Croup

Grades: Exertional stridor → only with exercise

At rest stridor

With retraction subcostal & intercostal

With Resp. failure “cyanosis”

1, 2 → outpatient treatment

3, 4 → hospitalization

Types: Bacterial: epiglottitis, tracheitis → high grade fever, anorexia, flushing, toxic, bad general

condition → organism is Staph. Aureus

Viral: laryngitis, lanyrgo-bronchitis → دي الذبحة ظهرت فجأة و برد و رشح شوية

Laryngo-tracheobronchitis → with wheezy chest

No tongue depressor in any case of croup → epiglottitis

Stridor is more common at night due to more congestion

Treatment

Humidify the vocal cords At the reception

Warm saline or

Epinephrine, racemic: 0.01 mg/kg/dose → (ampule 1mg/1ml) →

علي كيلوا 10احله لكل اديشرطة و سم

At home

Vapozol ( جاو يستنشقه ½ → (صبغة و ساخن ماء لتر علي معلقة

لمدة دافئة بخار حمامات دقائق 10او

β2 agonists are contraindicated → broncho-dilatation → ↑ dead space of bronchi → ↓ gas exchange in the alveoli

Antitussive is contraindicated

Corticosteroids Injection (at the hospital)

1

Dexamethasone

Trade name: apidone, Fortecortin, dexamethasone, decadron, epidron

Ampule: 8mg/2ml

Dose: 0.25-0.5 (0.4) mg/kg/dose → كيلو لكل شرطة

Takes 3-4 hours to work

Can be repeated

Hydrocortisone

Fast take ½ hour to work

Dose: 5-10 mg/kg/dose

Solu-Cortef (100mg/2ml) → لكل كيلوجرام 10امبول

Sigmacortin (500mg/5ml) → 1 لكل كيلوا 10سم

Oral (at home)

Oral steroids maximum for 3 days → if longer → gradual ↓

Dexamethasone

0.1-0.2 mg/kg/day

Trade name: apidone, vendexine, Orazone, phenadol (0.5mg/5ml)

1 علي يتقسم كجم لكل جرعات 3سم

Prednisone

Dose: 1-2 mg/kg/day

Trade name: Predsol, Xilone (5mg/5ml)

اليوم 1 في كجم لكل سم

Iron Deficiency anemia

Diagnosis and investigation Serum ferritin

HB electrophoresis

RDW → ↑↑ >20% in Fe def. anemia

→ ↓ or Normal in thalassemia

2

TreatmentOral iron 6mg/kg/day for at least 3 months

Ferose 50mg/5ml ( disadvantage Fe in the form of ferric require Gastric Hcl to be active

Sytron 27.5mg/5ml ( little amount per 1 ml)

Ferretal 35mg/5ml

Gastroenteritis (plan C)

Renal failure: Urine output 1ml/kg/hour

Blood pressure “pre renal failure”

Metabolic acidosis: cosmol breathing “D.D from grunting”

Investigation

Renal function tests

ABG

RBS → DKA

Chest x-ray

Aminoaciduria → metabolic acidosis

Oliguria challenge test10-20 mg/kg ringer IV

Or lasix 1-2 mg/kg → ساعة استني الضغط و متابعة مع

No → 5mg/kg/dose

Another 1 hour if still no → 10mg/kg/hour

Antibiotics

Macrolides Oral except azithromycin → بسغالية حقن ممكن

Taken for 7 days

Active against:

G +ve

3

E.Coli → Gastroenteritis

Klebsiella, mycoplasma → atypical pneumonia

Erythromycin Against G +ve → Upper airway (sore throat)

Dose 30-50 mg/kg/day ( average 40 mg )

Trade name: erythromycin, erythrocin, erythrin syrup ( 200mg/5 ml every 1 ml = 40 mg)

Dosage = 1 ml (1 cm3) / kg / day

Primomycin (erythromycin + sulpha) → 6-8 h

Clarithromycin Dose: 15 mg/kg/day divided over (/12 h)

