Empiric dose: 2-3g/day

Preparation: 8%/100ml
Epinephrine *
Neonate Calcium
Asystole and Bradycardia Empiric dose: 200-400/day
1.1 – 0.03 mkdose 1:10,000 Preparation: 100mg/ml
1.1 – 0.3 ml/kg/dose IV/ET * Wt x ED = mg/d x prep 1ml/100mg
Infants and Children
Sodium
1st dose: 0.01 mg/kg 1:10,000
Empiric dose:
1.1 ml/kg max dose: 1 mg (10ml)
Preparation: 2.5 meqs/mL
ET * Wt x ED
Uncuffed in patients ≤ 8 y/o 2.5
Age in years + 4 (uncuffed) Potassium
4 + 3 (cuffed) Empiric dose:
16 + age/4 Preparation: 2 meqs/mL
Depth: 3x FT size * Wt x ED
2
Dopamine
IVRF x (dopa) x 60
800 or 400 TPR of Newborns
800 – 1 cc dopa + 49cc D5W BW 1-2 days 3-4 days 7-30 days
400 – 0.5 cc dopa + 49 cc D5W <750 g 100-250 150-300 120-180
750-1000g 80-150 100-150 120-180
Blood component Replacement 1000-1500g 60-100 80-150 120-180
Volume of PRBC’s = EBV (ml) x DHCT – Actual
>1500g 60-80 100-150 120-180
HCT of PRBC’s
(0.55)
CPAP
CA = 100 – F102 x CPAP
Estimated Blood Volume 79
Age Total Blood Volume O2 = CPAP – CA
(ml/kg)
Preterm 90-105
Term 78-86 WHO Treatment Plan for Dehydration
1-12 mos 73-78 Plan A ORS
1-3 years 74-82 <24 months 50-100ml 500ml/day
4-6 years 80-86 2-10 years 100-200ml 1000ml/day
7-18 year 83-90 10 years or more As tolerated 2000ml/day
Plan B Moderate or Some Dehydration
TPN ORS to be given in the 1st 4 hours
* 75ml/kg BW
Compute for electrolytes first (Na, K, Ca,
AA) Plan C Severe Dehydration: IV
100ml/kg PLRS or PNSS
AA of milk – 10.48 x volume of feeding
<12 mos older
1000
AA of milk – AA required = AA TPN 30ml/kg 1 hr 30 mins
70ml/kg 5 hours 2 1/2hours

Feeding Anion Gap

Breastmilk: 20 cal/30ml or 1 oz. [Na] – ([HCO 3] + [Cl])
Normal: 12 meqs/L (range: 8-16meqs/L)
Formula: 24 cal/3oml or 1 oz. Increased Anion Gap
DKA
Renal Failure
Total Caloric Input
Lactic acidosis
Amount of feeding x Frequency x Cal
Hyperglycemic Nonketotic Coma
30cc =
Disorders of AA metabolism
Present weight
Large amount of Penicillin
Salicylate poisoning
Dextrosity Ethylene glycol/methanol ingestion
Decreased Anion Gap
K = Desired Dx – Actual Dx or Total of
electrolytes x Dx/45 Nephrotic syndrome
D50 – Actual Lithium ingestion
K x TFR x weight = Amount of D5050 Multiple myeloma

