Herpesvirus Diseases: Differential Diagnosis & Treatment Guide

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// ═══════════════════════════════════════════════════════════════════════════════
//  DOCUMENT CONTENT
// ═══════════════════════════════════════════════════════════════════════════════

const children = [];

// ── COVER PAGE ─────────────────────────────────────────────────────────────────
children.push(
  new Paragraph({ spacing: { before: 1200, after: 60 } }),
  new Paragraph({
    children: [bold("THE GP BIBLE", 72, C.darkBlue)],
    alignment: AlignmentType.CENTER, spacing: { before: 0, after: 40 }
  }),
  new Paragraph({
    children: [bold("INDIA EDITION", 48, C.medBlue)],
    alignment: AlignmentType.CENTER, spacing: { before: 0, after: 80 }
  }),
  new Paragraph({
    children: [new TextRun({ text: "━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━", size: 24, color: C.medBlue, font: "Calibri" })],
    alignment: AlignmentType.CENTER, spacing: { before: 0, after: 80 }
  }),
  new Paragraph({
    children: [bold("VOLUME 2", 56, C.teal)],
    alignment: AlignmentType.CENTER, spacing: { before: 0, after: 20 }
  }),
  new Paragraph({
    children: [bold("PEDIATRICS", 56, C.teal)],
    alignment: AlignmentType.CENTER, spacing: { before: 0, after: 60 }
  }),
  new Paragraph({
    children: [italic("Practical Handbook for MBBS Doctors, Medical Officers & NEET PG", 24)],
    alignment: AlignmentType.CENTER, spacing: { before: 0, after: 120 }
  }),
  new Paragraph({
    children: [new TextRun({ text: "━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━", size: 24, color: C.medBlue, font: "Calibri" })],
    alignment: AlignmentType.CENTER, spacing: { before: 0, after: 80 }
  }),
  para([bold("Chapters:", 22, C.darkBlue)], AlignmentType.CENTER),
  para([normal("1. How to Calculate Pediatric Doses  |  2. Weight Estimation (Age-Based)", 20, C.black)], AlignmentType.CENTER, 20, 20),
  para([normal("3. Top 60 Syrups — Dose, Brand, Indication  |  4. Top 40 Pediatric Injections", 20, C.black)], AlignmentType.CENTER, 20, 20),
  para([normal("5. Weight-Wise Dosing Tables (5–50 kg)  |  6. Neonatal Drug Reference", 20, C.black)], AlignmentType.CENTER, 20, 20),
  para([normal("7. IAP Vaccination Schedule 2023–24  |  8. NIP (Universal) Schedule", 20, C.black)], AlignmentType.CENTER, 20, 20),
  para([normal("9. Pediatric Emergency Protocols  |  10. Common Pediatric Prescriptions", 20, C.black)], AlignmentType.CENTER, 20, 20),
  para([normal("11. Red Flags & Referral Criteria  |  12. Normal Pediatric Vitals", 20, C.black)], AlignmentType.CENTER, 20, 20),
  new Paragraph({ spacing: { before: 120 } }),
  new Paragraph({
    children: [italic("Based on IAP 2023-24 guidelines, ICMR STW, Red Book 2021, Harriet Lane Handbook 23e, WHO IMCI", 18)],
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  }),
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// ── CHAPTER 1: HOW TO CALCULATE DOSES ────────────────────────────────────────
children.push(
  heading1("CHAPTER 1 — HOW TO CALCULATE PEDIATRIC DOSES"),
  heading2("The Golden Formula"),
  para([bold("Required Dose (mg)  =  Dose per kg (mg/kg)  ×  Body Weight (kg)", 22, C.darkBlue)], AlignmentType.CENTER, 80, 80),
  para([bold("Volume to give (mL)  =  Required Dose (mg)  ÷  Concentration of syrup (mg/mL)", 22, C.darkBlue)], AlignmentType.CENTER, 40, 80),
  heading3("Worked Example"),
  para([normal("Drug: Paracetamol syrup (120 mg / 5 mL = 24 mg/mL)   |   Dose: 15 mg/kg   |   Weight: 12 kg")]),
  para([bold("Step 1: Required dose = 15 × 12 = 180 mg")]),
  para([bold("Step 2: Volume = 180 ÷ 24 = 7.5 mL ✓")]),
  heading3("Important Rules"),
  bullet("Always use body weight (not age) to calculate dose"),
  bullet("Always check the CONCENTRATION on the bottle before calculating volume"),
  bullet("Round dose to nearest 0.5 mL for syrup; nearest 0.1 mL for injections < 1 mL"),
  bullet("Never exceed the ADULT maximum dose even in large children"),
  bullet("Re-weigh child at each visit — dose must be adjusted as weight increases"),
  alertBox("⚠ COMMON MISTAKE:", "Paracetamol syrup exists as 120 mg/5 mL AND 250 mg/5 mL — ALWAYS check label concentration", C.lightAmber, C.amber),
);

// ── CHAPTER 2: WEIGHT ESTIMATION ─────────────────────────────────────────────
children.push(
  heading1("CHAPTER 2 — WEIGHT ESTIMATION BY AGE"),
  heading2("Quick Formulas (When Scale Unavailable)"),
  makeTable(
    ["Age", "Formula / Estimate", "Example"],
    [
      ["0–12 months", "Weight (kg) = (Age in months + 9) ÷ 2", "3 months → (3+9)/2 = 6 kg"],
      ["1–6 years",   "Weight (kg) = (Age in years × 2) + 8",  "3 years → (3×2)+8 = 14 kg"],
      ["7–12 years",  "Weight (kg) = (Age in years × 3) + 3",  "9 years → (9×3)+3 = 30 kg"],
      ["APLS formula (ED use)", "Weight (kg) = (Age in years + 4) × 2",   "6 years → (6+4)×2 = 20 kg"],
    ],
    [25, 45, 30]
  ),
  heading2("Normal Weights by Age — Quick Reference"),
  makeTable(
    ["Age", "Expected Weight (kg)", "Expected Length/Height", "Head Circumference"],
    [
      ["Birth (term)",   "2.5 – 3.5",  "48 – 52 cm", "33 – 35 cm"],
      ["3 months",       "~6",          "~61 cm",      "~40 cm"],
      ["6 months",       "~7.5",        "~67 cm",      "~43 cm"],
      ["9 months",       "~9",          "~72 cm",      "~44 cm"],
      ["12 months",      "~10",         "~75 cm",      "~46 cm"],
      ["18 months",      "~11",         "~82 cm",      "~47 cm"],
      ["2 years",        "~12",         "~87 cm",      "~48 cm"],
      ["3 years",        "~14",         "~96 cm",      "~49 cm"],
      ["5 years",        "~18",         "~110 cm",     "~50 cm"],
      ["10 years",       "~32",         "~138 cm",     "~52 cm"],
    ],
    [20, 25, 30, 25]
  ),
  heading2("Normal Pediatric Vitals"),
  makeTable(
    ["Age", "HR (bpm)", "RR (/min)", "SBP (mmHg)", "SpO2 (%)"],
    [
      ["Neonate (0–28 d)", "100–160", "40–60", "60–90",  "≥95"],
      ["Infant (1–12 mo)", "100–150", "30–40", "70–100", "≥95"],
      ["Toddler (1–3 yr)", "90–140",  "25–35", "80–110", "≥95"],
      ["Preschool (3–5 yr)","80–120", "22–30", "85–110", "≥95"],
      ["School (6–12 yr)", "70–110",  "18–25", "90–120", "≥95"],
      ["Adolescent (>12)", "60–100",  "12–20", "100–130","≥95"],
    ],
    [22, 16, 16, 22, 24]
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);

