Amino acid

Epinephrine
Empiric dose: 2-3g/day
Neonate
Preparation: 8%/100ml
Asystole and Bradycardia
*
0.01 – 0.03 mkdose 1:10,000 Calcium
0.1 – 0.3 ml/kg/dose IV/ET Empiric dose: 200-400/day
Infants and Children Preparation: 100mg/ml
1st dose: 0.01 mg/kg 1:10,000 * Wt x ED = mg/d x prep 1ml/100mg
0.1 ml/kg max dose: 1 mg (10ml)
ET Sodium
Uncuffed in patients ≤ 8 y/o Empiric dose:
Preparation: 2.5 meqs/mL
Age in years + 4 (uncuffed)
4 + 3 (cuffed) * Wt x ED
2.5
16 + age/4 Potassium
Depth: 3x FT size Empiric dose:
Preparation: 2 meqs/mL
Dopamine * Wt x ED
IVRF x (dopa) x 60 2
800 or 400
800 – 1 cc dopa + 49cc D5W
400 – 0.5 cc dopa + 49 cc D5W
TPR of Newborns
BW 1-2 days 3-4 days 7-30 days
Blood component Replacement
<750 g 100-250 150-300 120-180
Volume of PRBC’s = EBV (ml) x DHCT – Actual
HCT of PRBC’s 750-1000g 80-150 100-150 120-180
(0.55) 1000-1500g 60-100 80-150 120-180
>1500g 60-80 100-150 120-180
Estimated Blood Volume
Age Total Blood Volume CPAP
(ml/kg)
CA = 100 – F102 x CPAP
Preterm 90-105 79
Term 78-86 O2 = CPAP – CA
1-12 mos 73-78
1-3 years 74-82
4-6 years 80-86 WHO Treatment Plan for Dehydration
7-18 year 83-90 Plan A ORS
<24 months 50-100ml 500ml/day
TPN 2-10 years 100-200ml 1000ml/day
Compute for electrolytes first (Na, K, Ca, 10 years or more As tolerated 2000ml/day
AA) Plan B Moderate or Some Dehydration
ORS to be given in the 1st 4 hours
AA of milk – 10.48 x volume of feeding
1000 * 75ml/kg BW
Plan C Severe Dehydration: IV
AA of milk – AA required = AA TPN
100ml/kg PLRS or PNSS
<12 mos older
30ml/kg 1 hr 30 mins
Feeding 70ml/kg 5 hours 2 1/2hours
Breastmilk: 20 cal/30ml or 1 oz.
Anion Gap
Formula: 24 cal/3oml or 1 oz. [Na] – ([HCO3] + [Cl])
Normal: 12 meqs/L (range: 8-16meqs/L)
Total Caloric Input Increased Anion Gap
Amount of feeding x Frequency x Cal DKA
30cc = Renal Failure
Present weight Lactic acidosis
Hyperglycemic Nonketotic Coma
Disorders of AA metabolism
Dextrosity Large amount of Penicillin
K = Desired Dx – Actual Dx or Total of Salicylate poisoning
electrolytes x Dx/45 Ethylene glycol/methanol ingestion
D50 – Actual Decreased Anion Gap
K x TFR x weight = Amount of D5050 Nephrotic syndrome
Lithium ingestion
Multiple myeloma
GIR
Dextrosity x desired rate x K (0.167)
Weight Total Fluid Requirement
Normal: 4-8 mg/kg/min Amount of feeding x frequency
Present weight
 Z-SCORES
PEFR in 6-7 y/o Length/ Weight for Weight BMI for
Height AGE for Age
MALES ( Height in cm – 100 ) 5+ 175 for AGE Length/
Height
FEMALES ( Height In cm – 100 ) 5+ 170 Above 3 Very tall Use weight OBESE
Above 2 NORMAL for length, OVERWEIGHT
Peak flow variability Above 1 BMI for age POSSIBLE RISK OF
= Highest Reading - Lowest reading x 100 chart OVERWEIGHT
Highest reading Median NORMAL
Below -1
Below -2 STUNTED Underweight WASTED
Below -3 Severely Severely SEVERELY WASTED
IMMUNIZATIONS Stunted Underweight
BCG
Intradermal
< 12 months: 0.05 ml VITAL SIGNS AT VARIOUS AGE
> 12 months: 0.1 ml
HBV HR BP RR
AGE
Intramuscular
1st dose: at birth (within 24 hours): 0.5ml Premature 120-170 55-75/ 35-45 40-70

