PEDIA 20Idiot20Notes 1

0.01-0.03 mkd q 3-5 min 0.02-0.03 mkd Maximum of 0.5mg 1-2mg subcutaneously q 20 minutes Adenocard: 6mg initially then 12mg next Adenosine: 6mg/2mL 1cc/kg/shift Preparation: 100mg/mL/10mL ampuole 0.3-0.5.0 mkd q 12 hrs Maximum of 6 mkD in 2-4 doses Capoten: 25mg tablet 1.0mkd bolus 20-50 mcg/kg/minute : 0.1-0.2 mkd q 4-6 hrs : 0.75-1 mkD in 2-4 doses Maximum of 7.5 mkD Apresoline: 10mg tablet; 25mg tablet; 20mg ampoule 0.25-0.5 mkd q 4-6 hrs 0.5-1.5mcg/kg/minute Department of Paediatrics 2011 and jed_steven1987 1

2.9mg/m 2/day q 8 hrs PO 1.5-2.0 mkd LD: 0.4-1.0 mkd MD: 0.25-0.5 q 4-6 hrs Preparation: 1.2% solution (1med/mL) 0.1 mkd q 2-3 Plain: 0.4 mg/mL Neonate: 0.02 mg/mL

100-200 mkD q 6 Vigopen: 250mg/5mL 40-60 mkD bid Augmentin: 156mg/5mL; 312mg/5mL 100-200 mkD 45-60 mkD q 8-12 hrs 50-100 mkD qid Prostaphlin-A: 125mg/5mL Department of Paediatrics 2011 and jed_steven1987 2

Orbenin: 250mg tablet; 500mg tablet 100-200 mkD IV Prostaphlin 100-200 mkD

60-100 mkD q 6-8 hrs : 20 mk q 18-24 hrs 300-400 mkD q 6-8 hrs 200-300 mkD q4-6 hrs 20 mkd q 8 hrs Meningitis: 40 mkd q 8 hrs

25-100 mkD q 6-8 hrs 50-100 mkD q 6-12 hrs 30 mkD bid Department of Paediatrics 2011 and jed_steven1987 3

Maximum of 2grams 50-100 mkD qid 50-100 mkD q 8 hrs

20-40 mkD q 8-12 hrs Ceclor/Xelent: 125mg/5mL; 250mg/5mL : 20-30 mkD bid : 50-100 mkD q 8hrs Pneumonia: 150mkD q 8 hrs 50-100 mkD qid

150mkD q 6-8 hrs : 100mkd q 12 hrs : 1gram/kg/day q 6-8 hrs : 2grams/kg/day q 8-12 hrs Meningitis: 200mkD q 8-12 hrs 50-75 mkD OD Department of Paediatrics 2011 and jed_steven1987 4

Meningitis:

: 75 mkd : 80-100 mkD

150 mkD q 8 hrs : 25-50mkD q 12 hrs Fortum 100-150 mkD q 8-12 hrs 80-160 mkD q 6-8 hrs Mefoxin 8 mkD q 12-24 hrs Tergecef 100mg/5mL

100-150 mkD q 8-12 hrs

15-30mkD q 12 hrs

Department of Paediatrics 2011 and jed_steven1987 5

: Penicillin G 100,000-250,000 units/kg/D q 4-6 hrs : Penicillin G 100,000-250,000 units/kg/D q 4-6 hrs Penicillin V 25-50 mkD q 4-8 hrs : Penicillin G Benzathine 300,000-1.2 M units q 3-4 weeks Penicillin G Procaine 25,000-50,000 units/kg/D x 10 days 40-60 mkD q 8 hrs Otitis Media: 80 mkD : 50-100 mkD q 12 hrs Meningitis: 150 mkD q 8 hrs : 100-200 mkD q 6 hrs Meningitis: 200-400mkD q 6 hrs 25 mkD q 6 hrs

: 10-15 mkD neonates : 15-25 mkD q 8-12 hrs Amikacide: 100mg/2mL; 250 mg/2mL 2.5 mkD q 8-12 hrs Nebcin


2.5 mkD q 8-12 hrs 15 mkD q 12 hrs

1.00 1.25 1.50 1.75 2.00 2.25 2.50 2.75 3.00 3.50 4.00 4.50 5.00 Amount per 24 hours

15.0 0.4 18.8 0.5 22.5 0.6 26.2 0.7 30.0 0.8 33.8 0.9 37.5 1.0 41.2 1.1 45.0 1.2 52.5 1.4 60.0 1.6 67.5 1.8 75.0 2.0 to be given in divided doses.

30 mkD q 6-8 hrs Flagyl: PO: 125mg/5mL; 250mg tablet IV: 500 mg; 100 mg Servizole: 200mg/5mL Department of Paediatrics 2011 and jed_steven1987 7

50-60 mg OD x 3 days if with AGE and liver involvement 15-20 mkD tid Kitnos: 40mg/5mL; 250mg tablet; 500mg tablet 5-7 mkD q 6 hrs

0.5-1 mL tid to qid x 7 days : 400,000 units/day : 1M-2M units/day Mycostatin: 100,000 units/mL; 500,000 unit tablet : 4-6 mkD Preparation: 500mg + 10 mL distilled water 10 mkD SD : 500-1000 mg/day but not more than 10 mkd single or divided dosea : 10 mkD in divided doses Grisovin: 125mg tablet Oral Candidiasis:

LD: 6 mkd MD: 3 mkD OD Oesophageal Candidiasis: LD: 6-12mkD MD: 3-12 mkD OD Department of Paediatrics 2011 and jed_steven1987 8

Systemic Candidiasis: 6-12 mkD for 28 days Prophylaxis: : LD: 12 mkD MD: 6 mkD : 6 mKd : 3.3-6.6 mkD SD Nizoral: 200mg/tab Not established in paediatric patients Fingernail Onychomycosis: 250mg tablet OD x 6 weeks Toenail Onychomycosis: 250mg tablet OD x 12 weeks Lamisil: 250 mg/tab

30-50 mkD Q 6-8 hrs Maximum of 2grams/day Erythrocin: 200 mg/5mL; 400mg/5mL; 100mg/2.5gtts 10 mkD OD x 3 days 15 mkD q 12 hrs or 7.5 mkd Klaricid: 125 mg/5mL (do not refrigerate)


45-60 mkD q 8-12 hrs 6-20 mkD q 12 hrs (based on Trimethoprim) Triglobe: 45mg/5mL Bactrim: 160 mg/5mL; 40mg tablet; 80mg tablet Macrobid: 40mg/5mL (IM, IV or PO) 10-40 mkD q 6-8 hrs Dalacin C 75mg/5mL (IV or PO) 50-75 mkD q 6-8 hrs Chloromycetin Chloramol 40-60 mkD

