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Emergency management of
common paediatric conditions,
presentations and the associated
drug doses
Department of Paediatrics,
Jinja regional referral Hospital
0
Directory
ABCD
Stages of
Management
Triage
Airway and
breathing
2
Circulation
Coma – BCS
Coma - GCS
Convulsions
Dehydration
5
6
7
8
9
Conditions
Diarrhoea
Presentations
Malaria
Pneumonia
TB
Malnutrition
Fever
Respiratory
distress
Severe pallor
Convulsions
Drug Formulary
Analgesia
Antibiotics
Paracetamol
Ibuprofen
3
4
Anticonvulsants
& neurological
agents
Antidiarrhoeals
Antifungals
10 Antihelmintics
(de-worming)
11
14 Antimalarials
17
19
22
24
25 Antihistamine
26 Binding agent
Asthma
35
34 Cardiac
medications
Diclofenac
33
morphine
35 Diuretics
Amoxicillin
29 Haemotinics
Ampicillin
29
Ampiclox
29 Steroids
Azithromycin
30
cefuroxime
31 Vitamins
Ceftriaxone
31
chloramphenicol 31
ciprofloxacin
31
Cloxacillin
32
Co-trimoxazole
32 Flow rates of IV
(septrin)
fluids
Erythromycin
33 Fluid
requirement
Gentamicin
34 Growth chart
Metronidazole
35
Tetracycline
37
Carbamazepine
31
Diazepam
Haloperidol
Phenobarbital
Phenytoin
Zinc sulphate
Griseofulvin
Albendazole
33
34
35
35
37
34
29
Ketoconazole
Mebendazole
Artesunate
Co-artem
Quinine
Salfadoxine/Pyrimethamine
(Fansidar)
Chlorphenamine
Charcoal
Aminophylline
Salbutamol
Steroids in separate section
Captopril
34
35
29
32
36
37
Digoxin
Frusemide
Folic acid
Iron
Dexamethasone
Prednisolone
Vit A
Vit B (pyridoxine)
Vit C
33
34
33
32
33
36
32
31
29
36
30
37
37
37
39
40
41
1
Key stages in the management of the sick child
1WHO hospital care for sick children
2
3
4
5
6
COMA
Modified Glasgow Coma Scale
Infant <1 year
4
3
2
1
5
4
3
2
1
6
5
4
3
2
1
Child 1-4yrs
Age 4yr-Adults
EYES
Open
Open
Open
To Voice
To Voice
To Voice
To Pain
To Pain
To Pain
No response
No response
No response
VERBAL
Coos, babbles
Orientated, speaks,
Orientated and alert
interacts
Irritable cry,
Confused speech,
Disorientated
consolable
disorientated, consolable
Cries persistently to
Inappropriate words,
Nonsensical speech
pain
unconsolable
Moans to pain
Incomprehensible, agitated Moans, unintelligible
No response
No response
No response
MOTOR
Normal
Normal spontaneous
Obeys commands
spontaneous
movement
movement
Withdraws from
Withdraws from touch
Withdraws from
touch
touch
Withdraws from
Withdraws from pain
Withdraws from pain
pain
Decerebrate flexion
Decerebrate flexion
Decerebrate flexion
Decorticate
Decorticate extension
Decorticate
extension
extension
No repsonse
No repsonse
No repsonse
Total score for normal GCS = 15, minimum score = 3
7
8
9
10
11
MALARIA IV Drug Dose
Artesunate IV Dosage Regime
Add 1ml sodium bicarbonate and wait for solution to become clear then add
5mls sterile water to give 60mg/6mls
Weight ml of
Weight ml of
Weight ml of
10mg/mL
10mg/mL
10mg/mL
solution
solution
solution
4
1
15
3.6
26
6.2
5
1.2
16
3.8
27
6.5
6
1.4
17
4.1
28
6.7
7
1.7
18
4.3
29
7
8
1.9
19
4.6
30
7.2
9
2.2
20
4.8
31
7.4
10
2.4
21
5
32
7.7
11
2.6
22
5.3
33
7.9
12
2.9
23
5.5
34
8.2
13
3.1
24
5.8
35
8.4
14
3.4
25
6
36
8.6
Give dose on admission, 12 hours after first dose and then 24 hours
after first dose. If improving and able to swallow switch to oral Coartem, if not continue above dose every 24 hours for 7 days
Quinine IV Dosage Regime
Intravenous 10mg/kg in 10mls/kg 5% glucose as infusion over 1 hour.
