Pediatric

ER Notes
1
 Cardiopulmonary Arrest Anti-arrhythmic drugs (advanced)

- CPR: Ambu + Chest compression

Inderal (propranolol) amp (1mg/1ml)
- Adrenaline: ‫ مرات‬٣ ‫ط من المحلل‬ ‫الوزن‬
0.1 mg/kg/dose
‫ مرات‬٣ ‫ط من غ المحلل‬ ‫ثم الوزن‬
‫الوزن السم ب طء‬ ‫ﺳم و ع‬١٠ ‫أمبول حل ﻋ‬
- Atropine: ‫ مرات‬٣ ‫ط من المحلل‬ ‫الوزن‬
Cordarone (amiodarone) amp (150mg/3ml)
‫ مرات‬٣ ‫ط من غ المحلل‬ ‫ثم الوزن‬
Loading: 5mg/kg/dose up to 2 times
- Aminophylline: ‫ط‬ ‫الوزن‬
‫خﻼل ثلﺚ ﺳاﻋة‬ ‫ ب طء شد د‬%٥ ‫ ﺳم ج‬٣٠ + ‫ط‬ ‫الوزن‬
- Ringer: 20 ml/kg/dose
- Hydrocortisone: 5 mg/kg/dose Maint.: 5-15 mcg/kg/min

- NaHCO3: %٥ ‫ نفس ال م ة ج‬+ ‫الوزن السم‬ added to 50 ml DW5% rate 4.1 ml/hr every 12 hrs.

- RBG: if low 5-10 ml/kg/dose DW10% Lidocaine (xylocaine) (1g/50ml-20mg/1ml)

Loading: 1mg/kg/dose

‫خﻼل ثلﺚ ﺳاﻋة‬ ‫ ب طء شد د‬%٥ ‫ ﺳم ج‬٣٠ + ‫ط‬ ‫الوزن‬

Heart Failure

- Lasix - Aldactone Maint.: 20-50 mcg/kg/min (wt x 0.72) in ml

added to 50 ml DW5% rate 4.1 ml/hr every 12 hrs.
- Capoten - Digoxin
- Antibiotic
- Lasix [1-2-3-4 mg/kg/dose] ‫حسب الحالة‬
1mg: ‫ ﺳاﻋة‬١٢-٨-٦ ‫الوزن ط قسم ل‬
2mg: ‫ ﺳاﻋة‬١٢-٨-٦ ‫ضعف الوزن ط قسم ل‬
- Capoten: 0.5-6 mg/kg/day divided/12 hr
- Aldactone: 1-2 mg/kg/day divided/12 hr
‫الوزن × الجرﻋة × م ة الماء ÷ ترك القرص‬ ‫ماء و ع‬ ‫حل‬

- Digoxin
- Antibiotic: ‫ أم ك‬، ‫يون كتام‬

2
 Shock - Adrenaline (1mg/1ml)
Hypotensive (cold) shock
 A-B-C and nasal O2
0.1-1 mcg/kg/min
 Shock therapy: NS 20 ml/kg or blood
[Wt x dose x 12 x 60 x 1] / [1000 x 1]
repeated till improvement or pt
- Noradrenaline (8mg/4ml)
becomes loaded.
Hypotensive (warm) shock
 RBG (correct if hypoglycemic)
0.2-2 mcg/kg/min.
 NaHCO3 if acidotic.
If no improvement after shock therapy N.B: Maximum inotropes combination is
(advanced) Dobutamine and Noradrenaline.
 Inotropes If no improvement, add:
- Dopamine (200mg/5ml)  Hydrocortisone (100mg/2ml)
10-40 mcg/kg/min 200 mg/day divided every 6 hrs
[Wt x dose x 12 x 60 x 5] / [1000 x 200]
i.e 1 ml / 6 hrs
Wt x 0.18 at dose 5 mcg
then double, triple the dose and so on to
reach the desired dose, e.g: N.B:

dose of 10 = Wt x 0.18 x 2 - If no urine, apply a catheter.

‫ معدل‬%٥ ‫ ﺳم ملح أو ج‬٥٠ ‫الجرﻋة السم تضاف إ‬ - If the patient becomes shocked again during
‫ ﺳاﻋة‬١٢ ‫ ن د نجة كه ائ ة ل‬٤٬١ inotrope withdrawal, consider adrenal
- Dobutamine (250/5ml – 250/20ml) insufficiency (so, hydrocortisone is a line of ttt of
Cardiogenic shock refractory shock).
(e signs of Heart failure or cardiogenic pulmonary edema)
10-40 mcg/kg/min
[Wt x dose x 12 x 60 x 20] / [1000 x 250] To summarize:
10 = Wt x 0.144 20 = Wt x 0.144 x 2 shock therapy – hydrocortisone
30 = Wt x 0.144 x 3 40 = Wt x 0.144 x 4 Choose inotrope according to type of shock.
‫ معدل‬%٥ ‫ ﺳم ملح أو ج‬٥٠ ‫الجرﻋة السم تضاف إ‬
‫ ﺳاﻋة‬١٢ ‫ ن د نجة كه ائ ة ل‬٤٬١
.‫أو حسﺐ الﺤالة‬ ‫طة ل ﺳاعت‬ ‫والديبوتركس كون معدل‬ ‫ﺳﺤﺐ الدو ام‬

