🩺 Pediatric Clinical Reference Handbook v2.0 (72 Conditions)

Searchable Point-of-Care App Matrix for OPD, Ward Protocols & IMNCI Guidelines

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1. IMNCI Integrated Screening Guidelines

General Danger Signs

Pink / Critical

Assess for: Inability to drink/breastfeed, vomits everything, history of convulsions in current illness, lethargy/unconsciousness.

Action: Classify as Severe. Administer urgent pre-referral medication treatments and arrange urgent transfer.

Young Infant (0-2M) Bacterial Screen

Yellow / Triage

Assess for: Umbilicus red/draining pus, extensive skin pustules, hypothermia (<35.5°C) or hyperthermia (>37.5°C).

Action: Give oral Amoxicillin 5 days if local infection. If severe signs match, refer for neonatal sepsis protocols.

2. Critical Emergency & Resuscitation Protocols

🚨 Septic Shock Triage

Emergency

Signs: Altered sensorium, capillary refill time (CRT) >2s, hyper/hypothermia with systemic inflammatory signs.

• Access IV/IO line within 90 seconds. Give Isotonic Crystalloid bolus **10-20 mL/kg** over 15 min.

• If fluid-refractory after 40 mL/kg, titrate Epinephrine **0.05-0.3 mcg/kg/min**.

🚨 Systemic Anaphylaxis

Emergency

Signs: Rapid progression of hives, facial angioedema, expiratory wheeze, inspiratory stridor or hemodynamic collapse.

• **First Line:** **Epinephrine (1:1000) IM** at **0.01 mg/kg** (max 0.3 mg) via anterolateral thigh aspect.

• Administer supplemental 100% oxygen via non-rebreather face mask. Repeat IM dose every 5-15 min if needed.

3. Respiratory Airway & Pulmonology Track (18 Conditions)

R1. Severe Pneumonia (IMNCI)

Dx: Cough/breathing problem + **chest indrawing** or general danger signs. Cutoffs: <2M (≥60), 2-11M (≥50), 12-59M (≥40).

Rx: Ampicillin 50 mg/kg IV/IM q6h OR oral Amoxicillin 40-45 mg/kg/dose q12h for 5 days. Supplementary Oxygen if SpO2 <90%.

R2. Acute Bronchiolitis

Dx: Child <2 years with viral upper respiratory prodrome progressing to wheezing and bilateral fine crackles.

Rx: Supportive therapy. Minimal disturbance, nasal suctioning, humidified oxygen. Maintain oral/IV hydration; avoid routine bronchodilators.

R3. Acute Asthma Exacerbation

Dx: Recurrent episodes of wheezing, dry cough, prolonged expiration, accessory muscle usage.

Rx: Salbutamol neb 2.5-5 mg q20 min for 3 doses, then hourly. Add oral Prednisolone 1-2 mg/kg/day for 3-5 days.

R4. Laryngotracheobronchitis (Croup)

Dx: Barking cough, inspiratory stridor, hoarseness. X-ray may show classic steeple sign.

Rx: Dexamethasone 0.6 mg/kg PO/IM/IV once. If stridor is present at rest, administer Nebulized Epinephrine (L-epinephrine 1:1000, 2-5 mL).

R5. Acute Epiglottitis

R5 (Critical)

Dx: High fever, drooling, dysphagia, distress, tripod posture. Lateral neck X-ray shows thumbprint sign.

Rx: Avoid examining throat with tongue depressor. Direct to OR for controlled intubation. Ceftriaxone 75-100 mg/kg/day IV.

R6. Pertussis (Whooping Cough)

Dx: Paroxysmal cough spells followed by an inspiratory 'whoop' sound and post-tussive emesis.

Rx: Azithromycin 10 mg/kg/day daily for 5 days (Infants <6M: 10 mg/kg/day for 5 days). Isolate and provide prophylaxis to household contacts.

R7. Foreign Body Aspiration

R7 (Critical)

Dx: History of sudden choking episode followed by monophonic wheeze, asymmetrical or decreased unilateral breath sounds.

Rx: Complete obstruction: Back blows/chest thrusts (<1Y) or Heimlich maneuver (≥1Y). Urgent rigid bronchoscopy removal.

