tratamente pediatrice
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medicinaTRANSCRIPT
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TRATAMENTE PEDIATRICE
25.05.2011
Dr. Doina Cherata
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Rahitismul
Tratament profilactic
� Antenatal: � Vitamina D – 500 UI dupa luna a 7-a de sarcina
� Postnatal:Postnatal:� Vitamina D – 500 UI/zi pana la 1 an, apoi in
anotimpul rece intre 1 – 7 ani
� Expunere la aer si soare
� Alimentatie corecta
� Calciu – 500 mg/zi (prematur, aparat gipsat, copil ceprimeste < 500 ml lapte/zi)
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Rahitismul
Tratament curativ
� Per os:
� Vitamina D:2000 – 5000 UI/zi pana la ameliorare, apoi se trece la doza profilacticaapoi se trece la doza profilactica
� Injectabil:
� Vitamina D – 100.000 UI/3 zile, 3 doze, apoi
� Vitamina D – 200.000 UI/2 saptamani, apoi
� Vitamina D – 200.000 UI/luna
� Calciu – 500 mg/zi
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Anemia
Tratament profilactic
� Antenatal:
� Fier per os, timp de 3 luni in trimestrul III
� Daca Hb < 10 g/dl – Venofer i.v.� Daca Hb < 10 g/dl – Venofer i.v.
� Postnatal:
� Fier Haussman – intre 6 luni – 1 an, 5 -10 picaturi/zi sau 10-25 mg/zi sau 1 mg/kg/zi
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Anemia
Tratament curativ
� Alimentatie: fructe, legume, galbenus
� Fier:� Fier:
Mg Fier = 2,5 x (13,5 – Hb) x G(kg) + 10
� La prematur – administrare de fier de la varsta de 3 saptamani
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Distrofia
Indici:
� Indicele ponderal (IP):
� IP = Gr/Gi (val normala = 1)
�Gr = greutate reala�Gr = greutate reala
�Gi = greutate ideala = G la nastere (sau 3000 g) + spor ideal corespunzator varstei
� Indice de nutritie (IN)
� IN = Gr/Gi pentru talie
�valori standardizate (ABACA)
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Distrofia
Grade de distrofie
� Risc de distrofie: IP = 1 – 0,90 sau IN = 1 – 0,90
� Distrofie gr I: IP = 0,89 – 0,76 sau IN = 0,89 – 0,81� Distrofie gr I: IP = 0,89 – 0,76 sau IN = 0,89 – 0,81
� Distrofie gr II: IP = 0,75 – 0,61 sau IN = 0,80 – 0,71
� Distrofie gr III (casexie, atrepsie, marasm): IP < 0,60 sau IN < 0,70
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Distrofia
Cauze de distrofie
� Ex alimentatione: cantitativ si/sau calitativ
� Ex constitutione� Ex constitutione
� Ex curatione: spitalizari repetate, carentepsihosociale, deprivare materna
� Ex infectione: infectii repetate sau trenante(adenoidite cronice, infectii urinare cronice, diareibacteriene sau parazitare, TBC, etc.)
