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Pediatrics Emergency And Medications Doses By Dr Essam Sidqi 2e.pdf

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Pediatrics Emergency And Medications Doses By Dr Essam Sidqi 2e.pdf

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2nd Edition and Most Updated Version.
Pediatrics medications doses and its emergency related cases were always problematic for new junior doctors.
I hope with this new update, I tried to make it much simpler and much easier to be accessed quickly in emergencies to reach its maximum benefits.

Any comment or recommendation is welcomed.

Thank you.

Dr. Essam Sidqi
April 2022

* Edits on below medications:
Ketotifen Syrup 1mg/5ml
0.025mg/kg/dose x2
0.125cc/kg/dose x2

Ventolin (Butadin) Syrup
2mg/5ml
>2 years  0.1-0.4mg/kg/dose x3
0.25-0.8cc/kg/dose x3

Vitamin D3 Oral Drops 10,000IU/ml
Prophylaxis:400IU/day (10mcg)1drop x1

Voltaren Suppository
12.5mg, 25mg, 50mg, 100mg
1-2mg/kg/dose x2 or x3

Oframax 500mg/Claforan 500mg Vial [Avoid R.L.]
25-50mg/kg/day ÷2
(Or weight in kg/day ÷2 in cc
(10cc dilution))

Ampicillin 500mg / Amoxicillin 500mg Vial
50-100mg/kg/day ÷2
(Or weight in kg/day ÷2 in cc (5cc dilution))
(Max. 500mg/dose)

Zofran (De-vomit) Amp 2mg/ml
0.15mg/kg/dose x3
2cc + 3cc D.W.  1cc/10kg x3
(Max. 5cc) (Max. 8mg/dose)

Parol Bottle 1gm/100ml
(Max. 60mg/kg/day)

Voltaren Amp. IM 75mg/2ml
<12 years1-2mg/kg/dose
>12 years x1 or x2

Lasix Amp. 20mg/2ml
0.5-1mg/kg/dose x2 or x3

Tagamet (Cimetidine) Amp. 200mg/2ml
5-10mg/kg/dose x4

Magnesium Sulphate MgSO4 Vial
50% 5g/10ml
10% 1g/10ml
25-50mg/kg/dose x3
IM or Infusion (Max. 2g/hr)

Potassium Chloride KCl Amp.
15%= 2mEq/ml = 2mmol/ml = 150mg/ml
7.5%= 1mEq/ml = 1mmol/ml = 75mg/ml
0.5-1mEq/kg/dose (Max. 40mEq/dose)
Infusion (Max. 10mEq/hr)

Albumin Bottle 20%
20g/100ml, 10g/50ml
20% = 200mg/ml
0.5-1g/kg/dose x1 x2 or x3
2.5-5cc/kg/dose x1 x2 or x3
Over 30min-2hr infusion

Sodium Bicarbonate NaHCO3 Vial 8.4% 50mEq/50ml
8.4% = 1mEq/ml = 84mg/ml
1mEq/kg/dose in 15-30min infusion
1cc/kg/dose in 15-30min

2nd Edition and Most Updated Version.
Pediatrics medications doses and its emergency related cases were always problematic for new junior doctors.
I hope with this new update, I tried to make it much simpler and much easier to be accessed quickly in emergencies to reach its maximum benefits.

Any comment or recommendation is welcomed.

Thank you.

Dr. Essam Sidqi
April 2022

* Edits on below medications:
Ketotifen Syrup 1mg/5ml
0.025mg/kg/dose x2
0.125cc/kg/dose x2

Ventolin (Butadin) Syrup
2mg/5ml
>2 years  0.1-0.4mg/kg/dose x3
0.25-0.8cc/kg/dose x3

Vitamin D3 Oral Drops 10,000IU/ml
Prophylaxis:400IU/day (10mcg)1drop x1

Voltaren Suppository
12.5mg, 25mg, 50mg, 100mg
1-2mg/kg/dose x2 or x3

Oframax 500mg/Claforan 500mg Vial [Avoid R.L.]
25-50mg/kg/day ÷2
(Or weight in kg/day ÷2 in cc
(10cc dilution))

