Acetaminophen Infants & child: 10 -15 mkdose q4-6H Amiodarone Vent arrhythmia/ PSVT

analgesic, >12y.o.:325-650mg q4-6h Antiarrythmic Class PO: <1yo: 600-800m/BSA/Day BID (X4-14D)
antipyretic MAX: 5 doses/24hr III >1yo: 10-15/20mkD BID x 10 D 5-
Ad rxn: fetal hepatic necrosis 10mkD
(Tx: acetylcysteine) Cut all doses in half after 1-4wks of Tx or
(100/ml drp, 120/5,250/5, 325mg,supp:125, control
250) IV: LD 5mkd x1hr  cont 5-15ug/k/min
Contra: markd sinus brady, 2nd & 3rd AVblock
Acetazolamide Neonates: 25mg/kg/24H BID, TID, or QID 4- Prep: 200mg/tab, 150mg/3mL amp
hydroceph, edema, 7D VT/VF: 5mkdose rapid IV for pulselessness
epilepsy Children w/ edema: diuresis: 5mg/k/24h Perfusing arrhythmias: same dose 20-60min
Ad rxn: metab acidosis, hypoCl, hypoK,
drowsiness, anorexia, muscle weakness
Prep: IV:500/5ml,PO:125mg, 250mg Ampicillin- At least 100mkday (based on Ampi)
Sulbactam 100-150(200child)mkD Q6h (mild/mod infxn)
Acetylcysteine 2-5ml TID, QID (infant) Aminopenicillin 200-300(400child)mkD q6h (meningitic/severe)
mucolytic 6-10ml TID, QID (child) (GBS, Listeria, E coli) Adult: 750max q6-8h IV PO: 20-40mkday
Adjust dose in renal
Ad rxn: bronchospasm(give dilator 10-15min Prep: 750(500), 1.5g(1g), 375(250), 250/5susp,
failure
b4) 375mg, 750mg/tab
(100/5ml syr, 100mg,200mg sachet, 600mg
tab) Amphotericin B 0.3 - 0.7mkd
X saline NB: Initial:0.25-0.5mgK IV Infusion:2-6H
Acyclovir >6yo- 800mg 4x/D solnprecipitate MD:0.5-1mg/kg IvQ24-48H
(Varicella, HZV) 2-6yo: 400mg QID Ampho B 50 mg dilute with 10ml dilute to make
Monitor: CBC, Crea,
>2yo- 200mg QID or 20mkdose QID x5D U/O, BUN, Crea, Elec a conc of 5mg/ml
Max: 800mg/day (200mg, 400mg, 800mg/tab) Test dose...
Herpex: 200mg/5mL susp eg 2.1kg
Day 1:0.25/kg
Adenosine Neonate & child: 0.05mkdose push then inc =(wt x0.25)=0.52mg
Paroxysmal SVT bolus doses by 0.05mkdose q2min (0.52/ 5)= 0.1ml
antiarrythmic Max: 0.25mk or 12mg 0.1 ml + 5.2 ml D5water to run for 6h
Prep:3mg/ml (2ml) Day2: 0.5ml/kg= 1/05mg
Ampho B 0.21ml + 10.5 ml D5W
Albendazole >2y.o 400mg or 10mL susp SD Reconstituted solution =wrapped in aluminum
1-2y.o.: 200mg/tab or 5mL SD foil to protect from life n store at ref
< 2y.o 200 SD Infusion line wrapped in aluminum foil
Prep: 400mg/tab, 4%susp 10mL Watch out for apnea, bradycardia, cyanosis
Be given in AM preferably
Albumin Neonate:0.5- 1g/kg/dose MAX: 1g/k/24hr Ampicillin 100-150(200)mkD q6h MAX: 500mg q6h
colloid Infants & child: 0.5-1g/k/dose Max: 6g GBS, Listeria, E coli MeninG: 200-400 mkd MAX: 12g/24hr
Adjust in RF NewBorn: 50mkdose q12, 100mkday q6H
Ad rxn: urticaria, fever, circ overload, edema
Prep: 25%/50cc,100cc, 12.5/50cc Postnatal Age Interval
Aldactone 2-3 mkday (od,bid,tid) <29 0-28 12
Spironolactone Prep:25mg, 50, 100/tab >28 8
Ad rxn: hyperK, agranulocytosis, headache 30-36 0-14 12
>14 8
AlOH,MgOH see 37-44 0-7 12
Maalox >7 8
Ambroxol 1.2 - 1.6 mkdose TID >45 All 6
Sinecod EXP (Novartis Approximates): Prep: 250mg, 500mg vial. 250mg, 500mg/cap
>12yo: 10ml BID 30mg/5ml syr 125/5mL, 250/5mL, 100/ml drops
7-12yo: 5ml BID to TID 15mg/5ml syr Amoxicillin 30-50mkDay/ 50-75mkDay H.D
3-6yo: 2.5ml TID 15mg/5ml syr Prep: 250, 500mg/cap, 125/5ml, 250/5mL
1-2yo: 2.5ml BID 15mg/5ml syr susp, 100/ml drops
13-14mos infant: 1.25ml BID to TID drops
7-12mos: 1ml BID or 12mkday Ansimar 10 mkdose BID (6-9)
3-6mos: 0.5ml BID or 6mkday Prep: 100mg/5mL
Tab: 30mg/tab,
Syr: 15mg/5ml, 30mg/5ml Antamin 0.3 mkdose
Drops 6mg/ml Amoxicillin- 20-40mkday PO TID based:Amox
Amikacin 15mkDay q8h MAX: 1.5g/24hr Sulbactam 40-50 mkday IV q8 based:Amox
NB:< 29 0-7 18 mkd 48H (Ultramox) 2-6yo: 375 IV Q6/Q8
8-28 15 mkd 36H 6-12yo: 750IV Q6/Q8
>28 15 mkd 24H Prep: 250/250/5mL, 750(500+250),
30-33 0-7 18 mkd 36H 1.5(1g+500)
>7 15 mkd 24H
>34 ALL 15 mkd 24H Co-Amoxiclav Oral:20-40mkDay (based:Amox) TID
Prep: 100mg/2mL, 250mg/2mL, 500mg/2mL Adjust in RF 25-45mkDay BID
15mkday OD IV:30-50 mkdose q8h
Amikacin given only once patient has Prep: 156/312 (125/250) TID
voided 228.5/457 (200/400) BID
Aminophylline ?3-5mkdose IV load: 6-8mk 375/625 (250/500)
(20min)
1-9yo: PO-27mkDay q4-6h IV:1-1.2mkhr Ascorbic Acid Scurvy: 100-300mkDay
9-12yo:PO-20mkDay q6h IV:0.9mkhr Urinary acidification: 500mg q6hrs
12-16yo:PO-16mkDay q6h IV:0.7mkhr
6mo-1yr: 0.6-0.7mkhr ASA 75 - 100 mkd Prep: 80,100,300mg/tab
6wks-6mos: 0.5mkhr Ad Rxn:
Kawasaki: 80-100 q6h (x2wks) during febrile
Neonate: IV: 0.2mkhr myelosuppression,
hepatotoxicity phase or until after 3-4days afebrile then dec to
Neonatal Apnea: 3-5m/k/day OD 6-8wks after or ESR & plt
LD- 5-6mkdose MD- 1-2mkdose q6-8h normal
Dilute to equal amt with IVF Rheumatic Fever: 60-100mkday q6hr
Refer: Inc HR, sZ, Hypo/hypertension, Contra: <16y w/ chickenpox or flu like Sx(Reye synd)
vomiting, arrhythmia, feeding intolerance
 (2nd gen) 20-40mkday (PO)BID
Atenolol 0.8 – 1.5mkday (max: 2mg/kg) Prep:125mg/5ml, 250mg/5ml;
HPN, arrythmia Contra: pulmo edema, cardio shock 250mg,500mg/cap;
Ad rxn: brady, hypotension, 2nd/3rd AV block, 750mg/vial
wheezing, headache, constipation Cefpodoxime 8-10 mkday BID Po

