MultiVitamins:

Ascorbic acid
Drops 100mg/mL: Syrup: 100mg/ml

<3mos: 0.3ml/day 2-6y/o: 5ml/day

3-12mos: 0.6ml/day 7-12y/o: 10ml/day
1-2y/0: 1.2ml/day

Vit. B complex + hysine + beclizine (Appebon syrup)

2-6y/o: 1-2tsp OD
7-14y/o: 2-4tsp OD
Iron wtx5/elem Fe
1mkday OD- prophylactic Hemarate 30/5
3-6mkday BID-therapeutic Iberet 26.25/5
Zinc RD 10-20mg/day Incremin 30/5
10mgdrops- infant Sangobion 12/10
20mg- >2yo Ferlin 30/15
Folic acid
2.5g/ml
0.2 mkday
Vitamin A
6-11mos: 100,000IU 1 dose
12-71mos: 200,000IU
<2yrs: drops
10mg/ml=1ml
>2yrs: syrup
20mg/5ml= 5ml

Analgesics/Antipyretic
Paracetamol (Q4h) Mefenamic Acid (q6-8hr)
 RD: 10-15mkdose PO RD: 5-8 mkdose
10mkdose IV Susp: 50mg/5ml
15mkdose-BFC 125mg/5ml
Drops: 100mg/ml Cap: 250mg/500
60mg/0.6mk
Syrup: 120mg/5ml Aspirin (Q4-6H)
125mg/5ml RD: 10-15mg/kg/dose upto
350mg/5ml 60-80mg/kg/24h
Tab: 325mg/tab Anti-inflam:60-100mg/kg/
250mg/tab 24hPO
500mg/tab Kawasaki: 80-100mkday
Amp: 150mg/ml
300mg/ml Nimesulide (BID)
RD: 2.5-5mkdose
100mg/tab

Ibuprofen

RD: 5-10 mg/kg/dose

PO Q6-8H
Susp: 100mg/5ml
Forte: 200ng/5ml
Cap: 200mg

Antacids
Ranitidine (Q8h-12h) Famotidine (Q12h/IV-Q8h)

RD: 0.75mkose PO RD: 0.2mkdose

0.8-1mkdose IV Amp: 25mg/2ml
Amp: 25mg/ml, 50mg/5ml Tab: 20mg/40
Tab: 150mg/300mg

Cimetidine (Q4-6h) Omeprazole

 RD: 10-15mkday 1mgkday
<1y.o: 20mkday
1-12y.o: 20-25mkday
Liquid: 100mg/5ml
Amp: 150mg/ml, 100mg/ml
Tab: 200mg, 400mg

AlMg (Maalox) (Q6h) Ursofalk

2-4 tabs max: 16tabs 10-15mkday

*take 30 minutes 1 hr after meal 200/5ml
at bedtime
Susp: 180ml; 355ml
Tab: chewable
Fw/flatulence-Almg+dimeticone
(Maalox plus)

Anti-emetic/ Anti-spasmodic
Metoclopramine Nifuroxide (Ercefuryl)

RD: 0.5mkdose PO <6mos- 10ml

0.2mkdose IV >6mos- 5ml
Amp: 10mg/2ml, 5mg/2ml Adult: 1cap Q6H
Syr: 5mg/5ml Susp: 220mg/5ml
Tab: 10mg Cap: 200mg

Dicycloverine HCL (Q8h) Hyosciene N-Butyl (Bromide)

Q6-8h

RD: 2.5-5mg/kg/day RD: 0.15mkdose

6mos-2y.o: 0.5-1ml Amp: 20mg/ml
2y.o-5y.o: 2.5-5ml Tab: 10mg
Drops: 5mg/ml, 15mg/ml
Syr: 2mg/ml, 10mg/ml
Tab: 10mg
 Domperidone (Motilium)Q8h*15

RD: 0.3mkdose
Dyspepsia: Adult: 1tab/2tsp Q8h
Children: 2.5ml Q8h Suspension: 1mg/ml Tab: 10mg
N/V: Adult: 2tab/4tsp Q6-8h
Children: 5ml Q6-8h
Dyspepsia N/V
10kg 2.5ml 5ml
20kg 5ml 10ml
30kg 7.5ml 15ml

Anti-Diarrheals
Paroromycin (Humagel) Erceflora Bacillus clausii

RD: 20-30mkday 3-4 dived dose >1mos: 1-2 vials/day

150mg/cap, 150 mg/5ml 2-11y.o: 1-2 vials/day
Adult: 2-3 vials/day

Racecadotril (Hidrasec) Nifuroxamide (Ercefuryl)

1 mos onwards <6mos: 1tsp BID

RD: 1.5mg/kg/day Q8h >mos: 1tsp TID

BW Hidrasec Sachet
<9kg 10mg 1 sachet
9-13kg 10mg 1 sachet
13-27kg 30mg 1 sachet
>27kg 30mg 2 sachet
Adult dose: 100mg/cap Q8h
Antihelminthics
Mebendazole

500mg/tab single dose

100mg/tab or 5ml BIDx3 consecutive days
20mg/ml susp: 5ml BIDx3 consecutive days
50mg/ml susp: 10ml SD
Enterobiasis (100mg or 5mg SDrpt 2 or 4 weeks)
Susp: 20mg/ml, 50mg/ml
Tab: 100mg; 500mg
*deworm @2-4 yrs old

Pyrantel Pamoate

RD: 10-20 mkdose

Susp: 125mg/5ml
Tab: 125mg; 850mg

Albendazole

RD: 75mkday
Susp: 200mg/5ml
Tab: 400mg

Quinolones
Ciprofloxacin - BID

Vial: 100mg/50ml, 200mg/100ml, 400mg/200ml

Amebicide
Metronidazole q6h Furazolidone
 RD: 30-50 mkday PO RD: 4-7 mkday
7.5 mkdose IV Liquid: 16.7 mg/5ml
15mkdose loading dose Susp: 50mg/ml
Vial: 5mg/ml
IV: 500mg/100
Susp: 125mg/5ml
200mg/5ml

Paramomycin Etofamide (Kitnos)

RD: 20-30 mkday RD: 15-20mkayX3 days Q12H

Susp: 150mg/15ml Susp: 100mg/5ml
Tab: 200mg; 500mg

Antihistamine
Hydroxyzine Hcl (Iterax) Desloratadine (Aerius)

Q12h x 5 days 6-11 mos: 2ml

RD: 1mg/kg/day or wt/4 1-5 y.o: 2.5 ml
Syrup: 2mg/ml 6-11y.o: 5ml
Tab: 10mg; 25mg >/=12y.o: 10ml
Amp: 5mg/ml Syr: 2.5ml/5ml
Tab: 5mg

Chlorphenamine Maleate Diphenhydramine Hcl

Q8h RD: 3-5 mkdose PO

RD: 0.2mkdose 1mkdose IV
Amp: 10mg/ml Syr: 12.5mg/5ml
Vial: 10mg/ml Cap: 25mg, 50 mg
Syrup: 2mg/5ml IV/IM: 50mg/ml
Tab: 4mg
*20kg-1/2 amp IM
>20kg-1amp IM
 Cetirizine diHCL-OD-BID Levocetirizine

RD: 0.25-0.27 mkdose 0.125mkdose

Drops: 10mg/ml
2.5mg/ml
Soln: 1mg/ml
Sry: 5mg/5ml
Tab: 10mg

Mucolytic
Carbocysteine (Q8-12h) Erdosteine (Q12h)

RD: 30-50 mkday RD: 10mkday

Drops: 50mg/5ml 10-20kg, 2-6y.o: 2.5ml
Syr: 100mg/5ml 21-30kg, 7-12y.o: 5ml
Cap: 500mg >30kg, >12y.o: 5mlTID/7.5ml
<3mos: 0.25ml BID
3-5mos: 0.5ml Susp: 115mg/ml; cap: 300mg
6-8mos: 0.75ml
9-12mos: 1 ml
5y.o: 5ml

Ambroxol (Q8h)

D: 1.2-1.8 mkday
Liq: 15mg/5ml; 30mg/ml
Soln for inhalation: 15ml/2ml
Amp: 15mg/2ml
Ped drops: 6mg/ml
Tab: 30mg; retard cap 75

Bronchodilators
Salbutamol TID Procaterol
 RD: 0.13-0.15 mkdose >/6: 5ml
Sry: 2mg/5ml </=5y.o: 2.5ml
100mg/5ml
Amp: 1mg/ml Bambuterol
Tab: 2mg
6-12y.o: 5mkdose
Terbutaline BID TID Oral soln: 1mg/ml
Tab: 10mg
1-15y.o: 2.5ml Aminophylline/Theophyline
<3y.o: 0.075mkdose
Syr: 1.5mg/5ml 3-5mkdose
Soln: 2.5mg/5ml 80mg/5ml; 125mg/tab, 175mg/
Amp: 0.5mg/ml tab
Tab: 2.5mg

Cephalosporins
1st generation
Cefuroxime Q6-8h
RD: 20-40mkday PO;
 Cefuroxime Q6-8h
RD: 20-40mkday PO;
Cefalexin Q6h 50-100mkday IV
RD: 30-50 mkday PO
50-100mkday IV Cefamandol
Drops: 100mg/ml RD: 50-100mkday
Susp: 125mg/ml
250mg/ml Cefprozil
Cap: 250mg; 500mg RD: 20-4-mkday
Powder: 125mg/5ml; 250mg/
Cefazolin
5ml
RD: 50-100mkday IV x 3dose Tab: 250mg; 500mg
Vial: 250mg
Inj: 500mg; 1g Cefotiam
RD: 50-100mkday
2nd generation Tab: 200mg
Vial: 0.5g; 1 gm
Cefaclor Q8h
RD: 20-40mkday Cefixime Q12h UTI: 8 TF: 20
Drops: 50mg/ml RD: 3-6mkday PO,
Susp: 125mg/5ml 15mkday
250mg/5ml Drops: 20mg/ml
Tab: 315mg; 750mg Susp: 100mg/5ml
Cap: 500mg Cap: 100mg;200mg