Ampicillin 500mg / Amoxicillin 500mg Vial
50-100mg/kg/day ÷2
(Or weight in kg/day ÷2 in cc (5cc dilution))
(Max. 500mg/dose)

Zofran (De-vomit) Amp 2mg/ml
0.15mg/kg/dose x3
2cc + 3cc D.W.  1cc/10kg x3
(Max. 5cc) (Max. 8mg/dose)

Parol Bottle 1gm/100ml
(Max. 60mg/kg/day)

Voltaren Amp. IM 75mg/2ml
<12 years1-2mg/kg/dose
>12 years x1 or x2

Lasix Amp. 20mg/2ml
0.5-1mg/kg/dose x2 or x3

Tagamet (Cimetidine) Amp. 200mg/2ml
5-10mg/kg/dose x4

Magnesium Sulphate MgSO4 Vial
50% 5g/10ml
10% 1g/10ml
25-50mg/kg/dose x3
IM or Infusion (Max. 2g/hr)

Potassium Chloride KCl Amp.
15%= 2mEq/ml = 2mmol/ml = 150mg/ml
7.5%= 1mEq/ml = 1mmol/ml = 75mg/ml
0.5-1mEq/kg/dose (Max. 40mEq/dose)
Infusion (Max. 10mEq/hr)

Albumin Bottle 20%
20g/100ml, 10g/50ml
20% = 200mg/ml
0.5-1g/kg/dose x1 x2 or x3
2.5-5cc/kg/dose x1 x2 or x3
Over 30min-2hr infusion

Sodium Bicarbonate NaHCO3 Vial 8.4% 50mEq/50ml
8.4% = 1mEq/ml = 84mg/ml
1mEq/kg/dose in 15-30min infusion
1cc/kg/dose in 15-30min

