MKD COMPUTATION Weight x mkd x preparation = mL per dose Example: 12kg x 10mg x 5ml/120mg = 5mL per dose * If per day, divided total (mL) by the number of divided doses Dose x preparation x frequency weight
Empirical dose 6 months 6 mos – 2 y/o 2-6 y/o 6-9 y/o 9-12 y/o
= mkd * mkd = mk dose
PARACETAMOL Drops = Wt move 1 dec. point to the left Age 1 2 3 4 5 6
Wt 10 kg 12 14 16 18 20
* mkD = mk Day * C = capsule D = drops N = nebule S = syrup/suspension T = tablet
1 drop 1 teaspoon 1 tablespoon 1 wineglass 1 glassful 1 grain 1 pint 1 quart 1 ounce 1 kg 1 lb
= 1/20 ml = 5 ml = 15 ml = 60 ml = 2 ounces = 250 ml = 8 ounces = 60 mg = 500 ml = 1000 ml = 30 ml = 2.2lbs = 0.45359 kg
V = vial Sup = suppository Sac = sachet
¼ tsp ½ tsp 1 tsp 1½ tsp 2 tsp
Aspirin
ANALGESIC & ANTI-PYRETIC 60-80 mkD
T: 80mg, 100mg, 325mg
Indomethacin
st
RHD: 100 mkD (1 2 weeks) 75 mkD (4 weeks) Anti-inflammatory: 60-90 mkD Kawasaki: 80-100 mkD Q6 1-2 mkD x 3 (PDA)
C: 100mg
Ibuprofen
6-8 mkd Q6
D: 100mg/2.5ml S: 100mg/5ml, 200mg/5ml C: 200mg, 800mg
Mefenamic acid
6.5 mkd Q6
S: 50mg/5ml C: 250mg, 500mg
Meperidine Midazolam
6 mkD/ 0.5-1 mkD 0.2 mkd
T: 15mg V: 1mg/ml, 5mg/ml
Morphine
0.1-0.2 mkd Q6 (max 15mg)
T: 10mg, 30mg, 60mg, 100mg V: 10mg/ml
Nalbuphine
0.1-0.2 mkd IM/IV
V: 10mg/ml
Naproxen T: 275mg, 550mg
5-7 mkD Q8-Q12 (>2 y/o)
Paracetamol D: 100mg/ml S: 120mg/5ml, 250mg/5ml T: 80mg, 500mg V: 150mg/ml, 300mg/2ml Sup: 125mg, 250mg
10-15 mkd Q4
Cetirizine D: 2.5mg/ml, 10mg/ml S: 1mg/ml, 5mg/5ml T: 10mg
ANTI-HISTAMINES 6 mons-1y/o 1ml OD 1-2y/o
V: 10mg/ml
2.5mg BID 1ml OD or BID Promethazine HCl
2.5y/o
¼ tab BID or ½ tab OD 5ml OD or 2.5ml BID
Diphenhydramine S: 12.5mg/5ml C: 25mg, 50mg V: 50mg/ml
Hydroxyzine HCl
½ tab BID 10ml OD or 5ml BID
>12y/o 1 tab OD 1-2mg/kg IV (max 100mg/dose) 3-5 mkD PO 2-6y/o 2.5ml Q6/Q8 6-12y/o 5ml Q6/Q8 1-2 mkD Q12 PO
S: 2mg/ml T: 10mg, 25mg
Adult
25mg BID-QID
Loratadine
1-2y/o
2.5ml OD
S: 1mg/ml, 5mg/5ml T: 10mg
2-12y/o
<30kg 5ml >30kg 10ml
>12y/o <1y/o
1 tab OD 2.5ml TID
1-3y/o
2.5-5ml TID
>6y/o
5ml TID
Chlorphenamine maleate S: 2mg/5ml T: 4mg
½ tab TID
Adult
1 tab TID or 2 tsp TID
IV/IM: 1ml OD 1mg/kg IM
V: 25mg/ml
Fexofenadine 6-12y/o
7-12y/o
T: 120mg, 180mg
120mg OD
Chlorphenamine maleate
COUGH & COLDS 0.2-0.3 mkD >12y/o
5ml TID or 1 tab TID
S: 2mg/5ml T: 4mg V: 10mg/ml
Ambroxol 30mg/tab