Klacid : 125, 250 → 1cm = 25 mg => 3cm/5 kg

Klarimix: 125

Used in

Upper airway: bronchiolitis → خاصة Asthmatic

Atypical pneumonia: mycoplasma, Klebsiella, بتحصل A شهور 6عند غالبا , (febrile pneumonia)

Roxithromycin The only in form of suppositories

Dose: 5mg/kg/day

Used in upper airway

Azithromycin Used in

Sore throat

Otitis media

GE

UTI

Atypical pneumonia

Typhoid: dosage in typhoid is 20mg/kg/day for 7 days

4

Eradication of post streptococcal GN: (Used for 10 days) (main symptom red urine, ↑ urea, ↑ creatine)

Used at least for 5 days

Used once daily, before meal by 1 hour or after meal by 2 hrs.

Dose: 10 mg/kg/day

Dosage

Syrup (30 ml – 60 ml – 90 ml) تركيزين منه يوجد

100mg/ 5 cm → as in zithrokan, unizithrin, zisrocin

WT/2 تركيز في علي 100يعني الوزن 2بنقسم

200mg/ 5cm → as in zithrokan, Zithromax, xithrone, aziwok, zithrodose

WT/4 تركيز في علي 200يعني الوزن 4بنقسم

Chloramphenicol: NOT used

Sulpha Not used before 2 years old

Active against E.Coli, G +ve

Dose: 1ml / 2kg/ day WT/2

Divided /12h

Bacteriostatic → used more than > 7 days

Uses

Sore throat

UTI

GE

Bacillary dysentery

Form and dosage

Syrup [not suspension, no injection]

Septazole, septrin, sutrim

Septazole tab: ساعة 12كل قرصين

5

Beta-lactamase Only in the form of injection, جدا غالية

Active against: G +ve, G –ve, anaerobes

فقط المستشفيات في الوالدة حديثي حاالت غالبا تسخدم

Mainly in neonates in hospitals

Names: imipenem, meropenem

Dose: 20 mg/kg/dose divided over /8h

½ gm. / 100cc

Uses

Severe neonatal sepsis

Meningitis: dose 40 mg/kg/day

Pseudomonas

Vancomycin Anti-staph

Only injection

Dose 15 mg/kg/dose divided over /8h

Trade name: vancomycin merk

Used in

Pneumonia

Pseudomembranous colitis → يشربه و األمبول يكسر

Anti-staph drugs

Ampicillin

Fluxacillin

Garamycin

ConvulsionsFirst time

Neonates→ most used phenytoin

Pediatric → first drug of choice is diazepam

6

Diazepam Dose: 0.3-0.5 mg/kg/dose

Trade names: neuril, valpam => 5mg/ml

Dosage = كيلوا لكل شرطة

If febrile convulsions → المفروضابدأ rectal

IV over 10 minutes → منفعش

For 3 successive doses if no improvement → بعده الي خشعلي

Phenobarbitone Trade name: sominelatte

Dose

Loading dose: 15-20 mg/kg/dose

Maintenance dose: 5mg/kg → used when convulsions is controlled

Dosage:

Sominelatte = 40mg/1ml

فيه الميللي اخلي ميلليجرام 10عايز

علي االمبول ميللجرام 10سم / 1 --, سم 3احل

االول 2 هدي في كيلوا لكل سم

ب و علي دقائق 10بعدها الكيلوا 10هدي في ميللجرام

هدي دقائق 10 كل كيلوا 1سم / 1 يعني

For 3 successive doses if no improvement → بعده الي خشعلي

Phenytoin Dose: 15-20 mg/kg/dose

Trade name: epanutin → 250mg/5ml

Every 1ml = 50 mg

في 1احل سم 4سم

االول هدي بعدين كيلوا 2 و لكل دقائق 10 كل سم

مفيشتحسن لو بعدها كيلوا / 1 و دقائق 10 كل سم

7

قبله الي زي

Maintenance → 5mg/kg

For 3 successive doses if NO improvement → بعده الي خشعلي

Midazolam Loading dose: 0.1-0.2 mg/kg/dose

Trade name: dormicum 5mg/1ml

Dosage:

اخلي فيه 1عايز ميللجرام 1سم

ال في 1 احل سم 4 سم

يكفي 1كدة كيلوا 10سم

الجرعة كيلوا = يبقي لكل شرطة

فيها الشرطة ميللجرام 0.1الن

عليشكل shots بيتاخد

If not → infusion = 0.05 mg/kg/hour

هي المعادلة

24 × الجرعة × الوزن

او

في احله و ملح 100امبول محلول سم

ساعة / / 1 وادي كيلو سم

First line therapy in convulsion is neuril but contraindicated in neonates

Antiepileptic

Depakine → first line in most of cases

بعد اال ابداء 2 → ال nd attack

EEG → prognostic value, determine site affected “frontal, temporal,…”

Depakine in all except

Partial complex seizures → tegretol [carbamazepine]

Infantile spasms (salaam attack) → ACTH

Rickets

8

Definition: failure of mineralization of Ca in bone

Causes: Breast feeding: milk is deficient in Vit. D, Vit. K

From the 4th month → prophylactic dose of vitamin D

Cow milk:

Contraindicated in pediatric < less than 1 year

Cow milk allergy, ↑ type 1 D.M, ↑ bronchial asthma

High in phosphorus → ↓ Ca absorption

Micro-hemorrhage in intestine

Buffalo milk is contraindicated before 6 months

↓ Ultraviolet rays exposure

↑ phytates in foods → جاهز مطبوخ خضار

Clinical pictureيمسكه الذي االسمنت فيه يوجد ال العظم

Early Cupping, broadening: wrist joint

Craniotabes: ping pong skull

D.D from

Osteogenesis imperfecta→ all the skull ايده او رجله مكسور هتالقيه الواد و الدماغ كل

Rickets → Parietal bone

Rosary beads: at costochondral junction

Marfan sign

Late Box shaped skull

Pigeon chest

Harrison sulcus

Pot belly abdomen, visceroptosis , laxity of ligaments

9

Kyphosis, kyphoscoliosis

Kyphoscoliosis → Co2 narcosis, congenital hypoventilation syndrome

Legs: bowing, coxa valga

InvestigationsX-Rays: on 2 wrists, 2 ankles

Active: cupping, frying, double periosteum, rarefaction

Healing

Healed

Serum Ca/ phosphorus level

Alkaline phosphatase

Treatment

Active Vitamin DTherapeutic:

Stooth therapy

Devarol once 600,000 unit

فهدي 200000الحقنة اليوم 3 وحدة نفس في حقن

+ Oral Ca with it or 1 day before it → الحقنة 15 لمدة بعد يوم

To prevent hypocalcemia

Dosage: Hical 50-70 mg/kg/day

اي ( و ) وبعدها تانية حقنة ادي مكنتشكويسة لو تانية عادية اشعة هعمل اسبوعين بعداسبوعين كمان استني

If good → healing rickets → oral Vitamin D

Therapeutic dose: 3000-5000 unit/day

Prophylactic dose: 400-600 unit/day

Trade name:

Decal 1000 unit/5ml → احسنهم ه

Vidrop: 100unit/drop

10

Pedical: 400 unit/5ml

Dosage:

15cm decal = 3000 unit → 5cm/8h كل 5هدي ساعات 8سم

For 1 month واحد شهر لمدة

To avoid vitamin D toxicity [fever, rash, ↓ alertness, jaundice, flushing]

Prophylactic dosage: from 4th month to 1 ½ years

Decal 2cm/day

Pedical 5cm/day

Vidrop → 4 drops/day

{ المغربية وقت بساعة المغرب قبل و الشروق {يتعرضللشمسوقت

نستون جبنة و زبادي ياكل

بعده اللي نخشفي ما قبل صغيرة قصة

It is said that the famous sophist Protagoras took on a student, Euathlus, on the understanding that the student pay Protagoras for his instruction after he had won his first case (in some versions: if and only if Euathlus wins his first court case). Some accounts claim that Protagoras demanded his money as soon as Euathlus completed his education; others say that Protagoras waited until it was obvious that Euathlus was making no effort to take on clients and still others assert that Euathlus made a genuine attempt but that no clients ever came. In any case, Protagoras decided to sue Euathlus for the amount owed.