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  1. 1. P E D I A T R I C S EMERGENCY & MEDICATIONS DOSES 2nd Edition BY: DR. ESSAM S. YAQOOB DUHOK - KURDISTAN REGION - IRAQ APRIL 2022
  2. 2. 1 | P r e p a r e d B y D r . E s s a m S i d q i - D u h o k - K u r d i s t a n R e g i o n - I r a q - A p r i l 2 0 2 2 Amoxil Syrup 30-50mg/kg/day ÷3 125mg/5ml → 1-2cc/kg/day ÷3 200mg/5ml → 0.75-1.25cc/kg/day ÷3 250mg/5ml → 0.5-1cc/kg/day ÷3 400mg/5ml → 0.35-0.65cc/kg/day ÷3 Augmentin Syrup 30-50mg/kg/day ÷3 ← (125/31.25mg)/5ml ← (200mg/28.5mg)/5ml ← (250mg/62.5mg)/5ml ← (400mg/57mg)/5ml Acyclovir Syrup 200mg/5ml <12 years → 20mg/kg/dose x4 0.5cc/kg/dose x4 >12 years → 800mg/dose x5 20cc/dose x5 (5 days) Suprax (Cefixime) Syrup 8mg/kg/day x1 100mg/5ml → 2cc/5kg x1 or ÷2 200mg/5ml → 1cc/5kg x1 or ÷2 Erythromycin Syrup 30-50mg/kg/day ÷3 125mg/5ml →1-2cc/kg/day ÷3 200mg/5ml →0.75-1.25cc/kg/day ÷3 250mg/5ml →0.5-1cc/kg/day ÷3 400mg/5ml →0.35-0.65cc/kg/day ÷3 Flagyl (Metronidazole) Syrup 30mg/kg/day ÷3 125mg/5ml →1cc/kg/day ÷3 200mg/5ml →0.75cc/kg/day ÷3 250mg/5ml →0.6cc/kg/day ÷3 Trimethoprim Syrup (40mg/200mg)/5ml >2 months → 8-12mg/kg/day ÷2 1cc/kg/day ÷2 Clarithromycin Syrup >6 months → 15mg/kg/day ÷2 125mg/5ml → 0.6cc/kg/day ÷2 250mg/5ml → 0.3cc/kg/day ÷2 Nystatin Oral Drops <1 year → 2cc x4 >1 year → 4-6cc x4 Azithromycin Syrup 10mg/kg/day x1 100mg/5ml → 0.5cc/kg/dose x1 200mg/5ml → 0.25cc/kg/dose x1 Nalidixic Acid Syrup 250mg/5ml, 300mg/5ml 55mg/kg/day ÷4 1cc/kg/day ÷4 Albendazole Syrup 100mg/5ml, 200mg/5ml <2 years → 200mg once >2 years → 400mg once Keflex (Cephalexin) Syrup 25-50mg/kg/day ÷3 or ÷4 125mg/5ml → 1-2cc/kg/day ÷3 or ÷4 250mg/5ml → 0.5-1cc/kg/day ÷3 or ÷4 Cefdinir Syrup >6months → 7mg/kg/dose x2 125mg/5ml → 0.3cc/kg/dose x2 250mg/5ml → 0.15cc/kg/dose x2 Mebendazole Syrup >2 years 100mg/5ml → 100mg/dose x2 (3 days) 500mg/5ml → 500mg/dose once. Pediatric Syrup Doses * All Doses are Age and Condition and Severity Dependent.
  3. 3. 2 | P r e p a r e d B y D r . E s s a m S i d q i - D u h o k - K u r d i s t a n R e g i o n - I r a q - A p r i l 2 0 2 2 Parol Syrup 10-15mg/kg/dose x3 or x4 120mg/5ml→ 0.5cc/kg/dose x3 or x4 250mg/5ml→ 0.2-0.3cc/kg/dose x 3 or x4 Adol Oral Drops 100mg/ml 2-3 drops/kg/dose x3 or x4 ParAzar Flu Syrup (Colden) (125mg/1mg)/5ml 1-2 years→ 2.5-5cc x3 1-6 years→ 5-10cc x3 6-12 years→ 10-15cc x3 Profen Syrup 100mg/5ml >6 months → 5-10mg/kg/dose x3 0.5cc/kg/dose x3 (Max. 40mg/kg/day) Depakin Syrup 200mg/ml B:10-15mg/kg/day ÷1 ÷2 ÷3 M: 30-60mg/kg/day ÷1 ÷2 ÷3 Ketotifen Syrup 1mg/5ml 0.025mg/kg/dose x2 0.25cc/10kg/dose x2 Fenistil (Dimethindene) Oral Drops 3 drops/kg/day ÷3 Loratadine Syrup 5mg/5ml >2-6 years→ 