Syrup (15mg/5ml)
Infant drops (6mg/ml)
5-10y/o >10y/o
½ tab TID 1 tab TID
Erdosteine S: 175mg/5ml C: 300mg
15-19kg 20-30kg >30kg
5ml TID 5ml TID 10ml BID
Procaterol (Meptin)
<5y/o
0.25 mkD BID-TID
S: 5mcg/ml T: 25mcg, 50mcg
>6y/o
5ml or 25mcg/tab OD-BID
Adult 2-6y/o
20ml or 50mcg/tab OD-BID ½ - 1 tsp TID
Salbutamol + Guaifenesin
6-12y/o
1 tsp TID
>12y/o Children
10ml TID, 1 cap BID-TID 100mg BID-QID
2-5y/o >5-10y/o >10y/o
2.5ml BID 5ml BID-TID 10ml TID
Acetylcysteine
<6mos 6-12mos >1-2y/o
0.5ml BID 1ml BID 1.25ml BID
Sach: 100mg, 200mg S: 100mg/5ml T(effervescent): 600mg
Adult
200mg BID-TID 600mg OD
Guaifenesin
6-12y/o
5ml TID-QID
Adult
5-10ml TID-QID 1-2caps TID-QID
Carbocisteine 2-3y/o 4-7y/o 8-12y/o
5ml TID 10ml TID 15ml TID
S: 100mg/5ml C: 200mg
Syrup (250mg/5ml)
2-3y/o 4-7y/o 8-12y/o
2.5ml TID 5ml TID 7.5ml TID
Drops (6.25mg/ml)
1-3mos0.25ml QID 4-6mos0.5ml QID 7-12mos 0.75ml QID 1-2y/o 1ml QID
Drops (50mg/ml)
<2mos 0.3ml TID 3-6mos0.6ml TID 7-12mos 0.9ml TID 13-24mos 1.2ml TID
Syrup (12.5mg/5ml)
2-6y/o 7-12y/o
Syrup (100mg/5ml)
Phenylpropanolamine
2.5ml QID 5ml QID
RESPIRATORY MEDS & BROCHODILATORS Aminophylline 3-5 mkD (0.6-0.9 mk/hr)
TERBUTALINE DRIP (0.1-0.4 g) x weight x 60 x 8 500g/ml
N: 5mg/ml
Loading dose: 3-6mg/kg x 20-30mins
Example: Terbutaline = ____ D5W = ____ 80cc or 100cc x 10 gtts/min (8hrs)
Maintenance dose: 2 mkd Q8 MD:
1-9y/o 9-12y/o 12-16y/o
0.8 0.7 0.6
1-1.2hr 0.9hr Q6-Q8
V: 100mg, 200mg, 250mg
*Example: 20kg = (Wt x dose) / prep (20 x 5) / 5 = 20cc SIVP as LD (20 x 2) / 2 = 8cc SIVP Q8 as MD 10 mkd LD, 4-9 mkd MD or 10-20 mkD LD or 3-5 mkd IV
Salbutamol
Asthma: 5-6 mkD Q8 MD 0.15-0.30 mkD Q6
Hydrocortisone
S: 2mg/5ml T: 2mg
Terbutaline S: 1.5mg/5ml N: 5mg/2ml
0.075 mkd Q6 PO 0.01 mkd (max 0.5cc)
BRICANYL DRIP Dose: 30-40g Weight x Dose = ____ cc 500 Example: Bricanyl = ____ 120cc x 24 hrs
D5W = ____
AMINOPHYLLINE DRIP Dose: 0.2-0.4 Weight x Dose = ____ cc 2 Example: (3kg x 0.4) / 2 = 0.6cc Aminophylline (0.6cc) + D5W (99.4cc) = 100cc or 80cc to run for 12 hrs at 8-9 gtts/min
V: 25mg/ml
Neonates
AMINOPHYLLINE PUSH Dilute 25 mg/ml vial + 4cc PNSS = 25 mg/ml concentration Then get 1cc to have 5mg/ml concentration LD: 4-6 MD: 1.5-3 mkd Q8-Q12 Order: Give 2.4cc of Amino as LD + EAD then after 12 hours give 1.2cc IV Q8 - OR –
Cefalexin
CEPHALOSPORINS 1st Gen 25-50 mkD Q6 (max 4g/D)