2nd dose: 1 month 0-3 mos 100-150 65-85/ 45-55 35-55

3rd dose: 6 months 3-6 mos 90-120 70-90/ 50-65 30-45
4th dose: 3rd dose given < 6 months; No birth dose given; 6-12 mos 80-120 80-100/ 55-65 25-40
Preterms, < 2 kg
1-3 yr 70-110 90-105/ 55-70 20-30
Measles Vaccine
Subcutaneous 3-6 yr 65-110 95-110/ 60-75 20-25
9 months but can be given as early as 6 months 6-12 yr 60-95 100-120/ 60-75 14-22
MMR 12 (*) yr 55-85 110-135/ 65-85 12-18
12 months
Booster: 4-6 years old
Given earlier: 4 weeks apart
MNEMONICS FOR WEIGHT
MMR + Varicella
Infants < 6 Wt. in grams= (age in mos x 600) + BW
Subcutaneous months old
12-15 months Infants 6-12 Wt. in grams= (age in mos x 500) + BW
Booster: 4-6 years old months old
Provided that last dose is 3 months apart from last dose ≥ 2 years old Wt. in Kg= (age in year x 2) + 8
6 to 12 years old Wt. in Kg= ((age in year x 7) – 5) / 2
Influenza
Intramuscular or Subcutaneous
February – June MNEMONICS FOR HEIGHT
Height in 1st year = 1.5 x birth length
2 doses separated by 4 weeks
Height in 2nd year= 30 inches or ½ of mature height (boys)
HAV Height in 3rd year = 36 inches (3 ft)
Intramuscular Height in 4th year = 40 inches or 2 x birth length
Recommended at 12 months Height in 13th year = 3 x birth length
2nd dose: 6-12 months from 1st dose Height in cm = (age in years x 5) + 80
Rotavirus
Monovalent: oral, 2 doses, 3 weeks – 14 weeks (<15weeks),
RECOMMENDED ENERGY and NUTRIENT INTAKE PER DAY (RENI)
minimum interval: 4 week, not later than 24 weeks From 0-18 years old
Pentavalent: oral 3 doses Population Group Weight (kg) Energy (kcal) Protein (g)
Typhoid Infants, mos
Intramuscular Birth - <6 6 560 9
History of travel 6- <12 9 720 14
Exposure to Salmonella typhi Children, y
2 years old, repeat every 2-3 years 1-3 13 1070 28
4-6 19 1410 38
7-9 24 1600 43
PRIMITIVE REFLEXES Males, y
10-12 34 2140 54
REFLEX APPEARS AT DISAPPEARS AT
13-15 50 2800 71
Suck Birth 3 mos
16-18 58 2840 73
Root Birth 3 mos
19-29 59 2490 67
Monro Birth 4-6 mos
30-49 59 2420 67
Tonic Neck Birth 6-7 mos
50-64 59 2170 67
Babinski Birth 2 years
65+ 59 1890 67
Landau 3 mos 12 mos
Parachute 7-9 mos Persists Females, y
throughout life 10-12 35 1920 49
Walking/ Birth 6 weeks 13-15 49 2250 63
Stepping 1618 50 2050 59
Palmar grasp Birth 5-6 mos
Galant Birth 4-6 mos
Swimming Birth 4-6 mos CLASSIFICATION of SEX MATURITY STATES in GIRLS
Babkin Birth
SMR PUBIC HAIR BREASTS
Palmomental Present in various
STAGE
neurologic conditions
such as Down’s 1 Preadolescent Preadolescent
syndrome 2 Sparse, lightly pigmented, Breast and papilla elevated as small
Shout/ pouting Infancy 1 year straight, medial border of mound; diameter of areola increased
labia
3 Darker, beginning to curl, Breast and areola enlarged, no
increased amount contour separation
4 Coarse, curly, abundant, but Areola and papilla form secondary
less than in adult mound
5 Adult feminine triangle, Mature, nipple projects, areola part
spread to medial surface of of general breast contour
thigh
 CLASSIFICATION of SEX MATURITY STATES in BOYS
SMR PUBIC HAIR BREASTS
WHO TREATMENT PLAN for DEHYDRATION
STAGE
1 None Preadolescent PLAN A ORS
<24 months 50-100 ml 500 ml/day
2 Scanty, long, slightly Enlarge scrotum, pink, texture
2-10 years 100-200 ml 10000 ml/day
pigmented altered
10 years or more As tolerated 2000 ml/day
3 Darker, starting to curl, Larger
PLAN B Moderate or Some Dehydration
small amount
ORS to be given in the 1st
4 Resembles adult type, Larger, scrotum dark 24 hours
but less quantity, *75 ml/kg BW
coarse, curly Plan C Severe Dehydration: IV
5 Adult distribution, Adult size 100 ml/kg PLRS or PNSS
spread to medical <12 mos older
surface of thigh 30 ml/kg 1 hr 30 mins
70 ml/kg 5 hours 2 ½ hours

MODIFIED GLASGOW COMA SCALE FOR INTANTS AND CHILDREN

Area Infants Children Score Assessment of Dehydration According to the World Health
Assessed
Eye Opening Open spontaneously Open spontaneously 4
Organization*
Open in response to Open in response to 3 Severe Dehydration Two of the following signs:
verbal stimuli verbal stimuli -Lethargic or unconscious
Open in response to Open in response to 2 -Sunken eyes
-Not able to drink or drinking poorly
pain only pain only
-Skin pinch goes back very slowly
No response No response 1
Verbal Coos and babbles Oriented, appropriate 5 Some Dehydration Two of the following signs:
Response -Restless, irritable
Irritable cries Confused 4 -Sunken eyes
-Thirsty, drinks eagerly
Cries in response to Inappropriate words 3
-Skin pinch goes back slowly
pain
No Dehydration Not enough of the above signs to classify as some
Moans in response in Incomprehensible words 2
or severe dehydration
pain or nonspecific sound
No response No response 1
Motor Moves spontaneously Obeys commands
DEHYDRATION
Response and purposefully 6
SYMPTOMS MINIMAL MILD NTO SEVERE
Withdraws to touch Localizes painful stimuli 5
OR NONE MODERATE (>9% BW)
Withdraws in response Withdraws in response 4 (<3% Loss (3-9% Loss of
to pain to pain of BW) BW)
Responds to pain with Responds to pain with 3 Mental Well; alert Normal, fatigued Apathetic,
decorticate posturing flexion Status or restless, lethargic,
(abnormal flexion) irritable unconscious
Responds to pain with Responds to pain with 2 Thirst Drinks Thirsty; eager to Drinks poorly;
decerebrate posturing extension normally, drink unable to drink
(abnormal extension) might refuse
liquids
No response No response 1
Heart Rate Normal Normal to Tachycardia
increased with
bradycardia in
GLASGOW COMA SCALE FOR <5 years old most severe
BEST MOTOR RESPONSE (6) cases
Spontaneous 6 Quality of Normal Normal to Weak, thread,
Localizes 5 Pulse decreased or impalpable
Normal Flexion 4 Breathing Normal Normal; fast Deep
Abnormal Flexion 3 Eyes Normal Slightly sunken Deeply sunken
Abnormal Extension 2
Tears Present Decreased Absent
Flaccid 1
Mouth and Moist Dry Parched
VERBALIZATION (5)
Tongue
Appropriate for age, fixes and follows, 5
Skinfold Instant < 2 secs >2 secs
social smile
recoil
Cries but consolable 4
Persistently irritable 3 Capillary Normal Prolonged Prolonged,
Restless/Lethargic 2 refill minimal
None 1 Extremities Warm Cool Cool; mottled,
EYE OPENING (4) cyanotic
Spontaneous 4 Urine Normal to Decreased Minimal
To voice 3 Output decreased
To pain 2
Not at all 1
MILD 14-15 CLINICAL CORRELATES OF DEHYDRATION
MODERATE 9-13 Severity Fluid Deficit in ml/kg SIGNS
SEVERE 3-8 Infants Adolescents
MILD 50 30 (3%) Typically minimal
(5%) findings but may
KRAMER JAUNDICE SCALE have slightly dry,
buccal mucus
Face TSB ~ 5 mg/dl
membranes,
Mid-abdomen TSB ~ 15 mg/dl increased thirst,
Feet excluding soles and palms TSB ~ 20 mg/dl slightly decreased UO
Including soles and palms TSB ~ 25 mg/dl MODERATE 100 50-60 (5-6%) Dry buccal mucus
(10%) membranes,
Grade 0 None tachycardia, little or
Grade 1 Face and neck only no UO, lethargy,
Grade 2 Chest and back sunken eyes and
fontanelles, loss of
Grade 3 Abdomen below umbilicus to skin turgor
knees SEVERE 150 70-60 (7-6%) Same as moderate
Grade 4 Arms and legs below knees (15%) plus a rapid thread
Grade 5 Hands and feet pulse, no tears,
cyanosis, rapid
breathing, delayed
capillary refill,
hypotension, mottled
skin, coma
 HOLLIDAY SEGAR METHOD
0-10 kg 100ml/kg ACTIVE RF
10-20 kg 50ml/kg 1.Joint symptoms
2. Murmurs
>20kg 20ml/kg 3. Inc. heart size
** total ml/kg divided by 24 hours 4. CHF
5. Subcutaneous Nodules
< 10y/o or < 40kg: D5IMB 6. Sleeping pulse rate of > 100/min
> 10y/o or >40kg: D5NM 7. + C-reactive protein
8. Consecutive fever for 3 days
Treatment for RF
DEFICIT THERAPY (DT) 1. Pen G/ Benzathine given once (ED: 100K-400K)
2. Penicillin V/Phenoxy methyl Penicillin 2-3 times per day given for 10
MILD MODERATE SEVERE days
<2 y/o or 5% 10% 15% 3. Erythromycin 2-4 times per day given for 10 days

