Num Drugs Rute Dose Dose\da formula

ber y
A /1 Acyclovir Infusion 10 8hrly(for 10- Susp 200mg\5ml
(inj) (Encephelitis) over one mg\kg\dose 20days) Vial (250)
Tabs 200 - 400 hour Tabs 200-400
2yrs -100mg (5 times \ day Tabs 200 – 400
oral 2 yrs – 200- )
400 mg For 5-7 days
Needs
adequate
hydration
2 Adrenalin 1:1000 IM\SC 0;01ml\kg\d Every 10- Vial (1 mg \1ml)
(Anaphylactic) ose 20minutes
Until
improvement
occur
3 Adrenalin 1:1000 Slow IV 0;01ml\kg\d Can be Vial 1mg\ml
(cardiac arrest) Over ose repeated in 10ml\ampoule
minutes double dose
if no
response
4 Albumin (infusion) IV 0.5-1 Max Bottle 50 mg\ml
Isotonic infusion g\kg\dose 6g\kg\day 5%
5%(hypovolaemia) over 1\2- 5o ml // 250 ml //
1hr 1000 ml
Conc. Solution Bottle 25% =
25% (severe IV 0.5- 1 Once \day 250mg\ml
hypovolaemia) infusion g\kg\dose Monitor vital 10ml\\20ml\\50m
Under over 3-6 signs l\\100ml
consultation hrs with ( 250mg\ml )
diuretics

5 Aminophyllin Slow IV 5mg\kg\dose 8hrly Infusion VIAL 250mg\10ml

\oral (1mg\kg\hr Tabs 3 times Tabs 100-200mg
infusion rate) \day
6 Amoclan Orally &iv 20-50 8hrly Susp 156 5ml tds
(amoxicillin over 3-4 Mg\kg\day 12 hrly 200mg\5mlBID
+clavulinate) min Dose based 400mg\5ml BID
on Tab 375 -625 – 1g
amoxicillin Inj 600-1200mg
 \vial

7 Amoxicillin Oral 20-50 8 hrly Susp 125 -250

Mg\kg\day \5ml
Caps 250 – 500mg
Drops 100mg\1ml
8 Ampiclox Oral \iv 25mg\kg\dos 6hrly Susp 250mg\5ml
\im e Vial 250 500
Caps 500mg
9 Antihistamin (non oral 5mg-10mg Once Susp 5mg\5ml
sedating ) eg <30kg 5mg Tab 10 mg
loratedine >30kg 10mg
2-12 yrs
10 Antistine Orally 0.1mg\kg\do 1-2yrs BID Susp 2 mg\5ml
(chlorphenaramine se 2-5yrs TDS Tabs 2-4mg
) Or 12yrs 6hrly Vial 10mg\1ml
Not recommended 1-2yrs 2mg
less than 1 yr 2-5yrs 6mg
6-12yrs
Emergency dose 12mg Single dose Can be repeated
(anaphylactic IM\SC\IV <2yrs 2.5mg up to 4 times if
reaction) Emergenc <5yrs 5mg necessary
y 6-12rs 10 mg
11 Artemether IM 1,6mg\kg\do First day two Vial 40mg\1\2ml
se doses then 40mg\1ml
once per day 80mg\1ml
for 6 days
12 Asprin Oral 80- 4-6hrly Tabs 75-81-100-
(antirheumatic) After 120mg\kg\da 300g
food y
13 Asprin analgesic Not Not Not Not
Not recommended recomme recommende recommende recommended in
in children <12yrs nded in d in children d in children children <12yrs
children <12yrs <12yrs
<12yrs
14 Atropine IV\IM 0.01- Once 2mg\1ml ampule
0.02mg\kg\d
ose
15 Azithromycin Oral 10mg\kg Once Susp 200mg\5ml
Caps 250-500mg
B / 16 Benzathine IM <12yrs 1.2 Once every 3- Vial 1.200.000i.u
penicillin >12yrs 2.4 4weeks 2.400.000i.u
17 Benzyle penicillin IV\IM 100.000I.U\k Vial 1000.000
g\dose
1wk
1\4million i.u
BID
1wk-1mon
1\4mill TDS
1mo-2mon
1\4mill 6hrly
2mon-1yrs
1\2mill 6hrly
>1yr 1mill
6hrly
18 Bisacodyl Oral 5-10mg Once at night Tab 5-10mg
(laxative) >6yrs
 Constipati <2yrs 5mg
on supposito >2yrs 10mg Once at
 Before ry morning Sup. 5mg
surgery
 radiology
19 Blood transfusion IV Wt X desired Over 3-4 hrs
(packed cell) raised in Hb
gm\dl X 3
20 Blood transfusion IV 10-20ml\kg Over 3-4 hrs
(whole blood)
C /21 Ca +2 gluconate Slow iv 1- Once (bolus Vial
(emergency) (over 10- 2ml\kg(neon dose),can be 10%10ml(0.22mm
monitor for 15 min) ate) repeated ol\ml)
bradycardia 2ml\kg(older every 6-8 hrs
Followed by Infusion children) Pass in 24 hr Vial
Ca*gluconate in 24hrs for 2-3 10%10ml(0.22mm
(maintinence) or oral 5- days(neonate ol\ml) (9mg ca**
7ml\kg\24hr &older element\ml)
children)
22 Ca+2 oral oral
Neonate 500-
Ca gluconate liquid 700mg\kg\da 4-6hrs 5ml
Older y liquid=1g(400mg
Ca carbonate 50mg\kg\day 8hrs ca element)
liquid Tab1.25g(500mg
Ca carbonate 50mg\kg\day 8hrs ca element)
chewable tabs Granules
Effervescent 50mg\kg\day 8hrs 2.5g(1000mg
 granules element ca)