R8. Empyema Thoracis

Dx: Persistent high fever with pneumonia, chest dullness to percussion, decreased tactile fremitus.

Rx: Chest tube thoracostomy drainage or video-assisted thoracoscopic surgery (VATS). Ceftriaxone 100 mg/kg/day + Clindamycin 30 mg/kg/day IV.

R9. Acute Tonsillopharyngitis

Dx: Sore throat, tonsillar exudates, palatal petechiae, tender anterior cervical lymphadenopathy.

Rx: If GABHS suspected: Benzathine Penicillin G IM single dose OR oral Amoxicillin 50 mg/kg/day for 10 days to prevent acute rheumatic fever.

R10. Acute Otitis Media (AOM)

R10

Dx: Otalgia, ear pulling in infants, otoscopy reveals a bulging, opaque, erythematous tympanic membrane with loss of landmarks.

Rx: High-dose oral Amoxicillin **80-90 mg/kg/day** divided every 12 hours for 5-7 days (10 days if <2 years old).

R11. Retropharyngeal Abscess

R11

Dx: Fever, neck hyperextension, muffled "hot potato" voice, drooling. Confirm with lateral neck X-ray or contrast CT.

Rx: Maintain airway. Surgical incision and drainage in OR. IV Ampicillin-Sulbactam 50 mg/kg q6h OR Clindamycin.

R12. Peritonsillar Abscess (Quinsy)

R12

Dx: Severe unilateral sore throat, trismus, medial deviation of the tonsil with displacement of the uvula to the contralateral side.

Rx: Needle aspiration or formal incision & drainage under local/general anesthesia. Follow with course of oral/IV antibiotics.

R13. Acute Bacterial Sinusitis

R13

Dx: Persistent purulent rhinorrhea or daytime cough lasting >10 days without clinical improvement, or severe onset fever for 3 consecutive days.

Rx: Amoxicillin-Clavulanate **80-90 mg/kg/day** of amoxicillin component PO divided q12h for 10-14 days.

R14. Pulmonary Tuberculosis (TB)

R14

Dx: Chronic unremitting cough >2 weeks, persistent fever, unexplainable weight loss, positive TST/IGRA, diagnostic chest radiography findings.

Rx: 2 Months HRZE (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol) followed by 4 Months HR phase. Dose carefully by weight bands.

R15. Allergic Rhinitis

R15

Dx: Paroxysmal sneezing, clear rhinorrhea, allergic shiners, transverse nasal crease (allergic salute).

Rx: Intranasal Fluticasone propionate (1 spray daily) + second-generation oral antihistamine (Cetirizine 0.25 mg/kg/day or fixed nightly dose).

R16. Laryngomalacia

R16

Dx: Congenital inspiratory stridor appearing in first weeks of life, loud when supine, decreases when prone. Laryngoscopy shows omega-shaped epiglottis.

Rx: Expectant conservative monitoring for most; resolve spontaneously by 18-24M. If failure to thrive or severe apnea, refer for supraglottoplasty.

R17. Neonatal Respiratory Distress Syndrome (RDS)

R17

Dx: Premature neonate presenting immediately at birth with tachypnea, grunting, retractions, cyanosis. CXR reveals fine ground-glass pattern.

Rx: Early nasal CPAP. Intratracheal Surfactant administration (e.g., Poractal alfa 100-200 mg/kg via InSurE technique) if oxygen requirement rises.

R18. Idiopathic Pulmonary Hemosiderosis (IPH)

R18

Dx: Triad of hemoptysis, iron deficiency anemia, and transient alveolar infiltrates. Sputum/gastric aspirate shows hemosiderin-laden macrophages.

Rx: Systemic Corticosteroids (Prednisolone 1-2 mg/kg/day) for acute alveolar hemorrhage episodes. Consider long-term immunosuppression (Azathioprine).

4. Gastroenteritides & Hepatobiliary Track (15 Conditions)

G1. Diarrhea with Some Dehydration

Dx: Two of: Irritable, sunken eyes, drinks eagerly, slow skin pinch response (<2 seconds).

Rx: **Plan B:** Give **75 mL/kg** Low-Osmolarity ORS over 4 hours. Zinc supplementation: 10 mg daily (<6M) or 20 mg daily (≥6M) for 14 days.