D: 100mg/ml S: 125mg/5ml, 250mg/5ml C: 250mg, 500mg, 1gm
Cefazolin
1st Gen
20-50 mkD Q6-8
2nd
Severe infection: 100 mkD 20-40 mkD Q8
V: 500mg, 1gm
Cefaclor
Gen
D: 50mg/ml S: 125mg/5ml, 250mg/5ml C: 250mg, 500mg
Cefuroxime
2nd Gen
3-5 mkD (0-6-0.9 mk/hr) LD: 3-6 mg/kg x 20-30mins MD: 2 mkd Q8 MD: 1-9 y/o 0.8 to 1-1.2hr 9-12 y/o 0.7-0.9hr 12-16 y/o 0.5hr Q6-8 (5mg/ml)
S: 125mg/5ml, 250mg/5ml T: 250mg, 500mg V: 750mg, 1.5gm
Example: For a 20kg patient
V: 250mg, 500mg, 1gm, 2gm
Wt x dose = 20 x 5 Prep 5
Ceftriaxone
= 20cc SIVP as LD 8cc SIVP Q8
Cefoxitin
2nd Gen
20-40 mkD Q12 50-100 mkD Q8 IV
80-160 mkD Q4-6 (max 12g/D) 20-40 mkD (infants)
V: 500mg, 1gm
Ceftazidime
3rd Gen 100-150 mkD Q8 IV
3rd Gen 50-100 mkD OD IV
V: 250mg, 500mg, 1gm, 2gm
Cefotaxime
3rd Gen 100-200 mkD Q4-6
V: 250mg, 500mg, 1gm
Cefixime
3rd Gen 3-8 mkD Q12
Amoxicillin
4th Gen
D: 100mg/ml S: 125mg/5ml, 250mg/5ml C: 250mg, 500mg V: 1gm
D: 20mg/ml S: 100mg/ml C: 100mg, 200mg
Cefepime
50 mkD Q8-12 x 10 days 500mg-1000mg Q12 (>12y/o)
V: 500mg, 1gm, 2gm
AmoxicillinClavulanic Acid
30-50 mkD Q8
30-50 mkD Q8 PO 50-100 mkD Q8 IV
(Co-Amoxiclav)
BETALACTAMS Penicillin 50-100 mkD Q6 Pen G Crystalline 100,000-200,000 ukD Q12 50,000-100,000 ukD Q8/Q12 (<7days) 75,000-150,000 ukD Q6-Q12 (>7days) Benzathine Penicillin Early syphilis: 500,000 u/K single dose
Sumapen
Syphilis: 50,000 u/K max dose 2.4M u/dose 50 mkD Q6
Phenoxymethyl penicillin 125/5 – 200,000 u/5ml 250/5 – 400,000 u/5ml
Ampicillin
Neonates
D: 125mg/1.25ml S: 125mg/5ml, 250mg/5ml C: 250mg, 500mg V: 125mg, 250mg, 500mg, 1gm
Meningitis:
Ampicillin-Sulbactam
100-200 mkD Q8 IV 1.5-12gm/day IV 50 mkD Q12 (<30kg) 2.25gm (single dose, gonorrhea)
Sultamicillin (Unasyn) S: 250mg/5ml C: 375mg. 750mg V: 750mg, 1.5gm
50-100 mkD Q6/Q8 100-200 mkD Q4/Q6 100-150 mkD Q8-Q12 200-400 mkD Q4/Q6
S: 156.25/5ml, 228.5/5ml, 312.5/5ml, 457/5ml T: 375mg, 625mg V: 600mg (500), 1.2gm (1000)
PiperacillinTazobactam
200-300 mkD Q6 6mons
150-300 mkD Q8
Aztreonam
Children
50 mkD Q6-Q8
V: 1gm
1wk-2y/o Septic:
30 mkD Q6-Q8 20 mkD Q12
V: 4gm/500mg, 2gm/250mg
Meropenem V: 500mg, 1gm
Imipenem V: 500mg
Meningtis: 40 mkD Q12 15 mkD (max 2gm/D) 50 mkD/1-2gm Q6-Q8 (max 5gm/D)
TETRACYCLINE 25-50 mkD
Tetracycline C: 250mg, 500mg
Doxycycline
4.4 mkD 2.2 mkD
Ciprofloxacin T: 250mg, 500mg V: 2mg/ml infusion