Cefdinir
RD: 9-8mkday
Cap: 100mg

3rd Generation 4th Generation

 Cefoperazone Cefepime OD-BID
RD: 100-150mkday IV RD: 50-100
Vial: 1.5g Vial: 500mg; 1g; 2g
Ceftriaxone BID
RD: 50-100mkday
Vial: 500mg; 1 g;
250mg
Ceftazidime
RD: 30-50mkday IV
Vial: 250mg; 500mg;
1g; 2g
Cefpodoxime
3-10mkday
Susp: 50mg/5ml
Tab: 100mg
Co-Amoxiclav: 228.5g/5ml; 457/5ml

Aminoglycosides Antihypertensives
 Gentamycin OD-BID Furosemide
RD: 0.5-1mkdose
5-8mkday Amp: 20mg/2ml
Tab: 40mg
Amikacin OD-BID
RD: 12-15mkday 15mkdose Hydralazine
OD RD: 0.1-0.2mkdose
\ Amp: 20mg/ml
Vancomycin Tab: 10mg; 15mg; 50mg

Aspirin
RD: 15mkday 75-100mkday

Nifedipine Q4-6h
RD: 10mkdose
Max: 10mg/kg/24h

Spironolactone
1.3-3mkday QID PO

Antifungal
 Nystatin Q6h Fluconazole OD
RD: 3-6mkday
Adult & children: 4-6ml Vial: 3mg/ml
Infant: 2ml Cap: 50, 150, 300mg
Tab: 500,000 U
Susp:100, 000 U/ml Griseofulvin
Tab: 125mg/500mg

Amphothericin B Ketoconazole x 5 days OD

RD: 0.3-0.7mkday Adult: 200mg/tab
Slow in Infusion 5-12y.o: 100mg/tab
*250mcg/kg/day-1mg/kg/day 1-4y.o: 50mg/tab
Vial: 50mg/5ml; 2mg/ml
Cap: 50mg; 100mg; 200mg
Isoprinosine: 50-100mkday

Macrolides
 Erythromycin q8h Azithromycin OD-BID
RD: 15-20mkday
RD: 35-50mkday Susp: 200mg/5ml
Granules: 200mg/5ml; Tab: 250mg; 500mg
400mg/5ml Vial: 500mg
Drops: 100mg/2.5ml
Tab: 250-500mg Chloramphenicol q6h
RD: 50-100mkday;
Clarithromycin Q12h 75mkday (enteric fever)
RD: 7.5mkdose; FT infant>/=2week: 25-50mg/kg/day
15mkdose
Susp: 125mg/5ml Cotrimoxazole BID
Tab: 250; 500mg RD: 5-8mkday; 8 UTI; 10 BPN
Susp: 200mg/40mg/5ml-
Roxithromycin OD-BID (40mg/5ml) (wt/2)
Adult: 150mg/tab; 400mg/80mg/5ml-(80mg/5ml)(wt/4)
300mg/tab Q12h Tab: 400mg/80mg; 800mg/
Children: >40kg 100mg
Kiddie tab: 100mg

Anti- TB drugs

1-10; R-15; S-20; E-35; P-30

Isoniazid Rifampicin:
RD: 5-10 RD: 10-15mkday
Syr: 100mg/5ml; 200mg/5ml Drops: 100mg/ml
Tab: 100mg; 200mg; 300mg Cap: 300; 45mg

Pyrazinamide Ethambutol
RD: 15-30mkday RD: 12-25mkday
Susp: 250mg/5ml Syr: 125mg/5ml
Tab: 500mg Tab: 400mg
 Streptomycin Amantadine HCL
RD: 15-20mg/kg/day RD: 4.4-8.8mkday
Vial: 1gm Syr: 50mg/5ml
Tab: 100mg

Ribavirin
RD: 10mkdose
Syr: 50mg/5ml
Tab: 100mg

Anticonvulsants/ Sedatives
Phenobarbital Midazolam
RD: 0.2mkdose
LD: 10mkday Tab: 15mg
MD: 5mkdose (max Amp: 5mg/ml, 5/5, 15/3
25mkdose)

Diazepam Phenytoin
RD: 0.2-0.8 mkdose LD: 10mkdose
MD: 5mkday
Susp: 30/5, 12/5
Cap: 30, 100

Steroids
Prednisone BID Dexamethasone
RD: 0.5 1mkdose
RD: 1mkday BID; 2mkday OD 0.3mkdose initial, then 0.1
Susp: 10mg/5ml mkdose 1-2mg/kg Q6h x 4
Syr: 5mg/5ml; 20mg/5ml *xtubate on 3rd dose
Tab: 1, 5, 10, 20, 30, 50mg
 Hydrocortisone Procaterol (Meptin) BID-TID
RD: 5mkdose Q6-8h RD: 0.25mkdose or 0.25xwt
LB: 10mkdose Syr: 5meq/ml
MD: 5(max 100) Tab: 25meq, 50meq
Vial inj: 100mg; 250mg;
500mg

Erdosteine (Ectrin/Zertin) Aminophylline

175mg/5ml-10mkday BID; LD: 5-7mkdose
300mg/cap BID MD: 3-5mkdose

Combivent: 200ug Ipatropium

<2y.o: 5-8 drops; 2-3 y.o: 3 drops; >4y.o: 20 drops

IVIG
Dose: 2g/kg in 12H or 400mg/kg/dose x 5d
2.5g/vial, dilute w/ 50ml diluents to make 50mg/ml administer the
ffL

Test dose:
1. 0.5ml/kg/H x 15min NAHCO3
2. 1ml/kg/H x 15min BE x wt x 0.3 or 1meq/kg can be
4. 1.5ml/kg/H x 15min given IV push or drip 50mcg/kg
8. 2ml/kg/H x 15min
NA>1-2 meq/kg
2.5ml/kg/H x 15min
3ml/kg/H x 15min
3.5ml/kg/H x 15min
4ml/kg/H x 15min
*if tolerated in fuse the rest at ____cc/h for 10hr watch out for
headache, flushing, hypotension, fever and chills

Aminosteril
0.5/kg-inc until 3g/kg
Wt x RD x 100/6%/24 or wt x RD/0.694
*start 1g x 48H then resume at 2g

Conversion of Hyponatremia
1ml=2.5 meqs NaCL
Wt: 1.8 kg
S.Na: 131.4
D-A x wt x 0.6 (140-131.4 x 1.8 x 0.6 = 9.2 meqs)+ wt x 3=
maintenance (1.8 x 3=5.4)

- 4.6 1.8 6.4 HYPONATREMIA

- 2.3 1.8 4.1 D-A x wt x 0.6 (2-3) maintenance
- 2.3 1.8 4.1

1st Shift HYOPCALCEMIA

D5W- 6.6 K/K (?) 0.1 to 0.3 meqs/k/H
D5IMB- 50 NK of Body= 50meqs
NaCl- 2.5 (?)
Hypokalemia
D-A x wt x 0.3 + (Wt x 2) ?

Wt x 0.2 x 8 x 3 x 2 x wt
Sk- <3-5% -0.05
<2.5-10%-0.10
Wt X 0.05 x 50 /wt x (2/maintenance)

RESPONSE TO PHOTOTHERAPY
*check rebound B2 for 12-24H after discharge

Bilirubin Age Action

<18 - Wean to single photo

</=18 - D/C home

</=14 49-7/2 D/C photo

</=15 >72 D/C photo

 Age in hours TSB (mg/dl)

24-48H <15 15-<20 20-<25 >/=25

49-72H <18 18-<24 25-<30 >/=30

>72H <20 20-<25 25-</=30 >/=30

Tx/rec OPD PHOTO INTENSIVE PHOTO/exc

PHOTO trans

IDEAL BODY WEIGHT

At birth 3kg
3-12mo Age (mo)+ 9 /2
1-6 yrs Age (yrs)x 2 + 8
7-12 yrs [Age (yrs)x 7 5 ]/2

IDEAL BODY WEIGHT GIVEN BIRTH WIEGHT

<6mo Age (mo) x 600 + BW in gm
6-12 mo Age (mo)x 500 + BW in gm

Age Conside Photo Exchange Exchange

r Photo transfusion if transfusion if
extensive intensive
photo photo

</=24d

25-48 >/=12 >/=15 >/=20 >/=25 (430)

(170) (260) (340)

49-72 >/=15 >/=18 >/=25 >/=30

(260) (310) (430) (510)
 >72 >/=17 >/=20 >/=25 >/=30
(290) (340) (430) (510)

EXPECTED BODY WEIGHT

Term: EBW= (Age in days - 10) x 20 + BW in gm
Preterm: EBW= (Age in days - 14) x 15 + BW in gm
Where 10: # of days to recover over physiologic wt loss
20: g/day gained

CARDIAC OUTPUT
Newborn: 180-240ml/kg/min or 4ml/beat
DOPAMINE DRIP
(200mg/250-800conc) 0.0375/26.6
(400mg/250ml-1600conc) 0.075/13.3
Wt x RD x 60 (0.075)

SHORT CUT: wt x RD WT X 3(50) X dose (10mg/kg)