Atropine sulfate Sinus brady: 0.02mkdose (min 0.1mg, MAX: Cefotaxime 50 -100 mkday q6-12H, usu q8h
Dose <0.1 paradoxical 0.5mg) q 5min (3rd gen) Up to 150 or 200mkday for life-threatening inf.
brady Antidote to organophosphate: 0.02-0.05mkd Premature infant: MAX 50mkday
q10-20min then q1-4hr for 24hrs Prep: 500mg, 1 gram/ vial

Azithromycin 10-50 mkdose OD x3days Ceftriaxone 75- 100 mkday IV OD (MAX: 3g/day)
OM: 10mkD x3d MAX:500mkday (3rd gen) 50 to 75mkday for mild to moderate infection
CAP(>6m): 10mkDx1 day 5mkD x4days 100mkday for severe infection (max 4gm/day)
ATP (>2y): 12mkD x5days MAX: 500mkday Order: ___mg IV OD via soluset to run for
Adolescents: 500mg x1day 250mg x4 days 30mins
or 500mg OD x 3days Prep: 500mg, 1gm/vial
Prep: 500mg, 2g/tab, 100/5, 200/5mL susp,
500IV Ceftazidime 30mkdose q12(<7days old)
Aztreonam 30mkdose q8h, inc by probenecid and furo (3rd gen) 50mkdose q8 (>7 days old)
monobactam Prep: 500vial Prep: 250, 500, 1g, 2g/vial
Carbamazepine 10-20 mkday 1.5-3 mkday
Bambuterol 0.25-0.27mkdose OD Prep: 20mg/mL , 100mg/5mL, 200/400 tab
Bambec Oral sol:1mg/ml, tab 10mg
Cetirizine 0.25mkday OD/BID
Benadryl 0.5-1 mkdose(IV) q6h-8h 5mg/5ml solution for 2yo and up
3 - 5 mkday(PO) q6h Oral solution (1mg/ml)
Prep: 25mg.50mg/cap; 12.5/5mL, 50mg/mL Drops 10mg/ml; 2.5mg/ml for 1 to 2yo
Usual Doses:
10mg/ml drops 1-2yo 5 drops BID
Bisacodyl <2yo– 5mg 5mg/5ml soln 2-6yo 5ml OD
>2yo– 10mg; (5-10mg/tab supp.) >6yo 10ml OD or 5ml BID
Prep: 5mg/tab; 10mg supp, 10mg/30mL enema Charcoal 1 – 2 g/kg q2-6H
Bromhexine 0.5-0.85 mkday in 3 doses 5 – 10 x wt of ingested poison
Budesonide 1-8 yo= 0.5mg/24 hr OD, BID Chloramphenicol IV: 50-100mkday q6h (>75 mkday:Typhoid)
Adrenal corticosteroid Max dose 4 doses/ 24 hrs PO: 30-50mkday
Anti-infl ammatory
PreMature/NB: 25 mkday
Prep: 125/5ml; 250-500/cap; 1g/vial
Buscopan 0.1-0.2mkdose MAX: 0.8mkD
0.15 mkD QID, 0.01mkdose Chlorphenamine 0.35mg/kg/24H
Prep: 10mg/tab, 2mg/ml syr, 20mg/amp Maleate 2mg/5ml; 4mg/tab; 10mg/ml amp

