Normal Values HR RR BP
Normal Values HR RR BP
Normal Values HR RR BP
HR RR BP
Preterm 120-170 40-70 55-75/40-70
0-3 mos 100-150 35-55 65-85/45-55
3-6mos 90-120 30-45 70-90/50-65
6-1 y/o 80-120 25-40 80-100/55-65
1-3 y/o 70-110 20-30 90-105/55-70
3-6y/o 65-110 20-25 95-110/60-75
6-12y/o 60-95 14-22 100-120/60-75
12y/o 55-85 12-18 100-135/65-85
ANTHROPOMETRICS
HC (cm/mo) RDA(kcl/kg/
0-3 2 115
3-6 1 110
6-9 0.50 100
9-12 0.50 100
1-3yr. 0.25 100
4-6yr. 1cm/yr 90-100
HT cm inches
Birth 50 20
1yr 75 30
2-12yr age(yr)x6+77 age(yr)x2.5+32
WT KG LBS
Birth 3.25 7
3-12mos age(mo)+9 age(mo)+11
2 2
1-6yr age(yr)x2+8 age(yr)x5+17
7-12yr age(yr)x7-5/2 age(yr)x7+5
DRUG INDEX
Penicillin 50-100mkD q6
Pen G
Crystalline 100,000-200,000 ukD q12
50,000 ukD q12 (renal dose)
50,000-100,000 ukD q8/12 (<7days)
75,000-150,000 ukD q6-12
(>7days)
Amox-sul 50-100mkD q8 IV
(Ultramox) 30-50mkD q8-12 po
250/5, 500mgtab,
500/250mg vial, 1000/500 vial
Amoxicillin 30-50 mkD q8
(100mg/ml, 125/5, 250/5)
DiCloxacillin 12.5-25mkD
Cloxacillin 50-100 mkD q6 (125/5)
Oxacillin 25-50mkD q6-8-12
50-100 mkD q8-12 IV (neonates)
100-200 mkD q6-8 IV (children)
Imipenem
NB: 20-25mkdose q12 1hr infusion
<40kg: 15-25 mkdose q6 (max 2g/D)
>40kg: 50mkdose / 1-2g q6-8 (max 4g/D; adult)
(500mg/vial), Nomal creatinine
Cephalosporins
1st Gen
Cefalexin 30-50mkD q8 (max: 4g/D)
(100/ml, 125/5, 250/5)
2nd Gen
Cefuroxime 20-40mkD q12 p.o
50-100mkD q6-8 IV (max: 6g/D)
(125/5, 250/5, 750, 1.5g/vial)
3rd Gen
Cefotaxime 100-200 mkD q8-12
(200, 500, 1g/vial)
Ceftazidime 100-150mkD q8-12 IV
50mkdose q8-12
(250,500,1,2g)
4th Gen
Cefepime 50-100mkdose q12
500mg-1g q12 (>12y/o)
(500,1g,2g/vial)
Aminoglycosides
Amikacin 10-15mkD q12/OD
(50, 125, 250mg/ml amp)
Netilmicin 6-8mkD OD
(50mg/ml, 75mg/ml)
Tetracyclines
Tetracycline 12.5mkdose q8; >7yo
Doxycycline 4.4 mkd, 2.2 mkd
Macrolides
Erythromycin 30-50mkD q8-12 (max 1g)
(200/5ml, 400mg/5ml,
40mg/ml,100mg/2.5ml drops)
Quinolones
Ciprofloxacin 7.5-15mkdose
(2mg/ml infusion)
Chloramphenicols
Chloramphenicol 50-100mkD q6-8 p.o.
