Cefaclor 20-40 MKD q12 Ceclor 50 mg/ml drops 125/5; 250/5 susp 250, 500 mg pulvule Third Gen Ceftazidime > 3 mo-1 yo: 80 MKD BID > 2 yo:160 MKD TID/QID Adult: 1-6 g/day BID/TID Neo-2mo: 90-100 MKD TID 30 MKd ≤29 wks (0-28 days): q12H (>28 days): q8H 30-36 wks (0-14 days): q12H (>14 days): q8H 37-44 wks (0-7 days): q12H (>7 days): q8H ≥45 wks: q8H Fortum 250; 500 mg; 1 g; 2 g Ceftriaxone 50-100 MKd OD Sepsis & disseminated GC: 50 MK q24H Meningitis: 100 MK LD, then 80 MK q24H Uncomplicated GC ophthalmia: 50 MK (max 125 mg) SD Rocephin 250; 500 mg; 1 g vial Cefotaxime 50 MKd GC Infection: 25 MKd GC ophthalmia: 100MK SD > 12 yo: 1 g BID ≤29 wks (0-28 days): q12H (>28): q8H 30-36 wks (0-14 days): q12H (>14 days): q8H 37-44 wks (0-7 days): q12H

(>7 days): q8H ≥45 wks: q 6H Claforan 250;500 mg; 1; 2 g vial Cefoperazone 100-150 MKD BID Cefobis 0.5g & 1 g vial Ceftizoxime 40-80MKD BID/QID:C 500 mg-2 g/day BID/QID: adult Tergecin 500 mg; 1g vial Ceftibuten 9 MKD BID/OD Cedax 200; 400 mg cap 38 mg/ml susp; 180/5 Cefixime 3-6 MKD q12H Tergecef 100/5; 20/ml 100mg/cap 50 mg/1g sachet Cefprozil 20 MKD OD or 15 MKD BID Procef 250/5 Cefoxitin 50-100 MKD Mefoxin 1g vial Cefdinir 9-18 MKD q8H Omnicef 50 mg/sachet 100 mg/cap Cefetamet 20 MKD q12H Globocef 250/5 4th Gen Cefepime < 2 mos: 30 MKD BID > 2 mos: 50 MKD BID (w/o ref: 24 H; w/ ref: 7 D) Cepimax 1g vial AMINOGLYCOSIDES Amikacin 10-15 MKD OD in NB & Infants < 27 wks: q 48H 28-30 wks: q 36H 31-33 wks: q 36H > 34wks: q 24H Amikacide 100/2; 250/2 Kanamycin 30-50 MKD Netilmycin 30-50 MKD Netromycin 50/2 Tobramycin 6-8 mKD Gentamycin 4-8 MKD 38 wks: 4 MKd q24H Garamycin 20; 40; 80/2 SULFONAMIDES RD: 8-10 MKD q12H Bacidal 80/5 Trizole 80/5 Triglobe 45/5 Bactrim 40/5; 10, 80 mg/tab Septrin 40/5; 160; 80 mg/tab Synermed 40/5 Synerzole 40/5 Cholramphenicol 50-100 MKD q6H Neonate: LD:20 mg/kg MD: begin 12 after LD PT < 1 mo 12.5 MKd q6H FT 1mo 5 MKd q6 FT > 1wk: 12.5 MKd q6H Pediachlor 125/5 Chloromycetin 125/5 Chloramol 125/5 Tetracycline 40-60 MKD Clindamycin 30-50 MKD NB: 5-7.5 MKd 14 days): q8H 37-44 wks (0-7 days): q8H (7 days): q6H > 45 wks: q6H MACROLIDES Erythromycin 30-50 MKD Erythrocin 100/2.5 DS 200/5 400/5 500/vial Azithromycin 10 MKD OD x 3 days Zithromax 600/ml; 1200/ml Clarithromycin 15 MKD q12H Klaricid 125/5 Roxithromycin 3-6 MKD q 12H Macrol 150 mg/tab Imepenem 60 MKD q6H Neonate: 20-25 MKd q12H Meropenem 20-40 MKd q12H Sepsis: 20 MKd q 12H

