PEDIA NOTES

Stunting = actual height

x 100
ideal height for age

ANTHROPOMETRIC
WEIGHT

FLUIDS

<6 months
= age x 600 + BW
6-12 months
= age x 500 + BW
2-6 years
= (age x 2) + 8
6-12 years
= (age x 7) - 5
2

IVF rate = vol x weight

24h
FLUIDS
Weight (kg)

TFR=cc/k/d

0-3

75

3-10

100

10-20

75

20-30

60

30-40

50

LENGTH

>40

40

The average birth length is 50cm or

20inches. Total average gains in length
during the first year reach about 25 cm
distributed as follows:
From birth to 3 months..9cm
From 3-6 months8cm
From 6-9 months5cm
From 9-12 months.3cm

>50

30

Weight
At 4-5 months..2 x BW
At 1 year.3 x BW
At 2 years..4 x BW
At 3 years..5 x BW
At 5 years..6 x BW
At 7 years..7 x BW
At 10 years10 x BW

Height in:
Centimeter = age in years x 5 + 80
Inches = age in years x2 +32
HEAD CIRCUMFERENCE
For the 1st year of life
1st 4 months1/2 in/mo..2inches
Next 8 months1/4 in/mo.2inches
2nd year..1inch
3rd to 5th years1/2 in/yr.1.5 inches
6th to 28th years1/2 in/5yrs1.5inches
Catch up growth
= Cal for wt age x IBW for height
actual body weight

WATERLOWE CLASSIFICATION
Stunting

Wasting

Normal

>95%

>90%

Mild

87.5-95%

80-90%

Moderate

80-87.5%

70-80%

Severe

<80%

<70%

<7y/o or
<15kg

>7y/o or
>15kg

Initial IVF

0.3 NaCl

0.9 NaCl

Maintenance

IMB

NM

1g glc = 4cal
100cc

1g= 4 cal

D50: 1cc= 2 cal =0.5g glc

D10: 1cc= 0.4 cal =0.1g glc
D12.5: 1cc= 0.5 cal
D5: 1cc= 0.2 cal = 0.05g
Milk Formula
PT: 0.8 cal/ml 24/30cc
T: 0.6cal/ml 20/30cc
DEXTROSITY
= desired available
D50 available
= D12.5 D5
D50 D5
= 7.5
45
= 0.1666 x 100
= 16.66 (vol of D50W to be mixed with
D5IMB or D5 0.3 NaCl)
Normal Urine Output=1-2 cc/k/h

LUDANs
Wasting = actual weight x 100
ideal weight

<2y/o or
<10kg

>2y/o or
>10kg

Mild

50/8

30/8

Moderate

100/8
PLR x 1h
0.3 x 7h

60/8
PLR x 1h
0.3 x 7h

150/8
1/3 PLR x
1h
2/3 0.3 x 7h

90/8
1/3 PLR x
1h
2/3 0.3 x 7h

Severe

Appearanc
e

Blue

Pink

Completel
y pink

Pulse Rate

(-)

<100

>100

Grimace

(-)

Grimac
e

Cry, cough

Activity

Limp

Some
flexion

Active

Respiration

(-)

Slow,
irregular

Good,
strong cry

DENGUE (Dr. Lim)

0-3

75

8 cc/k/h

3-10

100

10-20

75

20-30

60

30-40

50

>40

40

1cc/k/h x 24 = 24 cc/k
2cc/k/h x 24 = 28 cc/k and so on
HEMOCONCENTRATION:

IV Ig 0.01-0.02 test dose mL/k/min

0.04 (max) mL/k/min
e.g. wt=14kg
dose 2g/kg
using 2.5g/vial, use 11 vials

NEONATOLOGY
NEONATES
DAY

Term

PT

SGA

70

80

80

80

90

90

90

100

120

110

110

150

130

120

180

140

160

210

160

180

240

160

200

270

1st day

<1kg D5W

>1kg D10W

2nd day

<1kg D5 0.3
or D5IMB

>1kg D10
0.3 or D10IMB

APGAR

Hypoglycemia
-push 2cc/k D10W
IV Ig (NICU)
Transfuse 0.1mL x 30min thru IV, WOF
tachycardia, hypotension, tachypnea, etc.
then give 0.5mL x 30min tehn 9.4 mL x 3hrs.

Infuse 8.4 cc/IV x30min thru perfusor pump.