Give every 8 hours for a minimum of 3 doses.
If then improving and able to swallow switch to oral quinine or if not
able to swallow continue IV quinine as above.
12
13
14
15
16
Anti- TB Dosage regime
Weight
Initial Phase (2
months)
5-9kg
10-14kg
15-19kg
20-29kg
RHZ
(60+30+150)mg
1 tab
2 tabs
2 tabs
3 tabs
30-37
38-54
55-69
70+
RHZE
(150+75mg+400
+275)mg
2
3
4
5
Continuation
Phase (minimum
4 months)
RH (60+30)mg
If
Ethambutol
indicated
E 400mg
If
Streptomycin
indicated
1/2 tab
1 tabs
1 ½ tabs
2 tabs
¼ tab
½ tab
¾ tab
1 tab
125mg
250mg
375mg
500mg
EH (400+150)mg
Streptomycin
if indicated
1½
2
3
3
500mg
750mg
1g
1g
**Ensure patients also started on pyridoxine**
For Re-treatment
CHILDREN: 2 SHRZ/RHZ/SRH
ADULTS AND CHILDREN >30KGS 2SHRZE/1RHZE/5 RHE
NB The concentration of Isoniazid and Rifampicin tablets are different in
initiation and continuations phases.
17
Management Steps of Severe
Malnutrition
Stabilisation
Days 1- Days 32
7
Hypoglycaemia
Hypothermia
Dehydration
Electrolytes
Infection
Micronutrients
Initiate feeding
Catch-up
growth
Sensory
stimulation
Prepare for
follow-up
NO IRON
Rehabilitation
Weeks 2-6
WITH IRON
18
DEHYDRATION IN SEVERE
MALNUTRITION
NEVER USE INTRAVENOUS FLUIDS (EXCEPT GLUCOSE) UNLESS THE PATIENT IS IN SHOCK
Hours Treatment
 If there is any doubt
0
5mls/kg intravenous 10%
about whether the
child will drink the
glucose.
required amount a
5mls/kg ReSoMal
nasogastric tube
should be inserted
30m 5mls/kg ReSoMal
immediately.
1
5mls/kg ReSoMal
 Ifsigns of fluid
1 ½ h 5mls/kg ReSoMal
overload (RR
increase by 5/min,
2
5mls/kg ReSoMal
pulse increase by
3
5-10mls/kg ReSoMal
15/min, frequent
urination, frequent
4
5-10mls/kg ReSoMal
loose stools or
vomiting) stop fluids
5
5-10mls/kg ReSoMal
for 1 hour and
6
5-10mls/kg F75
reassess.
7
5-10mls/kg ReSoMal
 Ongoing losses (e.g.
8
5-10mls/kg ReSoMal
diarrhoea) should be
replaced as well as
9
5-10mls/kg ReSoMal
giving the fluids in
this chart.
10
5-10mls/kg F75
>10
Following this F75 should be given every 2
hours as per feeding guide.
19
FEVER
Respiratory
Distress
Common
Presentations
Severe
Pallor
Convulsions
20
Fever
Definition: Temperature >38 degrees
All children with a history of fever or a fever on presentation who may require admission
into hospital should have a BS for MPS, Hb and group and save if signs of pallor.
If a child is extremely unwell & is to be admitted as an emergency & the
diagnosis is not clear then immediately give:
- Oxygen
- 10% glucose
- IV Artesunate
- Ceftriaxone (if none available use ampiclox)
- Gentamicin.
If the diagnosis is clear then treatment for that condition should be started immediately.
Fever + pallor
Mostly likely malaria – Insert Cannula and send blood for BS + Hb + cross match.
Give bolus if 10% glucose 5mls/kg and IV artesunate 2.4mg/kg immediately.
Check results as soon as available.
Bacterial Infections can cause severe pallor (especially if child has Sicle cell
disease), if any concern about septicaemia (Ceftriaxone/Ampiclox + Gentamicin)
or pneumonia (Xpen + gentamicin) start antibiotics.