10-20 mkd 100 mkd bid x 3 days Antiox: 100mg tablet; 500mg tablet; 20mg suspension Combantrin: 125mg tablet; 250mg tablet; 125mg/5mL suspension >15 years old 500 mg 10-14 years old 375 mg Department of Paediatrics 2011 and jed_steven1987 10

5-9 years old < 5 years old

250 mg 125 mg

50-100 mkD Isoprinosine: 250mg/1mL 50mkD Immunosin: 250mg/5mL 10-15 mkD Zovirax: 250mg/5mL; 200mg tablet

Refer to http://www.drugs.com/dosage/fentanyl.html for adult or paediatric dosing as classified by purpose. Low: 2mkD Moderate: 2-20mkD High: 2-50 mkD 5-10 mkd q 6 hrs Dolan: 100mg/5mL; 200mg/5mL 3-5 mkD Department of Paediatrics 2011 and jed_steven1987 11

Ponstan: 50mg/5mL 0.1 mkd Dormicum: PO: 5mg tablet IV: 5mg/mL 0.1-0.2 mkD Preparation: 10 mg/mL 0.1 mkD Nubain: 10mg/mL 0.4-0.1 mkD

4-5 mkD q 8 hrs 0.7 mkd q 12 hrs 0.6-0.7 mk OD Preparation: 20mg; 40mg 10-20 mkD q 12 hrs Preparation: 200mg/mL


0.1 mkd q 8 hrs

< 6 years: >6 years:

0.12-0.15 mkd q 8 hrs 2mg/dose tid or qid

: 0.005 mkd : 0.075 mkd Drip: 0.003 mkH Bricanyl: PO: 1.5mg/5mL; 2.5mg/5mL IV: 0.5mg/mL 3-5 mkd Nuellin:

80mg/15mL; 50mg tablet; 125mg tablet; 250mg tablet

Apnea: Neonates:

: 6-10 mkd : 2-4 mkd q 12 hrs

6 weeks – 6 months: 10 mkD 6 months – 1 year: 12-18 mkD 1 year – 9 years: 20-24 mkD 9 years – 12 years: 16 mkD 12 years – 16 years: 13 mkD


Drip: 0.5-0.9 mk/hour + equal amount of diluents : LD: 6 mkd IV or PO MD: 2.5-3mkd q 12 hrs IV or PO : 6 weeks – 6 months 0.5 mk/hour 6 months – 1 year 0.7 mk/hour 1 year – 9 years 1 mk/hour 9years – 12 years 0.9 mk/hour 12 years – adult 0.7 mk/hour Preparation: 25mg/mL 6-9 mkd q 12 hrs Ansimar: 100mg/5mL Other options for asthma : 

0.01 mkd subcutaneous administration 

: 5-6 mkd over 20 min : 1mk/hour; or 1 mk IV q 6 hrs 

25-75 mkd IV drip for 20 minutes then q 8 hrs 

Drip: 0.1-0.4 mcg/kg/minute Preparation: 500mcg/mL


3-5 mkD tid to qid Preparation: 12.5 mg/5mL; 25mg capsule 1mkD once to two times a day Iterax: 2mg/mL; 10mg tablet 0.25 mkD Virlix: 10 mg/mL > 3 years, < 30kg: 5mg/day >30 kg: 10mg/day 0.025mkd q 12 hrs Zadec: 1mg/5mL Zaditen: 0.2mg/mL Number of drops = weight in kilograms x 0.25 Xyzal

< 6yo initial:

5 mkD in 2-4 doses; May increase q 5-7 days by 5mg/kilo 6-12 yo initial: 10 mkD in 2-4 doses


Increase by 100mg or 5mkD at weekly intervals until treatment levels are achieved 0.01-0.3 mkD in 2-3 divided doses Increase by 0.5mg/24 hrs q 3-5 days until patient responds 0.2-0.4 mkd Maximum of 2-5mg Valium: 10mg/2mL Antiemetic: 0.04-0.08 mkd q 6 hrs IV Anxiolytic/Sedative: 0.05-0.1 mkd q 4-8 hrs 0.1-0.2 mkd Anticonvulsant : : 0.15mg/kg administered intravenously over 5 minutes : 0.06-0.4mg/kg/hour at 1-7 mcg/kg/minute Child : 15-20mkd : 5-6 mkD q 12-24 hrs Neonate : : 20mkd : 3-4 mkD q 12-24 hrs


Neonate:

Children:

LD: 15-20 mkd Maximum of 0.5mg/kg/minute MD: 5 mkD d 12-24 hrs LD: 15-18 mkd Maximum of 1-3mg/kg/minute MD: 5-6 years: 8-10 mkD 7-9 years: 6-8 mkD q 12-24 hrs 10-16 years: 6-7 mkD q 12-24 hrs

10-15 mkD in 3 divided doses Increase weekly by 5-10 mkD until patient responds

(PO, IM or IV) Post-intubation: 0.5-2 mkD q 6 hrs Anti-inflammatory: 0.08-0.3 mkD q 6-12 hrs Bacterial meningitis: 0.6 mkD q 6 hrs for 1-4 days of antibiotics 5 mkd q 6 hrs then gradually taper 0.7 mkD 0.5-1 mkD Pred10: 10mg/5mL 1.5 mkD q 6 hrs Department of Paediatrics 2011 and jed_steven1987 17

Hytone/ Lacticare Betnovate/Diprolene Synalar/Aplosyn Momate/Elica Dermovate

RD: 10-15 mkd Aeknil Biogesic Calpol Naprex Opigesic Rexidol Tylenol

300mg/2mL 100mg/mL; 250mg/5mL 120mg/5mL; 250mg/5mL 250mg/5mL 125mg suppository; 250mg suppository 150mg/5mL 120mg/5mL

: 0.04-0.06 mkd q 6 hrs x 4 doses Department of Paediatrics 2011 and jed_steven1987 18

Maximum of 1mg/day : 1/8 the loading dose q 12 hrs Pedia Elixir: 0.05mg/mL; 0.25mg/ml PO: 0.25mg tablet IV: 0.5mg/2mL

0.3-1mkD q 6 hrs 0.5-2mcg/kg/dose nebulization q 2-4 hrs Preparation: 20mcg/mL vial 1 vial = 9mL PNSS 0.25mL/kg bid or tid Meptin

:

1-2mkD : 4-5mkD Ferlin drops: 15mg/mL Ferlin syrup: 30mg/5mL

:

