MultiVitamins:

 Ascorbic acid
Drops 100mg/mL: Syrup: 100mg/ml
<3mos: 0.3ml/day 2-6y/o: 5ml/day
3-12mos: 0.6ml/day 7-12y/o: 10ml/day
1-2y/0: 1.2ml/day
 Vit. B complex + hysine + beclizine (Appebon
syrup)
2-6y/o: 1-2tsp OD
7-14y/o: 2-4tsp OD
 Iron wtx5/elem Fe
1mkday OD- prophylactic Hemarate 30/5
3-6mkday BID-therapeutic Iberet 26.25/5
Zinc RD – 10-20mg/day Incremin 30/5
10mgdrops- infant Sangobion 12/10
20mg- >2yo Ferlin 30/15
 Folic acid
2.5g/ml
0.2 mkday
 Vitamin A
 6-11mos: 100,000IU – 1 dose
 12-71mos: 200,000IU
 <2yrs: drops
10mg/ml=1ml
 >2yrs: syrup
20mg/5ml= 5ml

Analgesics/Antipyretic
Paracetamol (Q4h) Mefenamic Acid (q6-8hr)
 RD: 10-15mkdose PO RD: 5-8 mkdose
10mkdose IV Susp: 50mg/5ml
15mkdose-BFC 125mg/5ml
Drops: 100mg/ml Cap: 250mg/500
60mg/0.6mk
Syrup: 120mg/5ml Aspirin (Q4-6H)
125mg/5ml RD: 10-15mg/kg/dose
350mg/5ml upto
Tab: 325mg/tab 60-80mg/kg/24h
250mg/tab Anti-inflam:60-
500mg/tab 100mg/kg/24hPO
Amp: 150mg/ml Kawasaki: 80-100mkday
300mg/ml
Nimesulide (BID)
RD: 2.5-5mkdose
100mg/tab

Ibuprofen
RD: 5-10 mg/kg/dose
PO Q6-8H
Susp: 100mg/5ml
Forte: 200ng/5ml
Cap: 200mg

Antacids
Ranitidine (Q8h-12h) Famotidine (Q12h/IV-
Q8h)
RD: 0.75mkose PO RD: 0.2mkdose
0.8-1mkdose IV Amp: 25mg/2ml
Amp: 25mg/ml, 50mg/5ml Tab: 20mg/40
Tab: 150mg/300mg
Cimetidine (Q4-6h) Omeprazole
RD: 10-15mkday 1mgkday
<1y.o: 20mkday
1-12y.o: 20-25mkday
Liquid: 100mg/5ml
Amp: 150mg/ml, 100mg/ml
 Tab: 200mg, 400mg
AlMg (Maalox) (Q6h) Ursofalk
2-4 tabs max: 16tabs 10-15mkday
*take 30 minutes 1 hr 200/5ml
after meal at bedtime
Susp: 180ml; 355ml
Tab: chewable
Fw/flatulence-
Almg+dimeticone (Maalox
plus)

Anti-emetic/ Anti-spasmodic
Metoclopramine Nifuroxide (Ercefuryl)
RD: 0.5mkdose PO <6mos- 10ml
0.2mkdose IV >6mos- 5ml
Amp: 10mg/2ml, Adult: 1cap Q6H
5mg/2ml Susp: 220mg/5ml
Syr: 5mg/5ml Cap: 200mg
Tab: 10mg
Dicycloverine HCL Hyosciene N-Butyl
(Q8h) (Bromide) Q6-8h
RD: 2.5-5mg/kg/day RD: 0.15mkdose
6mos-2y.o: 0.5-1ml Amp: 20mg/ml
2y.o-5y.o: 2.5-5ml Tab: 10mg
Drops: 5mg/ml,
15mg/ml
Syr: 2mg/ml, 10mg/ml
Tab: 10mg

Domperidone (Motilium)Q8h*15
RD: 0.3mkdose
Dyspepsia: Adult: 1tab/2tsp Q8h
Children: 2.5ml Q8h Suspension: 1mg/ml
Tab: 10mg
N/V: Adult: 2tab/4tsp Q6-8h
Children: 5ml Q6-8h
Dyspepsia N/V
10kg 2.5ml 5ml
 20kg 5ml 10ml
30kg 7.5ml 15ml

Anti-Diarrheals
Paroromycin (Humagel) Erceflora – Bacillus
clausii
RD: 20-30mkday 3-4 dived >1mos: 1-2 vials/day
dose 2-11y.o: 1-2
150mg/cap, 150 vials/day
mg/5ml Adult: 2-3 vials/day
Racecadotril (Hidrasec) Nifuroxamide
(Ercefuryl)
1 mos onwards <6mos: 1tsp BID
RD: 1.5mg/kg/day Q8h >mos: 1tsp TID

BW Hidrasec
Sachet
<9kg 10mg 1
sachet
9-13kg 10mg 1
sachet
13-27kg 30mg 1
sachet
>27kg 30mg 2
sachet
Adult dose: 100mg/cap
Q8h

Antihelminthics
Mebendazole
500mg/tab single dose
100mg/tab or 5ml BIDx3 consecutive days
20mg/ml susp: 5ml BIDx3 consecutive days
50mg/ml susp: 10ml SD
Enterobiasis (100mg or 5mg SDrpt 2 or 4 weeks)
 Susp: 20mg/ml, 50mg/ml
Tab: 100mg; 500mg
*deworm @2-4 yrs old
Pyrantel Pamoate
RD: 10-20 mkdose
Susp: 125mg/5ml
Tab: 125mg; 850mg
Albendazole
RD: 75mkday
Susp: 200mg/5ml
Tab: 400mg

Quinolones
Ciprofloxacin - BID
Vial: 100mg/50ml, 200mg/100ml, 400mg/200ml

Amebicide
Metronidazole q6h Furazolidone
RD: 30-50 mkday PO RD: 4-7 mkday
7.5 mkdose IV Liquid: 16.7 mg/5ml
15mkdose – loading Susp: 50mg/ml
dose
Vial: 5mg/ml
IV: 500mg/100
Susp: 125mg/5ml
200mg/5ml
Paramomycin Etofamide (Kitnos)
RD: 20-30 mkday RD: 15-20mkayX3 days
Susp: 150mg/15ml Q12H
Susp: 100mg/5ml
Tab: 200mg; 500mg

Antihistamine
Hydroxyzine Hcl Desloratadine (Aerius)
(Iterax)
Q12h x 5 days 6-11 mos: 2ml
RD: 1mg/kg/day or wt/4 1-5 y.o: 2.5 ml
Syrup: 2mg/ml 6-11y.o: 5ml
 Tab: 10mg; 25mg >/=12y.o: 10ml
Amp: 5mg/ml Syr: 2.5ml/5ml
Tab: 5mg
Chlorphenamine Maleate Diphenhydramine Hcl
Q8h RD: 3-5 mkdose PO
RD: 0.2mkdose 1mkdose IV
Amp: 10mg/ml Syr: 12.5mg/5ml
Vial: 10mg/ml Cap: 25mg, 50 mg
Syrup: 2mg/5ml IV/IM: 50mg/ml
Tab: 4mg
*20kg-1/2 amp IM
>20kg-1amp IM
Cetirizine diHCL-OD-BID Levocetirizine
RD: 0.25-0.27 mkdose 0.125mkdose
Drops: 10mg/ml
2.5mg/ml
Soln: 1mg/ml
Sry: 5mg/5ml
Tab: 10mg

Mucolytic
Carbocysteine (Q8-12h) Erdosteine (Q12h)
RD: 30-50 mkday RD: 10mkday
Drops: 50mg/5ml 10-20kg, 2-6y.o: 2.5ml
Syr: 100mg/5ml 21-30kg, 7-12y.o: 5ml
Cap: 500mg >30kg, >12y.o:
<3mos: 0.25ml 5mlTID/7.5ml BID
3-5mos: 0.5ml Susp: 115mg/ml; cap:
6-8mos: 0.75ml 300mg
9-12mos: 1 ml
5y.o: 5ml
Ambroxol (Q8h)
D: 1.2-1.8 mkday
Liq: 15mg/5ml; 30mg/ml
Soln for inhalation:
15ml/2ml
Amp: 15mg/2ml
Ped drops: 6mg/ml
 Tab: 30mg; retard cap
75

Bronchodilators
Salbutamol TID Procaterol
RD: 0.13-0.15 mkdose >/6: 5ml
Sry: 2mg/5ml </=5y.o: 2.5ml
100mg/5ml
Amp: 1mg/ml Bambuterol
Tab: 2mg
Terbutaline BID TID 6-12y.o: 5mkdose
1-15y.o: 2.5ml Oral soln: 1mg/ml
<3y.o: 0.075mkdose Tab: 10mg
Syr: 1.5mg/5ml
Soln: 2.5mg/5ml Aminophylline/Theophyline
Amp: 0.5mg/ml
Tab: 2.5mg 3-5mkdose
80mg/5ml; 125mg/tab,
175mg/tab

Cephalosporins
1st generation
Cefalexin Q6h Cefuroxime Q6-8h
RD: 30-50 mkday PO RD: 20-40mkday PO;
50-100mkday IV 50-100mkday IV
Drops: 100mg/ml
Susp: 125mg/ml Cefamandol
250mg/ml RD: 50-100mkday
Cap: 250mg; 500mg
Cefprozil
Cefazolin RD: 20-4-mkday
RD: 50-100mkday IV Powder: 125mg/5ml;
x 3dose 250mg/5ml
Vial: 250mg Tab: 250mg; 500mg
Inj: 500mg; 1g
Cefotiam
2nd generation RD: 50-100mkday
 Tab: 200mg
Cefaclor Q8h Vial: 0.5g; 1 gm
RD: 20-40mkday
Drops: 50mg/ml Cefixime Q12h UTI: 8
Susp: 125mg/5ml TF: 20
250mg/5ml RD: 3-6mkday PO,
Tab: 315mg; 750mg 15mkday
Cap: 500mg Drops: 20mg/ml
Susp: 100mg/5ml
Cap: 100mg;200mg