13.3 (800-conc) 6 (100)
Wt x RD Rate (1cc/hr)
26.6 (1600-conc)
1.6
To check: AD: dose given x Prep/60/wt
Or WT x RD X 140D/ 1600/24
Max: 20

LEVOPHED
4mg/4ml; 2mg/ml
e.g 2ml/ml
2/100 x 1000= 20 conc

(WT x dose x 60)= ml

Conc

To check: ml x conc/60/15= dose

DRIP FORMULA
 6 x wt (kg)x mcg/kg/min mgin100ml of D5NSS
MI/H

ISOPROTERENOL/EPINEPHRINE/NOREPINEPHRINE
0.6 x wt (kg) = mgin100ml O
*1ml/H will deliver 0.1 mcg/kg/min

DOPAMINE/ DOBUTAMINE/ AMRINONE/ NITROPRUSSIDE

6 x wt (kg)= mg in 100ml
*0.1 ml/H will deliver 1mcg/kg/min

DOPAMINE/ DOBUTAMINE
6 x wt (kg) = # mg to add to diluents to make 100ml volume

DOBUTAMINE DRIP
2.5 15mcg/kg/min (max: 40mcg/kg/min)
Peak effect: 10-20min
Prep: 12.5 mg /ml x 20ml/vial= 250mg/250ml (vial)
Premix: 1000mcg/ml in 250= 250/250 (1mg/ml)
2000mcg/ml in 250 ml= 500mg/250 (2mg/ml)

Dobu-premix
0.06-1000=250/250 D%W
0.03-2000
Wt x dose x 0.06/0.03

Wt x RD x 60 or wt x RD x 1400/12500 or 6 x wt in kg= ____mg in

2000 100ml(1mcg/kg/min)
Ex: 250mg in D5W 250cc(1mg/ml) 500mg in D5W250cc(2mg/ml)
Mcgtt/min= (Wt x DD)/16.6 ugtts/min=(wt x DD)/33.2
= Wt x DD x 0.06 = Wt x DD X 0.03
*to check: 7.5 actual x 2000/ 60 /wt
actual x conc/60/wt
FUROSEMIDE DRIP
20 mg/2ml
**4ml + 20cc PNSS to run @ 1cc/h
(wt)15 x (dose) 0.1 x 24
36 x 2/20 = 3.6
3.6/4ml = 0.9 or 1cc

Prep: 10mg/ml amp (2m)

Dose: infant and child: 0.05 mg/kg/H (titrate to clinical effect)
Adult: 0.1 mg/kg/H (max: 0.4 mg/kg/H)

Wt(kg)x dose x 24 = mg in 24 ml of NS to make: 1ml/H =

0.1mg/kg/H
Wt(kg) x dose x 24 x 5= mg in 120ml NS to make 5ml/
H=0.1mg/kg/H

*20mg furo + 20cc distilled water to make conc of 1mg/ml

Infusion rate: 0.05 x wt eg: 0.05 x mg x 1 = 4 cc

EPINEPHRINE DRIP
Wt x 0.6 mg = mg added to 100mgD5W
1cc/H = 0.1 ug/kg/min
5cc/H = 0.5 cc/min ml/H= wt x dose x 60
10cc/H = 1mg/kg/min conc
0.1mkd/0.1cc/kg/dose

INSULIN DRIP
1. 1 cc or ml/H
Wt x 0.1 x 24 = # of ml/cc of insulin to be added to NSS to make 24
ml soln to run for 24H

MIDAZOLAM DRIP
Prep: 5mg/ml amp
Dose: intermittent: 0.05 0.15mg/kg/dose
Continuous: 1-2mcg/kg/dose
6 x wt(kg)x mcg/kg/min = mg in 100ml of D5W/NS
mL/H
Max total dose: 10mg (intermittent); can cause respiratory
depression, hypotension, bradycardia

AMIODARONE DRIP
Prep: 50mg/ml amp
Dose: infant and child: 5mg/kg over 30 min ff by infusion starting at
5mcg/kg/min
Max dose: 10mcg/kg/min or 20 mg/kg/H must be diluted in D5W
infusion concentration should not exceed 2 mg/ml
wt(kg)x dose x 60 x 50 = mg in 50mlD5W
1000
To make: 1ml/H= 1mcg/kg/min

INSULIN DRIP
Prep: 1U/ml amp
Dose: Infant and Child 0.1Ukg/H (titrate to clinical effect)
Glucose drop: 80-110mg/dl/H

Wt(kg)x dose x 24 = U in 24ml NS or

Wt (kg)x dose x 24 x 5 = U in 120ml of NS
*to make: 5ml/H= 0.1U/kg/H

NICARDIPINE DRIP
Prep: 2.5mg/ml= 5mg/10ml ampule
Dose: Child: 0.5-5mcg/kg/min (titrate to clinical effect)
Adult: start with 5mg/H, increase dose as needed by
2.5mg/H Q 5 -15 min (Max dose: 15mg/H) decreased by
3mg/H as needed to maintain desired response

AMINOPHYLLINE DRIP
LD: 5mg/kg BW in 30cc 5W in a soluset (if px is not maintained
on oral theophylline) or
25mg/vial dilute 1ml + 4ml NSS to make 5 mg/ml so;ution.
Aspirate ____mL give per iv infusion for 30 min as LD
(5mg/kg)
D5W250cc + Aminophylline 250mg/amp at ____ugtts/min

Main drip: 0.4 0.8mg/kg/H

Formula ugtts/min = dose x BW
Note: maintenance infusion rate must be induced to 0.2 0.3 mg /kg/
H for elderly px, pregnant px and those in CHF. Liver dse or cor
pulmonale watch out for hypoglycemia and tachycardia.

DUET (Double Volume Exchange Transfusion)

Blood volume: 80cc/kg
ABC: no correction if <10
E.g wt: 3kg
B.D
3 x 80 x 74-60/74 = 3360/74
45cc to be exchanged
160-180cc/kg/FWB
Mothers Blood type wt 80 x 2
INDICATIONS:
Corrected WBC:
Sepsis e.g RBC = 7500= 75000/500-15
S. Bilirubin >20mg/dl for every RBC = 1 WBC
Hypoxia and acidosis WBC = 37-15=22 corrected RBC
Hemolytic dose of NB
ABO incompatibility
Prematurity

COMPLICATIONS:
Vascular embolism
Infection
Cardiac arrhythmia vol overdose
CP arrest
Electrolyte imbalance

FIO2: 100% target FiO2 X TRF (S)

79

ABDOMINAL UTZ
Stomach LUQ, directly under the L diaphragm

Small Intestines- central abdomen,

can have a random faceted/ tesseliated appearance
 when air filled (but not dilated).
Encircling valvulae connivantes visible depending on
degree of air filling.
Valvulae connivantes more widely spaced in ileum

Large Intestines circumferential, tends to frame the small intestines

Feces of variable consistency
Haustral folds interspaced w/ plicae semilunaris

Neurotoxicity
Cisplatin ototoxocity, p. neuropathy
Paclitaxel p. sensory, neuropathy
Vinca Alkaloids- motor , sensory, autonomic
neuropathy, adynamic ileus, urinary bladder atony

Cardiac Toxicity
Doxorubicin, Daunomycin cardiomyopathy

Pulmonary Toxicity
Bleomycin interstitial
Alkylating agent pneumonistis w pulmonary fibrosis

Gastrointestinal Toxicity
Mathotraxate hepatic fibrosis
Vinca Alkaloids- adynamic ileus, urinary bladder atony

Genitourinary Toxicity
Cisplatin azotemia, Mg wasting
Methotrexate oliguria RF
Cyclophosphamide/ Ifosfamide chronic hemorrhagic
cyctitis

Dermatologic Toxicity
 Doxorubicin Skin necrosis, sloughing
from
Actinomycin D drug extravasation
Vincristine

Gonadal Dysfunction
Azospermia recovery is uncommon

Hematologic toxicity
Granulocytopenia/neutropenuia
- 6-12 days after administration
- Recovery in 21-24 days
ANC= (WBC count)(%segmenters)
- Must be 1500 for chemo to proceed
Thrombocytopenia
- Recovers 4-5 days later than granulocytes
- 100,000/mm3 for chemo to proceed

Fontanels anterior closes at 18 mos (as early as 9=12 mos)

- Posterior 6-8 weeks

Colostrum 1st 2-4 days postpartum CHON, vitamins, salt, Ig

fat and sugar

Absolute Contraindications to BF
Galactosemia
Tyrosinemia
Relative Contratindications to BF
Psychosis
Active TB

WATERLOW CLASSIFICATION
> 90 no PEM
75-90 MILD WT for Age: Actual WT x 100%
60-74 MODERATE Wt at P50
<60 SEVERE
HT for Age= Actual HT X 100
Ht at P50

Wt for HT = Actual wt X 100

Wt at P50 of HT at P50

HT WT
>95 - no stunting >90 no wasting
90-95 mild 80-90- mild
85-89- moderate 70-80- moderate
<85- severe <70- severe

