Pediatric Dosage ???????

1
Pediatric Dosage???????

• ????? ???
• InstructorR2???

2
Fulid supplement

• 010Kg (4 MD/kg)100ml/kg/day
• 1020kg(2 MD/kg)1000?( BW-10 ) 50?/day
• gt20kg (1 MD/kg)1500?( BW-20 ) 20?/day

• Example 1
• BW25 kg,Keep IV route with 0.33G/S
  ______MD/min
• Ans (10 4) (10 2) (5 1) 65 MD/min
• Example 2
• BW30 kg,Keep IV route with 0.33G/S
  ______MD/min
• 
  ______c.c. qd
• Ans (10 4) (10 2) (10 1) 70 MD/min
• (10 100) (10 50) (10 20) 1700
  c.c./day

3
Management of Dehydration

• Access fluid deficit
• lt 5(mild) Consolable, Dry tongue, Mild loss of
  skin turgor
• 5 -10(moderate) Irritable, Reduced urine
  output, Deep set eyes, Tachypnea, Marked loss of
  skin turgor
• gt 10(severe) Lethargy or Coma, Sunken anterior
  frontanelle and eyes, Cold extremities, Weak or
  impalpable pulse, Hypotension

4
Management of Dehydration

• Rehydration First 8 hr Later 16 hr
• Deficit 1/2
  1/2
• Maintenance 1/3
  2/3
• e.g. 10kg, 10 loss, ?3 days ?
• Deficit 10 x 10 (kg) x 0.6(deficit from ECF )
  X 1000 600 ml
• Maintenance 10 x 100 1000 ml
• First 8 hr
  later 16 hr
• Deficit 300ml 300ml
• Maintenance 333ml 660ml

5
Management of Dehydration

• Shock
• 20ml/kg N/S or Lactate Ringers
• or 10ml/kg 5 albumin, blood, plasma
• Loading speed 10ml/kg/hr, ( 2ml/kg/hr in CHF )

6
Electrolyte supplement

• Na34 mEq/kg/day
• 3NaCl 1ml 0.5 mEq
• 0.9 NaCl 500ml 77mEq
• K 23 mEq/kg/day
• 15KCl 1ml2 mEq
• Ca2001000 mg/kg/day q8h-qd
• 10 Ca gluconate(100mg/1ml,1Amp10ml)
• NaHCO31 mEq/kg ( if PHlt7.2 )
• 17 mEq/20cc/amp

7
Correct Metabolic Acidosis

• Tachypnea (BEPCO2 1.5 x HCO3 8 ? 2 )
• BE HCO3
• Mild lt10 gt17 ?
  Observation
• Moderate 10-20 17-8 ? Slow
  correction
• Severe gt20 lt 8 ? Rapid
  supply IVD 10,
• 
  taper the speed if PH gt 7
• 7 NaHCO3 ( 17 mEq/20ml ) supply half in
  2-8 hours
• 2-4 mEq/kg/dose
• BE x 0.3 x BW
• ( 15-HCO3 ) x 0.6 x BW

8
Common Dose????

• gt20kg????
• 40Kg1 po qid
• 30Kg1 po tid ???,???
• 20Kg1/2 po qid
• 10Kg1/4 po qid
• lt20kg??
• ????????????BW/4 c.c.
• ??????????BW/2 c.c.
• ?????????????????????

9
Antipyretics ???

• Scanol (500mg/1)
• 1015mg/kg/dose q4hq6h (50 mg/kg/day)
• Antiphen (Acetaminophen syrup)
• BW/2 ? q4h prn if BT ? 38.5?(120mg/kg/dose)
• Macsafe(Ibuprofen syrup)NSAIDs
• ? 38.5? BW/4 cc q6h ? 39.5? BW/2 cc q6h
• Diclofen (supp)( 12.5mg )
• lt6kg 1/3 supp q6h prn if BT ? 39.5?
• 610kg 1/2 supp q6h prn if BT ? 39.5?
• gt10kg 1 supp q6h prn if BT ? 39.5 ?