50-100mkD q6 IV,
25mkD q6 (Neonates)
(125/5, 1g/vial, 250, 500mg/cap)
Others
Co-trimoxazole 8-12mkD q 12
(80mg/5ml (400), 40mg/5ml (200)
Anti-viral
Acyclovir 10-20mkdose q6
200mg 5x daily (adult, >2y/o)
½ adult dose (children <2y/o)
(200mg/5ml)
Anti-fungal
Fluconazole 12mkD LD
6mkD OD (MD)
(50mg/tab, 150mg/tab (divide into paper tab), 2mg/ml/vial)
Griseofulvin 10mkD
(125mg, 500mg)
Anti-TB
Isoniazid 5-10mkD OD (100,150,200/5ml)
Analgesics/ Antipyretics
Aspirin 60-80mkD
RHD 100mkD (1st 2 weeks)
75mkD (4 weeks)
Anti-inflam 60-90mkD
Kawasaki 80-100mkD q6
afebrile 3-5/8mkD OD
Midazolam 0.05-2mkdose
Phenytoin 10-20mkd LD
(Dilantin) 5mkD q12 MD
(125/5, 250/5, 15,30,60,90mg)
Max dose: 1 gram
Steroids
Bethamethasone 0.0178- 0.25 mkD q6-8
(max 9mg/D)
Nephro Drugs
Nephrotic >40mg/kg/day, hypoalb <2.5mg/dl
Prednisone 60mg/kg/day x 4-6 weeks
then 40mg/kg/day (am) x 2-3mos
Alternate day dose
If steroid resistant: +2protein q 8 weeks
steroid dependent: relapse within 28 days
frequent relapse: relapse >12x per month
Bronchodilators/ Respiratory
Aminophylline 3-5mkD (0.6-0.9mk/hr)
LD 3-6mg/kg x 20-30mins
MD 2mkdose q8
MD 1-9y/o 0.8- 1-1.2hr
9-12y/o 0.7- 0.9hr
12-16y/o 0.5
q6-8 (5mg/ml)
Ex: 20kg wt x dose = 20x5 = 20cc SIVP as LD
Prep 5 8cc SIVP q8
Cough/Colds
Chlorpheniramine maleate 0.2-0.3mkD
Ambroxol (d.i. co amox, cefu, doxy,)
(c.i. 1st trim preg)
>10y/o 1tab TID
5-10y/o ½ tab TID
Syrup (15mg/5ml)
>10y/o 10ml TID
6-10y/o 5ml BID-TID
2-5y/o 2.5ml BID
Infant Drops (6mg/ml)
1-2y/o 1.25 ml BID
7-12 mo 1ml BID
<6mos 0.5ml BID
Cardio/Anti-Hypertensives/ Diuretics/Emergency
Aldactone 2-3,5mkD
Aspirin 65mkD
RHD 1st 2 weeks 100mkD
4 weeks 75mkD
Anti-inflam 60-90mkD
Kawasaki 100mkD q6
(-) Fever 3-8/10 mkD OD
Ca Carbonate 30-50mkdose q8
DOPA drip
Dopamine: 1-2 ug/kg/min
Wt x 60 x desired dose
Conc. dopa drip
Desired Dose:
Renal 2-5
Cardio 5-10
Adrenergic 7-8
EPINEPHRINE Drip
Prep: 1mg/ml
Dose: 0.1 – 1mkdose
Dose: 0.5-1mkdose
Wt x 60 x dose
20
DOBUTAMINE drip
Prep: 50mg/ml OR premix
Dose: 10-20ug/kg/min
Wt x 60 x desired dose
Conc. dobu drip (1000)
LIDOCAINE drip
Dose: 2-10mkdose OR 0.5-1.0mkd q10mins, max 5mg/kg
Bolus: 1-2mkdose
NITROGLYCERIN drip
Dose: 0.25-5ug/kg/min dose; can start at 0.15
Prep: 10mg/ml or 100mg/10ml
MILRINONE drip
Dose: 0.3-5ug/kg/min
Prep: 10mg/ml
Anti-histamines
Cetirizine 6-12y/o ½ tab BID
>12y/o 1tab OD
2-6y/o 5mg OG/ 5 gtts BID
6-12y/o 10mg OD/ 20gtts q12
(Drops 10mg/ml, Soln 1mg/ml)
Diphen 1-2mg/kg IV (max 100mg/dose)
3-5mkD p.o.