// ── CHAPTER 3: TOP 60 SYRUPS ─────────────────────────────────────────────────
children.push(
  heading1("CHAPTER 3 — TOP 60 SYRUPS (Dose · Brand · Indication)"),
  heading2("A. Antipyretics & Analgesics"),
  makeTable(
    ["Drug", "Concentration", "Dose (mg/kg)", "Frequency", "Max Dose", "Indian Brands", "Indication"],
    [
      ["Paracetamol (PCM)", "120 mg/5 mL\n250 mg/5 mL", "15 mg/kg", "Q4–6h PRN", "1 g/dose; 4 g/day", "Calpol, Metacin, Pyrigesic, Fepanil", "Fever, mild pain"],
      ["Ibuprofen", "100 mg/5 mL", "5–10 mg/kg", "Q6–8h", "40 mg/kg/day; max 400 mg/dose", "Brufen, Ibugesic, Advil peds", "Fever, pain, inflammation (>6 months)"],
      ["Mefenamic acid", "50 mg/5 mL", "5 mg/kg", "Q8h", "3 days; 20 mg/kg/day", "Meftal-P, Ponstan syrup", "Fever, pain, dysmenorrhoea"],
      ["Nimesulide", "50 mg/5 mL", "NOT for <12 yr", "Avoid", "BANNED <12 yr in India", "Banned / Nimulid only adult", "Avoid in children — hepatotoxicity"],
    ],
    [14, 14, 12, 11, 17, 18, 14]
  ),
  heading2("B. Antibiotics"),
  makeTable(
    ["Drug", "Concentration", "Dose (mg/kg/day)", "Doses/Day", "Duration", "Indian Brands", "Indication"],
    [
      ["Amoxicillin",        "125 mg/5 mL\n250 mg/5 mL", "40–80 mg/kg/day\n(high dose for AOM/pneumonia: 80–90)", "TID",  "5–10 d", "Mox, Novamox, Amoxil", "Pharyngitis, AOM, sinusitis, URTI"],
      ["Amoxicillin+Clav",  "228 mg/5 mL\n312 mg/5 mL", "40–80 mg/kg/day (amoxicillin component)", "BD or TID", "5–7 d", "Augmentin, Clavam, Amoxyclav", "AOM, sinusitis, LRTI, skin infections"],
      ["Azithromycin",       "200 mg/5 mL", "10 mg/kg Day 1, then 5 mg/kg Days 2–5", "OD",  "5 d", "Azithral, Zithromax, Azee", "Atypical pneumonia, URTI, pertussis"],
      ["Cefixime",           "50 mg/5 mL\n100 mg/5 mL", "8 mg/kg/day", "BD or OD", "5–10 d", "Taxim-O, Cefix, Zifi", "UTI, AOM, tonsillopharyngitis, typhoid"],
      ["Cetirizine",         "5 mg/5 mL",  "0.25 mg/kg/dose", "OD",  "Ongoing", "Cetrizet, Cetzine, Alerid", "Allergic rhinitis, urticaria"],
      ["Cotrimoxazole (TMP-SMX)", "40/200 mg per 5 mL", "TMP 8 mg/kg/day\nSMX 40 mg/kg/day", "BD", "5–10 d", "Bactrim, Septran, Cotrim", "UTI, PCP prophylaxis, MRSA skin"],
      ["Erythromycin",       "125 mg/5 mL", "30–50 mg/kg/day", "QID", "5–7 d", "Erythrocin, Althrocin", "Pertussis, strep throat, Campylobacter"],
      ["Metronidazole",      "200 mg/5 mL", "20–30 mg/kg/day", "TID", "5–7 d", "Flagyl, Metrogyl, Aldezole", "Giardia, amoeba, anaerobic infections"],
      ["Fluconazole",        "50 mg/5 mL",  "6 mg/kg on Day 1, then 3 mg/kg/day", "OD", "7–14 d", "Forcan, Zocon, Diflucan", "Candidiasis, tinea infections"],
      ["Furazolidone",       "25 mg/5 mL",  "5 mg/kg/day", "QID", "5–7 d", "Furoxone", "Giardia, diarrhea (not 1st line)"],
    ],
    [14, 12, 16, 8, 9, 17, 24]
  ),
  heading2("C. Respiratory Drugs"),
  makeTable(
    ["Drug", "Concentration", "Dose", "Frequency", "Indian Brands", "Indication"],
    [
      ["Salbutamol",       "2 mg/5 mL",   "0.1–0.15 mg/kg/dose", "Q6–8h", "Asthalin, Ventolin, Salbair", "Acute bronchospasm, asthma"],
      ["Montelukast",      "4 mg/5 mL",   "Age 6 mo–5 yr: 4 mg/day; 6–14 yr: 5 mg/day", "OD (night)", "Montair, Singulair, Romilast", "Allergic rhinitis, asthma prophylaxis"],
      ["Levocetrizine",    "2.5 mg/5 mL", "0.1 mg/kg/dose",   "OD (night)", "Xyzal, Levocet, Levorid", "Allergic rhinitis, urticaria"],
      ["Loratadine",       "5 mg/5 mL",   "2–5 yr: 5 mg/day; >5 yr: 10 mg/day", "OD", "Lorfast, Clarityne, Alavert", "Allergic rhinitis, urticaria"],
      ["Fexofenadine",     "30 mg/5 mL",  "6–11 yr: 30 mg BD; >12 yr: 60 mg BD", "BD", "Allegra, Histafree", "Allergic rhinitis"],
      ["Dextromethorphan", "10 mg/5 mL",  "0.5–1 mg/kg/dose", "Q6–8h", "Grilinctus, Alex, Coscopin", "Dry cough (>2 yr)"],
      ["Bromhexine",       "4 mg/5 mL",   "0.5 mg/kg/dose", "TID", "Bisolvon, Bromhexine syrup", "Productive cough, mucus clearance"],
      ["Ambroxol",         "15 mg/5 mL",  "1.2–1.6 mg/kg/day", "BD–TID", "Mucosolvan, Ambrolite, Ambril", "URTI with productive cough"],
      ["Ipratropium neb.", "0.25 mg/mL",  "250 mcg/dose (child)",    "Q6h", "Ipravent, Atrovent", "Severe bronchospasm (add to salbutamol)"],
    ],
    [16, 14, 18, 12, 20, 20]
  ),
  heading2("D. GI Drugs"),
  makeTable(
    ["Drug", "Concentration", "Dose", "Frequency", "Indian Brands", "Indication"],
    [
      ["ORS (WHO)",          "Per sachet in 1 L water", "50–100 mL/kg over 4 h (mild-mod dehydration)", "Ad lib", "Electral, ORS-IP, Pedialyte", "Dehydration, diarrhea — first line"],
      ["Zinc sulfate",       "20 mg/5 mL", "<6 mo: 10 mg/day; ≥6 mo: 20 mg/day", "OD × 14 days", "Zincovit, Zinctus, Z&D", "Diarrhea adjunct (WHO/IAP recommendation)"],
      ["Domperidone",        "5 mg/5 mL",  "0.2–0.4 mg/kg/dose", "TID before feeds", "Domstal, Motilium, Vomikind", "Nausea, vomiting, gastroparesis"],
      ["Ondansetron",        "2 mg/5 mL",  "0.15 mg/kg/dose (max 4 mg)", "Q8h", "Emeset, Ondaforce, Zofer", "Acute vomiting, post-chemo N&V"],
      ["Lactulose",          "3.3 g/5 mL", "1–3 mL/kg/day", "BD", "Duphalac, Lactofree", "Constipation, hepatic encephalopathy"],
      ["Ranitidine",         "75 mg/5 mL", "2–4 mg/kg/day", "BD", "Zinetac, Aciloc, Histac", "GERD, peptic ulcer (largely replaced by PPIs)"],
      ["Omeprazole",         "20 mg capsule (sprinkle)", "0.5–1 mg/kg/day", "OD before food", "Omez, Prilosec, Omizac", "GERD, peptic disease"],
      ["Simethicone",        "40 mg/0.6 mL dropper", "40–80 mg after feeds", "QID", "Infacol, Simethicone drops", "Infantile colic, flatulence (<2 yr)"],
      ["Albendazole",        "200 mg/5 mL", "12.5 mg/kg single dose (max 400 mg)", "Single dose", "Albendazole, Zentel, Bandy", "Ascaris, hookworm, giardia (>1 yr)"],
      ["Mebendazole",        "100 mg/5 mL", "100 mg BD × 3 days (>2 yr)", "BD × 3 d", "Vermox, Wormin", "Roundworm, hookworm"],
    ],
    [14, 14, 20, 12, 20, 20]
  ),
  heading2("E. CNS / Neurology Drugs"),
  makeTable(
    ["Drug", "Concentration", "Dose", "Frequency", "Indian Brands", "Indication"],
    [
      ["Diazepam rectal","5 mg/mL","0.5 mg/kg PR","Single if seizing","Calmpose, Valium","Active seizure (no IV access)"],
      ["Phenobarbitone","20 mg/5 mL","3–5 mg/kg/day (maintenance)","OD–BD","Phenobarbitone, Gardenal","Epilepsy, neonatal seizures"],
      ["Sodium valproate","200 mg/5 mL","20–40 mg/kg/day","BD–TID","Valparin, Encorate, Epilex","Epilepsy, absence, myoclonic"],
      ["Levetiracetam","100 mg/mL","20–60 mg/kg/day","BD","Levipil, Keppra, Levilex","Focal, generalised epilepsy"],
      ["Carbamazepine","100 mg/5 mL","10–20 mg/kg/day","BD–TID","Tegretol, Mazetol, Zen","Focal epilepsy, trigeminal neuralgia"],
      ["Clonazepam drops","2.5 mg/mL","0.01–0.05 mg/kg/dose","BD–TID","Clonotril, Rivotril","Absence, myoclonic seizures"],
    ],
    [16, 14, 18, 12, 22, 18]
  ),
  heading2("F. Iron, Vitamins, Nutritional"),
  makeTable(
    ["Drug", "Dose", "Frequency", "Indian Brands", "Indication"],
    [
      ["Iron (elemental)","3–6 mg/kg/day elemental iron","OD between meals","Feronia, PediaSure, Tonoferon","Iron-deficiency anemia"],
      ["Folic acid","1 mg/day (therapeutic)","OD","Folvite, Folic acid tabs","Megaloblastic anemia, NTD prevention"],
      ["Vitamin A","6–11 mo: 100,000 IU; ≥12 mo: 200,000 IU — repeat every 6 months","Single dose q6 months","Arovit, Vitamin A capsules","Vitamin A deficiency, measles"],
      ["Vitamin D","400 IU/day (0–1 yr); 600 IU/day (1–18 yr)","OD","D-Rise, Calcirol, Oleovit","Rickets prevention, supplementation"],
      ["Cholecalciferol (therapeutic)","60,000 IU/week × 8 weeks then 60,000 IU/month","Weekly × 8 wk","Arachitol, D-Bright, D-Shine","Nutritional rickets (serum 25OHD <20)"],
      ["Calcium","500 mg elemental/day in divided doses","BD","Shelcal, Calcimax, Calcium-C","Rickets, hypoparathyroidism"],
      ["Multivitamin drops","As per brand instruction","OD","Polybion, Tonoferon, VI-Daylin","General supplementation, malnutrition"],
    ],
    [20, 20, 12, 25, 23]
  ),
);

