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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