10
Antitussives and expectorants?????

• Medicon-A ( 20mg/cap ) Common dose
• Medicon syrup (Dextromethorphan)(2.5mg/ml)
• BW/4 cc po qid ,1-2mg/kg/day q6-8h
• Mucosolven (Ambroxol liq.)(3mg/ml) (??)
• BW/4 cc qid lt2 y/o2.55 cc bid 25y/o2.55 cc
  tid 510y/o 510cc tid
• Unitussin (Glyceryl guaiacolate)(20mg/ml)(??gt??)
• BW/4 cc qid 26y/o2.55 cc qid 612y/o
  510cc qid

11
Antihistamines Decongestants ???,??????

• Cyproh syrup (Cyproheptadine 0.4 mg/ml)
• BW/4 cc po qid
• Cyproh tablet (??,????)Common dose
• Demin (Chlorpheniramine 0.5mg/ml )
• BW/4 cc po qid
• CTM tablet (??,????)Common dose
• Venalin (Diphenhydramine 30mg/amp) 10-50mg IV or
  IM q2-3h, max 400mg/day (1mg/kg/dose)
• Urticaria, angioedema or EPS???

12
Antihistamines Decongestants ???,??????

• Clarityne(10mg/tab)
• lt30kg 1/2 po qdgt30kg 1 po qd
• Clarityne syrup (Loratadine 1mg/ml 60ml )
• lt30kg 5ml po qdgt30kg 10ml po qd
• Allegra (60mg tab) 1 bid -gt1 qd

13
Bronchodilator ?????

• Bricanyl (Terbutaline 2ml/5mg )
• lt20Kg½ in N/S 3ml for neubrilization q6h
  gt20Kg1 in N/S 3ml for neubrilization q6h
• Ventolin (Salbutamol neubule 2.5ml/5mg)
• The same with Bricanyl
• Tab(2mg) 0.1 mg/kg/dose up to 2 mg PO tid
• Berotec(Fenoterol HBr) syrup(0.5mg/ml)
• BW/4BW/5 cc tid lt1 y/o2.5 cc bid 16y/o2.55
  cc tid 614y/o 5cc tid
• Meptin(Procaterol) syrup(mg/ml)
• lt6 y/oBW/4BW/5 cc q12h gt6y/o5 cc po q12h

14
Bronchodilator ?????

• Xidanef (Ketotifen)100 ml syrup
• 2.5-5ml bid
• Atrovent (Ipratropium UDV 0.5mg/2ml)
• 1 vial q6h prn
• Epinephrine(11000) 0.01ml/kg/dose(Max 0.5ml)
  q15minSC

15
Xanthines???

• Aminophylline
• S.Enausea, vomiting, insomnia, tachycardia
• Loading dose5(26)mg/kg/dose iv drip for 2030
  minMaintain1mg/ kg/hr
• Infantsgt 0.20.9mg/kg/hr,
  1-9y/ogt11.2mg/kg/hr
• 9-16y/ogt0.81mg/kg/hr
• youngsmoker0.81mg/kg/hr,
• nonsmoker0.50.7mg/kg/hr
• Apnea of prematurity46mg/kg iv 30 min ,then
  maintaince 1.53 mg/kg/dose iv q8-12h

16
Xanthines???

• Ventol3ml/kg/day qid
• Aminophylline tab.200mg/tab po qid dose iv
  form

17
Steriods ???

• Decadron0.1 mg/kg/dose im q8h.
• Rinderon (4mg/ml) 0.1 mg/kg/dose im,iv q8h
• Prednisolone(5mg/tab)12mg/kg/day po qdqid
  max48(2040) mg/day for 35 day.
• 40kg?Pulmicort (steroid ,200mcg/dose)
• 12 puff bid for 3 month for prevent
  asthma(?????????)