Cefdinir
RD: 9-8mkday
Cap: 100mg

3rd Generation 4th Generation

Cefoperazone Cefepime OD-BID
RD: 100-150mkday RD: 50-100
IV Vial: 500mg; 1g; 2g
Vial: 1.5g
Ceftriaxone BID
RD: 50-100mkday
Vial: 500mg; 1 g;
250mg
Ceftazidime
RD: 30-50mkday IV
Vial: 250mg; 500mg;
1g; 2g
Cefpodoxime
3-10mkday
Susp: 50mg/5ml
Tab: 100mg
Co-Amoxiclav: 228.5g/5ml; 457/5ml
Aminoglycosides
Antihypertensives
Gentamycin OD-BID Furosemide
5-8mkday RD: 0.5-1mkdose
Amp: 20mg/2ml
Amikacin OD-BID Tab: 40mg
RD: 12-15mkday –
15mkdose OD Hydralazine
\ RD: 0.1-0.2mkdose
Vancomycin Amp: 20mg/ml
Tab: 10mg; 15mg; 50mg

RD: 15mkday Aspirin

75-100mkday

Nifedipine Q4-6h
RD: 10mkdose
Max: 10mg/kg/24h

Spironolactone
1.3-3mkday QID PO

Antifungal
Nystatin Q6h Fluconazole – OD
Adult & children: RD: 3-6mkday
4-6ml Vial: 3mg/ml
Infant: 2ml Cap: 50, 150, 300mg
Tab: 500,000 U
Susp:100, 000 U/ml Griseofulvin
Tab: 125mg/500mg

Amphothericin B Ketoconazole x 5 days

RD: 0.3-0.7mkday OD
Slow in Infusion Adult: 200mg/tab
5-12y.o: 100mg/tab
 *250mcg/kg/day- 1-4y.o: 50mg/tab
1mg/kg/day
Vial: 50mg/5ml;
2mg/ml
Cap: 50mg; 100mg;
200mg
 Isoprinosine: 50-100mkday

Macrolides
Erythromycin q8h Azithromycin OD-BID
RD: 35-50mkday RD: 15-20mkday
Granules: Susp: 200mg/5ml
200mg/5ml; Tab: 250mg; 500mg
400mg/5ml Vial: 500mg
Drops:
100mg/2.5ml Chloramphenicol q6h
Tab: 250-500mg RD: 50-100mkday;
75mkday (enteric
Clarithromycin fever)
Q12h FT infant>/=2week: 25-
RD: 7.5mkdose; 50mg/kg/day
15mkdose
Susp: 125mg/5ml Cotrimoxazole BID
Tab: 250; 500mg RD: 5-8mkday; 8 UTI;
10 BPN
Roxithromycin OD- Susp: 200mg/40mg/5ml-
BID (40mg/5ml) (wt/2)
Adult: 400mg/80mg/5ml-
150mg/tab; (80mg/5ml)(wt/4)
300mg/tab Q12h Tab: 400mg/80mg;
Children: >40kg 800mg/100mg
Kiddie tab: 100mg

Anti- TB drugs

1-10; R-15; S-20; E-35; P-30

 Isoniazid Rifampicin:
RD: 5-10 RD: 10-15mkday
Syr: 100mg/5ml; Drops: 100mg/ml
200mg/5ml Cap: 300; 45mg
Tab: 100mg; 200mg;
300mg
Pyrazinamide Ethambutol
RD: 15-30mkday RD: 12-25mkday
Susp: 250mg/5ml Syr: 125mg/5ml
Tab: 500mg Tab: 400mg
Streptomycin Amantadine HCL
RD: 15-20mg/kg/day RD: 4.4-8.8mkday
Vial: 1gm Syr: 50mg/5ml
Tab: 100mg
Ribavirin
RD: 10mkdose
Syr: 50mg/5ml
Tab: 100mg

Anticonvulsants/ Sedatives
Phenobarbital Midazolam
LD: 10mkday RD: 0.2mkdose
MD: 5mkdose (max Tab: 15mg
25mkdose) Amp: 5mg/ml, 5/5,
15/3
Diazepam Phenytoin
RD: 0.2-0.8 mkdose LD: 10mkdose
MD: 5mkday
Susp: 30/5, 12/5
Cap: 30, 100

Steroids
Prednisone – BID Dexamethasone
RD: 1mkday BID; RD: 0.5 – 1mkdose
2mkday OD 0.3mkdose
Susp: 10mg/5ml initial, then 0.1
Syr: 5mg/5ml; mkdose 1-2mg/kg
20mg/5ml Q6h x 4
 Tab: 1, 5, 10, 20, *xtubate on 3rd dose
30, 50mg
Hydrocortisone Procaterol (Meptin)
RD: 5mkdose Q6-8h BID-TID
LB: 10mkdose RD: 0.25mkdose or
MD: 5(max 100) 0.25xwt
Vial inj: 100mg; Syr: 5meq/ml
250mg; 500mg Tab: 25meq, 50meq
Erdosteine Aminophylline
(Ectrin/Zertin) LD: 5-7mkdose
175mg/5ml-10mkday MD: 3-5mkdose
BID;
300mg/cap BID
Combivent: 200ug Ipatropium
<2y.o: 5-8 drops; 2-3 y.o: 3 drops; >4y.o: 20
drops

IVIG
Dose: 2g/kg in 12H or 400mg/kg/dose x 5d
2.5g/vial, dilute w/ 50ml diluents to make
50mg/ml administer the ffL

Test dose:
0.1 0.5ml/kg/H x 15min
NAHCO3
0.2 1ml/kg/H x 15min BE x wt x 0.3 or
0.4 1.5ml/kg/H x 15min 1meq/kg can be given IV
0.8 2ml/kg/H x 15min push or drip 50mcg/kg
2.5ml/kg/H x 15min NA>1-2 meq/kg
3ml/kg/H x 15min
3.5ml/kg/H x 15min
4ml/kg/H x 15min
*if tolerated in fuse the rest at ____cc/h for 10hr
watch out for headache, flushing, hypotension,
fever and chills

Aminosteril
0.5/kg-inc until 3g/kg
Wt x RD x 100/6%/24 or wt x RD/0.694
*start 1g x 48H then resume at 2g

Conversion of Hyponatremia
1ml=2.5 meqs NaCL
Wt: 1.8 kg
S.Na: 131.4
D-A x wt x 0.6 (140-131.4 x 1.8 x 0.6 = 9.2 meqs)+
wt x 3= maintenance (1.8 x 3=5.4)

½ - 4.6 – 1.8 – 6.4 HYPONATREMIA

¼ - 2.3 – 1.8 – 4.1 D-A x wt x 0.6 ÷ (2-3) maintenance
¼ - 2.3 – 1.8 – 4.1

1st Shift
HYOPCALCEMIA
D5W- 6.6 K/K (?) – 0.1 to 0.3 meqs/k/H
D5IMB- 50 NK of Body= 50meqs
NaCl- 2.5 (?) K/R –meqs KCL/#Hrs/wt
Hypokalemia
D-A x wt x 0.3 + (Wt x 2) ?

Wt x 0.2 x 8 x 3 x 2 x wt
Sk- <3-5% -0.05
<2.5-10%-0.10
Wt X 0.05 x 50 /wt x (2/maintenance)

RESPONSE TO PHOTOTHERAPY
*check rebound B2 for 12-24H after discharge

Bilirubin Age Action

<18 - Wean to single
photo
</=18 - D/C home
</=14 49-7/2 D/C photo
</=15 >72’ D/C photo
Age in TSB (mg/dl)
hours
24-48H <15 15-<20 20-<25 >/=25
49-72H <18 18-<24 25-<30 >/=30
 >72H <20 20-<25 25-</=30 >/=30
Tx/rec OPD PHOTO INTENSIVE PHOTO/exc
PHOTO trans

IDEAL BODY WEIGHT

At birth 3kg
3-12mo Age (mo)+ 9 /2
1-6 yrs Age (yrs)x 2 + 8
7-12 yrs [Age (yrs)x 7 – 5 ]/2

IDEAL BODY WEIGHT GIVEN BIRTH WIEGHT

<6mo Age (mo) x 600 + BW in gm
6-12 mo Age (mo)x 500 + BW in gm

Age Conside Phot Exchange Exchange

r Photo o transfusio transfusio
n if n if
extensive intensive
photo photo
</=24
d
25-48 >/=12 >/=1 >/=20 >/=25
(170) 5 (340) (430)
(260
)
49-72 >/=15 >/=1 >/=25 >/=30
(260) 8 (430) (510)
(310
)
>72 >/=17 >/=2 >/=25 >/=30
(290) 0 (430) (510)
(340
)

EXPECTED BODY WEIGHT

Term: EBW= (Age in days - 10) x 20 + BW in gm
Preterm: EBW= (Age in days - 14) x 15 + BW in gm
 Where 10: # of days to recover over
physiologic wt loss
20: g/day gained

CARDIAC OUTPUT
Newborn: 180-240ml/kg/min or 4ml/beat
DOPAMINE DRIP
(200mg/250-800conc) 0.0375/26.6
(400mg/250ml-1600conc) 0.075/13.3
Wt x RD x 60 (0.075)

SHORT CUT: wt x RD WT X 3(50) X dose

(10mg/kg)
13.3 (800-conc) 6 (100)
Wt x RD Rate (1cc/hr)
26.6 (1600-conc)
1.6
To check: AD: dose given x Prep/60/wt
Or WT x RD X 140D/ 1600/24
Max: 20