Carbamazepine 10-20mkday, then 1.5-3 mkday Cimetidine PO, IV, IM:20–40 mg/kg/24 hr q6H (Nelson)
200-400MG/Tab, 100/5mL susp Syr 100mg/5ml
Carbocisteine Inf: 10-20 mkday TID Amp: 150mg/ml
Child: 30-50 mkday q8-12H Ciprofloxacin 20-40 mkday BID PO
Solmux Approximates: (Ciprobay) Typhiod relapse: 10-20mkday
>12yo :1 cap TID NOT for <18yo Max: 500mg q12h
8-12yo : 15ml ped 100mg/5ml susp TID Prep: 250mg, 500mg/tab
4-7yo : 10ml ped 100mg/5ml susp TID
2-3yo : 5ml ped 100mg/5ml susp TID 10mkdose IV q8H max 1200mkday
1-2yo : 1.5ml drops TID Prep:100mg/50ml, 200mg/100ml,
Drops: 40mg/ml (Solmux) 400mg/200ml IV infusions
Ped Susp: 100mg/5ml, 200mg/5ml Clarithromycin 15mkday BID or 7.5mkdose BID
Forte Susp: 500mg/5ml 125mg/5ml; 250mg/5ml
Cap: 500mg Clindamycin PO: 10-20mkday mild q6-8h
Captopril Premature:0.01m/kdose q8-12H IV: 20-40mkday severe q6-8h
Neonate:0.05-0.10mkdose q12-24H Prep: 75mg/5ml syr; 150-300m/cap; 150/ml IV
Children:0.3–0.5mkdose Clonazepam 0.01– 0.03m/k/24h in 2-3 divided doses
Max:6m/k/24H Prep: 2mg/tab
Cefaclor 20 - 40 mkday TID (MAX 1gm/day)
(2nd gen) Durration:7,10,14days Cloxacillin 25-50 mkday q6h
Prep: 125mg/5mL, 250mg/5mL Prep: 125-250mg/5ml syr; 250-500mg/cap
Drops: 50mg/mL
Tabs:500mg CoTrimoxazole 4mkdose BID PO based on trimethoprim
Cefixime Pneumonia:10-12 mkday BID x7days (Trimethoprim + IV: 8-10mkday q8-12H (Max 960mg/day)
(2nd gen) Typhoid: 15-20mkday BID x10-14days Sulfamethoxazole) Prep: 200mgSMZ/40mgTM/5ml syr;
Prep: 20mg/mL drops; 100mg/5mL susp; 400/80/5ml adult syr
100-200mg/cap
Cefalexin 30 - 50 mkday TID to QID (q6H) Co-Amoxiclav PO:40mkday BID to TID (based on Amox)
(1st gen) Prep: 125mg/5ml; 250mg/5mL, 250-500mg/cap 156.25mg (125mg Amox;31.25)/5ml
Cefazolin 100mkday q6h IVTT 228.5mg (200mg Amox; 28.5)/5ml
(1st gen) 500mg vial, 1g vial 312.5mg (250mg Amox;62.5)/5ml
Cefepime 30mkdose q12 ( < 14days old)) 457mg (400mg Amox;57)/5ml
(4th gen) 50mkdose q8 (meningitic, severe sepsis) 625mg tab BID to TID
100-150mkday q8h MAX: 6 grams OD
Cefoxitin 20-40mkdose IV q6-8H, up to 200mkday, IV:30-50mkdose q8H
(2nd gen) max 12g/day for severe infections
Desloratadine >12yo 10ml OD
Cefoperazone 100-150 mkday q8/12h (Aerius) 6-11y: 5ml OD Prep: 2.5mg/5ml
MAX: 12grams OD 1-5 y: 2.5ml OD 5mg/tab
Prep: 1.5g/vial(1gr); 2g/vial(1gr) 6-11mos: 2ml OD
Cefuroxime 75- 100 mkday(IV)q8 MAX 750mg IV q8
Dexamethasone 0.5-1 mkday (LD) FeSO4
0.2-0.4 mkday (MD) 4 - 6 mkday (Therapeutic) Incremin: 30mg/5ml
Dicycloverine 1 mkdose q6h PO Prep: 10/5ml syr 1-3 mkday (Prophylactic) Ferlin drops: 25mcg/ml
(relestal/bentyl) 6-12y: 5ml 5mg/ml drops Preterm: 2-4mkday Ferlin syrup: 150mg/5ml
2-5y: 2.5-5ml Iberet: 26.25mg/5ml, 105mg/tab
6mos-2 yrs: 0.5-1ml
Digoxin Neonate: 10-30mcg (LD) Supplemental Therapeutic
Prep: 0.25mg/tab 5-10mcg (MD) (Prophylactic Dose
0.05mg/ml syr 1mos-2yr: 30mcg (LD) Age Dose)
0.25/2ml amp 10-15mcg (MD) Group
Child >10yo: 10mcg (LD)
2-5 mcg/k/day (MD) Orally, once Orally, 3 times
Diphenhydramine IM, IV, PO:5 mkday q6H as needed daily a day
(max: 300 mg/24 hr).(Nelson Ref)
1mkdose IV q6H
Syr: 12.5mg/5ml  Oral Drops
Cap:25mg, 50mg    4-<6 months 0.5 mL 0.5 mL
Ampule: 50mg/ml    6-12 months 0.75-1 mL 0.75-1 mL
Doxycycline 2 - 4 mkd    1-2 years 1 mL 1 mL
100mg/cap
Dimetapp 0.1 mg /k/dose(drops)
(bromphenamine + 1 - 6 mos -0.5ml TID  Syrup
pseudoephedrine) 2 - 24 mos 1ml TID    2-6 years 2.5 mL (½ tsp) 2.5 mL (½ tsp)
syrup: 2 - 4yo 3/4 tsp TID prep: 2m/5/5ml    7-12 years 2.5 mL (½ tsp) 5 mL (1 tsp)
4 - 12 yo 5ml TID
Diazepam 0.2- 0.5 mkdose Gentamycin 5 - 8 mkday q8h
Rectal: 0.5 (2-5y) 0.3(>6y)
Prep: 2mg, 5mg,10mg/tab, 10mg/2ml amp Guaifenesin 100mg/5ml syr
(Benadryl 2-6yo 5ml TID
Domperidone 0.3mkdose q8H Expectorant) 6-12yo 10ml TID
(Motilium) 1mh/ml susp; 10mg tab Not for <2yo
Dyspepsia: 2.5ml/10kg body wt TID (Motilium) Hemostan 10mg/kg/dose
Nausea/vomiting: 5ml/10kg body wt TID-QID Prep: 250-500mg/cap
Epinephrine 0.01-0.03mkdose (1:10,000) (0.1-0.3ml/k) Hydrocortisone 4-6 mkdose q6H IV
Q3-5min 10mkdose as loading dose, then 5mkdose q6
Erceflora (B. Clausii) Prep: 100mg/2ml amp; 250mg/2ml amp;
(Bacillus clausii) >1mo= 1-2 vials/day (BID) 500mg/4ml amp
2-11yo 1-2 vials/day
Ercefuryl <6mos: 1 tsp BID Note: High dose steroid given beyond 48-72H
(nifuroxazide) >6mos: 1 tsp TID may cause hypernatremia
Adult: 1 cap QID Hydralazine 0.15mkdose(IV) (0.1 to 0.2mkdose q4-6h)
Prep: 200/cap; 220/5ml susp (antihypertensive) 0.75mkd(PO)
Erdostein 1mkday(BID) max: 0.5mkdose, 3.5mkday
2-6y:(10-20) 2.5ml Prep: 20mg/ml ampule
7-12y(21-30) 5ml Given w/ food
>12y (>30) Racecadotril 1.5mkdose(TID) Prep:10mg/sch
(Hidrasec) 1 mo-9 mos: 1 sachet/dose 30mg/scht
Erythromycin 30 - 50 mkday q6-8h 9 mos-30 mos: 2 sachets/dose 100mg/cap
Prep: 200/5ml 30 mos-9 yrs: 1 sachet/dose
400mg/5ml susp >9yrs: 2 sachets/dose
Drops: 100mg/2.5ml Hydroxyzine diHCl PO=
Tab: 250mg, 500mg (Iterax) 12mos-6yo : 1-2.5mkday TID ( for pruritus)
>6yo : 1-2 mkday TID
Esomeprazole <10y : 10mg PO BID Prep:10mg/sachet Pre-op: 1mkdose 1 hour prior to surgery
(nexium) 10-12y: 20mg PO BID 20-40mg/tab IM=0.5-1mkdose q4-6H
12-17y: 20-40mg OD PO/IM (Nelson’s): 0.6 mg/kg/dose q 6 hr.
GERD 20 mg once daily for 4 wk-8 wks Syr: 2mg/ml syr
Dissolve 1 sachet in 15ml NC water Tab: 10mg, 25mg

Ethambutol 15 mkday IVIg Prep: 2.5g/50cc vial

10g/200cc vial
Famotidine PO= 1-1.2mkday q8-12: 20-40mg/tab RD: 2g/kg/dose, infuse x12hrs
IV = 0.5mkday q8h: 25mg/2ml amp Test dose: 0.01-0.02 cc/kg/min
<3mos: IV= 0.25-0.5mkday OD infuse for 30 mins

Fluconazole 4-6mkday OD Ibuprofen 5-10mkdose q6-8hr

(Diflucan) Prep: 50mg, 150mg, 200mgcap ; 2mg/ml x JRA: 30-50mkday q6h
100ml vial Closure of PDA: <32wks=0.5-1.5kg
10mkdose x15mkdose (24 & 48hr) in 15min
Furosemide IV= 0.5-1.0 mkdose q8h (max:40mkday) Prep: 100mg/5ml susp
PO=1-2mkdose q8h 200mg/5ml susp
Prep: 20-40mg/tab, 20mg/2ml amp Cap: 200mg (capsule or softgel)
Inosiplex 250mg/5ml
(Immunosin) <6mos 1ml 2-6yo 3ml
6-12mos 1.5m 6-12yo 5ml q3-4H
Methisoprinol 250mg/5ml, 500mg tab
(Isoprinosine) <1yo (<9kg) ¼ tsp
1-3yo (9-14kg) ½ tsp
3-7yo (14-21kg) ¾ tsp
>7yo (>21kg) 1 tsp TID
Ketoconazole 200mg tab
Fungal infections 50 to 100mg OD
eg tinea corporis,
tinea pedis 2% Cream (eg Nizoral by Zuellig) 5g, 10g tube
(athlete’s foot) tinea Apply to affected area OD x 2-6weeks PO: >6mos: 0.25-0.5mkdose max:20mg
cruris 6mo-5yr: 1mkdose
L- Carnitine 50-100 mkday q8-12h Max:300 Nelson’s:
Prep: 330mg/tab; 1gram/10ml Neonates: IV: Continuous infusion 0.15–0.5
μg/kg/min for sedation; IV bolus 0.05–0.15
Lactulose Inf: 5ml/day mg/kg q 2–4 hr.
1-6y: 5-10ml/day
7-14y: 10ml/day Infants and children:
Prep: 3.3 g/5ml Status epilepticus: IV:loading dose of 0.15
Lanoxin 0.003 mkdose BID mg/kg followed by continuous infusion of
Prep: 0.25mg/tab; 0.05mg/ml elixir; 0.25mg/2ml 1 μg/kg/min.
amp
Sedation: IV:loading dose of 0.05–0.2 mg/kg,
Lanzoprazole 15mg/FDT tab OD then either same dose q 1–2 hr or continuous
(Prevacid) <10kg: 7.5 mg PO OD infusion of 1–2 μg/kg/min.
NOT for <1yo 11-30k: 15mg PO QD-BID
>30kg: 30 mg PO QD-BID Motilium/ vometa 0.15-0.4mkdose q6h
Prep: 15-30mg/FDT; 15-30mg/cap (Domperidone) 2.5ml/10kg TID
15mg tab + 5ml water in syringe PO not to exceed 1mkday
Levocetiriine 6-12mos: 1.25mg (5drops) OD prep: 1mg/ml syr; 10mg/tab
(xyzal) 1-6 yrs: 2.5mg/day (10drops) BID
6-12yrs: 5mg (20 drops) OD or 1 tab N- Acetylcysteine 100mg bid-qid
Prep: 5mg/ml drops; 5mg/tab (Para antidote) Neb: inf: 1-2ml of 20% soln + equal H20/NSS
Caution in 2-4ml of 10% TID-QID
Levothyroxine <6mos =25-50mcg (8-10mcd/k/dose) QD asthmatic; Child: 3-5ml of 20%; 6-10ml of 10% soln
6-12mos = 50-75mcg (6-8) Not for <2yo Adolescent: 5-10ml of 10% or 20%
1-5 y= 75-100mcg (5-6) Prep: 100mg/5ml syr, 100mg/ml inh;
6-12y = 100-150mcg (4-5) Prep:100mcg/tab 100-200mg/sachet; 600mg/eff tab in 75cc h20
>12y = 150-200mcg (2-3) 50mcg/tab
Loratadine 1-2y = 2.5ml Sample: Fluimucil 200mg sachet in 4
2-12y(<30kg) = 5ml OD HS tablespoons water BID
2-12y(>30k) = 10ml Mometasone AR: 2-11y: 50mcg(1 spray) QD
Prep: 5mg/5ml syr (nasonex) >12y: 100mcg(2 sprays) QD

