ARTERIAL BLOOD GAS

Acidosis
Alkalosis

pH
pCO2
pO2
HCO3
BE
O2 sat

ph<7.35
ph>7.45

Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
Hypoxemia pO2 <85

pCO2 >45
pCO2 <35
HCO3 <24 dec BE
HCO3 >24 inc BE

At birth
Birth to 3 months
3-6 months
6-9 months
9-12 months
1 year and above

Note:
For every 10mmHg pCO2 = pH of 0.05
For every 10mmHg pCO2 = pH of 1

pH

Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis

BLOOD GAS ANALYSIS

NB & Infants
Children & Adults
7.25-7.45
7.35-7.45
27-40
35-48
54-95
83-100
20-22
22-27
-10 to -2
-7 to -1 + 2
40-90
95-99

HCO3

pCO2

MECHANICAL VENTILATOR
NICU: FiO2 100
Pip/PEEP: 18/4
TV: wt x 10 x 6 8
IT -0.5 18cc

1-4 months
4 -12 months
1-2 years
3-5 years
6-20 years

DESIRED LENGTH
50 cm
+9 cm
+8 cm
+5 cm
+3 cm
Age in years x 5 + 80

3cm/month
2.67cm/month
1.6cm/month
2cm/month

HEAD CIRCUMFERENCE
+ 5.08cm (1.27cm per month)
+ 5.08cm (0.635cm per month)
+2.54cm
+3.81cm (1.27cm per month)
+3.81cm (1.27cm per month)

WATERLOW CLASSIFICATION
Wasting
Actual weight
x 100
Ideal weight for actual length/height

Child: PEEP 2-4cm H2O

PIP = 20-30 cm H2O
Rate 16-20
TV: 10-15ml/kg

Classification: Normal 90%, Mild 80-90%, Moderate 70-80%, Severe 70%

Stunting

Pressure Vent: Restrictive Lung Disease

Volume vent: Non pulmo
TV : wt x 10

Actual Height/Length
Ideal Length/Height for Age

x 100

Classification: Normal 95%, Mild 90-95%, Moderate 80-90%, Severe 80%

AC control: with peep

SIMV: back up
T piece: Fio2 only

Head Circumference
0-3 months
3-6 months
6-9 months
9-12 months
1-3 y/o
4-6 y/o

(cm/mo)
2
1
0.50
0.50
0.25
1cm/yr

RDA (kcl/kg)
115
110
100
100
100
90-100

DESIRED WEIGHT
At birth
< 6 months (Kg)
>6 months (Kg)
2 6 years old (Kg)
6-12 years old (lbs)

3kg (Filipino) or 3.25kg (Caucasian)

Age in months x 600 + birth weight
Age in months x 500 + birth weight
Age in years x 2 + 8
Age in years x 7 + 5

AGE OF INFANT
4-5 months
1 year old
2 years old
3 years old
5 years old
7 years old
10 years old

IDEAL WEIGHT
2 x birth weight
3 x birth weight
4 x birth weight
5 x birth weight
6 x birth weight
7 x birth weight
10 z birth weight

AGE
Preterm
0-3 months
3-6 months
6mons -1 y/o
1-3 y/o
3-6 y/o
6-12 y/o
12 y/o

HR
120-170
100-150
90-120
80-120
70-110
65-110
60-95
55-85

RR
40-70
35-55
30-45
25-40
20-30
20-25
14-22
12-18

BP
55-75/40-70
65-85 / 45-55
70-90 / 50-65
80-100 / 55-65
90-105 / 55-70
95-110 / 60-75
100-120 / 60-75
100-135 / 65-85

ENDOTRACHEAL TUBE SIZE

ET Size = age in years +4
4
Size in mm= 16 + age in years /4
ET Level= ET size x 3 OR Add 6 to infants weight
Weight
<1000
1000-2000
2000-3000
>3000
NB
Infant
1 year
3years
6years
10years
Adolescent
Adult

Gesta age
<28
28-34
34-38
>38

Tube size
2.5
3.0
3.5
3.5-4.0
3.0-3.5
3.5-4.0
4.0-4.5
4.5-5.0
5.0-5.5
6.0-6.5
7.0-7.5
7.5-8.0

Plan B
Weight (Kg) x 75mL to be given in 4 hours
Plan C
Age
<12 months
>12 months