3
 ‫‪Gasping Respiration‬‬ ‫‪Bronchial Asthma‬‬

‫‪- ABC (e O2, shock therapy if in need,‬‬ ‫‪ -‬د ادرون‬ ‫‪ -‬جلسات‬

‫)‪RBG, ... according to the case‬‬ ‫‪Aminophylline -‬‬ ‫‪ -‬أوكسج‬
‫ط اﻵن ‪- Aminophylline‬‬ ‫الوزن‬ ‫‪MgSO4 -‬‬ ‫‪ -‬زنتاك‬
‫‪ -‬شف ط لو محتاج‬ ‫‪ -‬أ سج‬ ‫يون كتام ‪ ،‬أم ك‬
‫‪ -‬أمبول ه دروكورت ون‬
‫‪Bronchiolitis‬‬
‫الت ادل مع أتروفنت‬ ‫‪ -‬جلسات فاركول‬
‫‪ -‬ﺳلفات ماغ سيوم لو ‪Tight‬‬
‫ﻋة وتصل حها‬ ‫‪ -‬ﺳحب غازات‬
‫‪ -‬محال ل لو محتاج‬ ‫‪ -‬أوكسج‬
‫ﻋة لمعرفة الس ب‬ ‫‪ -‬إذا أمكن ﻋمل ‪CXR‬‬
‫‪ -‬زنتاك‬ ‫‪ -‬د ادرون‬
‫تور لمعرفة ‪SO2‬‬ ‫‪ -‬الذهاب للعنا ة والتوص ل ﻋ مون‬
‫‪ ،‬أتروفنت ‪ ،‬ملح مركز‬ ‫‪ -‬جلسات فاركول‬
‫‪Croup‬‬ ‫‪ -‬يون كتام ‪ ،‬أم ك‬ ‫‪CXR‬‬ ‫‪-‬‬
‫ب نهم ر ــع ﺳاﻋة‬ ‫‪ ٢ -‬جلسة أدر نال‬
‫‪Pleural Effusion & Severe Pneumonia‬‬
‫الفﺤص‬ ‫‪ -‬جلسة الم كورت‬
‫‪ -‬فانكولون )‪٦٠-٤٠‬مجم كجم يوم( ل ‪ ٨‬ﺳاﻋات‬
‫ط اﻵن(‬ ‫‪ -‬د اردرون )الوزن‬
‫الجرﻋة تضاف إ ‪ ٣٠‬مل ملح‬
‫دخل لو ‪RD Grade III or IV‬‬ ‫‪-‬‬
‫الوزن ﺳم ل ‪ ١٢‬ﺳاﻋة‬ ‫‪ -‬روﺳ ف‬
‫ل ﺳاﻋت‬ ‫‪ -‬جلسة أدر نال‬
‫‪ -‬فﻼزول الوزن × ‪ ١٫٥‬ﺳم ل ‪ ٨‬ﺳاﻋات‬
‫اﻷوض‬ ‫)‪٠٫٢٥-٠٫٥‬مجم(‬ ‫‪ -‬د ادرون‬
‫‪ -‬أوكسج‬
‫)‪٠٫٥-١‬مجم كجم(‬ ‫أو ﺳوليوم درول‬
‫الت ادل مع أتروفنت ‪ ٨‬ﺳاﻋات‬ ‫‪ -‬جلسات فاركول‬
‫‪ -‬زنتاك‬ ‫‪ -‬محال ل ور د ة‬
‫‪ -‬محال ل الورد‬
‫‪ -‬يون كتام‬ ‫‪ -‬أ سج‬
‫‪ -‬اﻷهم‪:‬ﻋرض ‪ Cardiothoracic‬لو ه كب ‪Tube‬‬
‫‪CXR to exclude F.G -‬‬
‫العﻼج السابق مع إضافة ‪maxilase‬‬ ‫ونع‬
‫‪ -‬التحال ل‪ :‬صورة و ولينا‬
‫العﻼج السابق مع‬ ‫‪ -‬لو مش ه كب ‪ Tube‬نع‬
‫‪Croup & Br. Asthma‬‬ ‫ﻋمل ‪ CXR‬يوم ا وﻋرضها ﻋليهم )ﻻزم(‬
‫اﺳت شاق )ب نهم ¼ ﺳاﻋة(‬ ‫‪٢ -‬جلسة أدر نال‬
‫‪ -‬أمينوف لل‬ ‫‪ -‬د ادرون‬
‫‪ -‬ﺳلفات ماغن سيوم‬ ‫‪ -‬أوكسج‬
‫‪ -‬زنتاك‬ ‫‪ -‬يون كتام‬

‫‪4‬‬
 Tight Chest Inhalation therapy ‫الجلسات‬

- O2 nasal - RBG - ABG  Farcolin (salbutamol) 5mg/ml

- Pulse oximetry - Ryle - Mild to moderate asthma:
- I.V line and I.V fluids
If spontaneously breathing, no need for < 20 kg: 0.5 ml + 3 ml NS
frequent ABG > 20 kg: 1 ml + 3 ml NS
- Continuous inhalation with face mask
- Severe asthma (continuous)
and O2.
- Sedation of agitated (e.g by chloral by ‫ ﺳم ملح ل ﺳاﻋة‬٣ + ‫ط‬ ‫الوزن‬
ryle tube or ketamine i.v advanced)  Atrovent (ipratropium) 250-500 mcg/2ml
Farcolin and Atrovent then reassess.
If no improvement 250-500 mcg + 3 ml NS every 4-6 hrs
- I.V steroids:  Adrenaline
Hydrocortisone: 4-8 mg/kg followed by
0.5 ml/kg/dose max. 5ml + 3 ml NS
2-4 mg/kg every 6 hrs.
Methylprednisolone: 2mg/kg then  Pulmicort (Budesonide) 0.25-0.5mg/ml
0.5-1 mg/kg every 4-6 hrs. 0.5-1 mg/day divided every 12 hr + 3ml NS
If no improvement (use one of the following)
- Adrenaline S.C or I.M
0.01 mg/kg (max. 0.5 mg) can be
repeated every 15-30 min.
- Mg sulfate: 25-75 mg/kg
(‫ﺳم‬١٠ ‫ ) حد أق‬%٥ ‫ ﺳم ج‬٣٠ ‫الوزن ﺳم ضاف إ‬
- Aminophylline 10 mg/kg/day up to 15
mg/kg/day divided every 8 hrs
If no improvement (call PICU)
Mechanical ventilation is considered

Signs of Respiratory Failure:

- Central cyanosis, diaphoresis
- DCL
- Absent breath sounds, gasping
- Inability to speak or cry
- Marked pulsus paradoxus

Indications of MV in tight chest

- Cardiorespiratory arrest
- Severe hypoxia or hypercapnia
- Rapid deterioration in mentality

5
 ‫‪Meningitis‬‬ ‫‪DCL‬‬

‫‪ -‬يون كتام‪ :‬الوزن ﺳم ‪ ٨‬ﺳاﻋات ]‪[300 mg‬‬ ‫)‪- ABC (examine RBG and pupils‬‬
‫ﻼفوران‪ :‬الوزن × ⅔ ‪ ٨ /‬ﺳاﻋات ]‪[200 mg‬‬ ‫‪-‬‬ ‫‪- History of drug intake.‬‬
‫ط ‪ ١٢‬ﺳاﻋة لمدة يوم ‪.‬‬ ‫د ادرون ‪ -‬زنتاك‪ :‬الوزن‬ ‫‪-‬‬ ‫‪- O2 nasal‬‬

‫مرة مان تول‬ ‫‪ -‬لو الطفل ‪ drowsy‬نع‬ ‫… ‪- RBG, KFTS, Electrolytes, ABG‬‬

‫وتحس ا لئﻼ كون ‪ encephalitis‬ضاف ‪Acyclovir‬‬ ‫‪- Ryle‬‬

‫‪Routine investigations & C.S.F examination‬‬ ‫‪- Urinary catheterization‬‬

‫‪- CT brain. If free, CSF.‬‬
‫‪Encephalitis‬‬

‫‪ -‬أﺳ لوف )الوزن ‪ ١٫٢٥‬ﺳم( ‪ ٣٠ +‬ﺳم ملح ‪ ٨‬س‬ ‫‪Brain edema‬‬

‫‪ -‬د ادرون ‪ ،‬زنتاك )الوزن ط( ‪ ١٢‬س لمدة يوم‬ ‫‪- Dexamethasone‬‬

‫لمدة ‪ ٤٨‬ﺳاﻋة ‪0.15 mg/kg/dose every 6 hrs‬‬
‫‪ -‬مان تول )الوزن × ‪ ٢٫٥‬ﺳم( ‪ ١٢‬س‬
‫‪- Mannitol 20%‬‬
‫‪] For ttt of brain edema‬مع ق اس الضغظ ق له[‬ ‫الوزن × ‪ ٢٫٥‬ل ‪ ١٢‬ﺳاﻋة مع متا عة الضغط لمدة ‪ ٤٨‬ﺳاﻋة‬
‫مكن تكراره مرة ثان ة لو الم ض ‪ drowsy‬مع متا عة الضغط‬ ‫‪- Zantac‬‬ ‫ط ل ‪ ١٢‬ﺳاﻋة‬ ‫الوزن‬