Maalox 2-4tsp/ tabs QID Montelukast 6mo-2y= 4mg/sachet OD in milk w/in 15 min
(AlOH,MgOH) 1hr after meals and HS 2-5 = 4mg/tab OD
2-4 chewable tabs 6-14= 5mg/tab
>15 = 10mg/tab
Mannitol 2.5-5cc/K/dose Nalbuphine 0.1 - 0.2 mkdose
Max: 100mg q6h Prep: 10mg/ml amp

Mebendazole 500 SD = 50mg/ml (10ml single dose) Nystatin 1ml QID as oral solution 400,000 U/day
100mg or 5ml BID x 3days 1.2 M units/day
5ml BID x3 days 20mg/ml (30ml);
Prep: 100-500mg/tab Nicardipine 5mg/hr by 2.5mg/hr max: 15mg/hr
Q5-15min
Meclizine 12.5 - 50 mkd
Prep: 12.5 – 25mg/tab Nifedipine 0.25 mkdose
Prep: 5,10,20,30,60mg/tab
Meropenem 20mkdose q8 OR 60-120mkday q8h
40mkdose q8 meningitic Nitrofurantoin 5-7mkday q6h
Cr cl <10 = ½ dose q24h UTI: 1-2mkdose qHS
10-25 = ½ dose q12h
26-50 = q12h Ondansetron 5mg/m2 BSA as single IV dose over 15mins
prior to chemotherapy
Meperidine 0.5 mkdose 2mg/ml ampule
4mg PO 12hours after chemotherapy
Metoclopromide IV:0.1–0.2 mkdose q 6–8 hr PRN (Nelson’s)
4mg, 8mg FC tab
0.1-0.2mkdose QID –dysmotility/ GERD
4-11y: 4mg TID
Prep: 10mg/tab; 5mg/5ml syr; 10mg/2ml IV
11-18y: 8mg TID
Metoprolol 1-2mkday BID
Omeprazole 1mkday OD-BID (0.5-1.5)
Max: 6mkday
<20kg: 10mg PO OD
Prep: 25-50-100mg/tab
>20kg: 20mg PO OD
Metronidazole 30-50 mkday PO(TID)
Oxacillin 150-200mkday IV q6h
125mg/5ml syr, 500mg tab
Prep: 250-500mg/vial
7.5mg/kg by slow IV infusion (30-60min) q6-8H
10mkdose IV q8H slow IV infusion
7.5 mkdose IV q6H slow IV infusion Paracetamol 10-15mkdose q4H for fever, q4-6H for pain
Drops: 100mg/ml
500/100ml IV infusion.
Syr: 120mg/5ml
250mg/5ml
Diloxanide 20mkday TID
Tablet: 250mg, 325mg, 500mg
Prep: 500mg/tab; 125mg/5ml susp
Ampule IV:150mg/ml, 300mg/ml
Max for IV: 300mg/dose (adult dose)
Mefenamic Acid 6.5 mkdose q6-8H (MAX 25mkday)
Prefer Ibuprofen if with G6PD
Prep: 50mg/5ml, 125mg/5ml
Phenobarbital MD: 5 mkday
Cap: 250mg, 500mg
LD: 15-20 mkdose +5mkday Max: 30
15mg/tab (gr ¼) 30mg/tab (gr1/2)
Midazolam IV: 6mo-5y: 0.05-0.1mkdose max: 0.6mkd
60 mg/tab(gr 1) 90 mg/tab (gr1 ½)
6-12yr: 0.025-0.05mkdose max: 10mg
>12: 0.5-2 mkdose
Piperazine 75mkday x3days
Ave:0.2mkdose (eg before lumbar puncture)
Piperacillin- <6mos: 150-200MKday (piperacillin) q6-q8h 20kg ¼ to ½ tab TID
Tazobactam >6mos: 300-400mkday q6-8h 20 to 30kg ½ to 1 tab TID
100-300mkday q4-6hrs max: 24g OD If >30kg 1 to 2 tabs TID
>40= 4.5g q8h
<40= 112.5mkdose q8h Nebule 5mg/2ml
<20kg ½ nebule q6-8H
Prednisone 1 - 2 mkday (preferably BID) >20kg 1 nebule q6-8H
Prep: 5,10,20mg/tab; Tetracycline 25-50mkday q6h
10mg/5ml; 15mg/5ml sus
Timentin 80mg/k Q6-8H
Phenytoin LD: 15–20m/k/day MAX: 1500mg/24hr 80mkdose q12H (termNB)
MD: 5m/k/day q12-24H Tobramycin <7days 5 mkdq12
Prep: 30-100mg/cap; 30mg/5ml; 125mg/5ml <5y 7.5 mkdq8
5 -10y 6 mkd q8
Pen G 50,000 U q6-8h (<28 DOL) Tranexamic Acid IV:10 mg/kg immediately before surgery, then
100,000-400,000 U/kday q6h (>28 DOL) 25 mg/kg/dose PO tid–qid for 2–8 days
Prep: 250mg, 500mg cap
Procaterol <5y= 0.25ml/kg BID/ TID IV: 250mg/2.5ml amp; 500mg/5ml amp
(Meptin) >6y= 5ml OD HS/BID Valproic Acid 15 mkday
Prep: 100mcg/ml inh; 5mcg/ml syr; Vancomycin 10 - 12 mkdose q8h (severe:15mkdose q8)
25-50mcg/tab 40-60mkday q6h
Zafirlukast 40mg/day PO q12H (20mg/tab)
Pyrantel pamoate 11mkday (Accolate)
125mg/5ml Zertin/Erdostein 7.5 mkdose q12
Racecadotril 1.5mg/kg/dose TID (min age: 1month)
(Hidrasec) 10mg, 30mg sachet for oral liquid Zinc sulfate syrup Drops: 27.5mg/15ml
Syr: 55mg/5ml
Weight Hidrasec # sachet Diarrhea: <6mos 2.5ml syr or 1ml drops OD
8kg 10mg 1 >6mos 5ml syr or 2ml drops OD
10kg 10mg 1 As supplement:
15kg 10mg 2 1-3yrs 1.25ml syr or 0.5ml drops OD
20kg 30mg 1 4-8yo 2.5ml syr OD
25kg 30mg 1 9-13yo 5ml syr OD
>27kg 30mg 2 Zinc + Ascorbic 6mos-2yo 0.6ml drops OD
Acid (Pedzinc 3-12yo 2.5ml syr OD
Ex: 1 sachet in 100cc water and take TID until Plus C) >12yo 5ml syr OD
with two normal/formed stools or maximum of 7
days.
*The granules should be added to food or
mixed with water in a glass or baby bottle.

