Normal Values

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

daily wt gain(g) length(cm/mo)

0-3 30 3.5
3-6 20 2
6-9 15 1.5
9-12 12 1.2
1-3yr. 8 1
4-6yr. 6 3 cm/yr

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)

Benzathine 500,000 u/K single dose (early syphillis)

50,000 u/K max dose 2.4 M u/dose (syphillis) (1.2 m.u., 2.4 m.u./vial)

Sumapen 25- 50 mkD q6

40,000 ukD q6-q8 (renal)
125/5 – 200,000 u/ 5ml
250/5 – 400,000 u/ 5ml

Ampicillin 50-100mkD q12 (neonates)

100-200 mkD q4/6
100-150 mkD q8-12 (neonatal meningitis)
200-400 mkD q4/6 (meningitis)
(100, 250, 500 mg, 1g)

Ampicillin-sul 50-100-200 mkD q8 IV

(Unasyn) 1.5-12g/day IV
30-50mkD q12 po
2.25g (single dose, gonnorhea)
(375, 750mg/ vial, 250/5, 375/tab)

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)

Amoxicillin-clavu 50-100mkD q6-q8 IV

(Co-amox) 30-50mkD q8 po
30-50mkD q12 : 457/5 (400)
(312.5/5 (250), 156.25/5 (125), 228.5/5(200) (300,600mg, 1.2g v)

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)

Meropenem 20mkdose q8-q12 (septic)

40mkdose q8 (meningitic)
(500mg/ 1gvial)

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

Aztreonam 50mkD q6-8 (children)

30mkD q6-8 (1wk-2 y/o)
(1g/vial)

Piper-tazo 200-300mkD or dose q6

150-300mkD q8 (<6mos) (2g/vial)

Cephalosporins
1st Gen
Cefalexin 30-50mkD q8 (max: 4g/D)
(100/ml, 125/5, 250/5)

Cefazolin 25-50mkD q6/8

100mkD (severe infection)
(500mg, 1g/vial)

2nd Gen
Cefuroxime 20-40mkD q12 p.o
50-100mkD q6-8 IV (max: 6g/D)
(125/5, 250/5, 750, 1.5g/vial)

Cefaclor 20-40mkD q8-12

(250mg, 500, 125/5, 250/5)

Cefoxitin 80-160 mkD q6-8 IV (max: 12g/D)

20-40 mkD (infants) (1g/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)

Ceftriaxone 50-100mkD q12-OD IV

(250, 500, 1g, 2g/vial)

Cefixime 3-8mkD q12

(tergecef) 10mkdose q12 (typhoid)
(ultraxime) 8mkD OD or 4mkdose BID
(20mg/ml, 100mg/5ml)
Adult: 400mg OD or 200mg BID
- For S. pyogenes, S. pneumonia, Klebsiella, Moraxella, H. influenza, E. coli
For drug resistant typhoid fever:
- Cefixime 14-20mkday OD or BID x 14 days
- Ceftriaxone80-100mkday for 5-7 days

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)

Gentamicin 5-8mkD q8-12-OD

(40mg/ml, 80mg/2ml)

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)

Clarithromycin 15mkD q12 (max 1g/D)

(125/5, 250/5)
Azithromycin 10mkD OD x 3 days
 10mkD 1st day, 5kD 2nd-5th day
(200/5, 500mg/vial)

Quinolones
Ciprofloxacin 7.5-15mkdose
(2mg/ml infusion)

Levofloxacin 8mkdose q12

Not to exceed 250mg

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)

Clindamycin NB: 5mkD q8-12 po

Infant/child: 15-25mkD q6 iv
20-30 mkD q6 po

Vancomycin <1200g (0-4wks) 15mkdose OD

>1200g (0-1wk) 20mkdose OD
(1-4wks) 30mkdose OD
Infant/child: 20mkdose q8; 60mkD q8
1hr infusion (500mg/vial)

Metronidazole 30-50mkD q8-12 p.o.