23 Cefaclor (midocef) oral 20- 8hrly-12hrly Susp 125-

40mg\kg\day 250mg\5ml
23 Cefixime (suprax) oral 8mg\kg\day Once or twice Susp 100mg\5ml
Caps 200-400
24 Cefotaxime (zetax) Iv\im 100- 6-8hrly Vial 250-500-
150mg\kg\da 1000mg
y
Neonates 12hrly
50mg\kg\day
25 Ceftazidime Iv\im 100- 6-8hrly Vial 250-500-
(fortum) 150mg\kg\da 1000mg
y

Neonates 15- 12hrly

30mg\kg\day
26 Ceftrixone Iv 20- Once or BID Vial 250-500-
(samixon – oncef ) infusion 80mg\kg\day 1000mg
in at least 100mg\kg\da
30 min y in
meningitis
27 Cefuroxime (maxil Iv\im Neonate 12hrly Susp 125-
– zinacef) 20- 250mg\5ml
60mg\kg\day Tabs 125-250-
Infant&childr 500mg
en75- 8hrly Vial 250-750mg
150mg\kg\da
y
28 Cephalexin oral 25- 6hrly Susp 125-250 mg
100mg\kg\da Caps 250-500mg
y
29 Chloral hydrate oral 25- Single dose 200mg\5ml
(sedative for 100mg\kg\d (one hr
procedure ) eg; CT ose before the
scan Echo procedure)
30 Chloramphinicol Oral\iv 50- 6hrly Susp 125mg\5ml
100mg\kg\da Caps 250mg
y Vial (1g)
31 Chloroquine oral 10mg\kg Syrup 50mg\5ml
initially Tabs 250-500-750
5mg\kg after mg
6 hrs Vial 200-400mg
D / 32 Dexamethazone Iv\im 0.6mg\kg\da 6hrlly (4 Vial 4mg\1ml
*meningitis y times)
 *croup IM single
0.6mg\kg