5cc/day x1 at night >6 years→ 10cc/day x1 at night Allermine (Chlorpheniramine) Syrup 2mg/5ml 0.35mg/kg/day ÷3 or ÷4 0.85cc/kg/day ÷3 or ÷4 Diphenhydramine Syrup 12.5mg/5ml 5mg/kg/day ÷3 or ÷4 0.5cc/kg/day ÷3 or ÷4 Desloratadine Syrup 0.5mg/ml 1-6 years→ 2.5cc/day x1 at night 6-12 years→ 5cc/day x1 at night >12 years→ 10cc/day x1 at night Actifed Syrup (30mg/1.25mg)/5ml >2 years → 4mg/kg/day ÷3 or ÷4 0.7cc/kg/day ÷3 or ÷4 Dexon Syrup 0.5mg/5ml 0.15-0.3mg/kg/day ÷3 1-3cc/kg/day ÷3 (Max. 16mg/day) (5 days) Prednisolone Syrup (5 days) 1-2mg/kg/day ÷2 5mg/5ml → 1-2cc/kg/day ÷2 15mg/5ml → 0.35-0.7cc/kg/day ÷2 Exidil (Bronquium) Syrup 2-6 years→ 5cc x2 or x3 6-12 years→ 10cc x2 or x3 >12 years→ 15cc x2 or x3 Solvodin Syrup 4mg/5ml 2-6 years→ 2.5cc x3 6-12 years→ 5cc x3 >12 years→ 10cc x3 DryCough Syrup 15mg/5ml 4-6 years → 2.5cc x3 6-12 years → 5cc x3 >12 years → 10cc x3 Samillin Syrup 1-5 years → 2.5cc x3 6-12 years → 5cc x3 >12 years → 10cc x3 Tussilet Syrup <1 year → 2.5cc x3 1-6 years → 5cc x3 6-12 years → 10cc x3 Ventolin (Butadin) Syrup 2mg/5ml >2 years → 0.1mg/kg/dose x3 0.25cc/kg/dose x3
  4. 4. 3 | P r e p a r e d B y D r . E s s a m S i d q i - D u h o k - K u r d i s t a n R e g i o n - I r a q - A p r i l 2 0 2 2 De-vomit (Zofran) Syrup 4mg/5ml 2mg/10kg/dose x3 2cc/10kg/dose x3 Motilium (Domperidone) Syrup 5mg/5ml 0.2-0.4mg/kg/dose x3 1-2cc/5kg/dose Biolact Sachet 6 months-2 years x1 >2 years x2 Bonnisan Syrup <1 month→ 2.5cc x3 1-6months→ 5cc x3 6 months-3 years→ 10cc x3 Colic EZ (Simethicone) Oral Drops <6 months→ 0.5cc x4 6 months-1 year→ 0.75cc x4 >1 year→ 1cc x4 Zinc Syrup 20mg/5ml (14 days) <1 year→ 10mg (2.5cc) x1 >1 year→ 20mg (5cc) x1 Buscopan (Spasmodain) Syrup 5mg/5ml <6 months → 1-4cc x3 6 months-6 years→ 5cc x3 6-12 years→ 10cc x3 Ferrous Fumerate Syrup 140mg/5ml 1-2mg/kg/day ÷3 Prophylaxis 3-4mg/kg/day ÷3 Mild →0.15cc/kg/day ÷3 4-6mg/kg/day ÷3 Severe IDA Periactin Syrup 2mg/5ml 2-6 years → 5cc x2 or x3 >6 years → 10cc x2 or x3 Multivitamins Oral Drops <1 year → 0.3cc (6 drops) x1 1-5 years→ 0.6cc (12 drops) x1 >5 years → 1cc (20 drops) x1 Vitamin D3 Oral Drops 10,000IU/ml Prophylaxis: 400IU/day (10mcg) x1 Treatment: <6 months → 3,000IU/day x1 (6 drops) >6 months → 6,000IU/day x1 (12 drops) Vitamin B6 (Pyridoxine) Syrup 20mg/5ml Convulsion: 50-100mg PNG Deficiency: 2.5-10mg/day NaCl Nasal Drops x4 or x6 Lactulose Syrup 667mg/ml 0.5cc/kg/dose x2 or x3 B.T. Enema 65ml Once. Voltaren Suppository 12.5mg, 25mg, 50mg, 100mg 1mg/kg x2 or x3 Paracetamol Suppository 125 mg, 250 mg 15mg/kg x2 or x3 Bisacodyl Suppository 10mg <6 years→ 5mg x1 >6 years→ 10mg x1 Oral Rehydration Solution ORS Add 1 Sachet to 1 L of water for 24hr and give as following (or more if child wants more accordingly): Mild dehydration: 10cc/kg after each diarrheal stool. Moderate dehydration: 20cc/kg/hr. (Reassess after 4hrs accordingly). Severe dehydration: 20cc/kg/hr. PO/PNG with IV Fluids. (Hospital admission).