18
Urticaria ???

• Benadryl (Diphenhydramine)1mg/kg IM
• Decardon (Dexamethasone)
• 0.1mg/kg/dose IM
• Periactin tab???? po qid.
• Prednisolone(5mg/tab.) 12 mg/kg/day

19
Antidiarrheals, digestives and antiflatulents?????
????

• Kaopectin
• lt6 mons3 ? po qid(????)
• 6 mons6 Y/O5 ? po qid
• gt6 Y/O10 ? po qid.
• Biofermin tab????2 po qid.
• Simethicone tab???? po qid.
• Bismuth ????po qid.

20
Antiemetics???

• Motilium(10 mg/tab) ???? po qid.
• Prepulsid0.10.2mg/kg/dose po qid
• Novamine or Priperam may cause EPS
• EPSAkinetonBiperidine(12mg5mg/1cc/amp)
• Adult2mg per 30 min.max 4 vial(20mg)

21
Laxatives ???

• Glycerine ball enema0.51 qd
• MgO tab???? po qid.
• Ducolax (Bisacodyl 5mg tab)
• 612 yo 1 po st.
• Cascara (Cascara sagrada) 12 po qhs

22
Anticonvulsants ????

• Valium(Diazepam)(10mg/2?/amp)
• lt5y/o 0.20.5mg/kg/dose iv slowly q15min 3 (
  max 5mg)
• gt5y/o the same as above except (max 10 mg)
• adolescents 5-10 mg/dose max 30mg.
• Neuropam(Lorazepan)(2mg/ml/amp) ??(10-15 hrs)
• 0.03-0.1mg/kg/dose q1520min 2 dose max
  4mg/dose

23
Anticonvulsants ????

• Dilantin(phenytoin) (250mg/5cc/amp)
• Loading 1020mg/kg iv with ratelt1mg/kg/min,max50mg
  /min ,Maintain 5mg/kg/day iv q12h, (????Glucose
  solution)
• Luminal(Phennobarbital) (100mg/cc/amp32mg/1)
• Loading 20mg/kg iv with ratelt30mg/min
  Maintain 5-10mg/kg/day to achieve serum level 40
  ug/ml
• Chloral hydrate enema(10 30ml)
• Neonates 25-50 mg/kg/dose,
• Children 25-100mg/kg/dose ? 1/23/4 BW cc enema

24
Antibiotics ???

• Penicillin Bctereimia2.5-5 Meningitis 7.5-10
  
• infection 10-25(???u/kg/dose q4-6h)
• Ampicillin IV 100mg/kg/day, q6h.
• Amoxicillin Cap(500mg) (Ac. tonsillitis, AOM)
• Hiconcil Cap(250mg)gt 50 mg/kg/day q8h.
• Amoxicillin syrup gt BW/2 po q8h.
• Augmentin (amoxicillin clavulanic acid,
  375mg/1,600mg/vial) BW/2 po q8h.

25
Antibiotics ???-Cephalosporins????

• Cephazolin(Veterin) IV 100mg/kg/day, q6h.
• Keflex(250mg/1,Cephalexin 1',Ceflexin
  500mg/1)25-50 mg/kg/day poq6h for G().
• Keflor (2 Cefaclor,250 mg/1,125mg/5cc/60cc/susp)
  50 mg/kg/day q8h. BW/2 q8h.(AOM)
• Zinacef (2 Cefuroxime, 250mg,750mg)
• lt2y/o125mg/dose po bid gt2mg250mg/dose po
  bid
• Zinnat (2 Cefuroxime, 25mg/ml)
• AOM lt2 y/o 5ml q12h gt2 y/o 10ml q12h
• Common infection 5ml q12h
• Rocephin,Syntrix(3Ceftriaxone 500mg/5cc/vial)
• 50-100mg/kg/day iv q12h-qd
  Meningitis100mg/kg/day q12h (max4g/day)
• Prostaphlin (Oxacillin)
• IV 100mg/kg/day, q6h. (Cellulitis)

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Antibiotics ???- Macrolides

• Erythromycin(Mycoplasma,Chlamydia,Legionella)
• Erythrocin syrup (40mg/cc)BW/4 cc po q6h
  Ilosone (250/1)30-50 mg/kg/day q6h.(20kg 1
  qid, 40kg 2 qid)
• Zithromax(Azithromycin,250mg/1,200mg/5cc/susp)
• child 1 qd 3day (gt40kg2)
• Zithromax syrup BW/4 cc po qd 3 days
• Klaricid(Clarithromycin ,250/tab)
• Adult 12 po bid
• Child7.5mg/kg bid

