BOOK
The Harriet Lane Handbook E-Book
Lauren Kahl | Helen K Hughes | Matthew Molloy | Lauren McDaniel | Keith Kleinman | Nicole Shikofski
(2017)
Additional Information
Book Details
Abstract
Written "by residents, for residents" and reviewed by expert faculty at The Johns Hopkins Hospital, Lauren Kahl, MD and Helen K. Hughes, MD, MPH, The Harriet Lane Handbook, 21st Edition, remains your #1 source of pediatric point-of-care clinical information. Updated and expanded content, as well as increased online coverage, keeps you fully current with new guidelines, practice parameters, and more. Easy to use, concise, and complete, this is the essential manual for all health care professionals who treat children.
- Updated and expanded content includes relevant laboratory workup for genetic conditions; sexually transmitted infections and pelvic inflammatory disease; nail disorders and disorders of pigmentation; treatment of acne; and fever of unknown origin, lymphadenopathy, and viral infections.
- Expanded coverage of pediatric procedures, including more ultrasound and ultrasound-guided procedures.
- Restructured "Fluids and Electrolytes" chapter helps you perform rapid calculations at the bedside.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Tables for first two pages | i | ||
| Half title page | iii | ||
| The Harriet Lane Handbook | v | ||
| Copyright Page | vi | ||
| Dedication | vii | ||
| Preface | ix | ||
| Table Of Contents | xiii | ||
| I Pediatric Acute Care | 1 | ||
| 1 Emergency Management | 2 | ||
| I. Circulation | 2 | ||
| A. Assessment | 2 | ||
| B. Management (Table 1.1) | 3 | ||
| II. Airway7-10 | 4 | ||
| A. Assessment | 4 | ||
| B. Management7-17 | 4 | ||
| III. Breathing2,7,8,18 | 9 | ||
| A. Assessment | 9 | ||
| B. Management | 9 | ||
| IV. Allergic Emergencies (Anaphylaxis)19,20 | 9 | ||
| A. Definition | 9 | ||
| B. Initial Management | 9 | ||
| V. Respiratory Emergencies | 10 | ||
| A. Asthma | 10 | ||
| B. Upper Airway Obstruction26-29 | 12 | ||
| VI. Neurologic Emergencies | 13 | ||
| A. Altered States of Consciousness30 | 13 | ||
| B. Status Epilepticus33,34 | 15 | ||
| References | 17 | ||
| 2 Poisonings | 20 | ||
| I. Web Resources | 20 | ||
| II. Initial Evaluation | 20 | ||
| A. History | 20 | ||
| B. Laboratory Findings | 20 | ||
| C. Clinical Diagnostic Aids (Table EC 2.A) | 21 | ||
| III. Toxidromes | 21 | ||
| IV. Ingestion and Antidotes | 21 | ||
| A. In General, the Following Are Guidelines of Supportive Care for the Management of Ingestions. | 21 | ||
| V. Acetaminophen Overdose6-10 | 22 | ||
| A. Four Phases of Intoxication: | 22 | ||
| B. Treatment Criteria | 22 | ||
| C. Antidotes: N-Acetylcysteine (See Formulary for Detailed Dosing Instructions). | 25 | ||
| VI. Lead Poisonings11-13 | 26 | ||
| References | 27 | ||
| 3 Procedures | 30 | ||
| I. General Guidelines | 30 | ||
| A. Consent | 30 | ||
| B. Risks | 30 | ||
| II. Ultrasound for Procedures | 30 | ||
| A. Introduction to Ultrasound | 30 | ||
| B. Ultrasound Basics | 31 | ||
| III. Vascular Access and Sampling | 31 | ||
| A. Heelstick and Fingerstick | 31 | ||
| B. Peripheral Intravenous Access | 32 | ||
| C. External Jugular Puncture and Catheterization | 32 | ||
| D. Radial Artery Puncture and Catheterization | 34 | ||
| E. Posterior Tibial and Dorsalis Pedis Artery Puncture | 36 | ||
| F. Central Venous Catheter Placement | 36 | ||
| G. Intraosseous (IO) Access (Fig. 3.9) | 43 | ||
| H. Umbilical Artery (UA) and Umbilical Vein (UV) Catheterization | 45 | ||
| IV. Body Fluid Sampling | 48 | ||
| A. Lumbar Puncture | 48 | ||
| B. Needle Decompression, Chest Tube Placement, and Thoracentesis | 51 | ||
| C. Pericardiocentesis | 55 | ||
| D. Paracentesis | 55 | ||
| E. Urinary Bladder Catheterization | 58 | ||
| F. Suprapubic Bladder Aspiration | 59 | ||
| G. Knee Arthrocentesis | 59 | ||
| H. Soft Tissue Aspiration | 61 | ||
| I. Incision and Drainage (I & D) of Abscess | 61 | ||
| V. Immunization and Medication Administration4 | 64 | ||
| A. Subcutaneous Injections | 64 | ||
| B. Intramuscular Injections | 64 | ||
| VI. Basic Laceration Repair3 | 65 | ||
| A. Suturing | 65 | ||
| B. Skin Staples | 67 | ||
| C. Tissue Adhesives | 68 | ||
| VII. Musculoskeletal Procedures | 68 | ||
| A. Basic Splinting | 68 | ||
| B. Selected Splints and Indications (Fig. 3.21) | 69 | ||
| C. Radial Head Subluxation (Nursemaid’s Elbow) Reduction | 70 | ||
| D. Finger/Toe Dislocation Reduction | 70 | ||
| References | 72 | ||
| 4 Trauma, Burns, and Common Critical Care Emergencies | 73 | ||
| I. Web Resources | 73 | ||
| II. Trauma: Overview | 73 | ||
| A. Primary Survey | 73 | ||
| B. Secondary Survey | 73 | ||
| C. AMPLE History | 73 | ||
| III. Specific Traumatic Injuries | 75 | ||
| A. Minor Closed Head Trauma | 75 | ||
| B. Cervical Spine Injuries | 78 | ||
| C. Blunt Thoracic and Abdominal Trauma | 78 | ||
| D. Orthopedic/Long Bone Trauma | 80 | ||
| IV. Common Critical Care Emergencies | 81 | ||
| A. Hypertensive Crisis | 81 | ||
| B. Increased Intracranial Pressure | 82 | ||
| C. Shock | 84 | ||
| D. Pulmonary Hypertension | 88 | ||
| E. Respiratory Failure | 89 | ||
| F. Critical Care Reference Data | 92 | ||
| G. Status Asthmaticus | 93 | ||
| H. Status Epilepticus | 93 | ||
| V. Animal Bites | 93 | ||
| A. Wound Considerations | 93 | ||
| VI. Burns3,26,36 | 95 | ||
| A. Evaluation of Pediatric Burns (Tables 4.6 and 4.7) | 95 | ||
| B. Burn Mapping | 95 | ||
| C. Emergency Management of Pediatric Burns37 | 96 | ||
| D. Further Management of Pediatric Burns | 100 | ||
| E. Burn Prevention: | 100 | ||
| VII. Child Abuse | 101 | ||
| A. Introduction | 101 | ||
| B. Evaluation and Management | 101 | ||
| References | 103 | ||
| Chapter 4 Color Plates | 106A1 | ||
| II Diagnostic and Therapeutic Information | 107 | ||
| 5 Adolescent Medicine | 108 | ||
| I. Web Resources | 108 | ||
| A. Websites for Clinicians | 108 | ||
| B. Websites for Patients | 108 | ||
| II. Introduction to Adolescent Health | 108 | ||
| A. Pubertal Development | 108 | ||
| B. Psychosocial and Medicosocial History | 109 | ||
| III. Adolescent Health Maintenance | 110 | ||
| A. Confidentiality | 110 | ||
| B. Chief Complaint | 110 | ||
| C. Review of Systems (Areas of Emphasis With an Adolescent) | 111 | ||
| D. Family History | 112 | ||
| E. Medical History | 112 | ||
| F. Adolescent Physical Examination (Most Pertinent Aspects) | 112 | ||
| G. Screening Laboratory Tests and Procedures | 113 | ||
| IV. Sexual Health | 123 | ||
| A. Sexual Orientation | 123 | ||
| B. Gender Identity | 123 | ||
| C. Contraception | 125 | ||
| D. Follow-Up Recommendations: | 131 | ||
| V. Mental Health | 132 | ||
| A. Anxiety and Depression | 132 | ||
| B. Suicidal Ideation31 | 132 | ||
| C. School Problems | 132 | ||
| D. Substance Use32 | 133 | ||