G2. Diarrhea with Severe Dehydration

G2 (Critical)

Dx: Two of: Lethargic/unconscious, sunken eyes, unable/poor drinking, very slow skin pinch (>2 seconds).

Rx: **Plan C IV Fluids:** 100 mL/kg Ringer's Lactate. Age <12M: 30 mL/kg in 1 hr, then 70 mL/kg over 5 hr. Age ≥12M: 30 mL/kg in 30 min, then 70 mL/kg over 2.5 hr.

G3. Acute Bacillary Dysentery

Dx: High fever, abdominal cramps, tenesmus, loose stools containing macroscopic blood and mucus (Shigella).

Rx: Oral Ciprofloxacin **15 mg/kg/dose** every 12 hours for 3 days OR Azithromycin 10 mg/kg/day once daily for 3 days.

G4. Persistent Diarrhea

Dx: Diarrheal episode originating acutely but extending continuously for **≥14 days** without resolution, causing nutritional decline.

Rx: Prevent dehydration with ORS. Introduce temporary reduced-lactose or lactose-free options. Supplement Vitamin A, Zinc, and multivitamins.

G5. GERD (Gastroesophageal Reflux)

Dx: Postprandial emesis, poor weight gain, irritability, arching of the back during feeds (Sandifer syndrome syndrome).

Rx: Thickened formula feeds, upright positioning for 30 min post-feeding. If complications manifest, start Omeprazole 1 mg/kg/day PO.

G6. Hypertrophic Pyloric Stenosis

Dx: Age 3-6 weeks, projectile **non-bilious emesis**, palpable "olive-like" mass in epigastrium. Hypokalaemic hypochloremic metabolic alkalosis.

Rx: Correct fluid deficit and electrolyte imbalances with 0.45% or 0.9% NS + Dextrose + KCl. Schedule definitive Ramstedt pyloromyotomy.

G7. Acute Intussusception

G7 (Critical)

Dx: Colicky abdominal pain, drawing up of legs, sausage-shaped right quadrant mass, late **"currant-jelly" bloody stools**.

Rx: NPO, IV fluid stabilization, urgent ultrasound (target/doughnut sign). Hydrostatic or pneumatic air enema reduction.

G8. Celiac Disease

Dx: Chronic diarrhea, abdominal distension, muscle wasting, failure to thrive after introducing gluten. Serology: Positive IgA anti-tTG antibodies.

Rx: Strict lifelong avoidance of dietary gluten (wheat, barley, rye grains). Correct underlying iron/vitamin deficiencies.

G9. Soil-Transmitted Helminthiasis

Dx: Vague recurrent periumbilical abdominal pain, pica, pallor, microscopy positive for Ascaris, Hookworm, or Trichuris ova.

Rx: Oral **Albendazole 400 mg** as a single dose PO (200 mg if child is aged 12-23 months). Repeat dose in 2 weeks for certain infections.

G10. Acute Viral Hepatitis (HAV/HEV)

G10

Dx: Fever, anorexia, dark tea-colored urine, followed by scleral icterus and tender right upper quadrant hepatomegaly. Elevated ALT/AST.

Rx: Supportive management. High-carbohydrate, low-fat diet. Monitor PT/INR to track early signs of fulminant hepatic failure.

G11. Fulminant Hepatic Failure

G11 (Critical)

Dx: Acute liver injury presenting with severe coagulopathy (INR ≥2.0) and hepatic encephalopathy (altered behavior, asterixis) within 8 weeks of jaundice.

Rx: Strict NPO/IV fluid maintenance, avoid sedatives. Administer Lactulose, Vitamin K1 (0.2 mg/kg IV). Triage immediately for emergent liver transplant evaluation.

G12. Intestinal Amoebiasis

G12

Dx: Subacute onset bloody diarrhea, tenesmus, minimal fever. Stool microscopy demonstrates trophozoites containing ingested RBCs.

Rx: Oral Metronidazole **35-50 mg/kg/day** divided every 8 hours for 7-10 consecutive days.

G13. Giardiasis

G13

Dx: Chronic, protracting, foul-smelling, greasy stools associated with abdominal distension, flatulence, and secondary malabsorption.

Rx: Metronidazole **15-30 mg/kg/day** PO divided every 8 hours for 5-7 days OR Nitazoxanide according to age protocol.