WOF for chest pain, H/A, flushing, urticaria,
dyspnea, etc. Then infuse 32cc/h thru IV thru
perfusor pump until all vials are consumed x
17hrs. Open 1 vial at a time.

CONVERSION FACTORS

Hct

0.01

DRUG

DOSE

Hgb

0.155

Acyclovir

Plt

1101

Retic

0.01

A: 800 mg 5xD for 7D

CH: >6yo = 800mg
2-6yo= 400mg
<2yo= 200mg

TB

17.17

Amikacin

10-15 mkd OD-q8

Chole

0.026

Aminophylline

6mkdose (LD)
2.5mkdose (MD) q12

Crea

88.4

Amoxicillin

30-50mkd q8 po

FBS

0.56

Ampicillin

TPAG

10

50-100mkd q6
200-400

OT/PT

0.46

Calcium glucona

BUN

0.357

1 cc/k/d
<3yo = 2-5 tsp
4-12 yo = 2-3 tbsp

CSF Ca

0.5

Cefaclor-2nd

20-40mkd q8

CSF glc

0.005

Cefalexin-1st

25-50 mkd q6

Hgt

18.18

Cefipime-4th

50 mkdose BID

Cefixime-3rd

3-6mkd BID
1.5-3 mkd BID

Cefotaxime-3rd

50-100 mkd q12

Ceftazidime-3rd

100-150 mkd q8

Ceftriaxone-3rd

50-100mkd
neonates 20-50mkd

Cefuroxime-2nd

50-100mkd q6 IV
15-20 mkd BID po

Cetirizine
10mg/tab
10mg/ml
1mg/ml

A/Ch = 20 drops OD
6-12 = 10 drops BID
2-6 = 5 drops BID

Chloramphenicol

50-100mkd q6
FT: >2wks 25-50 mkd
PT & NB: 25mkd q6

Chloroquine

150mg/base=250mg
tab
10mg/k/base
5mg/k/base

Cimetidine

5 mkdose

Ciprofloxacin

20mkd BID

Cisapride

0.1-0.3 mkd TID-QID

for GERD

Clarithromycin

7.5mkdose BID

Clindamycin

Mild 8-16mkd q6
Severe 16-20 mkd q6

Cloxacillin

50-100mkd q6

Co-amoxiclav
312.5 (250mg/
5ml)
228 (200mg/5ml)
156.25 (125mg/
5ml)

30-50 mkd

ANTIBIOTICS

Co-trimoxazole

5-8mkd BID

Dexamethasone
(BPD)

0.5mg/k/d x 3 days
then 0.4, 0.3, 0.2
then DC for a total of
15 days or 2 weeks
0.3mkday then
0.1mkday or
0.5mg-1mkday q6
beginning 24h prior to
extubation &
continued for 4-6
doses

(laryngeal edema)

Metronidazole

LD: 15mkd
MD: 7.5 mkdose q8
30mkd q8 po

Midazolam

0.1-0.3 mkdose

Mycostatin

50,000 u/k/dose

Nalidixic acid

50-55mkd q6 po

Naloxone

0.1/mg/k/dose

Netilmycin

10-20 mkd q12-q8

Diazepam

0.2-0.8 mkdose

Oxacillin

100-150mkd q6

Diphenhydramine

1 mkdose IV
3-5mkday po

Penicillin G

Domperidone
(Motilium)

0.3-0.6 mkdose TID

AC

100-250T u/k/d q4-6

adult 300-600T u
q4-6

Phenobarbital

Erythromycin

30-50mkd q8
GERD: 1-6mkd BIDTID

10-20 mg LD
max dose 300mg

Piperacillin

200-300mkd q6

Prednisone

1-2mkd

PZA

15-30 mkd OD-BID

Ranitidine

1 mkdose IUV
2-4mkd TID po

Ferrous sulfate
30mg/5ml
15mg/ml drops

6mkday

Gentamicin

5-8mkd q12-q8

Hydrocortisone

5mkdose q8-q6

RIF

10-20 mkd OD

Ibuprofen 100mg/
5ml

10-20mkd q6

Salbutamol po

0.15mkdose

Imipinem

15mkdose q8-q6

Tazocin

Indomethacin
(PDA)

0.2mkdose x 3doses
q8
extended
dose-5doses more
OD or rpt the initial
dose
0.1 mkdose OD
q6days

100mkdose q12
Reconstitute 2g/vial
with 10cc H2O for
single inection & get
the desired mL from
the reconstituted
solution. Dilute
further with 10cc DW
to run for 30min.
VLBW 50mkdose q8

INH

5-10 mkd OD

Terbutaline po

0.075 mkdose

Loratadine

>12yo = 1 tab OD
10ml OD
2-12 yo 10ml >30kg
5ml < 30kg
1-2yo 2.5ml OD

Theophylline

2.5mkdose q12

Tobramycin

5-8 mkd q8

Vancomycin

30-40 mkday

Zinc

10mkdose?