| VI. Transitioning Adolescents Into Adult Care | 134 | ||
| References | 134 | ||
| 6 Analgesia and Procedural Sedation | 136 | ||
| I. Web Resources | 136 | ||
| II. Pain Assessment | 136 | ||
| A. Infant1 | 136 | ||
| B. Preschooler | 136 | ||
| C. School-Age and Adolescent | 136 | ||
| III. Analgesics1,4 | 138 | ||
| A. Safety | 138 | ||
| B. Nonopioid Analgesics | 138 | ||
| C. Opioids (Table 6.3) | 139 | ||
| D. Local Anesthetics4,10,11,12 | 139 | ||
| E. Nonpharmacologic Measures of Pain Relief14,15 | 142 | ||
| IV. Patient-Controlled Analgesia | 143 | ||
| A. Definition | 143 | ||
| B. Indications | 143 | ||
| C. Routes of Administration | 143 | ||
| D. Agents | 143 | ||
| E. Adjuvants | 144 | ||
| F. Complications | 144 | ||
| V. Opioid Tapering4 | 144 | ||
| A. Indications | 144 | ||
| B. Withdrawal | 144 | ||
| C. Guidelines | 144 | ||
| D. Examples | 145 | ||
| VI. Procedural Sedation1,4,10,11,12,19 | 145 | ||
| A. Definitions | 145 | ||
| B. Preparation | 146 | ||
| C. Monitoring | 148 | ||
| D. Pharmacologic Agents | 148 | ||
| E. Discharge Criteria12 | 148 | ||
| F. Examples of Sedation Protocols (Tables 6.10 and 6.11) | 148 | ||
| References | 154 | ||
| 7 Cardiology | 156 | ||
| I. Web Resources | 156 | ||
| II. Physical Examination | 156 | ||
| A. Heart Rate | 156 | ||
| B. Blood Pressure | 156 | ||
| C. Heart Sounds | 164 | ||
| D. Systolic and Diastolic Sounds | 165 | ||
| E. Murmurs | 165 | ||
| III. Electrocardiography | 166 | ||
| A. Basic Electrocardiography Principles | 166 | ||
| B. ECG Abnormalities | 172 | ||
| C. ECG Findings Secondary to Electrolyte Disturbances, Medications, and Systemic Illnesses (Table 7.10) | 173 | ||
| D. Long QT | 173 | ||
| E. Hyperkalemia: | 179 | ||
| F. Myocardial Infarction (MI) in Children | 182 | ||
| IV. Imaging | 183 | ||
| A. Chest Radiograph | 183 | ||
| B. Echocardiography | 184 | ||
| C. Cardiac Catheterization | 184 | ||
| V. Congenital Heart Disease | 185 | ||
| A. Pulse Oximetry Screening for Critical Congenital Heart Disease | 185 | ||
| B. Common Syndromes Associated With Cardiac Lesions | 185 | ||
| C. Acyanotic Lesions | 185 | ||
| D. Cyanotic Lesions (Table 7.13) | 185 | ||
| E. Surgeries and Other Interventions (Fig. 7.14) | 190 | ||
| VI. Acquired Heart Disease | 191 | ||
| A. Endocarditis | 191 | ||
| B. Bacterial Endocarditis Prophylaxis | 191 | ||
| C. Myocardial Disease | 193 | ||
| D. Pericardial Disease | 194 | ||
| E. Kawasaki Disease | 196 | ||
| F. Rheumatic Heart Disease | 198 | ||
| G. Lyme Disease | 198 | ||
| VII. Exercise Recommendations for Congenital Heart Disease | 199 | ||
| VIII. Lipid Monitoring Recommendations | 199 | ||
| A. Screening of Children and Adolescents | 199 | ||
| B. Goals for Lipid Levels in Childhood | 200 | ||
| C. Management of Hyperlipidemia | 200 | ||
| IX. Cardiovascular Screening | 200 | ||
| A. Sports | 200 | ||
| B. Attention–Deficit/Hyperactivity Disorder (ADHD) | 201 | ||
| References | 201 | ||
| 8 Dermatology | 203 | ||
| I. Evaluation and Clinical Descriptions of Skin Findings | 203 | ||
| A. Primary Skin Lesions (Fig. 8.1A) | 203 | ||
| B. Secondary Skin Lesions (See Fig. 8.1B) | 203 | ||
| II. Vascular Anomalies | 203 | ||
| III. Infections | 207 | ||
| A. Viral | 207 | ||
| B. Parasitic Infestations | 208 | ||
| C. Fungal (Figs. 8.14 to 8.17, Color Plates) | 210 | ||
| D. Bacterial | 211 | ||
| IV. Hair Loss: Diagnosis and Treatment (Figs. 8.17 to 8.21, Color Plates) | 211 | ||
| A. Tinea Capitis (see Fig. 8.17, Color Plates) | 211 | ||
| B. Alopecia Areata (see Fig. 8.19, Color Plates) | 212 | ||
| C. Telogen Effluvium (See Fig. 8.20, Color Plates) | 212 | ||
| D. Traction Alopecia (See Fig. 8.21, Color Plates) | 212 | ||
| E. Trichotillomania | 213 | ||
| V. Acne Vulgaris | 213 | ||
| A. Pathogenesis | 213 | ||
| B. Clinical Presentation | 213 | ||
| C. Classification: Used to Estimate Severity, but Not Always Practical In A Clinical Setting | 213 | ||
| D. Treatment (Table 8.1) | 214 | ||
| VI. Common Neonatal Dermatologic Conditions (Fig. 8.22; Figs. 8.23 to 8.31, Color Plates) | 216 | ||
| A. Erythema Toxicum Neonatorum (See Fig. 8.23, Color Plates) | 216 | ||
| B. Transient Neonatal Pustular Melanosis (See Figs. 8.24 and 8.25, Color Plates) | 217 | ||
| C. Miliaria (Heat Rash, Prickly Heat) (See Fig. 8.26, Color Plates) | 219 | ||
| D. Milia (See Fig. 8.27, Color Plates) | 219 | ||
| E. Neonatal Acne (See Fig. 8.28, Color Plates) | 219 | ||
| F. Seborrheic Dermatitis (Cradle Cap) (See Figs. 8.29 and 8.30, Color Plates) | 219 | ||
| G. Congenital Dermal Melanocytosis (Previously Known as Mongolian Spots) | 219 | ||
| H. Diaper Candidiasis (See Fig. 8.31, Color Plates) | 219 | ||
| VII. Autoimmune and Allergic Lesions (Figs. 8.32 to 8.41, Color Plates) | 220 | ||
| A. Autoimmune Bullous Diseases | 220 | ||
| B. Contact Dermatitis | 221 | ||
| C. Atopic Dermatitis (Eczema) (See Figs 8.35 to 8.39) | 221 | ||
| D. Papular Urticaria (See Fig. 8.40, Color Plates) | 224 | ||
| VIII. Nail Disorders | 224 | ||
| A. Acquired Nail Disorders | 224 | ||
| B. Congenital/Hereditary Nail Disorders | 225 | ||
| IX. Disorders of Pigmentation | 225 | ||
| A. Hyperpigmentation | 225 | ||
| B. Hypopigmentation and Depigmentation | 226 | ||
| C. Dyspigmentation | 227 | ||
| References | 227 | ||
| Chapter 8 Color Plates | 228A1 | ||
| 9 Development, Behavior, and Mental Health | 229 | ||
| I. Web Resources | 229 | ||
| II. Developmental Definitions1 | 229 | ||
| A. Developmental Streams | 229 | ||
| B. Developmental Quotient (DQ) | 230 | ||
| C. Abnormal Development | 230 | ||
| III. Guidelines for Normal Development and Behavior | 230 | ||
| A. Developmental Milestones (Table 9.1) | 230 | ||
| IV. Developmental Screening and Evaluation | 230 | ||
| A. Developmental Surveillance and Screening Guidelines | 230 | ||
| B. Commonly Used Developmental Screening and Assessment Tools | 236 | ||
| V. Medical Evaluation of Developmental Disorders | 236 | ||
| A. History | 236 | ||
| B. Physical Examination | 236 | ||
| C. Laboratory Investigations, Imaging Studies, Other Tests | 239 | ||
| VI. Disorders of Development | 241 | ||
| A. Overview | 241 | ||
| B. Intellectual Disability (ID) | 241 | ||
| C. Communication Disorders | 242 | ||
| D. Learning Disabilities (LDs) | 242 | ||
| E. Cerebral Palsy (CP) | 242 | ||
| F. Autism Spectrum Disorders (ASDs) | 244 | ||
| VII. Developmental Referral and Intervention | 246 | ||
| A. State Support | 246 | ||
| B. Multidisciplinary involvement | 246 | ||
| VIII. Disorders of Mental Health | 246 | ||
| A. Overview | 246 | ||
| B. Attention Deficit/Hyperactivity Disorder | 247 | ||
| C. Anxiety Disorders | 248 | ||
| D. Depressive Disorders | 249 | ||
| E. Feeding and Eating Disorders | 250 | ||
| F. Substance Use Disorders | 250 | ||
| IX. Mental Health Referral and Intervention | 251 | ||