Protagoras argued that if he won the case he would be paid his money. If Euathlus won the case, Protagoras would still be paid according to the original contract, because Euathlus would have won his first case.

Euathlus, however, claimed that if he won then by the court's decision he would not have to pay Protagoras. If on the other hand Protagoras won then Euathlus would still not have won a case and therefore not be obliged to pay.

The question is: which of the two men is in the right?

يقول بالعربي ترجمة عايز اللي

مصر في كيو اي اعلي انتوا ده بسياجماعة

بعده الي خشعلي و سيبك

Antipyretic

Paracetamol Safe from 1st day of life

11

Not effective if fever is > 38 c → as it work in peripheral PG

Dose: 10-15 mg/kg/dose for 3-4 times /day

Form/ trade names/dosage

Drops

Cetal, pyral 5mg/drop

نقطة 20سم = 1القطارة =

2 drops/kg/dose → الواحد المرة في كيلوا لكل ةنقطتين

Suppositories

Pyral 125

Cetal 125

Pyral 250

In 125 → تكفي تقسمها كيلوا 12اللبوسة ممكن و الواحدة المرة في

Syrup [PAC]

Pyral syrup:120 mg/5ml → 1cm = 2.5 kg → dosage= WT/2

Abimol syrup: 150mg/5ml → 30mg/1ml → 1cm = 3 kg → dosage= WT/3

Cetal syrup: 250mg/5ml → 50mg/1ml → 1cm = 5 kg → dosage = WT/5

Tablets: Cetal 500 mg → االطفال في استعماله نادر

Ibuprofen Not before 1 year old → سنة قبل ممنوع

Dose: 10-15mg/kg/dose

Forms/dosage/trade names

Drops Flabu الواحدة المرة في كيلو لكل نقطة

Brufen syrup: 100mg/5ml → 1 يكفي كيلوا 2سم → dosage = WT/2 ( ÷الوزن2)

Suppositories: macrofen 100mg ( for 10 kg) or 300 mg ( for 30 kg)

Paracetamol + ibuprofenCetafen, megafen: 100 mg ibuprofen + 162.5 paracetamol → علي 2الوزن (WT/2)

Acetyl salicylic acid Contraindicated in pediatric till 12 years old

Dose: 10-15 mg/kg/dose

Only used is → Aspegic → central effect → pass blood brain barrier → on Amino acid Alanine متركبعلي

Aspegic 500mg/5ml → 1ml/100 mg → 1ml = 10 kg → كيلوا لكل شرطة

Diclofenac Na Dose: 0.5-1 mg/kg/dose

Not safe before 1 year → سنة قبل ممنوع

12

Dosage/ forms/ trade names

Drops: dolphin K → الواحدة المرة في كيلوا لكل نقطة

Suppositories: dolphin, baby relief, adwiflam

12.5 Or 25 or 50 mg

injection: voltaren, dolphin, epifenac 75mg/3ml

1cm = 25 kg

كيلو 2الشرطة =

شرطة 2 ÷ الوزن لكل

Olfen 75mg/2ml

جرعة 3÷ الوزن لكل شرطة لكل

ketoprofen dose: 0.5-1 mg/kg

trade name: ketofan syrup

nimesulide dose: 2-3 mg/kg/dose

trade names/ dosage

Nimesulide, nilsid, nimalox → 50mg/5ml → 1 لكل كيلو 2سم

Drug doses Antiemetic

Primperan (0.5 mg/kg/day)

Ampule 10mg/2ml → ال في كجم لكل ساعة 24شرطة

اليكرر

TTT of overdose → Avil 40 injection

→ Phenergan syrup

Drops: (drop = 0.1mg) → كل ساعات 8الوزن

Domperidone (1mg/kg/dose)