‫‪Intracranial Hemorrhage‬‬ ‫‪Febrile Convulsions‬‬

‫‪- Control of convulsions‬‬ ‫‪ -‬نوقف ال شنجات لو موجودة‬

‫سحب ‪ PT, PC, PTT‬مع تحد د فص لة وﺳؤال‬ ‫‪-‬‬ ‫‪ -‬ب فلجان الور د ﻋند اللزوم و ‪NSAIDs‬‬

‫ﻋن دم طازج أو ﻼزما‬ ‫‪ -‬يون كتام‬

‫‪ -‬يون كتام )½ الوزن ل ‪ ٨‬ﺳاﻋات(‪ ،‬أم كن‬ ‫‪ -‬متا عة الحرارة وحدوث شنجات‬

‫‪- Control of bleeding‬‬ ‫‪ -‬ﻋند الخروج‬

‫‪٢٫٥‬ﺳم ‪ ١٢‬ﺳاﻋة(‬ ‫ف‪.‬ك )‪١‬مل ‪٥ +‬ﺳم و ع‬ ‫‪Valinil 5mg tab.‬‬

‫ط ‪ ١٢‬ﺳاﻋة(‬ ‫دا سنون ‪ ،‬ابرون )الوزن‬ ‫عدها‬ ‫نصف قرص ل ‪ ١٢‬ﺳاﻋة أثناء ف ة السخونة و وم‬

‫‪- Zantac‬‬

‫‪6‬‬
 Convulsions Hypoglycemia
 ABC RBG < 60 mg/dl [<40 in neonates]
 RBG
 Control of convulsions Glucose 10% 5-10 ml /dose
1. BDZ: Glucose 25% 2-4 ml /dose
- Diazepam (0.2-0.5 mg/kg)
‫ مرات‬٣ ‫ط ح‬ ‫نصف الوزن‬
Hypocalcemia (↓ Ca)
- Dormicum (0.1-0.5 mg/kg)
‫ مرات‬٣ ‫ط ح‬ ‫نصف الوزن‬ %١٠ ‫ ﺳم كجم السيوم جلوكونات‬٢-١ -
2. Epanutin (250mg/5ml)
- Loading: 15-20mg/kg (‫ مل ملح‬٤٠ + ‫ مل السيوم‬١٠ ‫ملح ) ل‬ ‫ضاف إ‬ -
‫ مرات‬٣ ‫ط ح‬ ‫ثﻼث أضعاف الوزن‬ ‫الجرﻋة الواحدة ل‬ ‫ﺳم السيوم‬١٠ ‫جرﻋة‬ ‫ أق‬-
- Maint.: 3-8 mg/kg
‫ ﺳاﻋة‬١٢ ‫نصف الوزن ط قسم ل‬ * ‫ ﺳاﻋات‬٦
‫ اﻹي انوت ضاف ﻋ ملح فقط‬:‫ملحوﻇة‬
‫ماغن سيوم ضعف الوزن‬ ‫ لو مش ب تصلح نع‬-
3. Sominaletta (40mg/ml)
- Loading: 15-20mg/kg (‫الجرﻋة‬ ‫ﺳم‬٢ ‫جرﻋة‬ ‫ط مرة واحدة )أق‬
‫ مرات‬٣ ‫نصف الوزن ﺳم ح‬
- Maint.: 3-8 mg/kg ‫ مع العﻼج الور دي‬Oral vit. D and Ca ‫نض ف‬
‫ ﺳاﻋة‬١٢ ‫ط قسم ل‬ ‫نصف الوزن‬
* Harriet Lane Handbook 20th e:
If No improvement
Max. Ca gluconate 10% (100mg/10ml) dose in tetany
4. Dormicum (15mg/3ml) Drip is 500mg/kg/day
1-5 mcg/kg/min
Not effective in focal convulsions
Wt x 0.144 ‫ م كرو‬١ ‫جرﻋة‬ Acidosis Correction
‫ ﺳاﻋة‬١٢ ‫ ﺳم ملح ل‬٥٠ ‫الناتج السم ضاف إ‬
٤٫١ ‫نجة كه ائ ة معدل‬ - pH 7.0 – 7.1: full correction wt x BE / 3
5. Valium (10mg/2ml) Drip - pH ≥ 7.2: half correction wt x BE / 6
0.2-0.3 mg/kg/hr
Wt x dose x 12 x 2 / 10
‫ ﺳاﻋة‬١٢ ‫ ﺳم ملح ل‬٥٠ ‫الناتج السم ضاف إ‬
٤٫١ ‫نجة كه ائ ة معدل‬
6. Propofol (advanced, in PICU)
1-2 mg/kg/bolus followed by 1-15 mg/kg/hr

If No improvement refer to ICU

N.B: Oral antiepileptic drug should be initiated
with intravenous anticonvulsants (oral or with ryle
tube, unless contraindicated) as Depakine on (30
mg/kg) or Tiratam (30-60mg/kg) divided every 12
hrs.

7
 Organophosphorus Toxicity Scorpion sting

‫ اﻷهم نغسل الجسم له أو ﻋ اﻷقل غ مﻼ سه‬- (‫)ﻻزم ﻻزم‬ ‫دخل مح‬ -

‫ أ سج‬- ‫شف ط لو ف ه إفرازات‬ - ‫ ن عﺚ اﻷهل جيبوه من اﻹ مان أو الشاملة‬:‫مصل العقرب‬ -