| References | 252 | ||
| 10 Endocrinology | 255 | ||
| I. Web Resources | 255 | ||
| II. Diabetes | 255 | ||
| A. Evaluation and Diagnosis | 255 | ||
| B. Diabetes Classification | 256 | ||
| C. Diabetic Ketoacidosis (DKA) | 257 | ||
| D. Type 2 Diabetes Mellitus | 259 | ||
| E. Monitoring | 260 | ||
| III. Thyroid Function11-13 | 261 | ||
| A. Thyroid Tests | 261 | ||
| B. Hypothyroidism (Table 10.7) | 262 | ||
| C. Hyperthyroidism | 262 | ||
| IV. Parathyroid Gland Function and Vitamin D | 266 | ||
| A. Parathyroid Gland | 266 | ||
| B. Vitamin D Deficiency (Table 10.8) | 267 | ||
| V. Adrenal Function21-23 | 267 | ||
| A. Adrenal Insufficiency | 267 | ||
| B. Adrenal Medulla: Pheochromocytoma | 273 | ||
| VI. Posterior Pituitary Function | 273 | ||
| A. Posterior Pituitary Hormones: Targets and Actions | 273 | ||
| B. Posterior Pituitary Disorders: Vasopressin | 274 | ||
| VII. Growth | 276 | ||
| A. Height | 276 | ||
| VIII. Sexual Development | 277 | ||
| IX. Neonatal Hypoglycemia Evaluation44 | 286 | ||
| A. Definition of Hypoglycemia: | 286 | ||
| B. Symptoms: | 286 | ||
| C. Treatment: | 286 | ||
| X. Additional Normal Values | 287 | ||
| References | 287 | ||
| 11 Fluids and Electrolytes | 290 | ||
| I. Overall Guidance in Fluid and Electrolyte Management | 290 | ||
| II. Maintenance Requirements | 290 | ||
| A. Maintenance Volume: Caloric Calculations | 291 | ||
| B. Maintenance Solute | 292 | ||
| III. Deficit Repletion1,11,12 | 293 | ||
| A. Water Deficit Volume | 293 | ||
| B. Solute Deficit: Isonatremic Dehydration | 293 | ||
| C. Solute Deficit: Hyponatremic Dehydration (Hyponatremic Hypovolemia) | 294 | ||
| D. Water and Solute Deficits: Hypernatremic Dehydration | 297 | ||
| E. Deficit Replacement Strategy | 297 | ||
| F. Calculation of Appropriate Fluids | 301 | ||
| IV. Ongoing Losses | 301 | ||
| V. Serum Electrolyte Disturbances | 304 | ||
| A. Sodium | 304 | ||
| B. Potassium | 304 | ||
| C. Calcium | 307 | ||
| D. Magnesium | 309 | ||
| E. Phosphate | 310 | ||
| VI. Acid–Base/Osmolar Gap Disturbances | 312 | ||
| A. Definitions | 312 | ||
| B. Rules for Determining Primary Acid–Base Disorders (See Table 24.3; Calculation of Expected Compensatory Response) | 312 | ||
| C. Etiology of Acid–Base Disturbances | 314 | ||
| References | 315 | ||
| 12 Gastroenterology | 316 | ||
| I. Web Resources | 316 | ||
| II. Gastrointestinal Emergencies | 316 | ||
| A. Gastrointestinal Bleeding | 316 | ||
| B. Acute Abdominal Pain | 317 | ||
| III. Conditions of the GI Tract (Esophagus/Stomach/Bowel) | 318 | ||
| A. Vomiting | 318 | ||
| B. Diarrhea | 319 | ||
| C. Constipation and Encopresis | 321 | ||
| D. Inflammatory Bowel Disease (IBD) | 323 | ||
| E. Gastrointestinal Reflux Disease | 323 | ||
| F. Eosinophilic Esophagitis (EE) | 324 | ||
| G. Celiac Disease | 325 | ||
| IV. Conditions of the Liver | 325 | ||
| A. Liver Function Studies: Table 12.6 | 325 | ||
| B. Acute Liver Failure (ALF) | 325 | ||
| C. Hyperbilirubinemia | 327 | ||
| V. Pancreatitis23-25 | 328 | ||
| A. Acute Pancreatitis | 328 | ||
| B. Chronic Pancreatitis | 329 | ||
| VI. Miscellaneous Tests | 330 | ||
| A. Occult Blood | 330 | ||
| B. Quantitative Fecal Fat | 330 | ||
| References | 330 | ||
| 13 Genetics | 333 | ||
| I. Web Resources | 333 | ||
| II. The Pedigree | 334 | ||
| A. Pedigree Construction | 334 | ||
| B. Patterns of Inheritance | 334 | ||
| C. U.S. Department of Health and Human Services My Family Health Portrait Tool | 334 | ||
| III. Metabolism | 334 | ||
| A. Clinical Presentation of Metabolic Disease (Box 13.1) | 334 | ||
| B. Evaluation | 334 | ||
| C. Treatment of Metabolic Crisis | 339 | ||
| D. Newborn Metabolic Screening | 340 | ||
| E. Categories of Metabolic Diseases | 341 | ||
| IV. Dysmorphology | 347 | ||
| A. History | 347 | ||
| B. Physical Examination | 347 | ||
| C. Workup | 347 | ||
| D. Specific Dysmorphology Conditions | 347 | ||
| V. Diagnostic Genetic Testing and Clinical Considerations | 357 | ||
| A. Ethics of Genetic Testing in Pediatrics | 357 | ||
| B. Informed Consent | 360 | ||
| C. Professional Disclosure of Familial Genetic Information | 360 | ||
| D. Disclosure of Incidental Findings | 360 | ||
| E. Diagnostic Genetic Testing and Clinical Considerations | 360 | ||
| References | 360 | ||
| 14 Hematology | 364 | ||
| I. Web Resources | 364 | ||
| II. Anemia | 364 | ||
| A. General Evaluation | 364 | ||
| B. Diagnosis | 364 | ||
| C. Evaluation of Specific Causes of Anemia (Decreased Production, Hemorrhage, or Increased Destruction) | 364 | ||
| III. Hemoglobinopathies | 368 | ||
| A. Hemoglobin Electrophoresis | 368 | ||
| B. Sickle Cell Anemia | 368 | ||
| C. Thalassemias | 369 | ||
| IV. Neutropenia | 372 | ||
| V. Thrombocytopenia | 373 | ||
| A. Definition | 373 | ||
| B. Causes of Thrombocytopenia | 373 | ||
| VI. Coagulation | 376 | ||
| A. Tests of Coagulation | 376 | ||
| B. Hypercoagulable States | 379 | ||
| C. Bleeding Disorders (Fig. 14.2 and Box 14.5) | 382 | ||
| VII. Blood Component Replacement | 385 | ||
| A. Blood Volume | 385 | ||
| B. Complications of Transfusions | 385 | ||
| C. Reasons Not to Consider a Directed Donor | 390 | ||
| D. Reasons to Consider a Directed Donor | 390 | ||
| E. Blood Product Components | 390 | ||
| F. PRBC Exchange Transfusion | 392 | ||
| VIII. Interpreting Blood Smears | 393 | ||
| A. RBC | 393 | ||
| B. WBC | 393 | ||
| C. Platelets | 393 | ||
| References | 393 | ||
| Chapter 14 Color Plates | 394A1 | ||
| 15 Immunology and Allergy | 395 | ||
| I. Allergic Rhinitis (AR) 1-6 | 395 | ||
| A. Epidemiology | 395 | ||
| B. Diagnosis | 395 | ||
| C. Differential Diagnosis | 396 | ||
| D. Treatment | 396 | ||
| II. Food Allergy7-12 | 397 | ||
| A. Epidemiology | 397 | ||
| B. Manifestations of Food Allergy | 397 | ||
| C. Diagnosis of Food Allergy (Fig. 15.1) | 398 | ||
| D. Differential Diagnosis | 400 | ||
| E. Treatment | 400 | ||
| F. Natural History | 401 | ||
| III. Drug Allergy13-14 | 401 | ||
| A. Epidemiology | 401 | ||
| B. Diagnosis | 401 | ||
| C. Management (Fig. 15.2) | 401 | ||
| IV. Evaluation of Suspected Immunodeficiency | 401 | ||
| V. Immunoglobulin Therapy24-27 | 401 | ||
| A. Intravenous Immunoglobulin (IVIG) | 401 | ||
| B. Intramuscular Immunoglobulin (IMIG) | 405 | ||
| C. Subcutaneous Immunoglobulin | 406 | ||
| D. Specific Immunoglobulins | 406 | ||
| VI. Immunologic Reference Values | 407 | ||
| A. Serum IgG, IgM, IgA, and IgE Levels | 407 | ||
| B. Serum IgG, IgM, IgA, and IgE Levels for Low Birth Weight Preterm Infants | 407 | ||
| C. Lymphocyte Enumeration | 407 | ||
| D. Serum Complement Levels | 407 | ||
| VII. Complement Pathway | 407 | ||
| References | 410 | ||
| 16 Immunoprophylaxis | 412 | ||
| I. Web Resources | 412 | ||
| II. Immunization Schedules | 412 | ||