ET Tube Size AOG SIZE

<1000 <28 2.5

1000-2000 28-34 3.0

2000-3000 34-38 3.5

>3000 >38 3.5-4.0

ET SIZE BY AGE

Premature 2.5mm

0-3 mo 3.0mm

3-7 mo 3.5mm

7-15 mo 4.0mm

15-24 mo 4.5mm

2-10 yrs Age (yrs)+16/4 or Age(yrs)+ 4/4

 10-20 yrs 6-8mm

ET level: size of tube x 3

Laryngoscope Blade Size

Term/Newborn Size 1

2-11 yrs Size 2

>12yrs Size 3

ET Tube Size & Depth

Weight Size Depth

500-1000 2.5 7.0

1000-1400 3.0 7.5

1400-1900 3.0 8.0

1900-2200 3.5 8.5

2200-2600 3.5 9.0

2600-3000 3.5 9.5

3000-3400 3.5 10

3400-3700 3.5 10.5

3700-4100 4.0 11.0

 4100-4500 4.0 11.5

>4500 4.0 12.0

BELL CLINICAL STAGING OF NEC

1. Suspect,
Infant with suggestive clinical signs but x-ray non
diagnostic
2. Definitive
Infant w/ pneumatosis intestinalis
2a: mildly ill
2b: moderately ill (acidosis, thrombocytopenia/ ascites)
3. Advanced
3a: critilac w/ impending perforation
3b: critical w/ proven perforation
MAXIMUM K that can be in cooperated per Liter IVF:
Parenteral: 40meqs
Central: 60-80meqs

Electrolyte Computation:
I. Potassium
N= 4-5.6 meq
N K deliuence: 0.1-0.4meq/kg
Deficit = (KD - KA)x wt x 0.6
Maintenance K: 2 x wt
Total K deficit: deficit + maintenance
Full Incorporation: 40meq/L or 20 meq/500cc
K infusion rate:
N= 0.2meq 0.4meq/kg
IV rate x amt of K (meq)
Vol of IVF x Wt
Deficit: Wt x 50 x __K__
Maintence 2 x wt

II. Sodium 135-145 meq

Maintence Na= 3 x Wt Na: 1 meq= 2.3mg/dl
Max target/day: 10 meq K= 1 meq= 3.91mg/dl
 NaHCO3= gr x = 650mg = 7.7meq
gr v = 325

III. Calcium: 8-10 meq

IV. Chloride: 98-106 meq
V. CO2 15meq

Rate x 24= ___ 100= ____ x 4

Creatinine Clearance:
1. Based on ht
*0.33 = pretem; lbw, <1 yr
0.45 = term, infant, <1yr
0.55 = children, adolescent female
0.7 = adolescent male
* X ht (cm)
Serum creatinine(mg/dl)

2. Adult *male: 72
Female: 85
140-age x wt
* x Creatinine (mg/dl)
Values:
80-120: normal
50-80: renal impairment
20-50: renal insufficiency
5-20: renal failure
<5: uremia

GFR: 125ml/min (75-150)

24 urinary Creatinine M: 15-20mg/k
F: 10-15mg/k

ACTUAL RETICULOCYTE COUNT (ARC)

Actual Hct x Reticulocyte ct
Desired Hct
Reticulocyte Index: ARC 2
 = HCT/Ret Count x 2
>2= hemolysis
<2= BM suppression

IDEAL TRACHEAL ASPIRATE: EC < 25

PMNS> 10
2. U- increase HGB by 2: HCT by 3

BLOOD TRANSFUSION
FWB 20cc/k (max)
PRCB 10-15cc/K (15cc/k in neaonates)

FWB: vol= desired-actual HB x 6 x wt

= desired actual Hct x wt
Rate= volume x 12 gtts/ml = gtts/min
60min x 4H
PRBC: vol = desired actual HB x 2 x Wt
= desired actual hct x wt
Desired Hct= vol/wt + actual hct

Platelet Count: 1U /6KBW

1U=30-50 (raises platelet count by 10K)
FFP= Fluid rate (5-20cc/k/h in 4h)

PHOTOTHERAPY
Indication: PT 10mg% Bilirubin
PT 15mg% Bilirubin

Complication: Osmotic diarrhea, Rashes

Bronze baby syndrome, Dehydration

Kramers Classification
ZONE JAUNDICE EST. LEVELS

1 Head/neck 6-8mg/dl
 2 Upper trunk 9-10mg/dl

3 Lower trunk to thigh 12-14mh/dl

4 Arms/legs/elbow/knees 15-18mg/dl

5 Hands/feet >18mg/dl
B1 uncongugated/ indirect
B2 conjugated/ direct Bilirubin

CREATININE CLEARANCE*
(140-age) (wt in kg) x 0.85 (F) 1(m)
Creatinine (mg/dl) x 72
* 88.4 mg/dl

STAGING
1 Kidney damage with NGFR >90

2 Mild GFK 60-90

3 Moderate GFK 30-59

4 Severe GFK 15-24

5 Kidnet failure <15

DEFICITS
Na= 135-150/3-4meq/kg/day
Na deficit= (Desired 140-actual) X TBW
TBW (L)= 0.6 x BW (kg) + Maintenance

BLOOD/ FFP TRANSFUSION

Transfuse ____ U ( cc)TS x 4h
Monitor VS q15mins @ 1st hr then Q 30min
Adjust IV rate to ___ cc/hr
Ex: 369cc/4h = 92.25 92
IVF = 125 = 33
92 * IVF rate to 33cc/hr
How: 125-92=33cc/hr
RBS (mmol/L) x 18 = ____ mg/dl
N: 280-300
DKA: 300-320
HHS: 330-380

FFP- 20cc/k
PLT conc- 1 uint/10kg
TPR
BP
02 stat
SCE, CBS
(-)DOB
CP status assessed, may transfuse 1 unit PRBC, type-specific, after
proper reverse typing x 4hrs. Monitor VS q 15mins on the 1st hr then
q30mins thereafter once stable IVF rate to ___ cc/hr (or KVO)
watch out for any BT reactions
Refer PRN
Thank you
PPE: awake, conscious, not in CPD, anicteric sclera, pinkish
conjunctivae, non hyperemic, non-enlarged tonsils, (-) CLAD, (-)NVE
SCE, CBS
AP, NCRRR (-)murmur
Flat, soft, NABS, Nontender, tympanitic, grossly N ext, full pulses
CRT < 2 sec.

TRANS-OUT ORDERS (SURGERY/OB)

May transfer px back to room
Monitor VS q15 until stable then q4h thereafter
D/c o2 and pulse oximeter
Monitor IO qhourly (if with FC)
Refer if with UO 30cc/hr or monitor IO qshift & record
Refer PRN
Thank you

Albumin Transfusion
Wt x 1cc x 50% = amount in CC
Kg 12.5

KAWASAKI DSE
Fever= 5 days
1. Bilateral bulbar conjunctival injection with limbic
sparing (-)exudates
2. Erythematous mouth and pharynx, strawberry tongue,
red, cracked lips
3. Polymorphous, generalized erythematous rash
4. Changes in peripheral extremities consisting of
induration of hands and feet
5. Acute nonsuppurative cervical lymphadenopathy (uni/
bilateral) ~1.5 cm

IVF: D10 1st24hrs of life

D10IMB after 24 hrs of life

How to replace fluids: 1st 24HDL wt x 80cc/kg if NPO

Day 1 90 cc/kg

2 100 cc/kg

3 110 cc/kg

4 120 cc/kg

5 130 cc/kg

6 140 cc/kg
 7 150 cc/kg

8 160 cc/kg (max)

D10IMB = Desired Actual x volume

Highest Lowest

Available: D5IMB; D50W, D10W

D10IMB= 10-5 x volume (100)
50-5
= 5 x 100
45
11ccD50W 11 D50W (subtract from the volume 100)
+ 89ccD5IMB 89 D5IMB
D10IMB
UMBILICAL CATHETERIZATION
Wt x 3 + 9 = answer + 1.2 cm
2

Allowable Blood loss in Preterm: 10% of BW

Allowable Blood loss in infants/neonates: 20% of BW
H. Influenzae: 7-10days
S. pneumonia: 10-14 days
N. meningitides: 7 days
E. coli, citrobacter, Senatia: 21 days
Enterococcus: 14 days

MENINGITIS
<1mo: GBS, enterobacteriaceae, listeria,
monocytogenes
Tx: Ampicilin & Cefotaxime
Alt: Ampicilin & gentamycin
(nosocomial- Ampi + gentamycin)

1mo-3mo: GBS, S. Pneumoniae, Hi. Influenza, N.

meningitides, Enterobacteriaceae
 Tx: Ampiciliin, Cefotaxine

>3mo & children S. Pneumoniae, N. meningitides, H.

influenza, neonatal pathogens
Tx: Cefotaxime/Ceftiaxone, Vancomycin added for
possible penicillin resistant S. Pneumoniae

AMINOSTERIL COMPUTATION
Wt x 1gm x 100 = ___ cc to run for 22hrs, rest for 4hrs
6
EX. Wt: 900gms 0.9x 1gm x 100 = 15cc
6
1. Order: Aminosteril 6% 15cc to run for 22 hrs; rest for 4 hrs x
2 cycles
(TFI 150- 1gm AA - FFP)
ex: FFP x 2 units 18cc/unit

150-15cc-15cc-18cc+18cc x wt = 84 24 = 3-4cc/hr IVF rate

24H

PIP 8 10 (Pacterm 12)

PEEP 4
100-FIO2 79 x PEEP = level of compressed air
PEEP compressed air level of pure air

RESPIRATORY DISTRESS SYNDROME

- Deficiency of pulmonary surfactant, a phospholipid protein
mixture that decreases surface tension & prevent alveolar
collapse.
- Type II alveolar cells from 32 weeks AOG
- Risk of RDS is decreased in babies born >24hrs and <7days
after maternal steroid administration
APNEA respiratory pause >20sec or a shorter pause assoc. w/
cyanosis, pallor, hypotonia or bradycardia
Causes: Thermal instability, prematurity, infection (NEC, meningitis,
neo sepsis), metabolic disorders, CNS problems (Seizures,
malformations), drugs (maternal/fetal), decreased O2 delivery
(anemia, hypoxemia, L to R shunt)
 Disturbance Primary PH Compensatory
Change Response