G14. Hirschsprung Disease

G14

Dx: Delayed meconium passage (>48 hours post-birth), chronic constipation, abdominal distension, explosive release of stool on rectal exam.

Rx: Avoid programmatic standard laxatives. Confirm with rectal suction biopsy (absence of ganglion cells). Schedule surgical pull-through resection.

G15. Cyclic Vomiting Syndrome (CVS)

G15

Dx: Recurrent, stereotypical, predictable episodes of severe nausea and vomiting with no apparent structural GI etiology. Association with migraines.

Rx: Acute phase: Aggressive IV hydration, Ondansetron, or IV triptans. Prophylaxis: Cyproheptadine (<5Y) or Amitriptyline (≥5Y).

5. Tropical Infections & Complex Febrile Pathologies (10 Conditions)

F1. Severe Malaria (Falciparum)

F1 (Critical)

Dx: Confirmed Plasmodium positive blood smear + any severe parameter: Coma, repeated convulsions, severe anemia (Hb <5 g/dL), or dark hemoglobinuria.

Rx: **Artesunate IV/IM 2.4 mg/kg/dose** at 0, 12, 24 hours, then daily for 3 days minimum. Transition to full course oral ACT when stable.

F2. Enteric Fever (Typhoid)

Dx: Step-ladder prolonged fever, bradycardia matching high fever (Faget sign), splenomegaly, abdominal rose spots. Blood culture gold standard.

Rx: Ceftriaxone 100 mg/kg/day IV divided q12h for 7-14 days OR oral Azithromycin 10-20 mg/kg/day for 7 days.

F3. Dengue Hemorrhagic Fever

F3 (Critical)

Dx: High continuous fever, severe retro-orbital headache, structural plasma leakage evidence, platelet count <100,000/mm³, rising Hct.

Rx: Careful maintenance of plasma volume. Isotonic fluid titration (Ringer's Lactate) at 3-5 mL/kg/hr; avoid NSAIDs (use Paracetamol only).

F4. Visceral Leishmaniasis (Kala-Azar)

Dx: Prolonged fever, profound cachexia, massive splenomegaly, hyperpigmentation, pancytopenia. Confirm via rK39 rapid antigen test.

Rx: **Liposomal Amphotericin B** 3-5 mg/kg/day IV on selected scheduled days or single **10 mg/kg infusion** protocol where validated.

F5. Leptospirosis (Weil Syndrome)

Dx: Exposure to contaminated water, high fever, severe calf muscle tenderness, conjunctival suffusion, jaundice, acute kidney injury.

Rx: Mild: Oral Doxycycline 2-4 mg/kg/day or Amoxicillin. Severe: Penicillin G 250,000 U/kg/day IV divided q6h OR IV Ceftriaxone.

F6. Scrub Typhus

Dx: Acute high fever, generalized lymphadenopathy, maculopapular rash, pathognomonic **black necrotic eschar** at chigger bite site.

Rx: **Oral Doxycycline 4.4 mg/kg/day** divided every 12 hours for 5-7 days. Azithromycin 10 mg/kg/day serves as safe alternative.

F7. Kawasaki Disease

Dx: Fever ≥5 days + 4 signs: Bilateral bulbar conjunctival injection, strawberry tongue/fissured lips, polymorphous exanthem, periungual desquamation.

Rx: **IVIG 2 g/kg** as a single slow infusion over 10-12 hours + high-dose Oral Aspirin (80-100 mg/kg/day) until febrile stage breaks.

F8. Brucellosis

Dx: History of raw/unpasteurized milk ingestion, undulant fever pattern, arthralgia/spondylitis, hepatosplenomegaly. Tube agglutination titer >1:160.

Rx: Children ≥8Y: Doxycycline + Rifampicin for 6 weeks. Children <8Y: Co-trimoxazole (TMP-SMX) + Rifampicin for 6 weeks.

F9. Chikungunya Fever

Dx: Abrupt onset high fever accompanied by severe, crippling, bilateral polyarthralgias, tenosynovitis, maculopapular truncal rash.

Rx: Supportive symptomatic management. Control pyrexia and joint pain via Paracetamol. Avoid NSAIDs until dengue is ruled out.