| III. Immunization Guidelines | 412 | ||
| A. Vaccine Informed Consent | 412 | ||
| B. Vaccine Administration | 419 | ||
| C. Vaccine Types | 419 | ||
| D. General Indications and Precautions for All Vaccines | 419 | ||
| E. Misconceptions | 420 | ||
| IV. Immunoprophylaxis Guidelines for Special Hosts | 420 | ||
| A. Children at High Risk for Pneumococcal Disease4 | 420 | ||
| B. Children at High Risk for Meningococcal Disease | 421 | ||
| C. Children at High Risk for Hib Disease | 422 | ||
| D. Functional or Anatomic Asplenia (Including Sickle Cell Disease) | 422 | ||
| E. Congenital Immunodeficiency Disorders | 422 | ||
| F. Known or Suspected HIV Disease | 422 | ||
| G. Oncology Patients | 423 | ||
| H. Solid Organ Transplant Recipients | 423 | ||
| I. Patients on Corticosteroids | 423 | ||
| J. Patients on Biological Response Modifier Therapy (Cytokine Inhibitors) | 423 | ||
| K. Pregnancy | 424 | ||
| L. Preterm and Low-Birth-Weight Infants | 424 | ||
| M. Patients Treated with Immunoglobulin or Other Blood Products | 426 | ||
| N. Travelers to Foreign Countries | 426 | ||
| V. Immunoprophylaxis Guidelines for Specific Diseases | 426 | ||
| A. Diphtheria/Tetanus/Pertussis Vaccines and Tetanus Immunoprophylaxis | 426 | ||
| B. Haemophilus influenzae Type B Immunoprophylaxis | 427 | ||
| C. Hepatitis A Virus Immunoprophylaxis | 428 | ||
| D. Hepatitis B Virus Immunoprophylaxis | 429 | ||
| E. Human Papillomavirus Immunoprophylaxis | 430 | ||
| F. Influenza Immunoprophylaxis | 431 | ||
| G. Japanese Encephalitis (JE) Immunoprophylaxis | 432 | ||
| H. Measles/Mumps/Rubella Immunoprophylaxis | 432 | ||
| I. Meningococcal Immunoprophylaxis | 434 | ||
| J. Pneumococcal Immunoprophylaxis | 435 | ||
| K. Poliomyelitis Immunoprophylaxis | 435 | ||
| L. Rabies Immunoprophylaxis | 436 | ||
| M. Respiratory Syncytial Virus (RSV) Immunoprophylaxis | 437 | ||
| N. Rotavirus Immunoprophylaxis | 438 | ||
| O. Tuberculosis Immunoprophylaxis | 439 | ||
| P. Typhoid Fever Immunoprophylaxis | 439 | ||
| Q. Varicella Immunoprophylaxis | 439 | ||
| R. Yellow Fever Immunoprophylaxis | 441 | ||
| S. Combination Vaccines | 441 | ||
| References | 442 | ||
| 17 Microbiology and Infectious Disease | 443 | ||
| I. Microbiology | 443 | ||
| A. Collection of Specimens for Blood Culture | 443 | ||
| B. Rapid Microbiologic Identification of Common Aerobic Bacteria (Fig. 17.1) and Anaerobic Bacteria | 443 | ||
| C. Choosing Appropriate Antibiotic Based on Sensitivities | 443 | ||
| II. Infectious Disease | 444 | ||
| A. Fever without Localizing Source: Evaluation and Management Guidelines | 444 | ||
| B. Evaluation of Lymphadenopathy | 446 | ||
| C. Intrauterine and Perinatal Infections | 455 | ||
| D. Common Neonatal and Pediatric Bacterial Infections: Guidelines for Initial Management (See Table 17.8) | 455 | ||
| E. Selected Viral Infections: Table 17.9 and Fig. 17.6 | 470 | ||
| F. Selected Tickborne Infections12: Table 17.10 | 470 | ||
| G. Fungal and Yeast Infections | 470 | ||
| H. Sexually Transmitted and Genitourinary Infections | 470 | ||
| I. Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) | 470 | ||
| J. Tuberculosis (TB) | 484 | ||
| K. Exposures to Bloodborne Pathogens and Prophylaxis | 486 | ||
| References | 487 | ||
| 18 Neonatology | 490 | ||
| I. Web Resources | 490 | ||
| II. Fetal Assessment | 490 | ||
| A. Fetal Anomaly Screening | 490.e1 | ||
| B. Estimation of Gestational Age | 490.e1 | ||
| C. Expected Birth Weight by Gestational Age | 490.e3 | ||
| D. Intrapartum Fetal Heart Rate (FHR) Monitoring | 490.e3 | ||
| III. Newborn Resuscitation | 490 | ||
| A. Neonatal Advanced Life Support Algorithm for Neonatal Resuscitation (Fig. 18.1) | 490 | ||
| B. Endotracheal Tube Size and Depth of Insertion | 490 | ||
| C. Ventilatory Support | 490 | ||
| D. Vascular Access (See Chapter 3 for Umbilical Venous Catheter and Umbilical Artery Catheter Placement) | 490 | ||
| IV. Routine Newborn Care of a Term Infant | 492 | ||
| A. General Care for the Full-term Healthy Newborn With Uncomplicated Delivery | 492 | ||
| B. Prior to Discharge | 493 | ||
| V. Newborn Assessment | 493 | ||
| A. Vital Signs and Birth Weight | 493 | ||
| B. Apgar Scores (Table 18.2) | 493 | ||
| C. New Ballard Gestational Age Estimation | 493 | ||
| D. Birth Trauma | 495 | ||
| E. Selected Anomalies, Syndromes, and Malformations (See Chapter 13 for Common Syndromes/Genetic Disorders) | 496 | ||
| V. Fluids, Electrolytes, and Nutrition | 496 | ||
| A. Fluids | 496 | ||
| B. Glucose | 496 | ||
| C. Electrolytes, Minerals, and Vitamins | 497 | ||
| D. Nutrition | 497 | ||
| VI. Cyanosis in the Newborn | 497 | ||
| A. Differential Diagnosis | 497 | ||
| B. Evaluation | 498 | ||
| VII. Respiratory Diseases | 500 | ||
| A. General Respiratory Considerations | 500 | ||
| B. Respiratory Distress Syndrome | 500 | ||
| C. Persistent Pulmonary Hypertension of the Newborn | 501 | ||
| D. Spontaneous Pneumothorax | 502 | ||
| VIII. Apnea and Bradycardia | 502 | ||
| A. Apnea | 502 | ||
| B. Bradycardia Without Central Apnea | 503 | ||
| IX. Cardiac Diseases | 503 | ||
| A. Patent Ductus Arteriosus (PDA) | 503 | ||
| B. Cyanotic Heart Disease | 504 | ||
| X. Hematologic Diseases | 504 | ||
| A. Unconjugated Hyperbilirubinemia in the Newborn | 504 | ||
| B. Conjugated Hyperbilirubinemia | 506 | ||
| C. Polycythemia | 507 | ||
| XI. Gastrointestinal Diseases | 507 | ||
| A. Necrotizing Enterocolitis | 507 | ||
| B. Bilious Emesis Differential | 508 | ||
| C. Abdominal Wall Defects | 508 | ||
| XII. Neurologic Diseases | 508 | ||
| A. Neonatal Hypoxic-Ischemic Encephalopathy (HIE): Initial Management | 508 | ||
| B. Intraventricular Hemorrhage | 510 | ||
| C. Periventricular Leukomalacia | 510 | ||
| E. Neonatal Seizures | 510 | ||
| F. Neonatal Abstinence Syndrome | 510 | ||
| G. Peripheral Nerve Injuries | 511 | ||
| XIII. Retinopathy of Prematurity (Rop) | 511 | ||
| A. Definition | 511 | ||
| B. Etiology | 511 | ||
| C. Diagnosis—Dilated Funduscopic Examination | 512 | ||
| D. Timing | 512 | ||
| E. Classification | 512 | ||
| F. Management | 513 | ||
| XIV. Congenital Infections | 513 | ||
| XV. Commonly Used Medications in the Neonatal Intensive Care Unit | 513 | ||
| References | 514 | ||
| 19 Nephrology | 516 | ||
| I. Web Resources | 516 | ||
| II. Urinalysis, Urine Dipstick, and Microscopy | 516 | ||
| A. Color | 516 | ||
| B. Turbidity | 516 | ||
| C. Specific Gravity | 516 | ||
| D. pH | 517 | ||
| E. Protein | 517 | ||
| F. Sugars | 517 | ||
| G. Ketones | 517 | ||
| H. Nitrite | 517 | ||
| I. Leukocyte Esterase | 517 | ||
| J. Hemoglobin and Myoglobin | 517 | ||
| K. Bilirubin, Urobilinogen (Table 19.1) | 518 | ||
| L. Red Blood Cells | 518 | ||
| M. White Blood Cells | 518 | ||
| N. Epithelial Cells | 518 | ||
| O. Sediment | 518 | ||