Meningitis & Pseudomonas nfxn: 40 MKd q8H Piperacillin Less serious: 100-200 MKD q6H Serious: 200-300 MKD Neonate: 50-100 MKd 14 days): q8H 37-44 wks (0-7 days): q12H (>7 days): q8H >45 wks: q6H ANTI-TB DRUGS INH 15-20 MKD Tx 10-15 MKD Px Trisovit 50/5 Nicetal 100/5 Primafort 100/5 Odinah 150/5 PyrobinH 150/5 Trisofort 200/5 Comprilex 200/5 Rifampicin 10-20 MKD Natricin 200/5 Ricyn 200/5 Rimactane 100/5; 200/5 *Meningococemia 3mo-1 yo: 5 MK q12H x 4 doses 1 yo-12 yo: 10 MK q12 x 4 doses adult: 600 MK q12 x 4 doses Pyrazinamide 20-30 MKD TID pc PZA-Ciba 250/5 Pharex PZA25/5 Ethambutol 15-20 MKD OD q8H ac Ethambin 125/5; 200 mg/tab Myambutol 200/5 Isoetam 150/5 Ethambin INH 125; 150/5 Pediambutol: Etham 125/5 INH 15/5 Pyridoxine 6/5

MD: 0.5-1 mg/k q24H to 48H 50 mg powder dilute in 10 ml dist water Griseofulvin 10 MK SD Fluconazole Systemic infxns inc meningitis: LD: 12 mg/kg MD: 6 mg/kg 14D): q48H 30-36 wks (0-14D): q48H (>14D): q24H 37-44 wks (0-7D): q48H (7D): q24H >45 wks: q24H Thrush: 6 MK day 1, then 3 MKd q24H PO Diflucan 2mg/ml 50, 150, 200 mg/cap Ketoconazole >30 kg: 200 mg OD 15-30 kg: 100 mg OD < 15 kg: 5 mg Nizral 200 mg/tab DIURETICS Furosemide 1-2 MKd Lasix 20/2; 40/2; 20; 40/tab Frusema 20/2; 20,40/tab Diaxozide 5-10 MKd 300mg/20ml Acetazolamide 20-30 MKD Diamox 250 mg/tab Spironolactone 1.5-3.0 MKD RD: edema: 100mg/day Essen HPN: 50-100 mg/day My. Gravis: 100-400 mg/day Aldactone 25, 50, 100 mg/tab Hydrochlorotiazide 1-2 MKD Dichlotride 25, 50 mg/tab MANNITOL 20% 1.5-2 gkd or 5 c/kg 200 g/L; 1 g=5 cc

Streptomycin 20-30 MKD OD IM IRON Tx: 4-6 mkD Px: 1-2 mkD Fer-in-sol 15mg/0.6ml 18mg/5ml Ferlin 30 mg/ ml 15 mg/ml Iberet 500 mg 26.25/5ml Incremin 30 mg/5ml Odiron-C 50 mg/10ml 25 mg/5ml Poly-vi-fer 10mg/ml Propan 25 mg/5ml

ANTIDERMATOSIS Hydrocotisone 1% TID x 2 wks Hytone Hydrotpic Eczacort Bethamethasone BID-TID Betnovate Diprolene Diprosone Fluocinolone acetonide BID-TID Aplosyn 10, 25, HP Synalar 10, 25, HP Mometasone OD Elica Clobetasol propionate Dermovate Diflucortolone valerate Nerisona Mupirocin Bactroban Desoximethasone BID-TID Esperson Eumovate for < 3mos Cutivate for > 3mos Draoplene cream for diaper rash ANTI-FUNGAL Nystatin 0.5-1.0 ml TID-QID x 7D 1 ml(PT) – 2 ml (FT) of 100 TU q6 Mycostain 100 TU/ml 500 TU/tab Aphotericin B Initial dose: 0.25-0.5 mg/kg