33 Dextran IV 20ml\kg\day Caution :

Plasma volume infusion (first day) bleeding
expander then ,interfere
10ml\kg\day with blood
for not more grouping and
than 5 days cross
matching so
take sample
before use
34 Diazepam IV \oral 0.3mg\kg\do Vial 10mg\2ml
se Tabs 5mg-10mg
IR 0.5mg\kg\do
se(IR)
35 Digoxin Oral 0.015mg\kg Tabs 0.1mg-
then after 6 0.125mg-0.25mg
hrs Inj 0.25mg
0.005mg\kg
then after 24
hrs
maintenance
0.003-
0.005mg\kg\
12hrly
36 Dopamine Infusion Renal dose 2- Vial 200mg\5ml
Serious drug \ 5mcg\kg\min
under consultation Cardiac dose
5-
15mcg\kg\mi
n
E / 37 Erythromycin Oral 30- 6 hrly Susp 125-
60mg\kg\day 250mg\5ml
Tabs 250mg
38 Ethambutol Oral 15mg\kg\day Once Tabs 100-400mg
39 Ethina Oral 15+5mg\kg\ Once Tabs 400\150 mg
(Ethambutol+INH) day
F / 40 Factor 8 Iv Minor Once may be Vial of dispensed
Concentrate infusion bleeding every 12 hrs powder = 200u -
2ou\kg\dose in severe 500u-100u
Major bleed bleeding for
30u\kg\dose up to 6 doses
Head injury
50u\kg\dose
or ( wt X 0.5
X DESIERED
 INCREASE IN
FACTOR 8 )

41 Factor 9 Iv 20- Once may be

concentrate infusion 40u\kg\dose every 12 hrs
according to
the type
bleeding
42 Fansidar Oral 0.5 once Tabs 500mg
tabs\10kg (sulphadoxine
500mg ,
pyremethamine
25mg)
43 Fe sulfate Oral Syrup
*therapeutic 3- 8-12hrly 50mg\5mg
6mg\kg\day saferon
(elemental Tabs 60mg
*prophylactic iron ) 8hrly - BID ferrous sulphate
1- Depends on the
2mg\kg\day preparation
44 Folic acid Oral 0.2mg\kg\da once Tab 5mg
y
45 Fresh frozen Iv 10-20ml\kg Over 30 min
plasma
G / 46 Gentamycin IV / IM 2.5 mg / kg / 8 – 12 hourly Vial 80 mg / 2 ml
dose
47 Griseofulvin Oral 10- Once or 12 Susp 125 mg\5ml
Tenia infection of 20mg\kg\day hrly Tabs 250-500mg
hair and nails
H / 48 Haloperidol Oral \im 0.02- 8-12 hrly Tabs 0.5mg
Not recommended 0.05mg\kg\d Inj 5mg\ml
<3yrs ay
49 Heparin Bolus dose
*thrombosis Iv 50u\kg
Followed by
continuous
infusion >
15-35
u\kg\hr
(monitor by
APTT >
therapeutic
up to 1.5-2.5
*for catheter > base line )
patency 0.5u\ml
50 Hydrocortizone IV 4- 6 hrly Vial 100 mg
 5mg\kg\dose

I / 51 Ibuprofen Oral 20 6-8hrly Susp 100-

mg\kg\dose 200mg\5ml
Tabs 200-400 mg
52 INH Oral 5mg\kg\day once Tabs 100 mg
53 Insulin The best regimen
(soluble – regular ) is insulin infusion
A – emergency 50 units insulin in
1 –DKA IV risk of 0.05- 0.9%saline (risk of
hypoglyca 0.1UN\KG\h hypoglycaemia
emia our &cerebral
&cerebral oedema
oedema )
2- Hypercalcaemia IV 0.1unit\kg
insulin and
2ml\kg
50%dextrose
iv
B –maintenance SC 0.7-1.2
unit\kg\day
(1\3dose
soluble and
2\3 dose
zink)
K / 54 K+ chloride Infusion
 Acute IV 0.5- Twice , over
deficit infusion 1mmol\kg\d dose may be Vial
(hypokalae ,the IV ose infusion fatal 10%(6.7meq\5ml)
mia) fluid must over 1-2 15%(10%meq\5m
not hours max l)
contain infusion rate 20%(13.3meq\5m
>40mmol is 0.4 l)
\l mmol\kg\hr
potassiu
m Syrup 1mmol\ml
 Maintenan Oral \ iv Oral : 12hrly Tab slow k
ce 2-4 (8mmol)
(requirem mmol\kg\da
ent ) y
L / 55 Lactulose Oral 1-As laxative 12hrly Solution
0.5-1ml\kg 10g\15ml
\day or 100mg\15ml
<1yr 2.5ml
1-5yr 5ml
5-10yrs 10ml
 2-In hepatic 6 hrly
failure
4ml\kg\day
56 Largactil Oral 0.5- 4-6hrly Tab 50-100mg
(chlorpromazine) 1mg\kg\dose Vial 50mg\2ml
57 Lasix Oral \iv 0.5- 8-12hrly Tab 40mg
(furosemide) 2mg\kg\dose Vial 20mg\2ml
M / 58 Magnesium sulfate Iv dilute 0.1ml\kg 8-12hrly 10ml\ampoule
injection ( as anti before over 20 min 2mmol\ml
convulsant ) giving iv then
Or 0.06ml\kg\hr