Adult: 100mg/cap 1 cap TID

Ranitidine 1mkdose IV q8-12H (MAX 50mg/dose)
Ampule: 25mg/ml; 50mg/5ml amp
2mkdose PO
Nelson’s: 1-5mkday
Tab: 75mg, 150mg, 300mg
Salbutamol 0.15mkdose TID
2mg/5ml syr
Approximate dosages:
2-6yo 2.5-5ml TID
7-12yo 5ml TID
>12yo 5-10ml TID
Nelson’s PO:
<6yo 0.1 – 0.2mkdose TID
6-12yo 2mkdose TID
>12yo 2-4mkdose TID
Salbutamol + 50mg/1mg/5ml
Guaifenesin 2-6yo 5ml TID
(Asfrenon) 7-12yo 10ml TID
>12yo 10-20ml TID
Salbutamol + 5-10ml syr TID
Guaifenesin + 1 tab TID
Bromhexine
(PECOF)
Salbutamol + 7-12 yo 2.5 – 5ml TID
Carbocisteine >12yo 1-2capsules TID
(Solmux Susp: 2mg/500mg/5ml
Broncho) Cap: 2mg/500mg
Simethicone <2y= 0.5ml TID-QID
(Restime) >2y= 1ml TID
Prep: 40mg/ml

Sucralfate 40-80mkday q6h

Prep: 1g/tab

Theophylline 20 mkd

Terbutaline 1.5mg/5ml syr

(Bricanyl) 0.075 mkdose TID

2.5mg tab
0.075 mkdose TID
 AGE Drugs
Infloran Berna dissolve contents of 1 cap in 15 ml
Antikoch’s Treatment of diluted formula TID
Furazolidone (Furoxone) Prep: 50mg/ml, 16.7,g/5 ml
Kidz Kit3 INH 200mg/5ml (5mkdose OD) RD= 4-7 mkday
RIF 200mg/5ml (10mkdose OD)
Ercefuryl (40-60/ 60-100)
PZA 500mg/5ml (15mkdose OD) for 2 mos
OD(60-100mkd)
Kidz Kit3 Forte INH 200mg/5ml Prep.: 220 mg/5 ml
RIF 200mg/5ml
Etofamide (kitnos) Prep. 100 mg/5ml
PZA 500mg/5ml
RD= 20-40 mkday
Ethambutol
Metronidazole Prep 125mg/5ml
Myrin P RD= 30-50mkday
Streptomycin Diloxanide Furamide Prep 125mg/5ml
RD= 20 mkday
Vitamins and Supplements Summary Secnedazole Prep:
RD= 30 mkday
Ascorbic Acid (Vit C) 100mg/ml drops
<3mos 0.3ml OD
3-12mos 0.6ml OD ANTISPASMODICS
1-2yo 1.2ml OD Dicycloverine - 0.15mkday
Bentyl 10 mg/tab, 20mg/ml
100mg/5ml syrup Relestal 10mg/5ml, 5 mg/ml
2-6yo 5ml (1 tsp) OD Hyoscine Butyl Bromide 10mg/tab, 5 mg/ml
7-12yo 5-10ml OD (Buscopan)
Diphenhydramine (BENDARYL) Syrup: 12.5 mg/5ml
100mg chewable tablet (eg Ceelin) Cap - 25 mg
2-6yo 1 tab OD Inj - 50 mg/ml
7-12yo 1 tab OD 3-5 mkday po
Ascorbic acid + Zinc 40mg Vit C/5mg Zinc/ml drops 1 mkdose IV
(Ceelin Plus) 6-11mos 0.5 to 1ml OD ANTIFUNGAL
1-2yo 1ml OD Mycostatin Tab: 1-2 tabs TID
Susp: infant 2ml QID
100mg Vit C/10mg Zinc/5ml syrup Children- 4-6 ml QID
1-3yo 2.5ml (1/2 tsp) OD Oral Susp : 2 ml QID
4-8yo 5ml OD to be swabbed on lips and
9-13yo 5-10ml OD buccal mucosa
Appebon 500 Syrup 2-6yo 5-10ml OD Difflucan (Fluconazole) 4-6 mkday
Buclizine + Vit B1 B6 7-14yo 10-20ml OD 50 mg/tab 1 tab divided into
B12 Iron L-lysine 4pptabs 1pptab OD with milk
Appebon 500 Tablet FOR ADULTS PO/IV=3-6mkday OD/q12H
Buclizine + Vit B1 B6 2tabs OB or 1 tab BID Bronchodilators
B12 Vit C Aminophylline RD= 3-5 mkdose
Appebon with Iron 5ml OD dilute with equal amt of IVF
Syrup refer for vomiting,
Vit B1 B6 B12 hypotension, H/A, Sz,
Iron(10mg elemental) tachycardia
L-lysine Theophylline syrup 80mg/15ml
Appebon Kid Syrup 2-12yo 5ml OD (Nuellin) Tab= 50 mg, 125 mg
Vit B1 B6 B12 Iron L- RD= 4 mkdose
lysine Budesonide
Adrenal corticosteroid
Nutrilin MTV Drops Anti-inflammatory
0-6mos 0.5ml OD
7mos – 2yo 1ml OD
Syrup
2-6yo 5ml OD
7-12yo 5-10ml OD
Propan with Iron 1 capsule OD to BID Emergency Drugs
(Buclizine, B NaHCO3 1-2 meq/kg/dose
vitamins,Iron) Atropine 0.04 mk SQ
Propan Syrup 2-6yo 5ml OD 0.02 mkdose IV
(Buclizine, B vitamins, 7-12yo 10-15ml OD Epinephrine 0.01 mkdose (1:1000)
++) 0.1 mkdose (1:10000)
Propan TLC Drops max. 3 ml q5-10 mins
Multivitamins <6mos 0.3ml OD
6mos-2yo 0.6ml OD DRIP:
Syrup 0.6 x wt(kg) x ug/k/min = __mg in 100mL of
1-3yo 2.5 to 5ml OD mL/Hr D5W/NS
4-12yo 5ml OD
Zinc sulfate syrup Drops: 27.5mg/15ml Nelson: 0.5-1mkday = 1mL/Hr will deliver 0.1 ug/k/min
Syr: 55mg/5ml Naloxone 0.1 mkdose
Diarrhea: <6mos 2.5ml syr or 1ml drops OD Mannitol 0.5-2 gkdose
>6mos 5ml syr or 2ml drops OD 1g= 5cc
As supplement: Albumin 0.5-1 g/K
1-3yrs 1.25ml syr or 0.5ml drops OD Prep: 25g/100cc
4-8yo 2.5ml syr 12.5/50cc
9-13yo 5ml syr Dilute in 50cc D5W x20-25 ugtts/min
Zinc + Ascorbic Acid 6mos-2yo 0.6ml drops OD Dobutamine Prep: 250mg/20cc
(Pedzinc Plus C) 3-12yo 2.5ml syr OD 12.5 mg/cc
>12yo 5ml syr OD cc/Hr = wt x ugm x 60
500
= 2 CC+ 48 cc D5W