LEVOPHED
4mg/4ml; 2mg/ml
e.g 2ml/ml
2/100 x 1000= 20 conc

(WT x dose x 60)= ml

Conc

To check: ml x conc/60/15= dose

DRIP FORMULA
6 x wt (kg)x mcg/kg/min – mgin100ml of D5NSS
MI/H

ISOPROTERENOL/EPINEPHRINE/NOREPINEPHRINE
0.6 x wt (kg) = mgin100ml O
 *1ml/H will deliver 0.1 mcg/kg/min

DOPAMINE/ DOBUTAMINE/ AMRINONE/ NITROPRUSSIDE

6 x wt (kg)= mg in 100ml
*0.1 ml/H will deliver 1mcg/kg/min

DOPAMINE/ DOBUTAMINE
6 x wt (kg) = # mg to add to diluents to make 100ml
volume

DOBUTAMINE DRIP
2.5 – 15mcg/kg/min (max: 40mcg/kg/min)
Peak effect: 10-20min
Prep: 12.5 mg /ml x 20ml/vial= 250mg/250ml (vial)
Premix: 1000mcg/ml in 250= 250/250 (1mg/ml)
2000mcg/ml in 250 ml= 500mg/250 (2mg/ml)

Dobu-premix
0.06-1000=250/250
D%W
0.03-2000
Wt x dose x
0.06/0.03

Wt x RD x 60 or wt x RD x 1400/12500 or 6 x wt in kg=
____mg in
2000
100ml(1mcg/kg/min)
Ex: 250mg in D5W 250cc(1mg/ml) 500mg in
D5W250cc(2mg/ml)
Mcgtt/min= (Wt x DD)/16.6 ugtts/min=(wt x
DD)/33.2
= Wt x DD x 0.06 = Wt x DD X 0.03
*to check: 7.5 – actual x 2000/ 60 /wt
actual x conc/60/wt
FUROSEMIDE DRIP
20 mg/2ml
**4ml + 20cc PNSS to run @ 1cc/h
(wt)15 x (dose) 0.1 x 24
36 x 2/20 = 3.6
3.6/4ml = 0.9 or 1cc

Prep: 10mg/ml amp (2m)

Dose: infant and child: 0.05 mg/kg/H (titrate to
clinical effect)
Adult: 0.1 mg/kg/H (max: 0.4 mg/kg/H)

 Wt(kg)x dose x 24 = mg in 24 ml of NS to make:

1ml/H = 0.1mg/kg/H
 Wt(kg) x dose x 24 x 5= mg in 120ml NS to make
5ml/H=0.1mg/kg/H

*20mg furo + 20cc distilled water to make conc of

1mg/ml
Infusion rate: 0.05 x wt eg: 0.05 x mg x 1 = 4 cc

EPINEPHRINE DRIP
Wt x 0.6 mg = mg added to 100mgD5W
1cc/H = 0.1 ug/kg/min
5cc/H = 0.5 cc/min ml/H= wt x dose x 60
10cc/H = 1mg/kg/min conc
0.1mkd/0.1cc/kg/dose

INSULIN DRIP
0.1 – 1 cc or ml/H
Wt x 0.1 x 24 = # of ml/cc of insulin to be added
to NSS to make 24 ml soln to run for 24H

MIDAZOLAM DRIP
Prep: 5mg/ml amp
Dose: intermittent: 0.05 – 0.15mg/kg/dose
Continuous: 1-2mcg/kg/dose

6 x wt(kg)x mcg/kg/min = mg in 100ml of D5W/NS

 mL/H
Max total dose: 10mg (intermittent); can cause
respiratory depression, hypotension, bradycardia

AMIODARONE DRIP
Prep: 50mg/ml amp
Dose: infant and child: 5mg/kg over 30 min ff by
infusion starting at 5mcg/kg/min
Max dose: 10mcg/kg/min or 20 mg/kg/H must be
diluted in D5W
infusion concentration should not
exceed 2 mg/ml
wt(kg)x dose x 60 x 50 = mg in 50mlD5W
1000
To make: 1ml/H= 1mcg/kg/min

INSULIN DRIP
Prep: 1U/ml amp
Dose: Infant and Child 0.1Ukg/H (titrate to
clinical effect)
Glucose drop: 80-110mg/dl/H

Wt(kg)x dose x 24 = U in 24ml NS or

Wt (kg)x dose x 24 x 5 = U in 120ml of NS
*to make: 5ml/H= 0.1U/kg/H

NICARDIPINE DRIP
Prep: 2.5mg/ml= 5mg/10ml ampule
Dose: Child: 0.5-5mcg/kg/min (titrate to clinical
effect)
Adult: start with 5mg/H, increase dose as
needed by
2.5mg/H Q 5 -15 min (Max dose: 15mg/H)
decreased by
3mg/H as needed to maintain desired response

AMINOPHYLLINE DRIP
LD: 5mg/kg BW in 30cc 5W in a soluset (if px is not
maintained
 on oral theophylline) or
25mg/vial dilute 1ml + 4ml NSS to make 5 mg/ml
so;ution.
Aspirate ____mL give per iv infusion for 30 min
as LD
(5mg/kg)
D5W250cc + Aminophylline 250mg/amp at ____ugtts/min

Main drip: 0.4 – 0.8mg/kg/H

Formula ugtts/min = dose x BW
Note: maintenance infusion rate must be induced to
0.2 – 0.3 mg /kg/H for elderly px, pregnant px and
those in CHF. Liver dse or cor pulmonale watch out
for hypoglycemia and tachycardia.

DUET (Double Volume Exchange Transfusion)

Blood volume: 80cc/kg
ABC: no correction
E.g wt: 3kg if <10 B.D
3 x 80 x 74-60/74 = 3360/74
45cc to be exchanged
160-180cc/kg/FWB
Mother’s Blood type – wt 80 x 2
INDICATIONS:
Corrected WBC:
Sepsis e.g RBC = 7500= 75000/500-
S. Bilirubin >20mg/dl 15
Hypoxia and acidosis for every RBC = 1 WBC
Hemolytic dose of NB WBC = 37-15=22 corrected
ABO incompatibility RBC
Prematurity

COMPLICATIONS:
Vascular embolism
Infection
Cardiac arrhythmia vol overdose
CP arrest
Electrolyte imbalance

FIO2: 100% target FiO2 X TRF (S)

79
ABDOMINAL UTZ
Stomach – LUQ, directly under the L diaphragm

Small Intestines- central abdomen,

can have a random faceted/ tesseliated
appearance
when air filled (but not dilated).
Encircling valvulae connivantes visible
depending on
degree of air filling.
Valvulae connivantes more widely spaced in
ileum

Large Intestines – circumferential, tends to frame

the small intestines
Feces of variable consistency
Haustral folds interspaced w/ plicae
semilunaris

Neurotoxicity
 Cisplatin – ototoxocity, p. neuropathy
 Paclitaxel – p. sensory, neuropathy
 Vinca Alkaloids- motor , sensory,
autonomic neuropathy, adynamic ileus,
urinary bladder atony

Cardiac Toxicity
 Doxorubicin, Daunomycin – cardiomyopathy

Pulmonary Toxicity
 Bleomycin – interstitial
 Alkylating agent pneumonistis w pulmonary
fibrosis
Gastrointestinal Toxicity
 Mathotraxate – hepatic fibrosis
 Vinca Alkaloids- adynamic ileus, urinary
bladder atony

Genitourinary Toxicity
 Cisplatin – azotemia, Mg wasting
 Methotrexate – oliguria RF
 Cyclophosphamide/ Ifosfamide – chronic
hemorrhagic cyctitis

Dermatologic Toxicity
 Doxorubicin Skin necrosis,
sloughing
from
 Actinomycin – D drug extravasation
 Vincristine

Gonadal Dysfunction
 Azospermia recovery is uncommon

Hematologic toxicity
 Granulocytopenia/neutropenuia
- 6-12 days after administration
- Recovery in 21-24 days
ANC= (WBC count)(%segmenters)
- Must be ≥ 1500 for chemo to proceed
 Thrombocytopenia
- Recovers 4-5 days later than
granulocytes
- ≥ 100,000/mm3 for chemo to proceed

Fontanels – anterior closes at 18 mos (as early as

9=12 mos)
- Posterior 6-8 weeks
Colostrum – 1st 2-4 days postpartum ↑ CHON,
vitamins, salt, Ig
↓ fat and sugar

Absolute Contraindications to BF
 Galactosemia
 Tyrosinemia
Relative Contratindications to BF
 Psychosis
 Active TB

WATERLOW CLASSIFICATION
WT for Age: Actual WT x
> 90 no PEM
100%
75-90 MILD
Wt at P50
60-74 MODERATE
<60 SEVERE

HT for Age= Actual HT X 100

Ht at P50

Wt for HT = Actual wt X 100

Wt at P50 of HT at P50

HT WT
>95 - no stunting >90 – no wasting
90-95 –mild 80-90- mild
85-89- moderate 70-80- moderate
<85- severe <70- severe

ET Tube Size AOG SIZE

<1000 <28 2.5
1000-2000 28-34 3.0
2000-3000 34-38 3.5
>3000 >38 3.5-4.0

ET SIZE BY AGE
 Premature 2.5mm
0-3 mo 3.0mm
3-7 mo 3.5mm
7-15 mo 4.0mm
15-24 mo 4.5mm
2-10 yrs Age (yrs)+16/4 or Age(yrs)+ 4/4
10-20 yrs 6-8mm

ET level: size of tube x 3

Laryngoscope Blade
Size
Term/Newbor Size 1
n
2-11 yrs Size 2
>12yrs Size 3

ET Tube Size & Depth

Weight Size Depth
500-1000 2.5 7.0
1000-1400 3.0 7.5
1400-1900 3.0 8.0
1900-2200 3.5 8.5
2200-2600 3.5 9.0
2600-3000 3.5 9.5
3000-3400 3.5 10
3400-3700 3.5 10.5
3700-4100 4.0 11.0
4100-4500 4.0 11.5
>4500 4.0 12.0