Magnesium in
pulmo HPN

0.2cc/kg dose IV +
equal amount of
DH2O
200mg = 0.8 mmol/L
200mg = 250mg
0.8mmol
X
x = 1 mmol
1mmol = 1mL
dose: 0.2 mkdose q8

Mannitol

1-2 cc/k

Meropenem

10-20mkdose BID
meningitic = 40
mkdose q8

Metoclopramide

0.1-0.3 mkd TID-QID

for GERD

PARACETAMOL: 10-20 mkdose

MEFENAMIC ACID: 10-20 mkdose
AMBROXOL: 0.15-0.30 mkdose TID

SHOCK
1.
2.
3.
4.
5.
6.
7.
8.
9.

consciousness
color
respiratory effort
temp
CRT
Heart rate
pulse
BP
UO

Naproxen Test
! 10 mg/kg
(+) feverinfection
(-) fevertumor

Dopamine drips
Wt x 480 x dose = cc /8hour to make 8cc of
D5W to run at 1cc/hr
40,000

DRIPS
Epinephrine Drip

Glucose Infusion
Rate

Dose 0.2-2
Wt x dose x 6=
20
1 mL + 24cc
D5W=0.5cc/h
1 mL + 49cc
D5W=1cc/h
= Dextrosity x IVF
rate
_________60_____
___
weight

Dopamine (NICU)
40mg/mL=200mg/
5mL
1ml =40mg =
0.8mg/cc
50cc 50cc
0.8 x 1000= 800ug/
cc
1cc=1000ug

= wt x 30mcg
prep (40)
=___cc/hr

Dobutamine
25mg/mL=250mg/
10mL

= wt x 30mcg
50

=wt x dose x 60s

strength 800ug
= cc dopa
= wt x 6 (rule of 6)
40

Dobutamine drips
Wt x 480 x dose = cc/8hour to make 8cc of
D5W to run at 1cc/hr
12,500
Length of umbilical vein catheter : wt x 3 + 9
2+1
Length of umbilical artery catheter : wt x 3 +
9
NaHCO3 drips (154 / 75 / 50 using D5imb,
D5 O.3 or D5 O.9)
full correction : wt x TFR x 154 = cc of
NaHCO3 to be diluted in total TFR
1000
Can be make in 8 hour running rate. The
TFR should divided in 8 hour
In PPHN : PH : above 7.5
pCO2 : 22-25
pO2 : higher
MgSO4 drips
LD: wt x 300 = diluted with D5W to run in 2
hour
M : wt x 30 = to run in 24 hour
NEUROLOGY

Vamin

Bricanyl drip

Aminophylline drip

Albumin

7 g/100cc
dose 1-2
7g = wt x dose
100
x
wt x TFR= vol of
vamin q8
3
D10 IMB:
D5 IMB ________
D50W (.11 of
TFR)
Vamin ________
Wt x dose x 60=
10
Mix 1 amp of 500ug
Terbutaline to 49cc
D5W to run at
____cc/h
Dose: 0.1-0.4ug/k/h
Dose 0.1-0.4
D5W 250cc + 1amp
APL to run at ___cc/
h
Wt x dose= running
rate
WOF hypotension,
tachycardia, BP q1
1 g/k (12.5g/50mL)
1.1 x 1g/k x 50 =
12.5

Post- LP Orders
flat on bed

NPO

Send specimen

Bottle 1: gross exam, Total cell

count, Sugar, Protein
Bottle 2: AFB, GS/CS
Bottle 3: save
Normal CSF values
Cell ct > PT
106cells/
L

NB

Neon
ate

Ther
eafte
r
0-5

Mono

0-25 0-20

0-5

Poly

0-10 0-70
0

0-25

RBC

0-10 0-800
00

0-50

NB

Infant/
child

There
after

1.66
-4.4
4

3.33/4.44

2.223.88

Glucose

CSF Leukocyte Diff Count

Lympho

62 + 34

Mono

36 + 20

Neutron

2+5

Histiocytes

0-rare

Ependymal cells

0-rare

eosinophils

0-rare

Modified GCS for Infants

24h protein= mg/m2/day

=mg/m2/hr
Glomerular Inf Rate GIR
= ht in cm x constant (0.55)
serum crea
HEMATOLOGY
Platelet = 1 u = 10,000 inc
= 1 u/ 10kg
dec PT = give vit K
dec PTT = give cryoppt 1 u/7kg
dec PT & PTT = give FFP 10-15cc/kg