<15kg Wt x 50 Wt x 100 Wt x 150 Diagnosis via 2 major or 1 major + 2 minor

Previous grp A streptococcal infection
>2 y/o or 3% 6% 9%
> 15kg Wt x 30 Wt x 60 Wt x 90
X1 X1.3 X1.5 TREATMENT of TYPHOID FEVER in CHILDREN
OPTIMAL THERAPY ALTERNATIVE EFFECTIVE DRUGS
** Run DT for 6 hours then re –assess
SUSCEPTI ANTIBIOTIC Daily Days Antibiotic Daily Days
BILITY Dose Dose
(mk/day (mk/day
KAWASAKI DISEASE )
Diagnostic criteria: UNCOMPLICATED TYPHOID FEVER
1. Remittent fever (41C) persisting for more than 5 days
Fully Chloramph 50-75 14- Fluoroquin 15 5-7
2. Bilateral conjunctival infection without exudates
Sensitive enicol 21 olone, eg.
3. Strawberry tongue, erythema and cracking of the lips
Ofloxacin or
4. Erythema and edema od the hands and feet
ciprofloxaci
5. Polymorphous exanthems
n
6. Unilateral CLAD > 1.5 CM
Amoxicillin 75-100 14
Treatment:
IVIG-treatment of choice Multidrug Fluoroquin 15 5-7 Azithromyci 8-10 7
-2 g/kg/day resistant olone or n
Aspirin 80-100 mg/kg/day cefixime
Diagnosis: serial 2d echo  aneurysm seen 15-20 7-14 Cefixime 15-20 7-14
ACUTE STAGE Quinolone Azithromyci 8-10 7 Cefixime 20 7-14
resistant n or
• ceftriaxone
Intravenous immunoglobulin 2 g/kg over 10-12 hr
75 10-
14
AND
SEVERE TYPHOID FEVER
• Aspirin 80-100 mg/kg/day divided every 6 hr orally until patient is afebrile for Fully Ampicillin 100 14 Fluoroquin 15 10-
at least 48 hr Sensitive or olone, eg. 14
Ceftriaxone Ofloxacin or
CONVALESCENT STAGE ciprofloxaci
• n
Aspirin 3-5 mg/kg once daily orally until 6-8 wk after illness onset 60-75 10-
14
LONG-TERM THERAPY FOR PATIENTS WITH CORONARY
ABNORMALITIES Multidrug Fluoroquin 15 10- Cefrtiaxone 60 10-
resistant olone 14 or 14
• cefotaxime
Aspirin 3-5 mg/kg once daily orally
80
• Quinolone Ceftriaxone 60-75 10- Fluoroquin 20-30 14
Clopidogrel 1 mg/kg/day (max 75 mg/day)
resistant 14 olone
• Most experts add warfarin or low-molecular-weight heparin for those patients
at particularly high risk of thrombosis
ACUTE CORONARY THROMBOSIS RECOMMENDED ERADICATION THERAPIES for H. pylori
• Prompt fibrinolytic therapy with tissue plasminogen activator or other Medications Dose Duration of
thrombolytic agent under supervision of a pediatric cardiologist Treatment
Amoxicillin 50 mg/kg/day in 2 divided doses 14 days
Clarithromycin 15 mg/kg/day in 2 divided doses 14 days
RHD PPI 1 mg/kg/day in 2 divided doses 1 month
Revised jones criteria or
Major Criteria Amoxicillin 50 mg/kg/day in 2 divided doses 14 days
1. Arthritis most common Metronidazole 20 mg/kg/day in 2 divided doses 14 days
2. Carditis PPI 1 mg/kg/day in 2 divided doses 1 month
3. Erythema Marginatum or
4. Sydenham’s Chorea Clarithromycin 15 mg/kg/day in 2 divided doses 14 days
5. Subcutaneous nodules Metronidazole 20 mg/kg/day in 2 divided doses 14 days
Minor Criteria PPI 1 mg/kg/day in 2 divided doses 1 month
1. Arthralgia
2. Fever < 39C
3. Elevated acute phase reactants  ESR, C-reactive ANTIBIOTICS USED for TREATMENT of BACTERIAL MENINGITIS
CHON NEONATES INFANTS and CHILDREN
4. Prolonged PR interval DRUG 0-7 days 8-28 days
Diagnosis via 2 major or 1 major + 2 minor Amikacin 15-20 days 20-30 divided q8h 20-30 divided q8h
Ampicillin 200-300 divided q8h 300 divided q4h or 300 divided q4-6h
Previous grp A streptococcal infection
q6h
RHD Cefotaxime 100 divided q12h 150-200 divided q8h 200-300 divided
1. Mitral regurgitation/ mitral stenosis on PE or q6h q8h or q6h
2. Left ventricular/ Right ventricular hypertrophy on ECG Ceftriaxone 100 divided q12h
3. Irregular cardiac borders on X-ray or q24h
Ceftazidine 150 divided q12h 150 divided q8h 150 divided q8h
Gentamicin 5 divided q12h 7.5 divided q8h 7.5 divided q8 h
Meropenem 120 divided q8h
Nafcillin 100-150 divided q8h 150-200 divided q8h 150-200 divided
INFECTIVE ENDOCARDITIS or q12h or q6h q4h or q6h
Infective Endocarditis Penicillin G 250,000-450,000 450,000 divided q6h 450,000 divided
1. Strep Viridians – most common, use Pen G and gentamycin divided q8h q4h or q6h
2. Staph Aureus – 2nd most common, use Methicillin and Rifampicin 20 divided q12h