ALBUMIN 0.5-1 gk Max: 6gld Albumer, albutren 50/1 (5%); 250/1 (25%) ANTIVIRAL Methisoprinosine 50-100 MKD Isoprinosine 250/ml; 500 mg/tab Inosinoplex 50 MKD Immunosine 250/5 Amantadine 5-8 MKD Symmetrel 50/5 Acyclovir 1-15 MKD q4 Zovirax 250/5; 200 mg/tab Virazole 10MKD ANTACIDS Cimetidine 1-20 MKD q12 Tagamet syr 200/10 Tab 200; 400; 800 IV 200/2; 300/2 Ranitidine 4-5 MKD q8 Zantac IV 50/2 PO 150/ml; 150, 300/tab Cisapride 0.2 MKD q8 Prepulsid 1 mg/ml Maalox 10-15 cc 1 hr after meals & HS Novalusid 1 Hr after meals & HS Famotidine 0.5 MKd q24 ANTISPASMODIC Dicycloverine 1 MKD Relestal 5 mg/ml gtts 10 mg/5 ml syr Bentyl 10/5 Hyoscine-N-butly bromide Buscopan 1-3 tab TID 1-2 tsp TID PO: 5mg/5ml; 10mg/tab IV: 25mg/amp Metoclopramide 0.5 MKD Plasil 10 mg/tab; 5mg/ml susp 10 mg/2ml amp ANTIHELMINTHICS Oxantel pyrantel pamoate RD: 10-20 MKd SD at HS Quantrel 20 mg/ml; 100/5 100 mg/tab Combantrin 125/5

125, 250/tab RD: >15 yo: 500 mg 10-14 yo: 375 mg 5-9 yo: 250 mg 5 yo: 125 mg Tetramizole 2.5-5 MKd SD TMZ 12.5/2.5; 50; 100/tab Mebendazole 100 mg BID x 3D Antiox 20 mg/ml; 100; 500 mg/tab ANTIAMOEBIC Metronidazole 40-50 MKD NB< 2kg: 15 MKD q12 NB>2kg, 2 kg, >7D: 30 MKD q8 IV LD: 15 MK MD: 7.5 MKd q8 Flagyl 125/5; 25; 500 mg IV 500/100 Servizole 200/5 Tinidazole 50-60 MK OD x 3 days Fasigyn 300; 500 Etofamide 15-20 MKD Kitnos 40 mg/5 ml; 250; 500 Secnidazole 30 MK once w/in 4H or 12H for children (4tabs) Flagentyl 500 mg/tab Furazolidone 5-7 MKD q8 Furoxone 16.7/5 Diloxanide furoate RD: 20 MKD x 10 days Furamide 125/5 ANTIHISTAMINES Diphenhydramine IV/IM: I MKD PO: 3-5 MKD TID Methdilazine 0.3 MKD q12-6H Tacaryl 4/5; 4;8 Clemastine 0.05 MKD q12 Tavegyl 0.5/5; 1 mg/tab 2 mg/2 ml amp Hydroxyzine 1 MKD Iterax 2 mg/ml; 10; 25 mg/tab Ceterizine Virlix 10 mg/ml; 10 mg/tab Loratadine 2-12 yo 30 kg: 2 tsp OD Claritin 5mg/5 ml; 10 mg/tab Ketotifen o..25 MKd q12 Zadec 1 mg/ml; Zaditen 0.2 mg/ml STEROIDS Dexametasone 0.15-0.4 MKd Decadron 4 mg/ml Hydrocortisone LD: 10 MK MD: 5-8 MKd Solu-cortef 100/2; 250/2;500 Predisolone 0.7 MKd Solumedrol 125/2 Prednisone 1-2 MKD B. Asthma: 1 MKD Neph. Syn: 60 m/SA/24H In 3-4 div doses Prep: 5 mg; 10 mg; Pred 10 VAMIN chon 2.4 gkD Gluc 5-9 mgKm Prep/L: chon 60 g Cal 650 cal Gluc 100 g Start dose at chon, 0.5 gkD