  5. 5. 4 | P r e p a r e d B y D r . E s s a m S i d q i - D u h o k - K u r d i s t a n R e g i o n - I r a q - A p r i l 2 0 2 2 Oframax 1gm / Claforan 1gm Vial [Avoid R.L.] (Max. 4g/day) 50-100mg/kg/day ÷2 (Or weight in kg/day ÷2 in cc (Neonates) (10cc dilution)) Clindamycin Amp. 300mg/2ml, 600mg/4ml 20-40mg/kg/day ÷3 or ÷4 Ampicillin 500mg / Amoxicillin 500mg Vial 50-100mg/kg/day ÷2 (Or weight in kg/day ÷2 in cc (Neonates) (5cc dilution)) (Max. 500mg/dose) Meropenem Vial 250mg, 500mg, 1g 20-40mg/kg/dose x3 Imipenem/Cilastatin Vial 250mg/250mg, 500mg/500mg 20-40mg/kg/dose x3 Vancomycin Vial 250mg, 500mg, 1g 15-20mg/kg/dose in 1hr x3 or x4 Gentamicin Amp. 20mg, 40mg, 60mg, 80mg 5-7mg/kg/day ÷2 Amikacin Vial 250mg, 500mg 15mg/kg/day ÷2 Flagyl Bottle 500mg/100ml 30mg/kg/day ÷3 2cc/kg/dose x3 Penicillin G Procaine Vial IM 25.000-50.000 units/kg/day Flucloxacillin Vial 500mg,1g 25-50mg/kg/dose x3 or x4 Acyclovir Vial 250mg, 500mg, 1gm 10-20mg/kg/dose x3 (5-10 days) Zofran (De-vomit) Amp 4mg/2ml 0.1mg/kg/dose x3 (Max. 4mg) 2cc + 3cc N.S. → 1cc/10kg x3 (Max. 5cc) Parol Bottle 1gm/100ml 10-15mg/kg/dose x3 or x4 1-1.5cc/kg/dose x3 or x4 (Max. 4g/day) Aminophylline Amp. 250mg/10ml (1cc+9cc N.S.) Bolus: 4-5mg/kg → 2cc/kg Maintenance: 3-6mg/kg → 1cc/kg/dose x3 Decadron Amp. 8mg/2ml Croup: 0.6mg/kg/day once Others: 0.2-0.6mg/kg/day ÷2 Voltaren Amp. IM 75mg/3ml <12 years→2mg/kg/dose >12 years→ x1 or x2 Cyklokapron Amp. 100mg/ml 10mg/kg/dose x3 infusion Hydrocortisone Vial 100mg 1-5mg/kg/day ÷2 or ÷3 Allergic Reaction: 4-5mg/kg/dose Diphenhydramine Amp. 10mg/ml, 50mg/ml 5mg/kg/day ÷4 Allarmine (Chlorpheniramine) Amp. 10mg/1ml 0.25mg/kg/dose Omeprazole Vial 20mg or 40mg 1mg/kg/day x1 infusion Buscopan Amp. 20mg/ml 0.3-0.5mg/kg/dose x3 Tagamet (Cimetidine) Amp. 200mg/2ml 25mg/kg/day ÷4 Morphine Amp. IM/SC 10mg/ml 0.05-0.2mg/kg/dose Lasix Amp. 20mg/2ml 1mg/kg/dose Hydralazine Amp. 20mg/ml 0.1-0.2mg/kg/dose. Can repeat after 20 min. Pediatric IV/IM Doses
  6. 6. 5 | P r e p a r e d B y D r . E s s a m S i d q i - D u h o k - K u r d i s t a n R e g i o n - I r a q - A p r i l 2 0 2 2 Magnesium Sulphate MgSO4 Vial 50% 5g/10ml 10% 1g/10ml 25-50mg/kg/dose x3 IM or Infusion Potassium Chloride KCl Amp. 15%= 2mEq/ml = 2mmol/ml = 150mg/ml 7.5%= 1mEq/ml = 1mmol/ml = 75mg/ml 0.5-1mEq/kg/dose Over 3-4 hrs (Max. 40mEq/dose) Calcium Gluconate 10% 1gm/10ml Amp. 0.5-1cc/kg/dose in 30min x2 or x3 (Max. 