| P. Urine Gram Stain | 518 | ||
| III. Evaluation and Management of Urinary Tract Infections3 | 519 | ||
| A. History | 519 | ||
| B. Physical Examination | 519 | ||
| C. Risk Factors | 519 | ||
| D. Method of Obtaining Urine Sample | 519 | ||
| E. Diagnosis | 519 | ||
| F. Culture-Positive UTI | 520 | ||
| IV. Kidney Function Tests | 523 | ||
| A. Tests of Glomerular Function | 523 | ||
| B. Tests of Kidney Tubular Function | 525 | ||
| V. Acute Kidney Injury10, 11 | 526 | ||
| A. Definition | 526 | ||
| B. Etiology (Table 19.5) | 526 | ||
| C. Clinical Presentation | 526 | ||
| D. Acute Tubular Necrosis | 528 | ||
| E. Treatment Considerations | 528 | ||
| F. Complications | 528 | ||
| G. Acute Dialysis | 529 | ||
| H. Radiographic Imaging Considerations in AKI/CKD | 529 | ||
| VI. Hematuria and Associated Disorders14,15 | 530 | ||
| A. Definitions | 530 | ||
| B. Etiologies | 530 | ||
| C. Evaluation (Fig. 19.2) | 530 | ||
| D. Management | 531 | ||
| VII. Proteinuria And Associated Disorders15,16 | 531 | ||
| A. Methods of Detection | 531 | ||
| B. Definitions | 534 | ||
| C. Etiologies (Box 19.1) | 534 | ||
| D. Evaluation17 | 534 | ||
| E. Nephrotic Syndrome18 | 534 | ||
| VIII. Tubular Disorders | 537 | ||
| A. Renal Tubular Acidosis (Table 19.9)8,19 | 537 | ||
| B. Type 3 (Combined Proximal and Distal) RTA | 537 | ||
| C. Fanconi Syndrome | 537 | ||
| D. Nephrogenic Diabetes Insipidus | 537 | ||
| IX. Chronic Kidney Disease | 538 | ||
| A. Etiology | 539 | ||
| B. Clinical Manifestations (Table 19.10) | 539 | ||
| X. Chronic Hypertension21-23 | 539 | ||
| A. Definition | 539 | ||
| B. Etiologies of Hypertension in Neonates, Infants, and Children | 541 | ||
| C. Evaluation of Chronic Hypertension | 541 | ||
| D. Treatment of Hypertension | 542 | ||
| E. Classification of Hypertension in Children and Adolescents, With Measurement Frequency and Therapy Recommendations | 542 | ||
| F. Antihypertensive Drugs for Outpatient Management of Hypertension in Children 1–17 Years of Age | 542 | ||
| XI. Nephrolithiasis24-26 | 542 | ||
| A. Epidemiology | 542 | ||
| B. Risk Factors | 542 | ||
| C. Presentation | 542 | ||
| D. Diagnosis | 542 | ||
| E. Management | 542 | ||
| F. Workup | 543 | ||
| G. Prevention | 545 | ||
| References | 546 | ||
| 20 Neurology | 548 | ||
| I. Web Resources | 548 | ||
| II. Neurologic Examination | 548 | ||
| A. Mental Status | 548 | ||
| B. Cranial Nerves | 548 | ||
| C. Motor | 548 | ||
| D. Sensory (Fig. 20.1 and Table 20.2) | 548 | ||
| E. Tendon Reflexes | 550 | ||
| F. Coordination and Movement | 551 | ||
| III. Headaches | 551 | ||
| A. Evaluation of Headaches | 551 | ||
| B. Migraine Headache | 553 | ||
| IV. Paroxysmal Events | 555 | ||
| A. Differential Diagnosis of Recurrent Events That Mimic Epilepsy in Childhood | 555 | ||
| B. Seizures: First and Recurrent | 555 | ||
| C. Special Seizure Syndromes | 564 | ||
| V. Hydrocephalus | 564 | ||
| A. Diagnosis | 564 | ||
| B. Treatment | 564 | ||
| VI. Ataxia | 564 | ||
| VII. Stroke | 565 | ||
| A. Etiology | 565 | ||
| B. Differential Diagnosis (Box 20.12) | 566 | ||
| C. Initial Workup | 566 | ||
| D. Management | 566 | ||
| References | 567 | ||
| 21 Nutrition and Growth | 570 | ||
| I. Web Resources | 570 | ||
| A. Professional and Government Organizations | 570 | ||
| B. Infant and Pediatric Formula Company Websites | 570 | ||
| II. Assessment of Nutritional Status | 570 | ||
| A. Elements of Nutritional Assessment | 570 | ||
| B. Indicators of Nutritional Status (Growth Charts) (Figs. 21.1 to 21.9; Figs. EC 21.A to 21.C on Expert Consult) | 571 | ||
| C. Recommendations for Management of Overweight and Obese Children (Fig. EC 21.D on Expert Consult) | 574 | ||
| III. Estimating Energy Needs | 578 | ||
| A. Definitions of Energy Needs | 578 | ||
| B. Estimated Energy Requirement Calculations | 581 | ||
| C. EER Under Stressed Conditions | 581.e1 | ||
| D. Catch-Up Growth Requirement for Malnourished Infants and Children (<3 years) | 582 | ||
| IV. Dietary Reference Intakes for Individuals | 583 | ||
| A. Dietary Reference Intakes | 583 | ||
| B. Protein Requirements | 583 | ||
| C. Fat Requirements | 583 | ||
| D. Vitamin Requirements (Table 21.4) | 583 | ||
| E. Mineral Requirements (Table 21.7) | 584 | ||
| F. Fiber Requirements | 585 | ||
| V. Breastfeeding and the Use of Human Milk | 585 | ||
| A. Breastfeeding Recommendations | 585 | ||
| B. Associated with Decreased Risk of | 585 | ||
| C. Breastfeeding Resources | 588 | ||
| D. Contraindications to Breastfeeding (Table 21.9) | 588 | ||
| VI. Enteral Nutrition | 592 | ||
| A. Mixing Instructions for Full-Term Standard and Soy-Based Infant Formulas | 592 | ||
| B. Common Caloric Modulars (Table 21.11) | 592 | ||
| C. Enteral Formulas, Including Their Main Nutrient Components (Table 21.12) | 592 | ||
| D. Clinical Conditions Requiring Special Diets and Suggested Formula(s) (Table 21.13) | 602 | ||
| E. Common Oral Rehydration Solutions | 602 | ||
| VII. Parenteral Nutrition | 602 | ||
| A. Situations Where Parenteral Nutrition (PN) Is Suggested | 603 | ||
| B. Suggested Formulations for Initiation and Advancement of PN (Table 21.15) | 603 | ||
| C. Recommended Parenteral Formulations (Table 21.16) | 604 | ||
| D. Suggested Monitoring Schedule for Patients Receiving PN | 604 | ||
| References | 605 | ||
| 22 Oncology | 607 | ||
| I. Web Resources | 607 | ||
| II. Presenting Signs and Symptoms of Pediatric Malignancies (Tables 22.1 and 22.2) | 607 | ||
| III. Features of a Pathologic Lymph Node | 607 | ||
| A. Size | 607 | ||
| B. Consistency | 607 | ||
| C. Sensation | 607 | ||
| D. Evaluation if Concern for Malignancy | 607 | ||
| E. Consider Lymph Node Biopsy | 611 | ||
| IV. General Management of Newly Diagnosed Pediatric Brain Tumors | 612 | ||
| A. Initial Approach | 612 | ||
| B. Laboratory Evaluation | 612 | ||
| C. Imaging | 612 | ||
| D. Medication Management | 612 | ||
| E. Additional Consults | 612 | ||
| V. Commonly Used Chemotherapeutic Drugs and Associated Acute Toxicities | 612 | ||
| VI. Oncologic Emergencies | 612 | ||
| A. Hyperleukocytosis/Leukostasis | 612 | ||
| B. Tumor Lysis Syndrome | 616 | ||
| C. Spinal Cord Compression | 616 | ||
| D. Increased Intracranial Pressure | 617 | ||
| E. Cerebrovascular Accident | 617 | ||
| F. Respiratory Distress and Superior Vena Cava Syndrome | 618 | ||
| G. Typhlitis (Neutropenic Enterocolitis) | 618 | ||
| H. Fever and Neutropenia | 618 | ||
| VII. Hematopoietic Stem Cell Transplantation (HSCT) | 619 | ||
| A. Goal | 619 | ||
| B. Preparative Regimens | 619 | ||
| C. Types of HSCT | 619 | ||
| D. Engraftment | 621 | ||
| VIII. Common Complications of Bone Marrow Transplantation | 621 | ||
| A. Acute Graft-Versus-Host Disease (aGVHD) | 621 | ||
| B. Chronic Graft-Versus-Host Disease (cGVHD) | 622 | ||