VITAMIN A < 5 mos…………..50,000 U 6 mos-1 yo……….100,000 U 1 yo & up………...200,000 U * 1 pearl=50,000 U NO DEFICIENCY < 1yo: 100,000 U as SD > 1yo: 200,000 U as SD WITH DEFICIENCY 200,000 U of oil miscible Vit A PO after dx, then give another 200,000 U the ff’g day then another 200,000 U after 2-4 wks

50 100

= ________________ # of ml of D50W to add to IVF in soln then: numerator + numerator x 100 denominator denominator Calories in IVF: D5 : 5 gm = 1 gm = 20 = 0.2 100 ml 4 cal 100 D7.5 : 7.5 gm = 1 gm = 30 = 0.3 100 ml 4 cal 100 D10 : 10 gm = 1 gm = 40 = 0.4 100 ml

Z-VITA 1 MKD 10mg/5 ml GLUCOSE INFUSION RATE (GIR) PNEMONICS Infant below 6 mos of age: Wt in gms = age (mos) x 600 x BW 6-12 months: wt in gms = age (mos) x 500 x BW children 2-6 yrs: wt in kg = age (yrs) x 2 + 8 wt in lbs = age (yrs) x 5 + 17 6-12 yo: wt in lbs = age (yrs) x 7 + 5 2 3-12 mos: wi in lbs = age (mos) + 10 IBW 2-12 mos = age in mos x 10 (in lbs) 4-5 mos = 2x BW 1 yo = 3x BW 2 yo = 4x BW 3 yo = 5x BW 5 yo = 6x BW 7 yo = 7x BW 10 yo = 10x BW GOMEZ CLASSIFICATION IBW 1 yo = (age in yrs x 2) + 8 (ABW/IBW) x 100 N0 = 91-100% 1st degree = 75-90% 2nd dgree = 74-60 % 3rd degree = 90% Mild = 80-90% Mod = 70-80% Severe = 90% Mild = 90-95% Mod = 80-90% Severe = 150 mg/dl = 3 IU 200-249 mg dl = 4 IU 250-299 mg/dl = 5 IU 300-349 mg/dl = 6 IU 350-399 mg/dl = 7 IU 400 mg/dl & ↑ = 8 IU *Get the total 24H Insulin Reqt based on the sliding scale then compute for the split dose Insulin Theraphy. U/A GLUCOSE: +4 = 20 U +3 = 15 U +2 = 5 U trace= 0 U COMPUTATION OF INSULIN U= (CBG – 200)/10 IF CRF = ½ U COMPUTATION OF DIABETIC DIET: IBW = (HT in cm – 100) – 10% x (HT in cm –100) TCR= IBW x BMR BMR: 25= bedrest 30= mild 40= heavy 45= hyper

CALORIC REQT: < 1 mo 110-140 cal/day 1-11 mo 110-115 1-2 yo 100-110 3-8 yo 90-100 7-9 yo 80-90 10-12 yo 70-80 13-15 yo 55-85 18-19 yo 45-50 0-6 mo 117 kcal/k 6-12 mo 108 kcal/k 1-3 yo 100 kcal/k 4-6 yo 90 kcal/k 7-10 yo 80 kcal/k 11-14 yo(M) 65 kcal/k 11-14 yo(F) 55 kcal/k 15-18 yo(M) 50 kcal/k 15-18 yo(F) 40 kcal/k PROTEIN RDA: 0-5 mo 2.5 g/k/day 8-11 mo 2.5-3.0 1-6 yo 2.0-2.5 7-12 yo 1.5-2.0 13-15 yo 1.5 18-19 yo 1.0-1.5 0-6 mo 6-12 mo 1-3 yo 4-6 yo 7-10 yo 11-14 (M) 15-18 (M)