15 mkd LD, 7.5 mkdose q8 IV
(125/5, 5mg/ml/ vial)

Anti-viral
Acyclovir 10-20mkdose q6
200mg 5x daily (adult, >2y/o)
½ adult dose (children <2y/o)
(200mg/5ml)

Amantadine 5-9mkD q12 (<8 y/o)

100-200 (>8 y/o; not > 200mg/D)
Not to exceed 150mkD
(100,250,500mg/vial)
Methisoprinosol 50mkD q6-8 (Isoprinosine)

Anti-fungal
Fluconazole 12mkD LD
6mkD OD (MD)
(50mg/tab, 150mg/tab (divide into paper tab), 2mg/ml/vial)

Ketaconazole 5mkD OD (<15kg)

100mkD OD (>20kg)
200mkD OD (>30kg)

Griseofulvin 10mkD
(125mg, 500mg)

Amphotericin B MD 0.5-1 mkD OD

TD 0.1 mkd to max 1mg x 30-60mins (50mg/10ml)

Anti-TB
Isoniazid 5-10mkD OD (100,150,200/5ml)

Rifampicin 10-15mkD (100,200mg/5ml)

Pyrazinamide 15-30mkD (250mg/5ml)

Ethambutol 5-25mkD 1st 2mos then 15 (200,400mg)

Not for <6 y/o, can’t monitor visual acuity

Streptomycin 20-30mkD (1g/vial)

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

Indomethicin 1-2mkd x 3 (PDA)

Ibuprofen 6-8 mkdose q6 (100, 200/5)

Meperidine 6mkD/ 0.5-1 mkd

Morphine 0.1 – 0.2mkdose q6 (max 15mg)

Nalbuphine 0.1-0.2mkdose IM, IV

Naproxen 15mkD q12 after meals

275mg tab

Paracetamol 10-15 mkdose q4

(100/ml, 120/5, 250/5)

Neuro meds/ Anticonvulsants

Diazepam 0.2-0.3mkd
(2,5,10mg/tab, 5/10mg/ml)
Max dose: <5y/o – 5mg
>5y/o – 10 mg
Drip: 50mg (10cc) + 250cc 0.9 NSS to run at 1cc/kg/hr

Midazolam 0.05-2mkdose

Mannitol 20% 2.5-5cc/kg q6-8

Carbamazepine 20-60mg/day inc by 20-60mg/day

(tegretol) (<4y/o)100mg/day
inc by 100mg weekly (>4y/o)
10-20mk MD

Phenobarbital 10-20 mkd LD

5 mkD q12 MD
(20mg.5ml, grain 1= 60mg)
Max dose: 1-2gms (300mg)

Phenytoin 10-20mkd LD
(Dilantin) 5mkD q12 MD
(125/5, 250/5, 15,30,60,90mg)
Max dose: 1 gram

Valproic acid 15mkd LD

20mkD q8 (MD)

Steroids
Bethamethasone 0.0178- 0.25 mkD q6-8
(max 9mg/D)

Dexamethasone 0.5-1mkD for ICP

0.4 or 0.6 IV ALTB
1-2 mkd x1; 1mkD q4-6 cerebral edema
 0.2-0.5 mkd bacterial meningitis
Dexa series (dengue)
½ or 0.5cc q30mins x 4doses
¼ or 0.25cc q2 x 4doses
¼ or 0.25cc q4 x 4doses

Hydrocortisone 4mkdose q6-8

(100,200,250mg/vial)
Prednisone 1-2mkD BID
(10,20/5, 10mg,20mg,30mg)
Prednisolone 1-2mkD OD

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

Cyclophosphamide 2-3mk/24hrs single dose 8-12wks

500m/kg/m2/day x 3-5days
(max 1g/day x 3days)
Methylpred 30mkD x 3-5days (max 1gm)

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

Salbutamol 0.15-0.30 mg/kg/day q6

(2mg/5ml, 2mg/tab)

Terbutaline 0.075 mkdose q6 p.o.