| C. Veno-Occlusive Disease (Sinusoidal Obstruction Syndrome) | 622 | ||
| D. Thrombotic Microangiopathy: Thrombotic Thrombocytopenic Purpura (TTP) or Hemolytic Uremic Syndrome (HUS) | 623 | ||
| E. Hemorrhagic Cystitis | 623 | ||
| F. Idiopathic Pneumonia Syndrome | 623 | ||
| G. Viral Infections in Bone Marrow Transplantation (BMT) Patients | 624 | ||
| IX. Common Chemotherapy Complications and Supportive Care | 624 | ||
| A. Anemia | 624 | ||
| B. Thrombocytopenia | 624 | ||
| C. Neutropenia | 624 | ||
| D. Mucositis | 624 | ||
| E. Nausea and Emesis | 625 | ||
| X. Antimicrobial Prophylaxis in Oncology Patients (Table 22.5) | 625 | ||
| XI. Beyond Childhood Cancer: Treating a Cancer Survivor | 625 | ||
| A. Understand the Treatment Regimen | 625 | ||
| B. Common Late Effects: | 625 | ||
| C. Vaccinations in Oncology Patients: See Chapter 16 and Expert Consult. | 625 | ||
| References | 627 | ||
| 23 Palliative Care | 628 | ||
| I. Web Resources | 628 | ||
| II. Palliative Care | 628 | ||
| A. Definition | 628 | ||
| B. Palliative Care Team Composition | 628 | ||
| III. Communication and Decision Making | 628 | ||
| A. Decision-Making Tools (DMTs) | 628 | ||
| B. Family Meetings | 629 | ||
| C. Communication Tools for Difficult Conversations | 630 | ||
| D. Child Participation | 631 | ||
| E Advance Directive | 631 | ||
| IV. Legacy and Memory Making | 631 | ||
| A. Memory Making | 631 | ||
| B. Rituals | 632 | ||
| C. Being at Home | 632 | ||
| V. Decisions to Limit Interventions | 632 | ||
| A. Do Not Attempt Resuscitation (DNAR) | 632 | ||
| B. Do Not Escalate Treatment | 632 | ||
| C. Discontinuing Current Interventions | 632 | ||
| D. State Forms | 633 | ||
| VI. Body, Mind, and Spirit Changes as Death Approaches | 633 | ||
| A. Physical Changes | 633 | ||
| B. Emotional Changes | 633 | ||
| C. Mental Changes | 634 | ||
| D. Spiritual Changes | 634 | ||
| VII. Last Hours: Medication and Management | 634 | ||
| VIII. Death Pronouncement | 634 | ||
| A. Preparation | 635 | ||
| B. Entering the Room | 635 | ||
| C. Procedure for Pronouncement | 635 | ||
| D. Document Death in the Chart | 635 | ||
| E. Death Certificate | 635 | ||
| F. Autopsy Consent | 635 | ||
| IX. After Death—Bereavement | 636 | ||
| A. Etiquette | 636 | ||
| B. Available Services | 636 | ||
| References | 636 | ||
| 24 Pulmonology | 637 | ||
| I. Web Resources | 637 | ||
| II. Respiratory Physical Examination | 637 | ||
| III. Evaluation of Pulmonary Gas Exchange | 637 | ||
| A. Pulse Oximetry | 637 | ||
| B. Capnography | 638 | ||
| C. Blood Gases | 639 | ||
| D. Analysis of Acid–Base Disturbances | 639 | ||
| IV. Pulmonary Function Tests | 639 | ||
| A. Peak Expiratory Flow Rate (PEFR) | 640 | ||
| B. Maximal Inspiratory and Expiratory Pressures | 640 | ||
| C. Spirometry (for Children ≥6 Years) | 641 | ||
| V. Brief Resolved Unexplained Event (BRUE) | 644 | ||
| A. Definition | 644 | ||
| B. Differential Diagnosis (Box 24.1) | 644 | ||
| C. Management | 644 | ||
| VI. Asthma | 646 | ||
| A. Definition | 646 | ||
| B. Clinical Presentation | 646 | ||
| C. Treatment | 646 | ||
| D. Prevention of Exacerbations | 646 | ||
| VII. Bronchiolitis | 653 | ||
| A. Clinical Presentation | 653 | ||
| B. Treatment | 653 | ||
| VIII. Bronchopulmonary Dysplasia (BPD) | 653 | ||
| A. Clinical Presentation | 654 | ||
| III Reference | 707 | ||
| 27 Blood Chemistries and Body Fluids | 708 | ||
| I. Reference Values | 708 | ||
| II. Evaluation of Body Fluids | 708 | ||
| A. Evaluation of Transudate Versus Exudate | 708 | ||
| B. Evaluation of Cerebrospinal Fluid | 708 | ||
| C. Evaluation of Synovial Fluid | 708 | ||
| III. Conversion Formulas | 708 | ||
| A. Temperature | 708 | ||
| B. Length and Weight | 708 | ||
| References | 719 | ||
| 28 Biostatistics and Evidence-Based Medicine | 721 | ||
| I. Web Resources | 721 | ||
| A. Evidence-Based Resources | 721 | ||
| B. Statistics Resources and Software | 721 | ||
| II. Evidence-Based Medicine | 721 | ||
| A. Formulate the Clinical Question: | 721 | ||
| B. Search for the Evidence to Answer the Question: | 721 | ||
| C. Critically Appraise the Evidence: | 721 | ||
| D. Apply the Evidence to the Clinical Question: | 722 | ||
| III. Biostatistics for Medical Literature | 723 | ||
| A. Statistical Tests | 723 | ||
| B. Statistical Terminology | 723 | ||
| C. Types of Study Designs: Table 28.2 | 725 | ||
| D. Measurement of Disease Occurrence and Treatment Effects | 725 | ||
| E. Measurements of Test Performance: Table 28.4 | 727 | ||
| References | 728 | ||
| IV Formulary | 731 | ||
| 29 Drug Dosages | 732 | ||
| I. Note to Reader | 732 | ||
| II. Sample Entry | 734 | ||
| III. Explanation of Breastfeeding Categories | 735 | ||
| IV. Explanation of Pregnancy Categories | 735 | ||
| V. Body Surface Nomogram and Equation | 736 | ||
| VI. Drug Index | 737 | ||
| Acetaminophen | 757 | ||
| Acetazolamide | 758 | ||
| Acetylcysteine | 759 | ||
| Acth | 760 | ||
| Acyclovir | 760 | ||
| Adapalene ± Benzoyl Peroxide | 762 | ||
| Adderall | 762 | ||
| Adenosine | 762 | ||
| Albumin, Human | 763 | ||
| Albuterol | 763 | ||
| Allopurinol | 764 | ||
| Almotriptan Malate | 765 | ||
| Alprostadil | 765 | ||
| Alteplase | 766 | ||
| Aluminum Hydroxide | 767 | ||
| Aluminum Hydroxide With Magnesium Hydroxide | 767 | ||
| Amantadine Hydrochloride | 768 | ||
| Amikacin Sulfate | 769 | ||
| Aminocaproic Acid | 770 | ||
| Aminophylline | 770 | ||
| Amiodarone Hcl | 771 | ||
| Amitriptyline | 772 | ||
| Amlodipine | 773 | ||
| Ammonium Chloride | 774 | ||
| Ammonul | 774 | ||
| Amoxicillin | 774 | ||
| Amoxicillin-Clavulanic Acid | 775 | ||
| Amphetamine | 776 | ||
| Amphotericin B (Conventional) | 777 | ||
| Amphotericin B Lipid Complex | 778 | ||
| Amphotericin B, Liposomal | 778 | ||
| Ampicillin | 779 | ||
| Ampicillin/Sulbactam | 780 | ||
| Antipyrine and Benzocaine (Otic) | 781 | ||
| Arginine Chloride—Injectable Preparation | 781 | ||
| Aripiprazole | 782 | ||
| Arnuity Ellipta | 783 | ||
| Ascorbic Acid | 783 | ||
| Aspirin | 783 | ||
| Atenolol | 784 | ||
| Atomoxetine | 785 | ||
| Atovaquone | 785 | ||
| Atropine Sulfate | 786 | ||
| Auralgan | 787 | ||
| Azathioprine | 787 | ||
| Azelastine | 788 | ||
| Azithromycin | 789 | ||
| Aztreonam | 790 | ||
| Bacitracin ± Polymyxin B | 791 | ||
| Baclofen | 792 | ||
| Beclomethasone Dipropionate | 793 | ||
| Benzoyl Peroxide | 794 | ||
| Benztropine Mesylate | 795 | ||
| Beractant | 795 | ||
| Betamethasone | 796 | ||
| Bicitra | 797 | ||
| Bisacodyl | 797 | ||
| Bismuth Subsalicylate | 797 | ||
| Brompheniramine With Phenylephrine | 798 | ||
| Budesonide | 799 | ||
| Budesonide and Formoterol | 801 | ||
| Bumetanide | 801 | ||
| Butorphanol | 802 | ||
| Caffeine Citrate | 802 | ||
| Calcitonin—Salmon | 803 | ||
| Calcitriol | 803 | ||