2.2 g/k 2.0 1.8 1.5 1.2 1.0 0.8

Est. Caloric Reqt for catch-up growth: Kcal/k/day = kcal/k req for wt-age x ideal wt for ht/ actual wt for age CHON REQT = CHON req for wt-age x ideal wt for ht/ actual wt for age CHF ACCDG TO: Function: I. asymptomatic II. symptomatic only w/ ordinary activity III. asymptomatic at rest, symptomatic w/ min activity IV. symptomatic at rest Therapeutic: A. no restricion of activity B. restriction of severe activity C. restriction of mod activity D. had restriction of ordinary activity E. restriction to complete rest in a chair or in bed LABS FOR MI: Onset CPK-MB 4-8H SGOT 8-12H LDH 12-24H

Peak Duration 12-24H 24-48H 38-48H 3-5 days 2-4 days 7-10 days

TYPES OF MURMUR: MIDSYS: Aortic & pulmo stenosis PANSYS: MR & TR, VSD DIASTOLIC: MS & AR SYS/DIA: PDA, venous hum, Pericarditis GRADING OF MURMUR: I very faint, need to tune in II quiet but heard upon placing stet on the chest III moderately loud IV loud V very loud w/ stet partly off the chest VI heard w/o chest

GLASCOW COMA SCALE Eye Opening 4 Spontaneous 4 Verbal command 3 To pain 2 NIL 1 Best Motor Response N0 spont. movement 6 Localize pain 5 Withdraws to pain 4 Decorticate rigidity 3 Decerebrate rigidity 2 NIL 1

6

Best Verbal Response 5 Oriented, conscious 5 Disoriented 4 Inappropriate words 3 Incomprehensible 2 NIL 1 TOTAL 15 MODIFIED COMA SCORE Eye Opening 4 Spontaneous 4 To speech 3 To pain 2 NIL 1 Best Motor Response No spont movement Withdraws to touch Withdraws to pain Abnormal flexion Abnormal extension NIL

GRADING OF REFLEXES: +4 hyperactive +3 brisker than average +2 average, normal +1 hypoactive 0 no response

6 6 5 4 3 2 1

Best Verbal Response 5 Coos, babbles 5 Irritable cries 4 Cries to pain 3 Moans to pain 2 NIL 1 TOTAL 15 Severe: 8 & above Mod: 9-13 Slight: 14-15 SEGMENTAL LEVEL OF REFLEXES: DTR: BICEPS C5-C8 TRICEPS C7-C8 KNEE L2-L4 ANKLE S1-S2 SUPINATOR/BRACHIORAD= C5-C8 SUPERFICIAL REFLEXES: UPPER ABD T8-T10 LOWER ABD T10-T12 CREMASTERIC L1-L2 PLANTAR L4-L5, S1-S2 SENSORY PATHWAYS: SPINOTHALAMIC TRACT: PAIN TEMP CRUDE TOUCH POST COLUMN: POSITION VIBRATION FINELY LOCALIZED TOUCH DERMATOME PATTERN: C3 front & back C8 thumb C7 middle finger C8 ring & little finger T4 nipple T10 umbilicus L1 inguinal L3 knee L5 ant ankle & foot S1 heel S5 perianal

MUSCLE GRADING 0 no muscle contraction 1 barely detectable flicker 2 active movement of the body w/ gravity limited 3 active movement against gravity 4 active movement against gravity w/ resistance 5 normal strength CRITERIA FOR BRAIN DEATH: 1. absence of EEG evoke response 2. (-) relflexes & respiration 3. (-) cerebral perfusion 4. absence of responsive & receptive DETN BET LMN & UMN LESION LMN UMN Paralysis present limited to Mx grp Tone spastic flaccid Reflex hyper (-) or hypo Atrophy (-) (+) Fasciculation none present BURNS *LUND & BREWER CLASSIFICATION 0-1 1-4 5-9 10-14 15 Head 2.1 19 15 13 11 Trunk 15.5 15.5 15.5 15.5 15.5 UE 9.5 9.5 9.5 9.5 9.5 LE 14 15 17 18 19 Genitalia 1 1 1 1 1 AMERICAN BURN ASSN PEDIA ADULT Head 18 9 UE 9 9 Trunk 18 18 LE 14 18 Genitalia 0 1