F10. Acute Rheumatic Fever (ARF)

F10

Dx: Modified Jones Criteria. Major: Carditis, migratory polyarthritis, Sydenham chorea, erythema marginatum, subcutaneous nodules. Positive ASLO.

Rx: Eradicate GABHS with Benzathine Penicillin G IM. Deliver High-dose Aspirin 50-100 mg/kg/day divided for joint arthritis phase.

6. Neurological & Neuro-Intensive Track (10 Conditions)

N1. Convulsive Status Epilepticus

N1 (Critical)

Dx: Continuous generalized tonic-clonic motor activity lasting >5 minutes without recovery of consciousness.

Rx: Lorazepam 0.1 mg/kg IV over 2 min OR Midazolam 0.2 mg/kg IM/Intranasal. If active past 10 min, give Levetiracetam 60 mg/kg IV or Phenytoin 20 mg/kg IV.

N2. Acute Bacterial Meningitis

N2 (Critical)

Dx: Fever, neck stiffness, Kernig/Brudzinski signs, bulging fontanelle, toxic appearance. Turbid CSF with low glucose, high protein.

Rx: Ceftriaxone 100 mg/kg/day IV divided q12h + Vancomycin 60 mg/kg/day. Give Dexamethasone 0.15 mg/kg IV before first antibiotic dose.

N3. Acute Viral Encephalitis

Dx: Fever, altered personality/behavior, focal neurological deficits, seizures. CSF PCR analysis confirms viral viral genome footprint.

Rx: Empiric IV **Acyclovir 10-20 mg/kg** (or 500 mg/m² per dose) every 8 hours for 14-21 days to cover suspected HSV-1 profile.

N4. Febrile Seizures (Simple vs Complex)

Dx: Seizure associated with fever in child aged 6M-5Y without CNS infection. Simple: Generalized, <15 min, single episode in 24h.

Rx: Reassurance. Abort active seizure via Midazolam if lasting >5 min. Use scheduled Paracetamol during fever spikes; routine antiepileptics are discouraged.

N5. Acute Raised ICP / Hydrocephalus

N5 (Critical)

Dx: Headache, projectile vomiting, papilledema, bradycardia, hypertension, irregular breathing (Cushing triad), "setting-sun" eye sign.

Rx: Elevate head to 30°, maintain midline orientation. Hyperventilate temporarily. Administer **Mannitol 0.25-1 g/kg IV** over 20 min. Arrange emergent neurosurgery review.

N6. Guillain-Barré Syndrome (GBS)

Dx: Progressive, symmetrical, ascending flaccid paralysis with loss of deep tendon reflexes. CSF shows albuminocytologic dissociation.

Rx: Monitor vital capacity and autonomic stability closely. Administer **IVIG 2 g/kg total** divided over 2-5 days OR schedule plasmapheresis.

N7. Acute Disseminated Encephalomyelitis (ADEM)

Dx: Multifocal neurological deficits plus encephalopathy following a viral infection or vaccination. Brain MRI shows widespread white matter lesions.

Rx: High-dose **Methylprednisolone 30 mg/kg/day IV** for 3-5 consecutive days, followed by structured oral prednisone taper phase.

N8. Cerebral Palsy (CP)

Dx: Non-progressive motor, tone, and postural impairment resulting from early developmental insults to the fetal or infant brain.

Rx: Multidisciplinary care matrix. Manage spasticity with oral Baclofen or localized Botulinum toxin injections. Intense daily physical therapy.

N9. Reye Syndrome

N9 (Critical)

Dx: Association with Aspirin use during influenza/varicella infections. Persistent vomiting, progressive encephalopathy, microvesicular fatty liver, elevated ammonia.

Rx: ICU admission. Infuse 10-20% Dextrose to prevent hypoglycemia. Direct management toward intracranial pressure containment and normalization of ammonia.

N10. Infantile Hypotonia (Floppy Infant)

N10

Dx: "Frog-leg" posture at rest, marked head lag on pull-to-sit maneuver, poor feeding/suction, diminished deep tendon reflexes.

Rx: Diagnostic tracking (CK levels, genetic screening for SMA, neuro-conduction). Maximize nutritional support and prevent aspiration events.