EYE
Spontaneous 4
To speech
3
To pain
2
None
1
VERBAL
Coo/babbles
Irritable/cries
Cries to pain
Moans
None

TFR= 400 x BSA + UO

(+) furo=UO/2

PRBC 10-15 cc/kg

FFP 15 cc/kg
Plt con 1u/10kg
Cryoppt 1u/7kg
Absolute retic count (0.5-1.
=observed retic count x RBC
=observed Hct x observed retic
desired Hct

5
4
3
2
1

MOTOR
No spontaneous movt
Withdrawal to touch
Withdrawal to pain
Flexion
Extension
None

6
5
4
3
2
1

COMA Scale
Birth-6months

6-12months

11

1-2years

12

2-5years

13

>5years

14

ENDOCRINOLOGY

Blood Transfusion
= desired HCT-actual Hct x wt or
= desired Hct actual Hct x blood vol
=
wt x 80
Hct to be transfused (0.7)
Phlebotomy
Estimate Blood Volume (80-100)
1. wt x bld vol x10-15%
e.g. 10 x80x 10-15% =60
2
60cc blood in 10 cycles
6cc/cycle
2. hydrate patient (mild/6-8h, PNSS
3. Run 60cc PNSS x 1h
4. extract blood
5. Dormicum 0.1mkdose
6. Use gauge 16/18

Diabetic Ketoacidosis

Exchange Transfusion

PNSS 150 cc/h8h

--16h
if Hgt is 250 mmol use D5 NSS

Blood vol 80 x 2
160 x wt (1.8)=300cc
in 5cc, out 5cc
Ca gluc for every 100-200cc blood
Req for: CBC, electrolytes, TB, B1, B2

NEPHROLOGY
BSA
0-5 kg x 0.05 + 0.05
6-10kg x 0.4 + 0.10
11-20kg x 0.03 + 0.2
>20kg x 0.02 + 0.4
BSA= wt x ht (sq root)
3600
< 10kg = kg x 4 + 9
100
> 10kg = wt x 4 + 7
wt + 90

ELECTROLYTES
ELECTROLYTE COMPONENT

Def: vol x % = cc
M: wt x (2-3) = cc
Potassium
Infusion Rate 0.02-0.04 meq/k/h
M: 2-4 mkd
Peripheral 6meqs
Central 8meqs
Digitalization
Dosage of oral prep 50mcg/ml
Age
TDD
Maintenance
Mcg/kg
mcg/kg/day
Pt
20
5
NB
30
8
< 2yo 40-50
10-12
> 2yo 30-40
8-10
Maint: 25% of TDD in 2 divided
doses
Ex 3mo, 5kg
5 x 40 divide by 4 then divide by 2
= xml per dose q 12hr
Do not give if CAR below normal
HR

Na

Cl

lactose

IMB

25

20

22

23

NM

40

13

40

16

LR

130

109

28

NR

140

98

50

0.3

51

51

0.45

75

75

0.9

154

154

Metabolic Acidosis
=wt x 0.3 x BEp
NaHCO3 + equal amount of DH2O
Give of full correction
Give NaHCO3 if
! pH < 7.25
! pCO2 <15
! BE > 6
Calcium Gluconate
=2 cc/kg
Na Correction
M: 2-3 meqs /day
=desired actual x 0.6 x wt + (wt x2)
K correction 50meqs/k
3.5-5.5 = N
3 3.4 =5%
2.5 -2.9 = 10%
2 2.4 = 15%
< 2.0 = 20%
K infusion rate: 0.2-0.5 meqs/k/h
Wt x 50= ____meqs

PULMONOLOGY
CPAP
F1O2 = (CA x 0.21) + (PA x 1)
TFR
TFR = CA + PA
CA= compressed air 21%
PA= pure air 100%
TFR= TV + RR x 2-3
Pleural Fluid
Transudate