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Distrofia
Tratament
� Etiologic
� Alimentatia: cresterea necesarului de principii nutritive Normal Distrofienutritive Normal Distrofie
hidrocarbonate 4 – 5 g/kg/zi 8 – 10 g/kg/zi
proteine 2 – 3 g/kg/zi 4 – 4,5 g/kg/zi
lipide 4 – 5 g/kg/zi 8 – 10 g/kg/zi
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Distrofia
Exemplu de meniu – sugar distrofic 7 luni
� I: lapte 150 ml + cereale� I: lapte 150 ml + cereale
� II: fructe + branza de vaci 50g + biscuiti
� III: piure de legume + supa + carne 50g (sau galbenusde ou) + ulei vegetal + fidea (galusti, faina)
� IV: branza de vaci + iaurt + biscuiti
� V: lapte 150 ml + cereale
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Antibioterapia
Afectiuni amigdaliene
� Agent etiologic: Streptococ beta hemolitic
� Tratament
� Penicilina V (Ospen): 50.000 – 100.000 UI/kg/zi divizat in 3 – 4 prize3 – 4 prize
� Macrolide:
� Claritromicina (Klacid, Fromilid): 15 mg/kg/zi in 2 prize
� Azitromicina(Azitrox, Sumamed): 10 mg/kg/zi priza unica
� Eritromicina: 40 – 50 mg/kg/zi in 4 prize
� Complicatii poststreptococice: RAA, Glomerulonefritapoststreptococica
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Antibioterapia
Afectiuni rinosinusale
� Antibiotice cu spectru larg:
� Amoxicilina 25 – 50 mg/kg/zi in 3 prize� Amoxicilina 25 – 50 mg/kg/zi in 3 prize
� Ampicilina 50 – 100 mg/kg/zi in 4 prize
� Amoxicilina + ac. clavulanic (Augmentin) 40 – 50 mg/kg/zi in 2 prize
� Ampicilina + sulbactam (Unasyn) 25 – 50 mg/kg/zi in 2 – 3 prize
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Antibioterapia
Afectiuni laringiene
� Agent etiologic: Haemophilus Influenzae
� Tratament:
� Cefalosporine gen. II sau III� Cefalosporine gen. II sau III
�Cefuroxim (Zinnat, Zinacef) 50 mg/kg/zi p.o sau inj.
�Ceftriaxona (Rocephin, Cefort) 50 mg/kg/zi inj.
� Alternative
�Amoxicilina
�Amoxicilina + ac.clavulanic
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Pneumonii
Etiologie
� Virala: v. respirator sincitial, v. gripale, v. paragripale, adenovirus, rhinovirus
� Bacteriana: streptococcus pneumoniae, mycobacterium tuberculosis, staphylococcus aureus, haemophilus influenzae, klebsiella legionella
� Mycoplasma pneumoniae
� Chlamidia pneumoniae
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Pneumonii
Pneumonia bacteriana
� Triada: febra, junghitoracic, tuse
� Obiectiv: sindr. de condensare
Pneumonia interstitiala
� Debut de tip gripal, febra, cefalee, mialgii, dispneeprogresiva cu tahipnee, cianoza periorala, bataiale aripilor nasului, tiraj
condensare
� Radiologic: opacitateomogena triunghiularalimitata la un lob
ale aripilor nasului, tiraj
� Obiectiv: MV aspru, raluridifuze, fara semne de condensare
� Radiologic: deseninterstitial accentuat, aspect de “val de calugar”
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Pneumonii
Tratament antibiotic
� Antibiotice cu spectru larg
Ampicilina�Ampicilina
�Amoxicilina
�Amoxicilina + ac. clavulanic
�Injectabil: ampicilina + gentamicina
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Boala diareica acuta (BDA)
Etiologie
� Infectioasa
� Bacteriana: E. Coli, Salmonella, caracterizata prin febra, frison, varsaturi, scaune multe cu puroi si sange
� Virala: Rotavirus, Enterovirus, caracterizata prin febra� Virala: Rotavirus, Enterovirus, caracterizata prin febrafoarte mare, scaune multe cu aspect aproape normal
� Parazitara: Giardia, caracterizata prin alternanta diaree / constipatie
� Micotica: Candida, diaree usoara, trenanta
� Greseli alimentare cantitative si/sau calitative
� Diareea la amoxicilina administrata oral
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BDA - tratament
Daca copilul primeste lichide – tratament ambulator
Daca copilul nu primeste lichide – internare