Total Fluid Requirement

GIR Amount of feeding x frequency
Dextrosity x desired rate x K (0.167) Present weight
Weight
Normal: 4-8 mg/kg/min
PEFR in 6-7 y/o
MALES ( Height in cm – 100 ) 5+ 175
FEMALES ( Heightacid
Amino In cm – 100 ) 5+ 170
Peak flow variability
= Highest Reading - Lowest reading x 100
Highest reading
 Above 3 Very tall Use weight OBESE
Above 2 NORMAL for length, OVERWEIGHT
Above 1 BMI for age POSSIBLE RISK OF
chart OVERWEIGHT
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
Premature 120-170 55-75/ 35-45 40-70
1st dose: at birth (within 24 hours): 0.5ml
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 3-6 yr 65-110 95-110/ 60-75 20-25
Subcutaneous 6-12 yr 60-95 100-120/ 60-75 14-22
9 months but can be given as early as 6 months
12 (*) yr 55-85 110-135/ 65-85 12-18
MMR
12 months
Booster: 4-6 years old
MNEMONICS FOR WEIGHT
Given earlier: 4 weeks apart
Infants < 6 Wt. in grams= (age in mos x 600) + BW
MMR + Varicella months old
Subcutaneous Infants 6-12 Wt. in grams= (age in mos x 500) + BW
12-15 months months old
Booster: 4-6 years old ≥ 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
Provided that last dose is 3 months apart from last dose
Influenza
Intramuscular or Subcutaneous MNEMONICS FOR HEIGHT
Height in 1st year = 1.5 x birth length
February – June
Height in 2nd year= 30 inches or ½ of mature height (boys)
2 doses separated by 4 weeks Height in 3rd year = 36 inches (3 ft)
HAV Height in 4th year = 40 inches or 2 x birth length
Intramuscular Height in 13th year = 3 x birth length
Recommended at 12 months Height in cm = (age in years x 5) + 80
2nd dose: 6-12 months from 1st dose
Rotavirus
RECOMMENDED ENERGY and NUTRIENT INTAKE PER DAY (RENI)
Monovalent: oral, 2 doses, 3 weeks – 14 weeks (<15weeks),
From 0-18 years old
minimum interval: 4 week, not later than 24 weeks
Population Group Weight (kg) Energy (kcal) Protein (g)
Pentavalent: oral 3 doses Infants, mos
Typhoid Birth - <6 6 560 9
Intramuscular 6- <12 9 720 14
History of travel Children, y
Exposure to Salmonella typhi 1-3 13 1070 28
2 years old, repeat every 2-3 years 4-6 19 1410 38
7-9 24 1600 43
Males, y
10-12 34 2140 54
PRIMITIVE REFLEXES 13-15 50 2800 71
REFLEX APPEARS AT DISAPPEARS AT 16-18 58 2840 73
Suck Birth 3 mos 19-29 59 2490 67
Root Birth 3 mos 30-49 59 2420 67
Monro Birth 4-6 mos 50-64 59 2170 67
Tonic Neck Birth 6-7 mos 65+ 59 1890 67
Babinski Birth 2 years Females, y
Landau 3 mos 12 mos 10-12 35 1920 49
Parachute 7-9 mos Persists 13-15 49 2250 63
throughout life
1618 50 2050 59
Walking/ Birth 6 weeks
Stepping
Palmar grasp Birth 5-6 mos
Galant Birth 4-6 mos CLASSIFICATION of SEX MATURITY STATES in GIRLS
Swimming Birth 4-6 mos SMR PUBIC HAIR BREASTS
Babkin Birth STAG
Palmomental Present in various E
neurologic conditions 1 Preadolescent Preadolescent
such as Down’s
2 Sparse, lightly pigmented, Breast and papilla elevated as small
syndrome straight, medial border of mound; diameter of areola
Shout/ pouting Infancy 1 year labia increased
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
Z-SCORES SMR PUBIC HAIR BREASTS
Length/ Weight for Weight BMI for
STAGE
Height AGE for Age 1 None Preadolescent
for AGE Length/ 2 Scanty, long, slightly Enlarge scrotum, pink, texture
Height pigmented altered
 3 Darker, starting to curl, Larger 10 years or more As tolerated 2000 ml/day
small amount PLAN B Moderate or Some Dehydration
4 Resembles adult type, Larger, scrotum dark ORS to be given in the 1st
but less quantity, 24 hours
coarse, curly *75 ml/kg BW
5 Adult distribution, Adult size Plan C Severe Dehydration: IV
spread to medical 100 ml/kg PLRS or PNSS
surface of thigh <12 mos older
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
Assessed Assessment of Dehydration According to the World Health
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
pain only pain only -Not able to drink or drinking poorly
No response No response 1 -Skin pinch goes back very slowly
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
MODERATE 100 50-60 (5-6%) Dry buccal mucus
Including soles and palms TSB ~ 25 mg/dl
(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