// ── CHAPTER 4: TOP 40 PEDIATRIC INJECTIONS ───────────────────────────────────
children.push(
  heading1("CHAPTER 4 — TOP 40 PEDIATRIC INJECTIONS"),
  heading2("Critical Rules for Pediatric Injections"),
  bullet("Always dilute for neonates and infants — never give adult-strength directly"),
  bullet("Check concentration BEFORE drawing up — errors most common at concentration step"),
  bullet("Flush line before and after to confirm placement and prevent drug interactions"),
  bullet("Extravasation of antibiotics/calcium causes tissue necrosis — check IV site before each dose"),
  alertBox("RED FLAG:", "IV Calcium chloride must ONLY be given via central line. IV Calcium gluconate is safer peripherally. Never mix calcium with bicarbonate.", C.lightRed, C.red),
  heading2("Antibiotics — IV/IM"),
  makeTable(
    ["Drug", "Dose", "Route", "Dilution", "Infusion Time", "Brands", "Indication"],
    [
      ["Ampicillin",       "50–100 mg/kg/dose Q6h\n(neonates: 50 mg/kg Q12h)", "IV/IM", "50 mg/mL in NS — infuse", "15–30 min", "Ampicillin inj", "Neonatal sepsis, meningitis, UTI"],
      ["Gentamicin",       "2.5 mg/kg/dose Q8h\n(neonates: 5 mg/kg Q24–36h)", "IV/IM", "1–2 mg/mL in NS", "30 min", "Gentamicin inj", "Gram-negative, neonatal sepsis"],
      ["Cefotaxime",       "50 mg/kg/dose Q8h\n(meningitis: Q6h)", "IV/IM", "100 mg/mL in NS", "15–30 min", "Claforan, Taxim", "Meningitis, sepsis, pneumonia"],
      ["Ceftriaxone",      "50–75 mg/kg/dose OD or BD\n(meningitis: 100 mg/kg/day)", "IV/IM", "100 mg/mL in NS", "30 min IV", "Monocef, Rocephin, Oframax", "Meningitis, sepsis, typhoid"],
      ["Cefoperazone-Sulbactam","30–60 mg/kg/day BD", "IV","10 mg/mL in NS","30 min","Sulbacin, Magnex","Resistant gram-negatives"],
      ["Piperacillin-Tazobactam","80 mg/kg Q6–8h","IV","≥10 mL NS","30 min","Piptaz, Zosyn","Nosocomial infections, febrile neutropenia"],
      ["Vancomycin",       "10–15 mg/kg/dose Q6h\n(neonates: Q12–24h)", "IV", "5 mg/mL in NS", "60 min (≥1 h — red man)", "Vancomycin inj", "MRSA, resistant gram+, meningitis"],
      ["Metronidazole",    "7.5 mg/kg/dose Q8h", "IV",  "Infuse as is", "30 min", "Metrogyl IV, Flagyl IV", "Anaerobic infections, abdominal sepsis"],
      ["Acyclovir",        "10–20 mg/kg Q8h\n(HSV encephalitis: 20 mg/kg Q8h × 21 d)", "IV", "7 mg/mL in NS, infuse over 1h", "1 hour", "Zovirax IV", "HSV encephalitis, neonatal HSV, VZV"],
      ["Fluconazole",      "6 mg/kg Day1; 3–6 mg/kg/day OD", "IV", "Ready to infuse (2 mg/mL)", "60 min", "Fluconazole IV, Forcan IV", "Invasive Candida, cryptococcal meningitis"],
    ],
    [14, 16, 7, 16, 10, 18, 19]
  ),
  heading2("Emergency Drugs — IV"),
  makeTable(
    ["Drug", "Dose", "Route", "Preparation", "Rate/Notes", "Indication"],
    [
      ["Adrenaline (Epinephrine)","Cardiac arrest: 0.01 mg/kg IV/IO (0.1 mL/kg of 1:10,000)\nAnaphylaxis: 0.01 mg/kg IM 1:1000", "IV/IO/IM", "1:10,000 = 0.1 mg/mL", "IV push in arrest; IM for anaphylaxis", "Cardiac arrest, anaphylaxis"],
      ["Atropine",    "0.02 mg/kg (min 0.1 mg) IV", "IV", "Give undiluted", "IV push", "Bradycardia, organophosphate poisoning"],
      ["Adenosine",   "0.1 mg/kg rapid IV push (max 6 mg)\n2nd: 0.2 mg/kg (max 12 mg)", "IV", "Undiluted, large bore", "RAPID IV push + flush immediately", "SVT"],
      ["Diazepam",    "0.3–0.5 mg/kg IV (max 10 mg)\n0.5 mg/kg PR", "IV/PR", "2 mg/mL, slow push", "2 mg/min IV; watch resp", "Active seizure"],
      ["Lorazepam",   "0.1 mg/kg IV (max 4 mg)", "IV", "0.5–1 mg/mL in NS", "1–2 min; watch resp", "Preferred IV benzodiazepine for seizure"],
      ["Midazolam",   "0.2 mg/kg IV; 0.2 mg/kg IM; 0.3 mg/kg IN (max 10 mg)", "IV/IM/IN", "1 mg/mL in NS", "2 min; preferred IM/IN route", "Status epilepticus"],
      ["Phenobarbitone","20 mg/kg IV loading (max 1000 mg)", "IV slow","10 mg/mL in NS","60 min; watch BP + resp","Status epilepticus 2nd/3rd line"],
      ["Levetiracetam","40–60 mg/kg IV (max 4500 mg)","IV","15 mg/mL in NS","15 min","Status epilepticus 2nd line — no sedation"],
      ["Phenytoin",   "15–20 mg/kg IV (max 50 mg/min)", "IV slow","1–10 mg/mL in NS ONLY (not dextrose)","50 mg/min max — ECG monitor","Status epilepticus — caution cardiac"],
      ["Mannitol",    "0.5–1 g/kg IV", "IV", "20% solution", "15–30 min", "Raised ICP, cerebral edema"],
      ["Dexamethasone","0.15 mg/kg IV pre-antibiotic or with 1st dose", "IV", "Ready", "IV push or 15 min infusion", "Bacterial meningitis, croup, anaphylaxis"],
      ["Hydrocortisone","Stress dose: 2 mg/kg IV Q6h; anaphylaxis: 5 mg/kg IV", "IV", "50 mg/mL in NS", "5–10 min", "Adrenal crisis, anaphylaxis, severe asthma"],
      ["Furosemide",  "1–2 mg/kg/dose IV (max 40 mg)", "IV", "10 mg/mL, dilute", "Over 2–4 min; not >4 mg/kg/min", "Fluid overload, pulmonary edema"],
      ["Glucose 10%", "Hypoglycemia: 2.5 mL/kg (= 0.25 g/kg dextrose)", "IV", "100 mg/mL = 10% dextrose", "Over 5 min, then check glucose", "Neonatal/pediatric hypoglycemia"],
      ["Calcium gluconate 10%","1 mL/kg IV (= 0.5 mEq/kg elemental Ca)","IV slow","Dilute 1:1 in NS","Over 10 min; ECG monitor; PERIPHERAL OK","Hypocalcemia, hyperkalemia (cardiac)"],
      ["Adenosine",   "See above","IV","See above","See above","SVT"],
      ["KCl (0.3 mEq/mL)","0.5–1 mEq/kg over 1–2 h (max 0.5 mEq/kg/h)","IV","Must be diluted; NEVER bolus","Infusion ONLY — central preferred","Severe hypokalemia"],
      ["Ceftriaxone + Dext","DON'T mix","IV","INCOMPATIBLE","Never mix in same line","Precipitates — separate flushes needed"],
    ],
    [14, 18, 7, 16, 18, 27]
  ),
);