27
Antibiotics ???-UTI

• Nitrofurantoin(Ninru,100mg/1)
• 57mg/kg/day, po qid (UTI),Adult1po qid.
• Prophylactic dose 1/31/4 therapeutic dose
• Azactam(Aztreonam 1 g/inj)90-120mg/kg/day iv
  q6-8h for G(--) and Pseudomonas
• Mycostatin( 50?u/1)for Candida(Oral thrush)
• Infant 2/5 (20?u)/dose q6h
• Child 1 (40-60u)/dose q6h
• Baktar(TMP-80 SMX-400)6-12 mg/kg/day po q12h
  (Contraindication lt 2 months,G6PD deficiency)

28
Cardiologic disease

• PGE1( PDA )IV 0.05-0.1µg/kg/min
• Supraventricular tachycardia
• Adenosine0.1mg/kg rapid IV push give double or
  triple the dose in 2-3 min (6mg max)
• Digoxin(not for WPW)loading 30-40µg/kg
• Give 1/2 dose, then 1/4 dose q6-8h for 2 more
  doses
• Verapamil(Isoptin 5mg/2ml/amp, 1 80mg)
• gt1y/o 0.075-0.15 mg/kg,slow IV, repeat twice q15m

29
??????

• Aspirin(500mg/13)
• Analgesic10-15 mg/kg/dose po q6-8h
• Anti-rheumatic65-100mg /kg/day po q6-8h
• Kawasaki disease 100mg/kg/day po q6h
• Indocin Dose No.1 No.2 No.3
• lt48h-- 0.2 0.1
  0.1 (mg/kg
• 2-7days -- 0.2 0.1
  0.2 q12-24h )
• gt7 days -- 0.2 0.1
  0.25
•  

30
??????

• Lasix(40mg/1,20mg/2cc/inj)1-2mg/kg/dose q6-12h
• Mannitol(60mg/20/300cc)0.5-1.0g/kg/dose iv for
  30min
• Insulin
• DKA0.05-0.1u/kg/hr iv drip ,
• maintain 0.5-1u/kg/day/SC
• Glucose intolerance in prematurity
  0.01-0.1u/kg/hr.
• Difflam Anti-Inflammatory Spray(??? ?????)
•   ???mL?Benzydamine Hydrochloride 15 mg
•   ??Benzydamine???????,???????????
•   ?????5-10?????????,?????,???,??1.5-3???????

31
CPR ??

• E-T tube size
• Newborn2.5 4 Fr gt2 Y/O 4(age / 4) Fr
• Depthlip-tip length (about3 E-T tube size)
• Depth 1/ 2/ 3/ 4 kg gt 7 / 8 / 9/ 10 cm
• Epinephrine ( 11000 )( 1mg1ml )
• 0.01 ml/kg/dose iv or 0.1 ml/kg/dose via ET tube
• Dopamine( 6BW ) kg in N/S final V100ml
  1MD/min1ug/kg/min
• N.E.(Levophed)1mg/ml 0.05-0.1ug/kg/min drip.
• Nitroprusside(Nipride) 0.5-1.0 ug/kg/min drip.

32
CPR ??

• Atropine0.02mg/kg (1ml0.1mg ) q5m, total max
  dose child1mg, adolescent 2mgminimal
  dose0.1mg
• NaHCO31 meq/kg ( if PHlt7.2 )
• Lidocaine(10mg/ml) 1mg/kg loading,
  20-50ung/kg/min,
• (60xBW)mg of lidocaine dilute with
  N/S to 100ml, then 1MD/min?10ug/kg/min
• Adenosine for PSVT
• Neonates and child 0.05mg/kg iv push, increase
  bolus doses by 0.05mg/kg q2min, max
  dose0.25mg/kg or 12mg
• Adult 6mg?12 mg? 12 mg