WHO TREATMENT PLAN for DEHYDRATION 0-10 kg 100ml/kg
PLAN A ORS 10-20 kg 50ml/kg
<24 months 50-100 ml 500 ml/day
>20kg 20ml/kg
2-10 years 100-200 ml 10000 ml/day
** total ml/kg divided by 24 hours
 < 10y/o or < 40kg: D5IMB 3. Erythromycin 2-4 times per day given for 10 days
Diagnosis via 2 major or 1 major + 2 minor
> 10y/o or >40kg: D5NM Previous grp A streptococcal infection

DEFICIT THERAPY (DT) TREATMENT of TYPHOID FEVER in CHILDREN

MILD MODERATE SEVERE OPTIMAL THERAPY ALTERNATIVE EFFECTIVE DRUGS
SUSCEPTI ANTIBIOTIC Daily Days Antibiotic Daily Days
<2 y/o or 5% 10% 15%
BILITY Dose Dose
<15kg Wt x 50 Wt x 100 Wt x 150 (mk/day (mk/day
>2 y/o or 3% 6% 9% )

> 15kg Wt x 30 Wt x 60 Wt x 90 UNCOMPLICATED TYPHOID FEVER

Fully Chloramph 50-75 14- Fluoroquino 15 5-7
X1 X1.3 X1.5 Sensitive enicol 21 lone, eg.
** Run DT for 6 hours then re –assess Ofloxacin or
ciprofloxaci
n
Amoxicillin 75-100 14
KAWASAKI DISEASE
Multidrug Fluoroquino 15 5-7 Azithromyci 8-10 7
Diagnostic criteria:
resistant lone or n
1. Remittent fever (41C) persisting for more than 5 days
cefixime
2. Bilateral conjunctival infection without exudates
3. Strawberry tongue, erythema and cracking of the lips 15-20 7-14 Cefixime 15-20 7-14
4. Erythema and edema od the hands and feet Quinolone Azithromyci 8-10 7 Cefixime 20 7-14
5. Polymorphous exanthems resistant n or
6. Unilateral CLAD > 1.5 CM ceftriaxone
Treatment: 75 10-
IVIG-treatment of choice 14
-2 g/kg/day SEVERE TYPHOID FEVER
Aspirin 80-100 mg/kg/day Fully Ampicillin 100 14 Fluoroquino 15 10-
Diagnosis: serial 2d echo  aneurysm seen Sensitive or lone, eg. 14
ACUTE STAGE Ceftriaxone Ofloxacin or
   •    Intravenous immunoglobulin 2 g/kg over 10-12 hr ciprofloxaci
   AND n
•    Aspirin 80-100 mg/kg/day divided every 6 hr orally until patient is afebrile 60-75 10-
   14
for at least 48 hr
Multidrug Fluoroquino 15 10- Cefrtiaxone 60 10-
CONVALESCENT STAGE resistant lone 14 or 14
   •    Aspirin 3-5 mg/kg once daily orally until 6-8 wk after illness onset cefotaxime
LONG-TERM THERAPY FOR PATIENTS WITH CORONARY 80
ABNORMALITIES Quinolone Ceftriaxone 60-75 10- Fluoroquino 20-30 14
   •    Aspirin 3-5 mg/kg once daily orally resistant 14 lone
   •    Clopidogrel 1 mg/kg/day (max 75 mg/day)
•    Most experts add warfarin or low-molecular-weight heparin for those
  
patients at particularly high risk of thrombosis RECOMMENDED ERADICATION THERAPIES for H. pylori
ACUTE CORONARY THROMBOSIS Medications Dose Duration of
•    Prompt fibrinolytic therapy with tissue plasminogen activator or other Treatment
  