DRIP:
 2.5 – 15 ug/kg/min (max: 40ug/kg/min) 500ug/mL
Peak effect: 10-20 min =0.02
Preparation: Terbutaline 0.1-0.4 0.6mg/kg 1mL/Hr=0.1ug/kg/min
12.5mg/mL x 20mL/_ = 250mg/mL
Premix:
1000ug/mL x 250mL = 250mg/250mL
PH<7.352000ug/mL
PH7.35-
in 250mLPH7.40-
= 500ug/250mL
PH>7.45
7.45 7.45
PCO2 <35 Part = 6 x wt(kg)
comp = __mg
Comp met in 100mL
Comp Resp alk
* 250mg inacid
met acid D5W 250cc (1mg/mL)
resp alk
Ugtts/min = wt(kg) x DD
16.6 Ph PCO2 HCO3 BE
PCO2 Met acid Normal Normal Met alka
= wt(kg) x DD x 0.06
35-45 Met Acid
* 500mg in D5W 250cc (2mg/mL)
PCO2 >45 Resp acidUgtts/min
Comp = wt(kg) xComp
DD met Part comp Uncompensatd  N   (-)
resp acid 33.2 alka met alka
Partly comp     (-)
= wt(kg) x DD x 0.03 Complt comp N    (-)
Dopamine Prep: 40, 80, 160 mg/ml
Met Alka
Cc/hr = wt x ugm x60
(200/250) 400 or 800 (400/250) Uncompnsatd  N   (+)
(1:100) (1:50) Partly Comp    (+)
DRIP: Complt Comp N    (+)
Premix: 200mg/250mL; 400mg/250mL
Prep: 40mg/mL x 5mL/amp = 200mg/mL Resp Acid
Uncompnstd   N N
= 6 x wt(kg) = __mg in 100mL Partly Comp    
(1mL/Hr = 1 ug/kg/min) Complt Comp N   
*200mg in D5W 250cc Resp Alka
Ugtts/mins = wt(kg) x desired dose(DD)
13.3 Uncomp   N N
= wt(kg) x DD x 0.075 Partly comp    
*400mg in D5W 250cc Complt Comp N   
Ugtts/mins = wt(kg) x DD
26.6
= wt(kg) x DD x 0.0375 Caloric Equivalent:
Dopamine/Dobutamine D50 2
Wt x desired x 60 x24 D10 0.4
Concentration D5 0.2
Ca 100-300 mkday (oral) D7.5 0.3
Gluconate 1cc/kg (LD-IV) D12.5 0.6
1 cc/kg/day (MD-IV) Amino acid 0.2
Epinephrine (mg)/100cc x X/1cc x 100 Intralipid 1.1
Drip
Vamin 0.67
cc/Hr= wt. X 0.3 -1 x 60
40 Corn oil 8.4
Prep: 1 amp in 25cc D5W Karo, Aminosteril 4
Acetazola- 250mg/tab MCT 7.6
mide 30 mkday q8H Olive Oil 9
NaHCO3 325mg/tab Breastmilk 20 /oz
8-10 mkday q8H PreNan 24
Furosemide Drip: NAN 22
Prep: 10 mg/mL ampule Enfalac 24
Dose: Pediasure 225kcal/225mL
Infant/Child: 0.05m/k/hr (titrate to clinical effect)
Adult: 0.1 m/k/hr (max: 0.4 m/k/hr Na
NB - 134- 146
Wt(kg) x DD x 24h = __mg in 24 mL of NS to make 1 Infant - 139- 146
cc/hr = 0.1 mg/kg/hr Child - 138 - 145
OR Thereafter - 136 - 146
Wt(kg) x DD x 24 x 5 = __mg in 120mL of NS to make 5
mL/hr = 0.1mg/kg/hr K
IV infusions = 6 x Desired dose(ug/k/min) x wt(kg) = mg drug <2mos 3.0 - 7.0
Desired rate(mL/Hr) 100mL fld 2- 12 m 3.5 - 6.0
>12m 3.5 - 5.0

Ca
Medication Usual Dilution in IV Infusion Rate Cordblood - 2.25 - 2.88
Dose 100mL D5W NB - 2.3 - 2.65
Dopamine 2-20 6mg/kg 1 mL/Hr=1ug/kg/min 24-48H - 1.75 - 3.0
Dobutamine 2.5-15 6mg/kg 1mL/Hr=1ug/kg/min 4-7d - 2.25 - 2.73
Epinephrine 0.1-1 0.6mg/kg 1mL/Hr=0.1ug/kg/min Child - 2.2 - 2.7
Lidocaine 20-50 0.6mg/kg 1mL/Hr=1ug/kg/min Thereaftr - 2.1 - 2.55
Prostaglandin 0.05- 0.3mg/kg 1mL/Hr=0.05ug/kg/min
E 0.1 For Patency of PDA:
-IV: begin infusion at 0.05-
0.1ug/kg/min, when Crea Mg/dl (x88.4) umol/L
desired effect is achieved, Cordbld 0.6 -1.2 === 53 -106
dec to 0.05-0.025- NB 0.3 -1.0 === 27-88
0.01ug/kg/min Infant 0.2 - 0.4 === 18 -35
-if unresponsive, inc to Child 0.3 - 0.7 === 27 -62
0.4ug/kg/min Adolescent 0.5-1.0 === 44 -88
-Ampule: 500ug/mL Adult M: 0.6-1.2 == 53-106
Eg. 2.6kg F: 0.5 - 1.1== 44-97
2.6kg x 0.05ug/kg/min x60
 IVF Na Cl K Ca Lactateac GIR:
Composition etate Rate(cc) x
0.9NSS 154 154 dextrosity
0.3NaCl 51 51 x0.167
LR 130 109 4 1.5 28lact
NR 140 98 5 1.5 27acet Wt
23gluc
NM 40 40 13 1.5 16lact OR
Imb 25 22 20 1.5 23acet
Dextrosity x
IVF rate x10
BUN Mg/dL (x0.357) mmol/L Wt(kg) x 60
Cordbld 21-40 ***** 7.5 - 14.3
Prem 3 - 25 ***** 1.1 - 9
NB 3 -12 ***** 1.1 - 4.3
Inf/Child 5 -18 ***** 1.8 - 6.4
Thereafter 7-18 ***** 2.5 - 6.4 Normal Values:
NB/Infants: 6-8 mg/kg/min
Children: 4-6 mg/kg/min
If hypoglycemic, may increase GIR to 15 mg/kg/min
PPN
Vamin : 100 x wt x dose Blood glucose monitoring:
Preparation(%) - Monitor
Daily Fluid Requirement
Ca Gluc: 2cc/kg/day CBG q6-8h
Weight (kg) D0-2 D3-4 D14-30 - if
BNC: 0.5-1cc/day 750g – 1kg 110 140 150
IVF: accdg to TFI 1 - 1.25 100 130 140
1.25 – 1.5 90 120 130
Cholesterol
Total mg/dl = mmol/L >1.5 80 110 130
1-3yr : 45-182 = 1.15 - 4.70 Add 25% if with PHOTOTHERAPY
4-6yr 109-189 = 2.80 - 4.80 CBG≤40mg/dL, give d10W 2cc/k/dose as slow IV push, get
6-9yr 5-75-95 5 -75- 95 CBG q15 mins, then q1Hr until stable
M 126-172-191 = 3.26- 4.45-4.94 - if feeding, no need to monitor
F 122- 173- 204= 3.16- 4.47-5.41 - if CBG is persistently LOW, check IV line
10-14yr - may need to increase dextrosity
M 130-179-204 = 3.36-4.63-5.28
F 124-174-217 = 3.21-4.50- 5.61
15-19yr
M 114-167-198 = 2.95-4.32-5.12
F 125-175-212 = 3.23-4.53-5.45

