Prescription

Rx

• Dose: 240 mg per dose (15 mg/kg x 16 kg = 240 mg)
• Give: 1 tab (250 mg) per dose - closest available tablet strength
• Route: Oral
• Frequency: Every 4-6 hours as needed for fever
• Duration: Until fever-free for 24 hours (max 5 doses/day)
• Max daily dose: 80 mg/kg/day = 1280 mg/day
• Note: Do NOT use aspirin in children

• Dose: 10 mg/kg x 16 kg = 160 mg
• Give: 8 mL (160 mg) per dose
• Route: Oral
• Frequency: Every 6-8 hours as needed for fever (alternate with paracetamol if needed)
• Duration: 3 days
• Only if fever not adequately controlled by paracetamol alone. Not to be used <6 months of age.

• Reconstitute 1 sachet in 200 mL clean water
• Give 50-100 mL after each loose stool
• Continue normal feeds and fluids
• WHO reduced-osmolarity ORS (Na 75 mmol/L, Glucose 75 mmol/L) is preferred - Tintinalli's Emergency Medicine

• Give: 1 tab (20 mg) once daily
• Route: Oral
• Duration: 14 days (per WHO/IAP recommendation for children >6 months: 20 mg/day x 14 days)
• Reduces duration and severity of diarrhea and prevents recurrence

• Give: 1 sachet/capsule twice daily with meals
• Duration: 5-7 days
• Evidence supports reduction of diarrhea duration when added to ORS

Advice

• Continue normal diet - do not withhold food; BRAT diet (banana, rice, applesauce, toast) may help
• Push fluids - water, diluted coconut water, rice water between ORS doses
• Monitor for danger signs - seek emergency care if:
  • Sunken eyes, dry mouth, no urine >6 hours (dehydration)
  • High fever >39.5°C not responding to antipyretics
  • Blood in stools
  • Vomiting repeatedly unable to keep ORS down
  • Child becomes drowsy or unconscious
• No antibiotics needed for a single episode of loose stools with fever - likely viral gastroenteritis; reassess if symptoms worsen beyond 48-72 hours
• Hand hygiene - wash hands before meals and after toilet

Dosing Summary Table

Disclaimer: This is a general clinical reference for a healthcare provider. Always individualize treatment based on full clinical assessment, local formulary availability, and current guidelines.

Updated Prescription

Rx

• 1 tablet per dose, oral
• Every 4-6 hours as needed for fever
• Max 5 doses/day
• Basis: 15 mg/kg x 16 kg = 240 mg → round to 250 mg

• 8 mL per dose, oral
• Every 6-8 hours if fever not controlled by paracetamol alone
• Duration: 3 days
• Basis: 10 mg/kg x 16 kg = 160 mg

• Dissolve 1 sachet in 200 mL clean water
• Give 50-100 mL after each loose stool
• Continue until diarrhea stops

• 1 tablet once daily, oral
• Duration: 14 days

• Composition: Bacillus mesentericus 1M spores + Clostridium butyricum 2M spores + Streptococcus faecalis 30M + Lactobacillus sporogenes 50M per 5 mL
• Dose for 7-year-old (16 kg): 5 mL (1 teaspoon) twice daily - after meals
• Route: Oral
• Duration: 5-7 days
• Store at room temperature, no refrigeration needed

Dosing Summary

Advice

• Continue normal diet, do not starve the child
• Push oral fluids - water, coconut water, rice water
• Return immediately if: sunken eyes, no urine >6 hours, blood in stool, persistent vomiting, high unresponsive fever, or child becomes lethargic

Note: Bifilac Syrup is given after meals to improve probiotic survival in the gut. The syrup formulation is suitable and palatable for this age group.

Prescription - Persistent Hiccups (Metoclopramide/Perinorm-Resistant)

Understanding the Classification

• Persistent hiccups = lasting >48 hours
• Intractable hiccups = lasting >1 month
• Metoclopramide (Perinorm) failed → escalate to next-line agents

Step 1 - Rule Out Underlying Cause First

• Foreign body in ear canal (hair touching tympanic membrane - common, easily missed)
• Gastric distension, GERD
• CNS lesion (stroke, tumor)
• Metabolic cause: uremia, hyperglycemia
• Drug-induced (dexamethasone, chemotherapy agents)
• Chest X-ray if not already done

Rx

• Initial dose: 25-50 mg orally (or 25-50 mg IV in hospital setting, repeat in 2-4 hours if needed)
• Maintenance: 25 mg three to four times daily
• Duration: Until hiccups resolve, then taper
• Watch for: Sedation, hypotension, extrapyramidal symptoms (EPS)
• Give with food to reduce gastric upset

• Initial dose: 10 mg orally
• Maintenance: 10 mg three times daily
• Can titrate up to 75 mg/day if needed
• Duration: 5-10 days, reassess
• Watch for: Sedation, muscle weakness, do not stop abruptly
• Preferred if CNS or spinal cord etiology suspected

• Initial dose: 100 mg orally
• Maintenance: 100 mg three times daily
• Can titrate up to 300-400 mg three times daily if needed
• Duration: 7-10 days
• Watch for: Dizziness, sedation

Drug Treatment Summary Table

Non-Pharmacological Maneuvers (Try Alongside)

• Swallow a teaspoon of dry granulated sugar (effective, simple)
• Sip ice-cold water rapidly
• Breath-holding or Valsalva maneuver
• Pharyngeal stimulation - nasopharyngeal catheter (hospital setting)
• Check and clear ear canal for hair/foreign body

Practical Recommendation for This Patient

1. Start Chlorpromazine 25 mg TDS - first pharmacological escalation
2. If no response in 24-48 hours → add Baclofen 10 mg TDS
3. Investigate for an underlying cause simultaneously (ear, CNS, metabolic)
4. If hiccups persist >1 month → refer for specialist workup

Sources: Tintinalli's Emergency Medicine (Table 62-7 - Drug Treatment of Hiccups); Textbook of Family Medicine 9e - Hiccups chapter

Caution: Chlorpromazine can cause significant hypotension - monitor BP especially if given IV. Use with caution in elderly patients or those on antihypertensives.