0.25mkD


Folart drops Folart syrup

1-2 mkd Lasix: 40mg tablet; 20mg/2mL ampule Frusema: 40mg tablet; 20mg tablet 0.5-1 gram/kg/dose Preparation: 20grams/100mL 1gram= 5mL 5-10 mkd Preparation: 300mg/2mL 20-30 mkD Preparation: 250mg tablet 1.5-3 mkD Aldactone: 25mg tablet 1-2 mkD Dichlotride: 25 mg tablet; 50mg tablet


NaHCO3 in mEq = 0.3 x Weight (kg) x Base deficit (mEq/L) 1-2 mEq/kg IV push over 10-30 minutes

Diarrhoea: Pneumonia:

<6 ≥6 <2 ≥2

months: months: years old: years old:

10mg 20mg 10mg 20mg

OD po x x 10-14 OD po x OD po x

10-14 days days 4-6 months 4-6 months

: 10mg/mL = 27.5mg/mL : 20mg/5mL = 55mg/5mL

: 1-2 mkD : 4-5 mkD Ferlin: Drops 15 mg/mL Syrup 30 mg/mL

AGE: 20 mkD OD PCAP: >24 months: 20 mkD OD <24 months: 10 mkD OD Folart: Tablet: 5 mg tablet Drops: 2.5 mg/mL Department of Paediatrics 2011 and jed_steven1987 21

Syrup:

5 mg/mL

5-10 mg/dose Children: 2-3 mg/24 hrs Adolescents and adults: 5-10 mg/24hrs

1.5mkd tid Hidrasec sachet: 10mg; 30mg

20mg + 50cc D5 water to make 0.4mg/cc : 3.5 mkd : 0.5mg/kg/hr via infusion pump

1-5µg/kg/min 5-10µg/kg/min 10-20µg/kg/min

Increases renal and splanchnic circulation Inotropic; no effect on heart rate Increases blood pressure

Preparation: 200mg/5mL Department of Paediatrics 2011 and jed_steven1987 22

800 1600 Preparation of Dobutamine:

1mL 2mL

49mL 48mL

4mL 8mL

46mL 42mL

250mg/2mL

1000 2000 Computation :

Rate x Concentration Weight in kilograms x 60 : Recommended dose x weight in kilograms x 60 Concentration

1.Get the rate of dopamine according to the desired dose 2.Get the volume of dobutamine to the desired dose using this formula: Weight in kilograms x Recommended dose x 60 Dopamine rate Concentration (1000)


3.In a soluset prepare the total volume of 50cc composed of the following:  Dopamine volume of  Calculated Dobutamine volume  D5 Water 4.Regulate to dopamine rate

0.1-2mg/kg/minute Start at 0.5mg/kg/minute?? 2mg + 48mL D 5W

 Secure

regular insulin at 100 IU/mL  Prepare as follows:  Aspirate 0.1mL from vial + 0.9mL of normal saline to make 10 IU/mL  Aspirate 0.1mL from the 10 IU/mL solution + 0.9mL of normal saline to make 1 IU/mL  Aspirate 0.6mL from the 1 IU/mL solution + 7.4mL D 5Water to make 8mL and run at 1mL/hr  Flush syringe and tubing with regular insulin  HGT one hour afte r (depends on physician’s preference) (O.02-0.1) AD x wt x hrs


Start with 10% at 0.5grams/kg/day via infusion pump for 12 hours Preparation : 10% = 10grams/100mL 20% = 20grams/100mL

Components: Congenital Adrenal Hyperplasia Congenital Hypothyroidism G6PD deficiency Galactosemia Phenylketonuria Perform at 48 hrs old May be done ideally until 6 weeks old May be done theoretically from 24 hrs old until 6 months old Do not perform if the patient: Has received blood transfusion Tests NOT affected:  Congenital Adrenal Hyperplasia  Galactosemia Placed on NPO Test affected:  Galactosemia     

 






Heart rate: < 2 months 140-160 2-12 months 120-140 1-2 years 100-120 2-8 years 90-110 Respiratory rate: < 2 months up to 60 2 months - 1year 50 1-5 years 40 Blood pressure: : Upper limit = Age in years x 2 + 90 Lower limit = Age in years x 2 + 70 30 mmHg lower than systolic BP

Weight in grams = age in months x 600 + birth weight Weight in grams = age in months x 500 + birth weight Weight in kilograms = age in years x 2 + 8


4-5months 1 year 2 years 3 years 5 years 7 years 10 years

Birth Birth Birth Birth Birth Birth Birth

weight weight weight weight weight weight weight

x x x x x x x

2 3 4 5 6 7 10

Height in centimeters = age in years x 5 + 80 Birth weight : 50cm 1st year : 25 cm 2nd year : 12.5 cm 3rd year : 6.25 cm 4th year : 3 cm

Age in years x 2 + 70

Systolic Blood Pressure – 30

Newborn to Day 7

> 95mmHg


Day 8 to Day 30 Infant to 2 years old 2 years old to 5 years old 6 years old to 11 years old

>105mmHg > 115/75mmHg >130/80mmHg > 135/85mmHg

Weight in kilograms x 4 + 7 Weight in kilograms + 90 Renal Meningitis Preterm BSA CHF BSA Cardiac MF < 2 years > 2 years

BSA x 400 BSA x 1500 x 1200 x 800 BSA x 200 BSA x 1500 BSA x 1200

Haematology BSA: Square root of

Weight in kilograms x Height in centimeters

3600

Nephrology BSA: 0-5 kilograms Weight in kilograms x 0.05 + 0.05 6-10 kilograms Weight in kilograms x 0.04 + 0.10 11-20 kilograms Weight in kilograms x 0.03 + 0.20 21-40 kilograms Weight in kilograms x 0.02 + 0.40 Department of Paediatrics 2011 and jed_steven1987 28

> 40 kilograms

Weight in kilograms x 0.01 + 0.80

Dry weight: = Actual weight – Estimated oedema = Actual weight – (Actual weight x 0.80) = Actual weight – [Actual weight – (Actual weight x 20%)]

Weight in kilograms Height in centimeters Height in centimeters x 10,000 < 5th percentile 5th – 84th percentile 85th – 94th percentile > 95th percentile

Underweight Normal weight At risk for overweight Overweight

Newborn 3-10 kilos 10-15 kilos 15-25 kilos 25-35 kilos 35-60 kilos >60 kilos

45-50 60-80 45-65 40-45 35-40 30-35 25-30

cal/kg cal/kg cal/kg cal/kg cal/kg cal/kg cal/kg


Maintenance fluid computation: (cc/hr) BCE x Weight in kilograms x 1.5 24 Fever Hyperventillation Bronchial Asthma Bililight Hypermetabolic Burns Sweating