Albumin
Prem 1 day - 1.8 -3.0 g/dl -- 18-30g/L
Fullterm <6days 2.5 - 3.4g/dl -- 25-34g/L
<5 yr 3.9 - 5.0g/dl -- 39 - 50g/L
5-19yr 4.0 - 5.3g/dl --- 40 - 53g/L
Peak Flow:
Protein Ht in cm - 100 x5 +175(M)
Prem 4.3 -- 7.6g/dl --- 43-76g/L 170(F)
Newborn: 4.6 -- 7.4 g/dl --- 46 - 74g/L
1--7 yr 6.1 -- 7.9 g/dl -- 46-74g/L Albumin: wt (g/Kg) x quantity of Stock(50cc or 100cc)
8-12yr 6.4 -- 8.1 g/dl -- 64 - 81g/L %
13 -19yr 6.6 -- 8.2 -- 66 - 82 g/L
IVF: cc/h x 24h x Dextrosity x 3.4
Corrected Reticulocyte: observed retic x observed hct 100
Normal hct for age
Aminosteril: wt x g/k x 100
Dextrosity: %
D5 = 50 glucose D10 = 100 glucose D12.5 = 125 glucose Cal: cc/day x % X 4
Limits of Dextrosity: Peripheral Line: D12 100
Central Line: D20
Materials for Surfactant instillation:
Total Fluid Intake (TFI): Term: 60-80; Preterm: 80-100 - Gloves #3 - OGT F8
TFI: Rate (cc) x 24 hr - Syringe 10cc (2) - Ruler
Wt(kg) - Betadine - Cotton balls
Computation: - ET size (same brand as inserted) - Ambubag
Wt(kg) x TFI = ___ divide 3 (soluset: 100cc)
Post Surfactant
To adjust dextrosity 10: eg. TFI: 90 - Maintain on NPO
D5IMB 80 x 0.05 = 4 - CXR-APL
D50W 10 x 0.50 = 5 - VBG/ABG 1 hr after
90 9 - B1B2, BUN, Crea, with S. Na, K, Ca
Check: 9 / 90 x 100 = 10 = Dextrosity: 10 - Wean FiO2 by 5% every 1-2 hrs pulse ox guided for O2 Sat >95% until 40 -
Then, 90 x 3 (q8h cycle) = 11.25cc/hr 50%
24h - No suctioning at least 1 hour aftre instillation unless with bradycardia,
“chart”: 90cc x 11cc/hr q8h cyanosis, hypotension, or obstruction
- Watch out for pneumothorax
Then, compute for: - Standby butterfly G23, 10cc syringe, 3-way stopcock, betadine, cotton
applicator, gloves

PNUEMONIA IN CHILDREN
0-3 mos C. trachomatis, S. aureus, Gr neg
4-11 mos S. Penumonia, H. influenzae
12-59 mos S. Pneumonia, H. influenza d. decreased lung compliance
>60 mos M. Pneumonia, S. pneumonia 2. Abnormal ventilation perfusion ratio
a. obstruction of small airway
CPAP b. atelectasis
Requirement : adequate spon. Respiration c. pneumonia
Components : O2 pressure d. pulmonary edema
Indications: 3. Increased extrapulmonary shunt
0. HMD a. pulmonary vasoconstriction
1. Inhalation/chemical pneumonitis * RDS, severe infection
2. Severe pneumonia b. Pulmonary hypoplasia
3. Meconium aspiration c. Cyanotic heart disease
4. Pulmo edema with or without assoc. CHF
5. Fluid overload Respiratory Alkalosis
6. General atelectasis 1. with hypoxamia
7. Infants with apnea of prematurity a. acute pulmonary disease -
8. Infants with ARDS - pneumonia and atelectasis, RDS, acute asthma
9. PaO2 < 50-60 mmHg, breathing b. Acute myocardial disease
 60-70 with recurrent apnea - MI, pulmonary edema, heart failure, CP bypass
2. Without hypoxemia
a. anxiety, neurosis, psychosis
b. pain
c. CNS disease
d. Anemia
e. Carbon monoxide poisoning
WEANING NEPHROTIC SYNDROME
1. Improvement in CXR TREATMENT: 1st Episode
2. ABG with PO2 > 50 mmHg 4weeks: 60mg/m2/day divided doses (max 80md/day)
3. Blood pH > 7.3 4weeks: 40mg/ m2 / alt days single am dose (max 60mg)
4. PCO2 < 55 mmHg 8days: 20mg/ m2 / alt days single am dose (max 20mg)
5. Hg 12-15 gm/Hct 36-45 8 days: 10 mg/ m2 / alt days single am dose (max 10mg)

GUIDELINES MCNS: relapse treatment (Eddy)

1. DEC. FiO2 by 3-5% every time PO2 . 70 Until urine remission: 60mg/ m2 /day in divided doses
2. With FiO2 = 40%, dec. Pressure by increments of 2 cm H2O if 2-4H until 2- 8 days: 60mg/ m2 alt days single am dose
3 cm is reached 8 days: 40mg/ m2 alt days single am dose
3. Transfer patient to O2 hood with FiO2 of 15-50% 8 days: 30mg/ m2 alt days single am dose
8 days: 20mg/ m2 alt days single am dose
Extubation 8 days: 10mg/ m2 alt days single am dose
1. Dexa 0.5mkd IVTT Q12H x2 doses prior to extubation Remission - absence of proteinuria 5 consecutive days
2. Salbuamol 0.5cc + NSS 0.5cc Q8H Difficult patients:
3. Epinephrine 0.2mkd Q4H x 2 doses 1. Steroid resistent
4. Dexamethasone Q12H x 2doses after extubation 2. Steroid dependent - 2 relapses/ 14 days after
5. Chest physiothearpy discontinuation od decrease in dose
6. Keep on right side position 3. Steroid toxic
7. NPO x 2h 4. Steroid Dependent/ Frequent relapsers - 2 relapses in 6 mos.
 PAI with 4.7cc NSS + 0.3cc Epinephrine QH x3 doses then maintain on PAI
with 2cc NSS Q6H. Dr. James Woo
BSA: wt X 4 +9 TFR: BSAx 500(<20k)/400 (>20k) + U.O
100
VENTILATOR PLANS
HMD PEEP = 4-6 cm H20 PFC PEEP= 2 cm H20 Dr Alcala/Caso BSA- Wt in Kg x Ht in CM
PIP = 18-30 cm H20 3600