BELL CLINICAL STAGING OF NEC

1. Suspect,
Infant with suggestive clinical signs but
x-ray non diagnostic
2. Definitive
 Infant w/ pneumatosis intestinalis
2a: mildly ill
2b: moderately ill (acidosis,
thrombocytopenia/ ascites)
3. Advanced
3a: critilac w/ impending perforation
3b: critical w/ proven perforation
MAXIMUM K that can be in cooperated per Liter IVF:
 Parenteral: 40meqs
 Central: 60-80meqs

Electrolyte Computation:
I. Potassium
 N= 4-5.6 meq
 N K deliuence: 0.1-0.4meq/kg
Deficit = (KD - KA)x wt x 0.6
Maintenance K: 2 x wt
Total K deficit: deficit + maintenance
Full Incorporation: 40meq/L or 20 meq/500cc
K infusion rate:
N= 0.2meq – 0.4meq/kg
IV rate x amt of K (meq)
Vol of IVF x Wt
Deficit: Wt x 50 x __K__
Maintence – 2 x wt

II. Sodium 135-145 meq

Maintence Na= 3 x Wt Na: 1 meq= 2.3mg/dl
Max target/day: 10 meq K= 1 meq=
3.91mg/dl

NaHCO3= gr x = 650mg = 7.7meq

gr v = 325

III. Calcium: 8-10 meq

IV. Chloride: 98-106 meq
V. CO2 15meq
 Rate x 24= ___ ÷ 100= ____ x 4

Creatinine Clearance:
1. Based on ht
*0.33 = pretem; lbw, <1 yr
0.45 = term, infant, <1yr
0.55 = children, adolescent female
0.7 = adolescent male
* X ht (cm)
Serum creatinine(mg/dl)

2. Adult *male: 72
Female: 85
140-age x wt
* x Creatinine (mg/dl)
Values:
80-120: normal
50-80: renal impairment
20-50: renal insufficiency
5-20: renal failure
<5: uremia

GFR: 125ml/min (75-150)

24 urinary Creatinine M: 15-20mg/k
F: 10-15mg/k

ACTUAL RETICULOCYTE COUNT (ARC)

Actual Hct x Reticulocyte ct
Desired Hct
Reticulocyte Index: ARC ÷ 2
= HCT/Ret Count x 2
>2= hemolysis
<2= BM suppression

IDEAL TRACHEAL ASPIRATE: EC < 25

PMNS> 10
1 “U”- increase HGB by 2: HCT by 3
BLOOD TRANSFUSION
FWB 20cc/k (max)
PRCB 10-15cc/K (15cc/k in neaonates)

FWB: vol= desired-actual HB x 6 x wt

= desired – actual Hct x wt
Rate= volume x 12 gtts/ml = gtts/min
60min x 4H
PRBC: vol = desired – actual HB x 2 x Wt
= desired – actual hct x wt
Desired Hct= vol/wt + actual hct

Platelet Count: 1U /6KBW

1U=30-50 (raises platelet count by 10K)
FFP= Fluid rate (5-20cc/k/h in 4h)

PHOTOTHERAPY
Indication: PT 10mg% Bilirubin
PT 15mg% Bilirubin

Complication: Osmotic diarrhea, Rashes

Bronze baby syndrome, Dehydration

Kramer’s Classification
ZONE JAUNDICE EST. LEVELS
1 Head/neck 6-8mg/dl
2 Upper trunk 9-10mg/dl
3 Lower trunk to thigh 12-14mh/dl
4 Arms/legs/elbow/knees 15-18mg/dl
5 Hands/feet >18mg/dl
B1 – uncongugated/ indirect
B2 – conjugated/ direct Bilirubin

CREATININE CLEARANCE*
(140-age) (wt in kg) x 0.85 (F) 1(m)
Creatinine (mg/dl) x 72
* ÷ 88.4 → mg/dl
STAGING
1 Kidney damage with >90
NGFR
2 Mild ↓ GFK 60-90
3 Moderate ↓ GFK 30-59
4 Severe ↓ GFK 15-24
5 Kidnet failure <15

DEFICITS
Na= 135-150/3-4meq/kg/day
Na deficit= (Desired 140-actual) X TBW
TBW (L)= 0.6 x BW (kg) + Maintenance

BLOOD/ FFP TRANSFUSION

Transfuse ____ “U” ( cc)TS x 4h
Monitor VS q15mins @ 1st hr then Q 30min
Adjust IV rate to ___ cc/hr
Ex: 369cc/4h = 92.25 → 92
IVF = 125 = 33
92 * ↓ IVF rate to 33cc/hr
How: 125-92=33cc/hr
RBS (mmol/L) x 18 = ____ mg/dl
N: 280-300
DKA: 300-320
HHS: 330-380

FFP- 20cc/k
PLT conc- 1 uint/10kg
TPR
BP
02 stat
SCE, CBS
(-)DOB
CP status assessed, may transfuse 1 unit PRBC,
type-specific, after proper reverse typing x 4hrs.
Monitor VS q 15mins on the 1st hr then q30mins
thereafter once stable ↓ IVF rate to ___ cc/hr (or
KVO) watch out for any BT reactions
Refer PRN
Thank you
PPE: awake, conscious, not in CPD, anicteric
sclera, pinkish conjunctivae, non hyperemic, non-
enlarged tonsils, (-) CLAD, (-)NVE
SCE, CBS
AP, NCRRR (-)murmur
Flat, soft, NABS, Nontender, tympanitic, grossly N
ext, full pulses CRT < 2 sec.

TRANS-OUT ORDERS (SURGERY/OB)

May transfer px back to room
Monitor VS q15 until stable then q4h thereafter
D/c o2 and pulse oximeter
Monitor IO qhourly (if with FC)
Refer if with UO ≤ 30cc/hr or monitor IO qshift &
record
Refer PRN
Thank you

Albumin Transfusion
Wt x 1cc x 50% = amount in CC
Kg 12.5

KAWASAKI DSE
Fever= 5 days
1. Bilateral bulbar conjunctival injection
with limbic sparing (-)exudates
2. Erythematous mouth and pharynx, strawberry
tongue, red, cracked lips
3. Polymorphous, generalized erythematous
rash
4. Changes in peripheral extremities
consisting of induration of hands and feet
 5. Acute nonsuppurative cervical
lymphadenopathy (uni/bilateral) ~1.5 cm

IVF: D10 – 1st24hrs of life

D10IMB – after 24 hrs of life

How to replace fluids: 1st 24HDL wt x 80cc/kg – if

NPO
Day 1 90 cc/kg
2 100 cc/kg
3 110 cc/kg
4 120 cc/kg
5 130 cc/kg
6 140 cc/kg
7 150 cc/kg
8 160 cc/kg (max)

D10IMB = Desired – Actual x volume

Highest – Lowest

Available: D5IMB; D50W, D10W

D10IMB= 10-5 x volume (100)
50-5
= 5 x 100
45
11ccD50W 11→ D50W (subtract from the volume
100)
+ 89ccD5IMB 89→ D5IMB
D10IMB
UMBILICAL CATHETERIZATION
Wt x 3 + 9 = answer + 1.2 cm
2

 Allowable Blood loss in Preterm: 10% of BW

 Allowable Blood loss in infants/neonates: 20%
of BW
H. Influenzae: 7-10days
S. pneumonia: 10-14 days
N. meningitides: 7 days
E. coli, citrobacter, Senatia: ≥ 21 days
Enterococcus: ≥ 14 days

MENINGITIS
 <1mo: GBS, enterobacteriaceae, listeria,
monocytogenes
Tx: Ampicilin & Cefotaxime
Alt: Ampicilin & gentamycin
(nosocomial- Ampi + gentamycin)

 1mo-3mo: GBS, S. Pneumoniae, Hi.

Influenza, N. meningitides,
Enterobacteriaceae
Tx: Ampiciliin, Cefotaxine

 >3mo & children – S. Pneumoniae, N.

meningitides, H. influenza, neonatal
pathogens
Tx: Cefotaxime/Ceftiaxone, Vancomycin
added for
possible penicillin resistant S.
Pneumoniae

AMINOSTERIL COMPUTATION
Wt x 1gm x 100 = ___ cc to run for 22hrs, rest for
4hrs
6
EX. Wt: 900gms 0.9x 1gm x 100 = 15cc
6
1. Order: Aminosteril 6% 15cc to run for 22 hrs;
rest for 4 hrs x 2 cycles
(TFI 150- 1gm AA - FFP)
 ex: FFP x 2 units 18cc/unit

150-15cc-15cc-18cc+18cc x wt = 84 ÷ 24 = 3-4cc/hr
IVF rate
24H

PIP – 8 – 10 (Pacterm 12)

PEEP – 4
100-FIO2 ÷ 79 x PEEP = level of compressed air
PEEP – compressed air – level of pure air

RESPIRATORY DISTRESS SYNDROME

- Deficiency of pulmonary surfactant, a
phospholipid protein mixture that decreases
surface tension & prevent alveolar collapse.
- Type II alveolar cells from 32 weeks AOG
- Risk of RDS is decreased in babies born >24hrs
and <7days after maternal steroid
administration
APNEA – respiratory pause >20sec or a shorter pause
assoc. w/ cyanosis, pallor, hypotonia or
bradycardia
Causes: Thermal instability, prematurity, infection
(NEC, meningitis, neo sepsis), metabolic disorders,
CNS problems (Seizures, malformations), drugs
(maternal/fetal), decreased O2 delivery (anemia,
hypoxemia, L to R shunt)