Motilium , Motinorm

Oral syrup→ 1 كيلوا لكل سم

Suppositories: 10mg, 20mg, 30mg

Antibiotic

Penicillin (100,000 unit/kg)

13

Penicillin G (3 L.E): vial 1,000,000 units for strept. Infection 10 times more potent than other penicillins

Tablets: ospen (1000)1000,000 (4.5 L.E) per tablet → كجم 10قرصلكل

Benzathine penicillin

Trade name: Durapen-S (5 L.E), lastipen (2.75 L.E), penadur (4.10 L.E), penicid L.A (1.50 L.E), retarpen (4.50 L.E), pencitard (3.75 L.E)

All are vial 1,200,000 IU

Dose

Less than 27 Kg → ½ vial every 2 weeks

More than 27 Kg → 1 vial every 2 weeks

Ampicillin (50-100 mg/kg/day)

Oral not effective → less than 40% are absorbed from GIT

Good with shigella infection

As injection

375Ampictam (3, 7.75, 11.75)Sulbin (4, 6.50, 9.25)Synerpen (4, 6.60, 9.75)Unasyn (8, 12, 17)Unictam (3.75, 6, 11)

Sulbactam 250 + ampicillin 125

750Sulbactam 500 + ampicillin 250

1500Sulbactam 1000 + ampicillin 500

Amoxicillin (50-100 mg/kg/day)

Oral syrup

156Augmentin (18, 28, 37)Curam (14, 21, 30)Emox-clav Hibiotic Klavox Magna-biotic

Amoxicillin 125mg/5ml

312Amoxicillin 250mg/5ml

625228+

MegamoxDeltaclavAmoxilanicAugmacillin

Amoxicillin 200mg/5ml

457Amoxicillin 400mg/5ml

Good for salmonella

Cephalosporin (50-100 mg/kg/day)

Ceftriaxone 3rd generation

14

Painful so with IM solvent is lidocaine

If IM is given IV it will lead to cardiac arrythemia, arrest

Gentamycin (5-7 mg/kg/day)

Amikacin (15mg/kg/day)

-ve and anti-staph

Erythromycin (30-50 mg/kg/day)

Erythrocin 200mg/5ml → 1 كجم لكل سم

Azithromycin (10mg/kg/day)

100mg/5ml → 1 لكل كجم 2سم

200 mg/5ml → 1 لكل كجم 4سم

Clarithromycin

125 mg/5ml→ 5 لكل كجم 8سم

250 mg/5ml → 5 لكل كجم 16سم

Flagyl

لكل 5 كجم 4سم

Antipyretic

Paracetamol (10 mg/kg/dose every 4-6 hours)

Cetal syrup (250 mg/5ml0

Cetal drops: 3 كجم لكل نقط

Ibuprofen (10-15 mg/kg/dose every 8-12 hours) maximum (40mg/kg/day)

Diclofenac (0.5-1 mg/kg/dose) maximum (2mg/kg/day)

No suppositories before 6 months

Paracetamol + ibuprofen

لكل 1 كجم 2سم

Steroids

Hydrocortisone (5-10 mg/kg/dose every 4-6 hours)

Dexamethasone (0.25-0.5 mg/kg/dose every 8-12 hours)

Contraindicated

Aspirin

15

Chloramphenicol

Tetracycline

Convulsions1st attack

Diazepam (0.5 mg/kg/dose)