iv \im 20-100mg\kg 4-6hrly as

route needed
59 Mannitol IV(infusio 0.25mg\kg\d Once Vial
(cerebral edema ) n) over ose over 20- increase 200mg\ml(20%)
 Increase 20-30 min 30 min or gradually up Note
ICP 1ml\kg\dose to Monitor ICP by
1g\kg\dose if serum osmolality
Promotion of necessary 310-320mosm\kg
diuresis Monitor dieresis
by UOP after a
test dose
=200mg\kg
60 Maxil IV / IM Neonate 20 – 12 hrly Sussp 125 -250
(cefuroxime - 60 mg / mg/ ml
zinacef) kg/day Tabs 125 – 250
Infant and 8 hrly mg
child Vial 250 – 750 mg
75 – 150
mg/kg/day
61 Mebendazole Oral General dose 12 hrly for 3 Sussp 100 mg/
(vermox) >2yrs 100 mg = days 5ml
dose Tabs 100 mg
Specific dose Single dose
for pin worm then the dose
100 mg for should be
each age , repeated in 2
whole family -3 wks
should
receive the
drug
62 Mefnamic acid Oral 6,5 Susp 50mg/5ml
 Fever\pain mg/kg/dose Tabs 250-500mg
 Dysmenorr >6 month 8 hourly after Caps 250-500mg
hoea age food
(adolescen 500 mg with
 t) meals
63 Metformine (type Oral with 500 mg/ Once Tabs 500 – 850
2 DM ) meal dose 12 hrly mg
increase it Or 8 hrly Caution : renal ,
500 mg hepatic
weekly to dysfunction ,
max 2000 metabolic acidosis
mg/ day
64 Metronidazole Oral / iv 7,5 mg / kg / 8 hrly Susp 200 mg / 5
(flagyl) infusion dose ml
Tabs 250 – 500
mg
Infusion 500 mg /
100 ml
65 Midazolam Iv (over 2- 0.05 mg /kg / Children over Vial 1 mg / 1 ml
(sedative for 3 min ) dose 7 years
procedure ) eg; CT 0.2 mg /kg /
scan Echo ) Intra dose
nasal
66 Morphine Im /sq 0.1 – 0.2 once Vial (10 mg/ 1 ml)
mg/kg/dose
67 N Na+bicarbonate IV slowly 1–2
 Cardiac meq/kg/dose
arrest
(cpr)
 Metabolic The amount
acidosis required in
meq =
(0.3xwtxbase
deficit )
Base deficit =
24 –
s.bicarbonat
e
68 Naldixic acid Oral 50 6 hrly Tab 500mg
mg/kg/day
69 Nifidipine (adalat) Oral 0.25 – 0.5 mg 8 – 12 hrly Tab 10 – 20 mg
/ kg / dose Caps 10 – 20 mg
P / 70 Paracetamol Oral 10 mg / kg / 6 hrly for 24 Syrup 120 mg / 5
dose hrs then on ml suppose 125 –
demand 250 mg
Tabs 500 mg
71 Pethidine IM 1 – 2mg / kg Once ( 4 – 6 Vial 50 mg / 1 ml
(analgesia) / dose hrs if needed)
72 Phenobarbitone Infusion LD : (older Vial (30 – 60 mg /
(as anticonvulsant) =< 30 mg ( 15 – 20 mg children only) ml )
/ kg/ min / dose ) Once orally Tabs 30 – 60 –
 MD : Once or BID ( 100 mg
Oral 3 – 4 mg / kg IV )
IV / dose
(neonate)
5 -6 mg / kg /
dose (child)
73 Phenoxymethyl Oral < 2 years 12 hrly Powder for susp
penicillin (125 mg = 400 mg
(ospinine) (for 2,5 ml) Tabs 500 – 1000
sickle cell >2 years 250 mg
prophylaxis) mg = 5 ml
74 Phenitoin Slowly IV LD : Susp 125 mg / 5
(as Over one ml
anticonvulsant) hour 15 – 20 Vial 250 mg / 5 ml
mg / kg /
dose
MD :
Oral 5 MG / KG / BID (IV )
DOSE
(NEONATE ) ONCE ( orally)
IV 6 – 10 mg /
kg / dose
(children )
Infusion rate
<=0.5 mg /kg
/ min
(neonate)
1 – 3 mg / kg
/ min
(children )