0.01 mkdose SQ (max 0.5cc)
(1.5mg/5ml syrup,5mg/2mlnebule)
Terbutaline Drip
(0.1-0.4ug) x wt. x 60 x 8 =___
500ug/ml
Terbutaline = ___
D5W = ___
80cc x 10 ugtts/min (8hrs)

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

Carbocisteine (excessive mucous)

Syrup (100mg/5ml)
6-12y/o 10ml TID
2-5y/o 2.5-5ml TID/QID
Syrup (250/5)
6-12y/o 5ml TID
2-5y/o 1.25-2.5ml QID
Erdosteine >30kg 10ml BID
20-30kg 5ml TID
15-19kg ml BID
Meptin 0.25cc/kg/dose OD- BID

Salbutamol + Guaifensain (2mg/5ml)

>12y/o 1-2tsp TID
6-12 y/o 1 tsp TID
2-6y/o ½ tsp – 1tsp TID
Phenylpropanolamine 1-2y/o-1ml
7-12mos – 3/4ml
4-6mos- 1/2ml
1-3mos – 1/4ml
(Drops 6.25mg/ml)
7-12y/o – 1tsp
 2-6y/o – 1/2tsp QID
(12.5mg/5ml)

Cardio/Anti-Hypertensives/ Diuretics/Emergency
Aldactone 2-3,5mkD

Amiodarone 10mg/kg/dose 30-1hr LD

Aspirin 65mkD
RHD 1st 2 weeks 100mkD
4 weeks 75mkD
Anti-inflam 60-90mkD
Kawasaki 100mkD q6
(-) Fever 3-8/10 mkD OD

Acetazolamide 20mkD; 250-375mg/day

(Diamox) (250mg/tab)

Captopril 0.5-2mkD q8-12

Ca gluc 25-50mkD q6-8 (100mg/ml)

Ca Cl 0.33/kg (27mg ca/cc)

Ca Carbonate 30-50mkdose q8

Digoxin 0.05 mg/kg IV/IM

Diazoxide 5mg rapid IV push

Furosemide 1-2mkdose q6-12

(20mg/2ml amp, 20mg, 40mg/tab)

Hydralazine 0.15-0.3 mkdose q4-6 IV

1-3mkD q4-6 po
(10,25,50 tab,20mg amp)

Enalapril 5mg tab OD (max 1mkD)

Nifedipine 0.5-1mkdose q4-6 po

(5,10mg cap)

Amlodopine 5mg tab OD or BID

Propanolol 1-2mkD q6-12 (5,10mg tab)

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

Concentration Dopa D5W

100 6 43
200 12.5 37.5
400 25 25
800 11 39 PREMIX

Ex. Start Dopa drip

Dopa 12.5
D5W 37.5
50cc x 4-5ugtts

EPINEPHRINE Drip
Prep: 1mg/ml
Dose: 0.1 – 1mkdose

(Wt x dose x 6) x 0.1(running rate)

Ex. Start Epi drip

Epi 1 cc
D5W 99 cc
100 cc x ____ugtts/min
OR

Dose: 0.5-1mkdose

Wt x 60 x dose
20

Ex. Start Epi drip

Epi 1 cc
D5W 49 cc
 50 cc x ___ugtts/min

Titrate by 0.1 dose

Epinephrine 0.01 mg/kg (1:10,000 IV)

0.1 mg/kg q3-4mis (ET)
0.1-0.5 ug/kg/min (drip)
2 ½ amps +48.5cc D5W
0.5cc epi +1.5cc NSS q15 x 3 doses pre-extubation then q4-6 (racemic)

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

Wt x 60 x dose = running rate

4000

Ex. Start Lidocaine drip

Lidocaine 10cc
D5W 40cc
50cc x ____ugtts

Lanoxin TDD: 0.035 x wt

LD: ¼ TDD x 4 doses q6
MD 1/10 TDD x 2 doses q12
OR
Wt x 0.004 x 2
0.05 (elixir)