// ── CHAPTER 5: WEIGHT-WISE DOSING TABLE ──────────────────────────────────────
children.push(
  heading1("CHAPTER 5 — WEIGHT-WISE DOSING TABLES"),
  heading2("Paracetamol (15 mg/kg) — Syrup 120 mg/5 mL"),
  makeTable(
    ["Weight (kg)", "Approx Age", "Dose (mg)", "Volume (120 mg/5mL)", "Max Doses/Day"],
    [
      ["5 kg",   "~2–3 mo",  "75 mg",   "3.1 mL",  "4"],
      ["7 kg",   "~4–6 mo",  "105 mg",  "4.4 mL",  "4"],
      ["10 kg",  "~12 mo",   "150 mg",  "6.3 mL",  "4"],
      ["12 kg",  "~18 mo",   "180 mg",  "7.5 mL",  "4"],
      ["15 kg",  "~3 yr",    "225 mg",  "9.4 mL",  "4"],
      ["18 kg",  "~4 yr",    "270 mg",  "11.3 mL", "4"],
      ["20 kg",  "~5–6 yr",  "300 mg",  "12.5 mL", "4"],
      ["25 kg",  "~7–8 yr",  "375 mg",  "15.6 mL", "4"],
      ["30 kg",  "~9–10 yr", "450 mg",  "18.8 mL", "4"],
      [">33 kg", ">10 yr",   "500 mg",  "Adult tablet — 500 mg", "4"],
    ],
    [15, 15, 20, 25, 25]
  ),
  heading2("Amoxicillin (80 mg/kg/day TID) — Syrup 250 mg/5 mL"),
  makeTable(
    ["Weight (kg)", "Daily Dose", "Per Dose (TID)", "Volume per dose (250 mg/5 mL)", "Max Duration"],
    [
      ["5 kg",  "400 mg/day",  "133 mg",  "2.7 mL",  "7–10 days"],
      ["7 kg",  "560 mg/day",  "187 mg",  "3.7 mL",  "7–10 days"],
      ["10 kg", "800 mg/day",  "267 mg",  "5.3 mL",  "7–10 days"],
      ["12 kg", "960 mg/day",  "320 mg",  "6.4 mL",  "7–10 days"],
      ["15 kg", "1200 mg/day", "400 mg",  "8 mL",    "7–10 days"],
      ["20 kg", "1600 mg/day", "533 mg",  "10.7 mL", "7–10 days"],
      [">25 kg","MAX: 1000 mg TID (adult dose)", "500 mg", "Adult capsule 500 mg", "7–10 days"],
    ],
    [15, 18, 18, 25, 24]
  ),
  heading2("Azithromycin (Day 1: 10 mg/kg, Day 2–5: 5 mg/kg) — Syrup 200 mg/5 mL"),
  makeTable(
    ["Weight (kg)", "Day 1 Dose (mg)", "Day 1 Volume", "Day 2–5 Dose (mg)", "Day 2–5 Volume"],
    [
      ["5 kg",  "50 mg",  "1.25 mL", "25 mg",  "0.6 mL"],
      ["7 kg",  "70 mg",  "1.75 mL", "35 mg",  "0.9 mL"],
      ["10 kg", "100 mg", "2.5 mL",  "50 mg",  "1.25 mL"],
      ["15 kg", "150 mg", "3.75 mL", "75 mg",  "1.9 mL"],
      ["20 kg", "200 mg", "5 mL",    "100 mg", "2.5 mL"],
      ["25 kg", "250 mg", "6.25 mL", "125 mg", "3.1 mL"],
      ["30 kg", "300 mg", "7.5 mL",  "150 mg", "3.75 mL"],
      [">40 kg","500 mg", "Adult tab","250 mg","Adult tab"],
    ],
    [15, 18, 18, 22, 22]
  ),
  heading2("Ibuprofen (10 mg/kg/dose Q8h) — Syrup 100 mg/5 mL"),
  makeTable(
    ["Weight (kg)", "Dose per dose (mg)", "Volume (100 mg/5mL)", "Max doses/day", "Notes"],
    [
      ["5 kg",  "50 mg",  "2.5 mL",  "3", ">6 months only"],
      ["7 kg",  "70 mg",  "3.5 mL",  "3", "With food"],
      ["10 kg", "100 mg", "5 mL",    "3", "Not in dehydration"],
      ["15 kg", "150 mg", "7.5 mL",  "3", ""],
      ["20 kg", "200 mg", "10 mL",   "3", "Max 400 mg/dose"],
      ["25 kg", "250 mg", "12.5 mL", "3", "Max 400 mg/dose"],
      [">40 kg","400 mg", "20 mL or Adult tab","3","Max 1200 mg/day children"],
    ],
    [15, 20, 22, 15, 28]
  ),
);