If BS negative ensure and unsure of diagnosis start antibiotics
(Ceftriaxone/Ampiclox + Gentamicin)
21
Fever + convulsions/decreased consciousness
Child needs to be seen and treated immediately.
Follow ABCD approach outlined on pages 3-7
Insert IV cannula and take blood for BS + Hb + Cross match
Give IV Artesunate, Ceftriaxone and Gentamicin
Insert NG tube to stop risk of aspiration and to give fluids and
nutrition.
Fever + respiratory distress
Is there also pallor? (severe pallor (anaemia) causes the body to
breath faster)
No severe pallor – most likely diagnosis pneumonia follow treatment
plan on page 11 and perform BS to exclude malaria
Severe pallor present – malaria more likely – perform BS and instigate
treatment for pneumonia (page 11) and malaria (page 8)
If there are any concerns about the management of a patient with fever seek
advice from a senior colleague immediately. Every hour a patient with sepsis
does not have the correct treatment increases the risk of death by 6%.
Paracetamol and ibuprofen can be used in infants who are distress and have a
fever to reduce their temperature.
22
Respiratory distress
Definition of respiratory distress:
1. Raised respiratory rate
2. Chest indrawing
3. Nasal flaring
4. Head bobbing
Raised respiratory rate:
<2 months
2months – 1 year
1 – 5 years
>60 bpm
>50 bpm
>40 bpm
Treatment of Respiratory distress:
1. Ensure their airway is safe and give oxygen.
2. Allow child to stay in position most comfortable for them
– often close to mum and sitting up.
3. Treat for pneumonia (see page 3)
4. Look for signs of pallor which may indicate a haemolytic
process (e.g. malaria or sickle cell disease) and manage if
present.
23
Severe pallor
The can be checked by looking for very pale/white conjunctiva
and looking for very pale palms of the hands or soles of the feet.
If present the following MUST be done:
1. Admit to Emergency department.
2. Follow ABCD approach as shown on pages 3-8
3. Insert IV cannula and send blood for MPS, Hb and cross
match.
4. IV glucose 10%, IV artesunate
5. If result of Hb<5 transfuse with 10mls/kg packed cells
(no lasix) or 20mls/kg whole blood with 1mg/kg lasix.
6. If BS negative or concerns about bacterial infection give
IV ceftriaxone and IV gentamicin.
The most common reason for severe pallor is Malaria, however
some bacterial infections can cause severe pallor. These are
more common in children with sickle cell disease or other
conditions that cause haemolysis (G6PD deficiency).
24
Convulsions
Abnormal movement of the arms or legs which do not stop
when you hold the limb(s), twitching of face or abnormal
movement of the eyes.
If present:
1. Admit to emergency department
2. ABCD approach (pages 3-8). Always give IV glucose
3. If convulsion greater than 5 minutes follow management
of page 6.
4. Consider possible causes – acute infection or epilepsy
Convulsions + Fever
Child needs to be seen and treated immediately.
NOTES
Follow ABCD approach outlined on pages 3-7
Possible diagnoses are meningitis or cerebral malaria –
treat for both unless you are sure it is a febrile convulsion.
Insert IV cannula and take blood for BS + Hb + Cross match
Give IV Artesunate, Ceftriaxone and Gentamicin
Insert NG tube to stop risk of aspiration and to give fluids
and nutrition.
25
Convulsions and severe pallor
Child needs to be seen and treated immediately.
Follow ABCD approach outlined on pages 3-7
Most likely diagnosis is cerebral malaria.
Insert IV cannula and take blood for BS + Hb + Cross
match
Give IV Artesunate
If there is ANY concern about a possible bacterial
meningitis give Ceftriaxone and Gentamicin.
Insert NG tube to stop risk of aspiration and to give fluids
and nutrition.
26
27
DRUG
FORMULARY
On the following pages are the drugs commonly found and used
at Jinja Regional Referral Hospital.
These should be used as a guide. IF there is ANY concern please
speak to a senior colleague.
28
Adrenaline – always calculate exact dose on body weight
For wheeze – 0.01ml/kg of 1:1,000 (max 0.3ml) subcutaneously
Severe croup – 2mls 1:1000 nebulised solution
For anaphylaxis – 0.01ml/kg of 1:1000 given subcutaneously.