2-6y/o 2.5ml q6/8
6-12y/o 5ml
(12.5/5 syrup, 50mg/ ml IV, 25mg, 50mg/cap)
Others
Adenosine 0.05mk x 4 q15
Atropine SO4 0.02mkd
IVIG transfusion
Prep: 2.5gm,5gm,2500mg,/50ml vial
Dose: 2g/kg single dose
Ex: wt 10kg
Wt x dose = # vials x 50ml = ___ ml in 12hrs
prep
test dose: wt x 0.01 x 30 mins
FLUIDS
IVF Dext Na Cl K Lactate Kcal/L HCO3
D5W 50g 170
D10W 100g 340
D20W 200g 680
D50W 500g 170
LRS 130 109 4 28 Ca-3
NSS 154 154
D5 0.9NaCl 50 154 154
D5 50 77 77
0.45NaCl
D5 0.3 NaCl 50 51 51
PLR 130 110 43 27 <10 27
D5LR 50 130 110 4 Ca-3 27
D5IMB 50 25 22 20 23 170 23
Mg-3,
po4-3
D5NM 50 40 40 13 170 16
Mg-3
D5NR 50 140 98 5 Mg-3,
Gluc-23
Ludans: hydration
Mild Moderate Severe
<15kg 50 100 150
FD ¼ FD 1/3
R 5-6hrs R5-6hrs
>15kg 30 60 90
FD ¼ FD ¼
R 5-6hrs R5-6hrs
IVF to use: D5 0.3 – 0-7y/o
D5LR – 8-10y/o
WHO Hydration
Severe: 100 cc/kg – LR
Age 30ml/kg 75ml/kg
<12 1 hr 5 hrs
>12 30 mins 2 ½ hrs
TFR
0-1 150mkD
1-3 140mkD
4-6 120mkD
7-9 100mkD
10-12 90mkD
13-15 70 mkD
16-17 50mkD
BSA
Wt (kg)
0-5 wt x .05+ .05
6-10 wt x .04+ .1 <10kg= wtx4+9
10-20 wt x .03+ .2 100
20-40 wt x .02+ .4
>40 wt x .01+ .8
Fluid limitation
ER: BSA X 500
Wards: BSA X 400 + ½ UO in 24hrs
Electrolyte Correction
Sodium
Deficit: (desired-actual) x wt x 0.6
137 - 129 x 11 x 0.6 = 53
Maintenance: wt x (2-3meq)
Deficit + Maintenance = total infusion
Give 50% - 1st 8 hours
25% - next 8 hrs
25% - next 8 hrs
Normal:135-145 meq/L
Significant hyponatremia: 120 meq/L
Maintenance dose: 2-3 meq/kg/24 hr
Prep: 2.5meq/ml/amp
Fast Correction: (values <120meq)
4ml/kg of 2.5 meq/ml prep
(For every ml of NaCl = 4ccsterile water)
Potasssium
Nephro
0.2-0.3meq/kg/hr
Ex. Wt = 10kg
0.2 x wt (10) = 2meq x 24 hrs = 48meqs (deficit)
2 x wt (10) = 20meq (maintenance)
68 meqs
Prep: 2meq/ml
Intensivist
Wt x 50 x transcellular K = ____ / 3
Transcellular K = 50mmol/kg
2.5 – 3 0.5 (5%)
2 – 2.5 .10 (10%)
1.5 – 2 .20 (20%)
Cardio
Desired – actual x wt x 0.3 = deficit
Wt x 2 meq/kg/day = maintenance
Deficit + Maintenance = total infusion q8
3
40meq/day/L = maximum; excess will cause arrhythmia
Calcium
100-300 mg/kg/day
Prep: 100mg/ml
Ex 2.6kg
2.6x100x 1= 2.6 /3 = 0.9cc in IVF for 8 hrs
100
0.9ml of 10% Ca gluc add in 100 ml
Chloride: 5meq/100ml
NaHCO3
Base excess x wt x 0.3 (half correction)
X 0.6 (full correction)
To be given as 50% slow IV push
50% incorporate in IVF to run 6-8hrs
1-2meqs/kg if deficit is too large
Rh Immunoglobulin: WinRho
Dengue
Dose: 50ug/kg/dose
Prep: 300ug/vial
I vial x 9-10mins
Dilute to complete 8.5cc to run for 10mins/vial
Use D5W to dilute
Kawasaki
Dose: 75ug/kg as single dose
Contraindication: hct <100, Rh+
Request CBC PC OD after 24hrs x 3days
Respiratory
ET size = age in years +4
4
Size in mm= 16 + age in years /4
ET Level=ET size x 3 OR
Add 6 to infant’s weight
Ventilator
NICU: FiO2 100
Pip/PEEP: 18/4
TV:wt x 10 x 6 – 8
IT -0.5 – 18cc
Child: PEEP 2-4cm H2O
PIP = 20-30 cm H2O
Rate – 16-20
TV: 10-15ml/kg
Acidosis ph<7.35
Alkalosis ph>7.45
Resp Acid pCO2 >45
Resp Alk pCO2 <35
Met Acid HCO3 <24 dec BE
Met Alk HCO3 >24 inc BE
Hypoxemia pO2 <85
Fluids in Neonates