// ── CHAPTER 6: NEONATAL DRUG REFERENCE ───────────────────────────────────────
children.push(
  heading1("CHAPTER 6 — NEONATAL DRUG REFERENCE"),
  alertBox("IMPORTANT:", "Neonatal doses differ significantly from older children. Always confirm gestational age, postnatal age, and weight before prescribing. When in doubt, consult a neonatologist.", C.lightRed, C.red),
  heading2("Neonatal Antibiotic Dosing"),
  makeTable(
    ["Drug", "Dose", "Route", "Frequency", "Indication", "Notes"],
    [
      ["Ampicillin",     "50 mg/kg/dose","IV/IM","<7d GA<30w: Q12h; >7d: Q8h; Term: Q6h","Neonatal sepsis, meningitis","Dilute in NS; 15–30 min infusion"],
      ["Gentamicin",     "5 mg/kg/dose","IV/IM","GA<30w: Q48h; 30–34w: Q36h; Term: Q24h","Gram-negative sepsis","Monitor levels after 3rd dose (peak/trough)"],
      ["Benzyl Penicillin","50,000 IU/kg/dose","IV","Q12h (<7 days); Q8h (>7 days)","Strep, congenital syphilis","Dilute in NS; 15 min infusion"],
      ["Cefotaxime",     "50 mg/kg/dose","IV/IM","Q12h (<7d); Q8h (>7d)","Meningitis, sepsis","Preferred over ceftriaxone in neonates"],
      ["Acyclovir",      "20 mg/kg/dose","IV","Q8h","Neonatal HSV","MUST dilute; infuse over 1 hour — risk nephrotoxicity"],
      ["Fluconazole",    "6 mg/kg/dose","IV/oral","Prophylaxis: twice weekly; Treatment: Q24–72h depending on GA","Candida sepsis","Used in VLBW <1000g prophylaxis"],
      ["Amphotericin B deoxycholate","0.5–1 mg/kg/day","IV","Q24h","Invasive fungal infection","Test dose 0.1 mg/kg; monitor renal fn"],
    ],
    [14, 13, 8, 20, 20, 25]
  ),
  heading2("Other Neonatal Drugs"),
  makeTable(
    ["Drug", "Indication", "Dose / Notes"],
    [
      ["Vitamin K (Konakion)","Hemorrhagic disease of newborn (HDN)","IM 1 mg stat at birth (0.5 mg if <1.5 kg); oral 2 mg at birth then 2 mg at 1 wk and 1 month (if breastfed)"],
      ["Caffeine citrate","Apnea of prematurity","Loading: 20 mg/kg IV/oral; Maintenance: 5–10 mg/kg/day OD (Indian brand: Cafcit, Neopuff)"],
      ["Surfactant (Poractant alfa)","RDS/HMD in premature infant","100–200 mg/kg intratracheal via ET tube; repeat 100 mg/kg Q12h up to 2 more doses (Curosurf, Survanta)"],
      ["Phenobarbitone","Neonatal seizures","Loading: 20 mg/kg IV over 20 min; maintenance 3–5 mg/kg/day OD — start 24 h after loading"],
      ["Indomethacin","PDA closure","0.2 mg/kg IV Q12–24h × 3 doses; monitor urine output + renal function"],
      ["Ibuprofen (IV)","PDA closure (preferred over indomethacin)","10 mg/kg IV Day 1, then 5 mg/kg Day 2–3 (Pedea)"],
      ["Dextrose 10%","Neonatal hypoglycemia (<2.6 mmol/L)","Bolus: 2.5 mL/kg IV over 5 min; maintenance 4–6 mg/kg/min infusion — GIR calculation required"],
      ["Epinephrine 1:10,000","Cardiac arrest at resuscitation","0.1 mL/kg IV/IO (= 0.01 mg/kg); via ET: 0.3–1 mL/kg of 1:10,000"],
      ["Thyroxine (T4)","Congenital hypothyroidism","10–15 mcg/kg/day oral OD (titrate TSH to 0.5–2 mIU/L) — start as soon as confirmed"],
      ["Valganciclovir","Symptomatic congenital CMV","16 mg/kg/dose oral BD × 6 months (check ANC monthly)"],
      ["Phototherapy (light)","Neonatal jaundice","Threshold based on birth weight + hours of age; use Bhutani nomogram; ensure adequate hydration"],
      ["Exchange transfusion","Severe neonatal jaundice / haemolytic disease","Double-volume (160–200 mL/kg); specialist procedure — REFER"],
    ],
    [20, 25, 55]
  ),
  heading2("Neonatal Resuscitation — Quick Guide (NRP 2021)"),
  bullet("WARM, DRY, STIMULATE — within 30 seconds of birth"),
  bullet("HR <100 + poor tone → Positive Pressure Ventilation (PPV): 40–60 breaths/min with room air (21%)"),
  bullet("HR <60 after 30 sec of effective PPV → Start chest compressions: 3:1 ratio (3 compressions : 1 breath) = 90 compressions + 30 breaths/min"),
  bullet("HR <60 after 60 sec CPR → IV/IO Adrenaline 0.01 mg/kg (0.1 mL/kg of 1:10,000) + consider volume (NS 10 mL/kg if blood loss)"),
  bullet("SpO2 targets: 1 min: 60–65%, 2 min: 65–70%, 3 min: 70–75%, 4 min: 75–80%, 5 min: 80–85%, 10 min: 85–95%"),
  alertBox("APGAR SCORE:", "0–3 = Severely depressed | 4–6 = Moderately depressed | 7–10 = Normal. Assess at 1 min and 5 min. NOT used to guide resuscitation — HR assessment guides management.", C.lightTeal, C.teal),
);