<15 Kg
>15 Kg
Mild

30cc/kg
st
1 hour
30 minute

70cc/kg
5 hours
2 hours

ORAL REHYDRATION SOLUTIONS

Na
Cl
K
WHO/ DOH
90
80
20
Pedialyte 45
45
35
20
Oreges (250mL)
90
80
20
Hydrite (2/200)
90
80
20
Glucolyte (per L)
63
50
20
Formulated ORS
50
50
20
Reformulated ORS
75
65
20

Ludans: hydration
LUDANS HYDRATION
MILD
MODERATE
50
100
30
60

WHO Hydration
Plan A
<24 months
50-100mL
2-10 years old 100-200mL
>10 year old
Ad libitum

SEVERE
150
90

Wt x factor (50 or 30) = _ugtts/min D5 0.3 NaCl

6 or 8 hours
Moderate
Wt x Factor (100 or 60) = _cc
1st hour: 1/4 (PNSS or PLR) to run for 1 hour
Next 7hours: 3/4 (D50.3NaCl) to run for 7 hours
Severe
Wt x Factor (150 or 90) = _cc
st

1 hour: 1/3 (PNSS or PLR) to run for 1 hour

Next 7hours: 2/3 (PNSS or PLR) to run for 7 hours
IVF
Use PLR if with UO, PNSS if without UO
Use D5.03 if 0-7 years old, D5LR if 8-10 years old

HOLIDAY SEGAR
100 x Weight
24hours
>10Kg: Weight -10 x 50 + 1000
24 hours
>20Kg: Weight-20 x20 + 1500
24 hours

Glucose
111
140
111
111
126.53
20
75

TOTAL FLUID REQUIREMENTS (TFR)

0-1
150 mkD
1-3
140 mkD
4-6
120 mkD
7-9
100 mkD
10-12
90 mkD
13-15
70 mkD
16-17
50 mkD
BSA
0-5
wt x .05+ .05
6-10
wt x .04+ .1
10-20
wt x .03+ .2
20-40
wt x .02+ .4
> 40
wt x .01+ .8
Hema/Endo:
Square root of wt x ht
3600
FLUID LIMITATION
ER: BSA X 500
Wards: BSA X 400 + UO in 24hrs

<10 Kg:

IVF:
<20Kg: D5IMB (500cc is the only preparation)
>20Kg: D5NM

DEXTROSITY
D5

D7.5

D10

D12.5

D15

D17.5

D20

.055

.11

.17

.22

.28

.33

D50
1.0

Add 10% if there are losses (Fever, vomiting, lbm)

DEXTROSITY
Example

GLUCOSE INFUSION RATE

NB and Infants = 6-8mg/kg/min
Children = 4-6 mg/kg/min

Inc dextrosity from D5 to D7.5

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

= 66cc
= 4cc
70cc x 8-9ugtts/min x 3doses

GIR = 0.167 X Dextrosity X ugtts/min

Weight

INTRALIPID
Prep: 10% , 20%
Dose: 0.5-3g/kg/day ; inc by 0.5 until 3 is reached
20% = 20g/100ml
Ex: Wt 2.35kg
Wt x 3 x 100 x 1.1
20

=====
NEWBORN WEIGHT GAIN

= 38cc x 20-24hrs at 1.9cc/hr

th

Birth weight regained on 10 DOL; 2-3 wks preterm

Preterm: 15-20gm/day
Term: 20-30gm/day
Fullterm: age in days 10 x 20 +BW
Preterm: age in days 14 x 15 +BW

MAGNESIUM SULFATE
Prep: 250mg/ml
LD: 100-200mg/kg/dose over 30mins
MD: 20-30mg/kg/day
Ex: wt = 3.2kg

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

Loading dose: Wt x 200

= 3.2kg x 200 = 640mg / 250
= 2.56cc + EAD in 30mins

B. Preterm
AGA (>2.5kg)
LBW (<2.5kg)
VLBW (<1.5kg)
ELBW (<1kg)

Maintenance dose: Wt x 30
= 3.2kg x 30 = 96mg x 24hrs
= 2304mg / 250
= 9.2ml in 24 hrs

70cc/kg/day
70CC/kg/day
80cc/kg/day
100cc/kg/day

C. Types of Fluids
1st 24hr : electrolyte free, D5W, D10W
Next 24hrs: with electrolytes, D5 0.3NaCl then D5imb
D. TPN
Electrolytes Preparation
NaCl
KCl
10% Ca gluc
7% AA

2.5mEq/mL
2 mEq/mL
100mg/mL
7g/100mL

Order:
Mg SO4 9.2ml + D5W 14.8ml to make 24cc to run at
1cc/hr for 24hrs
250mg/ml
LD: 100-200mg/kg/dose over 30mins
MD: 20-30mg/kg/day

Normal
2-4 mEq/kg/day
1-3 mEq/kg/day
100-400 g/kg/d
0.5-3 g/kg/day

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

KCl: 2mEq/kg/day X wt / 2 mEq/ml X 1.1 / 3
Ca: 200g/kg/day X wt / 100g/ml X 1.1 / 3
AA: 3g/kg/day X wt 100 X 1.1 / 3
7

CPAP
Settings
FiO2
60%
80%

O2
3
4.5

PEEP
6

FiO2 and PEEP = already set

1.