75 Platelet IV 0.2 unit / kg Over 15 min

transfusion 4 – 6 unit /
m2
76 Prazequantel
 Belharzia 40 mg / kg Tabs 600 mg
 Taenia Oral 10 – 20 mg / Single dose
worm kg / day
 H.nana 25 mg / kg
77 Predisolone Oral 1 – 2mg / kg 6 - 12 hrly Tabs 5 mg
/ day
78 Primaquine (for Oral 0.15 mg / kg 12 hrly for 14 Tabs 7 .5 mg
p.vivax&ovale) / dose days
For the liver stage
after anti malarial
drugs
 Procaine penicillin IM 50,000 IU / once Vial 1000,000 IU
(skin sensitivity kg / day
before use)
79 Propranolol Oral 0.5 mg / kg / 6 – 12 hrly Tabs 10 – 40 mg
(hypertension) Infusion dose Inj 1 mg / ml
Caution in over 10 – 0.02 – 0.1 mg
asthmatic patients 15 min /kg/dose
80 Pyrazinamide Oral 25 mg /kg / Once Tabs 400 mg
dose
Q / 81 Quinine Oral 10 mg / kg / 8 hourly Tabs 300 mg
Infusion dose Vial 600 mg / 2 ml
R / 82 Racaemic nebulized 0.05 ml / kg / In severe 2.25 %
(adrenaline) dose diluted cases every
 Croup in saline 20 min
83 Rifampicine Oral 10 mg /kg / Once Tabs 150 mg
dose
84 Rifina ( Oral 10 + 5 mg / once Tabs 150 / 75 mg
rifamp+INH) kg / day
(15 mg )
S / 85 Salbutamol Oral 0,1 – 0.15 mg 8 hrly Susp 2 mg / 5 ml
(ventoline) / kg / dose Tabs 4 mg
86 Septrin (co- Oral 20 mg / kg / 12 hrly Susp 240 -
trimoxazole) dose (sulpha 480 mg / ml
methoxazole Tabs 480 mg
)
87 Spironolactone Oral 2 – 3 mg / kg Tabs 25 – 50 mg
/ day 8 – 12 hrly
88 Streptokinase 3500 – 4000
 Thromposi units infusion
s over 30 min
 Catheter Then
patency continuous
(clotted infusion
catheter) 1000 – 1500
units
10000 –
25000 IU in
NS (the
volume of
the catheter
instilled into
the catheter
for one min
then
aspirated )
89 Streptomycine IM 12 – 18 mg / once Vial 1000 mg
kg / dose
T / 90 Tegretol oral Starting dose 12 -24 hrs Susp 100 mg / 5
(capamazepine) 5mg\kg\day (bid-once) ml
building dose to Building Tabs 100 – 200
reach control dose to mg
increase every 5 reach control
days by 2.5 mg \kg increase
till control but not every 5 days
reach max dose by 2.5 mg \kg
20mg\kg\day till control
but not reach
max dose
20mg\kg\day
91 Tetanus antitoxin child
 Prophylact SC\IM <30kg
ic IV 1500unit
 Therapeuti >30kg 3000-
c 5000units
40,000-
100,000
92 Tetanus IG
 Prophylact IM 4units\kg
ic IM 500-
 Ttt 3000units
93 Thiazina oral 10-20 once Tabs 150 -300mg
(thioacetazone+IN mg\kg\dose
H)
V / 94 Vit B6 IM / 20 – 50 mg Once – TDS Vial (100mg\2ml)
 Neonatal slowly IV =dose Tabs 25-50-
seizures 100mg
 Maintenan Oral 50 – 100 mg For three
ce = day weeks
 Deficiency Oral 5 -25 mg =
day
95 Vit K1 IM\SC
(phytomenadioe) Vial (10mg\1ml)
Max 10mg\day
 Neonate IM 1MG
a.prophyla
xis
(haemorra Single dose
hgic
disease of IM 1-2MG\DAY
the
neoborn) IM\SC\IV 1-2mg\dose
b.therapiu
tic
 Infant
 &child
(deficincy)