TratamentTratament
� Igienodietetic
�Reechilibrare hidoelectrolitica
�Regim de tranzitie
�Reluarea alimentatiei
� Etiologic
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BDA – tratament
Solutii pentru rehidratare orala
� Pentru 1 l
� Glucoza 20 g
� K Cl 1,5 g� K Cl 1,5 g
� Bicarbonat de Na 2,5 g
� Na Cl 3,5 g
� Se administreaza in apa sau ceai de menta neindulcit
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BDA – tratament
Alimentatie de tranzitie
� Supa de morcovi, mucilagiu de orez (la sugarul mic –decoct de orez)
Reluarea alimentatieiReluarea alimentatiei
� Lapte de mama sau formule fara lactoza
� La copilul diversificat
� Branza de vaci, iaurt (factor bifidus), paine prajita, pesmet
� NU lapte dulce, zahar, cartofi
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BDA – tratament
Tratament antibiotic
� Daca etiologia bacteriana a fost dovedita prin coprocultura
� Aspect clinic sugestiv pentru diareea bacteriana (sacun cu puroi si sange)
� Se folosescBiseptol 6 – 8 mg/kg/zi in 2 prize� Biseptol 6 – 8 mg/kg/zi in 2 prize
� Furazolidon 25 – 50 mg de 4 ori/zi� Ac. Nalidixic 55 mg/kg/zi in 4 prize� Quinolone
� Norfloxacin 400 mg de 2 ori/zi� Ciprofloxacin 500 mg de 2 ori/zi
� Ampicilina doar injectabil
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Infectii urinare
� Simptome la copil: subfebrilitati, dureri abdominale, inapetenta, stagnare in greutate
� Urocultura pozitiva: > 100.000 colonii
� Se trateaza conform antibiogramei
� Se repeta urocultura
� Daca uroculotura este din nou pozitiva se cauta altecauze: litiaza, malformatii renale, ptoza renala, hidronefroza, prolaps uterin etc.
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Convulsii
� Combaterea febrei mari > 390C
�Impachetari
�Antipiretice
� Tratament profilactic
�Diazepam 0,2 mg/kg intrarectal sau i.v.
�Fenobarbital 3 – 5 mg/kg per os
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Boli eruptive
Rujeola Rubeola Scarlatina Varicela
Antecedente Nu Nu Amigdalita anterior cu aprox 3 sapt
Nu
Incubatie 14 – 21 zile 14 – 21 zile 14 – 21 zile 14 – 21 zile
Debut Febra, facies plans Mai lent, subfebra, adenopatie
Febra mare, disfagie artralgii
pseudogripaladenopatieoccipitala
disfagie artralgii
Eruptie Maculopapuloasa, generalizata
Maculopapuloasa, generalizata
Nu prinde fataSemn Pastia –Grozovici (respectaplica cotului)
Vezicule perlate, in diferite stadiievolutive, extensiecentripeta
Enantem Faringe hiperemic, limba eritematoasa
+/- Faringe foarte rosu, limba zmeurie
+/-
Febra prezenta prezenta prezenta, mare prezenta
Varsta sugar sugar scolar (nu la sugar) prescolar, scolar
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Boli eruptive
Tratament
� Izolare
� Regim hidrolactozaharat si fainos
Igiena individuala� Igiena individuala
� Tratament simptomatic: febra, tuse, prurit etc.
� Se trateaza la domiciliu, exceptie rujeola si rubeola la sugari
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Boli parazitare
� Giardioza� Metronidazol (Flagyl) 15 – 20 mg/zi 7 zile
� Tinidazol (Fasygin) 50 – 75 mg/kg priza unica
� Albendazol (Zentel) 400 mg priza unica
� Oxiuroza� Mebendazol (Vermox) 100 mg priza unica repetat la 2 saptamani� Mebendazol (Vermox) 100 mg priza unica repetat la 2 saptamani
� Albendazol (Zentel) 400 mg priza unica repetat la 2 saptamani
� Ascaridioza� Levamisol (Decaris) 2,5 mg/kg se poate repeta la 2 saptamani
� Mebendazol (Vermox) 100 mg de 2 ori/zi 3 zile
� Albendazol (Zentel) 400 mg priza unica
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Boli dermatologice
� Eczema
� Seboreea
� Dermatita de contact
� Pitiriazis� Pitiriazis
� Scabia
� Pediculoza
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Tratamente simptomatice
� Febra
� Tuse
� Varsaturi
� Rinoree� Rinoree
� Prurit
� Durere