For resuscitation – 0.1ml/kg of 1:10,000 max 10mls.
To make 1:10,000 solution add 1ml of 1:1000 solution to 9mls normal saline.
Albendazole
Dose: 400mg single dose to children >2years
1-2 years
>2years
400mg tablets
½ tab
1 tab
Amoxicillin
Dose: 25mg/kg 8 hourly for 5 days
3-6kg 6-10kg 10-15kg 15-20kg 20-29kg >30kg
250mg tablet
1/2
1
1½
2
2
2
Syrup (125mg/5ml) 5ml
10ml
15ml
Aminophylline
Dose: 5-6mg/kg every 6 hours until patient is able to talk in full sentences
3-6kg 6-10kg 10-15kg 15-20kg 20-29kg
250mg/10ml vial
1ml
1.5ml
2.5ml
3.5ml
5ml
Ampicillin; add 2.1mls sterile water to give 500mg/2.5mls
Dose: 50mg/kg. if < 7 days 12 hourly. if 7-21 days 8 hourly. if >21 days 6 hourly.
3-6kg 6-10kg 10-15kg 15-20kg 20-29kg >29kg
500mg/2.5mls 1ml
2ml
3ml
5ml
6ml
Use ceftriaxone
.
Ampiclox – add 5mls sterile water to give 500mg/5mls
Dose: 50mg/kg if <7days 12 hourly. If 7-21days 8 hourly.
3-6kg 6-10kg 10-15kg 15-20kg
500mg/5ml vial 2.5mls 4mls
6mls
9mls
250mg capsules 1 tab
1 tab
If >21 days 6 hourly
20-29kg 30-45kg
12.5mls 15mls
2 tab
2 tab
29
Artesunate – add 1mls sodium bicarbonate vial and allow solution to clear then add 5mls
sterile water to give 60mg/6mls (10mg/ml)
Dose: 2.4mg/kg at 0,12,24 hours (NB; the third dose is 24 hours from the first dose, not from
the second dose).
After 3 doses if improving and able to swallow use co-artem or continue artesunate once
daily until able to swallow or for maximum of 7 days.
Weight ml of 10mg/mL
Weight ml of 10mg/mL
Weight ml of 10mg/mL
solution
solution
solution
4
1
15
3.6
26
6.2
5
1.2
16
3.8
27
6.5
6
1.4
17
4.1
28
6.7
7
1.7
18
4.3
29
7
8
1.9
19
4.6
30
7.2
9
2.2
20
4.8
31
7.4
10
2.4
21
5
32
7.7
11
2.6
22
5.3
33
7.9
12
2.9
23
5.5
34
8.2
13
3.1
24
5.8
35
8.4
14
3.4
25
6
36
8.6
Artesunate/Amodiaquine tablets
Age
Artesunate
5 – 11 months ½ tablet (25mg)OD for 3 days
Amodiaquine
½ tablet (76mg) OD for 3days
1-6 years
1 tablet (50mg) OD for 3 days
1 tablet (153mg) OD for 3 days
7-13 years
2 tablet (100mg) OD for 3 days 2 tablet (306mg) OD for 3 days
>13 years
4 tablet (200mg) OD for 3 days 4 tablet (612mg) OD for 3 days
Azithromycin
Dose: 10mg/kg once daily for 3 days
3-6kg 6-10kg 10-15kg 15-25kg 26-35kg 36-45kg >45kg
250mg/5ml syrup 2mls
2.5mls 4mls
6mls
10mls
12.5mls
(Use for treatment of trachoma)
30
Benzylpenicllin (Xpen) – 600mg vial mixed with 9.6mls sterile water to give 1,000,000
units/10mls
Dose: 50,000 IU/kg. If <7 days 12 hourly. if 7- 21 days 8 hourly. if >21 days 6 hourly
3-6kg 6-10kg 10-15kg 15-20kg 20-29kg
30-45kg
1,000,000 units/10mls
2mls
3.5mls
6mls
8.5mls
12.5mls
17.5mls
Captopril
Dose:
3-6kg 6-10kg 10-15kg 15-20kg 20-29kg 30-45kg >45kg
25mg tab ¼ tab ¼ tab ¼ tab
½ tab
½ tab
½ tab
½ tab
Carbamazepine
Dose: 2.5mg/kg BD. Increase by 2.5mg/kg every 5 days as
needed. Max dose 7.5mg/kg
<1 year 1-5
510-15
>15years
years
10years years
12 hourly ¼ tab
½ tab
1 tab
2 tab
3 tabs
Each of the above doses can be doubled if following 2 weeks of treatment there is limited response.