+ 12% for ever degree above 37.5 oC + 25-50% + 50% + 20% + 25-50% + 14% for 1 st degree + 10-25%

 Feeding

per orem  Weight gain of 10-30 grams/24 hrs  Thermoregulated  No apnea or bradycardia  On PO meds  Reached 1,800-2,100 grams  Adequate home settings

80cc/kg x 2 or Body weight x 80% x 2


 Divide

by 10 or 20 to get volume for exchanges  Put on NPO before and after DVET  Pre DVET laboratory tests:  Calcium  Chloride  Random Blood Sugar  Sodium  Potassium  Arterial Blood Gas  Total Bilirubin and Direct Bilirubin

: Vancomycin

60 mkD q 6 hrs :

Cefotaxime 200 mkD q 6 hrs Ceftriaxone LD: 75 mkd MD: 80-100 mkD Ceftriaxone, OR Penicillin 400,000 units/kg/D q 4-6 hrs x 10-14 days Penicillin 400,000 units/kg/D q 6 hrs x 5-7 days Ampicillin 100-200 mkD q 12 hrs


Dexamethasone 0.15 mkd q 6 hrs x 2 days for patients with HiB Give 1-2 hrs prior to antibiotics

: 0.2-0.4 mkd q 5 min : 0.5 mkd : 20-40 mkd, increase by increments of 10 : 5 mkD q 12 hrs, start 12 hrs after LD

:

Tetracycline 50 mkD qid x 3 days Contraindicated in <9years old. Instead, use:  Co-Trimoxazole 8-10 mkD bid PO  Erythromycin 40 mkD Doxycycline 5mkD single dose

1.2-1.6 mkd bid Mucosolvan: 15mg/5mL Expel: 0.6mg/mL Zobrixol: 15mg/5mL Department of Paediatrics 2011 and jed_steven1987 32

20-30 mkD Loviscol: 50mg/mL; 100mg/mL Solmux: 40mg/mL; 200mg/5mL

2 months - 2 years:  Send

home  Trimethoprim + Sulfomethoxazole  Treat the fever  Follow up in 2-4 days  Admit  Intravenous

or intramuscular Benzyl Penicillin  Treat the fever and wheezing  Supportive care  Reassess daily  Admit  Give

oxygen inhalation  Give Chloramphenicol  Treat the fever and wheezing  Reassess two times a day or every 15 minutes possible < 2 months:

if


 Hospitalize  Keep

warm st  Give 1 dose antibiotics  Benzyl Peicillin  Garamycin; or  Gentamycin

Ampicillin 100 mkD q 6 hrs Ceftriaxone 50 mkD Nalidixic Acid 55 mkD q 6 hrs : Ciprofloxacin 15-30mkD q 12 hrs **Treat for 5 days

Grading : Grade I Grade II Grade III

Fever + non-specific signs and symptoms + positive tourniquet test Grade I + signs of spontaneous bleeding Grade II + manifestations of circulatory failure:  Rapid, weak pulse  Narrow pulse pressure  Hypotension  Cold, clammy extremities


Grade IV

Profound shock with undetectable blood pressure and pulse

Classical Dengue Fever: Thrombocytopenia not < 100K/ µL Haemoconcentration not ≥ 20% of baseline  

IM: 0.01 mkd max of 0.5 mL Preparation: 1:1000 : 1-2 mkd q 4-6 hrs Maximum of 50mg : 1-2 mkD q 6 hrs Maximum of 50mg : 5-10 mkd q 4-6 hrs Maximum of 100-500mg

Sodium Potassium Calcium Chloride

135-145 mEq/L 4.5-6 mEq/L 8-10 mEq/L 98-106 mEq/L

(RV = 136 mEq) (RV = 4 mEq)


Deficit: (Desired – Actual) x Weight in kilograms x 0.6

Sodium Potassium Chloride

3mEq/L 2mEq/L 2mEq/L

Mild Moderate Severe

< 6.5mEq/L 6.5 – 7.5mEq/L > 7.5mEq/L

Management :  If with significant ECG abnormalities: to stabilize myocardial cells;  given with patient attached to cardiac monitor 0.1-0.2 mkd administered over 5-10 minutes; or 1cc/kg/shift; or 30 x weight in kilograms 9  For redistribution of potassium to correct acidosis and to induce  intracellular shift of potassium 1-2 mEq/kg IV push over 10-30 minutes Department of Paediatrics 2011 and jed_steven1987 36

to shift potassium intracellularly 1unit/10kilograms D water to to prevent hypoglycemia from insulin 50 administration to promote intracellular shift of  potassium  For removal of potassium 

 

cation exchange resin to bind with potassium and to enable excretion



Kumumi Score for IVIg resistance < 6 months old 1 point Before 4 days of illness 1 point Platelet count < 30K/ µL 1 point CRP >8 mg/dL 1 point ALT > 80 IU/L 2 points indicates IVIg resistance with 78%  Score of sensitivity and 76% specificity Harada Score Intravenous gamma globulin is given to children who fulfill 4 of the following criteria, assessed within 9 days of onset of illness: Department of Paediatrics 2011 and jed_steven1987 37

blood cell count >12 000/mm 3 3  Platelet count <350 000/mm  CRP > 3+  Haematocrit <35%  Albumin <3.5 g/dL  White

 Age

12 months  Male sex For children with < 4 risk factors but with continuing acute symptoms, reassess daily. ≤

Source: http://pediatrics.aappublications.org/content/114/6/1708.full

K x height in centimeters Serum Creatinine Where K (Constant) is: Preterm and Low birth weight Term and > 1 year old Child, female adolescent Child, male adolescent Interpretation: 80-120 50-80 20-50 5-20 <5

0.33 0.45 0.55 0.77

normal renal impairment renal insufficiency renal failure uremia


Post-LP orders:  NPO until fully awake  Flat on bed for 4 hrs  Send tubes to lab: Tube #1: Gm stain, culture, KOH and India ink, AFB Tube #2: Glucose and CHON Tube #3: Cell count and Differential count  Do

not forget to take opening pressure  Do not forget HGT Contraindications :  Increased ICP  Severe CP depression  Infected skin  Decreased platelet count or blood d/o  Brain abscess CSF :

Colorless: WBC: CHON: Glucose:

50-80 mmH 20 5/mm 3 < 45 mg/dL 60-75% of HGT

CSF Normal Values : Newborn 80-110 mm H 2O Department of Paediatrics 2011 and jed_steven1987 39