Weight from age :

Between (3-12month) age in month + 9
2
Between (1-6 years) age in years x 2 +8

Between (7-12years) age in years x 7 – 5

2

N.G Tube :
Practically size from nose to
angle of jaw to xiphoid
process
Neonate size 5
Infancy size 6
Children size 6-8
Adolescent size 10

URINARY CATHETER :
Neonate & Infancy 5

Older Children 6---10

Adolescent 12---14
ENDOTRACHEAL TUBE SIZES :

Size Weight in gm
2.5 1000
3 1000-2000
3.5 2000-3000
3.5 3000

Definition of HTN by age :

Significant Severe HTN
HTN
Age Syst Diast Syst Diast
7 days >96 >106
8 – 30 days >104 >110
Infant < 2 >112 >74 >118 >82
years
3 -5 yrs >116 >76 >124 >86
6 – 9 yrs >122 >78 >130 >86
10 – 12 yrs >126 >82 >134 >90
13 – 15 yrs >136 >86 >144 >92
16 – 18 yrs >142 >92 >150 >98

Hypertensive emergency treatment :

In this table slowly over 20 min

Diazoxide
Hydralazine IM –IV slowly 0.2- 0.5 mg/kg/dose hrly till
control
Nifidipine (sublingual) SL 0.2-0.5 mg/kg every 2 hrs till control
Sodium nitroprusside IV infusion rate 0.5 micro gm /kg/min

IV fluids for paediatric volume resuscitation :

Crystalloids Colloids
0.9 % sodium chloride 5% human albumin
Ringer lactate 20% -25% human albumin
Hypertonic saline 10 % dextran
Fresh frozen plasma
 Whole blood

Daily requirement of fluid ( maintenance )

Within first 10 kg x100

2ed 10 kg x 50
The rest x 20

Infusion rate :
Drops / min = quantity (fluids)/4xnumbers of hours

Insensible losses 300 ml / surface area / day or

15 – 17 ml / kg / day
Oliguric phase =< 0.5 ml / kg / hr
Or
< 200 ml / surface area / day
Polyuric phase > 2000 ml / surface area / day