| Calcium Acetate | 804 | ||
| Calcium Carbonate | 805 | ||
| Calcium Chloride | 805 | ||
| Calcium Citrate | 806 | ||
| Calcium Glubionate | 806 | ||
| Calcium Gluconate | 807 | ||
| Calcium Lactate | 807 | ||
| Calcium Phosphate, Tribasic | 808 | ||
| Calfactant | 808 | ||
| Captopril | 808 | ||
| Carbamazepine | 809 | ||
| Carbamide Peroxide | 811 | ||
| Carbinoxamine | 811 | ||
| Carnitine | 812 | ||
| Carvedilol | 812 | ||
| Caspofungin | 813 | ||
| Cefaclor | 814 | ||
| Cefadroxil | 815 | ||
| Cefazolin | 815 | ||
| Cefdinir | 816 | ||
| Cefepime | 816 | ||
| Cefixime | 817 | ||
| Cefotaxime | 817 | ||
| Cefotetan | 818 | ||
| Cefoxitin | 819 | ||
| Cefpodoxime Proxetil | 819 | ||
| Cefprozil | 820 | ||
| Ceftaroline Fosamil | 820 | ||
| Ceftazidime | 821 | ||
| Ceftibuten | 821 | ||
| Ceftriaxone | 822 | ||
| Cefuroxime (Iv, Im)/Cefuroxime Axetil (Po) | 823 | ||
| Celecoxib | 824 | ||
| Cephalexin | 824 | ||
| Cetirizine ± Pseudoephedrine | 825 | ||
| Charcoal, Activated | 826 | ||
| Chloramphenicol | 826 | ||
| Chloroquine Phosphate | 826 | ||
| Chlorothiazide | 827 | ||
| Chlorpheniramine Maleate | 828 | ||
| Chlorpromazine | 828 | ||
| Cholecalciferol | 829 | ||
| Cholestyramine | 830 | ||
| Choline Magnesium Trisalicylate | 830 | ||
| Ciclesonide | 831 | ||
| Cidofovir | 832 | ||
| Cimetidine | 832 | ||
| Ciprofloxacin | 833 | ||
| Citrate Mixtures | 835 | ||
| Clarithromycin | 835 | ||
| Clindamycin | 836 | ||
| Clobazam | 837 | ||
| Clonazepam | 838 | ||
| Clonidine | 839 | ||
| Clotrimazole | 840 | ||
| Corticotropin | 841 | ||
| Cortisone Acetate | 841 | ||
| Co-Trimoxazole | 841 | ||
| Cromolyn | 842 | ||
| Cyanocobalamin/Vitamin B12 | 842 | ||
| Cyclopentolate | 843 | ||
| Cyclopentolate With Phenylephrine | 844 | ||
| Cyclosporine, Cyclosporine Microemulsion, Cyclosporine Modified | 844 | ||
| Cyproheptadine | 845 | ||
| Dantrolene | 846 | ||
| Dapsone | 847 | ||
| Darbepoetin Alfa | 848 | ||
| Deferoxamine Mesylate | 850 | ||
| Desmopressin Acetate | 850 | ||
| Dexamethasone | 851 | ||
| Dexmedetomidine | 852 | ||
| Dexmethylphenidate | 853 | ||
| Dextroamphetamine ± Amphetamine | 854 | ||
| Diazepam | 855 | ||
| Diazoxide | 857 | ||
| Dicloxacillin Sodium | 857 | ||
| Digoxin | 857 | ||
| Digoxin Immune Fab (Ovine) | 859 | ||
| Diltiazem | 859 | ||
| Dimenhydrinate | 860 | ||
| Dimercaprol | 861 | ||
| Diphenhydramine | 861 | ||
| Divalproex Sodium | 862 | ||
| Dobutamine | 862 | ||
| Docusate | 863 | ||
| Dolasetron | 864 | ||
| Dopamine | 864 | ||
| Dornase Alfa/Dnase | 865 | ||
| Doxapram Hcl | 865 | ||
| Doxycycline | 866 | ||
| Dronabinol | 867 | ||
| Droperidol | 867 | ||
| Edetate (Edta) Calcium Disodium | 868 | ||
| Edrophonium Chloride | 868 | ||
| Emla | 869 | ||
| Enalapril Maleate (Po), Enalaprilat (Iv) | 869 | ||
| Enoxaparin | 870 | ||
| Epinephrine Hcl | 872 | ||
| Epinephrine, Racemic | 873 | ||
| Epoetin Alfa | 873 | ||
| Ergocalciferol | 875 | ||
| Ergotamine Tartrate ± Caffeine | 876 | ||
| Ertapenem | 876 | ||
| Erythromycin Preparations | 877 | ||
| Erythropoietin | 878 | ||
| Escitalopram | 878 | ||
| Esmolol Hcl | 879 | ||
| Esomeprazole | 880 | ||
| Etanercept | 881 | ||
| Ethambutol Hcl | 882 | ||
| Ethosuximide | 882 | ||
| Famciclovir | 883 | ||
| Famotidine | 884 | ||
| Felbamate | 885 | ||
| Fentanyl | 885 | ||
| Ferric Gluconate | 887 | ||
| Ferrous Sulfate | 887 | ||
| Fexofenadine ± Pseudoephedrine | 887 | ||
| Filgrastim | 888 | ||
| Flecainide Acetate | 888 | ||
| Fluconazole | 889 | ||
| Flucytosine | 890 | ||
| Fludrocortisone Acetate | 890 | ||
| Flumazenil | 891 | ||
| Flunisolide | 892 | ||
| Fluoride | 892 | ||
| Fluoxetine Hydrochloride | 893 | ||
| Fluticasone Furoate + Vilanterol | 894 | ||
| Fluticasone Preparations | 894 | ||
| Fluticasone Propionate and Salmeterol | 896 | ||
| Fluvoxamine | 897 | ||
| Folic Acid | 898 | ||
| Fomepizole | 899 | ||
| Formoterol | 899 | ||
| Foscarnet | 900 | ||
| Fosphenytoin | 901 | ||
| Furosemide | 902 | ||
| Gabapentin | 903 | ||
| Ganciclovir | 904 | ||
| Gatifloxacin | 905 | ||
| Gcsf | 905 | ||
| Gentamicin | 905 | ||
| Glucagon Hcl | 906 | ||
| Glycerin | 907 | ||
| Glycopyrrolate | 907 | ||
| Granisetron | 908 | ||
| Griseofulvin | 909 | ||
| Guanfacine | 909 | ||
| Haloperidol | 910 | ||
| Heparin Sodium | 911 | ||
| Hyaluronidase | 912 | ||
| Hydralazine Hydrochloride | 913 | ||
| Hydrochlorothiazide | 913 | ||
| Hydrocortisone | 914 | ||
| Hydromorphone Hcl | 915 | ||
| Hydroxychloroquine | 915 | ||
| Hydroxyzine | 916 | ||
| Ibuprofen | 917 | ||
| Imipenem and Cilastatin | 918 | ||
| Imipramine | 919 | ||
| Immune Globulin | 920 | ||
| Indomethacin | 922 | ||
| Insulin Preparations | 922 | ||
| Iodide | 923 | ||
| Iohexol | 923 | ||
| Ipratropium Bromide ± Albuterol | 924 | ||
| Iron Dextran | 925 | ||
| Iron Sucrose | 925 | ||
| Iron—Injectable Preparations | 925 | ||
| Iron—Oral Preparations | 927 | ||
| Isoniazid | 928 | ||
| Isoproterenol | 929 | ||
| Isotretinoin | 929 | ||
| Itraconazole | 930 | ||
| Ketamine | 931 | ||
| Ketoconazole | 931 | ||
| Ketorolac | 932 | ||
| Labetalol | 933 | ||
| Lacosamide | 934 | ||
| Lactulose | 935 | ||
| Lamivudine | 935 | ||
| Lamotrigine | 936 | ||
| Lansoprazole | 939 | ||
| Levalbuterol | 940 | ||
| Levetiracetam | 940 | ||
| Levocarnitine | 941 | ||
| Levofloxacin | 942 | ||
| Levothyroxine (T4) | 943 | ||
| Lidocaine | 944 | ||
| Lidocaine and Prilocaine | 945 | ||
| Lindane | 946 | ||
| Linezolid | 946 | ||
| Lisdexamfetamine | 947 | ||
| Lisinopril | 948 | ||
| Lithium | 948 | ||
| Lodoxamide | 949 | ||
| Loperamide | 950 | ||
| Loratadine ± Pseudoephedrine | 950 | ||
| Lorazepam | 951 | ||
| Losartan | 952 | ||
| Low Molecular Weight Heparin | 952 | ||
| Lucinactant | 952 | ||
| Magnesium Citrate | 953 | ||
| Magnesium Hydroxide | 953 | ||
| Magnesium Oxide | 954 | ||
| Magnesium Sulfate | 954 | ||
| Mannitol | 955 | ||
| Mebendazole | 955 | ||
| Medroxyprogesterone | 956 | ||
| Mefloquine Hcl | 956 | ||
| Meropenem | 957 | ||
| Mesalamine | 958 | ||
| Metformin | 960 | ||
| Methadone Hcl | 961 | ||
| Methimazole | 961 | ||
| Methyldopa | 962 | ||
| Methylene Blue | 962 | ||
| Methylphenidate Hcl | 963 | ||
| Methylprednisolone | 965 | ||
| Metoclopramide | 965 | ||
| Metolazone | 966 | ||
| Metoprolol | 966 | ||
| Metronidazole | 967 | ||
| Micafungin Sodium | 969 | ||
| Miconazole | 970 | ||
| Midazolam | 971 | ||
| Milrinone | 972 | ||
| Mineral Oil | 972 | ||
| Minocycline | 973 | ||
| Minoxidil | 974 | ||
| Mometasone Furoate ± Fomoterol Fumarate | 974 | ||
| Mometasone Furoate: | 975 | ||
| Mometasone Furoate + Fomoterol Fumarate (Dulera): | 975 | ||
| Montelukast | 976 | ||
| Morphine Sulfate | 976 | ||
| Mupirocin | 978 | ||
| Mycophenolate | 978 | ||
| Nafcillin | 979 | ||
| Naloxone | 980 | ||
| Naproxen/Naproxen Sodium | 981 | ||