‫ دخول مح‬- ‫ء الفم‬ ‫ﻻ‬ -

‫ ووضع فحم‬،‫ غس ل معدة مع أخذ ﻋينة‬- ‫ أهم حاجة شف ط ك س‬-

‫ لو أقل من ﺳاﻋة‬activated charcoal ‫ إﻋطاء ه دروكورت ون اﻵن‬-
‫ دقائق‬٥-٣ ‫ط من المحلل ل‬ ‫ الوزن‬: ‫ أترو‬- ‫ط اﻵن‬ ‫ الوزن‬:‫ أف ل‬-
pin point pupil ‫لو ف ه إفرازات ﻋ الصدر أو‬ ‫ ﻻزم يتوصل ﻋ مون تور‬-
(In severe cases undiluted atropine may be given)
(‫ ق اس السكر )ﻻزم‬-
pupil ‫ح تتحسن اﻷﻋراض و توﺳع الـ‬ ‫يتم إﻋطاء أترو‬
‫ﺳم ملح‬٥٠ ‫حل المصل ﻋ‬ -
atropine toxicity: tachycardia and tremors ‫ظهر أﻋراض‬ ‫أو‬
Then, symptomatic treatment:
‫ ﺳاﻋة‬١٢ ‫ط ل‬ ‫ الوزن‬:‫ د ادرون‬-
‫ ﺳاﻋات‬٤ ‫ فاركول‬،‫ جلسات أتروفنت‬-
‫ ﺳاﻋة‬١٢ ‫ط اﻵن و ل‬ ‫ الوزن‬:‫ زنتاك‬-
‫ أمينوف لل‬-
Submaintenance :‫ المحال ل‬-
(Maint., shock or sub.) :‫ المحال ل‬-
Complications
‫ ﺳاﻋة‬١٢ ‫ط‬ ‫ الوزن‬:‫ د ادرون‬،‫ أف ل‬،‫ زنتاك‬- - Shock → ringer’s lactate
Anticonvulsant if needed - - Disturbed LOC = brain edema
‫ يون كتام‬- ‫مان تول وممكن دورم م لو ا شنج‬ ‫لو حصل هلوﺳة نع‬
- ttt: pralidoxime ‫ العنا ة‬25-50 mg/kg slowly - Crepitation = pul. edema ‫ﻻزكس و شف ط‬
over 30 min.
- Myocarditis → Solumedrol
- Investigations: ‫ ﺳاﻋات‬٦ ‫ط ل‬ ‫الوزن‬

CBC, KFT, ABG, RBG - Toxic ileus → ‫را ل مفت ح ك س جمع بول‬
‫والعﻼمات الحي ة ل ﺳاﻋت‬ ‫ متا عة حدقة الع‬- - Severe bronchospasm (see tight chest)
‫ ال شف ط ﻋند اللزوم‬-
- Investigations
- N.B: Atropine Toxicity:
ABG, CPK (CK-MB), LDH, CBC, KFT,
Flushed face, mydriasis, constipation, urine
RBG / CXR
retention, irritability, tachycardia

8
 ‫‪Food Poisoning‬‬ ‫‪Potas‬‬

‫‪ -‬دخول مح‬ ‫‪ ،‬غاز‬ ‫لور ‪ ،‬بوتاس ‪ ،‬ك وﺳ‬

‫‪ -‬غس ل معدة ‪ +‬أخذ ﻋينة‬
‫)ﻋرض أنف وأذن ق ل الدخول لو‬ ‫‪ -‬دخول مح‬
‫‪ -‬زنتاك‪ ،‬أف ل‪ ،‬د ادرون‬
‫الحالة مستقرة(‬
‫‪ -‬يون كتام‬
‫‪ -‬ممن ع غس ل المعدة‬
‫‪ -‬محال ل ور د ة‬
‫ء الفم ‪ +‬محال ل‬ ‫‪ -‬ﻻ‬
‫‪ -‬التحال ل‪ :‬صورة دم ‪ ،‬بولينا‬
‫‪ -‬أ سج ‪nasal‬‬
‫ف ﺳوليوم درول‬ ‫لﺤ‬ ‫ط ‪ ١٢‬ﺳاﻋة‬ ‫‪ -‬د ادرون‪ :‬الوزن‬
‫‪Aspirin Toxicity‬‬ ‫ط ‪ ٦‬ﺳاﻋات‬ ‫‪ -‬ﺳوليوم درول )اﻷهم(‪ :‬الوزن‬

‫‪ -‬دخول مح‬ ‫‪ -‬أف ل و زنتاك‬

‫‪ -‬غس ل معدة اﺳتخدام ب ك ونات صوديوم مع‬ ‫ط ‪ ٣٠ +‬ﺳم ملح مرة واحدة فقط‬ ‫‪ -‬ن كس م‪ :‬الوزن‬

‫أخذ ﻋينة‬ ‫‪ ½ :α-chemotrypsin -‬اﻷمبول ‪ ١٢‬ﺳاﻋة‬

‫‪ -‬يون كتام ‪ ،‬دا سنون ‪ ،‬ابرون‬ ‫‪ -‬متا عة العﻼمات الحي ة و تغ الصوت‬

‫ط ‪ ٣٠ +‬مل ملح مرة واحدة‬ ‫‪ -‬ن كس م‪ :‬الوزن‬ ‫‪Stridor → intubation or tracheostomy‬‬

‫‪ -‬محال ل‬ ‫‪ -‬جل للفم‬

‫‪ -‬التحال ل‪ :‬صورة ‪ ،‬بولينا‬ ‫‪ -‬ﻋرض أنف وأذن‬

‫ﻋند الخروج‪ :‬نكتب ما س ﻼز و ‪amoxacillin-Clavulinic‬‬ ‫‪-‬‬
‫‪Primperan Toxicity‬‬
‫ابتﻼع جسم صلﺐ‬
‫‪ -‬أمبول أف ل اﻵن )مهم(‬
‫‪ -‬أمبول ه دروكورت ون‬ ‫لو الطفل ‪ stable‬ن عثه عمل ‪CXR‬‬ ‫‪-‬‬
‫نعمل ‪ Request‬حسب م ان الجسم‬ ‫‪-‬‬
‫‪ -‬المحال ل‬
‫أنف وأذن )‪(if above the clavicle‬‬
‫‪ -‬ﻋﻼج ال شنجات لو موجودة‬ ‫جراحة قلب وصدر‬
‫ط‬ ‫دورم م ½ الوزن‬ ‫‪ -‬نع‬ ‫جراحة ﻋامة‬
‫لو ﺳ دخل اﻻﺳتق ال‪:‬‬
‫)‪ Buspirone (Akinetone‬لعﻼج ‪Extrapyramidal‬‬ ‫‪-‬‬
‫دخول مح‬ ‫‪-‬‬
‫‪Akinetone 2mg:‬‬ ‫½ قرص ل ‪ ١٢‬ﺳاﻋة‬ ‫يون كتام ‪ ،‬أم ك ‪ ،‬محال ل‬ ‫‪-‬‬
‫‪ -‬أ سج ‪nasal‬‬ ‫جلسات فاركول‬ ‫‪-‬‬
‫التحال ل‪ :‬صورة دم ‪ ،‬بولينا‬

‫‪9‬‬
Additional Notes
Antipsychotic drug toxicity: Edema
- Gastric wash if less than 2 hrs After history and Examination
- Forced diuresis  Hepatic: LFTs and U/S
 Renal: - urine analysis for Albumin
1.5 x maint. IVF and Lasix 1 mg/kg/day - 24 hr protein in urine
- ECG - Alb/creat. Ration (the best)
- ABG  Cardiac
- Follow up  Nutritional
Salt-free albumin 5ml / kg
Disturbed patient due to unknown cause
Marasmus
or indefinite history
Wt loss = [ideal wt - actual wt] / idea x 100
You should suspect everything
- 1st degree: 25 – 29 %
SAMPLE history (Signs/Symptoms, Allergy, nd
- 2 degree: 30 – 49 %
Medications, Past medical history, Last meal, rd
- 3 degree: ≥ 50 %
Events leading to this situation)
Caloric needs = 150 – 200 kcal
‫دخول بمحضر‬ Oliguria or Anuria
CBC, KFT, electrolytes
- Urinary catheter
ABG, RBC - Fluids, or
CT and if free do C.S.F - Lasix, or
- Dopamine (5 mcg)
Forced diuresis - KFTs, Abdominal US
Urinary catheter
Sepsis

RBG Fluid chart

Good antibiotic coverage.
If abdominal distension:
Abd. U/S, Plain erect and surgical consult.

