15. PEDIATRIC SECTION
After appropriate correction for hypovolemia with 10-15 ml/kg NS, routine maintenance is started as follows:
It is easier for the nurses to run a number divisible by 24; therefore, the following table is offered:
Initial bolus of crystalloid is NS 10-20 ml/kg; then D5NS, D5½NS, NS, or ½NS with maintenance volumes as above + replacement as necessary as NS or ½NS. Once voiding well, routine maintenance fluid can be D5Isolyte M, which is similar to D5¼NS but with potassium and acetate.
For intra-abdominal infection (e.g. appy, GI perforation), usual antibiotic doses for over one week of age:
P.O. regimen for post discharge (only for patients with resolving infectious complications of appendicitis):
For treatment of Staph aureus infection:
For treatment of UTI:
*If patient remains symptomatic 24 hours after start of treatment for UTI, a repeat urinalysis and urine culture and change of antibiotics is warranted.
Generally contraindicated antibiotics in pediatrics are the floxacins because of cartilage damage in the growing child, tetracyclines because of tooth staining, chloramphenicol in infants because of gray baby syndrome and in older children because of idiosyncratic bone marrow suppression. Other than allergies, the remainder of the antibiotic armamentarium is not contraindicated.
Antibiotic Suspensions and Chewables for Pediatrics
Antibiotic Type Preparation Sizes (ml)
· First choice PCA pump-parent or nurse may adjust dosage for patients 7 years of age or older using the standard PCA orders.
· Second choice Demerol 1mg/kg IV, 2mg/kg IM q4h
· First choice Tylenol (per dosing chart)
· Second choice Tylenol with codeine (120mg acetaminophen/ 12mg codeine). Based on codeine dose of 0.5-1 mg/kg/dose q4h, approximate doses:
· Alternative is Ibuprofen Suspension (100mg/ 5ml)
160 mg/5 mL
|Jr. Size Tab
|Adult Size Tab
|0.4||1/4 tsp||1/2 tab|
|0.8||1/2 tsp||1 tab|
|1/2 tsp||1.5 tabs|
|1 tsp||2 tabs|
|1.5 tsp||3 tab|
|2 tsp||4 tabs||2 tabs||1 tab|
|2.5 - 3 tsp||5-6 tabs||2.5 - 3 tabs||1.5 - 2 tabs|
|4 tabs||2 tabs|
*Kaiser Permanente does not endorse a brand name-any similar product may be used.
STIMULANT LAXATIVES Peri-op
· Dulcolax (bisacodyl) tablets: (results within 6-8h)
· Dulcolax (bisacodyl) suppositories:
· Colace (docusate) 20mg per 5ml:
* Pediatrics section contributed by Dr. Alan Alter (Pediatrics)
Reviewed by Dr. John Crabtree (General Surgery)