7. Hematology, Nutrition & Oncology Track (11 Conditions)

H1. Iron Deficiency Anemia (IDA)

Dx: Pallor, pica, fatigue. CBC: Microcytic hypochromic anemia with high RDW. Low serum ferritin levels confirm diagnosis.

Rx: Elemental Iron **3-6 mg/kg/day** PO divided single/twice daily for 3 months past Hb correction. Co-administer with Vitamin C.

H2. β-Thalassemia Major

Dx: Severe progressive anemia presenting within first year of life, hepatosplenomegaly, "chipmunk facies" bony changes. Hb electrophoresis confirms diagnosis.

Rx: Lifelong regular Leuko-depleted Packed RBC transfusions to maintain Hb target >9.5 g/dL. Initiate iron chelation (Deferasirox) once ferritin exceeds 1000 ng/mL.

H3. Sickle Cell Disease (Vaso-Occlusive Crisis)

Dx: Severe bone/joint pain, acute dactylitis (hand-foot syndrome) in toddlers, acute chest syndrome risk, sickle forms on blood smear.

Rx: High-volume hydration (1.5x maintenance), scheduled round-the-clock analgesia (Morphine IV for severe pain), empiric antibiotics, oxygen if hypoxic.

H4. Immune Thrombocytopenic Purpura (ITP)

Dx: Sudden onset generalized petechiae, purpura, bruising in an otherwise completely healthy child following viral viral illness. Isolated platelet count <100,000.

Rx: Restrict physical activity. If mucosal bleeding is present or platelets drop <20,000, administer single dose IVIG 1 g/kg OR oral Prednisolone 4 mg/kg/day for 4 days.

H5. Hemophilia A / B (Acute Hemarthrosis)

Dx: Male child with prolonged post-traumatic oozing, spontaneous deep muscle bleeding, or painful joint swelling (hemarthrosis). Elevated isolated aPTT.

Rx: Immediate Factor VIII (Hemophilia A) or Factor IX (Hemophilia B) concentrate replacement target kinetics. Avoid Aspirin/NSAIDs and IM injections.

H6. Nutritional Rickets

Dx: Craniotabes, rachitic rosary, wrist widening, genu varum (bow legs). X-ray reveals metaphyseal fraying and cupping configuration.

Rx: Vitamin D3 (Cholecalciferol) 2,000-5,000 IU daily PO for 6-12 weeks OR single oral megadose 300,000-600,000 IU, accompanied by elemental Calcium support.

H7. Severe Acute Malnutrition (SAM)

Dx: MUAC <115 mm, weight-for-height/length < -3 Z-scores, or presence of bilateral pitting nutritional edema (Kwashiorkor profile).

Rx: Ten step stabilization protocol. Treat/prevent hypoglycemia and hypothermia. Feed via F-75 therapeutic formula initially, then scale up to RUTF.

H8. Acute Lymphoblastic Leukemia (ALL)

Dx: Pallor, petechiae, fever, bone pain, hepatosplenomegaly, generalized lymphadenopathy. Peripheral blood smear or bone marrow aspirate shows excess >20% blast cells.

Rx: Supportive stabilization (blood products, management of tumor lysis syndrome). Refer immediately to specialized pediatric oncology centers for multi-agent chemotherapy.

H9. Vitamin A Deficiency (Xerophthalmia)

Dx: History of night blindness, dry conjunctiva, foaming white **Bitot's spots** on bulbar conjunctiva, corneal ulcerations.

Rx: Administer oral Vitamin A instantly: Age <6M (50,000 IU), 6-11M (100,000 IU), ≥12M (200,000 IU) on days 1, 2, and 14.

H10. Scurvy (Vitamin C Deficiency)

H10

Dx: Irritability, painful limb swelling due to subperiosteal hemorrhages, "scorbutic rosary" configurations, swollen/bleeding gums.

Rx: Ascorbic Acid (Vitamin C) **100-300 mg/day** PO divided into 3 doses for at least one week, until clinical pain parameters resolve.

H11. Tumor Lysis Syndrome (TLS)

H11 (Critical)

Dx: Onset after chemotherapy initiation for high-grade leukemias/lymphomas. Hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia.

Rx: Aggressive IV hydration (no potassium additives). Administer **Rasburicase 0.2 mg/kg/day IV** or Allopurinol. Monitor cardiac rhythm for dangerous hyperkalemic ECG changes.