Acute resp. HCO3 by 1 meq/l for

Acidosis PaCO2 pH each 10mmhg rise in
PaCO2

Acute Resp. HCO3 by 1-3meq/L for

Alkalosis PaCO2 pH each 10mmhg fall in
PaCO2

Chronic Resp. HCO3 by 4meq/L for

Acidosis PaCO2 pH each
10mmhg rise in PaCO2

Chronic Resp. HCO3 by 2-5meq/L for

Alkalosis PaCO2 pH each 10mmhg fall in
PaCO2

Metabolic PaCO2 by 1 1.5 x fall

HCO3 pH
Acidosis in HCO3

Metabolic PaCO2 by 0.25 1 x

HCO3 pH
Alkalosis rise in HCO3

EPINEPHRINE : 1:10, 000 (0.1mg/ml)

Recommended IV does: 0.1-0.3 mg/kg of 1:10, 000 soln via umbilical
vein
5. 1mg/kg via ET

FFP 4cc/k/ APTT by 1gm/dL

CEFEPIME
 Term and preterm infants greater than 28 days of age:
50mg/kg per dose every 12 hrs
Term and preterm infants 28 days of age and younger: 30
mg/kg per dose every 12 hrs
Meningitis and severe infections due to Pseudomonas
aeruginosa or Enterobacter spp: 50mg/kg per dose every 12
hrs
Administer via IV infusion by syringe pump over 30 minutes
or IM.
To reduce pain at IM injection site, cefepime may be mixed
with 1% Lidocaine without epinephrine
CEFOTAXIME
50 mg/kg dose IV infusion on syringe pump over 30 minutes, or IM.
Dosing Interval Chart
PMA (Weeks) PostNatal (day) Interval (hours)

29 0 to 28 12
> 28 8

30 to 36 0 to 14 12
> 14 8

37 to 44 0 to 7 12
>7 8

45 All 6
Disseminated Gonococcal Infections: 25 mg/kg per dose IV over
30 minutes or IM every 12 hrs for 7 days with a duration of 10 to 14
days if meningitis is documented.

CEFTAZIDIME
30 mg/kg per dose IV infusion by syringe pump over 30
minutes or IM.
To reduce pain at IM injection site, Cfetazidime may be
mixed with 1% Lidocaine without epinephrine.
Dosing Interval Chart
 PMA (Weeks) PostNatal (day) Interval (hours)

29 0 to 28 12
> 28 8

30 to 36 0 to 14 12
> 14 8

37 to 44 0 to 7 12
>7 8

45 All 6
RANITIDINE
Oral: 2mg/kg per dose every 8 hrs.
IV: Term: 1.5 mg/kg per dose every 8 hours slow push
Preterm: 0.5 mg/kg per dose every 12 hours slow push
Continuous IV infusion: 0.0625 mg/kg per hour; dose range. 0.04 to
0.1 mg/kg per hour

FLUCONAZOLE
Invasive Candidiasis: 12 to 25 mg/kg loading dose, then 6
to 12 mg/kg per dose IV infusion by syringe pump over 30
minutes or orally.
Consider the higher doses for treating severe infections or
Candida strains with higher MICs (4 to 8 mcg/ml). Extended
dosing intervals should be considered for neonates with
renal insufficiency (serum Creatinine greater than 1.3 mg/dl)
NOTE: the higher doses are based on recent
pharmacokinetics data but have not been prospectively
tested for efficiency or safety
Prophylaxis: 3 mg/kg per dose via IV infusion twice weekly
or orally. A dose of 6 mg/kg twice weekly may be considered
if Candida strains with higher MICs (4 to 8mcg/ml). Consider
prophylaxis only in VLBW infants at high risk for invasive
fungal disease.
Thrush: 6mg/kg on day 1 then 3mg/kg per dose every 24 hrs
orally.
 INVASIVE CANDIDIASIS DOSING INTERVAL CHART
Gestational age Post Natal (Days) Interval (hours)
(weeks)

29 0 to 4 48
>14 24

30 and Older 0 to 7 48
>7 24

OXACILLIN
Usual Dosage: ____mg/kg per dose IV over at least 10 minutes
Meningitis: 50 mg/kg per dose

DOSING INTERVAL CHART

PMA (Weeks) PostNatal (day) Interval (hours)

29 0 to 28 12
> 28 8

30 to 36 0 to 14 12
> 14 8

37 to 44 0 to 7 12
>7 8

45 All 6

MEROPENEM
Sepsis: 20mg/kg per dose IV
Less than 32 weeks GA: less than or equal to 14 days PNA, every 12
hrs, greater than 14 days PNA, every 8 hrs
32 weeks and older GA: less than or equal to 7 days PNA, every 12
hours; greater than 7 days PNA, every 8 hours
Meningitis and infections caused by Pseudomonas species, all ages:
40mg/kg per dose every 8 hours.
Give an IV infusion over 30 minutes, longer infusion times
(up to 4 hrs) may be associated with improved therapeutic
efficacy.

METRONIDAZOLE
Loading dose: 15mg/kg orally or IV infusion by syringe punp over 60
minutes
Maintainance dose: 7.5 mg/kg per dose orally or IV infusion over 60
minutes. Begin one dosing interval after dose.

DOSING INTERVAL CHART

PMA (Weeks) PostNatal (day) Interval (hours)

29 0 to 28 12
> 28 8

30 to 36 0 to 14 12
> 14 8

37 to 44 0 to 7 12
>7 8

45 All 6

COMPOSITION OF AVAILABLE PARENTERAL FLUIDS

IV Na Cl K Mg Ca HCO3

0.9NSS 154 154 - - - -

0.3NSS 51 51 - - - -
 LR 130 109 4 - 1.5 Lactate

NR 140 98 5 1.5 - Acetate/

Gluconate

NM 40 40 13 1.5 1.5 Acetate

IMB 25 22 20 1.5 - Acetate

Serum Anion Gap (AG)= Na (Cl + HCO3)

Urine Anion Gap= (Na + K) Cl
Delta
HowGap= ActualIVF
to Adjust AGrate
10once on Feeding
24-Actual
Example: HCO3 (90)
IVF: D5IMB
WT: 2840gms
Computations: 90 x 2.84kg 24H = 10-11cc/hr IVF rate
Advance feeding to 10ccq 3 hrs x 3 feedings
If tolerated, increase to 20cc every feeding until 30cc is
reached.
Adjust IVF rate accordingly
to 8cc/hr at 10cc feeding
to 6cc/hr at 15cc feeding
to 5cc/hr at 20cc feeding
to 1cc/hr at 30cc feeding

10 x 8 24 = 3 [IVF 3 = 8]
15 x 8 24 = 5 [IVF 5 = 6]
20 x 8 24 = 6 [IVF 6 = 5]
30 x 8 24 = 10 [IVF 10 = 1]
feeding q3H 24h 3h = 8
DC CBG monitoring once 20cc feeding is tolerated.

BICARBONATE CORRECTION
(15 initial HCO3) x Vol x Kg BW
 Serum HCO3 level (meq/L) Volume of Distribution (Vol)

>10 0.5
5-10 0.75
<5 1.0
TOTAL PROTEIN SPILLAGE (TPS)
TPS= Total Protein (mg)
BSA (m2) x 24H

FLUID LIMITATION

Volume in 24H = 400-500ml x BSA + Urine output in 24H

Length: inches to cm, multiply by 2.54
Weight: lbs to kg, divide by 2.2

EPINEPHRINE DRIP:
6 X Wt in Kg x mcg/K/min = ____mg in 100ml of D5W/NS
mL/Hr
Set your own rate: ex: 4ml/hr
6 x wt x 0.1 mcg/kg/min
4ml/h
If wt is 40 kg: 6 x 40 x 0.1 = 6mg in 100ml D5W
4
Order: Start epinephrine drip: 6mg epinephrine + 100cc D5w x
4cc/Hr (0.1 mcg/k/min)

BEVV
BEVV x 0.6 x Wt
- (1/2 push then to run for _____) or
- Desired actual x 0.3 x wt
 DRUGS RD PREPARATION

Tab: 30mg, Syr:

1.2 1.6 mkdose(BID-
Ambroxol 15mg/ml
TID)
Drops: 6mg/ml

Amikacin
10mkdose (LD) Amp/Vial: 50mg/
(Amikin,
15mkdose (MD) mlx2ml
Amikacide,
15mg/kg/day (BID) 250mg/mlx2ml
Onikin)

Cap: 250mg;
500mg
Amoxicillin Syr: 250mg/5ml,
30-50 mkday (TID)
(Pediamox) Ped drops: 125mg/
1.25ml, 100mg/ml
Vial: 500mg

50-100mkday (IV),
Amphotericin B 30-50mkday (PO), 1mg/ Vial: 50mg/10ml
kgBW (alternate day)

Cap: 250mg;
500mg
Syr: 125mg/5ml,
Forte Syr: 250mg/
Ampicillin 50-100mkday (IV),
5ml,
(Ampicin, 30-50mkday (PO), 1mg/
Ped Drops:
Pensyn) kgBW (alternate day)
125mg/1.25ml,
100mg/ml
Vial: 500mg
 Tab: 4mg,
Amp: 5mg/ml
Antamin 0.2-0.3mkdose
Vial: 5mg/mlx10ml
Syr: 2mg/5ml