PEDIA METER SQ OF ENTIRE BODY SURFACE (M) = (KGbw x 4 + 9) + 100 meter sq of area burned = (% of burn x M2) + 100 (MB) 1st H fluid rqt Nelson Cc/day = (5000 x M2B) + (2000 x M2) Del Mundo cc/day = (2cc x kg x %burn) + (100 cc x kg) cc/day = (70cc x M2 x %burn) + (1500 x M2) initially 20 cc/kg/H for 1-2H then 1st 8H = ½ of total computed fluid nxt 16H = remaining ½ is given 2nd hr fluid reqt Nelson Cc/day = (4000 x M2 B) + (1500 x M2) Del Mundo Cc/day = ¼ of the 1st 24H fluid & Add 20-30 meq of K then Start oral feesing 3rd hr fluid reqt Do blood or plasma transfusion Plasma deficit = bld vol – RC vol + hct RC vol = bld vol x 0.4

CUSHING’S TRIAD: Initially: inc BP dec HR dec RR Advance: dec BP dec HR dec RR

Urine output = M2 x ave UO x hr Average UO = 25-30 cc/ sq meter/hr Caloric Reqt = 4000 x M2 x %burn X 0.576 Notes: *if > 50% SA burn, compute up to 50% only *start dangerous if >15% SA is involved *if >10% BW is lost → severe fld lost * do not exceed 4-5 L of fluid

ETT SIZE Age (yrs) + 4 4 PT 2.5-3.0 uncuffed NB 3.0-3.5 uncuffed 6 mos 3.5-4 uncuffed 1yo 4-4.5 uncuffed 2 yo 4.5-5 uncuffed 4 yo 5-5.5 uncuffed 6 yo 5.5 uncuffed 8 yo 6.0 cuffed or uncuffed 10 yo 6.5 cuffed or uncuffed 12 yo 7.0 cuffed adolescent 7-8 cuffed Depth = internal dia x 3 mm > 2yo= age (y) + 12 2 No BLD Values (Harriet Lane) AGE Hgb HCT WBC 26-30 wks 13.4 41.4 4.4 (11) (34.9) (2.7) 28 wk 14.5 45 32 wk 15.0 47 Term(cord) 16.5 51 18.1(9-10) (13.5) (42) 1-3 dy 18.5 56 18.9(9.4-34) (14.5) (45) 2 wk 16.6 53 11.4(5-20) (13.4) (41) 1 mo 13.9 44 10.8(4-19.5) (10.7) (33) 2 mo 11.2(9.4) 35 (28) 6 mo 12.6 36 11.9(6-17.5) (11.1) (31) 6mo-2yr 12 36 10.6(6-17) (10.5) (33) 2-6yr 12.5 37 8.5(5-15.5) (11.5) (34) 6-12yr 13.5 40 8.5(4.5-13.5) (11.5) (35) 12-18yr M 14.5 43 7.8(4.5-13.5) (13) (36) F 14.0 41 7.8(4.5-13.5) (12) (37) Tx Regimen for H. pylori PEDIA: 1. Omeprazole + Claritho + Metro x 2 weeks 2. Metro x 2 wks + 4 wks Bismuth subsalicylate 3. Amox + Bi x 6 wks 4. Amox + Tinidazole x 6 wks ADULT: 1. Omeprazole 40 mg QD + Clarithro TD x 2 wks then Omeprazole 20mg QD x 2 wks 2. Ranitidine 400mg BD + Clarithro TD x 2 wks, then Ranitidine 400mg BD x 2wks 3. Pepto-bismol 525mg QD + Metro 250 mg QD + Tetra 500mg QD + H2RA x 4 wks 4. Lanzoprazole 30mg + Amox 1g + Claritro 500mg BDx 2 wks Asthma Wood Score 1 2 3 PaO2 70-100,