* should not exceed weight of px

0.04/kg loading divide by 4doses
0.04 maintenance/ dose
0.5max/day

Elixir 0.05 mg/ml

Tab 0.25mg/tab
IV 0.025mg/ml or 0.5mg/2cc
Defibrillation: 2.5joules/kg x 3

NITROGLYCERIN drip
Dose: 0.25-5ug/kg/min dose; can start at 0.15
Prep: 10mg/ml or 100mg/10ml

Running rate = Wt x 60 x dose

100

Ex. Start Nitroglycerin drip

NTG 5 cc
D5W 45 cc
50 cc x ___ugtts/min

MILRINONE drip
Dose: 0.3-5ug/kg/min
Prep: 10mg/ml

Running rate = Wt x 60 x dose

200

Ex. Start Milrinone drip

Mil 10 cc
D5W 40 cc
50 cc x ___ugtts/min (5cc/hr)

Gastro/ Anti-ulcers/ Anti-Helmintics

Mebendazole 500mg OD single dose
AlMg (OH)3(Maalox) 2-4tabs 20mins before meals &HS
AlMg(OH)3,dimethicone 2-4tsp/tab QID
Bisacodyl 5-10mg/ 0.3 mkD OD (6-12y/o)
10-15mg OD (>12 y/o)
Buscopan 1-2 tab 3-5x/day; max 100mg/day (>12y/o )
0.3-0.6mkd; max 1.5 mkD (Infants & young children)
Cimetidine 5mkd LD 5-20mkD q6
Dicycloverine 6mos-2yo 0.5-1ml
2-5yo 2.5-5ml
6-12yo 5ml
(5mg.ml, 10mg/5ml)
Domperidone 0.2ml/kg/dose q8; 0.5 max
2.5-5mg/ 10kg, q8/6, before meals
Erceflora 1 vial BID x 5days
Lactulose 2ml/kg/dose q6
Nitrofuroxide <6mos 1tsp BID
(Ercefuryl) >6mos 1tsp TID
(220mg/5ml, 200mg/cap)

Prozinc <6mos – 10mg, >6mos 20mg

Drops 0.5-1ml OD
(1ml=10mg elemental zn)
Syrup 2.5-5mlOD
(5ml=20mg elemental zn)

Racecadotril <9kg 10mg/1 sachet TID

(Hidrasec) 9-13kg 10mg/2sachet TID
13-27kg 30mg/1sachet TID
>27kg 30mg/2sachet TID
Adults 100mg/cap TID

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)

Hydroxyzine Hcl 1-2mkd q12 PO

(2mg/ml, 10mg/tab, 25mg/tab)

Loratadine 1-2y/o 2.5ml OD

2-12y/o <30kg – 5ml
>30kg – 10ml
(5mg/5ml, 10mg/tab)
Promethazine HCl 1mg/kg IM
(Phenergan)

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

Ideal Body Weight

<6mos >12mos
1 3.6 1 10
2 4.2 2 12
3 4.8 3 14
4 5.4 4 16
5 6 5 18
6 6 6 20
7 6.5 7 22
8 7 8 22.5
9 7.5 9 29
10 8 10 32.5
11 8.5 11 36
12 9 12 39.5
13 43
14 46.5
15 50

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

Holiday Segar Maintenance

D5IMB <20kg
D5NM >20kg
1st 10 kg : 100kcal/kg
2nd 10kg : 1000 + 50kcal/kg
>20kg : 1500 + 20kcal/kg

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

Newborn Weight Gain:

Birth weight regained on 10th DOL; 2-3 wks preterm
Preterm: 15-20gm/day
Term: 20-30gm/day
Fullterm: age in days – 10 x 20 +BW
Preterm: age in days – 14 x 15 +BW

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

Hema/Endo: Square root of wt x ht

3600

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

Weight Gestational age Tube size

<1000 <28 2.5
1000-2000 28-34 3.0
2000-3000 34-38 3.5
>3000 >38 3.5-4.0
NB 3.0-3.5
Infant 3.5-4.0
1 year 4.0-4.5
3years 4.5-5.0
6years 5.0-5.5
10years 6.0-6.5
Adolescent 7.0-7.5
Adult 7.5-8.0