Tab: 375mg;
625mg
Susp: 156.25/5ml;
228.5/5ml;
Augmentin 20-40mkday (BID-TID) 312.5mg/5ml;
457mg/5ml, IV
Vial: 300mg;
600mg
Tab: 1g

Tab: 250mg.
500mg
ASA 75-100mkday (TID)
Enema: 4mg
Susp: 250mg

Aztreonam 30-50mkday

Cap: 25mg, 50mg

3-5mdose (PO TID-QID)
Benadryl Syr: 12.5mg/5ml
1mkdose (IV OD)
Inj: 50mg/ml

0.01mkdose q6h Tab: 10mg

Buscopan
0.02-1.5mkday Amp: 20mg

Cap: 500mg,
10-20mkday(infant)
Carbocisteine Syr: 100mg/5ml
(TID-QID)
Susp: 250mg/ml

Caterizine 0.25mkday
 Cap: 250mg,
500mg
Cefaclor 20-40mkday (TID)
Susp: 125mg/5ml,
250mg/5ml

Cap: 500mg
Cefadroxil 25-50mkday (TID)
Syr: 125mg/5ml

Cefetamet 20mkday (BID)

Cefotaxime 50-100mkday (BID) Vial: 1g

Cefepime 50mkday q 8h Vial: 500mg; 2g

Ceftazidime 50-100mkday Vial: 500mg; 1g

Cefazolin 50-100mkday Vial: 500mg; 1g

Vial: 250mg,
Ceftriaxone 50-100mkday (TID-QID) 500mg, 1mg plus
10ml diluent

Tab: 500mg/
500mg
Susp: 125mg/5ml,
50-100mkday (IV);
Cefuroxime 250mg/5ml
20-40mkday(oral)
Vial: 250mg,
750mg,
1.5g

Cap: 250mg,
30-50mkday (PO), 500mg
Cefalexin
50-100mkday (IV) Susp: 125mg/5ml
Drpos: 100mg/ml
 Cap: 250mg,
Chloramphenic 500mg
50-100mkday
ol Susp: 125mg/5ml
Vial: 1g

Cap: 250mg,
400mg
Cimetidine 50-100mkday Syr: 100mg/5ml
Amp: 200mg/2ml,
300mg/2ml

Tab: 250mg,
Ciprofloxacin
7.5mkday (BID) 500mg
(Klaricid)
Susp: 125mg/5ml

Cap: 250mg,
Cloxacillin 500mg
50-100mkday (BID)
(Pharex) Oral soln powder:
125mg/5ml

Tab: 400mg/80mg;
800mg/180mg
Cotrimoxazole 8-12mkday (BID)
Susp: 200mg/
40mg/5ml

Tab: 2mg, 5mg

Diazepam 0.2mkdose
Amp: 10mg/ 2ml

Cap: 50mg;
Diflucan 6-13mkday 150mg; 250mg
Vial: 2mg/ml

Tab: 500mg
Diloxanide 20mkday (TID)
Susp: 125mg/5ml

Doxycyxline 204mkday Cap: 100mg

 Cap: 250mg;
500mg
Susp: 200mg/5ml;
Erythromycin 30-50mkday
400mg/5ml
Drpos: 100mg/
2.5ml

Tab: 400mg;
Ethambutol 15mkday
200mg

Cap: 250mg
1mkday (MRD)4-6mkday
Ferrous Sulfate Syr: 220mg/5ml
(Txc)
Drops: 75mg/0.6ml

LD:12-20mkday
Fluconazole
MD: 6-12mkday

Tab: 100mg
Furazolindone 4-7mkday Amp: 50mg/5ml

Tab: 20mg, 40mg

Furosemide 0.5-1mkdose
Amp: 10mg/ml

Vial: 40mg/ml;
Gentamycin 5-8mkday
80mg/2ml

Tab: 25mg
Hydralazine 0.15mkdose (IV)
Amp: 20mg/2ml

Vial: 259mg Amp:

Hydrocortisone 5mkdose 100mg, 250mg,
500mg

0.01mkdose; Tab: 100mg; Amp:

Hyoscine
0.02-0.15mkday 20mg
 Tab: 200mg;
Ibuprofen 5-10mkdose 400mg; 600mg
Syr: 100mg/5ml

Tab: 300mg
INH 5-10mkday (Premeal)
Syr: 100ml/5ml

Tab: 500mg
Isoprinosine 50mkday
Syr: 250mg/5ml

Meclizine 12.5-50mkday

Cap: 250mg,
Mefenamic
6.5mkdose (Q6h) 500mg
Acid
Susp: 50mg/5ml

Meperidine 6mkday; 0.5mkdose

Syr: 5mg/5ml
Amp: 5mg/ml,
Metoclopramid 0.25mkdose (IV, IM)
10mg/ml
e 1mkday(PO)

Tab: 250mg,
500mg
Susp: 125mg/5ml
Metronidazole 30-50mkday TID Inj: 500mg
Infusion: 500mg/
100ml
Vial: 5mg/ml

Nafcillin 50-100mkday TID

Nalbuphine 0.1-0.2mkdose 10mg/ml

 Tab: 5mg, 10mg,
0.25mkdose (IV, IM)
Nifedipine 20mg, 30mg,
1mkday (OP)
60mg

400,000U/day NB 1.2M
Nystatin Oint: 5g
U/day

Tab:200mg,
Ofloxacin 20-30mkday 400mg IV Soln:
200mg/100ml

Tab: 500mg
Susp: 120mg/5ml,
Paracetamol 5-25mkdose q4h
250mg/5ml
Drops: 100mg/ml

50-100,00U/mkday,
Penicillin G 200,000-400,000U/
1.2M U
(Penadur) mkday
(meningitic dose)

Tab: 15mg, 30mg,

10mkdose (LD) 5nkdose
Phenobarbital 60mg, 90mg
(MD)
Amp: 130mg/ml

Phenoxymethyl Adult: 250-500mg QID

penicillin K Child: 50mkd QID

Piperacillin
100-300mkday Vial: 2.25, 4.5g
(Tazocin)

Prednisone
Tab: 5mg, 10mg,
(Oracort,
1-2mkday 20mg
Orasone,
Susp: 10mg/5ml
Prolix)
 Tab: 500mg
Pyrazinamide 15-30mkday Susp: 500mg/5ml,
250mg/5ml

Tab: 150mg,
300mg
Ranitidine 1-2mkdose BID q8-12h
Amp: 25mg/ml;
50mg/2ml

Cap: 300mg;
Rifampicin 10-15mkday (premeal) 450mg; 600mg
Susp: 200mg/5ml

Tab: 2mg
Salbutamol
Syr: 2mg/5ml
(Ventolin,
0.15mkdose TID-QID MDI: 100mcg/dose
Asmalin,
Nebule: 2.5mg/
Combivent)
5ml, 5mg/ml

Tab: 25mg, 50mg,

Spironolactone 1-3mkday
100mg

Streptomycin 20-40mkday Vial: 1g

Sucralfate
1g/dose QID
(Iselpin) Tab: 1g

Terbutalin
Tab: 2.5mg, 5mg
(Bricanyl,
0.075mkdose BID-TID Syr: 1.5mg/5ml
Terbulin,
Neb: 5mg/2ml
pulmoxcel)

Tetracycline 20-50mkday QID Cap: 250mg

 Tab: 125mg
Theopylline 20mkday q6h SR tab: 250mg
Syr: 80mg/15

DOPAMINE
Wt x ug/min 26.6
Ex: 40kg x 15ug/min or 10ug/min 26

DOBUTAMINE
Wt x ug/min 16.6

DOPAMINE DRIP
(5-8mg/k/min)
100cc 6 x wt x dose = 21mg of Dopamine
Rate___
1.6
79cc D5W + 21mg of Dopamine

25cc 1.5 x wt x dose = 5mg of Dopamine

Rate___
1.6
5mg of Dopamine in 20cc D5W

HEMODIALYSIS PRESCRIPTION

Blood Flow Rate: 5ml/kg/min

Dialyzer: F4: BSA 0.7
F5: BSA 1.0
F6: BSA 1.3

NSS Flushing 100ml q 15min or Heparin LD: 10-20IU/kg

MD: 10-20IU/kg
Ultrafiltrate 0.2ml/kg/min x ____ hrs
Duration: initial 1.5 2 hrs
2nd day: 3hrs
3rd day: maintemance 4hrs
Bicarbonate bath: prime solution with NSS 120ml

Weigh pt pre & post HD and record

Monitor VS q15mins while on HD
Watch out for Headache, nausea, disorientation,
hypotension, seizure, muscle cramps & vomiting
Labs: pre & post HD
Intradialytic transfusion (if any )
Initial HD: Mannitol 0.5-1.0g/kg to decrease disequilibrium
syndrome in pt w/ elevated BUN (>35mmol/L)
Refer accordingly.