IV Fluids

Cardiac 0.5 maintenance

Chest 0.7 maintenance
SCD 1.5 maintenance

10
 Hematology 1

Pediatric Hematology Notes

Blood Products Transfusion

Whole blood:
Notes:
(stored between 2-6°)

indicated in  Vitamin K dependent coag. Factors

1972: factors X, IX, VII, II (prothrombin)
- Acute massive blood loss  Prolonged PT (N 10-14 sec.)
- Exchange transfusion.
Extrinsic pathway defect.
Packed RBCs:  Prolonged aPTT (N 28-35 sec.)
(stored between 2-6°) Intrinsic pathway defect.
 Prolonged TT (N 16-22)
Platelet concentrates:
Common pathway defect.
(stored at room temp. 20-24° with gentle
agita on for 5 days)

Plasma (Fresh Frozen Plasma):

(stored between -18 to -70°)

Contains all clotting factors including labile

factors (Factor VIII, V) and factor IX
Indicated in:
- All coagulation factors deficiencies
- Hemophilia A.
- Hemophilia B.
Cryoprecipitate: (4°)
rich in factors VIII, vWF, XIII, fibrinogen,
fibronectin
Indicated in:
- Hemophilia A This Page is adapted from:
- Von Willebrand factor (vWF) deficiency Handbook of Clinical Pathology for Undergraduate
- Hypo- and dysfibrinogenemia Student, clinical pathology department, Assiut
University.
 Hematology 2

 Absolute Neutrophilic count (ANC) Normal Values:

[WBCs X Neutrophils% X 1000] /100 - PT 12 – 16
- PC 70 – 100 %
- > 1500 N - 1000 – 1500 mild
- PTT up to 30
- < 500 severe - < 100 profound
- INR up to 1.1
 Mentzer index = MCV/RBCS
- > 14 iron deficiency
- Ionized Ca 0.8 – 1.2
- < 12 thalassemia
- Na 135 – 145
- 12-14 equivocal
- K 3.5 – 5.5
 Retics index:
[Re cs X HCT / 45] X [1/HCT]
- S. ammonia 10 – 47
- <1 pure red cell aplasia
- S. lactate 5 – 12
- <3 iron deficiency
- >3 hemolysis
0.5 = 40-45 1 = 35-40 Common prescription drugs in
hematology unit ‫ارت خروج لحالة أمراض دم‬
1.5 = 30-35 2 = 25-30
- Folic acid ‫قرص يوم ا‬
2.5 = 20-25
- Rota C drops ١٢ ‫نصف القطارة ل‬
 Impaired PT (N 11-14): ↓ factors 1972 ‫ﺳاﻋة‬
- Fruital syrup ‫ ﺳاﻋة‬١٢ ‫ﺳم ل‬٥
TTT: FFP, vit. K
- L-Carnitine ‫ ﺳاﻋة‬١٢ ‫نصف القطارة ل‬
1. Plasma: (10-20 ml/kg)
Should be given within 6 hours.
If anemic H.F: give FFP over 4 hrs and
subtract it from IV fluid.
PRBCs are not subtracted.
2. Vit. K
‫ ﺳم ماء مقطر ول س ملح‬٥ ‫حل اﻷمبول ﻋ‬
‫ ﺳاﻋة‬١٢ ‫ ﺳم ل‬٢٬٥ ‫و ع‬
 Impaired PTT: ↓ FVIII, vWF, FIX
TTT: FFP

 Impaired PT, PTT: common pathway

↓ Factors V, X, II, I (fibrinogen)
TTT: FFP
 Hematology 3

Hemophilia A ITP

Factor VIII deficiency: Grades:

- < 1% severe spontaneous bleeding  Grade I: purpura < 100
- 1-5% moderate (minor trauma) ecchymosis < 5
- > 5% mild bleeding (severe trauma) - no admission but instructions to avoid
trauma
Treatment: - Rota C, kapron, dycenone
- FFP or Cryo - Follow up with CBC, number and size
- Factor VIII (Green factor TM) of ecchymosis.
Therapeu c dose: 50 mg/kg divided  Grade II: purpura > 100
every 12 hrs Ecchymosis > 5
Prophylac c dose: 20-25 mg/kg - May be admitted.
- Follow up with CBC.
FVIII I.U required = Wt X desired level X 0.5  Grade III: moderate mucosal bleeding
Hemophilia B Admission &Treatment:
Treatment: 1. Gamma globulin (400-800 mg/kg)
Once daily until platelets count
FFP
exceeds 20,000
Factor VIII concentrate [BenefixTM] 2. Steroids (methylprednisolone)
Solumedrol TM (500mg/7.8ml)
- 10 mg/kg/day once (hematology unit)
Thrombasthenia - Other regimen (if it is chronic, i.e > 1yr):
4mg/kg/day for 4 days
Treatment:
- Or 2mg/kg/day for 2 weeks then
- Platelet-rich plasma gradually withdrawn.
- Platelets concentrate  Grade IV: severe bleeding plus
- Minirine spray ‫ كجم‬٣٠ ‫خة ل ل‬ peritoneal or intracranial hemorrhage
- Or minirine tab ‫ كجم‬٣٠ ‫قرص ل ل‬ - Consult Intermediate care.
- Admission.
- Steroids after BM aspirate.
 Hematology 4

Sickle Cell Disease (SCD)

 Hydroxyurea (Hydrea) 500 mg cap
SCD with pain (vaso-occlusive crisis)
Used in SCD (to increase Hb F level)
1. Good hydra on (1.5 maint.)
2. Analgesic: paracetamol, NSAIDs, up to Dose: 25 mg/kg/day un l reaching 35 mg/kg/dose
morphine.  Deferoxamine (Desferal) I.V or S.C
3. If feverish: CBC, CRP
4. Folic acid Iron-chelating agent used in thalassemia
5. Antibiotic (prophylactic) or iron overload.
ExjadeTM: oral iron-chelating agent.