Determine CA first

2.

CA = 100 FiO2 X PEEP (60-80) x 4-6

79 (K)
PEEP CA = O2

DEXTROSITY
D10 = ___ml D50-50
D10 = 10
D7.5 = 7.5

CA
3
1.5

Dr.Murallon CPAP
D50-50 = (10 x TFR) 5 (TFR total electrolytes)
45 / 3

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

compressed air + O2

D5W = TFR Electrolytes D50 = ____ / 3

To check, compute D10
50 x D50-50 =
5 x D5W = ______
Total divided by TFR
If < 10: correct

ex. 5 (0.21) + 1 = 0.34

6
BPD regimen
Budesonide q8
Salbutamol q6
Furosemide q12

G-CSF (granulocyte-colony stimulating factor)

Brand: Filgrastim
Prep: 300mcg/ml
Dose: 5mcg/kg/day OD IV or SQ
To boost the immune system
Stimulates the production of WBC
SODIUM
Deficit: (desired-actual) x wt x 0.6
137 - 129 x 11 x 0.6 = 53
Maintenance: wt x (2-3meq)
Deficit + Maintenance = total infusion
st
Give 50% - 1 8 hours
25% - next 8 hrs
25% - next 8 hrs
Normal:135-145 meq/L
Significant hyponatremia: 120 meq/L
Maintenance dose: 2-3 meq/kg/24 hr
Prep: 2.5meq/ml/amp
Fast Correction: (values <120meq)
4ml/kg of 2.5 meq/ml prep
(For every ml of NaCl = 4ccsterile water)

POTASSIUM
Nephro
0.2-0.3meq/kg/hr
Ex. Wt = 10kg
0.2 x wt (10) = 2meq x 24 hrs = 48meqs (deficit)
2 x wt (10) =
20meq (maintenance)
68 meqs
Prep: 2meq/ml
Intensivist
Wt x 50 x transcellular K = ____ / 3
Transcellular K = 50mmol/kg
2.5 3
0.05 (5%)
2 2.5
0.10 (10%)
1.5 2
0.20 (20%)

NEPHROLOGY
ESTIMATED GFR
Ht in cm x 0.55 /serum crea (mg/dl)
Ht in cm x BSA x 0.48 /serum crea x 1.73 m2
Values:
90-120mL/min
< 89 mL/min
< 30 mL/min
< 10 mL/min

CREATININE CLEARANCE
Creatinine Clearance ml/min
For urine vol > 1liter
= TV ml x Ucr mg% x 1.73m2
1440 min x Crea mg% x bsa
For urine volume <1 liter
= wt kg x [140-age] x 0.85
72 x Serum crea mg % x bsa
Creatinine clearance
= K x height (cm)
Plasma crea (mmol/L)
K= 29 (<2.5 kg)
40 (0-18mos)
49 (2-16yrs girls)
49 (2-13yrs boys)
62 (13-16 yrs boys)

Normal
Renal impairment
Renal insufficiency
Renal failure 5-20
Uremia

80-120
50-80
20-50
<5

To get % = creatinine clearance divided by 120

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

Cardio
Desired actual x wt x 0.3 = deficit
Wt x 2 meq/kg/day = maintenance
Deficit + Maintenance = total infusion q8
3
40meq/day/L = maximum; excess will cause arrhythmia

Normal
Renal Insufficiency
CRF (Chronic Renal Failure)
ESRD

TOTAL PROTEIN SPILLAGE

=UTP / bsa - g/day
=1000xUTP / BSA x 24hmg/m2/hr
N = <4mg/m2/hr or 100mg/m2/day

100-300 mg/kg/day
Prep: 100mg/ml

For nephrotics
=if >40mg/m2/hr or 4g/day
start pred at 60mg/m2

Ex 2.6kg
2.6x100x 1= 2.6 /3 = 0.9cc in IVF for 8 hrs
100

Normal : 20

CALCIUM

0.9ml of 10% Ca gluc add in 100 ml

NaHCO3
Base excess x wt x 0.3 (half correction)
X 0.6 (full correction)
To be given as 50% slow IV push
50% incorporate in IVF to run 6-8hrs
1-2meqs/kg if deficit is too large
CHLORIDE: 5meq/100ml