Levofloxacin
C: 100mg
MACROLIDES 30-50 mkD Q8-Q12 (max 1gm)
Erythromycin D: 100mg/2.5ml S: 200mg/5ml, 400mg/5ml
Clarithromycin
15 mkD Q12 (max 1gm/D)
S: 125mg/5ml, 250mg/5ml T: 250mg, 500mg V: 50mg/ml
Azithromycin
10 mkD x 3 days 10 mkD 1st day, 2 mkD 2nd-5th day
S: 200mg/5ml C: 250mg, 500mg V: 500mg
Amikacin
AMINOGLYCOSIDES LD: 15 mkD MD: 10 mkD Q12
V: 50mg/ml, 125mg/5ml, 250mg/ml
Gentamycin
5-8 mkD Q8-Q12
V: 40mg/ml, 80mg/2ml
Neltilmicin V: 50mg/ml, 75 mg/ml
6-8 mkD OD
FLUOROQUINOLONES 7.5-15 mkD
T: 250mg, 500mg V: 5mg/ml infusion
8 mkD Q12 (max 250mg)
Chloramphenicol S: 125mg/5ml C: 250mg, 500mg V: 1gm
Co-trimoxazole
50-100 mkD Q6-Q8 PO 50- mkD Q6 IV 25 mkD Q6 (neonates)
Fluconazole
ANTIFUNGAL LD: 12 mkD MD: 6 mkD
T: 50mg, 100mg, 150mg, 200mg V: 2mg/ml
5-8 mkD Q12
Ketoconazole S: 40mg/ml (200), 80mg/5ml (400), 160mg/5ml (800) T: 400mg/80mg, 800mg/160mg
T: 200mg
Griseofulvin
Clindamycin
Newborn
5 mkD Q8-12 PO
S: 75mg/5ml granules C: 150mg, 300mg V: 150mg/ml SIVP in 30mins
Infant/Child
15-25 mkD Q6 IV 20-30 mkD Q6 PO
Vancomycin
<1,200g (0-4wks)
<15kg >20kg >30kg 10 mkD
5 mkD OD 100 mkD OD 200 mkD OD
T: 125mg, 500mg
Amphotericin B
MD:
0.5-1 mkD OD
V: 5mg/ml, 50mg/10ml
15 mkd OD Amphotericin B
V: 500mg
>1,200g (0-1wk) 1-4wks
Metronidazole S: 125mg/5ml T: 500mg V: 5mg/ml
20 mkd OD
30 mkd OD
Infant/Child: 20mkd Q8 PO 60 mkD Q8 1-3hr infusion 30-50 mkD Q8-Q12 PO 15 mkD LD, 7.5 mkD Q8
Prep: 50mg/vial Dose: 0.1 mkD, max 30-35mk in 3 weeks Should be properly covered Dilute 50mg vial + 10cc D5W to make a concentration of 5mg/10ml - then aspirate 1cc + 4cc D5W = 5mg/ml - then aspirate from the solution 1cc + 9cc D5W = 1mg/ml - then aspirate from the solution 1cc to make 0.1mg/ml Wt 1kg Test does: 0.1 mkd 1cc of solution + 19cc D5W x 30mins Day1 0.25mk: 2.5cc + 17.5cc D5W x 4hrs Day2 0.5mk: 5cc + 15cc D5W x 4hrs Day3 0.75mk: 7.5cc + 12.5cc D%W x 4hrs Day4 1mk: 10cc + 10cc D5W x 4hrs then OD
ANTI-VIRALS 10-20 mkD Q6
Acyclovir
Pyrantel Pamoate S: 200mg/5ml T: 200mg, 400mg, 800mg V: 250mg
Amantadine
Adult, children >2 y/o
200mg 5x daily
Children <2 y/o ½ adult dose <8 y/o 5-9 mkD Q12
T: 100mg, 250mg V: 500mg
>8 y/o
Methisoprinosol
50 mkD Q6-Q8
100-200mg
ANTI-TUBERCULOSIS 10-20 mkD OD AC
D: 100mg/5ml S: 200mg/5ml C: 150mg, 300mg, 450mg
Isoniazid (H)
Pyrazinamide (Z)
200-500 mkD OD single dose