gentamycin Tobramycin 5 divided q12h 7.5 divided q8h 7.5 divided q8h
Vancomycin 30 divided q12h 30-45 divided q8h 60 divided q6h
 Albumin
FINDINGS: BACTERIAL MENINGITIS Premature 1 day 1.8-3.0 g/dl
1. See Nigrovic Clinical Decision Rule Full term <6 days 2.5-3.4 g/dl
<5 years old 3.9-5.0 g/dl
2. CSF Color: Cloudy CSF
5-19 years 4.0-5.3 g/dl
3. CSF Glucose much less that 50
Sodium
4. CSF Protein much greater that 45
Newborn 134-146 mmol/L
5. CSF Leukocytes: Markedly increased Neutrophils
Infant 139-146 mmol/L
6. CSF Opening Pressure: increased >200 Child 138-145 mmol/L
Thereafter 136-146 mmol/L
Potassium
FINDINGS: FUNGAL MENINGITIS <2 months 3.0-7.0 mmol/L
1. CSF Color: Clear to Cloudy Fluid 2-12 months 3.5-6.0 mmol/L
2. CSF Glucose <50 >12 months 3.5-5.0 mmol/L
3. CSF Protein >45 Chloride
4. CSF Leukocytes: Monocytes increased Cord blood 96-105 mmol/L
5. CSF Opening Pressure: increased Newborn 97-110 mmol/L
Thereafter 98-106 mmol/L
Bicarbonate (HCO3)
FINDINGS: VIRAL MENINGITIS Arterial 21-28 mmol/L
Venous 22-29 mmol/L
1. CSF Color: Clear to Cloudy Fluid
2. CSF Glucose: Normal Carbon Dioxide Partial
Pressure (PCO2) 27-40 mmHg
3. CSF Protein >45
Newborn 27-41 mmHg
4. CSF Leukocytes: Increased CSF Lymphocytes
Infant 35-48 mmHg
5. CSF Opening Pressure: Normal or increased Thereafter M 32-45 mmHg
Thereafter F
Glucose
FINDINGS: TUBERCULOSIS MENINGITIS Cord blood 45-96 mg/dl
1. CSF Color: Cloudy Fluid Premature 20-60 mg/dl
2. CSF Glucose <50 Neonate 30-60 mg/dl
Newborn
3. CSF Protein >45
1 day 40-60 mg/dl
4. CSF Leukocytes
>1 day 50-90 mg/dl
a. Early: Neutrophils increased Child 60-100 mg/dl
b. Later: Lymphocytes increased Adult 70-105 mg/dl
Creatinine
Cord blood 0.6-1.2 mg/dl
FINDINGS: GUILLAIN-BARRE Newborn 0.3-1.0 mg/dl
1. CSF Color: Clear to Cloudy Fluid Infant 0.2-0.4 mg/dl
2. CSF Glucose: Normal Child 0.3-0.7 mg/dl
3. CSF Protein much greater than 45 Adolescent 0.5-1.0 mg/dl
4. CSF Leukocytes: Lymphocytes normal or Adult M 0.6-1.2 mg/dl
increased Adult F 0.5-1.1 mg/dl
5. CSF Opening Pressure: Normal Creatinine clearance: newborn 40-65 ml/min/1.73
m2 | <40 yr, M: 97-137, F: 88-128
Calcium Total
FINDINGS: NEOPLASM Cord blood 9.0-11.5 mg/dl
Newborn (3-24 hours) 9.0-10.6 mg/dl
1. CSF Color: Clear to xanthochromic
24-48 hours 7.0- 12.0 mg/dl
2. CSF Glucose: Normal or decreased 4-7 days 9.0-10.9 mg/dl
3. CSF Protein: Normal or increased Child 8.8-10.8 mg/dl
4. CSF Leukocytes: Normal or increased lymphocytes Thereafter 8.4-10.2 mg/dl
5. CSF Opening Pressure: increased >200
Calcium Ionized
Cord blood 5.0-6.0 mg/dl
Newborn (3-24 hours) 4.3-5.1 mg/dl
FINDINGS: NEUROSYPHILIS 24-48 hours 4.0-4.7 mg/dl
1. CSF Color: Clear to Cloudy Fluid Thereafter 4.8-4.92 mg/dl
2. CSF Glucose: Normal Blood Urea Nitrogen
3. CSF Protein >45 Cord blood 21-40 mg/dl
4. CSF Leukocytes: Monocytes increased Premature (1 wk) 3-25 mg/dl
5. CSF Opening Pressure: Normal or increased Newborn 3-12 mg/dl
Infant or child 5-18 mg/dl
Thereafter 7-18 mg/dl
FINDINGS: INTRACRANIAL HEMORRHAGE
1. CSF Color: Bloody CSF with xanthocromia RABIES EXPOSURE
2. CSF Glucose: Normal or decreased CATEGORY EXPOSURE MANAGEMENT
3. CSF Protein >45 CATEGORY Feeding or touching an animal Wash exposed skin
4. CSF Leukocytes: Increased 1 Licking of intact skin immediately with soap and
5. CSF Opening Pressure: increased >200 Exposure to patients with s/sx of rabies water
by sharing or eating or drinking utensils NO VACCINES OR RIG
Casual contact to patients with s/sx of NEEDED
rabies May opt to give pre-
Blood Component Replacement exposure prophylaxis
Volume of PRBC’s= EBV (ml) x DHCT – Actual CATEGORY Nibbling or nipping of uncovered skin COMPLETE VACCINATION
HCT of PRBC’s (0.55) 2 with bruising UNTIL DAY 30
Minor scratches or abrasions without (If animal is rabid, died,
bleeding killes, or unavailable for 14
Licks on broken skin day observation or died
Estimated Blood Volume
during period of
Age Total Blood Volume (ml/kg) observation within 14
Preterm 90-105 days)