Disturbance Primary PH Compensatory

Change Response
Acute resp. ↑ HCO3 by 1 meq/l
Acidosis ↑PaCO2↓ ↓pH for each 10mmhg
rise in PaCO2
Acute Resp. ↓ HCO3 by 1-3meq/L
Alkalosis ↓ PaCO2 ↑ pH for each 10mmhg
fall in PaCO2
 Chronic ↑ HCO3 by 4meq/L for
Resp. each
Acidosis ↑PaCO2↓ ↓ pH
10mmhg rise in
PaCO2
Chronic ↓ HCO3 by 2-5meq/L
Resp. ↓ PaCO2 ↑ pH for each 10mmhg
Alkalosis fall in PaCO2
Metabolic ↓ PaCO2 by 1 – 1.5
Acidosis ↓ HCO3 ↓ pH
x fall in HCO3
Metabolic ↑ PaCO2 by 0.25 – 1
Alkalosis ↑ HCO3 ↑ pH
x rise in HCO3

EPINEPHRINE : 1:10, 000 (0.1mg/ml)

Recommended IV does: 0.1-0.3 mg/kg of 1:10, 000
soln via umbilical vein
0.5 – 1mg/kg via ET

FFP – 4cc/k/ → ↑APTT by 1gm/dL

CEFEPIME
 Term and preterm infants greater than 28 days
of age: 50mg/kg per dose every 12 hrs
 Term and preterm infants 28 days of age and
younger: 30 mg/kg per dose every 12 hrs
 Meningitis and severe infections due to
Pseudomonas aeruginosa or Enterobacter spp:
50mg/kg per dose every 12 hrs
 Administer via IV infusion by syringe pump over
30 minutes or IM.
 To reduce pain at IM injection site, cefepime
may be mixed with 1% Lidocaine without
epinephrine
CEFOTAXIME
50 mg/kg dose IV infusion on syringe pump over 30
minutes, or IM.
Dosing Interval Chart
 PMA (Weeks) PostNatal (day) Interval
(hours)
≤29 0 to 28 12
> 28 8
30 to 36 0 to 14 12
> 14 8
37 to 44 0 to 7 12
> 7 8
≥45 All 6
Disseminated Gonococcal Infections: 25 mg/kg per
dose IV over 30 minutes or IM every 12 hrs for 7
days with a duration of 10 to 14 days if meningitis
is documented.

CEFTAZIDIME
 30 mg/kg per dose IV infusion by syringe pump
over 30 minutes or IM.
 To reduce pain at IM injection site,
Cfetazidime may be mixed with 1% Lidocaine
without epinephrine.
Dosing Interval Chart
PMA (Weeks) PostNatal Interval
(day) (hours)
≤29 0 to 28 12
> 28 8
30 to 36 0 to 14 12
> 14 8
37 to 44 0 to 7 12
> 7 8
≥45 All 6
RANITIDINE
Oral: 2mg/kg per dose every 8 hrs.
IV: Term: 1.5 mg/kg per dose every 8 hours slow
push
Preterm: 0.5 mg/kg per dose every 12 hours slow
push
Continuous IV infusion: 0.0625 mg/kg per hour; dose
range. 0.04 to 0.1 mg/kg per hour

FLUCONAZOLE
 Invasive Candidiasis: 12 to 25 mg/kg loading
dose, then 6 to 12 mg/kg per dose IV infusion
by syringe pump over 30 minutes or orally.
 Consider the higher doses for treating severe
infections or Candida strains with higher MICs
(4 to 8 mcg/ml). Extended dosing intervals
should be considered for neonates with renal
insufficiency (serum Creatinine greater than
1.3 mg/dl)
 NOTE: the higher doses are based on recent
pharmacokinetics data but have not been
prospectively tested for efficiency or safety
 Prophylaxis: 3 mg/kg per dose via IV infusion
twice weekly or orally. A dose of 6 mg/kg twice
weekly may be considered if Candida strains
with higher MICs (4 to 8mcg/ml). Consider
prophylaxis only in VLBW infants at high risk
for invasive fungal disease.
 Thrush: 6mg/kg on day 1 then 3mg/kg per dose
every 24 hrs orally.

INVASIVE CANDIDIASIS DOSING INTERVAL CHART

Gestational Post Natal Interval
age (weeks) (Days) (hours)
≤29 0 to 4 48
>14 24
30 and Older 0 to 7 48
>7 24

OXACILLIN
Usual Dosage: ____mg/kg per dose IV over at least
10 minutes
Meningitis: 50 mg/kg per dose
 DOSING INTERVAL CHART
PMA (Weeks) PostNatal Interval
(day) (hours)
≤29 0 to 28 12
> 28 8
30 to 36 0 to 14 12
> 14 8
37 to 44 0 to 7 12
> 7 8
≥45 All 6

MEROPENEM
Sepsis: 20mg/kg per dose IV
Less than 32 weeks GA: less than or equal to 14
days PNA, every 12 hrs, greater than 14 days PNA,
every 8 hrs
32 weeks and older GA: less than or equal to 7 days
PNA, every 12 hours; greater than 7 days PNA, every
8 hours
Meningitis and infections caused by Pseudomonas
species, all ages: 40mg/kg per dose every 8 hours.
 Give an IV infusion over 30 minutes, longer
infusion times (up to 4 hrs) may be associated
with improved therapeutic efficacy.

METRONIDAZOLE
Loading dose: 15mg/kg orally or IV infusion by
syringe punp over 60 minutes
Maintainance dose: 7.5 mg/kg per dose orally or IV
infusion over 60 minutes. Begin one dosing interval
after dose.

DOSING INTERVAL CHART

PMA (Weeks) PostNatal Interval
(day) (hours)
≤29 0 to 28 12
 > 28 8
30 to 36 0 to 14 12
> 14 8
37 to 44 0 to 7 12
> 7 8
≥45 All 6

COMPOSITION OF AVAILABLE PARENTERAL FLUIDS

IV Na Cl K Mg Ca HCO3
0.9NS 15 15 - - - -
S 4 4
0.3NS 51 51 - - - -
S
LR 13 10 4 - 1. Lactate
0 9 5
NR 14 98 5 1. - Acetate/Glucona
0 5 te
NM 40 40 1 1. 1. Acetate
3 5 5
IMB 25 22 2 1. - Acetate
0 5
Serum Anion Gap (AG)= Na – (Cl + HCO3)
Urine Anion Gap= (Na + K) – Cl
Delta Gap= Actual AG – 10
24-Actual HCO3
How to Adjust IVF rate once on Feeding
Example: IVF: D5IMB (90)
WT: 2840gms
Computations: 90 x 2.84kg ÷ 24H = 10-11cc/hr IVF
rate
 Advance feeding to 10ccq 3 hrs x 3 feedings
If tolerated, increase to 20cc every feeding
until 30cc is reached.
 Adjust IVF rate accordingly
↓ to 8cc/hr at 10cc feeding
↓ to 6cc/hr at 15cc feeding
 ↓ to 5cc/hr at 20cc feeding
↓ to 1cc/hr at 30cc feeding

10 x 8 ÷
24 = 3 [IVF – 3 = 8]
15 x 8 ÷
24 = 5 [IVF – 5 = 6]
20 x 8 ÷
24 = 6 [IVF – 6 = 5]
30 x 8 ÷
24 = 10 [IVF – 10 = 1]
feeding q3H → 24h ÷ 3h = 8
 DC CBG monitoring once 20cc feeding is
tolerated.

BICARBONATE CORRECTION
(15 – initial HCO3) x Vol x Kg BW

Serum HCO3 level Volume of Distribution

(meq/L) (Vol)
>10 0.5
5-10 0.75
<5 1.0
TOTAL PROTEIN SPILLAGE (TPS)
TPS= Total Protein (mg)
BSA (m2) x 24H

FLUID LIMITATION

Volume in 24H = 400-500ml x BSA + Urine output in

24H
Length: inches to cm, multiply by 2.54
Weight: lbs to kg, divide by 2.2

EPINEPHRINE DRIP:
6 X Wt in Kg x mcg/K/min = ____mg in 100ml of
D5W/NS
mL/Hr
 Set your own rate: ex: 4ml/hr
6 x wt x 0.1 mcg/kg/min
4ml/h
 If wt is 40 kg: 6 x 40 x 0.1 = 6mg in 100ml D5W
4
Order: Start epinephrine drip: 6mg epinephrine
+ 100cc D5w x 4cc/Hr (0.1 mcg/k/min)

BEVV
BEVV x 0.6 x Wt
- (1/2 push then ½ to run for _____) or
- Desired –actual x 0.3 x wt

DRUGS RD PREPARATION
Tab: 30mg,
1.2 – 1.6
Ambroxol Syr: 15mg/ml
mkdose(BID-TID)
Drops: 6mg/ml
Amikacin
10mkdose (LD) Amp/Vial:
(Amikin,
15mkdose (MD) 50mg/mlx2ml
Amikacide,
15mg/kg/day (BID) 250mg/mlx2ml
Onikin)
Cap: 250mg;
500mg
Syr:
Amoxicillin 250mg/5ml,
30-50 mkday (TID)
(Pediamox) Ped drops:
125mg/1.25ml,
100mg/ml
Vial: 500mg
Amphotericin 50-100mkday (IV), Vial:
B 30-50mkday (PO), 50mg/10ml
 1mg/kgBW (alternate
day)
Cap: 250mg;
500mg
Syr:
125mg/5ml,
50-100mkday (IV),
Ampicillin Forte Syr:
30-50mkday (PO),
(Ampicin, 250mg/5ml,
1mg/kgBW (alternate
Pensyn) Ped Drops:
day)
125mg/1.25ml,
100mg/ml
Vial: 500mg

