Archive

Diarrhea

#

1. IV therapy

    1. for adults:

        1. Serum 1/3 2/3 1-2 lit IV infusion

    2. for Children

        1. start with N/S 20cc/kg in 20 minutes repeat if needed *3

        2. Dehydration: w*(5-10-15)*10cc

        3. Maintenance (100-50-20cc/kg)

        4. if febrile >38C ⇒ 120cc/1 C

        5. Type of serum: HS + DW5%

            1. Serum DW5% ? cc + 30meq kcl + 112meq NaCl ⇒ 1/2 in 8 hours and 1/2 in 16 hours

        6. for each time defecation ⇒ 10cc/kg cc from HS + DW5%

        7. for each time vomiting ⇒ 4cc/kg cc from serum N/S 1 lit + 10meq/lit kcl

2. N/V

    1. Amp ondansetron 4mg IV (0.15mg/kg)

        1. or Amp plasil 10mg IV (0.1-0.2 mg/kg)

3. Abdominal pain

    1. Amp hyoscine #1 IM

        1. or Amp dicyclomine #1 IM

        2. or Tab dicyclomine 10 mg qid #20

        3. or Elixir dicyclomine 10mg qid #1

4. Inflammatory diarrhea ⇒ use Ab therapy

    1. >48 hrs

    2. bloody

    3. >40 C fever

    4. >50 y/o and severe abdominal pain

    5. tropical passenger

    6. >70 y/o

    7. immunodeficient

    8. severe watery diarrhea (vibrio)

    9. chef or hospital staff

5. Ab therapy

    1. Tab ciprofloxacin 500 mg #6 po bid

    2. for pregnancy and <18 y/o

        1. Tab azithromycin 500 mg #3 qd

    3. or

        1. Amp ceftriaxone 1 gr IV stat

        2. Amp Apotel 1gr IV stat

    4. for Giardia, Amebic

        1. Tab metronidazole 250 mg #20 tds

    5. if Hx of Ab therapy or suspicious of C. diff

        1. Tab metronidazole 500 mg tds #30

            1. or Vial vancomycin 1gr #10 PO

        2. Cap familact #60 BID

6. Non-inflammatory diarrhea

    1. Tab loperamide 2mg po #8, 2tab stat, 1tab/defecation, max 8 tabs

        1. or Tab diphenoxylate and atropine #8 q6h for 2 days

7. Pro-biotics in 2 hours post Ab therapy

    1. Cap familact #60 bid for adults

    2. Drop Pedilact 5 drops bid (1m/o-2y/o)

    3. Sachet Kidilact BID (mixed with food)

8. PO hydration

    1. Mild:

        1. Powder ORS 50cc/kg in 4 hours

    2. Moderate to severe

        1. Powder ORS 75cc/kg in 4 hours

    3. Handmade ORS: 4 tea spoon of sugar + 1/2 tea spoon of salt in 1 lit H2O

9. Fever + N/V + Inflammatory diarrhea

    1. Amp ondansetron 0.15mg/kg

    2. syrup acetaminophen 10-15mg/kg qid

        1. or amp acetaminophen 150 mg IV stat

    3. Syrup zinc sulfate 5mg/5ml 0.5mg/kg bid

    4. syrup azithromycin 120mg po start then 60 mg po qd for 4 days

10. Check

    1. S/E, S/C

    2. U/A, U/C

    3. CBC, diff

    4. B/C

    5. NA, K, BUN, Cr

DDx, Inf. Diseases
April 16, 2026 (0)

 Diaper Rash

#

1. Treatment

    1. oint zinc oxide 2% #1 PRN

        1. or Powder sucralfate #1 PRN

    2. Oint hydrocortisone 1% bid #1

    3. For bacterial infection:

        1. Oint mupirocin 2% bid #1

    4. For candida infection with satellite lesions

        1. cream clotrimazole 1% bid #1

            1. or oint nystatin bid #1

            2. or cream ketoconazole 2% bid #1

2. do not use steroids with anti fungal

3. if after 3 days of treatment with anti biotics, the pt is still symptomatic with new satellite lesions, treat candida

4. DDx: millia

    1. keratin pearl

    2. no need for treatment

DDx, Inf. Diseases, Pediatrics
April 16, 2026 (0)

Diabetes mellites

#

1. Diagnostic criterion:

    1. FBS>126

    2. HbA1c>6.5

    3. 2hpp>200

    4. Random BS>200 + typical symptoms

    5. if one is positive, repeat it or use two of them to confirm diagnosis

2. Treatment

    1. Tab metformin 500 mg qd #30 (increase every 2 week about 500 mg daily, max dose/day 2 gr)

    2. Tab gliclazide 30 mg #30 before meal

    3. or Tab sitagliptin 50 qd #100

    4. Tab Zipmet (Metformin + sitagliptin) 50/500 or 50/1000 mg

3. Insulin

    1. start when after triple therapy:

        1. BS is not well controlled

        2. GFR<30

        3. high Cr

        4. FBS>250 from beginning

    2. Start with 0.3-0.4 u/kg

    3. Vial insulin regular

    4. vial insulin NPH

4. Goal of treatment

    1. FBS<130 check every 2 weeks

    2. HbA1c<7 check every 3 month

    3. 2hpp<180

DDx
April 16, 2026 (0)

Depression

#

1. All choices for prescription:

    1. SSRIs:

        1. Cap Fluoxetine (Prozac) 10, 20mg, and syrup 20mg/5ml

            1. Contraindicated in

                1. DM

                2. Seizure poorly controlled

                3. CKD

                4. Liver disease

            2. side effects:

                1. headache

                2. anxiety

                3. anger

                4. xerostomia

                5. N/V

                6. GI upset

                7. sleep problem as بیخوابی

            3. in Breast feeding and pregnancy, with measuring advantages V.s disadvantages

        2. Tab sertraline (Asentra,  Zoloft) 25, 50, 100mg

        3. Tab Citalopram (Celexa) 20, 40mg

        4. Tab Paroxetine 10, 20, 30mg

        5. Tab Escitalopram (Lexatal) 5, 10, 20mg

    2. SSRIs have drug interaction with methadone

2. How to choose:

    1. young, no PMHx, lack of energy

        1. Cap fluoxetine 10mg #100 qd at morning

    2. with PMHx and DHx:

        1. Tab Asentra 25mg #100 qd

            1. or Tab Lexatal 5mg #100 qd

    3. postnatal depression

        1. Tab Prozac 10mg #60 qd

    4. for impotence:

        1. Tab sildenafil 50mg #30 1hour before intercourse

        2. Tab bupropion 75,100, 150mg #30 qd

3. Refer if:

    1. no proper care

    2. misdiagnosis

    3. need for paraclinic

    4. possibility of homicide or suicide

DDx
April 16, 2026 (0)

Cystitis

#

1. Symptoms:

    1. Dysuria

    2. frequency

    3. hypogastric pain

    4. more seen in women

2. Treatment

    1. Tab TMP-SMX 800-160mg bid for 3 days

        1. or tab ciprofloxacin 500mg bid

        2. or tab nitrofurantoin 100mg tds

    2. for dysuria:

        1. Tab phenazopyridine #10 qid

            1. causes urine color change

            2. do not use for more than 3 days

    3. in pregnancy

        1. Cap cefalexin 500mg qid for 7 days

            1. or Tab nitrofurantoin 100mg tds

    4. in men, always take U/A, U/C

3. In Old person with frequency but without any sign/symptoms of BPH and NL lab data

    1. Tab oxybutynin 5mg #10 tds

        1. or tab tolterodine 1mg #10 bid

        2. or Tab solifenacin 5mg #10 bid

DDx, Inf. Diseases
April 16, 2026 (0)

Croup

#

1. Etiology:

    1. parainfluenza virus

2. Symptoms

    1. in <6y/o

    2. most common in 6m/o-3y/o

    3. low grade fever

    4. barking cough

    5. Hx of common cold from 2-3 days prior to visit

3. Orders:

    1. observe for 3 hours, discharge if stridor resolved and Family is alert

    2. Neck x-ray AP and Lateral (for steeple sign)

    3. Nep epinephrine 1:1000 2.5 cc in 3 ml N/S

        1. >5y/o 5 cc & <5y/o 2.5 cc

    4. Amp dexamethasone 0.6mg/kg IM

4. Other treatments:

    1. tab prednisolone 2mg/kg/day 2-3 times/day

5.

DDx, Inf. Diseases
April 16, 2026 (0)

Cradle cap

#

1. characteristics:

    1. a form of seborrheic dermatitis

    2. yellowish dandruff

2. Treatment

    1. Olive oil at night, wash at morning

    2. for refractory cases:

        1. Shampoo ketoconazole 2 times/week for 2 weeks

DDx, Inf. Diseases
April 16, 2026 (0)

Contact dermatitis

#

1. Moisturizing agents:

    1. Cream Moringa #1

    2. Cream Doctor Jilan #1

    3. Cream Face Doux #1

    4. Cream QV #1

2. Corticosteroids

    1. Oint hydrocortisone 1% bid for 2 weeks #1 ⇒ use for sensitive and thin skin

        1. or Oint Tacrolimus 0.03% for >18 y/o #1

        2. Or oint tacrolimus 0.1% for >2y/o #1

    2. Oint betamethasone bid for 2 weeks #1

DDx
April 16, 2026 (0)