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

Blood Gas Analysis

NB & Infants Children & Adults
pH 7.25-7.45 7.35-7.45 <7.2
pCO2 27-40 35-48
pO2 54-95 83-100
HCO3 20-22 22-27 <15
O2sat 40-90 95-99
BE -10 to -2 -7 to -1 + 2 >10

For every 10mmHg inc pCO2 = dec in pH of 0.05

 10mmHg dec in cCO2 = inc in pH of 1

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

Pressure Vent: restrictive lung disease

Volume vent: non pulmo
TV : wt x 10
SIMV: back up
AC control: with peep
T piece: Fio2 only

Fluids in Neonates

A. Term: 60cc/kg/day, inc daily by 10 until 150

B. Preterm
AGA (>2.5kg) 70cc/kg/day
LBW (<2.5kg) 70
VLBW (<1.5kg) 80cc/kg/day
ELBW (<1kg) 100cc/kg/day

C. Types of Fluids
1st 24hr : electrolyte free, D5W, D10W
Next 24hrs: with electrolytes, D5 0.3NaCl the D5imb

D. TPN
Electrolytes Preparation Normal

NaCl 2.5mEq/ml 2-4 mEq/kg/day

KCl 2 mEq/ml 1-3 mEq/kg/day
10% Cal gluc 100mg/ 100-400 g/kg/d
7% AA 7g/100ml 0.5-3 g/kg/day

NaCl: 3mEq/kg/day X wt / 2.5 mEq/ml X 1.1 / 3

KCl: 2mEq/kg/day X wt / 2 mEq/ml X 1.1 / 3
Ca: 200g/kg/day X wt / 100g/ml X 1.1 / 3
AA: 3g/kg/day X wt 100 X 1.1 / 3
7
Dextrosity
D10 = ??? ml D50-50
D10 = 10
D7.5 = 7.5

D50-50 = (10 x TFR) – 5 (TFR – total electrolytes)

45 / 3

D5W = TFR – Electrolytes – D50 = ____ / 3

To check, compute D10

50 x D50-50 =
5 x D5W = ______
Total divided by TFR
If < 10: correct

D5 D7.5 D10 12.5 D15 D17.5 D20 D50

0 .055 .11 .17 .22 .28 .33 1.0

Inc dextrosity from D5 to D7.5

TFR 210, d5imb 70cc x 8-9ugtts/min x 3doses
0.055 x 70 = 4cc
D5imb = 66cc
D50-50 = 4cc
70cc x 8-9ugtts/min x 3doses

Glucose Infusion Rate

GIR = 0.167 X Dextrosity X ugtts/min
Wt
NB and Infants = 6-8mg/kg/min
Children = 4-6 mg/kg/min

Magnesium sulfate

Prep: 250mg/ml
LD: 100-200mg/kg/dose over 30mins
MD: 20-30mg/kg/day

Ex: wt = 3.2kg

Loading dose: Wt x 200 = 3.2kg x 200 = 640mg / 250

= 2.56cc + EAD in 30mins

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

FiO2 and PEEP = already set

1. Determine CA first

CA = 100 – FiO2 X PEEP (60-80) x 4-6

79 (K)
2. PEEP – CA = O2

Murallon cpap

FiO2 = compressed air (0.21) + O2 (0-5lpm)

compressed air + O2

ex. 5 (0.21) + 1 = 0.34

6

Intralipids

Prep: 10% , 20%

Dose: 0.5-3g/kg/day ; inc by 0.5 until 3 is reached
20% = 20g/100ml

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

Dilute 50mg vial in 10cc D5W to make a concentration of 5mg/10ml,

then aspirate 1cc + 4ccD5W = 5mg/ml,
then aspirate from the solution, 1cc + 9cc D5W = 1mg/ml,
then aspirate from the solution 1cc to make 0.1mg/ml