MGH orders for KD

Repeat CBC, Plt, ESR, after 2 weeks
Repeat 2D echo after 6 weeks
Home meds: ASA 80mg/tab 1 tab OD x 6 weeks take on full
stomach
No live attenuated vaccine for at least 11 months

KAWASAKI DISEASE
Febrile, examthematous, multisystem vasculitis
Fever for at least 4 days
+ clinical features (at least 4/5)
1. Bilateral bulbar conjuctival injection w/o exudates w/
lumbar sparing
2. Erythematous mouth & pharynx, strawberry tongue
and red, cracked lips
3. Polymorphous, generalized erythematous rash
(morbilliform, maculopaular or scarlatiniform )
4. Changes in peripheral extremities (induration of hands
and feet w/ erythematous palm & soles later w/
periungual desquamation)
5. Acute, nonsuppurative, unilateral cervical
lymphadenopathy at least 1.5cm in diameter or if w/
coronary actery aneurysims

ATYPICAL KD common in <12 mo old

 Coronary artery ectasia/dilatation: confirms diagnosis
(1-4 wks DOI)
Labs: CRP > 3.0mg/dl 1st 2 weeks of illness
ESR > 40mm/h
PLT ct >450 on days 10-12 of illness
without aspirin & IVIg, fever can last upto 2 weeks or
longer. After fevr resolves, pt can remain notablefor 2-3
weeks. Desquamation of groin, finger, toes after 2-3
weeks may occur.
Labs normalizes w/in 6-8 weeks

Treatment
IVIg high dose within 10 days
Aspirin
IVIg: 2g/kg as single dose over 10-12hrs
Aspirin: 80-100mg/kg/day x 4 doses
After fever is controlled, Aspirin to 3-5 mg/kg/day,
discontinue after 6-8 weeks if no heart problems

Recommended Dosage and Drip Rate for Kawasaki Patient

Dosage: 2g/kg/12hrs
EX: Pt: 10kg
Patient total needs: 20g of Immunorel
Total Volume need: 400ml to be divide by 12 hrs = 33.33ml
Initial Test drip: 33.33ml/4= 8.33ml for 1st hour
Succeeding Drip Rate
2nd hour: 8.33ml x 16.67ml
Total Volume left: 375ml/10hrs=37.5ml/hr
* Courtesy of Dr. Ana Marie Morelos, Dr. James Angtuaco and Dr.
Edison Ty

GUIDELINES FOR PEDIATRIC PLATELET TRANSFUSION

Children/Adolescents
<50 x 109/L and bleeding
<50 x 109/L and invasive procedure
<20 x 109/L and bone marrow failure with age risk factor
<10 x 109/L and bone marrow failure w/o age risk factor
Infants within the 1st 4mos of life
<100 x 109/L and bleeding
<50 x 109/L and invasive procedure
<20 x 109/L and clinically stable
<100 x 109/L and clinically unstable

WHO GRADING OF DHF

I. Hemocencentration, fever, & constitutional sx; + TT
II. Spontaneous bleeding + grade 1
III. Circulatiry failure, pulse pressure <20mmhg
SBP normal DSS
IV. Profound shock, hypotension/unrecordable BP

NORMAL HEMATOCRIT VALUES FOR AGE

Age Range (%) Mean (%)

2 weeks 42-66 50
3 months 31-41 36
6 months 6 yrs 33-42 37
7 yrs 12 yrs 34-40 38
Adult:
Male 42-52 47
Female 37-47 42
Source: Nelson textbook of Pediatrics, 15th edition p. 1379

WHO CASE DEFINITION OF DHF (WHO 1975, 1986)

All of the ff criteria nust be present:
1. Fever (high and continuous of 2-7 days duration)
2. Hemorrhagic diathesis (at least a positive tourniquest
test except in shock)
3. Thrombocytopenia (less than 100,000/mm3)
4. Hemoconcentration (20% or more relative to baseline
or evidence of increased capillary permeability) or
evidence of plasma leakage (i.e. pleural effusion,
ascites and/or hypoproteinemia)
OTHER CLINICAL MANIFESTATIONS SUGGESTIVE OF DHF
ARE:
 1. Hepatomegaly (which may be tender)
2. Circulatory disturbances (restlessness, cool
extremities), capillary refill time >2 sec., tachycardia)
3. A fall in hematocrit following volume relacememnt
~ These along with a platelet count below 100,000/mm3 can
justify notification of the case as DHF
~ Hematoconcentration may be absent during earlt fluid
replcemnt or in cases where bleeding has occurred.

Unstable VS, urine output

Signs of shock
Immediate rapid volume replacement 10-20ml/kg (or rapid bolus)normal saline or LR
solution

Improvement No Improvement
O2 to Correct Acidosis

Hematocrit
Adjust IVT Hematocrit

Colloid infusion 10-20 ml/kg IV

Blood transfusion 10ml/kg
SCABIES Plasma/Hemaccel / 5% Albumin/
~ Treatment for dengue shock syndrome gradesDextran340and 4
Crotamion (Eurax)lotion apply from neck down x 24h then rinse

DOPAMINE DRIP
200mg in D5W 200cc
mcgtt/mins = wt x DD/13.3
= wt x DD x 0.75

400mg in D5W 250cc

mgtt/min = wt x DD/26.6
 = wt x DD x 0.375

6 x wt in kg = ___ mg in 100ml (1ml/hr = 1mcg/k/min)

CRANIAL NERVE EXAMINATION LIST

Rapport with patient Introductions

Sit on edge of bed

General inspection Diagnostic facies IVC

NGT
IDC
Facial asymmetry
Pupil symmetry
Scars Ptosis eye patch
eye glasses Hearing aide

1. Ask for change in

smell

2. Test visual acquity Snellen chart Left eye

Right eye

Test visual fields Hat pin Left eye Right eye

Test light reflexes Direct Consensual

Swinging torch

Test accommodation Hat pin

Fundoscopy Optic disc Retinopathy

3, 4, 6. Test ocular Dysconjugate gaze (MLF)
movements ; ask if H pattern testing Diplopia
diplopia occur Nystagmus Vertical
Horizontal
Test Intorsion (if CN3 palsy)

5. Trigeminal Sensory & Pin prick testing V1 V2

Motor V3
Light touch testing Corneal
reflex
Clench teeth & palpation of
masseter muscle
Open jaw & ptyerygoid
resistance
Jaw jerk

7. Test Facial Muscles Forehead wrinkling Eye

closure
Blowing of cheeks Smiling
Ear Mastoid Parotid
Palate

8. Test Hearing and Inspection of ear and

Balance tympanum
whisper High tone 68
Low tone 100 Rinnes R
L
Webers (256Hz)
Nystagmus
Hallpikes +/- Epleys

9, 10. Deviation to Dysphonia Swallowing

Normal side Coughing Uvual deviation
Gag reflex
 11. test shoulder & neck Trapezius mm: Shoulder
movements shrug
SCM mm: Head turning

12. Tongue Protrusion; Wasting Fasiculation

deviation to affected side Dysarthria

Ask for BSL

If relevant assess other Peripheral nervous system

neurological system Cerebellar system

Summary &
interpretation

HEART RATE MEAN

NB- 3MOS 85-205 140

3MOS-2YRS 100-190 130

2YRS-10 YRS 60-140 80

>10YRS 60-100 75

WEIGHT

6MOS-12MOS AGE in mos + 9 2

1 YR-6YRS Yrs x 2 + 8

7YRS-12YRS Yrs x 7 - 5
 HEIGHT

Ht in cm AGE in yrs x 5 + 80

Ht in inches AGE in yrs x 2 + 32

Light index
D2 diameter of collapsed lung
DH diameter of hemithorax on the collapsed side
% of pneumothorax= 100-(D23/DH3 x 100)

DOBUTAMINE DRIP
6 X WT in Kg = ______mg in 100ml

250mg in D5W 250cc (1mg/ml)

Mcgtt/min= wt x DD/16.6
= wt x DD x 0.06

500mg in D5W 250cc (2mg/ml)

Mgtts/min = wt x DD/33.2
= wt x DD x 0.03

EPINEPHRINE/NOREPINEPHRINE DRIP
0.6 X WT = ______mg in 100ml
1ml/hr will deliver 0.1mcg/kg/min

Treatment for Chicken Pox

Children: 800mg/tag, 1tab QID
>40mg (3, 200mg PO in 4 divided doses)

Nasal Cannula

Oxygen Flow rate Est. FIO2 in %

 1 24%

2 28%

3 32%

4 36%

5 40%

6 44%

SIMPLE FACE MASK

5-6 40%

6-7 50%

7-8 60%

Anion gap (serum)= Na- (Cl + HCO3)

Corrected Ca= Actual Ca + [(40-alb)x 0.02]
Sodium deficit= DNa-Ana x BW x 0.6
Potassium deficit = DK AK /0.27 x 100%

Sodium
The needed to infuse
DNa-Ana
0.5 meqs / hr
L
Amount of PNSS needed =
Computed Na deficiency 154
Drip rate = amount of PNSS needed
Time needed to infuse
Methylmed
 30mkdose + 100cc D5W x 2h q 24H via
infusion pump x 3 doses

SCLEREMA NEONATORUM
- In an infant, fat has higher saturated-to-unsaturated fatty
acid ration compared to adult fat and thus a higher melting
point. Prematurity, hypothermia, shock and metabolic
abnormalities have been postulated to further increase this
ratio, possibly as a result of enzymatic alteration allowing
precipitation of fatty acid crystals within the lipocytes. This
condition has been suggested to result in the dramatic
clinical findings in affected skin. X-ray diffraction techniques
have confirmed that infants with sclerema neonatorum have
an increase in saturated fats and that the crystals within the
fat cells are composed of triglycerides.