ANION GAP

Na - ( HCO3 + Cl )
134 (12 + 98) = 24
ALBUMIN TRANSFUSION
Prep: 12.5gm/50ml (25%) OR 10gm/50ml (20%)
Dose: 0.5 - 1gm per day;
1ml = 0.25gm to run for 2-4hrs as q12 or OD
Wt 0.81
Wt x 50 = 3.2ml
12.5

Ca Carbonate (TUMS)
Prep: 500mg tab
Dose: 50mkD
Ca Gluconate
Prep: 10cc/vial
Max 10cc vial + EAD q8 SIVP in 30mins
Alkalka
Prep: 10mg tab = 10meq
Dose: 1-2mkD
May give 2 tabs q8
K: 0.2-0.5kg/hr, inc to 0.5 if sx noted

ACUTE GLOMERULONEPHRITIS
Typical course
Latent
: few days- 3 wks
Oliguric
: 7 - 10 days
Diuretic
: 7- 10 days
Convalescent : 7 - 10 days
Normalization of urine sediment
Gross hematuria
: 2 - 3 wks
Complement level : 6 - 8 wks
Protenuria
: 3 - 6 mos
Micro- hematuria : 6 - 12 mos
Bladder capacity: y/o x 2 oz x 30

NEPHORITIC SYNDROME
Prednisone
>40mg/kg/day, hypoalb <2.5mg/dl
60mg/kg/day x 4-6 weeks theN
40mg/kg/day (am) x 2-3mos alternate day dose
If steroid resistant: +2protein q 8 weeks
steroid dependent: relapse within 28 days
frequent relapse: relapse >12x per month
Cyclophosphamide
2-3mk/24hrs single dose 8-12wks
500m/kg/m2/day x 3-5days
(max 1g/day x 3days)
Methylpred 30mkD x 3-5days (max 1gm)

24 HOUR URINE PROTEIN

Urine protein = 1.12
100mg/g x urine protein
BSA x 24 hours
Example
100 x 1.12 = 6.86 normal
0.68 x 24

URINE CONCENTRATING ABILITY

Osmolality
Urine osmolality : more precise that usg
Urine osmolality = (usg-1.000) x 40000
Normal = 400to 600 mOsm/L
Serum osmolality = 2Na + {glucose (mg/dl)/18} + {bun
(mg/dl)/2.8}
Normal = 230 to 300 mOsm
Urine Specific Gravity
Each 15 mmol/L (2.7 g) glucose : inc USG by 0.001
Each 4 g/L Protein : inc USG by 0.001

Normal bladder residual <5cc or 10% of bladder

capacity means greater risk for UTI
Clean catch : >100,000/ml
catheter : >100/ml
suprapubic : 1 col/ml

NEPHROTIC SYNDROME
Remission: protein free/ edema free x 3-4 mos
Relapse: recurrence of edema & or proteinuria
Steroid responsive: (-) protein after 4-6 weeks
Steroid resistant: (+) protein after 4-6 weeks of
continuous daily divided doses of prednisone (60mkd);
use methyl prednisolone
Steroid dependent:
- if you withdraw the tx, protenuria recur
- 2 consecutive relapses occurring during therapy
or w/in 14 days of completing steroid therapy
Frequent relapser
- responds to corticosteroid treatment but
experiences 2 relapses w/in 6 mos after the
initial response
- has 4 relapses w/in any 1 yr

RENAL FAILURE STAGES

Diminished renal reserve
GFR 50-80
may still be asymptomatic
Chronic renal insufficiency
GFR 30-50;
Hypocalcemia; decrease tolerance to stress
Chronic renal failure
GFR 10-30
Anemia,hpn, bone problem, metab
disorder
dialysis
End stage renal disease
GFR <10
Kidneys are small and contracted
dialysis, kidney transplant

DIABETIC KETOACIDOSIS
Antibodies:
1CA, 1AA, GADA, 1A2
(if + should wof development of dm in the future)
Start of symptoms:
80-85% of islet cells have been destroyed
Diagnosis: (Signs and Symptoms +)
FBS more than or equal to 126 or RBS more than
200
heavy glycosuria (more than 55mmol/L)
possible ketonuria
Additional workups: insulin levels, c-peptide
Management:
Fluid requirement in 48hrs: 2 FM + deficit
48
Deficit: wt x 30
48 hr maintenance dose: 2 x FM