thrombolytic agent under supervision of a pediatric cardiologist Amoxicillin 50 mg/kg/day in 2 divided doses 14 days
Clarithromycin 15 mg/kg/day in 2 divided doses 14 days
PPI 1 mg/kg/day in 2 divided doses 1 month
RHD or
Revised jones criteria Amoxicillin 50 mg/kg/day in 2 divided doses 14 days
Major Criteria Metronidazole 20 mg/kg/day in 2 divided doses 14 days
1. Arthritis most common PPI 1 mg/kg/day in 2 divided doses 1 month
2. Carditis or
3. Erythema Marginatum Clarithromycin 15 mg/kg/day in 2 divided doses 14 days
4. Sydenham’s Chorea Metronidazole 20 mg/kg/day in 2 divided doses 14 days
5. Subcutaneous nodules PPI 1 mg/kg/day in 2 divided doses 1 month
Minor Criteria
1. Arthralgia
2. Fever < 39C ANTIBIOTICS USED for TREATMENT of BACTERIAL MENINGITIS
3. Elevated acute phase reactants  ESR, C-reactive NEONATES INFANTS and CHILDREN
CHON DRUG 0-7 days 8-28 days
4. Prolonged PR interval Amikacin 15-20 days 20-30 divided q8h 20-30 divided q8h
Diagnosis via 2 major or 1 major + 2 minor Ampicillin 200-300 divided q8h 300 divided q4h or 300 divided q4-6h
q6h
Previous grp A streptococcal infection
Cefotaxime 100 divided q12h 150-200 divided q8h 200-300 divided
RHD or q6h q8h or q6h
1. Mitral regurgitation/ mitral stenosis on PE Ceftriaxone 100 divided q12h
2. Left ventricular/ Right ventricular hypertrophy on ECG or q24h
3. Irregular cardiac borders on X-ray Ceftazidine 150 divided q12h 150 divided q8h 150 divided q8h
Gentamicin 5 divided q12h 7.5 divided q8h 7.5 divided q8 h
Meropene 120 divided q8h
m
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

