Where are you
You are FY2 in Medicine.Who the patient is
Tracy Yates, aged 6 years, has been diagnosed with peritonsillar abscess (quinsy). She was managed in the ER. There are no signs of dehydration. Patient cannot eat or drink. Weight of the child is 23 kg.Other information
Consultant has advised the following medications:
Phenoxymethylpenicillin
Metronidazole
IV fluids maintenance. Available fluid bag volume 500 ml.Special note
Patient is allergic to clarithromycin. Patient had itching.What you must do
Write down the prescription for the above medications. Check dose with BNF. Calculate the fluid dose.
Shortcut:
- Antibiotic: BENZYLPENICILLIN SODIUM 575 mg IV 7 days QID
Additional information: Review in 48 hours - Antibiotic: METRONIDAZOLE 172 mg IV 7 days TDS
Additional information: Review in 48 hours - Child Fluid Prescription Chart: Write 3 times, Volume 500 ml, Infusion fluid 0.9% NaCl + 5% DEXTROSE, Additives 10 mmol KCL, Rate 63 ml/hr
Explanation:
In Quincy, route of administration will be IV Antibiotics instead of oral, irrespective of child’s eating and drinking status. Both Metronidazole and Benzylpenicillin.
- Benzylpenicillin Sodium 25 mg per kg IV every 6 hours for 7 days. (If weight is 23 kg then dose is 575mg)
- Metronidazole 7.5 mg per kg 8 hourly IV for 7 days. (If weight is 23 kg then dose is 172mg)
Ref : BNF/BNFC
So we can prescribe the IV Antibiotics for 7 days, but in additional information do write to review in 48 hours.
Main aspect is the correct choice of fluids in all children scenarios it’s almost always Normal Saline with 5 percent dextrose with additive 10mmol of potassium Chloride per 500 ml bag
Note: Giving oral medication, if it is clearly given that child can eat and not vomiting is also fine, but its upto you, your decision.
Alternative method for fluid calculation
| Per Day (over 24 hours) | Rate Per Hour | |
|---|---|---|
| First 10kg | 100 mL/kg/day | 4 mL/kg hr |
| Next 10kg | 50 mL/kg/day | 2 mL/kg/br |
| ≥ 20.1kg | 20 mL/kg/day | 1 mL/kg/br |
Take total, divide by 24 to get rate per hour
For example:
| Per Day (over 24 hours) | |||
|---|---|---|---|
| First 10kg | 1 to 10 kg | 10 x 100 mL/kg/day | = 1000 mls |
| Next 10kg | 11 to 20 kg | 10 x 50 mL/kg/day | = 500 mls |
| ≥ 20.1kg | Above 20 kg | 3 x 20 mL/kg/day | = 60 mls |
| Total | =1560 mls / 24 hrs | ||
| = 65 mls / hr |
Because we have only 500ml bag we’ll give 3 x 500 ml bag = 1500 mls