Autoimmune Hemolytic Anemia SandimmuneTM: immunosuppressant

(immune-modulating) drug
TTT:
1. Solumedrol (methylprednisolone):
10 g/kg/day single dose for 3 days
2. Gamma globulin
 Commonly Used Drugs in Hepatic Patients Decompensated Liver Cell Failure

 Antibiotics Hepatic Encephalopathy, Ascites, Jaundice

- Fotum (ceftazidime)
Investigations:
- Cefobid (cefoperazone)
- 100 mg/kg/day every 12h RBG, CBC, ABG, KFT, LFTs, PT, PC, Blood group

 Liver support 1. Fortum: 100 mg/kg/day

- Silymarin (hepaticum) 2. Neomycin: 500 mg tab – 200mg susp.
- Hepa merz. 50-100 mg/kg/day divided every 12hr.
 fat-soluble vitamins 3. Lasix or Aldactone 1-2 mg/kg/day
- A- viton cap - E- viton cap 4. Sandostatin (0.1mg/ml)
- Vi drops or decal B12 Dose: 1mcg/kg/hr
- Vit. K amp or tab (konakion) ‫ر ــع قرص يوم ا‬ (dose x wt x 0.12) = ml/12h
 Anti-itching therapy ‫ ﺳاعة‬١٢ ‫ ن دق قة ل‬٩ ‫ معدل‬%٥ ‫ ﺳم ج‬١٠٠ ‫الناتج السم ضاف إ‬
- Ursogall (158.5 mg/5ml) susp.
5.GIT emptying:
15-20 mg/kg/day
- Gastic lavage may be indicated.
- Cholestyramine (chelestran 4g sach)
- Lactulose syrup: 5ml every 8 hrs
250 mg/kg/day
- Enema
- Sominale a: 5-10 mg/kg
6.IV fluids maint. or submaint.
7.Liver support:
- Hepaticum (silymarine) syrup:
5ml x 3 (or 0.3 wt in ml x 3)
- Hepa merz amp
‫ ﺳاعة‬١٢ ‫ ن دق قة ل‬٩ ‫ معدل‬%٥ ‫ ﺳم ج‬١٠٠ ‫½ أو أمبول مل‬
Until the patient stabilized
Contraindicated in elevated renal chemistry.
8. Fat-soluble vitamins (A, D, E, K)
- Vit. K (and dycinone if bleeds)
- Vit. A: A viton cap
- Vit. E: E viton cap
- Decal B12
9. Multivitamins
e.g Fruital or polyvital syrup (0.3 wt in ml x 3)
Fruital and polyvital syrup contains: vit.A,
vit.B1,2,3,6, vit.C, vit.D, vit.E

10. Digestin syrup: 5ml x 3

GIT 1
 Omeprazole Silymarin (Hepaticum)

Not before the first year of age Hepa cum 50mg/5ml susp.
Dose: 0.7-1.4 mg/kg/day Dose: 5ml 3 mes daily (5-10 mg/kg)
NexiumTM (40 mg) RisekTM (40 mg) Vial The silymarin exerts membrane-stabilizing and
antioxidant activity. It promotes hepatocyte
‫جرﻋة واحدة يوم ا مل ح‬ ‫ﺳم و ع‬٤ ‫حل ﻋ‬ regeneration and reduces the inflammatory
%٥ ‫ ﺳم ج‬٥٠ reaction, and inhibits the fibrogenesis in the liver.
Féher J, Lengyel G. Silymarin in the prevention and treatment of
NexiumTM (10mg sach, 20, 40 mg Tab) liver diseases and primary liver cancer.

‫ ﺳم ماء وتقسم الجرﻋة‬١٠ ‫ مجم ﻋ‬٢٠ ‫حل قرص‬ Curr Pharm Biotechnol. 2012Jan;13(1):210-7.

‫ ﺳاﻋة لمدة أﺳبوﻋ‬١٢ ‫ل‬ L-ornithine-L-aspartate [LOLA] (Hepa merz)

‫مجم ثا أﺳبوﻋ‬١ ‫ثم‬ ‫مجم أول أﺳبوﻋ‬٢ ‫مكن ال دء ـ‬
Hepa merz 5g/10ml amp – 3g sach.
Hepa merz is a stable salt of two natural nonessential
Erosive GERD L-amino acids: ornithine and aspartic acid. It is
esophagitis formulated and marketed in low and high doses. Low
doses are used as a food supplement and high doses
1-11 years
(above 5 g) as a medicinal product to lower blood
 < 20 kg 10 mg once daily 10 mg once
ammonia concentration and to eliminate symptoms of
 > 20 kg 10-20 mg once/d daily
hepatic encephalopathy associated with liver cirrhosis.
12-17 years 40 mg once daily 20 mg once
daily Sikorska H, Cianciara J, Wiercińska-Drapało A.
Physiological functions of L-ornithine and L-aspartate in the
body and the efficacy of administration of L-ornithine-L-
aspartate in conditions of relative deficiency. Pol Merkur
Lekarski. 2010 Jun;28(168):490-5.

Salt-free Albumin 20% (20g/100ml) Tritone/Gastreg susp

Dose: 1g/kg (5ml /kg) Gaviscon advance susp ‫ثلﺚ الوزن ل‬

Miopan susp ‫ ﺳاﻋات‬٨

Potassium syrup
Calcium Glubionate (Hi cal 1200mg/5ml)

Dose: 600 - 2000 mg/kg/day divided

H. Pylori
Given after meal.
TTT: (triple therapy)
Oseltamivir (TamifluTM) 1. Amoxicillin
2. Clarithromycin (klacid)
Dose: 1mg/kg/dose twice daily for 5 days
3. Omeprazole (Nexium)

GIT 2
 Normal Vital Signs according to Age
B.P
Age H.R R.R
Systolic Diastolic
0-3 months 100 - 150 35 - 55 65 - 85 45 - 55
3-6 months 90 - 120 30 - 45 70 - 90 50 - 65
6-12 months 80 - 120 25 - 40 80 - 100 55 - 65
1-3 years 70 - 110 20 - 30 90 - 105 55 - 70
3-6 years 65 - 110 20 - 25 95 - 110 60 - 75
6-12 years 60 - 95 14 - 22 100 - 120 60 - 75
> 12 years 55 - 85 12 - 18. 110 - 135 65 - 85
GCS (Glasgow Coma Scale)
Activity Score Child/Adult Score Infant
Eye Opening 4 Spontaneous 4 Spontaneous
3 To speech 3 To speech/sound
2 To pain 2 To pain
1 None 1 None
Verbal 5 Oriented 5 Coos/babbles
4 confused 4 Irritable cry
3 Inappropriate 3 Cries to pain
2 Incomprehensible 2 Moans to pain
1 None 1 None
Motor 6 Obeys commands 6 Normal spontaneous
5 Localizes to pain 5 Withdraws to touch
4 Withdraws to pain 4 Withdraws to pain
3 Abnormal flexion 3 Abnormal flexion (decorticate)
2 Abnormal extension 2 Abnormal extension (decerebrate)
1 None 1 None
 Downe's Score for evaluation of respiratory distress

Grades of respiratory distress

 Grade I (mild distress):

Tachypnea, working ala nasi and tachycardia.