Neuril 10 mg/2ml → كجم لكل شرطة

IV كانيوال في الزم يخففو ال

Rectal by insulin syringe → انسولين ادي 100سرنجة كجم 10و لكل

Cause

Febrile convulsions

6 months – 5 years

Once per disease

Recurrence 15% in another disease

In all not more than 2-3 times in all age: عن ماتزيد الولد 3عمرها عمر في مراتكله

EEG is normal

Atypical febrile convulsions

Treated as a case of epilepsy

Metabolic

Hypocalcemia

↓ feeding: بقري لبن او مخفف لبن

Endocrinal problem

Carpo-pedal spasm

Invest: Serum Ca

TTT: Ca gluconate 10% 1cm/kg over 10 minutes

Vit D orally 5000 unit/day

Hypo, hyper natermia

GE, dehydration

Hypoglycemia

16

Serum glucose < 45

First attack of epilepsy

Organic brain lesion: CP, encephalitis

Pediatric clinic 3 march 2011Antibiotics – PenicillinsNatural penicillinDose: 50,000unit/kg/day

Indications :Eradication of post strept. GN, ASO titer ≥ 444

Rheumatic feverTypesProcaine penicillin

Trade name and formula: Retarpen, Durapen, pencitard (1,000,000 units per vial)In meningitis dose is 100,000 – 200,000 units/kg/day

Unstable injection → used only onceUsed for 10 days) لمدة حقنة يوميا واحدة )ايام 10مرة

Benzathine penicillin (50,000 -100,000 units/kg/day)Penicillin G 1,200,000 unit per vial IM only

Painful in injectionPhenoxy methyl penicillin (25,000 – 50,000 units/kg/day)

Oral Penicillin VUsed in URI

If patient refuse injection or doesn’t tolerate injectionTrade name and dosageOspen 400,000 unit/5ml

كل بالسرنجة 5مللي = 5يعني فيهم = سم صغيرة وحدة 400معلقة الف كل فيه 1مللي = 1يعني بالسرنجة وحدة 80فيه 5÷400سم الف

Dose: 40,000 units/kg/day كل يكفي 1يبقي كيلوا 2سم

1 لكل اليوم 2سم في كجم ½/ الوزن او كجم لكل 2سم

علي تقسم كل ( 3الجرعة )ساعات 8مراتClacil 300,000 units/5mlEvery 1 ml = 60,000 units

علي اليوم 30احسب في كجم لكل وحدة الفDose: 30,000 units/kg/day

1 لكل كيلوا 2سم الوزن 2÷او مشموجود

Taste is very badSynthetic penicillins (broad spectrum)Ampicillin, amoxicillin (IV, IM, Oral)Ampicillin (dose 50 – 100 mg/kg/day)

Dose for injection (IM or IV): 100 mg/kg/dayDose for oral (suspension, caps): 50 mg/kg/day

InjectionTrade name and formula: ampicillin 250 mg / 50 mg / 1 g

17

OralTrade name and formula

Ampicillin125 mg/5ml2 كجم لكل سم

كجم 2501 لكل سم2÷ الوزن 500

Any antibiotic must be given for 7 days at leastTo calculate average weight for child by age (from 1 → 6 years): (age × 2) + 8

The half life time for synthetic penicillins is 6 – 8 hoursAll antibiotic injections are unstable except 3rd generation cephalosporin

For exampleTonsillitis in 1 years old kidWT= 1×2+8 = 4+8 = 10 kgFor injection = 1000 mg/day

Ampicillin 500 IM كل يومين 12حقنة لمدة ساعةFor oral: 500 mg/day

Ampicillin 250 Susp 3.5 كل بالفم لمدة 8سم ايام 7ساعاتAmoxicillin (25 – 50 mg/kg/day)

Trade name and formulaInjection: amoxicillin, E-Mox 250, 500, 1 g

Oral: amoxicillin, E-Mox (125mg/5ml, 250mg/5ml)Antistaph

Used mainly in pneumonia with pleural effusionAmpicillin + (Flucloxacillin, Dicloxacillin, Cloxacillin)

Amoxicillin + Flucloxacillin (Flumox, Amoflux, Famox, Flucamox) األموكسيسللين وكذلك عادي األمبيسلين جرعة علي بحسب

Flumox is very painful as IM injection and Very bad taste as suspension) يرجع الواد و )هياخده

Penicillin combinationAmpicillin + sulbactam (150 mg/kg/day for whole Combination)Injection