Tab: 4mg,
Amp: 5mg/ml
Antamin 0.2-0.3mkdose Vial:
5mg/mlx10ml
Syr: 2mg/5ml
Tab: 375mg;
625mg
Susp:
156.25/5ml;
20-40mkday (BID- 228.5/5ml;
Augmentin
TID) 312.5mg/5ml;
457mg/5ml, IV
Vial: 300mg;
600mg
Tab: 1g
Tab: 250mg.
500mg
ASA 75-100mkday (TID)
Enema: 4mg
Susp: 250mg
Aztreonam 30-50mkday
Cap: 25mg,
3-5mdose (PO TID- 50mg
Benadryl QID) Syr:
1mkdose (IV OD) 12.5mg/5ml
Inj: 50mg/ml
 0.01mkdose q6h Tab: 10mg
Buscopan
0.02-1.5mkday Amp: 20mg
Cap: 500mg,
Carbocistein 10-20mkday(infant)
Syr: 100mg/5ml
e (TID-QID)
Susp: 250mg/ml
Caterizine 0.25mkday
Cap: 250mg,
500mg
Cefaclor 20-40mkday (TID) Susp:
125mg/5ml,
250mg/5ml
Cap: 500mg
Cefadroxil 25-50mkday (TID)
Syr: 125mg/5ml
Cefetamet 20mkday (BID)
Cefotaxime 50-100mkday (BID) Vial: 1g
Vial: 500mg;
Cefepime 50mkday q 8h
2g
Vial: 500mg;
Ceftazidime 50-100mkday
1g
Vial: 500mg;
Cefazolin 50-100mkday
1g
Vial: 250mg,
50-100mkday (TID- 500mg, 1mg
Ceftriaxone
QID) plus 10ml
diluent
Tab:
500mg/500mg
Susp:
50-100mkday (IV); 125mg/5ml,
Cefuroxime
20-40mkday(oral) 250mg/5ml
Vial: 250mg,
750mg,
1.5g
Cap: 250mg,
30-50mkday (PO), 500mg
Cefalexin
50-100mkday (IV) Susp:
125mg/5ml
 Drpos:
100mg/ml
Cap: 250mg,
500mg
Chlorampheni
50-100mkday Susp:
col
125mg/5ml
Vial: 1g
Cap: 250mg,
400mg
Syr: 100mg/5ml
Cimetidine 50-100mkday
Amp:
200mg/2ml,
300mg/2ml
Tab: 250mg,
Ciprofloxaci
500mg
n 7.5mkday (BID)
Susp:
(Klaricid)
125mg/5ml
Cap: 250mg,
500mg
Cloxacillin
50-100mkday (BID) Oral soln
(Pharex)
powder:
125mg/5ml
Tab:
400mg/80mg;
Cotrimoxazol
8-12mkday (BID) 800mg/180mg
e
Susp:
200mg/40mg/5ml
Tab: 2mg, 5mg
Diazepam 0.2mkdose
Amp: 10mg/ 2ml
Cap: 50mg;
Diflucan 6-13mkday 150mg; 250mg
Vial: 2mg/ml
Tab: 500mg
Diloxanide 20mkday (TID) Susp:
125mg/5ml
Doxycyxline 204mkday Cap: 100mg
Cap: 250mg;
Erythromycin 30-50mkday
500mg
 Susp:
200mg/5ml;
400mg/5ml
Drpos:
100mg/2.5ml
Tab: 400mg;
Ethambutol 15mkday
200mg
Cap: 250mg
Ferrous 1mkday (MRD)4- Syr: 220mg/5ml
Sulfate 6mkday (Txc) Drops:
75mg/0.6ml
LD:12-20mkday
Fluconazole
MD: 6-12mkday
Tab: 100mg
Furazolindon
4-7mkday Amp: 50mg/5ml
e
Tab: 20mg,
Furosemide 0.5-1mkdose 40mg
Amp: 10mg/ml
Vial: 40mg/ml;
Gentamycin 5-8mkday
80mg/2ml
Tab: 25mg
Hydralazine 0.15mkdose (IV)
Amp: 20mg/2ml
Vial: 259mg
Hydrocortiso
5mkdose Amp: 100mg,
ne
250mg, 500mg
0.01mkdose; 0.02- Tab: 100mg;
Hyoscine
0.15mkday Amp:20mg
Tab: 200mg;
Ibuprofen 5-10mkdose 400mg; 600mg
Syr: 100mg/5ml
Tab: 300mg
INH 5-10mkday (Premeal)
Syr: 100ml/5ml
Tab: 500mg
Isoprinosine 50mkday
Syr: 250mg/5ml
Meclizine 12.5-50mkday
Mefenamic Cap: 250mg,
6.5mkdose (Q6h)
Acid 500mg
 Susp: 50mg/5ml
Meperidine 6mkday; 0.5mkdose
Syr: 5mg/5ml
Amp: 5mg/ml,
Metocloprami 0.25mkdose (IV, IM)
10mg/ml
de 1mkday(PO)

Tab: 250mg,
500mg
Susp:
Metronidazol 125mg/5ml
30-50mkday TID
e Inj: 500mg
Infusion:
500mg/100ml
Vial: 5mg/ml
Nafcillin 50-100mkday TID
Nalbuphine 0.1-0.2mkdose 10mg/ml
Tab: 5mg,
0.25mkdose (IV, IM)
Nifedipine 10mg, 20mg,
1mkday (OP)
30mg, 60mg
400,000U/day NB
Nystatin Oint: 5g
1.2M U/day
Tab:200mg,
Ofloxacin 20-30mkday 400mg IV Soln:
200mg/100ml
Tab: 500mg
Susp:
120mg/5ml,
Paracetamol 5-25mkdose q4h
250mg/5ml
Drops:
100mg/ml
50-100,00U/mkday,
Penicillin G 200,000-
1.2M U
(Penadur) 400,000U/mkday
(meningitic dose)
Tab: 15mg,
Phenobarbita 10mkdose (LD)
30mg, 60mg,
l 5nkdose (MD)
90mg
 Amp: 130mg/ml
Phenoxymethy Adult: 250-500mg
lpenicillin QID
K Child: 50mkd QID
Piperacillin Vial: 2.25,
100-300mkday
(Tazocin) 4.5g
Prednisone
Tab: 5mg,
(Oracort,
1-2mkday 10mg, 20mg
Orasone,
Susp: 10mg/5ml
Prolix)
Tab: 500mg
Susp:
Pyrazinamide 15-30mkday
500mg/5ml,
250mg/5ml
Tab: 150mg,
1-2mkdose BID q8- 300mg
Ranitidine
12h Amp: 25mg/ml;
50mg/2ml
Cap: 300mg;
10-15mkday 450mg; 600mg
Rifampicin
(premeal) Susp:
200mg/5ml
Tab: 2mg
Syr: 2mg/5ml
Salbutamol
MDI:
(Ventolin,
0.15mkdose TID-QID 100mcg/dose
Asmalin,
Nebule:
Combivent)
2.5mg/5ml,
5mg/ml
Tab: 25mg,
Spironolacto
1-3mkday 50mg,
ne
100mg
Streptomycin 20-40mkday Vial: 1g

Sucralfate
1g/dose QID
(Iselpin) Tab: 1g
 Terbutalin Tab: 2.5mg,
(Bricanyl, 5mg
0.075mkdose BID-TID
Terbulin, Syr: 1.5mg/5ml
pulmoxcel) Neb: 5mg/2ml
Tetracycline 20-50mkday QID Cap: 250mg
Tab: 125mg
Theopylline 20mkday q6h SR tab: 250mg
Syr: 80mg/15

DOPAMINE
Wt x ug/min ÷26.6
Ex: 40kg x 15ug/min or 10ug/min ÷ 26

DOBUTAMINE
Wt x ug/min ÷ 16.6

DOPAMINE DRIP
(5-8mg/k/min)
 100cc 6 x wt x dose = 21mg of Dopamine
Rate___
1.6
79cc D5W + 21mg of Dopamine

 25cc 1.5 x wt x dose = 5mg of Dopamine

Rate___
1.6
5mg of Dopamine in 20cc D5W

HEMODIALYSIS PRESCRIPTION

Blood Flow Rate: 5ml/kg/min

Dialyzer: F4: BSA 0.7
F5: BSA 1.0
F6: BSA 1.3

NSS Flushing 100ml q 15min or Heparin LD: 10-

20IU/kg
MD: 10-20IU/kg
Ultrafiltrate 0.2ml/kg/min x ____ hrs
Duration: initial 1.5 – 2 hrs
2nd day: 3hrs
3rd day: maintemance – 4hrs

Bicarbonate bath: prime solution with NSS 120ml

 Weigh pt pre & post HD and record

 Monitor VS q15mins while on HD
 Watch out for Headache, nausea, disorientation,
hypotension, seizure, muscle cramps & vomiting
 Labs: pre & post HD
 Intradialytic transfusion (if any )
 Initial HD: Mannitol 0.5-1.0g/kg to decrease
disequilibrium syndrome in pt w/ elevated BUN
(>35mmol/L)
 Refer accordingly.