Infant

<

200 mmH 2O

Premature Term

24-63 mg/dL (CSF: Blood ratio 55-105%) 44-128 mg/dL (CSF: Blood ratio 44-158%)

Premature Term

65-150 mg/dL 20-170 mg/dL

Premature Term

0-25 cells/mm 3 (57% PMNs) 0-22 cells/mm 3 (61% PMNs)

WBC correction in traumatic tap: Peripheral WBC x 1000 x1,000 = 5,000,000

WBC 1,000 RBC

Total WBC x % of neutrophils and bands Mild neutropenia Moderate Severe

1000-1500 /uL 500-1000/uL <500/uL

VCO 8 kcal/mL Aminosteril 650 kcal/1000mL NAN 67 kcal/100mL Department of Paediatrics 2011 and jed_steven1987 40

EBM 20 kcal/oz Milk formula 30kcal/oz Intralipid 650kcal/1000mL D5 0.2 kcal/cc D7.5 0.3 kcal/cc D10 0.4 kcal/cc

>0.5 >0.6

<0.5 <0.6

Specimen for pleural fluid analysis: Tube1: CHON, LDH Tube 2: Differential count and cell count Tube 3: Gram stain, AFB stain, Culture and Sensitivity to get  Serum ODH  Serum CHON

Initial Fluid: 20cc/kg to be administered in 2 hrs Regulated Fluid: (Maintenance fluid + deficit) – 20cc/kg 24 hours Department of Paediatrics 2011 and jed_steven1987 41

Maintenance fluid calculation use Holiday-Segar Deficit:

5% 10% 15%

3% 6% 9%

(¼ of the fluids in the 1st hour, ¾ in the Hydrite 1 tablet in 100cc water good for Glucost 1 sachet in 100cc water good for Oresol 1 sachet in 1L water good for 24 Glucolyte 1 sachet in 200cc water

next 7 hours) 8 hrs 8 hrs hrs

Hypotonic :  D5 Water  D5 NM  D5 0.3% NaCl  D5 IMB  Isolyte  D5 Maintresol Isotonic :  D5LR  D5 NSS  PLR Department of Paediatrics 2011 and jed_steven1987 42

PNSS Hypertonic :  D50 Water  D10 Water 

245 mmol/L Sodium Glucose Chloride Citrate Potassium

25 40 154 130 40 40 25 51 102 77

20 13 4 30 35 20

75 75 65 10 20

22 40 154 109

23 16

3 3

3 3

28

3

3

40 20 51 102 77


90 45

20 20

80 35

1mEq sodium = 23mg 1mEq potassium = 39.1mg

Maintenance < 2 years Maintenance > 2 years Preterm Neonate LBM Vomiting Bronchial Asthma Fever and Sweating Drowning Ascites CHF Hypertension Heat Stroke Burns Azotemia Increased BUN Bleeding UTI Profuse Bleeding Dengue Fever Diabetes Mellitus

D 5IMB D 5NM Electrolyte free D 5 PLR D 5 NSS D 5 0.3% NaCl D 5 0.3% NaCl D 5 Water D5 Water; D 10 Water D5 NSS D 5 0.3% NaCl D 5 NSS PLR D 5 Water D 10 Water D 5 0.3% NaCl D5 NSS D 5 0.3% NaCl D 5 0.3% NaCl PNSS


Term 60cc/kg/day Preterm 70cc/kg/day  Increase by increments of 10cc/kg/day until a maximum of 150cc/kg/day

HGT < 40 mg/dL Volume to give: 2cc/kg Volume of D 50: Volume to give x 0.11 Volume of D 5: Volume to give – Volume of D 50 D10 = Volume of D 50 + Volume of D 5

 

D5 is readily available How much D 50 are you going to add to D5? Amount of D50 = (Desided Dextrosity – Actual Dextrosity) – 45

Glucose Infusion Rate (GIR): Rate in mL/hr x Dextrosity in mg/mL Weight in kilograms x 60 Normal values : Peripheral lines: 4-6 As high as D 12.5 in preterm Department of Paediatrics 2011 and jed_steven1987 45

Conversion :

Central lines: 10-12 As high as D 20 in preterm D10 0.11 D7.5 0.055 D12.5 0.16 D15 0.2 D20 0.3

55 25 15

60 10 90

50-60 140 130 130 50-55 50 140 10-100

10-15 5 5 15-20 25-35 5 4-5 20-100

90-150 50-100 100 120 0-40 55 100 70-100

0 100 40 25-30 15-50 0 25 0

**mEq/L Department of Paediatrics 2011 and jed_steven1987 46

 G18

ambucath  Specimen bottles # 3  Gauze  Macro set  Sterile bottle  Normal Saline Solution  Tongue depressor  Gloves  10cc syringe Specimen: Bottle # 1: CHON, LDH Bottle # 2: Differential count and cell count Bottle # 3: Gram stain, AFB stain, Culture and Sensitivity to get  Serum CHON  Serum LDH

Uncomplicated : 

50-75 mkD x 14-21 days  Department of Paediatrics 2011 and jed_steven1987 47

75-100 mkD x 14 days 

15 mkD x 15 day 

15-20 mkD x 7-14 days 

75 mkD x 10-14 days Severe : 

100 mkD x 14 days 

60-75 mkD x 15 days 

15 mkD x 15 days

Major Criteria:  Carditis  Arthritis  Sydenham’s chorea  Erythema marginatum  Subcutaneous nodules Minor Criteria:  Arthralgia  Fever  Laboratory test results: Department of Paediatrics 2011 and jed_steven1987 48

Elevated CRP and ESR  Prolonged PR interval on ECG  Positive ASO titer  Positive Group A Streptococci culture 2 major criteria; or 1 major + 2 minor criterion 

Class I: Class II: Class III: Class IV:

Class V: E:

Activity

Healthy patient, no systemic disease Mild systemic disease without functional limitations (mild CRF, IDA, mild asthma) Severe systemic disease with functional limitations Severe systemic disease that is a constant threat to life (critically ill or acutely ill pts with major systemic disease) Moribund patient not expected to survive 24 hrs with or without surgery Emergency surgery

Able to move four extremities voluntarily or on command Able to move two extremities voluntarily or on command No motion

