Pediatrics Dosing Considerations Flashcards
When is weight-based dosing recommended?
<18y who are <40kg
What equation is used to calculate CrCl in LBW infants- 21y?
Schwart’s equation;
(k x L (cm)) / SCr
What equation is used to calculate CrCl in Infants <1y?
Bedside Schwart’s equation;
(0.413 x L(cm)) / SCr
What age are most children not able to swallow SODFs?
<6y
What are potentially harmful excipients for children?
- benzyl alcohol
- ethanol
- propylene glycol
- natural/ synthetic coloring
Why should propylene glycol be avoided in children?
- potential for lactic acidosis
- Arrhythmia
- CNS/respiratory depression
- seizures
What is the max limit of ethanol in children <6y?
0.5%
What is the max limit of ethanol in children 6-12?
<5%
What is the max limit of ethanol in children >12y?
<10%
What are issues with benzyl alcohol in neonates?
- liver/kidneys have a decreased capacity for metabolism –> neurologic symptoms
- toxic gasping syndrome
What coloring agents should be avoided in children?
azo dyes:
tartrazine (yellow 5)
Blue 1
Why are SEs with azo dyes?
anaphylactoid reactions, HSR
What medications should be avoided in patients with HSR to azo dyes due to cross sensitivity?
- aspirin
- sodium benzoate
- indomethican
What is the definition of failure to thrive?
weight for age/height is <5th percentile OR fall off of 2 or more major percentiles
When should weight lost after the first few day of birth be regained?
1st-2nd week of life
When is enteral nutrition indicated for children?
- premature neonates <32-34 weeks gestation
- infant too sick to breast feed or bottle feed
- on mechanical ventilation
- needs not met via oral route
When is parenteral nutrition indicated for children?
- needs not met via EN
- GI tract does not function
What is the recommended daily maintenance fluids for a child 3-10kg?
100 mL/kg x day
What is the recommended daily maintenance fluids for a child 11-20 kg?
1000 mL/kg x day + 50 mL/kg (>10 kg)
What is the recommended daily maintenance fluids for a child >20 kg?
1500 mL/kg x day + 20 mL/kg (>20kg)
What is the recommended daily maintenance fluids for neonates <1500g?
140-190 mL/kg/day
What is the recommended daily maintenance fluids for neonates 1500g-2000g?
140-160 mL/kg/day
What factors increase fluid requirements for pediatrics?
- premature/ LBW
- fever
- vomiting
- diarrhea
- increased ambient temperatures
- hyperventilation
- phototherapy
- radiant warmers
- diuretics
- nasogastric suction
- ostomy/fistula drainage
- glucosuria
What factors decrease fluid requirements for pediatrics?
- bronchopulmonary dysplasia
- intraventricular hemorrhage
- PDA
- congestive HF
- liver/renal failure
What are the daily caloric requirements for preterm neonates?
90-120 kcal/kg
What are the daily caloric requirements for 1-12 months?
80-105 kcal/kg
What are the daily caloric requirements for 1-7y?
75-90 kcal/kg
What are the daily caloric requirements for 7-12y?
50-75 kcal/kg
What are the daily caloric requirements for 12-18y?
30-60 kcal/kg
What factors would increase daily caloric needs in children?
- critical illness
- congenital heart disease
- bronchopulmonary dysplasia
What factors would decrease daily caloric needs in children?
- developmental delays
- immobility
Do protein requirements increase or decrease with age?
decrease
What does breastfeeding decrease the babys risk of?
- upper respiratory infection
- UTI
- NEC
- Meningitis
- diarrhea
- sepsis
- SIDs
- diabetes
- cancer
- anemia
- obesity
How many calories do standard infant formulas provide?
20 kcal/oz
How many calories do standard children’s formulas provide?
30 kcal/oz
What is the primary cause of dehydration in children?
acute diarrhea
What are clinical presentations of dehydration?
- appearance (normal, lethargic, comatose)
- pulse (normal/rapid)
- decreased urine output
- % weight loss
- skin (temperature, turgor capillary refill)
- sunken eyes
- grayish skin
How is % weight loss calculated?
(pre illness wt - illness wt) / preillness wt x100
What % loss of body weight is considered minimal dehydration?
<3%
What % loss of body weight is considered mild -mod dehydration?
3-9%
What % loss of body weight is considered severe dehydration?
> 9%
When should IV therapy for dehydration be given?
severe dehydration
When should PO therapy for dehydration be given?
mild-moderate dehydration and tolerating oral intake
What type of tonicity should ORS have?
isotonic or hypotonic; replace water, Na, K, HCO3
Why should coke or juice not be used when the child is dehydrated?
hypertonic
How much Na is in ORS?
75-90 mEq/L
How should ORS be dosed for mild dehydration?
rehydration: 50 mL/kg
maintenance: 10 mL/kg for every stool or emesis over a 4h period
How should ORS be dosed for moderate dehydration?
rehydration: 100 mL/kg
maintenance: 10 mL/kg for every stool or emesis over a 4h period
How should ORS be administered?
1 tsp (5 mL) every 5 min; if child vomits, wait 10 min and try again
What is the treatment of bacterial meningitis in neonates <1mo?
Ampicillin + Cefotaxime or Gentamicin
What is the treatment of bacterial meningitis in neonates 1-23 mo?
Vancomycin + Ceftriaxone or Cefotaxime
What is the treatment of bacterial meningitis in neonates 2+y?
Vancomycin + 3rd generation cephalosporin
What are the issues with Ceftriaxone in pediatrics?
- displaces bilirubin from albumin
- can precipitate with Ca containing solutions
By what age have most children been exposed to Respiratory Syncytial Virus (RSV)?
2y
What is used for RSV prophylaxis?
Nirsevimab; long-acting monoclonal antibody
When is Nirsevimab recommended for RSV prophylaxis?
infants <8 mo born during or entering their first RSV season and parents did not receive RSVpreF vaccine or < 14 days before birth
What is the treatment for CROUP?
systemic steroids for mild, moderate, and severe cases;
Dexamethasone 0.6 mg/kg x 1 PO/IM/IV max 16mg/dose
What patients should systemic steroids be used in caution with?
- CV disease
- cerebrovascular disease
- thyroid disease
- diabetes
What are non pharm treatments for nocturnal enuresis?
- behavioral approaches (positive reinforcement)
- establish normal daytime hydration and voiding patterns
- alarm therapy
What are pharm treatments for nocturnal enuresis?
Desmopressin; synthetic analog of ADH
OTC products should not be used in children at less than what age?
6y
What is the DOC for intestinal gas?
Simethicone taken after meals (can be miked with liquids)
What is the DOC for nasal congestion?
NaCl 0.9% nasal solution 2-6 drops per nostril+ gentile suction
What are treatments for constipation?
- pear/ prune juice
- glycerin suppositories (retained for 15min)
What age groups is Codine NOT recommended in?
- <12y
- <18y after 2 common childhood surgeries (tonsillectomy and adenoidectomy)
What age groups is Tramadol NOT recommended in?
<12y
What age groups is Promethazine NOT recommended in?
<2y
What age groups are quinolones NOT recommended in?
all pediatrics
What age groups is tetracyclines NOT recommended in?
<8y
What age groups is Ceftriaxone NOT recommended in?
neonates (1-28 days)
What age groups are OTC cough and cold products NOT recommended in?
<6y