MGH orders for KD

 Repeat CBC, Plt, ESR, after 2 weeks
 Repeat 2D echo after 6 weeks
 Home meds: ASA 80mg/tab 1 tab OD x 6 weeks take
on full stomach
 No live attenuated vaccine for at least 11
months

KAWASAKI DISEASE
 Febrile, examthematous, multisystem vasculitis
 Fever for at least 4 days
+ clinical features (at least 4/5)
1. Bilateral bulbar conjuctival injection w/o
exudates w/ lumbar sparing
2. Erythematous mouth & pharynx, strawberry
tongue and red, cracked lips
3. Polymorphous, generalized erythematous
rash (morbilliform, maculopaular or
scarlatiniform )
 4. Changes in peripheral extremities
(induration of hands and feet w/
erythematous palm & soles later
w/periungual desquamation)
5. Acute, nonsuppurative, unilateral cervical
lymphadenopathy at least 1.5cm in diameter
or if w/ coronary actery aneurysims

ATYPICAL KD – common in <12 mo old

 Coronary artery ectasia/dilatation:
confirms diagnosis (1-4 wks DOI)
 Labs: CRP > 3.0mg/dl 1st 2 weeks of
illness
ESR > 40mm/h
↑ PLT ct >450 on days 10-12 of illness
“without aspirin & IVIg, fever can last
upto 2 weeks or longer. After fevr
resolves, pt can remain notablefor 2-3
weeks. Desquamation of groin, finger, toes
after 2-3 weeks may occur. ”
 Labs normalizes w/in 6-8 weeks

Treatment
 IVIg high dose within 10 days
 Aspirin
 IVIg: 2g/kg as single dose over 10-12hrs
 Aspirin: 80-100mg/kg/day x 4 doses
 After fever is controlled, ↓ Aspirin to 3-5
mg/kg/day, discontinue after 6-8 weeks if
no heart problems

Recommended Dosage and Drip Rate for Kawasaki

Patient
Dosage: 2g/kg/12hrs
EX: Pt: 10kg
Patient total needs: 20g of Immunorel
 Total Volume need: 400ml to be divide by 12
hrs = 33.33ml
Initial Test drip: 33.33ml/4= 8.33ml
for 1st hour
Succeeding Drip Rate
2nd hour: 8.33ml x 16.67ml
Total Volume left:
375ml/10hrs=37.5ml/hr
* Courtesy of Dr. Ana Marie Morelos, Dr. James
Angtuaco and Dr. Edison Ty

GUIDELINES FOR PEDIATRIC PLATELET TRANSFUSION

Children/Adolescents
<50 x 109/L and bleeding
<50 x 109/L and invasive procedure
<20 x 109/L and bone marrow failure with age risk
factor
<10 x 109/L and bone marrow failure w/o age risk
factor

Infants within the 1st 4mos of life

<100 x 109/L and bleeding
<50 x 109/L and invasive procedure
<20 x 109/L and clinically stable
<100 x 109/L and clinically unstable

WHO GRADING OF DHF

I. Hemocencentration, fever, & constitutional
sx; + TT
II. Spontaneous bleeding + grade 1
III. Circulatiry failure, pulse pressure
<20mmhg
SBP normal
DSS
IV. Profound shock, hypotension/unrecordable
BP

NORMAL HEMATOCRIT VALUES FOR AGE

Age Range (%) Mean (%)
 2 weeks 42-66 50
3 months 31-41 36
6 months – 6 33-42 37
yrs 34-40 38
7 yrs – 12 yrs
Adult: 42-52 47
Male 37-47 42
Female
th
Source: Nelson textbook of Pediatrics, 15 edition
p. 1379

WHO CASE DEFINITION OF DHF (WHO 1975, 1986)

All of the ff criteria nust be present:
1. Fever (high and continuous of 2-7 days’
duration)
2. Hemorrhagic diathesis (at least a positive
tourniquest test except in shock)
3. Thrombocytopenia (less than 100,000/mm3)
4. Hemoconcentration (20% or more relative to
baseline or evidence of increased
capillary permeability) or evidence of
plasma leakage (i.e. pleural effusion,
ascites and/or hypoproteinemia)
OTHER CLINICAL MANIFESTATIONS SUGGESTIVE OF DHF
ARE:
1. Hepatomegaly (which may be tender)
2. Circulatory disturbances (restlessness,
cool extremities), capillary refill time
>2 sec., tachycardia)
3. A fall in hematocrit following volume
relacememnt
~ These along with a platelet count below
100,000/mm3 can justify notification of the
case as DHF
~ Hematoconcentration may be absent during
earlt fluid replcemnt or in cases where
bleeding has occurred.

Unstable VS, ↓ urine

output
Signs of shock
 Immediate rapid volume replacement 10-20ml/kg (or rapid
bolus)normal saline or LR solution

Improvemen No
O2 to Correct Improvement
t Acidosis
Hematocrit
Adjust IVT Hematocrit ↑↑
↓↓

Colloid infusion 10-20 ml/kg IV

Blood transfusion 10ml/kg
Plasma/Hemaccel ®/ 5% Albumin/
SCABIES Dextran 40
~ Treatment for dengue shock syndrome grades
3 and Crotamion
4 (Eurax)lotion apply from neck down x
24h then rinse

DOPAMINE DRIP
200mg in D5W 200cc
mcgtt/mins = wt x DD/13.3
= wt x DD x 0.75

400mg in D5W 250cc

mgtt/min = wt x DD/26.6
= wt x DD x 0.375

6 x wt in kg = ___ mg in 100ml (1ml/hr =

1mcg/k/min)

CRANIAL NERVE EXAMINATION LIST

Rapport with  Introductions

patient
Sit on edge of bed
General inspection  Diagnostic facies 
IVC  NGT
 IDC
 Facial asymmetry
 Pupil symmetry
 Scars  Ptosis  eye
patch
 eye glasses  Hearing
aide
1. Ask for change
in smell
2. Test visual  Snellen chart  Left
acquity eye  Right eye
Test visual  Hat pin  Left eye 
fields Right eye
Test light  Direct  Consensual 
reflexes Swinging torch
Test  Hat pin
accommodation
Fundoscopy  Optic disc 
Retinopathy
3, 4, 6. Test  Dysconjugate gaze
ocular movements ; (MLF)
ask if diplopia  H pattern testing 
occur Diplopia
 Nystagmus  Vertical
 Horizontal
 Test Intorsion (if
CN3 palsy)
5. Trigeminal  Pin prick testing V1
Sensory & Motor V2 V3
 Light touch testing 
Corneal reflex
  Clench teeth &
palpation of masseter
muscle
 Open jaw & ptyerygoid
resistance
 Jaw jerk
7. Test Facial  Forehead wrinkling 
Muscles Eye closure
 Blowing of cheeks 
Smiling
 Ear  Mastoid 
Parotid  Palate
8. Test Hearing  Inspection of ear and
and Balance tympanum
 whisper  High tone
68
 Low tone 100  Rinne’s
 R  L
 Weber’s (256Hz) 
Nystagmus
 Hallpike’s +/- Epley’s
9, 10. Deviation  Dysphonia 
to Normal side Swallowing
 Coughing  Uvual
deviation
 Gag reflex
11. test shoulder  Trapezius mm:
& neck movements Shoulder shrug
 SCM mm: Head turning
12. Tongue  Wasting 
Protrusion; Fasiculation
deviation to  Dysarthria
affected side
Ask for BSL
 If relevant assess  Peripheral nervous
other neurological system
system  Cerebellar system
Summary &
interpretation

HEART RATE MEAN

NB- 3MOS 85-205 140
3MOS-2YRS 100-190 130
2YRS-10 YRS 60-140 80
>10YRS 60-100 75

WEIGHT
6MOS-12MOS AGE in mos + 9 ÷ 2
1 YR-6YRS Yrs x 2 + 8
7YRS-12YRS Yrs x 7 - 5

HEIGHT
Ht in cm AGE in yrs x 5 + 80
Ht in inches AGE in yrs x 2 + 32

Light index
D2 diameter of collapsed lung
DH diameter of hemithorax on the collapsed side
% of pneumothorax= 100-(D23/DH3 x 100)

DOBUTAMINE DRIP
6 X WT in Kg = ______mg in 100ml

250mg in D5W 250cc (1mg/ml)

Mcgtt/min= wt x DD/16.6
= wt x DD x 0.06

500mg in D5W 250cc (2mg/ml)

Mgtts/min = wt x DD/33.2
= wt x DD x 0.03
EPINEPHRINE/NOREPINEPHRINE DRIP
0.6 X WT = ______mg in 100ml
1ml/hr will deliver 0.1mcg/kg/min

Treatment for Chicken Pox

Children: 800mg/tag, 1tab QID
>40mg (3, 200mg PO in 4 divided doses)

Nasal Cannula

Oxygen Flow rate Est. FIO2 in %

1 24%
2 28%
3 32%
4 36%
5 40%
6 44%

SIMPLE FACE MASK

5-6 40%
6-7 50%
7-8 60%

Anion gap (serum)= Na- (Cl + HCO3)

Corrected Ca= Actual Ca + [(40-alb)x 0.02]
Sodium deficit= DNa-Ana x BW x 0.6
Potassium deficit = DK – AK /0.27 x 100%

Sodium
 The needed to infuse
 DNa-Ana
0.5 meqs / hr
L
 Amount of PNSS needed =
Computed Na deficiency ÷ 154
  Drip rate = amount of PNSS needed
Time needed to infuse
Methylmed
30mkdose + 100cc D5W x 2h q 24H via
infusion pump x 3 doses

SCLEREMA NEONATORUM
- In an infant, fat has higher saturated-to-
unsaturated fatty acid ration compared to adult
fat and thus a higher melting point.
Prematurity, hypothermia, shock and metabolic
abnormalities have been postulated to further
increase this ratio, possibly as a result of
enzymatic alteration allowing precipitation of
fatty acid crystals within the lipocytes. This
condition has been suggested to result in the
dramatic clinical findings in affected skin. X-
ray diffraction techniques have confirmed that
infants with sclerema neonatorum have an
increase in saturated fats and that the crystals
within the fat cells are composed of
triglycerides.
 Fluids and Electrolytes

> 5 years old (>20kgs)D5LR

> 3 years old (<15kg)D50.3Nacl/ D5IMB
(>15kg)D5NM

Deficit <10 kg >10kg

Mild 50 30
Moderate 100 60
Severe 150 90

Maintenance (24 H)
0-3 kg 75cc/kg
3-10 kg 100cc/kg
10-20kg 75cc/kg
20-30kg 60cc/kg
30-40kg 50cc/kg
>40kg 40cc/kg

Newborn
0-1 day 80cc/kg/hr
old
2 90cc/kg/hr
3 100cc/kg/hr
4 110cc/kg/hr
5 120cc/kg/hr
6 130cc/kg/hr
7 140cc/kg/hr
 8 150cc/kg/hr
Mild Dehydration
30-50cc/kg/6h D50.3Nacl
Moderate Dehydration
60-90cc/kg/6h
¼ of computed deficit give D5LRX2hrs then ¾
to be given for the next 6hrs D50.6Nacl
Severe Dehydration
>100cc/kg/6h
1/3 with D5LRX2H then 2/3 with D50.3Nacl X
6H

Medical Prophylaxis
Diphtheria – update DPT immunization status
for all age
groups and Erythromycin 4-050mkd in 4
days divided doses X 10 days (max
2g/day).
 Alternative: Benzathine Pen G IM single
dose
 <30kg – 600,000 units
 >30kg – 1.2 Million units

NOTE: Close contact should be observed for 7

days for evidence of the disease.