ACTIVE RF
1.Joint symptoms
FINDINGS: BACTERIAL MENINGITIS
2. Murmurs 1. See Nigrovic Clinical Decision Rule
3. Inc. heart size 2. CSF Color: Cloudy CSF
4. CHF 3. CSF Glucose much less that 50
5. Subcutaneous Nodules
4. CSF Protein much greater that 45
6. Sleeping pulse rate of > 100/min
7. + C-reactive protein 5. CSF Leukocytes: Markedly increased Neutrophils
8. Consecutive fever for 3 days 6. CSF Opening Pressure: increased >200
Treatment for RF
1. Pen G/ Benzathine given once (ED: 100K-400K)
2. Penicillin V/Phenoxy methyl Penicillin 2-3 times per day given for 10
days FINDINGS: FUNGAL MENINGITIS
 1. CSF Color: Clear to Cloudy Fluid 2-12 months 3.0-7.0 mmol/L
2. CSF Glucose <50 >12 months 3.5-6.0 mmol/L
3. CSF Protein >45 3.5-5.0 mmol/L
4. CSF Leukocytes: Monocytes increased Chloride
5. CSF Opening Pressure: increased Cord blood 96-105 mmol/L
Newborn 97-110 mmol/L
Thereafter 98-106 mmol/L
FINDINGS: VIRAL MENINGITIS Bicarbonate (HCO3)
Arterial 21-28 mmol/L
1. CSF Color: Clear to Cloudy Fluid
Venous 22-29 mmol/L
2. CSF Glucose: Normal
Carbon Dioxide Partial
3. CSF Protein >45
Pressure (PCO2) 27-40 mmHg
4. CSF Leukocytes: Increased CSF Lymphocytes Newborn 27-41 mmHg
5. CSF Opening Pressure: Normal or increased Infant 35-48 mmHg
Thereafter M 32-45 mmHg
Thereafter F
FINDINGS: TUBERCULOSIS MENINGITIS Glucose
1. CSF Color: Cloudy Fluid Cord blood 45-96 mg/dl
2. CSF Glucose <50 Premature 20-60 mg/dl
Neonate 30-60 mg/dl
3. CSF Protein >45
Newborn
4. CSF Leukocytes
1 day 40-60 mg/dl
a. Early: Neutrophils increased >1 day 50-90 mg/dl
b. Later: Lymphocytes increased Child 60-100 mg/dl
Adult 70-105 mg/dl
Creatinine
FINDINGS: GUILLAIN-BARRE Cord blood 0.6-1.2 mg/dl
1. CSF Color: Clear to Cloudy Fluid Newborn 0.3-1.0 mg/dl
2. CSF Glucose: Normal Infant 0.2-0.4 mg/dl
3. CSF Protein much greater than 45 Child 0.3-0.7 mg/dl
4. CSF Leukocytes: Lymphocytes normal or Adolescent 0.5-1.0 mg/dl
increased Adult M 0.6-1.2 mg/dl
5. CSF Opening Pressure: Normal Adult F 0.5-1.1 mg/dl
Creatinine clearance: newborn 40-65 ml/min/1.73
m2 | <40 yr, M: 97-137, F: 88-128
FINDINGS: NEOPLASM Calcium Total
Cord blood 9.0-11.5 mg/dl
1. CSF Color: Clear to xanthochromic
Newborn (3-24 hours) 9.0-10.6 mg/dl
2. CSF Glucose: Normal or decreased 24-48 hours 7.0- 12.0 mg/dl
3. CSF Protein: Normal or increased 4-7 days 9.0-10.9 mg/dl
4. CSF Leukocytes: Normal or increased lymphocytes Child 8.8-10.8 mg/dl
5. CSF Opening Pressure: increased >200 Thereafter 8.4-10.2 mg/dl
Calcium Ionized
Cord blood 5.0-6.0 mg/dl
FINDINGS: NEUROSYPHILIS Newborn (3-24 hours) 4.3-5.1 mg/dl
1. CSF Color: Clear to Cloudy Fluid 24-48 hours 4.0-4.7 mg/dl
2. CSF Glucose: Normal Thereafter 4.8-4.92 mg/dl
3. CSF Protein >45 Blood Urea Nitrogen
4. CSF Leukocytes: Monocytes increased Cord blood 21-40 mg/dl
5. CSF Opening Pressure: Normal or increased Premature (1 wk) 3-25 mg/dl
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
2. CSF Glucose: Normal or decreased RABIES EXPOSURE
3. CSF Protein >45 CATEGORY EXPOSURE MANAGEMENT
4. CSF Leukocytes: Increased CATEGORY Feeding or touching an animal Wash exposed skin
5. CSF Opening Pressure: increased >200 1 Licking of intact skin immediately with soap
Exposure to patients with s/sx of and water
rabies by sharing or eating or drinking NO VACCINES OR RIG
utensils NEEDED
Blood Component Replacement
Casual contact to patients with s/sx of May opt to give pre-
Volume of PRBC’s= EBV (ml) x DHCT – Actual rabies exposure prophylaxis
HCT of PRBC’s (0.55) CATEGORY Nibbling or nipping of uncovered skin COMPLETE VACCINATION
2 with bruising UNTIL DAY 30
Minor scratches or abrasions without (If animal is rabid, died,
Estimated Blood Volume bleeding killes, or unavailable for
Licks on broken skin 14 day observation or
Age Total Blood Volume (ml/kg) died during period of
Preterm 90-105 observation within 14
Term 78-86 days)
CATEGORY Transdermal bites or scratches START VACCIONE AND
1-12 mos 73-78 3 Mucous membranes contamination RIG IMMEDIATELY
1-3 years 74-82 with saliva