Cefuroxime
Dose: 3 months -2years 125mg 12 hourly. >2years 250mg 12 hourly.
3-6kg
6-10kg
10-15kg 15-20kg 20-29kg
500mg tabs 1/4
1/4
1/4
1/4
1/2
> 30kg
1/2
Ceftriaxone – Vial of 1g mixed with 9.6mls sterile water to give 1g/10mls.
Dose: 100mg/kg once daily
3-6kg
6-10kg
10-15kg 15-20kg 20-29kg > 30kg
Number
3mls
6mls
10mls
14mls
20mls
30mls
mls
Ciprofloxacin
Dose: 10mg/kg BD
Weight
3-6kg
500mg tablets
IV 200mg/100mls 12ml
6-10kg 10-15kg
¼ tab BD
24ml
40ml
15-20kg
¼ tab BD
60mls
20-29kg
½ tab BD
80mls
>30kg
1 tab BD
100mls
31
Charcoal
Dose:1g/kg max 50g
Weight
3-6kg 6-10kg
25mg tab ¼
10-15kg 15-20kg 20-29kg 30-45kg >45kg
½
1
1
1½
2
Chloramphenicol
Dose: Neonates: 12.5mg/kg 12 hourly for. >1month 12.5mg/kg 6 hourly
3-6kg
6-10kg 10-15kg 15-20kg 20-29kg 30-45kg >45kg
250mg capsules 1 tab
1 ½ tabs 2 tabs
3 tabs
Chlorphenamine
Weight 3-6kg 6-10kg 10-15kg 15-20kg 20-29kg
4mg
¼ tab ¼ tab
½ tab BD ½ tab
tablets
BD
BD
QDS
30-45kg
½ tab
QDS
>45kg
1 tab
QDS
Cloxacillin add 5mls sterile water to 500mg vial to get 500mg/5mls
Dose: 50mg/kg. If <7 days 12 hourly. IF 7-21 days 8 hourly. If >21 days 6 hourly.
3-6kg
6-10kg
10-15kg 15-20kg 20-29kg 30-45kg
500mg/5mls
2.5mls
4mls
6mls
9mls
12.5mls
15mls
500mg tabs
1/2
1
1
1
Co-artem
Weight
5-14kg
15-24kg
25-34kg
>35kg
Dose
1 tablet BD for 3 day
2 tablet BD for 3 day
3 tablet BD for 3 day
4 tablet BD for 3 day
Cotrimoxazole (septrin)
Treatment for Pneumocystis jiroveci (PCP)
Dose: 60mg/kg 12 hourly
3-6kg
6-10kg 10-15kg 15-20kg 20-29kg 30-45kg >45kg
240mg/5mls
5mls
7.5mls 12.5mls syrup
120mg tabs
2 tab
3 tab
BD
BD
32
960mg tabs
-
-
¾ tab
BD
Prohpylaxis for Pneumocystis jiroveci (PCP)
Dose: 450mg/m2 (max 960mg)
3-5kg
5-10kg 10-15kg
240mg/5mls
2.5mls 5mls
10mls
syrup
120mg tabs
1
2
2
480mg tabs
¼ tab
½ tab
½ tab
960mgtabs
-
1 tab
BD
1 ½ tabs 2 tabs
BD
BD
3 tabs
BD
15-20kg 20-29kg 30-45kg >45kg
4
1
½ tab
4
1
½ tab
2
1
2
1
NB never give to children under 6 weeks of age
Dexamethasone
Dose: 0.01mg – 0.1mg/kg/day and should be given in 4 dividend doses
3-6kg
6-10kg 10-15kg 15-20kg 20-29kg 30-45kg >45kg
0.5mg tabs
¼ tab
½ tab
¾ tab
1 tab
1 ½ tabs 2 tabs
Diazepam
Dose: Rectal 500 micrograms/kg. Intravenous 300 micrograms/kg.