// ── CHAPTER 7: IAP VACCINATION SCHEDULE ──────────────────────────────────────
children.push(
  heading1("CHAPTER 7 — IAP VACCINATION SCHEDULE 2023–24"),
  heading2("Private / Urban Practice Schedule (IAP-ACVIP 2023-24)"),
  makeTable(
    ["Age", "Vaccines", "Route/Site", "Key Points"],
    [
      ["Birth\n(within 24 h)", "BCG + OPV-0 + Hep B-1", "BCG: ID left arm\nOPV: oral\nHep B: IM left thigh", "BCG before discharge; Hep B within 24 h of birth (MANDATORY)"],
      ["6 weeks", "DTwP/DTaP-1 + IPV-1 + Hib-1 + Hep B-2 + PCV-1 + Rotavirus-1", "IM right thigh (combo)\nIM left thigh (PCV)\nOral (Rota)", "Use combination vaccines where affordable. DTaP preferred (less reactogenic). IPV in hexavalent if available"],
      ["10 weeks", "DTwP/DTaP-2 + IPV-2 + Hib-2 + Hep B-3 + PCV-2 + Rotavirus-2", "Same as 6 weeks", "Maintain 4-week minimum interval between doses"],
      ["14 weeks", "DTwP/DTaP-3 + IPV-3 + Hib-3 + Hep B-4 + PCV-3 + Rotavirus-3", "Same as 6 weeks", "Last dose of Rotavirus (if RV1/2 doses); if RV5 = 3 doses"],
      ["6 months", "Influenza-1 (Flu)", "IM deltoid", "Annual influenza vaccine recommended from 6 months"],
      ["7 months", "Influenza-2 (2nd dose first year only)", "IM", "Only in first year — single dose subsequently"],
      ["6–9 months", "Typhoid Conjugate Vaccine (TCV)-1", "IM", "Preferred over polysaccharide typhoid; single dose covers longer"],
      ["9 months", "MMR-1 (Measles + Mumps + Rubella)", "SC right upper arm", "NIP schedule: Measles at 9 mo; IAP gives full MMR at 9 months"],
      ["12 months", "Hepatitis A-1", "IM", "Inactivated (Havrix, Vaqta) or live (Biovac-A). Live = single dose"],
      ["12–15 months", "PCV Booster", "IM", "Complete 4-dose PCV series"],
      ["15 months", "MMR-2 + Varicella-1", "SC", "Give MMR and Varicella at same visit (different sites) or 4 weeks apart"],
      ["16–18 months", "DTwP/DTaP Booster 1 + IPV Booster + Hib Booster", "IM", "Use combination (Penta/Hexa) where available"],
      ["18–19 months", "Hep A-2 (if inactivated) + Varicella-2", "IM / SC", "2nd Hep A only needed for killed vaccine; live = single dose"],
      ["2 years", "TCV-2 or Typhoid polysaccharide", "IM", "If TCV given at 9 mo, give booster at 2 yr"],
      ["4–6 years", "DTwP/DTaP Booster 2 + IPV Booster + MMR-3", "IM / SC", "Pre-school booster — important before school entry"],
      ["9–14 years (girls AND boys)", "HPV (9vHPV): 2-dose schedule at 0 and 6 months", "IM", "IAP 2023-24: HPV now recommended for BOYS too. Gardasil-9 / Cervavac (4v)"],
      ["10–12 years", "Tdap (Tetanus + Diphtheria + Pertussis)", "IM deltoid", "Replaces DTwP at this age — acellular component"],
      ["16–18 years", "Td booster", "IM", "NEW IAP 2023-24 addition: Td booster at 16–18 yr"],
      ["Annual (all ages ≥6 mo)", "Influenza vaccine (single dose if previously vaccinated)", "IM", "Seasonal — October ideally in India"],
    ],
    [15, 30, 15, 40]
  ),
  heading2("NIP (Universal Immunization Programme) Schedule — Government Sector"),
  makeTable(
    ["Age", "Vaccine", "Route", "Notes"],
    [
      ["Birth",         "BCG + OPV-0 + Hep B-1",             "ID / Oral / IM", "Free at government hospital"],
      ["6, 10, 14 wk",  "Pentavalent (DPT+HepB+Hib) + OPV",  "IM / Oral",      "Pentavac = DTwP+Hep B+Hib combined"],
      ["9 months",      "Measles-Rubella (MR-1)",             "SC",             "NIP gives MR; IAP gives full MMR"],
      ["16–24 months",  "MR-2 + DPT Booster + OPV Booster",  "SC / IM / Oral", "Booster doses"],
      ["5–6 years",     "DPT Booster-2",                     "IM",             "Pre-school"],
      ["10 years",      "TT (Tetanus Toxoid)",                "IM",             ""],
      ["16 years",      "TT booster",                        "IM",             ""],
      ["JE endemic areas","JE vaccine (Encevac) × 2 doses at 9 mo and 13 mo","IM","Endemic areas only"],
      ["Rotavirus","Rotarix (2 doses) or Rotateq (3 doses) now in NIP in many states","Oral","Free in many state programs"],
    ],
    [18, 28, 14, 40]
  ),
  alertBox("CATCH-UP RULE:", "If vaccines are delayed, NEVER restart the series. Continue from where you left off. Minimum intervals still apply. Use a catch-up schedule for missed vaccines.", C.lightBlue, C.medBlue),
  heading2("Cold Chain & Vaccine Storage"),
  bullet("BCG, MMR, Varicella, OPV: Store at -15°C to -25°C (freeze-sensitive — once thawed, discard)"),
  bullet("IPV, Hep B, DPT, Rotavirus, PCV, Hib, Hep A: Store at +2°C to +8°C — NEVER freeze"),
  bullet("Cold chain break protocol: Shake test for adsorbed vaccines (DPT, Hep B, Hib); OPV must be discarded if thawed again"),
  bullet("Reconstituted BCG and MMR: Use within 4 hours, discard remainder"),
);