CATEGORY Transdermal bites or scratches START VACCIONE AND RIG
Term 78-86
3 Mucous membranes contamination IMMEDIATELY
1-12 mos 73-78 with saliva
1-3 years 74-82 Handling of infected carcass or
4-6 years 80-86 ingestion of raw infected meat
Category II on head and neck area
7-18 years 83-90 Exposure to rabies patient
contamination of mucous membranes
with saliva or fluid through platerring
 GINA CLASSIFICATION OF ASTHMA SEVERITY Hematocrit (Hct)
Symptoms Symptom PEF/ PEF 1 day 48-69%
/Day s/ Nights FEV1 Variability 2 days 48-75%
STEP 1 <1 times a 3 days 44-72%
Intermitt week 2 months 28-42%
ent 6-12 months 35-45%
</= 2
Asymptomat >/= 12-18 months M 37-49%
times a <20%
ic and 80%
month 12-18 months F 36-46%
normal PEF
between
18-49 years M 41-53%
attacks 18-49 years F 36-46%
STEP 2 >1 times a Hemoglobin (hgb)
Mild week but <1 1-3 days 14.5-22.5 g/dl
Persistent time a day 2 months 9.0-14.0 g/dl
>2 times a >/=
20-30% 6-12 years 11.5-15.5 g/dl
month 80%
Attacks may
12-18 years M 13.0-16.0 g/dl
affect
activity 12-18 years F 12.0-16.0 g/dl
STEP 3 Daily 18-49 years M 13.5-17.5 g/dl
Moderate 18-49 years F 12.0-16.0 g/dl
>1 times a 60-
Persistent Attacks >30% WBC
week 80%
affects Birth 9.0-30.0 x 1,000/mm3
activity
12 hours 9.4-34.0 x 1,000/mm3
STEP 4 Continouos
1 month 5.0-19.5 x 1,000/mm3
Severe
Persistent Limited </= 1-3 years 6.0-17.5 x 1,000/mm3
Frequent >30% 4-7 years 5.5-15.5 x 1,000/mm3
physical 60%
activity 8-13 years 4.5-13.5 x 1,000/mm3
Adult 4.5-11.0 x 1,000/mm3
Myelocytes 0%
Neutrophils-bands 3-5%
LEVELS OF ASTHMA CONTROL Neutrophils-segmenters 54-62%
Characteristics Controlled (All of Partly Controlled Uncontrolled Lymphocytes 25-33%
the Following) (Any measure Monocytes 3-7%
present in any week) Eosinophils 1-3%
Daytime None (≤ >twice/ week Three or Basophils 0-0.75%
symptoms twice/week) more
Plt ct NEWBORN: 84-478 Plt ct ADULT: 150-
Limitations of None Any features of
activities partly x 10^6 (after 1 wk, same 400x10^6
Nocturnal None Any controlled as adult)
symptoms/ asthma
awakening present in
Need for None (≤ >twice/ week any week HEMODYNAMIC ASSESSMENT
reliever/ rescue twice/week)
PARAMETERS Stable Compensated Hypotensive Shock
treatment
condition Shock
Lung function* Normal <80% predicted or
(PEF or FEV1 personal best Sensorium Clear and Clear and lucid Change of mental
Exacerbation None One or more/year One in any lucid status (restless and
week combative)
Capillrary Brisk < 2 sec Prolonged > 2 sec Very prolonged,
refill time mottled skin
Classification of asthma severity (0-4 years of Extremities Warm and Cool peripheries Cold and clammy
Components of age) pink
severity Peripheral Good Weak and thread Feeble or absent
Intermit Persistent
pulses volume
tent Mild Moderate Severe Heart Rate Normal for Tachycardia Severe tachycardia
Symptoms <2 >2 Daily Throug age with bradycardia in
days/we days/week hout the late shock
ek but not the BP Normal for Normal systolic Narrowed PP < 20
daily day age pressure but rising
Nighttime 0 1-2x/month 3- >1x/w diastolic pressure
awakenings 4x/month eek RR Normal Tachypnea Hyperpnea,
Impai Kussmaul breathing
Short-acting <2 >2 Daily Severa
rmen
beta2- days/we days/week l times
t
agonist use ek but not per
for symptom daily day CRITERIA FOR DISCHARGE
control (not All of the following must be met:
prevention of 1. No fever for at least 24-48 hours
EIB 2. Improvement in clinical status (general well-being,
Interference None Minor Some Extrem appetite, hemodynamic status, urine output, no
with normal limitation limitation ely respiratory distress)
activity limited 3. Stable hematocrit
Risk 0-1/year >2 exacerbations in 6 months 4. Increasing trend of platelet count (usually preceded
requiring oral systemic by rising WBC)
Exacerbation corticosteroids, or >4 wheezing
s requiring episodes/1 year lasting >1 day AND
oral systemic risk factors for persistent asthma
corticosteroi Consider severity and interval since
ds last exacerbation, frequency and severity
may fluctuate over time.