 Grade II (moderate distress):

Chest retraction "in-drawing" (e.g subcostal and intercostal) due to moderate

hypoxemia.

 Grade III (severe distress):

Grunting which is due to severe hypoxemia and indicate alveolar lesion (i.e
parenchymatous lung disease). Here O2 supply is needed and patient must be
hospitalized. Grunting is the last compensatory mechanism.

 Grade IV:

Cyanosis and disturbed consciousness and endotracheal tube is needed here.

Dr. Ibrahim Samaha (simple medicine website)
 Drug Dosage
Antimicrobial Generic Name Dilution Practical Dose
Unictam Ampicillin/Sulbactam 375mg/3.7ml ½ Wt/8 hr [150 mg/kg/day] or Wt/8hr [300] in meningitis (max. 8g/day)
Amikin Amikacin 100mg/2ml Wt ‫ط‬ X 1.5/dose every 12 hr (for 5 days only) (max.1.5 g/day)
Aqueous Penicillin Penicillin G 1 million U /5ml ½ Wt (ml)/6 hr [400,000 U/kg/day] (max. 24 millions U/day)
Ceftriaxone (Rociphen) Ceftriaxone 1 g/10ml ½ Wt (ml)/12 hr [100] (max. 2-4 g/day)
Claforan (Cefotax) Cefotaxime 1g/10ml ½ Wt (ml)/12 hr [100] or Wt X ⅔/8hr [200] in meningitis (max. 12g/day)
Fortum Ceftazidime 1g/10ml ½ Wt (ml)/12 hr [100] (½ Wt/8hr in serious infec ons-max. 6g/day)
Augmentin Amoxacillin/Clavulinic 600mg/6ml 90mg/kg/day divided /8hr (max. 2-3 g/day)
Maxipime Cefepime 1g / 10ml ½ Wt (ml)/12 hr [100] (½ Wt/8hr in serious infections-max. 6g/day)
Cefobid Cefoperazone 1g / 10ml ½ Wt (ml)/12 hr [100]
Flagyl (Flazole) Metronidazole 500mg/100ml 1.5 Wt (ml)/8 hr [7.5 mg/kg/dose]
Garamycin Gentamicin 80mg/2ml 7.5 mg/kg/day divided every 12 hr
Vancolon Vancomycin 500mg/10ml 15-20 mg/kg/dose every 6-8 hr
Sutrim (oral) TMP-SMX 40+200mg/5ml (‫ ﺳﺎﻋﺔ‬١٢ ‫يوم ﺎ )ر ــع الوزن ل‬ ‫نصف الوزن قسم ﻋ مرت‬
100mg/50ml 1.5 or 3 X Wt (ml)/12hr [3-6mg/kg/day] for 3-10 days
Diflucan Fluconazole
2mg/ml Loading 12mg Maint. 6mg (max. 12mg/kg/day)
Wt (ml) / 2.5 [10mg/kg/dose] + 30 ml NS /8hr
Acyclovir (Zovirax) Acyclovir 250mg/5ml vial
Wt (ml) / 1.25 [20mg/kg/dose] + 30 ml NS /8hr (encephali s)
Perfelgan Paracetamol (Infusion) 10mg/ml ‫ ﻋند اللزوم‬١٫٥ × ‫الوزن‬
Decadron Dexamethasone 8mg/2ml ‫ ﺳﺎﻋﺔ‬١٢ ‫ط ل‬ ‫الوزن‬
Zantac Ranitidine 50mg/2ml ‫ ﺳﺎﻋﺔ‬١٢ ‫ط ل‬ ‫الوزن‬
Dicynone Ethamsylate 250mg/2ml ‫ ﺳﺎﻋﺔ‬١٢ ‫ط ل‬ ‫الوزن‬
kapron Tranexamic acid 100mg/1ml ‫ ﺳﺎﻋﺔ‬١٢ ‫ط ل‬ ‫الوزن‬
Vitamin K 10mg/ml ‫ ﺳﺎﻋﺔ‬١٢ ‫ ﺳم ل‬٢٫٥ ‫ ﺳم و ع‬٥ ‫حل‬
Lasix Furosemide 40 mg / ml 1-4 mg/kg/day every 6-8-12 hr (with B.P follow up)
Capoten Captopril 25mg tab(¼tab+6ml) 0.5-6 mg/kg/day Q 6-24hr ‫الوزن × الجرﻋﺔ × م ﺔ المﺎء ÷ ترك القرص‬ ‫مﺎء و ع‬ ‫حل‬
Aldactone Spironolactone 25mg tab(¼tab+6ml) 1-2 mg/kg/day Q 12hr ‫الوزن × الجرﻋﺔ × م ﺔ المﺎء ÷ ترك القرص‬ ‫مﺎء و ع‬ ‫حل‬
Loading= 0.03 mg/kg/day
Digoxin (lanoxin) Digoxin 0.5 mg / 2 ml amp ‫ ﺳﺎﻋﺎت‬٨ ‫ ﺳﺎﻋﺎت ثم ¼ عد‬٨ ‫أخذ نصف الجرﻋﺔ اﻵن ثم ¼ عد‬
Maintenance= 0.01/mg/kg/day (after 24hr of loading) divided every 12 hr
Solu medrol methylprednisolone 500mg/7.8ml 1 mg/kg every 6 hrs (Max. 60-80 mg/day) in status asthmaticus
3mg/kg/day added to 100 DW5% IV infusion over 12 hr (9ml/hr)
Sacrofer Iron (I.V) 100mg/5ml
given every other day for 3 doses in severe cases
Desferal Deferoxamine 500mg vial Iron-chelating: added to 150 ml NS IV infusion over 12 hr (15m/hr)
1 ml /kg/8hr (max. 10 ml/dose) + 30 ml Glucose 5%
Ca gluconate 10% 100mg/10ml
For 3 days (with H.R monitoring) with oral calcium
Maintenance 30-60mg/kg/day (Max. 1g/day) ‫ﺳلوﺳ ت‬ ‫ الوزن ﺳم ملح‬+ ‫ط‬ ‫الوزن‬
Mg sulphate (10%) Tight Chest 25-75mg/kg/dose over 20 min. (Max. 2g/dose) ‫ﺳلوﺳ ت‬ ‫ مل ملح‬٣٠ ‫( ضﺎف إ‬Max. 10 ml) ‫الوزن ﺳم‬
Hypomagnesemia 25-50mg/kg/dose Q4-6hrs for 3-4 doses Max.2g/dose ‫( ضﺎف إ الوزن ملح‬Max. 2ml/dose) ‫ط‬ ‫ضعف الوزن‬
Synacthen amp ACTH-like action 1mg/1ml for ttt of infantile spasm ‫الف زر‬ ‫ﻋضل وتحفظ‬ ‫ع‬
Gamma Globulin IV Immunoglobulin 50 mg/1ml 400-800mg/kg/day ‫ أ ﺎم‬٥ ‫زجﺎجﺔ واحدة يوم ﺎ لمدة‬
Mannitol 20% 1g/5ml Wt X 5ml /day once or divided every 12 (after B.P measurement)
Zyrtec or Cetrak Cetirizine 5 mg/5ml (oral) ‫نصف الوزن ل ﻼ مرة واحدة‬
‫سم‬١٠ ‫يكمل حتى‬ Loading 50 I.U/kg directly ‫ط‬ ‫الوزن‬
Heparin (5000 I.U/ml)
(‫ وحدة‬٥٠ = ‫)الشرطة‬ Maintenance 25 I.U/kg/hr infusion added to 100 ml DW5% or NS
Underlined italic words are adapted from Harriet lane Handbook 20th e
 Anti-Epileptic Drugs (AED)