2 1 0


Respiration

Circulation

Pulse Rate

Consciousness

O2 Saturation

Color

Able to breathe deeply and cough freely Dyspnea or limited breathing Apneic BP ± 20% of pre-anaesthetic level BP ± 20 – 40% of pre-anaesthetic level BP ± 50% of pre-anaesthetic level Pulse ± 20 beats of pre-sedation rate Pulse ± 50 to 21 beats of pre-sedation rate Pulse > ± 51 beats of pre-sedation rate Fully awake Arousable Not responding Maintains baseline saturation on room air Needs O2 to maintain >90% saturation O2 saturation <90% with O2 supplement Pink Pale and blotchy Cyanotic

2 1 0 2 1 0 2 1 0 2 1 0 2 1 0 2 1 0

Score of three points below baseline  Maintain 1:1 surveillance and q 5 minute documentation of vital signs Score of two points below baseline  q 15 minute surveillance and documentation of vital signs Score of one point below baseline  q 15-30 minute surveillance and documentation of vital signs depending on patient’s condition


 Patients

who have received reversal agents will require q 15 minute surveillance and documentation of vital signs for a minimum of two hours post-reversal administration  Patients with Aldrete score of two points or more below baseline must be referred to the physician responsible for the procedure for further evaluation. equal to baseline post-procedure will be  Patients discharged from the procedure area as in 5.0 of the Sedation/ Analgesia Policy

Pancreatitis:  Age

> 55 years  Leukocytosis > 16,000/ µL  Hyperglycemia > 200mg/dL (11mmol/L)  Serum LDH > 400 IU/L  Serum SGOT (AST) > 250 IU/L  Haematocrit

fall > 10%  Fluid sequestration > 6,000mL  Hypocalcemia < 8mg/dL (1.9mmol/L)  Hypoxemia PO2 < 60mmHg)  BUN rise > 5mg/dL (>1.8mmol/L) after IV fluid hydration  Hypoalbuminemia < 3.2g/dL (32g/L)


Gallstone pancreatitis:  Age

in years > 70 years 3  White blood cell count > 18000 cells/mm  Blood glucose > 12.2 mmol/L (> 220 mg/dL)  Serum AST > 250 IU/L  Serum LDH > 400 IU/L  Calcium

(serum calcium < 2.0 mmol/L (< 8.0 mg/dL)  Haematocrit fall > 10%  Oxygen (hypoxemia P O2 < 60 mmHg)  BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration  Base deficit (negative base excess) > 5 mEq/L  Sequestration of fluids > 4 L Interpretation : If the score ≥ 3, severe pancreatitis likely. If the score < 3, severe pancreatitis is unlikely or Score 0 to 2: 2% mortality Score 3 to 4: 15% mortality Score 5 to 6: 40% mortality Score 7 to 8: 100% mortality


 Typical

pain: retrosternal, severe, pain lasting >30min, unrelieved by nitrates, cold, clammy perspiration  Evolutionary ST elevation followed by Q wave formation and ST segment inversion  Elevation of serum CPK-MB

4-6 hrs 8-12 hrs 12-24 hrs

12-24 hrs 36-48 hrs 2-4 days

24-48 hrs 3-5 days 7-10 days

Clinical Jaundice: Manifestation of color starting at serum bilirubin levels of 5-7mg/dL Criteria to rule out physiologic jaundice: st  Clinical jaundice in the 1 24 hrs of life  Increase in total serum bilirubin at > 5 mg/dL/day (85µmol/L)  Total serum bilirubin > 12mg/dL in full term, and > 15mg/dL in preterm  Direct bilirubin > 1.5-2mg/dL (26-34 µmol/L)  Jaundice lasting for more than 1 week for term, 2 weeks for preterm


Class 1 Class 2 Class 3 Extrapulmonary

3 months INH 9 months INH 2 months HRZ + 4 months HR 2 months HRZ + E or S, then 10 months HR ± E or S

10 mkD OD ac breakfast 200mg/5mL 5 mkD OD ac breakfast 200mg/5mL 15 mkD bid pc meals 250mg/5mL 20 mkD 20-30 mkD OD IM

Chest x-ray findings: Pericardial Effusion infiltrates Heart Failure:

:

Big

heart

with

no

lung

Big heart with lung infiltrates


Expected FEV 1 Females: Males:

(height in centimeters - 100) x 5 +170 (height in centimeters - 100) x 5 +175

Oxygen delivery: FiO2 = O2 in liters per minute x 5 + 21 Expected PaO 2 = FiO2 x 5 ARDS  If P/F ratio is <200  If P/F ratio is <300 Acute Lung Injury Pulmonary volumes : Volume inspired or expired with each normal breath Volume that can be inspired over and above the TV

Volume that remains in the lungs after maximal expiration Anatomical : Volume of the conducting airways Physiological functional measurement : Volume of the lungs that does not eliminate CO 2 (usually greater in lung diseases with V/Q inequalities)


Signs of Acute Respiratory Distress  Acute/sudden onset of hypoxemia  PF ratio < 200 (ARDS)  No cardiac lesion  X ray of bilateral infiltrates Alveolar-Arterial Oxygen Difference (713 x FiO 2) -

PCO2 0.8

- PaO2

Normal: 10 to 20  The smaller the number, the better the result Indications for :  ABG Low PO2 (<60%) Increased PCO2 (>45) P/F ratio PaO2 < 80%  Depressed neurologic status  Increased work of breathing  Hemodynamic status changes: HR, BP, decreased CRT    

Endotracheal tube size : > 2 years old Age in years + 4 4 Continuous Positive Airway Pressure Department of Paediatrics 2011 and jed_steven1987 56

Total Flow Rate (TFR): Weight x tidal volume (10-15) x respiratory rate x IE ratio (2) + 2000 (2L) x Formula for getting FiO 2 : Compressed Air x 0.2 + O 2 x 100 TFR TFR of 6 is usually used Compressed Air: 100 – FiO2 x TFR 79 1LPM = 4% FiO 2 Continuous Positive Airway Pressure Guidelines  Initially CPAP is set at 6 cm water. If there is no increase in PO 2 in 15 minutes, pressure must be increased by 2cm increments to a maximum of 10 cm if by endotracheal tube or by 12 cm in other methods.  If there is an increase in PaO 2, reduce pressure.  If 10-12 cm water pressure is attained and if PaO 2 remains under 50, FiO 2 must be increased by 5-10% increments.  CPAP failure is evident if PaO 2 remains less than 50 in 100% FiO2 with 10-12cm water.  If CPAP fails under non invasive method, an ETT must be inserted.


 If

CPAP fails with endotracheal tube, mechanical ventilation is indicated.