Common PICU medication dosages :-

Adenosine 0.1 mg/, 12 g kg for 1st for 2nd dose max 6 mg

dose
Amiodarone 5 mg/kg IV load over 150 mg max
25 min
Atropine 0.02 mg/kg IM/IV/ET 1 mg max
0.1 mg min
Calcium chloride 30 mg/kg IV central
only
Calcium 50-100 mg/kg IV
gluconate
Dextrose 1 g/kg 1 ml/kg D50,
2 ml/kg D25,
5 ml/kg D10
Dopamine D 1-3 mcg/kg/min ß 3-10 a 10-20 mcg/kg/m
mcg/kg/m
Enalapril 0.05 – 0.25 mg/kg PO
Epinephrine 0.01 mg/kg IV 0.1 ß 0.01-0.1 a 0.1 - 1 0.1ml/kg
mg/kg ET mcg/kg/m mcg/kg/min 1:1000, 0.1
1:10,000, ml/kg
Fentanyl 25 mcg/kg IV 1 mcg/kg/hr
Hydralazine 0.1 – 0.2 mg/kg IV max 20
mg/day
Magnesium 25-50 mg/kg IV 2 g max
Midazolam 0.05 mg/kg IM/IN/IV
0.05 mg/kg/hr
Milrinone 0.25 – 1 mcg/kg/min
Morphine 0.05 mg/kg IV
Norepinephrine ß 0.01-0.1 mcg/kg/m
a 0.1 - 1 mcg/kg/min
Sodium 1 – 2 meq/kg IV
bicarbonate
Vasopressin 0.5 – 40 mU/kg/hr
Vecuronium 0.1 mg/kg IV

Normal values of vital signs in paediatrics :

Age Average RR Fast breathing
< 2 month 40 60 / min
2 -12 month 30 50 min
>1 – 6 years 25 40 / min
>6 – 12 years 20 30 / min

Pulse rate :

Age PR/MIN
Neoborn 130
Infancy 110 – 120
Early childhood 100
Late childhood 90

Temperature :
Type The normal
Oral 36.5 – 37.4
Rectal 0.5 c more than normal
Axillary 0.5 c less than normal

Age Head circumference (cm)

Birth 35
3 month 41
6 month 43
9 month 44
1 year 45
3 years 49
5 years 50
7 years 52
12 years 53
Adult 55

Mid upper arm circumference (M.U.A.C) PME classification

Arnold classification bet 1 -5 years

M.U. A.C Diagnosis:

Between 13.5 - 14.5 Normal
Between 12.5 - 13.5 Mild to moderate
Below 12.5 Severe

Welcome classification of PEM :

Body wt as % edema Deficit in wt for hight

Under wt 60 -80 - Mild
Nutritional dwarf <60 - Mild
Marasmus <60 - Marked
Kwashiorkor 60 – 80 + Mild
Marasmic <60 + Marked
kwashiorkor

Standard is taken as the 50 th percentile of normal values for weight

Weight for height = wt of the pt x 100

Wt of normal child at same height

Short notes about dehydration (IMCI)

No dehydration (plan A)
Given more fluids than usual ( home made fluids – ORS – water – breast milk)
<2 years …………….50 – 100 ml
>2 years …………..100 - 200ml
After each loose stools
Some dehydration (plan B)
ORS 75 ml / kg every 4 hours ( cup – spoon – NG tube )
Severe dehydration ( plan C ) :
Ringer lactate or normal saline 100 ml / kg IV ( 6 hours or 3 hours )
30 ml / kg 70 ml / kg
Less than 1 year 1 hour 5 hours
More than 1 year ½ hour 2.5 hours

Shock :
20 ml / kg directly IIV as rapid as you can and repeat the dose if no response

Malaria
Treatment of un complicated malaria :

Start with first line and shift to other line when there is treatment failure .

*First line: 1st line treatment in sudan is ( Artesunate AS +sulfadoxine pyrimethamine SP )

inform of tablet

Artisunate (AS) is available in sudan for children as 50mg.side effect are not common
besidetransient rise in transaminase& transient reduction inreticulocyte count has been
reported.

In case of 100 mg or 200 mg adjust the dose and numbers of tablets accordingly .

Sulfadoxine-pyrimthemine(as):is afixed dose combination of two anti folate is available in sudan

in form of tablet(500mg sulfadoxine+25mg pyrimethamine).

Side effect: Are revresable GITdisturbance &visual disterbance .cutaneous reactions .anaroxia.