10mg/2ml
3-6kg
6-10kg
10-15kg
15-20kg
solution
RECTAL
0.4ml
0.75ml
1.2ml
1.7ml
INTRAVENOUS 0.25ml
0.4ml
0.6ml
0.75ml
20-29kg
2.5ml
1.25ml
To be given if seizure lasts greater than 5 minutes.
DO NOT USE IN A BABY LESS THAN 28 DAYS OLD.
Diclofenac
Dose: 0.3-1mg/kg (max 50mg) 8 hourly
3-6kg 6-10kg
Oral 50mg tab
¼ tab
Rectal 100mg suppository IV/IM 75mg/3mls
0.4mls
10-15kg
¼ tab
¼ sup
0.5mls
15-20kg
¼ tab
¼ sup
0.7mls
20-29kg
½ tab
¼ sup
1ml
30-45kg
½ tab
1/3 sup
1.5mls
Digoxin
Dose: 1month-5years 10micrograms/kg. >5years 6microgrmas/kg. Max dose 150
micrograms
3-6kg
6-10kg
10-15kg
15-20kg
20-29kg
62.5 microgram tab
½
1 tab
2 tab
2 ½ tab
3 tab
>45kg
1 tab
½ sup
2mls
>30kg
4 tab
33
Erythromycin – 125mg/5ml syrup
Dose: 12.5mg/kg 4 times a day for 3 days.
3-6kg 6-10kg 10-15kg 15-20kg 20-29kg
125mg/5ml syrup 2.5mls 5mls
10mls
10mls
250mg tablet
¼
½
1
1
1½
Folic Acid
Dose: neonate; 50micrograms/kg OD. >1m 500micrograms/kg. Max 5mg
3-6kg 6-10kg 10-15kg 15-20kg 20-29kg 30-45kg >45kg
5mg tablets ¼ tab ½ tab 1 tab
1 tab
1 tab
1 tab
1 tab
Frusemide
Dose:1mg/kg every 12 hours. Increased to 2mg/kg every 12 hours if needed
3-6kg
6-10kg
10-15kg
15-20kg
20-29kg
40mg tablets ¼
¼-½
¼-½
½-1
½-1
IV 10mg/ml
0.4-0.8mls 0.8-1.6mls 1.2-2.4mls 1.7-3.4mls 2.5-5mls
Gentamicin 80mg/2mls vial for IV administration
Dose: 3mg/kg OD if <2.5kg. 5mg/kg OD if >2.5kg.
ALWAYS WORK OUT CORRECT DOSE FOR EACH PATIENTS WEIGHT
GENTAMCIN IS THE MOST COMMON DRUG THAT IS PRESCRIBED INCORRECTLY CHECK YOU DOSE TWICE.
Griseofulvin
Dose: 10mg/kg once daily
3-6kg 6-10kg 10-15kg 15-20kg 20-29kg 30-45kg >45kg
500mg tab ¼ tab ¼ tab
½ tab
½ tab
¾ tab
1 tab
Haloperidol
Dose: For pyschosis; 12-18 years 05-5mg 8 hourly. For Tics 25 micrograms/kg
< 1 year
1-5 years
6-12 years
>12 years
10mg tablets
½ tab
1 tabs
34
Ibuprofen
Dose: 5-10mg/kg 8 hourly
3—6kg 6-10kg 10-15kg 15-20kg 20-29kg 30-45kg
200mg tab ¼
¼
½
¾
1
400mg tab ¼
1/2
1/2
Iron
Dose: 3mg/kg/day of iron equivalent
3—6kg 6-10kg 10-15kg 15-20kg 20-29kg 30-45kg
200mg tab (65mg iron)
¼
½
1
1
1½
2
125mg/ml drops (25mg iron/ml) 3mls
5mls
7mls
9mls
12mls
15mls
Ketoconazole
<15kg 15-30kg >30kg
200mg tab ¼ tab ½ tab
1 tab
Mebendazole
Dose: Threadworm 6m-18m 100mg stat. All other worms 100mg 12 hourly for 3 days
1-2 years
Over 2 years
100mg tabs
2 ½ tab
5 tab
Metronidazole
Dose: 7.5mg/kg every 8 hours in children over 28 days and every 12 hours in children less
than 28 days. Max dose 400mg.