20cc/dose) Albumin Bottle 20% 20g/100ml, 10g/50ml 20% = 200mg/ml 0.5-1g/kg/dose x2 or x3 2.5-5cc/kg/dose x2 or x3 Over 1-2hr infusion Mannitol Bottle Bolus: 0.25-1g/kg Maintenance: 0.25-0.5g/kg x2 or x3 20% = 200mg/ml B:5cc/kg, M:2.5cc/kg x2 or x3 infusion 10% = 100mg/ml B:10cc/kg, M:5cc/kg x2 or x3 Sodium Bicarbonate NaHCO3 Vial 8.4% 50mEq/50ml 8.4% = 1mEq/ml = 84mg/ml 1mEq/kg/dose in 15-30min infusion 1cc/kg/dose in 30min Caffeine Amp. 10mg/ml, 20mg/ml Bolus: 10-20mg/kg Maintenance: 5-10mg/kg/day Vitamin B6 (Pyridoxine) Amp. 100mg/2ml, 100mg/ml Convulsion: 70mg/kg over 10 min. Deficiency: 10-20mg/day for 3 weeks Vitamin K Amp. 1mg/0.5ml Prophylaxis IM: term 1mg or preterm 0.5mg Treatment SC: 1mg Hypertonic G.W. D10% = 100mg/ml <5 year Bolus: 0.25-0.5g/kg → 2-5cc/kg 2cc G.W50%+ 8cc D.W = G.W.10% 1cc GW50%+9cc GW5% ≈GW10% Maintenance: 5-8mg/kg/min. Hypertonic G.W. D25% = 250mg/ml <12 years 0.25-0.5g/kg → 1-2cc/kg 5cc G.W50% + 5cc D.W = G.W.10% 4cc GW50% + 6cc GW5% ≈ GW10% Hypertonic G.W. 25g/50ml D50% = 500mg/ml >12 years 0.25-0.5g/kg → 0.5-1cc/kg (Diluted) Whole Blood 500ml/pint 10-15cc/kg/over 3-4hr (NEED ABO, Rh Compatibility) PRBC 350ml/pint 10–15cc/kg/over 3-4hr (NEED ABO, Rh Compatibility) FFP 200-300ml/pint 10-15cc/kg in 20min (JUST ABO Compatibility) Platelets 200-300ml/pint 5-10cc/kg in 20min (NEED ABO, Better Rh Compatibility too) Cryoprecipitate 10-20ml/pint 1-2pints/10kg (Preferred ABO Compatibility) * All Doses are Age and Condition and Severity Dependent.
  7. 7. 6 | P r e p a r e d B y D r . E s s a m S i d q i - D u h o k - K u r d i s t a n R e g i o n - I r a q - A p r i l 2 0 2 2 Adrenaline Amp. 1mg/1ml (1:1000) <30kg→0.1mg/kg/dose >30kg → 0.3-0.5mg/kg/dose 1cc + 9cc N.S. → 0.1cc/kg/dose Repeat if needed after 3-10min Atropine Amp. 0.6mg/1ml 0.03mg/kg/dose 1cc + 4cc N.S. → 0.2cc/kg/dose Propranolol Amp. 1mg/ml 0.1mg/kg/dose in 15 min Noradrenaline Amp. 0.05-0.1mcg/kg/min. (Max. 1-2mcg/kg/min) 4cc + 46cc D5% = 4mg/4ml → 0.04-0.08cc/kg/hr. (Max. 0.08-0.15cc/kg/hr.) 8mg/4ml → 0.02-0.06cc/kg/hr. (Max. 0.04-0.07cc/kg/hr.) Dopamine Amp. 200mg/5ml, 400mg/10ml 1-5mcg/kg/min. Then 5-20mcg/kg/min. (Max. 50mcg/kg/min.) 5cc + 45 D5% → 0.15-0.08cc/kg/hr. Then 0.08-0.3cc/kg/hr. (Max.0.75cc/kg/hr.) Dobutamine Amp. 250mg/20ml 0.5mcg-1mcg/kg/min. Then 2-20mcg/kg/min. (Max. 40mcg/kg/min.) 20cc + 30cc D5% → 0.006-0.012cc/kg/hr. Then 0.024-0.24cc/kg/hr. (Max. 0.5cc/kg/hr.) Amiodarone Amp. 150mg/3ml Cardiac Arrest: 5mg/kg (Max. 300mg) 3cc + 12cc D5% → 0.5cc/kg. May repeat up to 2 times. Fentanyl Amp. 50mcg/ml Bolus: 0.5-2mcg/kg Maintenance: 0.5-2mcg/kg/hr. 2cc + 10cc N.S. →0.1cc/kg Propofol Amp. 1% 10mg/ml Bolus: 2.5-3.5mg/kg Maintenance: 