S: 20mg/ml, 50mg/ml T: 100mg, 500mg
STEROIDS 0.0178-0.25 mkD Q6-Q8 (max 9mg/D)
T: 500mcg V: 1ml, 2ml
Dexamethasone
ICP:
0.5-1 mkD
T: 500mcg, 750mcg, 4mg V: 2mg/ml, 4mg/ml, 5mg/ml
Cerebral edema:
1 mkD Q4-Q6
Bacterial meningitis: 0.2-0.5 mkd Adult dose Asthma:
5-10mg IV Q6 10-15 mkD LD, 4-6 mkD Q6-Q8 MD
T: 20mg V: 100mg, 200mg, 250mg, 400mg, 500mg
Dengue:
3-4 mkD
Prednisone
1-2 mkD Q12
S: 10mg/5ml T: 5mg, 20mg
Nephrotic:
Hydrocortisone 15-30 mkD OD PC
S: 250mg/5ml C: 400mg, 500mg
Ethambutol (E)
15 mkD OD
C: 275mg, 400mg, 800mg
<2mons 5-25 mkD 10 mkD OD Q48 or EOD
V: 1gm
Mebendazole
10-20 mkD OD AC
S: 200mg/5ml C: 75mg, 100mg, 200mg, 300mg, 400mg
Streptomycin (S)
S: 125mg/5ml T: 125mg
Betamethasone
S: 250mg/5ml T: 500mg
Rifampicin (R)
ANTI=PARASITIC 11 mkD x 3 doses OD
BSA x 60 mkD
Tonic-Clonic
Absence Myoclonic Partial Undentifiable
ANTI-SEIZURE 1st line 2nd line Valproic Acid Lamotrigine Carbamazepine Oxycarbazepine Phenytoin Valproic Acid Exthosuzimide Lamotrigine Na Valproate Lamotrigine Carbamazepine Lamotrigene Phenytoin Oxacarbazepine Valproic Acid Na valproate Lamotrigine
ANTI-SEIZURE DRUGS Carbamazepine 10-30 mkd BID-TID Clonazepam 0.1-0.3 mkd TID-QID Ethosuximide 15-40 mkd TID-QID Phenobarbital 2-5 mkd BID-TID Phenytoin 5-8 mkd BID, TID Valproic acid 30-80 mkd OD, BID, TID, QID Gabapentin 15-45 mkd TID Lamotrigine 5-15 mkd BID, TID Topiramate 5-9 mkd BID Leviteracitam 20-40 mkd BID Oxcarbazepine 8-10 mkd BID
NEUROLEPTICS & ANTI-CONVULSANTS Diazepam 0.2-0.3 mkD Max dose: <5y/o 5mg T: 5mg, 10mg >5y/o 10mg V: 5mg/ml, 10mg/ml
Carbamazepine
Mannitol 20% Phenobarbital 20mg/ml; Grain 1 = 60mg T: 15mg, 30mg, 60mg, 90mg V: 130mg/ml
Phenytoin S: 30mg/5ml, 125mg/5ml V: 50mg/ml
Valproic Acid S: 250mg/5ml V: 100mg/ml
Drip: 50mg (10cc) + 250cc 0.9 NSS to run at 1cc/kg/hr MD: 10-20 mk <4y/o 20-60mg/day by 20-60mg OD 4y/o 100mg/day 100mg weekly 2.5-5cc/kg Q6-Q8 LD: 10-20 mkd MD: 5 mkD Q12 Max: 1-2gms (300mg)
LD: MD:
10-20 mkd 5 mkD Q12
Max: 1gm LD: MD:
15 mkD OD/BID 20 mkD Q8
G-CSF (Granulocyte-Colony Stimulating Factor) Filgrastim Prep: 300mcg/ml Dose: 5mcg/kg/day OD IV/SQ To boost imuune system Stimualte the production of WBC IVIG transfusion Prep: 2.5gm, 5gm, 2,500mg/50ml Dose: 2gm/kg single dose Pre-meds: Diphen & Hydrocort Example: Wt 10kg Wt x dose = # vials x 50ml = ___ml in 12hrs Prep Test dose: Wt x 0.01 x 30mins