// ── CHAPTER 8: PEDIATRIC EMERGENCY PROTOCOLS ─────────────────────────────────
children.push(
  heading1("CHAPTER 8 — PEDIATRIC EMERGENCY PROTOCOLS"),

  heading2("8.1 Febrile Seizure"),
  para([bold("Definition: ", 20), normal("Seizure in a child 6 months–5 years with fever >38°C, without CNS infection or metabolic cause")]),
  heading3("Simple vs Complex"),
  makeTable(
    ["Feature", "Simple Febrile Seizure", "Complex Febrile Seizure"],
    [
      ["Duration",     "<15 minutes",      ">15 minutes (EMERGENCY)"],
      ["Type",         "Generalized",       "Focal / partial"],
      ["Recurrence",   "Single in 24 h",    "Multiple in 24 h (>2)"],
      ["Post-ictal",   "Brief",             "Prolonged neurological deficit"],
      ["Management",   "Observation, treat fever, reassure", "Active seizure management + LP to rule out meningitis"],
    ],
    [25, 35, 40]
  ),
  heading3("Management"),
  bullet("Lay child on side, protect airway, remove restrictive clothing"),
  bullet("Measure and treat fever: Paracetamol 15 mg/kg oral/rectal"),
  bullet("If still seizing at 5 min: Diazepam rectal 0.5 mg/kg (insert with syringe) OR Midazolam 0.2 mg/kg IM/intranasal"),
  bullet("If still seizing at 10 min: Lorazepam 0.1 mg/kg IV (if IV access) OR repeat Midazolam"),
  bullet("If still seizing at 20 min: REFER — Status epilepticus protocol (Phenobarbitone / Levetiracetam IV)"),
  bullet("After seizure: LP indicated if age <18 months (meningitis mimicry), or complex seizure, or first febrile seizure in child on antibiotics"),
  alertBox("PARENTAL REASSURANCE:", "Febrile seizures do NOT cause brain damage or death. Risk of epilepsy is only slightly above baseline (~2–4%). Explain and document this at every visit.", C.lightGreen, C.green),

  heading2("8.2 Acute Bronchiolitis (Age <2 years)"),
  para([bold("Diagnosis: ", 20), normal("Viral LRTI; tachypnea, wheeze/crackles, intercostal retractions, feeding difficulty. RSV is commonest cause.")]),
  heading3("Severity Assessment"),
  makeTable(
    ["Feature", "Mild", "Moderate", "Severe — ADMIT"],
    [
      ["SpO2",           "≥95%",   "90–94%",   "<90%"],
      ["RR",             "<50/min","50–70/min", ">70/min"],
      ["Feeding",        "Normal", ">50% normal","Poor; <50%"],
      ["Retractions",    "None",   "Mild–moderate","Severe; nasal flare"],
      ["Apnea",          "No",     "No",         "Yes → ICU"],
    ],
    [22, 20, 20, 38]
  ),
  heading3("Treatment"),
  bullet("Mild: Supportive at home — nasal saline drops + suction, small frequent feeds, paracetamol for fever, return if worsens"),
  bullet("Moderate-Severe: Oxygen (target SpO2 ≥94%), IV/NG fluids if feeding <50%"),
  bullet("Trial of Salbutamol nebulization 2.5 mg in 3 mL NS — continue ONLY if clear response (most cases do not benefit)"),
  bullet("Hypertonic saline (3%) nebulization: 4 mL Q6–8h — reduces length of stay in admitted patients"),
  bullet("Antibiotics: NOT indicated unless secondary bacterial pneumonia is suspected"),
  bullet("Steroids: NOT effective in bronchiolitis"),
  alertBox("ADMIT CRITERIA:", "SpO2 <94%, RR >70, poor feeding (<50% normal), apnea, age <3 months, prematurity, congenital heart/lung disease.", C.lightRed, C.red),

  heading2("8.3 Croup (Laryngotracheobronchitis)"),
  para([normal("Viral (parainfluenza), barking cough, stridor, hoarse cry. Age 6 months–3 years. Worse at night.")]),
  makeTable(
    ["Severity", "Features", "Treatment"],
    [
      ["Mild",     "Barking cough, hoarse voice, no stridor at rest, no retractions, normal SpO2", "Dexamethasone 0.15 mg/kg oral single dose (max 10 mg). Reassure. Discharge with return precautions."],
      ["Moderate", "Stridor at rest, mild–moderate retractions, SpO2 ≥94%", "Dexamethasone 0.15–0.6 mg/kg IM/IV. Nebulized adrenaline 5 mL of 1:1000 (0.5 mL/kg max 5 mL). Observe 2–4 h."],
      ["Severe",   "Severe stridor, severe retractions, altered consciousness, SpO2 <94%", "ADMIT. Dexamethasone 0.6 mg/kg IV + Repeat adrenaline nebs Q20 min. Heliox if available. ENT/ICU."],
    ],
    [15, 35, 50]
  ),