| Neo-Polymycin Ophthalmic Ointment | 982 | ||
| Neo-Polycin Hc | 982 | ||
| Neomycin Sulfate | 982 | ||
| Neomycin/Polymyxin B Ophthalmic Products | 983 | ||
| Neomycin/Polymyxin B + Gramicidin: | 983 | ||
| Neomycin/Polymyxin B + Hydrocortisone: | 983 | ||
| Neomycin/Polymyxin B + Bacitracin + Hydrocortisone: | 983 | ||
| Neomycin/Polymyxin B ± Bacitracin | 984 | ||
| Neomycin/Polymyxin B + Bacitracin: | 984 | ||
| Neosporin Ophthalmic Solution | 984 | ||
| Neostigmine | 984 | ||
| Nevirapine | 985 | ||
| Niacin/Vitamin B3 | 986 | ||
| Nicardipine | 986 | ||
| Nifedipine | 987 | ||
| Nitrofurantoin | 988 | ||
| Nitroglycerin | 989 | ||
| Nitroprusside | 990 | ||
| Norepinephrine Bitartrate | 990 | ||
| Nortriptyline Hydrochloride | 990 | ||
| Nystatin | 991 | ||
| Octreotide Acetate | 991 | ||
| Ofloxacin | 992 | ||
| Olanzapine | 993 | ||
| Olopatadine | 994 | ||
| Omeprazole | 995 | ||
| Omnipaque | 996 | ||
| Ondansetron | 996 | ||
| Oseltamivir Phosphate | 997 | ||
| Oxacillin | 999 | ||
| Oxcarbazepine | 999 | ||
| Oxybutynin Chloride | 1001 | ||
| Oxycodone | 1002 | ||
| Oxycodone and Acetaminophen | 1002 | ||
| Oxycodone and Aspirin | 1003 | ||
| Oxymetazoline | 1003 | ||
| Palivizumab | 1003 | ||
| Pancrelipase/Pancreatic Enzymes | 1004 | ||
| Pancuronium Bromide | 1006 | ||
| Pantoprazole | 1006 | ||
| Paromomycin Sulfate | 1008 | ||
| Paroxetine | 1008 | ||
| Penicillin G Preparations—Aqueous Potassium and Sodium | 1009 | ||
| Penicillin G Preparations—Benzathine | 1010 | ||
| Penicillin G Preparations—Penicillin G Benzathine and Penicillin G Procaine | 1011 | ||
| Penicillin G Preparations—Procaine | 1011 | ||
| Penicillin V Potassium | 1012 | ||
| Pentamidine Isethionate | 1013 | ||
| Pentobarbital | 1013 | ||
| Permethrin | 1014 | ||
| Phenazopyridine Hcl | 1015 | ||
| Phenobarbital | 1015 | ||
| Phentolamine Mesylate | 1016 | ||
| Phenylephrine Hcl | 1017 | ||
| Phenytoin | 1018 | ||
| Phosphorus Supplements | 1019 | ||
| Physostigmine Salicylate | 1020 | ||
| Phytonadione/Vitamin K1 | 1020 | ||
| Pilocarpine Hcl | 1021 | ||
| Pimecrolimus | 1022 | ||
| Piperacillin With Tazobactam | 1022 | ||
| Polycitra | 1023 | ||
| Polyethylene Glycol—Electrolyte Solution | 1023 | ||
| Polymyxin B Sulfate and Bacitracin | 1024 | ||
| Polymyxin B Sulfate and Trimethoprim Sulfate | 1024 | ||
| Polymyxin B Sulfate, Neomycin Sulfate, Hydrocortisone Otic | 1025 | ||
| Polytrim Ophthalmic Solution | 1025 | ||
| Polysporin | 1025 | ||
| Poractant Alfa | 1025 | ||
| Potassium Iodide | 1025 | ||
| Potassium Supplements | 1026 | ||
| Pralidoxime Chloride | 1027 | ||
| Prednisolone | 1028 | ||
| Prednisone | 1029 | ||
| Primaquine Phosphate | 1029 | ||
| Primidone | 1030 | ||
| Probenecid | 1031 | ||
| Procainamide | 1031 | ||
| Prochlorperazine | 1032 | ||
| Promethazine | 1033 | ||
| Propranolol | 1033 | ||
| Propylthiouracil | 1035 | ||
| Prostaglandin E1 | 1035 | ||
| Protamine Sulfate | 1035 | ||
| Pseudoephedrine | 1036 | ||
| Psyllium | 1037 | ||
| Pyrantel Pamoate | 1037 | ||
| Pyrazinamide | 1038 | ||
| Pyrethrins With Piperonyl Butoxide | 1038 | ||
| Pyridostigmine Bromide | 1038 | ||
| Pyridoxine | 1039 | ||
| Pyrimethamine | 1040 | ||
| Quetiapine | 1040 | ||
| Quinidine | 1043 | ||
| Quinupristin and Dalfopristin | 1044 | ||
| Ranitidine Hcl | 1045 | ||
| Rasburicase | 1045 | ||
| Rho (D) Immune Globulin Intravenous (Human) | 1046 | ||
| Ribavirin | 1047 | ||
| Riboflavin | 1049 | ||
| Rifabutin | 1049 | ||
| Rifampin | 1050 | ||
| Rimantadine | 1051 | ||
| Risperidone | 1052 | ||
| Rizatriptan Benzoate | 1053 | ||
| Rocuronium | 1054 | ||
| Rufinamide | 1055 | ||
| Salmeterol | 1055 | ||
| Scopolamine Hydrobromide | 1056 | ||
| Selenium Sulfide | 1057 | ||
| Senna/Sennosides | 1057 | ||
| Sertraline Hcl | 1058 | ||
| Sildenafil | 1059 | ||
| Silver Sulfadiazine | 1060 | ||
| Simethicone | 1060 | ||
| Sirolimus | 1061 | ||
| Sodium Bicarbonate | 1062 | ||
| Sodium Chloride—Inhaled Preparations | 1062 | ||
| Sodium Phenylacetate and Sodium Benzoate | 1063 | ||
| Sodium Phosphate | 1064 | ||
| Sodium Polystyrene Sulfonate | 1064 | ||
| Spironolactone | 1065 | ||
| Streptomycin Sulfate | 1066 | ||
| Succimer | 1066 | ||
| Succinylcholine | 1067 | ||
| Sucralfate | 1068 | ||
| Sulfacetamide Sodium Ophthalmic | 1068 | ||
| Sulfadiazine | 1069 | ||
| Sulfamethoxazole and Trimethoprim | 1069 | ||
| Sulfasalazine | 1070 | ||
| Sumatriptan Succinate | 1071 | ||
| Surfactant, Pulmonary/Beractant | 1072 | ||
| Surfactant, Pulmonary/Calfactant | 1072 | ||
| Surfactant, Pulmonary/Poractant Alfa | 1073 | ||
| Tacrolimus | 1074 | ||
| Tazarotene | 1075 | ||
| Terbutaline | 1076 | ||
| Tetracycline Hcl | 1077 | ||
| Theophylline | 1077 | ||
| Thiamine | 1078 | ||
| Thioridazine | 1079 | ||
| Tiagabine | 1079 | ||
| Tiotropium | 1080 | ||
| Tobramycin | 1081 | ||
| Tolnaftate | 1083 | ||
| Topiramate | 1083 | ||
| Trazodone | 1084 | ||
| Tretinoin—Topical Preparations | 1085 | ||
| Triamcinolone | 1086 | ||
| Triamterene | 1087 | ||
| Trifluridine | 1087 | ||
| Trilisate | 1088 | ||
| Trimethobenzamide Hcl | 1088 | ||
| Trimethoprim and Sulfamethoxazole | 1088 | ||
| Ursodiol | 1088 | ||
| Valacyclovir | 1089 | ||
| Valganciclovir | 1090 | ||
| Valproic Acid | 1091 | ||
| Valsartan | 1093 | ||
| Vancomycin | 1093 | ||
| Varicella-Zoster Immune Globulin (Human) | 1095 | ||
| Vasopressin | 1096 | ||
| Vecuronium Bromide | 1096 | ||
| Verapamil | 1097 | ||
| Vigabatrin | 1098 | ||
| Vitamin a | 1099 | ||
| Vitamin B1 | 1099 | ||
| Vitamin B2 | 1099 | ||
| Vitamin B3 | 1099 | ||
| Vitamin B6 | 1099 | ||
| Vitamin B12 | 1100 | ||
| Vitamin C | 1100 | ||
| Vitamin D2 | 1100 | ||
| Vitamin D3 | 1100 | ||
| Vitamin E/α-Tocopherol | 1100 | ||
| Vitamin K | 1100 | ||
| Voriconazole | 1101 | ||
| Warfarin | 1102 | ||
| Zidovudine | 1104 | ||
| Zinc Salts, Systemic | 1106 | ||
| Zolmitriptan | 1106 | ||
| Zonisamide | 1107 | ||
| Bibliography | 1108 | ||
| 30 Drugs in Renal Failure | 1110 | ||
| I. Dose Adjustment Methods | 1110 | ||
| A. Maintenance Dose | 1110 | ||
| B. Dialysis | 1110 | ||
| II. Antimicrobials Requiring Adjustment in Renal Failure | 1111 | ||
| III. Nonantimicrobials Requiring Adjustment in Renal Failure | 1125 | ||
| References | 1136 | ||
| Index | 1137 | ||
| A | 1137 | ||
| B | 1149 | ||
| C | 1153 | ||
| D | 1165 | ||
| E | 1171 | ||
| F | 1175 | ||
| G | 1179 | ||
| H | 1182 | ||
| I | 1188 | ||
| J | 1193 | ||
| K | 1194 | ||
| L | 1195 | ||
| M | 1198 | ||
| N | 1205 | ||
| O | 1209 | ||
| P | 1212 | ||
| Q | 1223 | ||
| R | 1223 | ||
| S | 1227 | ||
| T | 1235 | ||
| U | 1240 | ||
| V | 1242 | ||
| W | 1246 | ||
| X | 1246 | ||
| Y | 1247 | ||
| Z | 1247 | ||
| Algorithms 1 | 1256 | ||
| Algorithms 2 | 1257 | ||
| Algorithms 3 | 1258 | ||
| Algorithms 4 | IBC1 | ||
| IFC_IE | IFC1 |