4-6 years 80-86 Handling of infected carcass or
ingestion of raw infected meat
7-18 years 83-90
Category II on head and neck area
Exposure to rabies patient
contamination of mucous membranes
Albumin with saliva or fluid through platerring
Premature 1 day 1.8-3.0 g/dl GINA CLASSIFICATION OF ASTHMA SEVERITY
Full term <6 days 2.5-3.4 g/dl Symptoms Symptom PEF/ PEF
<5 years old 3.9-5.0 g/dl /Day s/ Nights FEV1 Variability
5-19 years 4.0-5.3 g/dl STEP 1 <1 times a
Sodium Intermitt week
ent
Newborn 134-146 mmol/L </= 2
Asymptomat >/=
Infant 139-146 mmol/L times a <20%
ic and 80%
Child 138-145 mmol/L month
normal PEF
Thereafter 136-146 mmol/L between
Potassium attacks
<2 months
STEP 2 >1 times a 6-12 months 35-45%
Mild week but <1 12-18 months M 37-49%
Persistent time a day 12-18 months F 36-46%
>2 times a >/=
20-30%
month 80% 18-49 years M 41-53%
Attacks may
affect 18-49 years F 36-46%
activity Hemoglobin (hgb)
STEP 3 Daily 1-3 days 14.5-22.5 g/dl
Moderate 2 months 9.0-14.0 g/dl
>1 times a 60-
Persistent Attacks >30% 6-12 years 11.5-15.5 g/dl
week 80%
affects
12-18 years M 13.0-16.0 g/dl
activity
STEP 4 Continouos
12-18 years F 12.0-16.0 g/dl
Severe 18-49 years M 13.5-17.5 g/dl
Persistent Limited 18-49 years F 12.0-16.0 g/dl
</=
physical Frequent >30% WBC
60%
activity Birth 9.0-30.0 x 1,000/mm3
12 hours 9.4-34.0 x 1,000/mm3
1 month 5.0-19.5 x 1,000/mm3
1-3 years 6.0-17.5 x 1,000/mm3
4-7 years 5.5-15.5 x 1,000/mm3
LEVELS OF ASTHMA CONTROL
8-13 years 4.5-13.5 x 1,000/mm3
Characteristics Controlled (All of Partly Controlled Uncontrolled
Adult 4.5-11.0 x 1,000/mm3
the Following) (Any measure
present in any week) Myelocytes 0%
Daytime None (≤ >twice/ week Three or Neutrophils-bands 3-5%
symptoms twice/week) more Neutrophils-segmenters 54-62%
Limitations of None Any features of Lymphocytes 25-33%
activities partly Monocytes 3-7%
Nocturnal None Any controlled Eosinophils 1-3%
symptoms/ asthma
present in
Basophils 0-0.75%
awakening
Need for None (≤ >twice/ week any week Plt ct NEWBORN: 84-478 Plt ct ADULT: 150-
reliever/ rescue twice/week) x 10^6 (after 1 wk, same 400x10^6
treatment as adult)
Lung function* Normal <80% predicted or
(PEF or FEV1 personal best
Exacerbation None One or more/year One in any HEMODYNAMIC ASSESSMENT
week
PARAMETERS Stable Compensated Hypotensive Shock
condition Shock
Sensorium Clear and Clear and lucid Change of mental
Classification of asthma severity (0-4 years of lucid status (restless and
Components of age) combative)
severity Intermi Persistent Capillrary Brisk < 2 sec Prolonged > 2 sec Very prolonged,
ttent Mild Moderate Severe refill time mottled skin
Symptoms <2 >2 Daily Throug Extremities Warm and Cool peripheries Cold and clammy
days/we days/week hout pink
ek but not the Peripheral Good Weak and thread Feeble or absent
daily day pulses volume
Heart Rate Normal for Tachycardia Severe tachycardia
Nighttime 0 1-2x/month 3- >1x/w
age with bradycardia in
awakenings 4x/month eek
Impai the late shock
Short-acting <2 >2 Daily Several BP
rmen Normal for Normal systolic Narrowed PP < 20
beta2- days/we days/week times age pressure but rising
t
agonist use ek but not per diastolic pressure
for symptom daily day RR Normal Tachypnea Hyperpnea,
control (not Kussmaul breathing
prevention of
EIB
Interference None Minor Some Extrem CRITERIA FOR DISCHARGE
with normal limitation limitation ely
All of the following must be met:
activity limited
1. No fever for at least 24-48 hours
Risk 0-1/year >2 exacerbations in 6 months 2. Improvement in clinical status (general
requiring oral systemic well-being, appetite, hemodynamic status, urine
Exacerbation corticosteroids, or >4 wheezing output, no respiratory distress)
s requiring episodes/1 year lasting >1 day AND 3. Stable hematocrit
oral systemic risk factors for persistent asthma 4. Increasing trend of platelet count
corticosteroi Consider severity and interval since (usually preceded by rising WBC)
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

