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Pediatric Dosage 小兒科藥物劑量 三軍總醫院 小兒部 Instructor:R2 王聖儒.

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Presentation on theme: "Pediatric Dosage 小兒科藥物劑量 三軍總醫院 小兒部 Instructor:R2 王聖儒."— Presentation transcript:

1 Pediatric Dosage 小兒科藥物劑量 三軍總醫院 小兒部 Instructor:R2 王聖儒

2 Fulid supplement 0 ~ 10Kg (4 MD/kg) : 100ml/kg/day 10 ~ 20kg(2 MD/kg) : 1000 ㏄+ ( BW - 10 ) ×50 ㏄ /day > 20kg (1 MD/kg) : 1500 ㏄+ ( BW - 20 ) ×20 ㏄ /day Example 1: BW=25 kg,Keep IV route with 0.33%G/S ______MD/min Ans: (10 ×4) + (10 ×2) + (5 ×1) = 65 MD/min Example 2: BW=30 kg,Keep IV route with 0.33%G/S ______MD/min ______c.c. qd Ans: (10 ×4) + (10 ×2) + (10 ×1) = 70 MD/min (10 ×100) + (10 ×50) + (10 ×20) = 1700 c.c./day

3 Management of Dehydration Access fluid deficit: < 5%(mild): Consolable, Dry tongue, Mild loss of skin turgor 5% -10%(moderate): Irritable, Reduced urine output, Deep set eyes, Tachypnea, Marked loss of skin turgor > 10%(severe): Lethargy or Coma, Sunken anterior frontanelle and eyes, Cold extremities, Weak or impalpable pulse, Hypotension

4 Management of Dehydration Rehydration: First 8 hr Later 16 hr Deficit 1/2 1/2 Maintenance 1/3 2/3 e.g.: 10kg, 10% loss, ≧ 3 days  Deficit : 10% x 10 (kg) x 0.6(deficit% from ECF ) X 1000 = 600 ml Maintenance: 10 x 100 = 1000 ml First 8 hr later 16 hr Deficit 300ml 300ml Maintenance 333ml 660ml

5 Management of Dehydration ShockShock: 20ml/kg N/S or Lactate Ringers or 10ml/kg 5% albumin, blood, plasma Loading speed: 10ml/kg/hr, ( 2ml/kg/hr in CHF )

6 Electrolyte supplement Na : 3 ~ 4 mEq/kg/day –3%NaCl 1ml = 0.5 mEq –0.9% NaCl 500ml = 77mEq K : 2 ~ 3 mEq/kg/day –15%KCl 1ml = 2 mEq Ca : 200~1000 mg/kg/day q8h-qd –10% Ca gluconate(100mg/1ml,1Amp = 10ml) NaHCO3 : 1 mEq/kg ( if PH < 7.2 ) –17 mEq/20cc/amp

7 Correct Metabolic Acidosis Tachypnea (BE=PCO2 – 1.5 x [HCO3] + 8  2 ) BE HCO3 Mild 17  Observation Moderate  Slow correction Severe >20 < 8  Rapid supply IVD 10’, taper the speed if PH > 7 7% NaHCO3 ( 17 mEq/20ml ) supply half in 2-8 hours: 2-4 mEq/kg/dose BE x 0.3 x BW ( 15-HCO3 ) x 0.6 x BW

8 Common Dose 一般劑量 > 20kg :錠劑磨粉 –40Kg : 1 # po qid –30Kg : 1 # po tid 若可吞, 不用磨 –20Kg : 1/2# po qid –10Kg : 1/4# po qid < 20kg :糖漿 – 一般咳嗽 ˙ 流鼻水糖漿多為 BW/4 c.c. – 退燒 ˙ 抗生素糖漿多為 BW/2 c.c. – 例外:止瀉藥水 ˙ 氣管擴張劑糖漿 ˙ 紅黴素類糖漿

9 Antipyretics 退燒藥 Scanol (500mg/1#) : –10 ~ 15mg/kg/dose q4h ~ q6h (50 mg/kg/day) Antiphen (Acetaminophen syrup) :  38.5 ℃ – BW/2 ㏄ q4h prn if BT  38.5 ℃ (120mg/kg/dose) Macsafe(Ibuprofen syrup) : NSAIDs  39.5 ℃ –  38.5 ℃ : BW/4 cc q6h ;  39.5 ℃ : BW/2 cc q6h Diclofen (supp)( 12.5mg ) : – < 6kg 1/3# supp q6h prn if BT  39.5 ℃ –6 ~ 10kg 1/2# supp q6h prn if BT  39.5 ℃ – > 10kg 1# supp q6h prn if BT  39.5 ℃