Age(year) Wt(kg) Day 1 Day2As(50mg Day3As(50mg

tab) tab)
 Sp(500+25mg Sp(50)tabs
tab)

>1 >10 1/2 1/2 1/2 1/2

1->7 20->10 1 1 1 1

7-11 00_20 2 2 2 2

10+ 00+ 1 0 0 0

Total
Numbers
Weight group Blister of tabs
Age group (Day 1) (Day 2) (Day 3)
in kg color

< 1 year < 10 kg The use is not recommended give quinine instead

6
1 tb , 1 tb , 1 tb ,
1 – < 3 year 10 to 14 kg Yellow

1 tb  1 tb  1 tb 

12
2 tb , 2 tb , 2 tb ,
3-<8y 15 -24 kg Blue

2 tb  2 tb  2 tb 
 18
3 tb , 3 tb , 3 tb ,
8 to 10 y 25 to 34 kg Orange

3 tb  3 tb  3 tb 

24
4 tb , 4 tb , 4 tb ,
> 11y > 35 Green

4 tb  4 tb  4 tb 
Second line : Coartem (Artemether 20 mg/Lumefantrine 120 mg) as fixed cmbined tabs for
uncomplicated malaria falciparum

Quinine:

found as Q Dihydrochloride,Q hydrochloride,Q sulphate orally should be used as a third line

drug in case of no response to Artemether-lumefantrine.

Oral quinine is used 10mg\kgbody weight 8 hourly for 7 days.

IM injection of quinine for those with reapeted vomiting .

SEVERE MALARIA

Case definition:

Severe malaria is define as malaria due to P.falciprum infection that is suffieciently serious to be
an immediate threat to life . Its amedical emergency which required hospitalization.

(1)Immediate &emergency measures.

(2)look &deal with evidence of complication.

(3)monitoring&assesment of the child condition.

Immediate measures :

1.Start resuscitation particulary patent airway.

2.Establish IV line.

3.Make a thick blood film for immediate parasite count.ICTmay be useful in certain condition.

4.Classify the degree of dehydration.

5.Control the fever by oral and rectal paracetamol.

6.Control convulsion

7.Detect &treat hypoglycaemia.

Evidence of complication :

8.Start Quinine IV or artemether IM.

1)shock, algid malaria.

2)consider the need of blood transfusion.

3)metabolic acidosis.

4)spontaneous bleeding &coagulapathy.

5)acute renal failure.

6)malarial hemoglobinuria(black-water fever).

7)cerebral oedema.

8)exclude common infections.

Treatment of severe malaria :

Quinine:is the preferable drug and should be given initially by IV infusion, 20 mg salt loading
dose over 4 hours ( give with IV fluid preferably with glucose 5 % or 10 % or DNS or in 50%
glucose ) .The dose is 10mg salt\kg body wt over 4 hours administered 8 hourly and shift to tabs
when patient can take orally for 7 days.

If IV Quinine is not possible: IM Quinine can be given with the same doseage diluted with
normal saline or distilled water to a concentration of 60mg\ml into both anterior upper thigh.

 Or quinine IV in the same dose as above for at least 3 days then shift to (AS + SP ).
 Or artemether IM 3.2 mg / kg divided in to two doses in the first day followed by 1.6 mg
/ kg daily for the next 6 days .
 Or artemether IM 3.2 mg / kg divided in to two doses in the first day followed by 1.6 mg
/ kg daily for at least 3 days and then shift to first line treatment (AS + SP ).

Pre – referral treatment of severe malaria :

Artesunate rectal suppository / capsules 50 or 200 mg per rectocap 10 mg / kg should be

given rectally as soon as possible once a diagnosis of severe malaria is made . if the rectal
capsule expelled within the first hour , another rectal capsule should be administered
immediately . a second dosec can be repeated after 24 hours .

Or quinine IM in standard dose . repeat the dose every 8 hours if referral is delayed .
 NB : do not keep the patient for more than 24 hrs .

Age Wt (Q) INJ ml Normal Total volume

(kg) saline ml

4mon> 5-6 0.2 0.8 1

4-11mon 7-10 0.3 1.2 1.5

1-2yr 11-14 0.4 1.6 2

3-4yr 15-18 0.6 2.4 3

5-7yr 19-24 0.8 3.2 4

8-10yr 25-35 1.1 4.9 6

11-13yr 36-50 1.3 5.7 7

14< <50 2 8 10

RENAL CHART

Fluids urine blood

date Wt Intake Albu RBC Pus casts B.urea creatinine K Na BP Remarks time
cells
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