Dengue
Kawasaki
RH Immunoglobulin: WinRho Dose: 50g/kg/dose Prep: 300g/vial 1 vial x 9-10mins Dilute to complete 8.5cc to run for 10mins/vial Use D5W to dilute Dose: 75g/kg single dose Contraindication: Hct <100, Rh+ Request CBC w/ PC OD after 24hrs x 3days
Al Mg (OH)3 Al Mg (OH)3 + Dimethicone Bisacodyl
GASTRO MEDS 2-4 tabs 20mins pre meal and HS 2-4 tsp or tab QID
Omeprazole
0.6-0.7 mkD OD
C: 20mg, 40mg V: 40mg
6-12y/o
5-10mg
Nitrofuroxide
<6mos
1tsp BID
T: 5mg Sup: 5mg (pedia), 10mg(adult)
>12y/o
10-15mg
S: 218gm/5ml C: 200mg
>6mos
1tsp TID
Prozinc
<6mos
10mg
Hyoscine-Nbutylbromide
12y/o
D: 0.5-1ml OD (1ml=10mg elemental zinc)
>6mos
20mg
T: 10mg V: 20mg
Infants 0.3-0.6 mkD & children LD: 5 mkD Q6 MD: 5-10 mkD Q6
<9kg
10mg/sachet TID
9-13kg
10mg/2sachet TID
13-27kg
30mg/sachet TID
>27kg
30mg/2sachet TID
Adult
100mg/cap TID
Cimetidine
1-2 tabs 3-5x/day (Max: 100mg/day)
T: 200mg, 400mg V: 100mg/ml, 150mg/ml
Ranitidine
1 mkD Q8
T: 75mg, 150mg, 300mg V: 25mg/ml
Adult
Dicycloverine
6mons-2y/o
150mg BID or 300mg OD 0.5-1ml QID
D: 5mg/ml S: 10mg/5ml T: 10mg
2-5y/o
2.5-5ml QID
Domperidone
6-12y/o 5ml QID 0.2ml kg/dose Q8
D: 5mg/ml S: 1mg/ml, 5mg/5ml T: 10mg
Erceflora Lactulose
1 vial BID x 5 days 2ml/kg/dose Q6
S: 2.5-5ml OD (5ml=20mg elemental zinc)
Racecadotril
CREATININE CLEARANCE Creatinine clearance ml/min For urine vol >1L
For urine vol <1L
= TV ml x Ucr mg% x 1.73 m2 1440 min x Crea mg% x BSA = Wt kg x (140-age) x 0.85 72 x serum crea mg% x BSA
Creatinine clearance = K x height (in cm) Plasma crea (mmol/L) Age <2.5kg 0-18mos 2-13y/o boys 2-16y/o girls 13-16y/o boys Normal Renal impairment Renal insufficiency Renal failure Uremia
K 29 40 49 49 62 80-120 50-80 20-50 5-20 <5
To get % = creatinine clearance 120 Creatinine 88.4; K in decimal point (0.29)
TOTAL PROTEIN SPILLAGE UTP BSA – gm/day (1000 x UTP) BSA x 24hr mg/m2/day N = <4mg/m2/hr or 100mg/m2/day Nephrotics:
if >40mg/m2/hr or 4gm/day, start PRED at 60mg/m2
24-hour URINE PROTEIN Urine protein = 1.12 100mg/g x urine protein BSA x 24 hours Example:
100 x 1.12 0.68 x 24
= 6.86 (normal)
URINE CONCENTRATING ABILITY Osmolality Urine osmolality: more precise than USG Urine osmolality = (USG – 1.000) x 40,000 Normal = 400 – 600 mOsm/L Serum osmolality = 2Na + (Glucose in mg/dl 18) + (BUN in mg/dl 2.8) Normal = 230 – 300 mOsm