Exudate

pH <7.30

Cytology

Few cells

WBC >
1000/m3

Pleural fl
prot
Serum prot

<0.5

>0.5

Pleural fl
LDH
Serum LDH

<0.6

>0.6

Pleural fl
LDH

<200 iu

>200 iu

Pleural fl
prot

<3 g/dL

>3 g/dL

Glucose

>60mg/dL

<60mg/dL

Indications for CTT

1.
gross pus in pleural space
2.
organisms visible in GS of pleural
fluid
3.
pleural fluid glucose <50mg/dL
4.
pelural fluid pH >7 & 0.5 units
lower than arterial pH

Total Flow Rate

NB=5,6,7
CA = room air 21%
PA = O2 100%

93cc x 24 x 6 = 133 meq/day

100
(KIR=
133 : 24hr : 15kg = .36) if using mild
Hydration

FiO2 = TFR x 4 + 20
e.g. 1 = 24 %

correction will be finished in:

133meq : 24hr = 5.5meq / hour
180 : 5.5meq = 32 hour
Correction ideal : minimal in > 24 hour

ET size
= 16 + age (yr)
4
Gestational Age
<30weeks
2.5
30-34 weeks
3.0
>35 weeks
3.5
Infant Wt (g)
1000.
2000.
3000.
4000.

Length (cm)

7
8
9
10

Pressure Controlled Ventilator

N lungs

RDS

PIP

12-18

20-25

PEEP

2-3

4-5

Rate

10-20

20-6-

I:E Ratio

1:2-1:10

1:1-1:3

Na correction:
Ex: 15kg Na: 128 TFR: 30/8 ( 56cc/hr)
Na deficit: 15 x .6 x (135-128) = 63
Na maintenance ( 2x BW)
= 30
93
Using D5 .9NaCL:
93 x 1000 = 603 cc of D5 .9 NaCl
154
Correction will be finished in : 603 / 56 = 10
hour (too fast)
If using d5.3 NaCl : 93 x 1000 = 1823cc
51
correction will be finish in 32 hr
(mabagal) better using D5 .45 or decrease
the IV rate.
Correction ideal : minimal in > 24 hour
K correction:
Ex: 15kg K; 1.2 TFR 75 ( 46 cc/hr)
K deficit : 15 x .20 x 50 = 150
K maintenance 2 x BW = 30
180
Try compute with max dose
of KCl incorp 6 meq / 100cc IVF
( peripheral line)
K infusion Rate : ..2 - .5 meq/kg/hr
46cc x 24 x 6 = 66meq / day
100
(KIR=
66 : 24hr : 15kg = .18) if using maintenance
rate
Try increase to mild hydration 50/8

Dopa Dobut drip using rule of 6

Dopa 0-3 ( renal) if more than 10
( vasoconstriction and tachycardia)
Ex: 15kg Dopa 10 Dobut 15
Rule of 6:
Dopa: 15 x 6 = 90mg : 40 = 2.2ml
Dobutamine :
(15 : 10) x 90 = 135mg : 50 = 2.7 ml
Preparation:
Dopa:
2.2 ml + Dobut 2.7ml + D5W 95.1ml = 100ml
Running rate: 10 cc/hr
To check Dopa and Dobut drip.
Wt x dose x 60 (second)
concentration
Concentration of Dopa:
90mg in 100ml
90000 : 100 = 900 microgram in ml
Concentration of Dobut:
135mg in 100ml
135000 : 100 = 1350 microgram in ml
Dopa: 15 x 10 x 60 = 10cc/hr
900
Dobut: 15 x 15 x 60 = 10cc/hr
1350
without RULE of 6 (as general)
15kg
Dopa 1ml (40mg) to be diluted in 50 ml of
D5W
Desired dose 10
The running rate is ?
Concentration : 40000 : 50ml = 800
microgram in ml
Running rate : 15 x 10 x 60 =11.2cc/hr
800
Patient with septic shock:
Hydrate with PNSS or PLR 20 40cc/hr
Start Dopa and Dobut
Give Calcium gluc
Mg Sulfate computation
Loading Dose 200mg/kg/dose X 2 hours
MD 30mg/kg/dose X 24 hours
Eg: BW 3kg
200mg x 3kg x 20/ 5000 = 2.4cc x 2 hours
30mg x 3kg x 24 x 20 / 5000 = 8.6cc x
24hours
via perfusor pump
WOF urine output
NICU
Adrenaline drips in D10 water

0.3/kg in 25ml dose 1ml/hr equivalent

0.2micro
Dopamine and Dobutamine in D10 W
30mg/kg in 25 ml dose 1ml/hr equivalent 20
micrograms