Hematocrit (Hct)
1 day 48-69%
2 days 48-75%
3 days 44-72%
2 months 28-42%
 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
5. Do not use wool blankets and
furry stuffed toys
6. Keep child away from dogs,
cats, hamsters, mice and
other pets
7. Wash curtains and shampoo
rugs
8. Clean child’s room regularly
STRICT 1. Proper hand washing before
eating and after using the
ENTERIC toilet
2. Proper hand washing before
handling and preparing food
PRECAUTIONS and cleaning utensils used for
preparation and cooking of
food
3. Boil drinking water for 15
minutes or more
4. Cook food thoroughly
5. Wash all fruits and vegetables
to be eaten raw
6. Keep fingernails clean and
short
 GENERIC BRAND PREPARATI EMPIRIC FREQU Ibuprofen DOLAN 200mg/5ml 5-10mkd Q6
ON DOSE ENCY 100mg/5ml
forte
Aluminum MAALOX <6mos=o.5 QID
hydroxide + ml Leviteraceta KEPPRA 100mg/5ml 10-30mkd BID
magnesium >6mos: 1ml m 500mg/tab
hydroxide Mupirocin FUSKINA TID for
Aluminum MAALOX <6mos:o.5m QID Ointment 7 days
hydroxide + PLUS l
magnesium >6mos: 1ml Mupirocin + FUSKINA-B BID for
hydroxide + Betamethaso 2 weeks
simethicone ne
Ambroxol Hcl AMBROLEX 30mg/5ml Wt x 0.2 TID Monmtelukas MONTAIR 4mg 6mos-5yrs: OD
15mg/5ml t 5mg 4mg
7.5mg/1ml 10mg 6-14yrs:
Amoxicillin HIMOX 250mg/ 5ml 30-50 mkd TID at 5mg
GLOBAPEN 100mg/1ml lowest >14yrs:
dose 10mg
BID at Mometasone ELICA OD
high furoate
dose
Azithromycin PEDIAZITH 200mg/5ml 10mkd OD Racecadotril HIDRASEC 10mg/sachet 1.5mkd TID
100mg/1ml 30mg/sachet
Bromphenira PEDIATAPP Wt x 0.2 TID 100mg/cap
mine + ZEDITAPP Racemic 2.25% 0.5ml <4yrs: Q1-2
phenylpropan Epinephrine via nebulizer 0.05mkd +
olamine 3ml NSS
Bacillus ERCEFLORA 1-2 plastic BID over 15 min
clausii tube PRN
Betamethaso TRIDERM BID for
ne + 2 weeks >4yrs: Q3-4
Gentamycin 0.5ml/dose
+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
250/5
Cetirizine ALNIX 5mg/5ml <6y/o: OD
Cefaclor 20-40 mkd BID-TID 125/5 187/5
diHcl 2.5mkd
/Q8 250/5 375/5
>6y/o: 5-
Cefalexin 25-100 mkd Q6 125/5
10mkd
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
+
457/5 – 400mg Amox
Phenylpropan
Diazepam IV: 0.04-0.2 Q2-4 1/1
olamine
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
IV: 100-200 Q4/Q6
Betamethaso 2 weeks
Paracetamol 10-20 Q4 100/1 -drops
ne +
120/5
Clotrimazole 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