Endocarditis – prophylaxis given 30-60 mins

after procedure
 Oral: Amoxicillin 50mg/kg
 Unable to tolerate PO
 Ampicillin 50mkdose IM/IV or
  Cefazolin/Ceftriaxone 50mg/kg
 Allergic to Penicillin
 Cephalexin 50mg/kg or
 CLindamycin 20mg/kg or
 Azithromycin/Clarithromycin 15mg/kg
 Allergic & unable to tolerate PO:
 Cefazolin/ceftriaxone 50mg/kg IM or IV
or
 Clindamycin 20mg/kg IM or IV

 Note: No prophylaxis for procedures

________ Respiratory, GI or Genitourinary
Tract

Hepatitis B
 Newborn with HBsAg (+) mother
- HBIG 0.5mL and Hep B vaccine 0.5ml
IM at birth or w/in 12 hrs followed
by Hep B vaccine at 6 weeks after
and after 6 months.
 Premature & HbsAg (-) mother
- Hep B vaccine delayed until child ≥
2000 gm
 Sexual contact with HBsAg (+) partner,
exposure to blood/ body fluids
- Hep B vaccine + HBIG 0.06ml/kg IM
(not later than 14 days from
exposure from sexual contact and
with in 7 days for percutaneous
exposure)
 Household/Sexual Contact with Chronic
Causes
 - Hap B vaccine only

Malaria
 Mefloquine (250mg/tab) to start 1 week
before travel then weekly until 4 weeks
after leaving endemic area as ff:
 < 45kg = 5mg/kg (max: 250mg)
 >45kg = 1 tab once a week
 Doxycycline daily to start 2-3 days
before travel then daily until 4 weeks
after leaving endemic area
 8 years old = 2mg/kg up to adult
dose of 100mg/day

 Note: Contraindicated for < 8years and

pregnant women

Meningococcemia
 Rifampicin in 2 divided doses X 2days
≤ 1 month – 5mkdose every 12 hrs
≥ 1 month – 10mkdose every 12 hrs (max
600mg)
 Alternative: Ceftriaxone single IM dose
< 15 years old – 125mg
≥ 15 years old – 250mg or

Ceprofloxacin (not for ≤18 years old)

≥ 18 years old: 20mk PO as SD (max 500mg)

Rheumatic Fever
 Benzathine Penicillin 1.2 Million U IM
every 4 weeks
 - <27kg (60lbs)- 600,000 U IM or
- Penicillin V 250mg PO twice daily for
patients allergic to Penicillin:
Erythromycin 250mg PO BID
 Duration:
 RF, (-) carditis: 5 years since last
episode ao ARF or until 21 years old
whichever is longer
 RF, (+) carditis w/o residual heart
disease (no valvular disease): 10
years or until 21 years old whichever
is longer
 RF, (+) carditis, (+) residual heart
disease:
10 years since last episode or at
least until 40 years old whichever is
longer

 Note: Consider lifelong prophylaxis for

people with severe valvular disease

VACCINATION
Absolute Contraindications
 Severe anaphylactic/allergic reaction to
previous vaccine
 Moderate – severe illness ± fever
 Encephalopathy within 7 days of vaccine
(pertussis)
 Immunodeficiency (Congenital – all live
vaccines ) or households contact (OPV)
 Pregnancy (MMR, OPV/IPV )
Relative Contraindications
 Immunosuppressive therapy (all live vaccines)
 Egg allergy (MMR)
 Seizure w/in 3 days of last dose (Pertussis)
 Shock w/in 48 hrs of last dose (Pertussis)
 Fever >40.5°C w/in 48hrs of last dose
(Pertussis)
Not Contraindications
 Mild illness ± low grade fever
 Current antibiotic therapy
 Positive PPD
 Prematurity

Nursery
 Please admit to NICU under the service of
Dr. _____
 TPR Q15minutes until stable
 Breastfeeding
 Labs: CBC, APC, BT, RH typing, NBS at 24h
old
Medications:
1. Terramycin ophthalmic ointment OU
2. Vit. K 1mg IM
3. Hep B vaccine 0.5mL IM
S/O:
 Routine newborn care
 Gastric lavage
 Suction secretion PRN
 Thermoregulate at 36.5-37.5°C
 Daily cord care w/70% IPA
 Watch out for tachypnea, tachycardia,
alar flaring, retractions
  Refer PRN

Newborn Final Diagnosis:

Fullterm (__wks), AGA, BW=__kg, cephalic via
NSVD, Live, Bb.Girl/Boy AS 9,10; Neonatal
sepsis; Uninvestigated physiologic jaundice

IVF:
 TFR x wt/24h/20% (if with
phototherapy)
 TFR x wt/24h-fdg-Aminosteril (use
formula if w/ Aminosteril & fdg)
eg: wt: 3kg TFR: 80
80x3/24/20%= 20 or
80x3=240x0.2= 48, next
240/48= 288/24h= 12cc/hr

1st 24h D10w, then

D10IMB
D5IMB

Preterm
 Please admit
 TPR q15 minutes until stable
 NPO
 D10W 250ccx7cc/hr
 Labs:
 CBC, APC @24HDL
 Blood & RH typing
 Na, K, Ca
 BUN, Creatinine 24HDL
  NBS
 ABG, Blood C/S, CBG q6H
 CXR, APL
 Vit. K 1mg IM now
 Hep B 0.5 ml Im now
 Terramycin/Erythromycin ophthalmic
ointment
 Ampicillin – q12h
 Oxygen
 Attach to pulse oximeter

HBsAg Reactive Mother

- Give HBIg 0.5ml deep IM w/in 12HOL
- CRP at 24HOL
- Blood C/S anytime after birth
 Normal CBG: 60-140
 Bilirubin: B1B2: ÷ 17.1 (start
phototherapy if ≥15)
 WBC: ≥20,000 start meds
 IT Ratio- stabs/juvenile/total
neutrophils = ≥0.2 (+) infection
 Reticulocyte – actual Hct/0.40 (desired
Hct)X Reticulocyte = N 1-1.5
≥ 1.0 = hemolysis
≤ 1 = bone marrow failure (CRT ÷ 2)

Seizure Disorder
 Please admit
 TPR q4h and record
 NPO temporarily
 Labs: CBS, APC, Urinalysis, fecalysis,
CBG now then q6h while on NPO
 IVF: D50.3Nacl 500cc+2meq KCL/150ccIVF
post voiding
 Meds:
 S/O:
 MIO qshift & record
 Monitor VS q4h & NVS qhour &
record
 Seizure precaution at bedside
 Standby O2, padded tongue
depressor at bedside
 Replace GI loses volume/volume
w/ PLR as sidedrip
 Refer PRN

Benign Febrile Seizure

 Please admit
 TPR q4h & record
 NPO temporarily
 Labs: CBC, APC, Urinalysis, Fecalysis,
CBC now then q6h while on NPO
 IVF: D50.3Nacl 50cc+ 2meq KCl/100cc IVF
IVF post voiding
 Meds: Paracetamol, Ibuprofen, Diazepam
(0.2mkdose)
 S/O:
 MIO qshift & record
 Monitor VS q4h, neuroVS qhour &
record
 Seizure precaution
  Standby O2, tongue depressor at
bedside
 Replace GI losses V/V w/ PLR as
sidedrip
 Refer PRN

Status Post Lumbar Puncture Orders

 Flat on Bed x 4h
 NPO x 4h
 Send the following specimen to lab as ff:
 TT#3 – CSF cell ct, diff ct
 TT#2 – CSF, sugar & protein
 TT#1 – CSF GS/CS, AFB, KOH
 RBS now
 Monitor VSq15min until stable
 Refer patient for any untoward s/sx
Status Post Extubation Orders
 Nebulizer with Racemic epinephrine now
 Extubate patient now
 Nebulize w/ Racemic epinephrine
q15minx3doses
 Nebulize w/ Salbutamol 1nebule q6h
 NPO x 6h
 CXR, APG 6h post extubation
 O2 6-10LPM
 Watch out for secretions, tachypnea, etc.
Note: Racemic Epi: PNSS: 4.7ml Epi: 0.3ml

Body Surface Area

𝑤𝑡𝑥ℎ𝑡
=
√3600
  ANC= WBC x Differentials x 10
 IT = stabs ÷ seg >0.2 bacterial
 BMI = wt (kg)÷ ht (m)2
 MIO + intake – output = +/- balance
 Output + output ÷ wt ÷24h = ____cc/k
(Output of chemo px: output ÷24h÷BSA =
_____cc/m2)

Dopamine
 0.5-4µgm/kg/min – renal vasodilation
 >10µgm/kg/min – vasodilation & decreased
peripheral and renal perfusion
 5-10 µgm/kg/min – increase inotropic
effect and cardiac output = increase BP

Management for Acute Respiratory Tract

Infection
 Central cyanosis  Admit
 IV Chloramphenicol/
 Severe respiratory
Very Ceftriaxone
distress YES
Severe  O2
 Not able to drink
Pneumonia  Tx fever
NO
YES Severe  Admit
Chest in drawing Pneumonia  PenG
 Manage Airway
NO  Tx Fever
YES
Fast Breathing Pneumonia
 Home management
 Amoxicillin
NO  Cough remedy
 Ff-up in 2 days
YES
No signs of PNA No PNA,