8. Nephrology & Urinary Tract Track (8 Conditions)

K1. Minimal Change Nephrotic Syndrome

Dx: Generalized pitting edema, heavy dipstick proteinuria (3+/4+), hypoproteinemia (albumin <2.5 g/dL), hyperlipidemia.

Rx: Oral **Prednisolone 60 mg/m²/day** (max 60 mg/day) daily for 6 weeks, then alternate-day maintenance **40 mg/m²** for another 6 weeks.

K2. Acute Post-Streptococcal Glomerulonephritis

Dx: Post-pharyngitis/impetigo delay, macroscopic hematuria (tea-colored urine), hypertension, mild oliguria. High ASLO, low C3.

Rx: Fluid restriction (Insensible losses 400 mL/m²/day + urine output). Treat hypertension via Furosemide 1-2 mg/kg IV and Amlodipine.

K3. Urinary Tract Infection (Acute Pyelonephritis)

Dx: Unexplained high fever in infants, dysuria/frequency in older kids. Pyuria on urinalysis, culture positive (>10^5 CFU/mL via clean catch).

Rx: Oral Cefixime 8-10 mg/kg/day or IV Amikacin / Ceftriaxone for 7-10 days. Schedule renal ultrasound following first febrile UTI episode.

K4. Hemolytic Uremic Syndrome (HUS)

K4 (Critical)

Dx: Follows STEC bloody diarrhea episode. Microangiopathic hemolytic anemia (schistocytes), thrombocytopenia, acute kidney injury.

Rx: Supportive intensive care. Strict fluid/electrolyte management, avoiding antimicrobials and antimotility agents. Provide hemodialysis or peritoneal dialysis if indicated.

K5. Acute Kidney Injury (AKI)

Dx: Abrupt decrease in GFR, oliguria (urine <0.5 mL/kg/hour for >6 hours), elevation of serum creatinine from baseline metrics.

Rx: Identify etiology (Pre-renal, Intrinsic, Post-renal). Balance fluids, discontinue nephrotoxic exposures, treat hyperkalemia urgently.

K6. Posterior Urethral Valves (PUV)

Dx: Newborn male, poor urinary stream, palpable distended bladder. Antenatal/postnatal ultrasound shows bilateral hydronephrosis, dilated posterior urethra ("keyhole sign").

Rx: Insert temporary 5-F or 8-F feeding tube to drain bladder. Fluid and electrolyte management. Refer to pediatric urology for endoscopic valve ablation.

K7. Vesicoureteral Reflux (VUR)

Dx: Diagnosed via Voiding Cystourethrogram (VCUG) performed following recurrent febrile UTIs. Retrograde flow of urine from bladder to ureters/kidneys.

Rx: Long-term low-dose antibiotic prophylaxis (Nitrofurantoin 1-2 mg/kg single nightly dose) for high-grade cases; surgical re-implantation for refractory presentations.

K8. Renal Tubular Acidosis (RTA)

Dx: Persistent hyperchloremic normal anion gap metabolic acidosis associated with severe unexplained failure to thrive and polyuria.

Rx: Direct administration of Sodium Bicarbonate or Potassium Citrate solutions tailored to normalize serum bicarbonate values (target 3-5 mEq/kg/day).

9. Master Drug Reference Index

Drug Name	Standard Clinical Dosing Target	Route / Interval Rules
Paracetamol	10-15 mg/kg per dose	PO / PR every 4-6 hours (max 75 mg/kg/day)
Amoxicillin	40-45 mg/kg/day (Standard) \|\| 80-90 mg/kg/day (High dose target)	PO divided every 12 hours
Ceftriaxone	50-75 mg/kg/day (Systemic) \|\| 100 mg/kg/day (Meningitis target)	IV / IM every 12 to 24 hours
Salbutamol Nebulizer	0.03-0.05 mL/kg/dose (Min 0.5 mL, Max 1 mL of 0.5% solution)	Diluted in 2-3 mL NS, deliver every 20 min to 4 hours prn
Diazepam (Rectal)	0.2 - 0.5 mg/kg per dose	PR single administration for acute status seizure abort
Albendazole	400 mg single dose PO (200 mg if infant aged 12-23M)	PO single stat dose; repeat in 14 days if needed

Pediatrics Handbook