UnasynUnictamSulbin

375 mg750 mg1500 mg

Oral: Unasyn, Unictam 250 mg/5ml → 1 اليوم في كجم لكل سمAmoxicillin + clavulinic (40 - 50 mg/kg/day for amoxicillin concentration)Oral

AugmentinCuramEmox-clav

156 =125mg/5ml2 كجم لكل سم

312 =250 mg/5ml1 كجم لكل سم

MegamoxDeltaclavAugmacillin

228.5 =200mg/5ml1 اليوم في كجم لكل سم

457 = 400 mg/5ml ½اليوم في كجم لكل سم

Hibiotic - N230 = 200 mg/5ml1 اليوم في كجم لكل سم460 = 400 mg/5ml÷اليوم 2الوزن في600 = 600 mg/5ml÷اليوم 3الوزن في

18

Giardia lamblia

Macrolides

Nifuroxazide

Flagyl: سنتين قبل Constipation, GIT upset → ممنوع

Milk types

حاجة 6قبل Bebelac 1 زي 1شهور

حاجة 6بعد bebelac 2زي 2شهور

ممنوع 6قبل cow milkشهور

من اقل صغير وزنة الواد كيلو 2لو

حاجة AS26أو Bebelac PTزي PTبندي

عالية ← 30مكيال / كالوري كمية

كل علي درة رضعات 4زيت

↑free fatty acids → 1gm = 9 calories

↑ Appetite

Lactose intolerance

Bebelac FL → المصري السوق في نوع انظف ده

Pneumonia

DefinitionLower respiratory tract + lung parenchyma

Causes Bacterial: staph, strept, pneumococci, haemophilus influenza, Klebsiella,

mycoplasma

Viral: Para-influenza viruses, adenovirus, RSV

Fungal: rare

Stages: 3 stages Inflammation: edema + secretion " red"

19

Consolidation: fibrin deposition "grey"

Resolution: lipotropic factors

Symptoms

General: High grade fever

Severe bronchospasm

Respiratory distress grade 4

Severe cough: spasmodic cough esp. if atypical pneumonia

Chest ↓ Air entry

Adventitious sounds: sibilant or sonorous rhonchi

Stage of consolidation → bronchial breathing

Fine crepitation

Types: According to Chest X-Ray Patchy pneumonia

Lobar pneumonia

Perihilar pneumonia → cotton fluffy appearance

X-ray: normal in 4 months child→ interstitial pneumonitis → no consolidation patches → mostly viral infection

Other investigations ABG for respiratory failure

H.R

Urea & creatinine

Treatment Cyanosis → respiratory failure = oxygenation

Nebulizer: ملح as mucolytic → محلول

±Atrovent if severe bronchospasm: Side effects: tachycardia

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There is no limited number for nebulizer sessions (in status asthmaticus: جلسات اربع ادي ممكن ساعة اول في

IV fluids: Maintenance therapy

كجم 100كجم ← 10اول لكل ميللي

كجم 50كيلو ← 10تاني لكل ميللي

كجم 20كيلو ← 10تات لكل ميللي

علي 4بقسم

ملح ¼ محلول المحلول

جلوكوز ¾ 5المحلول %

بدي لكل 1 و بوتاسيوم محاليل 100سم سم

To avoid volume overload → heart failure, pulmonary congestion, brain Edema

Fluid restriction by 20% or 30%: واضربها عايزها انا الي الكمية 0.8 × احسب

الرضاعة feeding اوقف

Respiratory distress → tachypnea → aspiration

Tubal feeding → شوية يهدي صدره لما

Antibiotics

Against G +ve: Penicillins انواعها بكل : ampicillin, amoxicillin

G –ve: 3rd generation cephalosporins

3-4 months → atypical pneumonia "mycoplasma & Klebsiella"