Wt 1kg
Test 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

- ht in cm x bsa x 0.48 /serum CR x 1.73 m2

90-120ml/min - normal
< 89 - renal insuff.
< 30 - CRF
< 10 - ESRD

Creatinine Clearance ml/min

for urine vol > 1liter

= TV ml x Ucr mg% x 1.73m2
1440 min x Crea mg% x bsa

for urine volume <1 liter

= wt kg x [140-age] x 0.85
72 x Serum crea mg % x bsa

Creatinine clearance = K x height (cm)

Plasma crea (mmol/L)

Where K= 29 (<2.5 kg)

 40 (0-18mos)
49 (2-16yrs girls)
49 (2-13yrs boys)
62 (13-16 yrs boys)

Normal 80-120
Renal impairment 50-80
Renal insufficiency 20-50
Renal failure 5-20
Uremia <5

To get % = creatinine clearance divided by 120

Creatinine divided by 88.4; K in decimal point (0.29); if >3 renal failure

Total Protein Spillage

=UTP / bsa - g/day
=1000xUTP / BSA x 24hmg/m2/hr

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

Abscence Valproic acid Ethosuximide

Lamotrigine

Myoclonic Na valproate Lamotrigine

Partial Carbamazepine Lamotrigine

Phenytoin Oxcarbazepine

Unidentifiable Valproic acid Na valproate

Lamotrigine

Carbamazepine 10-30 mkd bid,tid

clonazepam 0.1-0.3 mkd tid,qid
ethosuximide 15-40 mkd tid,qid
phenobarbital 2-5 mkd bid,tid
phenytoin 5-8 mkd bid,tid
valproic 30-80 mkd od,bid,tid,qid
gabapentin 15-45 mkd tid
lamotrigine 5-15 bid,tid
topiramate 5-9 mkd bid
leviteracetam 20-40 mkd bid
oxcarbazepine 8-10 mkd bid

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:

s/sx + fbs more than or equal to 126 or

rbs more than 200

+ heavy glycosuria (more than 55mmol/L)

+ possible ketonuria

additional workups: insulin levels, c-peptide

management:

fluid requirement in 48hrs: 2 FM + deficit

48
deficit: wt x 30
48 hr maintenance dose: 2 x fm

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

strict uo q1 with monitoring sheet at bedside

may start nahco3 at 1meq/kg sivp to run for 30 mins

when plasma glucose =14-17mmol/L (250-300) give pnss

if less than 250 cbg give D5 0.45nacl to prevent rapid decrease in plasma glucose conc and
hypoglycemia:

500 d5 0.9 nacl + 500 d5w = d5 0.45 nacl

if less than 100 cbg give D10 0.45 nacl

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

split-mixed insulin injection:

<2yo =0.5u/kg/day
>2yo = 1u/kg/day
pubertal = 0.8-1.5u/kg/day

am: 2/3 = 2/3 intermediate + 1/3 short

pm: 1/3 = 2/3 intermediate + 1/3 short

NUTRITION

approximate daily requirements per kilogram desirable body weight of filipino infants, children
and adolescents for calories and proteins
(Del mundo)

Age cal/kg protein g/kg

0-5 mos 115 3.5
6-11 mos 110 3.0
1-2yrs 110 2.5
3-6yrs 90-100 2.0
7-9yrs 80-90 1.5
10-12yrs 70-80 1.5
13-15yrs 55-65 1.5
16-19yrs 45-50 1.2
1g cho = 4 cal
1g chon =4 cal
1g fats = 8 cal
1000cal = 1kcal
1kcal = 4.184 kj

in general, the ave distribution of calories would be:

11% = proteins
35% = fats
60% = carbohydrates

approximate daily water requirements of filipino infants and children

age water (ml/kg)

0-3days 120
10days 150
1-5mos 150
6-12mos 150
1-3yrs 140
4-6yrs 120
7-9yrs 100
10-12yrs 90
13-15yrs 70
16-19yrs 50