10 Antitussives and expectorants 止咳化痰藥 Medicon-A ( 20mg/cap ): Common dose Medicon syrup (Dextromethorphan)(2.5mg/ml) : –BW/4 cc po qid,1-2mg/kg/day q6-8h Mucosolven (Ambroxol liq.)(3mg/ml) ( 化痰 ): –BW/4 cc qid ;<2 y/o:2.5~5 cc bid; 2~5y/o:2.5~5 cc tid ; 5~10y/o 5~10cc tid Unitussin (Glyceryl guaiacolate)(20mg/ml)( 化痰 > 止咳 ): –BW/4 cc qid ; 2~6y/o:2.5~5 cc qid ; 6~12y/o 5~10cc qid

11 Antihistamines & Decongestants 流鼻水, 鼻塞 ‚ 抗過敏藥 Cyproh syrup (Cyproheptadine 0.4 mg/ml) : — BW/4 cc po qid Cyproh tablet ( 嗜睡, 增加食慾 ) : Common dose Demin (Chlorpheniramine 0.5mg/ml ) : — BW/4 cc po qid CTM tablet ( 嗜睡, 使痰更濃 ) : Common dose Venalin (Diphenhydramine 30mg/amp): 10-50mg IV or IM q2-3h, max 400mg/day (1mg/kg/dose) –Urticaria, angioedema or EPS 時可用

12 Antihistamines & Decongestants 流鼻水, 鼻塞 ‚ 抗過敏藥 Clarityne(10mg/tab) : – < 30kg 1/2# po qd ;> 30kg 1# po qd Clarityne syrup (Loratadine 1mg/ml 60ml ) – < 30kg 5ml po qd ;> 30kg 10ml po qd Allegra (60mg tab) : 1# bid ->1# qd

13 Bronchodilator 氣管擴張劑 Bricanyl (Terbutaline 2ml/5mg ) : – 20Kg:1 # in N/S 3ml for neubrilization q6h Ventolin (Salbutamol neubule 2.5ml/5mg) : –The same with Bricanyl; –Tab(2mg): 0.1 mg/kg/dose up to 2 mg PO tid Berotec(Fenoterol HBr) syrup(0.5mg/ml) : –BW/4~BW/5 cc tid ;<1 y/o:2.5 cc bid; 1~6y/o:2.5~5 cc tid ; 6~14y/o 5cc tid Meptin(Procaterol) syrup(mg/ml) : – 6y/o:5 cc po q12h

14 Bronchodilator 氣管擴張劑 Xidanef (Ketotifen)100 ml syrup: –2.5-5ml bid Atrovent (Ipratropium UDV 0.5mg/2ml): –1 vial q6h prn Epinephrine(1:1000) : 0.01ml/kg/dose(Max 0.5ml) q15minSC

15 Xanthines 茶鹼類 Aminophylline S.E : nausea, vomiting, insomnia, tachycardia Loading dose : 5(2~6)mg/kg/dose iv drip for 20 ~ 30 min;Maintain : 1mg/ kg/hr Infants=> 0.2~0.9mg/kg/hr, 1-9y/o=>1~1.2mg/kg/hr; 9-16y/o=>0.8~1mg/kg/hr; youngsmoker:0.8~1mg/kg/hr, nonsmoker:0.5~0.7mg/kg/hr Apnea of prematurity : 4~6mg/kg iv 30 min,then maintaince : 1.5~3 mg/kg/dose iv q8-12h

16 Xanthines 茶鹼類 Ventol:3ml/kg/day qid Aminophylline tab. : 200mg/tab po qid ; dose = iv form

17 Steriods 類固醇 Decadron : 0.1 mg/kg/dose im q8h. Rinderon (4mg/ml): 0.1 mg/kg/dose im,iv q8h Prednisolone(5mg/tab):1~2mg/kg/day po qd~qid ; max:4#~8#(20~40) mg/day for 3~5 day. 40kg 給 Pulmicort (steroid,200mcg/dose) : –1~2 puff bid for 3 month for prevent asthma( 可有效 預防氣喘再發 )