Macrolides & Aminoglycosides :مجموعتين

علي Protein synthesis : بتشتغل

Flagyl for anaerobic bacteria

بسغالية كله علي بتشتغل حاجات فيه

Imipenem: االطفال رعاية في اال يعطي خالصوال برة مشموجود

Anti-staph

Ampicillin + flucloxacillin

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Gentamycin

Vancomycin dose: 12mg/kg/dose

Heart failure: transient except if congenital heart disease

Tachycardia, tachypnea, tender enlarged liver

Treatment

Frusemide: Lasix 1mg/kg/day

Lasix 20mg/2ml

في السم اليوم 9بحل في كيلو لكل سم واحد ادي و سم

كيلوا لكل شرطة ادي ماحله غير من او

كل اقسمة ساعة 12و

To decrease afterload: Capoten: dose 0.5-5mg/kg/day

علي 2 → بندي mg/kg/day

علي 25قرص ملح 12.5يحل محلول سم

فيه سم كل ميلليجرام 2يبقي

كل 1يبقي اقسمة و اليوم في كيلوا لكل ساعة 12سم

Digitalis:

Loading dose: 0.05mg/kg or (50μg /kg)

Maintenance dose: 0.01mg/kg/day or (10μg/kg/day)

Digitalizing dose: 50μg/kg

علي ½ الكمية ساعات 8هدي

علي ¼ الكمية ادي ساعات 8ثم

علي ¼ اخر ساعات 8ثم

Digitalis is contraindicated in: obstructive lesions as in M.S

Don't tire tired horse

Pulmonary stenosis

Cardiomyopathy

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H ypertrophic Obstructive Cardiomyopathy (HOCM) → infant of diabetic mother (As ↑ insulin → ↑ deposition of phospholipids in the septum) → هيشيع النوكسين خد لو دي → ده الحالة ايه عالجها → Inderal

Any neonate with cough in the first 4 months is considered pneumonia until proved otherwise

Treated as pneumonia in the outpatient: بسفي الرئوي االلتهاب زي هيتعالجالحارجية العيادة

Antibiotics course for 7-10 days at least

G-ve injection

G +ve

Oral macrolides: azithromycin or erythromycin

Amoxicillin + clavulinic acid

Cough depressant Herbal سنة اول في نهائي حاجة ممنوعة ممكن

Active respiratory infection حاالت في ممنوع

After 1 year Cough sedative for dry cough or pertussis

All doses are: 1-2mg/kg/day except 1 drug

2P 2B 1C DONE

2P P holcodine 0.5-1 mg/kg/day

Cyrinol 4mg/5ml → 0.7mg/1ml → 0.7mg/kg/day → 1ml/kg/day 1 سماليوم في كيلوا لكل

P ipazethate 1-2mg/kg/day

Selgon

Suppositories 10mg → تقضي سنة ( 10اللبوسة قبل ممنوع )كيلوا

Drops 40mg/1ml every 1 ml =20 drops → 40mg/20drops → 2mg/drop → 2mg/kg/day → 1drop/kg/day اليوم في كيلوا لكل نقطة

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2B B utamirate 1-2mg/kg/day

Sinecod فيهم واحد اقوي ده

Syrup 7.5mg/5ml → 1.5mg/1ml → 1.5mg/kg/day → 1ml/kg/day 1 سماليوم في كيلوا لكل

Drops: 0.5mg/drop → 4 كيلوا لكل نقطتين او كيلوا لكل نقط

Other trade name: Cough cut syrup: 1 اليوم في كيلوا لكل سم

B enproperine 1-2mg/kg/day

Pectipro syrup 10mg/5ml → 2mg/1ml → 2mg/kg/day → 1 كيلو لكل سماليوم في

1C C olbutinol 1-2mg/kg/day

Silomat (drops, syrup, injection) مشموجود

DON D extromethorphan 1-2mg/kg/day

Codilar 7.5mg/5ml → 1 اليوم في كجم لكل سم

Pulmonal-N → 1 اليوم في كجم لكل سم

O xeladine

Oxeladine syrup 10mg/5ml →1 اليوم في كجم لكل سم

Paxeladine → مشموجود

N oscapine

Tusscapine syrup → 1 اليوم في كجم لكل سم

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