Parameters to be met before weaning :  Improvement in chest x-ray  ABG showing PO 2 ≥ 50 mmHg  Blood pH ≥ 7.3  PCO2 ≤ 55 mmHg  Haemoglobin of 12-15 grams/dL or Haematocrit of 36-45% Weaning from CPAP :  Decrease FiO 2 by 3-5% every time PaO 2 reaches > 70  With FiO2 of 40%, reduce pressure by increments of 2 cm water every 2-4 hrs until pressure of 2-3 cm is achieved.  Transfer patient to oxygen hood with FiO 2 of 15-50% Indications for :  Frank pus  Positive Gram’s stain  Parapneumonic effusion with evidence of loculation  pH < 7.2  Glucose load < 40 mg/dL  LDH > 1000  Massive effusion with overwhelming sepsis (Hib and Staphylococcus) Indications for

:


 Drainage

< 30-50 cc/day  Draining fluid is clear yellow  Improved constitutional symptoms  Non-functioning CTT

Haematocrit Values: 1day 45-69% 2 days 48-75% 3 days 44-72% 2 months 28-42% 6 months – 12 years 35-45% 12 – 18 years Males: 37-49% Females: 36-46% 18 – 49 years Males: 41-53% Females: 36-46% Hemoglobin Values 1 - 3 days 2 months 6months - 12 years 12 – 18 years Males: Females: 18 – 49 years Males: Females:

14.5-22.5 9-14 11.5-15.5 13-16 12-16 13.5-17.5 12-16

Reticulocyte Index (RI) Department of Paediatrics 2011 and jed_steven1987 59

% Reticulocyte x

Patient’s Haematocrit Normal Haematocrit

Reticulocyte Production Index (RPI) Reticulocyte Index Maturation Correction

36-45 26-35 16-25 <15

1.0 1.5 2.0 2.5

Callman’s Equation for Desired Haematocrit Age in years Haemoglobin = + 11.1 10

Haematocrit = Haemoglobin x 3 Blood Transfusion 10-15cc/kg Maximum of 20cc/kg Volume to be transfused: Desired Haematocrit – Actual Haematocrit Weight in kilograms 10-15 cc/kg Department of Paediatrics 2011 and jed_steven1987 60

Neonates: 15cc/kg 1unit for every 6 kilogram body weight 1 unit increases platelet by 10K/L 10-15cc/kg at maintenance fluid rate 1 unit for every 7 kilogram body weight Guidelines for RBC transfusion Severe pulmonary and cardiac disease Moderate pulmonary major surgery Symptomatic anemia

< 13g/dL < 10g/dL < 8g/dL

Acute loss of > 25% circulating blood volume Perioperative and symptomatic anemia <8g/dL Severe cardiopulmonary disease <13g/dL

Volume needed for transfusion: Hemoglobin x Weight 2

Age in years 10

+ 11.1


: Administer Platelet at Administer PRBC: If not congested, If congested,

1gram/kg/dose

Desired – Actual x 1.2 x Weight in kilograms

7.35 – 7.45 35 – 45 22 – 26 O saturation 2 Normal Mild Hypoxemia Moderate Hypoxemia Severe Hypoxemia

7.3 – 7.4 35 – 45 24 - 26

> 80% 60-80% 40-60% < 40%

Acid base deficit: Full incorporation for

:


0.3 x ABE x Weight in kilograms Full incorporation for : 0.6 x ABE x Weight in kilograms Correction: 2cc/kg NaHCO 3 IV bolus, give remaining in drip in 1 hr Computation: Metabolic Acidosis: pCO2 = 1.5 (HCO 3) + 8.4 ± 2 Metabolic Alkalosis: 0.6-0.7mmHg increase in pCO 2 for every 1mEq/L increase in HCO3 Respiratory Acidosis: Acute: 1mEq/L increase in HCO 3 for every 10mmHg increase in pCO 2 Chronic: 3-3.5mEq/L increase HCO 3 for every 10mmHg increase in pCO 2 Respiratory Alkalosis: Acute: 2-2.5 mEq/L decrease in HCO 3 every 10mmHg decrease in pCO 2 Chronic: 4-5mEq/L decrease in HCO 3 every 10mmHg decrease in pCO 2 Oxygen Delivery Index: FiO2 x MAP PaO2


Spontaneous Speech Pain None Oriented Confused Inappropriate Incomprehensible None Obeys commands

4 3 2 1 5 4 3 2 1 6

Localizes pain Withdraws to pain Decorticate Decerebrate None

5 4 3 2 1

Spontaneous Speech Pain None Coos, babbles Irritable cries Cries to pain Moans to pain None Spontaneous movements Withdraws to touch Withdraws to pain Abnormal flexion Abnormal extension None

4 3 2 1 5 4 3 2 1 6 5 4 3 2 1

Indications : : 10mg/dL bilirubin : 15mg/dL bilirubin Complications :  Osmotic diarrhea  Rashes  Bronze baby syndrome Department of Paediatrics 2011 and jed_steven1987 64



Dehydration

Acute Prominent Non-faecaloid Frequent Minimal

Less acute Less prominent Faecaloid Less frequent Prominent

Suspected or proven infection or a clinical syndrome associated with high probability of infection 2 out of 4 criteria, 1 of which must be abnormal temperature or abnormal leukocyte count  Core temperature >38.5°C or <36°C (rectal, bladder, oral, or central catheter)  Tachycardia: mean heart rate >2 SD above normal for age in absence of external stimuli, chronic drugs or painful stimuli; OR  Unexplained persistent elevation over 0.5 –4 hrs; OR  Persistent bradycardia in children <1 yr old over 0.5 hr (mean heart rate <10th percentile for age in Department of Paediatrics 2011 and jed_steven1987 65

absence of vagal stimuli, β blocker drugs, or congenital heart disease)  Respiratory rate >2 SD above normal for age or acute need for mechanical ventilation not related to neuromuscular disease or general anesthesia  Leukocyte count elevated or depressed for age (not secondary to chemotherapy) or >10% immature neutrophils

SIRS plus a suspected or proven infection : Sepsis plus one of the following  Cardiovascular organ dysfunction defined as - Despite >40mL/kg of isotonic intravenous fluid in 1 hr - Hypotension <5th percentile for age, systolic blood pressure <2 SD below normal for age OR - Need for vasoactive drug to maintain blood pressure OR - Two of the following  Unexplained metabolic acidosis: base deficit >5 mEq/L  Increased arterial lactate >2 times upper limit of normal  Oliguria: urine output <0.5 mL/kg/hr  Prolonged capillary refill 5 sec  Core to peripheral temperature gap >3°C  Acute respiratory distress syndrome (ARDS) as defined by the presence of a Pa O2/FiO2 ratio ≤300 mm Hg, bilateral Department of Paediatrics 2011 and jed_steven1987 66

infiltrates on chest radiograph, and no evidence of left heart failure OR Sepsis plus 2 or more organ dysfunctions (respiratory, renal, neurologic, hematologic, or hepatic) : Sepsis plus cardiovascular organ dysfunction defined as defined above Presence of altered organ function such that homeostasis cannot be maintained without medical intervention