18 Urticaria 蕁麻疹 Benadryl (Diphenhydramine):1mg/kg IM Decardon (Dexamethasone): –0.1mg/kg/dose IM Periactin tab : 普通劑量 po qid. Prednisolone(5mg/tab.) :1~2 mg/kg/day

19 Antidiarrheals, digestives and antiflatulents 止瀉、消化、消氣劑 Kaopectin : – < 6 mons : 3 ㏄ po qid (嚴重再給) –6 mons ~ 6 Y/O : 5 ㏄ po qid – > 6 Y/O : 10 ㏄ po qid. Biofermin tab :普通劑量 ×2 po qid. Simethicone tab :普通劑量 po qid. Bismuth: 普通劑量 po qid.

20 Antiemetics 止吐劑 Motilium(10 mg/tab) :普通劑量 po qid. Prepulsid : 0.1~0.2mg/kg/dose po qid Novamine or Priperam may cause EPS EPS : Akineton=Biperidine(1#=2mg;5mg/1cc/am p) –Adult : 2mg per 30 min.max 4 vial(20mg)

21 Laxatives 輕瀉劑 Glycerine ball enema : 0.5~1# qd MgO tab :普通劑量 po qid. Ducolax (Bisacodyl 5mg tab) : 6~12 yo 1# po st. Cascara (Cascara sagrada) : 1~2# po qhs

22 Anticonvulsants 抗痙攣劑 Valium(Diazepam)(10mg/2 ㏄ /amp): –<5y/o: 0.2 ~ 0.5mg/kg/dose iv slowly q15min × 3 ( max 5mg) –>5y/o: the same as above except (max 10 mg) –adolescents: 5-10 mg/dose; max: 30mg. Neuropam(Lorazepan)(2mg/ml/amp) ; 中效 ( hrs) : – mg/kg/dose q15 ~ 20min × 2 dose max: 4mg/dose

23 Anticonvulsants 抗痙攣劑 Dilantin(phenytoin) (250mg/5cc/amp) : –Loading 10 ~ 20mg/kg iv with rate < 1mg/kg/min,max50mg/min,Maintain 5mg/kg/day iv q12h, ( 不可加於 Glucose solution ) Luminal(Phennobarbital) (100mg/cc/amp;32mg/1#) –Loading 20mg/kg iv with rate < 30mg/min ; Maintain 5-10mg/kg/day to achieve serum level 40 ug/ml Chloral hydrate enema(10% 30ml) : –Neonates: mg/kg/dose, –Children: mg/kg/dose → 1/2~3/4 BW cc enema

24 Antibiotics 抗生素 Penicillin :Bctereimia:2.5-5 ;Meningitis ; infection 10-25( 單位:萬 u/kg/dose q4-6h) Ampicillin : IV 100mg/kg/day, q6h. Amoxicillin Cap(500mg) : (Ac. tonsillitis, AOM) Hiconcil Cap(250mg)=> 50 mg/kg/day q8h. Amoxicillin syrup => BW/2 po q8h. Augmentin (amoxicillin + clavulanic acid, 375mg/1#,600mg/vial) : BW/2 po q8h.

25 Antibiotics 抗生素 - Cephalosporins 頭芽孢素 Cephazolin(Veterin) : IV 100mg/kg/day, q6h. Keflex(250mg/1#,Cephalexin 1',Ceflexin 500mg/1#): mg/kg/day poq6h for G(+). Keflor (2’ Cefaclor,250 mg/1#,125mg/5cc/60cc/susp) 50 mg/kg/day q8h.; BW/2 q8h.(AOM) Zinacef (2’ Cefuroxime, 250mg,750mg): 2mg:250mg/dose po bid Zinnat (2’ Cefuroxime, 25mg/ml) AOM : 2 y/o 10ml q12h Common infection: 5ml q12h Rocephin,Syntrix(3’Ceftriaxone 500mg/5cc/vial): mg/kg/day iv q12h-qd; Meningitis:100mg/kg/day q12h (max:4g/day) Prostaphlin (Oxacillin) : –IV 100mg/kg/day, q6h. (Cellulitis)