DIABETIC KETOACIDOSIS2

DIABETIC KETOACIDOSIS4
Transition of Insulin IV to SQ

Clinical improvement

No acidosis

Oral intake
to prevent rebound hyperglycemia, stop iv infusion only
after 60min of giving the 1st sq injection of regular
insulin
Split-mixed insulin injection:
<2yo =0.5u/kg/day
>2yo = 1u/kg/day
pubertal = 0.8-1.5u/kg/day
AM: 2/3 = 2/3 intermediate + 1/3 short
PM: 1/3 = 2/3 intermediate + 1/3 short
Fluids with the CBG of:
>300: PNSS 1L + 40meqs KCl x 28gtts/min
100-300:
D5 0.45 NaCl x 28cc/hr (D5W 500 + D5 0.9 NaCl +
40meqs KCl)
<100:
D10 0.45 NaCl x 28cc/hr (D10W 500 + D5 0.9
NaCL + 40meqs KCl)

Insulin drip:
>2yo = 0.1u/kg/hr
<2yo = 0.05u/kg/hr
make 5u in 50cc pnss or
10u in 100cc pnss to run __cc/hr (running rate is
equivalent to weight in kg)
ECG
Na, K, Phos, Mg, Ca
Hba1c
FBS
BUN, Crea
ABG
Urine ketones
Strict uo q1 with monitoring sheet at bedside
May start NaHCO3 at 1meq/kg sivp to run for 30 mins
DIABETIC KETOACIDOSIS3
If plasma glucose =14-17mmol/L (250-300) give PNSS
If less than 250 CBG give D5 0.45nacl to prevent rapid
decrease in plasma glucose conc and hypoglycemia:
500 d5 0.9 nacl + 500 d5w = d5 0.45 nacl
If less than 100 CBG give D10 0.45 NaCl
When rbs is decreasing by > or = 100mg/hr, may titrate
insulin drip by 25% until 0.05u/kg/hr

PHLEBOTOMY
FFP transfusion:
Wt x EBV (70-80) x 0.15 (.10-.15)
Give 30-1hr before phlebo, then remaining
during phlebotomy
PNSS can be also be used
1meq/kg NaHCO3 if with hypoxic spells

NUTRITION
Daily requirements per kg desirable Body Weight
(Filipinos) for Calories and Proteins:
Age
0-5 mos
6-11 mos
1-2yrs
3-6yrs
7-9yrs
10-12yrs
13-15yrs
16-19yrs

cal/kg
115
110
110
90-100
80-90
70-80
55-65
45-50

protein g/kg
3.5
3.0
2.5
2.0
1.5
1.5
1.5
1.2

1g cho = 4 cal
1g chon =4 cal
1g fats = 8 cal
1000cal = 1kcal
1kcal = 4.184 kj
In general, the ave distribution of calories would be:
11% = proteins
35% = fats
60% = carbohydrates

NUTRITION
Approximate daily water requirements of filipino
infants and children
Age
0-3days
10days
1-5mos
6-12mos
1-3yrs
4-6yrs
7-9yrs
10-12yrs
13-15yrs
16-19yrs

Water (ml/kg)
120
150
150
150
140
120
100
90
70
50

ANALGESIC & ANTI-PYRETIC

60-80 mkD
st
T: 80mg, 100mg, 325mg
RHD: 100mkD (1 2 wks), 75 mkD
(4 wks)
Anti-inflammatory: 60-90 mkD
Kawasaki: 80-100mkD q6
Indomethacin
1-2 mkD x 3 (PDA)
Aspirin

C: 100mg

Ibuprofen

6-8 mkd q6

D: 100mg/2.5mL
S: 100mg/5mL, 200mg/5mL
C: 200mg, 800mg

Mefenamic Acid

6.5 mkd q6

S: 50mg/5mL
C: 250mg, 500mg

Meperidine
Midazolam

6 mkD/ 0.5-1 mkD

0.2 mkd

T: 15mg
V: 1mg/mL, 5mg/mL

Morphine

0.1-0.2 mkd q6 (max 15mg)

T: 10mg, 30mg, 60mg,

100mg
V: 10mg/mL

Nalbuphine

0.1-0.2 mkd IM, IV

V: 10mg/mL

Naproxen

5-7 mkD q8-q12 (>2y/o)

T: 275mg, 550mg

Paracetamol

10-15 mkd q4

D: 100mg/mL
S: 120mg/5mL, 250mg/5mL
T: 80mg, 500mg
V: 150mg/mL, 300mg/2mL
Supp: 125mg, 250mg