C. Types of Fluids
1st 24hr : electrolyte free, D5W, D10W
Next 24hrs: with electrolytes, D5 0.3NaCl the D5imb
D. TPN
Electrolytes Preparation Normal
Magnesium sulfate
Prep: 250mg/ml
LD: 100-200mg/kg/dose over 30mins
MD: 20-30mg/kg/day
Ex: wt = 3.2kg
Maintenance dose: Wt x 30
3.2kg x 30 = 96mg x 24hrs
= 2304mg / 250
= 9.2ml in 24 hrs
Order: Mg SO4 9.2ml + D5W 14.8ml to make 24cc to run at 1cc/hr for 24hrs
CPAP
Setting
FiO2 CA O2 PEEP
60% 3 3 6
80% 1.5 4.5
1. Determine CA first
Murallon cpap
Intralipids
Ex: wt 2.35kg
x 3 x 20g x 1.1
100ml
38cc x 20-24hrs at 1.9cc/hr
Fentanyl
Prep: 100mcg/2ml
Dose: 1-4mcg/kg dose q2-4 SIVP; 5-10 for anesthesia
Ex: Wt 1kg
Dilute 100mcg/2ml solution in 8cc sterile water to make a concentration of 10mcg/ml,
then give 0.1cc (1mcg/kg) q4 IV SIVP
Amphotericin B
Prep: 50mg/vial,
Dose: 0.1mkD, max 30-35mk in 3wks
Wt 1kg
Test dose: 0.1mk
1cc of the 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 D5W x 4hrs
Day4 1mk: 10cc + 10cc D5W x 4hrs then OD
Estimated GFR
- ht in cm x 0.55 /serum crea mg/dl
90-120ml/min - normal
< 89 - renal insuff.
< 30 - CRF
< 10 - ESRD
Normal 80-120
Renal impairment 50-80
Renal insufficiency 20-50
Renal failure 5-20
Uremia <5
N = <4mg/m2/hr or 100mg/m2/day
for nephrotics
=if >40mg/m2/hr or 4g/day
start pred at 60mg/m2
Anion Gap
Normal : 20
Na - ( Hco3 + Cl )
134 – (12 + 98) = 24
Albumin transfusion
Prep: 12.5gm/50ml (25%) OR 10gm/50ml (20%)
Dose: 1gm per day; 1ml = 0.25gm
Wt 0.81
Wt x 50 = 3.2ml
12.5
Ca Carbonate (TUMS)
Prep: 500mg tab
Dose: 50mkD
Ca Gluconate
Prep: 10cc/vial
Max 10cc vial + EAD q8 SIVP in 30mins
Alkalka
Prep: 10mg tab = 10meq
Dose: 1-2mkD
May give 2 tabs q8
K: 0.2-0.5kg/hr, inc to 0.5 if sx noted
Desferal
Dose: 25-45 per kg
30mkdose each, before and after BT to run for 6hrs
5cc/kg prbc x 2hrs x 4doses q8
Phlebotomy
FFP transfusion: Wt x EBV (70-80) x 0.15 (.10-.15)
Give ½ 30-1hr before phlebo, then remaining during phlebo
PNSS can be also be used
1meq/kg NaHCO3 if with hypoxic spells
Anti-seizure meds
1st line 2nd line
Tonic-clonic Valproic acid Lamotrigine (Lamictal)
Carbamazepine Oxcarbazepine (Trileptal)
Phenytoin
Diabetic Ketoacidosis
antibodies:
1CA, 1AA, GADA, 1A2
(if + should wof development of dm in the future)
start of symptoms:
80-85% of islet cells have been destroyed
diagnosis:
+ possible ketonuria
management:
insulin drip:
>2yo = 0.1u/kg/hr
<2yo = 0.05u/kg/hr
make 5u in 50cc pnss or 10u in 100cc pnss to run __cc/hr (running rate is equivalent to weight
in kg)
for ecg, na, k, ph, mg, ca, hba1c, fbs, bun, crea, abg, urine ketone
when rbs is decreasing by > or = 100mg/hr, may titrate insulin drip by 25% until 0.05u/kg/hr
transition of insulin iv to sq
clinical improvement
no acidosis
oral intake
to prevent rebound hyperglycemia, stop iv infusion only after 60min of giving the 1st sq
injection of regular insulin
<2yo =0.5u/kg/day
>2yo = 1u/kg/day
pubertal = 0.8-1.5u/kg/day
NUTRITION
approximate daily requirements per kilogram desirable body weight of filipino infants, children
and adolescents for calories and proteins
(Del mundo)