3-6kg 6-10kg 10-15kg 15-20kg 20-29kg 30-45kg >45kg
200mg tab 8 hourly
¼ tab
½ tab
½ tab
½ tab
1 tab
2 tab
IV 500mg/100mls
Work out correct dose per kilogram for each patient
Morphine
Calculate exact dose for weight.
Oral dose 200micrograms/kg 4 hourly. Can be increased up to 400 micrograms in SEVERE
pain.
35
Paracetamol
Dose: 15-20mg/kg 8 hourly
3—6kg 6-10kg 10-15kg 15-20kg 20-29kg 30-45kg
500mg tabs 1/4
¼
½
1/2
1
Phenobarbital
Dose: Intravenous – Load with 15mg/kg over 30 minutes. Maintenance 2.5-5mg/kg. Oral
2.5mg/kg BD. Increased up to 5mg/kg BD
3-6kg 6-10kg 10-15kg 15-20kg 20-29kg >30kg
Loading dose (IV) if available
Starting maintenance dose
¼ tab ½ tab
¾ tab
1 ½ tabs 2 tabs
3 tabs
tabs
Max maintenance dose
½ tab 1 tabs
2 tabs
3 tabs
4 tabs
6 tabs
Phenytoin
Dose: 2.5mg/kg 12 hourly
3-6kg 6-10kg 10-15kg 15-20kg 20-29kg 30-45kg >45kg
Starting dose 12 hourly
¼ tab ¼ tab
½ tab
1 ¼ tabs 1 ½ tabs 2 tabs
Maximum dose 12 hourly ¾ tab 1 tab
1 ¼ tabs 2 tabs
3 tabs
3 tabs
Prednisolone
Dose: 1-2mg/kg once daily for 3 days. Any course longer than 3 days (i.e. TB meningitis)
will need a gradually reducing course to prevent iatrogenic adrenal suppression.
3-6kg
6-10kg
10-15kg
15-20kg
20-29kg
5mg tabs
1
2
3
4
5
Pyridoxine
<6years >6years
25mg tablets ½ tab
1 tab
36
Quinine
Dose: Intravenous 10mg/kg in 10mls/kg 5% glucose as infusion over 1 hour. Give every 8
hours for a minimum of 3 doses. If then improving and able to swallow switch to oral
quinine for 7 days, or if not able to swallow continue IV quinine as above. Oral dose is
10mg/kg 8 hourly for 7 days.
5-10kg 10-18kg 18-24kg 24-30kg 30-40kg 40-50
>50kg
kg
300mg tabs
¼ tab
½ tab
¾ tab
1 tab
1 ¼ tab 1 ½ tabs 2 tabs
IV 600mg/2mls
Work out correct dose for specific patient’s weight
Salbutamol
Dose: Nebulisers should be repeated until patient is able to talk in full sentences and then
repeat as soon as patient or attendant states they are breathing is getting worse. Oral
tablets 0.1mg/kg 6 hourly for 3 days or longer if needed (oral absorption of salbutamol is
very poor and the benefit is therefore extremely limited)
Under 5 years
Older than 5 years
2.5mg vial for
1 vials with 3 mls saline
2 vials with 3 mls saline
nebulisation
50mg/10ml vial
0.5mls with 3 mls saline
1ml with 3mls saline
3-6kg 6-10kg 10-15kg
4mg tablets
-
-
¼ tab
15- 2020kg 29kg
½
½ tab
tab
3045kg
1 tab
>45kg
1 tab
Salfadoxine/Pyrimethamine (Fansidar)
Dose: Prophylaxis for malaria in Sickle cell Disease; Stat dose once monthly
3-6kg
6-10kg 10-15kg 15-20kg 20-29kg 30-45kg >45kg
500/25
1 tab
1 tab
1 tab
2 tab
2 tab
3 tab
tabs
Tetracycline 1% eye ointment
Apply to both eyes in any newborn, infant or child with suspected localised eye infection.