0.125-0.3mg/kg/min 0.1cc/kg (Pure) Adenosine Amp. 6mg/2ml, 12mg/4ml 0.1mg/kg (2cc + 4cc N.S.) → 0.1cc/kg/dose 2 syringes: 1st for adenosine, 2nd for >5cc N.S. → To be pushed together at same time in 3 sec. rapid flush. Repeat if needed after 1-2 min. Isoptin Amp 5mg/2ml, 10mg/4ml >1 year → 0.1-0.3mg/kg in 2 min. (Max. 5mg) 2cc + 3cc N.S. → 0.1-0.3cc/kg/dose in 2 min. (Max. 5cc) Repeat if needed after 30 min. Lidocaine Amp. 1% = 10mg/ml 2% = 20mg/ml VT/VF/Local Anesthesia Bolus: 0.5-1mg/kg (Max. 4.5mg/kg) Maintenance: 1.2-3mg/kg/hr. Ventolin (Salbutamol) Neb. 5mg/2.5ml >2 years→ 0.1mg/kg x4 (Max. 2.5mg/dose) (2-4cc N.S. dilution) Pulmicort Neb. 0.25mg/ml >1 year→ 1-2cc x2 (2-4cc N.S. dilution) Adrenaline amp Neb. 1mg/ml 0.5-1cc/dose (2-4cc N.S. dilution)
  8. 8. 7 | P r e p a r e d B y D r . E s s a m S i d q i - D u h o k - K u r d i s t a n R e g i o n - I r a q - A p r i l 2 0 2 2 IV Fluids Therapy Maintenance for Neonates: First 2 days is G.W. D10% then change to G.S. (5%-1/5) If on Phototherapy: add 30cc/kg/24hr. (IV Fluid) If on Feeding: 10-15cc/kg/day every 2-3hrs (i.e. ÷12 or ÷8) then Subtract this amount from the total maintenance. Mature or >1kg Premature or <1kg 1st day:60-70cc/kg/24hr 2nd day: 80cc/kg/24hr 3rd day: 100cc/kg/24hr 4th day: 120cc/kg/24hr 5th day: 140cc/kg/24hr Others: 150cc/kg/24hr 1st day: 80cc/kg/24hr 2nd day: 95cc/kg/24hr 3rd day: 110cc/kg/24hr 4th day: 125cc/kg/24hr 5th day: 140cc/kg/24hr Others: 150cc/kg/24hr Bolus (Shoot) → N.S. or R.L. 20cc/kg in 20min-1hr up to 3 times Maintenance for Older Children: G.S. <10kg (1st 10kg) 100cc/kg/24hr 10-20kg (2nd 10kg) (1000cc + 50cc/kg for every Kg >10)/24hr >20kg (3rd 10kg) (1500cc + 20cc/kg for every Kg >20)/24hr Deficit for Older Children: G.S. Mild dehydration 30-50cc/kg Moderate dehydration 60-100cc/kg Severe dehydration 90-150cc/kg • Inform The Police for a Police Paper for cases of Poisoning, Inhalation and Ingestion of Foreign Body or Animal or Ticks Bites and Scorpion Sting or Any Abuse or Suspicious case. • Any case Death on Arrival, inform the police and refer to Forensics. • Any new case being referred or admitted to the floor (wards) from the emergency department that needs follow-up medications and vitally, like DKA or convulsion etc, the JHOs in ER should inform the JHO on call in the floors (wards). 23hr Fluid for Older Children = Maintenance + Deficit – Bolus ½ amount in first 8hr. ½ amount in other 15hr.