0 1 2 3 4 5

No movement Flicker of contraction with no associated movement at a joint Movement present but can’t sustain against gravity Movement against gravity but not with resistance Movement against some resistance Movement against full resistance

110-140 cal/kg/day 110-115 cal/kg/day 100-110 cal/kg/day Department of Paediatrics 2011 and jed_steven1987 67

90-100 cal/kg/day 70-80 cal/kg/day 80-90 cal/kg/day 55-65 cal/kg/day 45-50 cal/kg/day

2.5 grams/kg/day 2.5-3.0 grams/kg/day 2.0-2.5 grams/kg/day 1.5-2.0 grams/kg/day 1.5 grams/kg/day 1.0-1.5 grams/kg/day

Date of birth: Time of birth: AS: BW: HC: AG: BS: BL: CC: T:  Please admit patient under the Department of Paediatrics under the service of Dr. .  Please secure consent to care  TPR q 4 hrs , gender , neonate,  Problem: A live, term or preterm delivered via NSDV or Caesarean Section , AS: , Department of Paediatrics 2011 and jed_steven1987 68

weeks by Ball ard’s Score, BW: , AGA, LGA, SGA, with or without microcephaly  Diet: Exclusive breastfeeding  Laboratory tests: o Newborn screening at 48 hours old o Cord blood typing if mother is type O o Others as needed  Medications: o Oxytertacycline 1 squirt per eye, OU o Vitamin K 0.1mL intramuscularly on the left thigh, single dose o Hepatitis B vaccine 0.5mL intramuscularly on the right thigh, single dose o BCG vaccine 0.05mL intradermally on the right deltoid (right gluteus if under Dr. Bullo)  Thermoregulate between 36.5-37.5 oC  Monitor vital signs every 15 minutes for the first hour, every 30 minutes for the second hour and every hour thereafter until stable  Refer for the following: o o o Temperature of < 36.5 C or > 37.5 C o Heart rate of < 120 bpm or > 160 bpm o Respiratory rate of < 40 cpm or > 60 cpm  Do routine newborn care o Daily bath with mild soap and water o Daily cord care with 70% alcohol. (use soap and water if under Dr. Amatong)


Daily early morning sunlight exposure for 10-15 minutes between 6AM to 8AM. (not done if under Dr. Amatong)  Please refer accordingly  Will inform attending physician of delivery  Thank you o

Equal None

Respiratory lag Minimal

Seesaw respiration Marked

None

Minimal

Marked

None None Scoring :

3-4 > 7

Minimal Audible with stethoscope give oxygen intubate

Marked Audible

Based on severity :


< 1/week

> 1/week

Daily

Daily

< 2/month

> 2/month

> 1/week

> 1/week

> 80

> 80

60-79

< 60

< 20 > 80

20-30 > 80

> 30 60-79

> 30 < 60

: Wood’s Score Cyanosis

Score 0 50-100

Score 1 < 70 in room air Unequal Moderate

Score 2 < 70 in 40% FiO2 Absent Maximum

Breath sounds Normal Accessory None muscles Expiratory None Moderate Extreme wheeze Cerebral Normal Depresses/ Agitated function Coma Scoring: 1-3 Mild asthma attack 4-6 Moderate, bedside treatment > 7 Severe; intubate

Group B streptococcus  Escherichia coli 


Other gram-negative bacilli  Streptococcus pneumonia  Haemophilus influenzae (type b, nontypable) 

Respiratory syncytial virus  Other respiratory viruses (parainfluenza viruses, influenza viruses, adenoviruses)  Streptococcus pneumonia  Haemophilus influenzae (type b, nontypable) 

           

Chlamydia trachomatis Mycoplasma hominis Ureaplasma urealyticum Cytomegalovirus Respiratory syncytial virus Other respiratory viruses (parainfluenza viruses, influenza viruses, adenoviruses) Streptococcus pneumonia Haemophilus influenzae (type b, nontypable) Chlamydia trachomatis Mycoplasma pneumonia Group A streptococcus Respiratory viruses (parainfluenza viruses, influenza viruses, adenoviruses)


             ≥

      

Streptococcus pneumoniae Haemophilus influenzae (type b, nontypable) Mycoplasma pneumonia Chlamydophila pneumonia Staphylococcus aureus Group A streptococcus Mycoplasma pneumonia Streptococcus pneumonia Chlamydia pneumoniae Haemophilus influenzae (type b, nontypable) Influenza viruses Adenoviruses Other respiratory viruses Mycoplasma pneumonia Streptococcus pneumonia Chlamydia pneumoniae Haemophilus influenzae (type b, nontypable) Influenza viruses Adenoviruses Legionella pneumophila

luids espiratory System Department of Paediatrics 2011 and jed_steven1987 73

nfection ardiovascular System/Circulation/Perfusion aematologic Status etabolism utput eurologic Status iet – to include amount of calories

Weight in kilograms x 30 9.4

Ca Gluconate mL in 24 hours = Preparation: 100mg/mL/10mL ampoule

Start with 0.5grams/kg/24 hours initially Increase by 0.5grams/kg/day May start at 2.5grams/kg/day Maximum of__________________ Aminosteril mL in 24 hours =

RD x Weight in kilograms x 0.6

2-3 grams/kg/24 hours

One medium sized banana One serving of grapes

10 mEq/banana 15mEq/serving


One serving of Prunes 15mEq/serving One watermelon 15 mEq/watermelon Kalium durule 10mEq/durule Give as high as 2 tablets three times a day pc KCl Incorporation One litre Maximum of 40mEq at 30gtts/minute One pint Maximum of 20mEq at maintenance fluid rate KCl infusion In a soluset, mix 90ccPNSS and 10-20mEq KCl with a preparation of 1mEq/mL to make a concentration of 0.1mEq/mL then regulate to a rate of 30cc/hour or to as high as 100cc/hour Actual dose = Rate x Concentration Maximum of 15mEq/hour Potassium infusion rate (KIR) Infusion rate x Actual Dose Volume x Weight in kilograms

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors and/or editors are not responsible for errors or omissions or of any consequences expressed or implied with respect to the currency, completeness or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner. Department of Paediatrics 2011 and jed_steven1987 75

PEDIA 20Idiot20Notes 1

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