Exacerbation of any severity may occur in

patients in any severity category.
Step 1 Step 2 Step 3 and
consider short
Recommended step course of oral
for initiating systemic
therapy corticosteroids
In 2-6 weeks, depending on severity, evaluate
level of asthma control that is achieved. If no
clear benefit is observed in 4-6 weeks, consider
adjusting therapy or alternating diagnoses
 pCAP C pCAP D
PEDIATRIC COMMUNITY pCAP A or B
ACQUIRED PNEUMONIA
Pneumonia I Pneumonia II
CLASSIFICATION Non-Severe
SEVERE VERY SEVERE
VARIABLES
CLINICAL
1. Dehydration NONE MILD MODERATE SEVERE
2. Malnutrition NONE MODERATE SEVERE
3. Pallor NONE PRESENT PRESENT
4. Respiratory rate
 3 to 12 mos ≥50/min to ≤60/min >60/min to ≤ 70 >70/min
 1 to 5 y/0 ≥40/min or ≤ 50/min >50/min >50/min
 > 5 y/o ≥30/min or ≤ 35/min >35/min >35/min
5. Signs of respiratory failure
a) Retraction NONE IC/ Subcostal Supraclavicular/IC/SC
b) Head bobbing NONE PRESENT PRESENT
c) Cyanosis NONE PRESENT PRESENT
d) Grunting NONE NONE PRESENT
e) Apnea NONE NONE PRESENT
f) Sensorium NONE IRRITABLE Lethargic/ Stuporous/Comastose
Diagnostic aid at site-of-care
1. Chest X-ray findings of any of
the ff: effusion, abscess, air NONE PRESENT PRESENT
leak, or lobar consolidation
2. Oxygen saturation at room air 95% <95% <95%
using pulse oximetry
ACTION PLAN
1. Site-of-care Outpatient Admit to Ward Admit to a critical care facility
2. Follow-up End of treatment

STRICT 1. Throw cans or tires to avoid

breeding grounds for
DENGUE mosquitoes
2. Cover water containers
3. Use insecticides to kill the
PRECAUTIONS
vector
4. Use mosquito repellants and
mosquito nets
STRICT 1. Avoid exposure to cold air,
smoke, and pollens
ALLERGIC 2. Avoid hair sprays, gel, strong
perfume, fabric softener,
powders, cosmetic, and chalk
PRECAUTIONS
dust
3. Wear warm clothing
4. Use hypoalleregenic sheets
and pillows GENERIC BRAND PREPARATI EMPIRIC FREQU
5. Do not use wool blankets and ON DOSE ENCY

furry stuffed toys Aluminum MAALOX <6mos=o.5 QID

hydroxide + ml
6. Keep child away from dogs, magnesium >6mos: 1ml
cats, hamsters, mice and hydroxide
other pets Aluminum MAALOX <6mos:o.5m QID
hydroxide + PLUS l
7. Wash curtains and shampoo magnesium >6mos: 1ml
rugs hydroxide +
simethicone
8. Clean child’s room regularly
Ambroxol Hcl AMBROLEX 30mg/5ml Wt x 0.2 TID
STRICT 1. Proper hand washing before 15mg/5ml
eating and after using the 7.5mg/1ml

ENTERIC toilet
Amoxicillin HIMOX
GLOBAPEN
250mg/ 5ml
100mg/1ml
30-50 mkd TID at
lowest
2. Proper hand washing before dose
handling and preparing food BID at
PRECAUTIONS high
and cleaning utensils used for dose
preparation and cooking of Azithromycin PEDIAZITH 200mg/5ml 10mkd OD
food 100mg/1ml
Bromphenira PEDIATAPP Wt x 0.2 TID
3. Boil drinking water for 15 mine + ZEDITAPP
minutes or more phenylpropan
olamine
4. Cook food thoroughly
Bacillus ERCEFLORA 1-2 plastic BID
5. Wash all fruits and vegetables clausii tube
to be eaten raw Betamethaso TRIDERM BID for
6. Keep fingernails clean and ne + 2 weeks
Gentamycin
short
+Clotrimazol +3ml NSS
e over 15 mins
Bromhexin BISOLVON 2mg/ 1ml Wt x 0.2 PRN
4mg capsule Rifampicin KIDZKIT 3 200mg/5ml 10mkd OD
Cefaclor RITE MED 250mg/ 5ml 20-40mkd Q8 Isoniazid + (1st 2 mos) 200mg/5ml 10mkd
125mg/5 ml Pyrazinamide 250mg/5ml 15mkd
50mg/1ml Rifampicin KIDZKIT2 200mg/5ml 10mkd
Cefalexin CEFALIN 250mg/ 5ml 25-100mkd Q6 Isoniazid 200mg/5ml 10mkd
125mg/5ml Salbutamol + PECOF WT X 0.2
100mg/1ml Guiafenasin+
Cefixime TERGECEF 100mg/5ml Infant: 8mkd Q12 Bromhexin
20mg/1ml Zinc Oxide + Calmoseptine TID for
Acute UTI: Calamine 3-5
16mkd Q12 for days
1st day Zinc Sulfate E-Zinc 55mg/5ml
8mkd 27.5mg/1ml
Q24 for Zinc Sulfate + PEDZINC <6mos: 10
13 days Vitamin C elemental
Ceftriaxone XTENDA 1gm + 10ml 1-5mos: Q6 zinc
vial 100-200mkd >6mos: 10
elemental
>/=6mos- Q6 zinc
child: 150-
200mkd