  9. 9. 8 | P r e p a r e d B y D r . E s s a m S i d q i - D u h o k - K u r d i s t a n R e g i o n - I r a q - A p r i l 2 0 2 2 Sliding Scale for Sub-Cutaneous Soluble Insulin Injection in Diabetic Patients: Pediatric DKA Management: 1. ABC and Double Cannula 2. Foley’s catheter 3. Bolus of N.S. 20cc/kg in 1hr then in the 2nd hr start the below: a) Fluid Per Hour for 23hr Equation: [ (Maintenance + Deficit 85cc/kg) – Bolus ] all divided by 23hr If RBS >250mg/dl then use N.S. If RBS <250mg/dl then use G.S. b) Soluble Insulin Infusion Per Hour: 0.1 unit/kg/hr. Calculate the dose for 6hrs, dilute it with 30cc N.S., to be infused in 6hrs with Syringe Pump. c) Antibiotics and Analgesics: Oframax Vial and Parol Bottle etc. d) KCl Amp.: 1cc/kg/24hr infusion in the fluid or 1cc for each 100cc of the fluid. (1cc=2mEq). RBS Every 6hr Amount of S.C. Soluble Insulin (Actrapid, Humulin R) 0-150 mg/dl Nothing 150-200 mg/dl 0.1 unit/kg 200-300 mg/dl 0.2 unit/kg 300-400 mg/dl 0.3 unit/kg 400-500 mg/dl 0.4 unit/kg >500 mg/dl 0.5 unit/kg
  10. 10. 9 | P r e p a r e d B y D r . E s s a m S i d q i - D u h o k - K u r d i s t a n R e g i o n - I r a q - A p r i l 2 0 2 2 Neonatal Convulsion IV cannula Vital signs including RBS, if hypoglycemic treat with G.W. D10% →2cc/kg. Luminal (Phenobarbital) Amp. 200mg/ml Bolus: 15-20mg/kg 1cc + 9cc N.S. →1cc/kg in 20 min. If no response give 2nd dose. If response put on maintenace after 12hr. Maintenance: 3-5mg/kg/day ÷2 1cc + 9cc N.S. →20 units/kg/day ÷2 in 20min. If no response: Phenytoin Amp. 250mg/5ml (50mg/ml) Bolus:15-20mg/kg 5cc + 10cc N.S. →1cc/kg in 20 min. Maintenance: 4-8mg/kg/day ÷2 5cc + 10cc N.S. →50 units/kg/day ÷2 in 30min only by N.S. If no response: * Midazolam Amp. 15mg/3ml (5mg/ml) Bolus: 0.05-0.4mg/kg 1cc + 4cc N.S. → 0.1-0.2cc/kg in 3 min. Maintenance: 0.03-0.2mg/kg/hr • Calculated as [(0.1mg × Kg × 24)mg changed to cc of the corresponding original amp. cc + X cc G.W.] = 24cc then 1cc/hr infusion. Diazepam Amp. 10mg/2ml IV: 0.2-0.5mg/kg 2cc + 3cc N.S. → 1cc/10kg PR: 0.2-0.5mg/kg or 0.25cc/kg Use NG tube or Foley’s catheter or small syringe. (Up to 3 doses) If no response: Luminal (Phenobarbital) Amp. 200mg/ml Dosing as above. If no response: Phenytoin Amp. 250mg/5ml (50mg/ml) Dosing as above. If no response: * Midazolam Amp. 15mg/3ml (5mg/ml) Dosing as above. Older Children Convulsion * If still no response in the last step, then consider Calcium Gluconate IV and Magnesium Sulphate IV and Pyridoxine PNG (neonate) or IV/IM.
  11. 11. 10 | P r e p a r e d B y D r . E s s a m S i d q i - D u h o k - K u r d i s t a n R e g i o n - I r a q - A p r i l 2 0 2 2 References: ➢ https://www.medscape.com/ ➢ https://www.medicines.org.uk/emc/ ➢ https://www.uptodate.com/ ➢ https://bestpractice.bmj.com/ ➢ https://www.drugs.com/ ➢ https://www.rxlist.com/ ➢ https://globalrph.com/ ➢ https://www.webmd.com/ ➢ BNF 81

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