Oxygenation Status Post Streptococcal Acute Glomerulonephritis

At room air, sea level: Diet: Low Salt diet
PaO2 80 -100 Normal or acceptable Labs: CBC,plt Na, K
<80 mild hypoxemia BUN, CreaC3
<60 moderate hypoxemia ASOT
<40 severe hypoxemia IVF: D5.03 NaCl (no KCl first)
On oxygen support: Furosemide (1-2mkdose, max:4mkdose);Hold:BP<80sys
PaO2 80 - 100 corrected hypoxemia Pen G/ Ampicillin-Sulbactam
>N overcorrected hypoxemia Limit Oral intake to TFR
<N uncorrected hypoxemia Watch out for HPN
Weigh Patient daily pre-breakfast/post-voiding
ROMS - resp opposite; metabolic same
Metabolic Acidosis: TFR: BSA x Insensible water loss + UO
1. RTA UO- if with Furosemide divide by 2
2. DKA; Starvation TUNE/MENDOZA PROTOCOL
3. Lactic acidosis WK Methylpred Dose PRED
1-2 30mg/kg 6 none
Metabolic Alkalosis:
2x/wk
1. Hypokalemia
3-10 30mg/kg 8 2mg/kg/48h
2. Hypochloremia
wkly
3. Vomiting
4. Massive steroid administration 11-18 30mg/kg 4 W/ or w/o
5. NaHCO3 administration q2wks tapering
19-50 30mg/kg 8 Slow
Respiratory Acidosis: q4wks tapering
1. Hypoventilation 51-82 30mg/kg 4 Slow
a. inadequate resp effort q8wks tapering
CNS problem
Neuromuscular disease Elises Protocol:
Mechanical ventilator setting 12 months - Monthly--- 3 consecutive days
b. upper airway not patent 6 months - 1 dose/ monthly --- cont prednisone 2 mg/kg
c. decreased lung tissue q other tapering
 * DVET and intensive photo
Alkylating Agents
 Cyclophosphamide - 2.5mg/kg/day X 8wks Photo for 1500g 1500-2000 >2000
- (Nelson) 3mg/kg/24h x 12wks Preterms
- (Total 140mg/kg)
- 500mg/m2 (BSA) 750mg 1g <24H >4 >4 >5
 Cyclosporine - 5mg/kg/day 24-48H >5 >7 >8
- immunosuppressive, altered perselectivity 49-72H >7 >9 >12
- steroid- sparing drug
≥72H >8 >10 >14
- high relapse rate when D/C

 Chlorambucin - 0.2mg/kg/day x 8-12 wks DVET for 1500g 1500- >2000g

- hematologic malignancy Preterms 2000g
<24H >10-15 >15 >16-18
 Nitrogen Mustard - 1958 24-48H >10-15 >15 >16-18
 LTVamisole - 2.5mg/kg/alternate days 49-72H >10-15 >16 >17-19
- maintain in remission in about 50% of losses of
>72H >15 >17 >18-20
steroid - dependent NS
 RENAL BIOPSY

Polin
LUPUS NEPHRITIS IN CHILDHOOD Wt (PT) Photo DVET
Classification <1.25 5-7 10-13
I - normal 1.25-1.49 7-10 13-16
II - pure Mesangiopathy (mesangial 19-27% 1.5-1.99 10-12 16-18
III - Segmental & Proliferaive GN (Focal Segmental 2.0-2.5 12-14 18-20
- 18 - 24%)
IV - Diffuse Proliferative Lupus Nephritis (39-44%) Sick Infant
V - Diffuse Membranous GN - (8-22%) Age Photo Exchange
VI - Advanced Sclerosing GN <24H 10-14 20
>24h 15 20
Seroassay-
1. ANA - unusual in children Healthy
- ANA titer does not correlate with disease severity Age Photo ET if Photo fails DVET
2. Antibodies to ds DNA & Smith (Sm) Antigen more specific level may 25-48 >15 >20 >25
present in 70% of 25% 49-72 >18 >25 >30
>72 >20 >25 >30
Anti ds DNA + Anti-Sm Ab + Serum C3 -
ECG
Renal Disease Activity
C3
AVR AVL
C3a, C5a C5b-a
(+)I
Leukocytes membrane attack
(+)150 (+30)
Hyperkalemia (+120) (+)60
Serum K >5.5meq III (+90) II
1. Sodium Bicarbonate - shifts K into cells AVF
- 1 meq/kg IV over 10 - 30 min
- onset 15-30 min QT -
2. Calcium Carbonate - (10%) - stabilizes membrane potential PR
- 0.5 -1ml/kg over 5-15 min QT
- onset immediate Rate
3. Glucose and Insulin - stimulates cellular uptake of K Axis
- glucose 0.5 mg/kg witn insulin 0.1mg/kg over 30
min AGE Preterm Newborn Infant 1 year
- onset: 30 - 120 min
Wt (kg) 1.5 3 5 10
4. B - Agonist (Albuterol/Salbutamol) - stimulates cellular
ETT size 2.5-3.0, 3.0-3.5, 3.5-4.0, 4.0-4.5,
uptake of K
uncuff uncuff uncuff uncuff
HYPOKALEMIA - 0.5-1 meq/kg/dose X 1h Suction 5 6 8 8
- continuous correction: 0.2-0.3 meq/kg/hr catheter
- fast correction K (symptomatic) Chest tube 8-10 10-12 10-12 16-20
0.5meq/kg/hr (child) x10 meq KCl in 166 ml fluid x 1-2hr[s NGT/Foley 5 5-8 5-8 8
max 40meq KCL/500cc PNSS x 1-2 hrs Laryngoscope 0 1 1 1-2
- ICU - 10meq/10cc (1:1) central line Mask NB NB NB- Infant
- Oral: 10% oral KCl soln has 1.34meq/ml infant

FT Consider Photo # * AGE 3 yr 6 yr 10 yr Adolescent

Photo Wt (kg) 15 20 30 50
≤24H ETT size 4.5-5.0, 5.0-5.5, 6.0-6.5, >6.5, cuffed
25-48H ≥12 ≥15 ≥20 ≥25 uncuff uncuff cuffed
Suction 8-10 10 10 10
catheter
49-72H ≥15 ≥18 ≥25 ≥30 Chest tube 16-20 20-28 28-32 32-40
NGT/Foley 8-10 10-12 12-14 14-18
>72H ≥17 ≥20 ≥25 ≥30 Laryngoscope 2 2 2-3 3
# DVET if photo fails Mask Child Child Adult Adult
 pH: N= 4.5-6.5
Acidic Alkalotic
Resp/ Metab acidosis Resp/ Metab acidosis
UTI by E. coli UTI w/ urea-splitting org
HypoKalemia Renal tubular acidosis
Starvation Vegetarian diet
High protein diet Prolonged urine storage
PROTEIN:
T race = <0.2 g/L protein 1+ = 0.3
2+ = 1 3+ = 3 4+ = >20

Technical Updates of the Guidelines on Integrated

Management of Childhood Illnesses (IMCI)
Acute Respiratory Oral amoxicillin should be used in
Infections 25mg/kg/dose twice daily for the
treatment of non-severe pneumonia
Oral amoxicillin should be given for three
days for non-severe pneumonia in
children 2-59 months of age
Where referral is difficult and injection is
not available, oral amoxicillin in
45mg/kg/dose twice daily should be
given to children with severe pneumonia
for 5 days
Injectable Ampicillin plus injectable
gentamicin is a better choice than
injectable chloramphenicol for very
severe pneumonia in children 2-59
months of age. A pre-referral dose of
7.5mg/kg intramuscular injection
gentamicin and 50 mg/kg injection
Ampicillin can be used
Children with wheeze and fast breathing
and/or lower chest indrawing should be
given a trial of rapid-acting inhaled
bronchodilator (up to 3 cycles) before
they are classified as pneumonia &
prescribed antibiotics. 0.5ml Salbutamol
diluted in 2 mL of sterile water per dose
nebulization should be used.
Diarrheal Disease Ciprofloxacin is the most appropriate drug
in place of nalidixic acid which leads to
rapid development of resistance

RTD: “Clinical Practice Guidelines in Pediatric Pulmonary Tuberculosis”

- Dr. A. Jiao
Latent TB
- infection with MTB, (+)Mantoux test, no clinical s/sx or CXR of TB
- implies devt of antibody of TB, exposure to TB
- carries high risk of progressing to TB disease
- carries high risk of progressing to TB disease

Bedside NEPHROLOGY
Urinalysis
- examined within 30 min
- can be preserved for up to 6 hours in 4⁰C
Interpretation of Urinalysis:
COLOR:
Yellow – Normal Dark red – Hemoglobin/Myoglobin
Tea-colored – Blood Black – Hemolysis
Greenish – Bile Milky – Fat/Chyle
Brown – Nitrofurantoin Red – Rifampicin
CLARITY:
Clear – Normal Cloudy – Infection, casts, protein