General Mechanisms of action

 Drugs effective against most common forms of epilepsy:

1. Inhibition of voltage-activated Na channels
- Valproate. - Phenytoin. - Carbamazepine. - Lamotrigine.
- Topiramate. - Zonisamide.
2. Enhancement of GABA synaptic inhibition
Inhibition of GABA metabolism:
- Valproate. - Vigabatrin. - Tiagabine.

Increase Cl- influx in response to GABA:

- Barbiturate. - Benzodiazepines (BDZ).

 Drugs effective against Absence seizures:
3. Inhibition of voltage-activated Ca channels (responsible for T-type Ca current)
- Ethosuxamide. - Valproate.

Old (1st generation) New (2nd generation)

Generalized & Partial Valproate 1,2,3 Lamotrigine 1 Topiramate 1
Phenytoin 1 Levetiracetam Felbamate
Carbamazepine 1 Oxcarbazepine Gabapentin
Phenobarbital 2 and primodine 2 Tiagabine 2 Zonisamide 1
Myoclonic Valproate 1,2,3
Clonazepam 2
Absence Ethosuxamide 3
Valproate 1,2,3
Clonazepam 2
Vigabatrin 2
- Numbers indicate mechanism of action as mentioned above.

- Adapted from Essential of pharmacology 2015, department of pharmacology, Assiut University.

 Resuscitation Medications
Adrenaline max. single dose 1mg ‫ مرات‬٣ ‫ط من غ المحلل‬ ‫ مرات ثﻢ الوزن‬٣ ‫ط من المحلل‬ ‫الوزن‬
Atropine max. single dose 0.5 mg ‫ مرات‬٣ ‫ط من غ المحلل‬ ‫ مرات ثﻢ الوزن‬٣ ‫ط من المحلل‬ ‫الوزن‬
Ringer or Normal saline 20 ml/kg can be repeated up to 3 mes
NaHCO3 ‫ أو مﺎء مقطر‬%٥ ‫الوزن ﺳﻢ ضﺎف إ نفس ال م ﺔ جلوكوز‬
Anticonvulsants
Intravenous
Drug Generic Name Dose Practical Dosage
Dormicum Midazolam (5mg/1ml) 0.1-0.2 mg/kg/dose (‫ مرات‬٣ ‫ط اﻵن )ح‬ ‫نصف الوزن‬
0.2-0.5 mg/kg/dose (max 5mg if<5y or 10mg if >5y) S.E: Apnea (‫ مرات‬٣ ‫ل ر ــع ساعة )ح‬ ‫ط من غ المحلل‬ ‫نصف الوزن‬
Valium Diazepam (5mg/1ml)
rectal dose: 0.5mg/kg/dose using IV dosage form
Phenobarbital(40mg/1ml) Loading: 15-20 mg/kg/dose (‫ مرات‬٣ ‫ ﺳﻢ ملﺢ )ح‬٣٠ + ‫نصف الوزن ﺳﻢ‬
Sominaletta
[if<6months] Maintenance: 5-10 mg/kg/dose (‫ ﺳﺎﻋﺔ‬١٢ ‫ ﺳﻢ ملﺢ ) ل‬٣٠ + ‫ط‬ ‫نصف الوزن‬
Loading: 15-20 mg/kg/dose (‫ مرات‬٣ ‫ ﺳﻢ ملﺢ )ح‬٣٠ + ‫ط‬ ‫ثﻼثﺔ أضعﺎف الوزن‬
Phenytoin (epanutin) Phenytoin (250mg/5ml)
Maintenance: 5-10 mg/kg/dose (‫ ﺳﺎﻋﺔ‬١٢ ‫ ﺳﻢ ملﺢ ) ل‬٣٠ + ‫ط‬ ‫نصف الوزن‬
Oral
Drug Generic Name Dose Practical Dosage
Tegretol Carbamazepine 10-30 mg/kg/day
‫ مرات‬٣ ‫ ﺳﻢ ل ل كجﻢ تقسﻢ ﻋ‬١-½
100mg/5ml syrup - 200mg/200mg cr/400mg cr tab
Trileptal Oxcarbazepine 10-30 mg/kg/day
‫ أ ﺎم‬٣-٢ ‫ر ــع الجرﻋﺔ اﻵن ونزود ر ــع ل‬
60mg/1ml susp - 150/300/600mg tab
Rivotril, Amotril, Apetryl Clonazepam 0.1-0.2 mg/kg/day ‫ مرات‬٣-٢ ‫نقطﺔ ل ل كجﻢ‬
2.5 mg/ml drops(0.1mg/drop) - 0.5/2mg tab ‫ مجﻢ ل أﺳب ع‬٠٫٠٥ ‫نزود الجرﻋﺔ‬
Depakine Valproic acid 20-40-60 mg/kg/day
57.5mg/ml syrup - 200mg/ml drops - 200mg tab
Decadel 40mg/ml syrup - Convulex 300mg/ml drops convulex ‫ ﺳﺎﻋﺔ‬١٢ ‫نقطﺔ ل ل ك لو ل‬
Sominaletta Phenobarbital 3-8 mg/kg/day
‫مرت‬ ‫قسﻢ ﻋ‬
15mg/5ml elixir - 15mg tab
Tritam, sycocetam Levetiracetam 30-60 mg/kg/day ‫ ﺳﺎﻋﺔ‬١٢ ‫ل‬
100mg/ml syrup - 500mg/1g tab
Epanutin Phenytoin 5-8 mg/kg/day ‫ ﺳﺎﻋﺔ‬١٢ - ٨ ‫ل‬
30mg/5ml susp - 100mg cap
Lamictal, Lamotrine Lamotrigine 0.3 - 0.6 mg/kg/day (down to the nearst whole tab) increase doses Q1-2 wk by 0.6mg/kg/day
25/50/100mg tab - lamotrine 2mg chewable tab maint. Dose 4.5-7.5 mg/kg/day max. dose 300mg/day divided every 12 hr