* If >3 = Renal failure Urine Specific Gravity Each 15 mmol/l (2.7g) Glucose: USG by 0.001 Each 4g/l protein: USG by 0.001
ANION GAP Normal = 20 Na – (HCO3 + Cl) ALBUMIN TRANSFUSION Prep: 12.5gm/50ml (25%) or 10gm/50ml (20%) Dose: 0.5-1gm/day 1ml = 0.25gm to run for 2-4hrs as Q12 or OD Example: Wt 0.81 Wt x 50 = 3.2ml 12.5 ACUTE GLOMERULONEPHRITIS Typical course Latent: Few days – 3 wks Oliguric: 7-10 days Diuretic: 7-10 days Convalescent: 7-10 days
NEPHROTIC SYNDROME Remission: protein free/edema free for 3-4 months Relapse: recurrence of edema and/or proteinuria Steroid responsive: (-) protein after 4-6 weeks Steroid resistant: (+) protein after 4-6 weeks of continuous daily divided doses of PRED (60mkd); use methyl prednisolone Steroid dependent: - if you withdraw the tx, proteinuria will recur - 2 consecutive relapses occurring during therapy or within 14 days of completing steroid therapy Frequent relapse - responds to corticosteroid treatment but experiences 2 relapses within 6 mos after the initial response - has 4 relapses within 1 yr Prednisone >40mg/kg/day, Hypoalbuminemia <2.5mg/dl 60mg/kg/day x 4-6 weeks then 40mg/kg/day (am) x 2-3 mos alternate day dose
Normalization of urine sediment Gross hematuria: 2-3 wks Complement level: 6-8 wks Proteinuria: 3-6 mos Micro-hematuria: 6-12 mos
*If steroid resistant: +2 protein Q8 weeks Steroid dependent: relapse within 28 days Frequent relapse: relapse >12x/month
Bladder capacity: age (y/o) x 2oz x 30
Cyclophosphamide 2-3 mk/24hrs single dose 8-12 wks 500mk/kg/m2/day x 3-5 days (max: 1g/day x 3days)
Normal bladder residual <5cc or 10% of bladder capacity means greater risk for UTI Clean catch: >100,000/ml Catheter: >100/ml Suprapubic: 1 col/ml
Methylpred 30 mkD x 3-5 days (max: 1gm)
RENAL FAILURE STAGES Diminished renal reserve - GFR 50-80 - may still be asymptomatic
CALCIUM 100-300 mg/kg/day Prep: 100mg/ml Example: 2.6kg
Chronic renal insufficiency - GFR 30-50 - hypocalcemia, decrease tolerance to stress
2.6 x 100 x 1 = 0.9cc in IVF for 8 hrs 100 0.9ml of 10% Ca Gluconate + in 100ml
Chronic renal failure - GFR 10-30 - anemia, hypertension, bon problem, metab disorder - for dialysis End-stage renal disease (ESRD) - GFR <10 - kidneys are small and contracted - for dialysis, kidney transplant SODIUM BICARBONATE Base excess x Wt x 0.3 (half correction) Base excess x Wt x 0.6 (full correction) To be given as 50% SIVP 50% incorporate in IVF to run for 6-8hrs 1-2 mEqs/kg if deficit is too large CHLORIDE: 5 mEqs/100ml