26 Antibiotics 抗生素 - Macrolides Erythromycin(Mycoplasma,Chlamydia,Legionella) Erythrocin syrup (40mg/cc) : BW/4 cc po q6h Ilosone (250/1#):30-50 mg/kg/day q6h.(20kg 1# qid, 40kg 2# qid) Zithromax(Azithromycin,250mg/1#,200mg/5cc/susp) child :1# qd * 3day (>40kg:2#) Zithromax syrup : BW/4 cc po qd * 3 days Klaricid(Clarithromycin,250/tab): Adult 1~2# po bid; Child:7.5mg/kg bid

27 Antibiotics 抗生素 -UTI Nitrofurantoin(Ninru,100mg/1#) : –5 ~ 7mg/kg/day, po qid (UTI),Adult::1#po qid. –Prophylactic dose: 1/3~1/4 therapeutic dose Azactam(Aztreonam 1 g/inj):90-120mg/kg/day iv q6-8h for G(--) and Pseudomonas Mycostatin( 50 萬 u/1#):for Candida(Oral thrush): – Infant: 2/5# (20 萬 u)/dose q6h – Child: 1# (40-60u)/dose q6h Baktar(TMP-80 + SMX-400):6-12 mg/kg/day po q12h (Contraindication < 2 months,G6PD deficiency)

28 Cardiologic disease PGE1 ( PDA ) :IV μg/kg/min Supraventricular tachycardia –Adenosine:0.1mg/kg rapid IV push give double or triple the dose in 2-3 min (6mg max) Digoxin(not for WPW):loading 30-40μg/kg –Give 1/2 dose, then 1/4 dose q6-8h for 2 more doses Verapamil(Isoptin 5mg/2ml/amp, 1# 80mg): –>1y/o; mg/kg,slow IV, repeat twice q15m

29 其他特殊用藥 Aspirin(500mg/13): Analgesic:10-15 mg/kg/dose po q6-8h Anti-rheumatic:65-100mg /kg/day po q6-8h Kawasaki disease: 100mg/kg/day po q6h Indocin: Dose : No.1 No.2 No.3 <48h (mg/kg 2-7days q12-24h ) >7 days

30 其他特殊用藥 Lasix(40mg/1#,20mg/2cc/inj):1-2mg/kg/dose q6-12h Mannitol(60mg/20%/300cc): g/kg/dose iv for 30min Insulin: DKA: u/kg/hr iv drip, maintain : 0.5-1u/kg/day/SC Glucose intolerance in prematurity: u/kg/hr. Difflam ® Anti-Inflammatory Spray (得伏寧 消炎噴液劑) ¨ 成份:每 mL 含 Benzydamine Hydrochloride 15 mg ¨ 作用: Benzydamine 為一抗炎止痛劑,可舒解口腔及咽喉疼痛。 ¨ 用法:直接噴 5-10 次於疼痛和發炎部位,再輕輕吞下,視需要,可每 小時重覆一次。

31 CPR 用藥 E-T tube size : –Newborn : 2.5 ~ 4 Fr ; > 2 Y/O = 4 + (age / 4) Fr –Depth:lip-tip length (about = 3 * E-T tube size) –Depth: 1/ 2/ 3/ 4 kg = > 7 / 8 / 9/ 10 cm Epinephrine ( 1 : 1000 ) : ( 1mg = 1ml ) –0.01 ml/kg/dose iv; or 0.1 ml/kg/dose via ET tube Dopamine : ( 6×BW ) kg in N/S final V = 100ml 1MD/min = 1ug/kg/min N.E.(Levophed):1mg/ml; ug/kg/min drip. Nitroprusside(Nipride): ug/kg/min drip.

32 CPR 用藥 Atropine : 0.02mg/kg (1ml = 0.1mg ) q5m, total max dose: child=1mg, adolescent: 2mg ; minimal dose=0.1mg NaHCO3 : 1 meq/kg ( if PH < 7.2 ) Lidocaine(10mg/ml): 1mg/kg loading, 20-50ung/kg/min, (60xBW)mg of lidocaine dilute with N/S to 100ml, then 1MD/min  10ug/kg/min Adenosine: for PSVT –Neonates and child: 0.05mg/kg iv push, increase bolus doses by 0.05mg/kg q2min, max dose:0.25mg/kg or 12mg –Adult: 6mg  12 mg  12 mg


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