Fluids and Electrolytes

> 5 years old (>20kgs)D5LR
> 3 years old (<15kg)D50.3Nacl/ D5IMB
(>15kg)D5NM

Deficit <10 kg >10kg

Mild 50 30

Moderate 100 60

Severe 150 90

Maintenance (24 H)
0-3 kg 75cc/kg

3-10 kg 100cc/kg

10-20kg 75cc/kg

20-30kg 60cc/kg

30-40kg 50cc/kg

>40kg 40cc/kg

Newborn
0-1 day old 80cc/kg/hr

2 90cc/kg/hr
 3 100cc/kg/hr

4 110cc/kg/hr

5 120cc/kg/hr

6 130cc/kg/hr

7 140cc/kg/hr

8 150cc/kg/hr

Mild Dehydration
30-50cc/kg/6h D50.3Nacl
Moderate Dehydration
60-90cc/kg/6h
of computed deficit give D5LRX2hrs then to be given
for the next 6hrs D50.6Nacl
Severe Dehydration
>100cc/kg/6h
1/3 with D5LRX2H then 2/3 with D50.3Nacl X 6H

Medical Prophylaxis

Diphtheria update DPT immunization status for all age

groups and Erythromycin 4-050mkd in 4 days
divided doses X 10 days (max 2g/day).
Alternative: Benzathine Pen G IM single dose
<30kg 600,000 units
>30kg 1.2 Million units
 NOTE: Close contact should be observed for 7 days
for evidence of the disease.

Endocarditis prophylaxis given 30-60 mins after

procedure
Oral: Amoxicillin 50mg/kg
Unable to tolerate PO
Ampicillin 50mkdose IM/IV or
Cefazolin/Ceftriaxone 50mg/kg
Allergic to Penicillin
Cephalexin 50mg/kg or
CLindamycin 20mg/kg or
Azithromycin/Clarithromycin 15mg/kg
Allergic & unable to tolerate PO:
Cefazolin/ceftriaxone 50mg/kg IM or IV or
Clindamycin 20mg/kg IM or IV

Note: No prophylaxis for procedures ________

Respiratory, GI or Genitourinary Tract

Hepatitis B
Newborn with HBsAg (+) mother
- HBIG 0.5mL and Hep B vaccine 0.5ml IM at
birth or w/in 12 hrs followed by Hep B vaccine
at 6 weeks after and after 6 months.
Premature & HbsAg (-) mother
- Hep B vaccine delayed until child 2000 gm
Sexual contact with HBsAg (+) partner, exposure to
blood/ body fluids
 - Hep B vaccine + HBIG 0.06ml/kg IM (not later
than 14 days from exposure from sexual
contact and with in 7 days for percutaneous
exposure)
Household/Sexual Contact with Chronic Causes
- Hap B vaccine only

Malaria
Mefloquine (250mg/tab) to start 1 week before travel
then weekly until 4 weeks after leaving endemic area
as ff:
< 45kg = 5mg/kg (max: 250mg)
>45kg = 1 tab once a week
Doxycycline daily to start 2-3 days before travel then
daily until 4 weeks after leaving endemic area
8 years old = 2mg/kg up to adult dose of
100mg/day

Note: Contraindicated for < 8years and pregnant

women

Meningococcemia
Rifampicin in 2 divided doses X 2days
1 month 5mkdose every 12 hrs
1 month 10mkdose every 12 hrs (max 600mg)
Alternative: Ceftriaxone single IM dose
< 15 years old 125mg
15 years old 250mg or

Ceprofloxacin (not for 18 years old)

 18 years old: 20mk PO as SD (max 500mg)

Rheumatic Fever
Benzathine Penicillin 1.2 Million U IM every 4 weeks
- <27kg (60lbs)- 600,000 U IM or
- Penicillin V 250mg PO twice daily for patients
allergic to Penicillin: Erythromycin 250mg PO
BID
Duration:
RF, (-) carditis: 5 years since last episode ao
ARF or until 21 years old whichever is longer
RF, (+) carditis w/o residual heart disease (no
valvular disease): 10 years or until 21 years old
whichever is longer
RF, (+) carditis, (+) residual heart disease:
10 years since last episode or at least until 40
years old whichever is longer

Note: Consider lifelong prophylaxis for people with

severe valvular disease

VACCINATION
Absolute Contraindications
Severe anaphylactic/allergic reaction to previous
vaccine
Moderate severe illness fever
Encephalopathy within 7 days of vaccine (pertussis)
Immunodeficiency (Congenital all live vaccines ) or
households contact (OPV)
Pregnancy (MMR, OPV/IPV )
Relative Contraindications
Immunosuppressive therapy (all live vaccines)
Egg allergy (MMR)
Seizure w/in 3 days of last dose (Pertussis)
Shock w/in 48 hrs of last dose (Pertussis)
Fever >40.5C w/in 48hrs of last dose (Pertussis)
Not Contraindications
Mild illness low grade fever
Current antibiotic therapy
Positive PPD
Prematurity

Nursery
Please admit to NICU under the service of Dr. _____
TPR Q15minutes until stable
Breastfeeding
Labs: CBC, APC, BT, RH typing, NBS at 24h old
Medications:
1. Terramycin ophthalmic ointment OU
2. Vit. K 1mg IM
3. Hep B vaccine 0.5mL IM
S/O:
Routine newborn care
Gastric lavage
Suction secretion PRN
Thermoregulate at 36.5-37.5C
Daily cord care w/70% IPA
Watch out for tachypnea, tachycardia, alar
flaring, retractions
Refer PRN
Newborn Final Diagnosis:
Fullterm (__wks), AGA, BW=__kg, cephalic via NSVD, Live,
Bb.Girl/Boy AS 9,10; Neonatal sepsis; Uninvestigated
physiologic jaundice

IVF:
TFR x wt/24h/20% (if with phototherapy)
TFR x wt/24h-fdg-Aminosteril (use formula if w/
Aminosteril & fdg)
eg: wt: 3kg TFR: 80
80x3/24/20%= 20 or
80x3=240x0.2= 48, next
240/48= 288/24h= 12cc/hr

1st 24h D10w, then

D10IMB
D5IMB

Preterm
Please admit
TPR q15 minutes until stable
NPO
D10W 250ccx7cc/hr
Labs:
CBC, APC @24HDL
Blood & RH typing
Na, K, Ca
BUN, Creatinine 24HDL
NBS
 ABG, Blood C/S, CBG q6H
CXR, APL
Vit. K 1mg IM now
Hep B 0.5 ml Im now
Terramycin/Erythromycin ophthalmic ointment
Ampicillin q12h
Oxygen
Attach to pulse oximeter

HBsAg Reactive Mother

- Give HBIg 0.5ml deep IM w/in 12HOL
- CRP at 24HOL
- Blood C/S anytime after birth
Normal CBG: 60-140
Bilirubin: B1B2: 17.1 (start phototherapy if 15)
WBC: 20,000 start meds
IT Ratio- stabs/juvenile/total neutrophils = 0.2 (+)
infection
Reticulocyte actual Hct/0.40 (desired Hct)X
Reticulocyte = N 1-1.5
1.0 = hemolysis
1 = bone marrow failure (CRT 2)

Seizure Disorder
Please admit
TPR q4h and record
NPO temporarily
Labs: CBS, APC, Urinalysis, fecalysis, CBG now then
q6h while on NPO
 IVF: D50.3Nacl 500cc+2meq KCL/150ccIVF post
voiding
Meds:
S/O:
MIO qshift & record
Monitor VS q4h & NVS qhour & record
Seizure precaution at bedside
Standby O2, padded tongue depressor at
bedside
Replace GI loses volume/volume w/ PLR
as sidedrip
Refer PRN

Benign Febrile Seizure

Please admit
TPR q4h & record
NPO temporarily
Labs: CBC, APC, Urinalysis, Fecalysis, CBC now
then q6h while on NPO
IVF: D50.3Nacl 50cc+ 2meq KCl/100cc IVF
IVF post voiding
Meds: Paracetamol, Ibuprofen, Diazepam
(0.2mkdose)
S/O:
MIO qshift & record
Monitor VS q4h, neuroVS qhour & record
Seizure precaution
Standby O2, tongue depressor at bedside
Replace GI losses V/V w/ PLR as sidedrip
Refer PRN
Status Post Lumbar Puncture Orders
Flat on Bed x 4h
NPO x 4h
Send the following specimen to lab as ff:
TT#3 CSF cell ct, diff ct
TT#2 CSF, sugar & protein
TT#1 CSF GS/CS, AFB, KOH
RBS now
Monitor VSq15min until stable
Refer patient for any untoward s/sx
Status Post Extubation Orders
Nebulizer with Racemic epinephrine now
Extubate patient now
Nebulize w/ Racemic epinephrine q15minx3doses
Nebulize w/ Salbutamol 1nebule q6h
NPO x 6h
CXR, APG 6h post extubation
O2 6-10LPM
Watch out for secretions, tachypnea, etc.
Note: Racemic Epi: PNSS: 4.7ml Epi: 0.3ml

Body Surface Area

=

ANC= WBC x Differentials x 10

IT = stabs seg >0.2 bacterial
BMI = wt (kg) ht (m)2
MIO + intake output = +/- balance
Output + output wt 24h = ____cc/k
(Output of chemo px: output 24hBSA = _____cc/m2)
 Dopamine
0.5-4gm/kg/min renal vasodilation
>10gm/kg/min vasodilation & decreased peripheral
and renal perfusion
5-10 gm/kg/min increase inotropic effect and
cardiac output = increase BP

Management for Acute Respiratory Tract Infection

Central cyanosis Admit

Severe respiratory distress Very IV
YES
Not able to drink
Severe Chloramphenicol/
Pneumonia Ceftriaxone
NO
YES Severe Admit
Chest in drawing
Pneumonia PenG
Manage Airway
NO
YES
Fast Breathing Pneumonia
Home
management
NO Amoxicillin

YES
No signs of PNA No PNA,
cough, cold Home
management
Fast Breathing:
Cough medications
60BPM in <2 months
50BPM in 2-11 months
40 BPM in 1-5 years