Zinc Sulphate
Dose
Up to 6 months Over 6 months
20mg tabs ½
1
37
VITAMINS
Multivitamin
Dose: 1 tablet per day to all patients
Vitamin A
<1year 50,000 units = 2 drops
1year-2 ½ years 100,000 units = 4 drops
>2 ½ years 200,000 units = 8 drops
Vitamin B
See pyridoxine
Vitamin C
Need to find out doses
Drugs not included in formulary
NAME:
Preparations:
Dose:
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Preparation
Preparation
NAME:
Preparations:
Dose:
Weight
Weight
Weight
Weight
Preparation
Preparation
NAME:
Preparations:
Dose:
38
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Weight
Preparation
Preparation
NAME:
Preparations:
Dose:
Weight
Weight
Weight
Weight
Preparation
Preparation
NAME:
Preparations:
Dose:
Weight
Weight
Weight
Weight
Preparation
Preparation
NAME:
Preparations:
Dose:
Weight
Weight
Weight
Weight
Preparation
Preparation
NAME:
Preparations:
Dose:
Weight
Weight
Weight
Weight
Preparation
Preparation
NAME:
Preparations:
Dose:
Weight
Weight
Weight
Weight
Preparation
Preparation
39
FLOW RATES FOR INTRAVENOUS FLUIDS
Blood giving set 10 drops/ml therefore 60drops/min = 6mls/min = 360mls/hr
Standard IV giving set 15 drops/ml therefore 60drops/min = 4mls/min =
240mls/hr
Drip
rate/min
Fluid/hour
(mls)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
4
8
12
16
20
24
28
32
36
40
44
48
52
56
60
64
68
72
76
80
84
88
92
96
100
104
Fluid/24
hours (mls)
Weight
96
192
1.3kg
288
1.9kg
384
2.5kg
480
4kg
576
5.8kg
672
6.7kg
768
7.7kg
864
8.6kg
960
9.6kg
1056 10.5kg
1152
13kg
1248
15kg
1344
17kg
1440
19kg
1536
22kg
1632 26.5kg
1728 31.5kg
1824 36.25kg
1920
41kg
2016
46kg
2112
50kg
2208 55.5kg
2304
60kg
2400
65kg
2496
70kg
40
Fluid Requirements for in Children greater than 2
months of age by weight in kilograms
400
500
600
700
800
900
1000
1050
1100
1150
1200
1250
1300
1350
1400
1450
1500
1520
1540
1560
1580
1600
1620
1640
1660
1680
1700
1720
1740
33
42
50
58
67
75
83
88
92
96
100
104
108
113
117
121
125
127
128
130
132
133
135
137
138
140
142
143
145
50
63
75
88
100
113
125
131
138
144
150
156
163
169
175
181
188
190
193
195
198
200
203
205
208
210
213
215
218
Weight
(kg)
Weight
(kg)
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Daily
2hrly
3hrly
volume volume volume
33
34
35
36
37
38
39
45
46
47
48
49
50
51
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Daily 2 hrly
3hrly
volume volume volume
1760
1780
1800
1820
1840
1860
1880
1900
1920
1940
1960
1980
2000
2020
2040
2060
2080
2100
2120
2140
2160
2180
2200
2220
2240
2260
2280
2300
147
148
150
152
153
155
157
158
160
162
163
165
167
168
170
172
173
175
177
178
180
182
183
185
187
188
190
192
220
223
225
228
230
233
235
238
240
243
245
248
250
253
255
258
260
263
265
268
270
273
275
278
280
283
285
288
41
2WHO Pocket book of hospital care for children
42
NOTES
43
NOTES
44
NOTES
45
REFERENCES
1. WHO Pocket book of hospital care for children. World Health Organisation 2005
2. British National Formulary for Children 2013.
3. ETAT Manual for Participants 2005
4. Ministry of Health (Uganda) Clinical Guidelines
5. Ministry of Health (Uganda) Management of HIV guidelines 2011
6. Management of Paediatric Conditions. Ministry of Health (Uganda). Adapted from Kenyan version.
7.
46
Printed in associated with CHERUBIC
for Jinja Regional Referral Hospital Department of Paediatrics
2013
Compiled by Dr Colin GIlhooley
47