DRUGS EMPIRIC DOSE FREQUENCY PREPARATION

Amikacin IV / IM: 15-22.5 mkd Q8
Cefuroxime KEFOX 750mg/vial Neonates:
Amoxicillin 30-50 mkd TID 50/1
250mg/vial 50-100mkd Q12 40-80 mkd 100mg/ml - drops
40: for virgin PN cases 125/5
Children: 250/5 - suspension
75-150mkd Q8 Ampicillin 100-200 mkd Q6 125/5
Cetirizine ALNIX 5mg/5ml <6y/o: OD 250/5
diHcl 2.5mkd Cefaclor 20-40 mkd BID-TID 125/5 187/5
>6y/o: 5- /Q8 250/5 375/5
10mkd Cefalexin 25-100 mkd Q6 125/5
250/5
Cetirizine + ALNIX PLUS 5mg/5ml <6y/o: OD
Cefixime 6-8 mkd BID 100/5
phenylephrin 2.5mkd
20/1
e >6y/o: 5-
Ceftazidime IV: 90-150 Q8
10mkd
Ceftriaxone IM/IV: 50-75 mkd BID
Chlorampheni CHLOROCAIR 125mg/5ml </= 2kg: OD
Cefuroxime O: 20-40 BID/Q12 125/5 (750mg/vial)
col palpitate E 25mkd I: 75-150 Q8 250/5
>2kg: Q12
Cetirizine <6y: 0.25 OD 2.5/ml
50mkd >6y: 5-10 5/5
Chlorphenami DISUDRIN WT X 0.2 Chloramphenicol O: 50-75 QID 125/5
ne + Clarithromycin O: 15 mkd BID 125/5
phenylephrin 250/5
e Cotrimoxazole 6-8 BID 400/80/5
Chlorphenami DYNATUSSIN WT X 0.2 200/40/5
ne + Cloxacillin O: 50-100 QID 125/5
Dexamethaso IV:100-200 Q4/Q6
ne + Co-amoxiclav 30-50 mkd Q12 156.25/5
Guiafenasin + 20-40 mkd BID 228/5ml
Paracetamol 25-40 mkd TID 312.5/5 – 250mg
+ BID Amox
Phenylpropan 457/5 – 400mg Amox
olamine Diazepam IV: 0.04-0.2 Q2-4 1/1
PO: 0.12-0.8 mkd Q6-8 5/1
Cloxacillin RITE MED 125mg/5ml 25-50mkd QID Rectal: 0.5
Co-amoxiclav NATRAVOX 250mg/625m <3mos: BID Diphenhydramine 1mkd Stat 6.25/5
(Amoxicillin AUGMENTIN g/5ml 30mkd 5 mkd Q6 12.5/5
+ Clavulanic 625mg/tab >3mos: 20- Diloxanide 20-40 mkd TID
Acid) 40mkd TID Erythromycin 30-50 mkd Q6-8
25-45mkd BID
Furosemide 1-2 mkd
Diphenhydra BENADRYL 12.5mg/5ml 5mkd Q6 Gentamicin 7.5 mkd Q8 10/1
mine IV: 5-8 40/1
Domperidone VOMETA 5mg/5ml Wt x 0.2 Ibuprofen 5-10 Q6 100/5
5mg/1ml 200/5
Ferrous Ferlin drops 15ml Premature: OD-BID INH (Isoniazid) 10-15 QID 50/5
sulfate + Ferlin syrup 120ml 2-4mkd Meropenem 60
Folic Acid + B Child: 3- OD-TID Metronidazole 35-50 TID 125/5
complex 6mkd 15-20 Giardia
Gentamycin + COMDIDERM BID for Oxacillin 50-100 mkd Q6 250/5
Betamethaso 2 weeks IV: 100-200 Q4/Q6
ne + Paracetamol 10-20 Q4 100/1 -drops
Clotrimazole 120/5
250/5
Gentiane SINUPRET Wt x 0.2
Pen G Na 100,000-400,000 ukd Q4-6
Radix
300,000-400,000 ukd –
meningitic dose
Piperacillin- <6y: 150-300 mkd IV
tazobactam >6y: 300-400 mkd IV
PPA (Phenyl- 12 BID-TID 12.5/5
propanolamine) 250/5
Pyrazinamide 15
Ranitidine O: 2-4
IV: 2-6
Rifampicin 10-20
SMX-TMP 6-8 mkd BID 200/40/5
Zinc 10: < 6 months old OD 55/5
20: > 6 months old