Calcium Carbonate (TUMS) Prep: 500mg/tab Dose: 50 mkD Calcium Gluconate Prep: 10cc/vial Max 10cc vial + EAD Q8 SIVP in 30mins Alkalka Prep: 10mg/tab = 10mEqs Dose: 1-2 mkD Max: give 2 tabs Q8 K: 0.2-0.5kg/hr, increase to 0.5 if symptoms noted
POTASSIUM
SODIUM Desired – Actual x Wt x 0.6 = deficit Wt x 2-3mEqs= maintenance
Nephro 0.2-0.3 mEq/kg/hr Example: Wt = 10kg 0.2 x Wt (10) = 2 mEqs x 24hrs = 2 x Wt (10) =
Deficit + Maintenance = Total infusion 48 mEqs (deficit) 20 mEqs (maintenance) 68 mEqs
Give 50%: 25%: 25%:
1st 8 hrs next 8 hrs next 8 hrs
Prep: 2 mEq/ml Intensivist Wt x 50 x transcellular K = ____ / 3 Transcellular K = 50 mmol/kg 2.5-3 0.05 (5%) 2-2.5 0.10 (10%) 1.5-2 0.20 (20%) Cardio Desired – Actual x Wt x 0.3 = deficit Wt x 2 mEq/kg/day = maintenance Deficit + Maintenance = Total infusion Q8 3 40 mEqs/day/L = maximum, excess will cause arrhythmia
Normal: 135-145 mEq/l Significant hyponatremia: 120 mEq/l MD: 2-3 mEq/kg/24hr Prep: 2.5 mEq/ml/amp Fast correction: values <120 mEq 4ml/kg of 2.5 mEq/ml prep (For every ml of NaCl = 4cc sterile water)
MAGNESIUM SULFATE Prep: 250mg/ml LD: 100-200mg/kg/dose over 30mins MD: 20-30mg/kg/day
Lanoxin LD: MD:
TDD: 0.035 x Wt
¼ TDD x 4 doses Q6 1/10 TDD x 2 doses Q12 Or
Example: Wt = 3.2kg
Wt x 0.004 x 2 0.05 (elixir)
LD: Wt x 200 = 3.2kg x 200 = 640mg / 250 = 2.56cc + EAD in 30mins MD: Wt x 30 = 3.2lg x 30 = 96mg x 24hrs = 2304mg / 250 = 9.2ml in 24 hrs
* should not exceed Wt of px 0.04/kg loading divide by 4 doses 0.04 maintenance/dose (max: 0.5/day)
Elixir: 0.05mg/ml T: 0.25mg/tab IV 0.025mg/ml or 0.5mg/2cc
DESFERAL Order: MgSO4 9.2ml + D5W 14.8ml to make 24cc to run at 1cc/hr for 24hrs 250mg/ml
Dose: 20-45/kg/dose Infuse in 100cc PNSS then give before and after BT run for 6hrs 5cc/kg PRBC x 2hrs x 4 doses Q8 or as ordered PHLEBOTOMY
LIDOCAINE DRIP Dose: 2-10 mkd or 0.5-1.0mkd Q10mins (max: 5mg/kg) Bolus: 1-2 mkd Wt x 60 x dose = running rate 4000 Example: Lidocaine D5W
10cc 40cc 50cc x ____gtts
FFP transfusion: - Wt x EBV (70-80) x 0.15 (0.10-0.15) - Give ½ 30mins-1hr before phlebo, then remaining during phlebotomy PNSS can be also be used 1 mEq/kg NAHCO3 if with hypoxic spells