Ibuprofen DOLAN 200mg/5ml 5-10mkd Q6

100mg/5ml DRUGS EMPIRIC DOSE FREQU PREPARATION
forte ENCY
Leviteraceta KEPPRA 100mg/5ml 10-30mkd BID Amikacin IV/IM: 15-22.5 mkd Q8 50mg/ml X 2 ml
m 500mg/tab 125mg/ml X 2 ml
Mupirocin FUSKINA TID for 250mg/ml X 2ml
Ointment 7 days Amoxicillin Neonate: 20-30 mkd TID 50/ml
Child: 25-50 mkd 100mg/ml - drops
Mupirocin + FUSKINA-B BID for 250mg/ml X 60ml
Betamethaso 2 weeks 30-50 mkd 125mg/1.25ml X
ne
40-80 mkd 10ml*
Monmtelukas MONTAIR 4mg 6mos-5yrs: OD
t 5mg 4mg
40: for virgin PN 125mg/5ml X 60ml
10mg 6-14yrs: cases 250/5 - suspension
5mg Ampicillin 100-200 mkd Q6 125/5
>14yrs: 250/5
10mg 250mg, 500mg X
Mometasone ELICA OD 1vial
furoate Cefaclor 20-40 mkd BID- 50mg/ml X 20ml*
TID 125mg/5ml X 30ml
Racecadotril HIDRASEC 10mg/sachet 1.5mkd TID
/Q8 125mg/5ml X 60ml
30mg/sachet
100mg/cap 125mg/5ml X
Racemic 2.25% 0.5ml <4yrs: Q1-2 100ml
Epinephrine via nebulizer 0.05mkd + 187/5
3ml NSS 250/5
over 15 min 375/5
PRN Cefalexin 25-100 mkd Q6 125mg/5ml X 60ml
250mg/5ml X 60ml
>4yrs: Q3-4
0.5ml/dose 100mg/ml X 10ml*
Cefixime 6-8 mkd BID 100/5
 TD: 15-20mkd 20/1 200mg/5ml X 60ml
Sachet: 50 mg 100mg/2.5ml X
Cap: 200mg 15ml*
Ceftazidime IV: 90-150 Q8 250mg/500mg/1g Isoniazid 10-15 QID Tab: 400mg
Ceftriaxone IM/IV: 50-75 mkd BID 1g (INH)
TD: 75-100 mkd 60 500mg/vial +
Meropenem
Cefuroxime PO: 20-40 BID/Q1 125/5 Sepsis dose: 120 diluent
IV: 75-150 2 (750mg/vial) Giargia: 15-20 TID Tab: 500mg
Metronidazole
Q8 250/5 25-50 ? pr 35-50? 125mg/5ml X 60ml
750mg + 10ml amp 50-100 mkd Q6
250/5
(diluent) IV: 100-200 Q4/Q6
Oxacillin Tab: 500mg
Cetirizine <6y: 0.25 OD 2.5mg/ml X 10ml* Meningitic dose: 50
Vial: 500mg
>6y: 5-10 5mg/5ml X 30ml mkd
Chlorampheni PO: 50-75 QID Cap: 250mg, 500mg Q4 100mg/ml X 15ml*
col PO: 50-100 125mg/5ml X 30ml --- drops
Paracetamol 10-20
125mg/5ml X 60ml 120mg/5ml X 60ml
Clarithromyci PO: 15 mkd BID Tab: 250mg, 500mg 250mg/5ml X 60ml
n 125mg/5ml X 25ml 100,000-400,000 ukd Q4-6
125mg/5ml X 50ml MD: 300k-400k ukd –
Penicillin G Na
125mg/5ml X 70ml ---
250/5 meningitic dose
Cotrimoxazole 6-12 BID 400/80/5 <6 yrs: 150-300 mkd 2g/250mg
200/40/5 Piperacillin- IV 4g/500mg
Syrup: 50ml Tazobactam >6 yrs: 300-400 mkd
Suspension: 60ml IV
Cloxacillin PO: 50-100 QID Cap: 500mg PPA (Phenyl- BID- 12.5/5
IV: 100-200 Q4/Q6 125mg/5ml X 60ml propanolamin 12 TID 250/5
Co- amoxiclav 20-40 mkd Q12 Tab: 375mg, e
25-40 mkd BID 625mg, 1g BID- 250mg/5ml X 60ml
30-50 mkd TID 156.25mg/5ml X Pyrazinamide 15 TID 250mg/5ml X
BID 60ml 120ml
228.5mg/5ml X PO: 2-4 Tab: 150mg, 300mg
Ranitidine
70ml IV: 2-6 25mg/ml X 2ml
312.5mg/5ml X 200mg/5ml X
Rifampicin 10-20
60ml – 250mg 120ml
Amox <6 mos: 10 mg 55mg/5ml X 60ml
Zinc
457mg/5ml X 35ml >6 mos: 20 mg 27.5mg/ml X 15ml*
----450mg Amox SMX -TMP 6-8 mkd BID 200/40/5
457mg/5ml X 70ml TD: Typhoid *Oral
dose, MD: drops
BID
Meningitic
dose

VITAL SIGNS AT VARIOUS AGES (NELSON)

AGE HEART RATE BLOOD RESPIRATORY

(BEATS/MIN) PRESSURE RATE
(MM HG) (BREATHS/MIN)

Premature 120–170[*] 55–75/35–45[†] 40–70[‡]

0–3 mo 100–150[*] 65–85/45–55 35–55
TOTAL FLUID REQUIREMENT 3–6 mo 90–120 70–90/50–65 30–45
Amount of feeding x frequency 6–12 mo 80–120 80–100/55–65 25–40
Present weight 1–3 yr 70–110 90–105/55–70 20–30
DEHYDRATION 3–6 yr 65–110 95–110/60–75 20–25
MINIMAL OR MILD TO 6–12 yr 60–95 100–120/60–75 14–22
NO MODERATE SEVERE
SYMPTOM 12[*] yr 55–85 110–135/65–85 12–18
(<3% LOSS OF (3–9% LOSS OF (>9% BW)
BW) BW)
Apathetic, MNEMONICS FOR WEIGHT
Mental Normal, fatigued or
Well; alert lethargic,
status restless, irritable Infants <6 mos. old Wt. In grams = (age in mos. x 600) + BW
unconscious
Drinks Drinks poorly; Infants 6-12 mos. old Wt. In grams = age in mos. x 500) + BW
Thirsty; eager to ≥2years old Wt. In kg = (age in year x 2) + 8
Thirst normally; might unable to
drink
refuse liquids drink 6 to 12 years old Wt. In kg = [(age in year x 7) – 5] /2
Tachycardia,
w/
Heart rate Normal Normal to increased bradycardia in
most severe
cases
Quality of Normal to Weak, thready,
Normal
pulses decreased or impalpable
Breathing Normal Normal; fast Deep
Eyes Normal Slightly sunken Deeply sunken
Tears Present Decreased Absent
Mouth and
Moist Dry Parched
tongue
Recoil in >2
Skinfold Instant recoil Recoil in <2 sec
sec
Capillary Prolonged;
Normal Prolonged
refill minimal
Cold; mottled;
Extremities Warm Cool
cyanotic
Normal to
Urine output Decreased Minimal
decreased
DRUGS EMPIRIC DOSE FREQU PREPARATION
ENCY
IV: 0.2-0.4 Q2-4 1/1
Diazepam PO: 0.12-0.8 mkd Q6-8 5mg/ml X 2ml
Rectal: 0.5 5mg/cap
Stat 12.5mg/5ml X 60ml
Diphenhydram Stat: 1mkd
Q6 12.5mg/5ml X
ine 5 mkd
120ml
Diloxanide 20-40 mkd TID
Q6-8 100mg/2.5ml X
30ml
Erythromycin 30-50 mkd
200mg/5ml X 60ml
400mg/5ml X 50ml
Tab: 20mg, 40mg
Furosemide 1-2 mkd
Amp: 20mg/2ml
PO: 7.5 mkd Q8 10/1
Gentamicin
IV: 5-8 mkd 40mg/ml X 2ml
Ibuprofen 5-10 mkd Q6 100mg/5ml X 60ml
 MNEMONICS FOR HEIGHT
Height in 1st year = 1.5 x birth length
Height in 2nd year = 30 inches or ½ of mature height (boys)
Height in 3rd year = 36 inches (3ft)
Height in 4th year = 40 inches or 2 x birth length
Height in 13th year = 3 x birth length
Height in cm = (age in years x 5) + 80