  heading2("8.4 Acute Diarrhea & Dehydration"),
  heading3("Dehydration Assessment"),
  makeTable(
    ["Sign", "No Dehydration", "Some Dehydration (5%)", "Severe Dehydration (>10%)"],
    [
      ["Eyes",          "Normal",   "Sunken",        "Very sunken + dry"],
      ["Skin pinch",    "Normal",   "Goes back slowly","Goes back very slowly (>2s)"],
      ["Thirst",        "Normal",   "Thirsty, drinks eagerly","Unable to drink"],
      ["Tears",         "Present",  "Reduced",       "Absent"],
      ["Mucous membrane","Moist",   "Dry",           "Very dry"],
      ["Fontanelle",    "Normal",   "Sunken",        "Very sunken"],
      ["Urine output",  "Normal",   "Reduced",       "No urine for >6 h"],
      ["Action",        "ORS at home","ORS 50–100 mL/kg over 4h in clinic","IV fluids immediately — admit"],
    ],
    [20, 20, 25, 35]
  ),
  heading3("Rehydration Protocol"),
  bullet("No dehydration: ORS 10 mL/kg after each loose stool at home"),
  bullet("Some dehydration: ORS 50–75 mL/kg over 4 hours in clinic/casualty; reassess after 4 hours"),
  bullet("Severe dehydration: IV Ringer's Lactate 100 mL/kg — infants (≤12 mo): 30 mL/kg over 1 h then 70 mL/kg over 5 h; older children: 30 mL/kg over 30 min then 70 mL/kg over 2.5 h"),
  bullet("Zinc sulfate: <6 months: 10 mg/day; ≥6 months: 20 mg/day × 14 days (IAP/WHO recommendation)"),
  bullet("Continue breastfeeding throughout. Restart normal feeds as soon as tolerated."),
  bullet("Ondansetron 0.15 mg/kg oral/IV for vomiting — reduces need for IV fluids"),
  bullet("Antibiotics: NOT routine. Only for dysentery (bloody diarrhea — Ciprofloxacin 20 mg/kg/day BD × 3d) or cholera"),

  heading2("8.5 Anaphylaxis"),
  alertBox("FIRST-LINE ALWAYS:", "Adrenaline 1:1000 IM — 0.01 mg/kg (max 0.5 mg) into anterolateral mid-thigh. NEVER delay for antihistamines or steroids.", C.lightRed, C.red),
  heading3("Protocol"),
  bullet("1. Call for help. Lay flat, legs elevated (unless airway compromise — then sit upright)"),
  bullet("2. Adrenaline 1:1000 IM: 0.01 mg/kg (= 0.01 mL/kg of 1:1000 solution). Max 0.5 mg. Can repeat Q5–15 min × 3"),
  bullet("3. O2 high-flow 10–15 L/min via non-rebreather mask"),
  bullet("4. IV access + NS 20 mL/kg bolus if hypotensive (repeat up to 60 mL/kg)"),
  bullet("5. Antihistamine: Chlorphenamine 0.1 mg/kg IV/IM (adjunct only, not first-line)"),
  bullet("6. Hydrocortisone 5 mg/kg IV (prevents biphasic reaction — adjunct only)"),
  bullet("7. Salbutamol nebulization 2.5 mg if bronchospasm persists"),
  bullet("8. Observe minimum 4–6 hours (24 h if severe) — biphasic reaction in 5–20%"),
  bullet("9. Discharge with Epipen prescription + anaphylaxis action plan + allergy referral"),

  heading2("8.6 Acute Asthma Attack"),
  makeTable(
    ["Severity", "Features", "SpO2", "Treatment"],
    [
      ["Mild",    "No distress, talks normally, mild wheeze", "≥94%", "Salbutamol MDI 2–4 puffs via spacer Q20min × 3; Prednisolone 1–2 mg/kg oral × 3–5 days"],
      ["Moderate","Speaks in sentences, moderate retractions, wheeze", "91–94%", "Salbutamol neb 2.5–5 mg Q20 min × 3 + Ipratropium 250 mcg neb × 3; O2; Prednisolone IV/oral"],
      ["Severe",  "Can't speak, severe retractions, silent chest", "<91%", "ADMIT/ICU: IV Salbutamol 15 mcg/kg over 10 min, Magnesium sulfate 40 mg/kg IV over 20 min (max 2g), IV Hydrocortisone 5 mg/kg, prepare intubation"],
      ["Life-threatening","Silent chest, cyanosis, exhaustion, altered GCS","<85%","ICU immediately. Intubation (avoid if possible). Continue above + anaesthetic referral."],
    ],
    [14, 30, 10, 46]
  ),

  heading2("8.7 Pediatric Sepsis — Quick Protocol"),
  alertBox("GOLDEN HOUR:", "Blood cultures → IV antibiotics → IV fluid bolus — ALL within 1 hour of recognition", C.lightRed, C.red),
  heading3("Recognition — ANY of:"),
  bullet("Temperature >38.5°C or <36°C with clinical signs of infection"),
  bullet("HR >2 SD above normal for age (Table Chapter 2)"),
  bullet("RR >2 SD above normal + altered mental status"),
  bullet("Poor perfusion: prolonged capillary refill >2 sec, mottled skin, cold peripheries"),
  heading3("Management"),
  bullet("A–B–C: Airway, high-flow O2, IV/IO access × 2"),
  bullet("Blood cultures × 2 + CBC + CRP + Procalcitonin + Blood glucose + Lactate + Urine C/S"),
  bullet("IV NS or RL 20 mL/kg over 5–10 min — reassess. Repeat up to 60 mL/kg total if no hepatomegaly/crepitations"),
  bullet("Empiric antibiotics within 1 hour:"),
  bullet("Community-acquired sepsis: Ceftriaxone 50–75 mg/kg IV + consider Ampicillin if meningitis suspected", 1),
  bullet("Neonatal: Ampicillin 50 mg/kg Q6–12h + Gentamicin 5 mg/kg Q24h", 1),
  bullet("Hospital-acquired: Piperacillin-Tazobactam 80–100 mg/kg Q6h + Vancomycin 15 mg/kg Q6h", 1),
  bullet("Glucose: Check STAT and repeat Q1h; target 4–8 mmol/L"),
  bullet("Norepinephrine 0.1–0.5 mcg/kg/min if fluid-refractory shock — ICU/PICU required"),
  bullet("REFER to PICU if: fluid-refractory shock, need for vasopressors, altered GCS, respiratory failure"),
);

// ── CHAPTER 9: COMMON PEDIATRIC PRESCRIPTIONS ────────────────────────────────
children.push(
  heading1("CHAPTER 9 — COMMON PEDIATRIC PRESCRIPTIONS"),
  heading2("RX 1: Fever Without Focus — Child 1–5 years, weight 12 kg"),
  para([bold("Diagnosis: ", 20), normal("Fever without focus (FWOF) — rule out source clinically")]),
  para([bold("Investigations: ", 20), normal("CBC, CRP, Urine R/M, blood culture if >38.5°C and age <3 yr or appears toxic")]),
  makeTable(
    ["Drug", "Dose for 12 kg child", "Frequency", "Duration", "Brand Example"],
    [
      ["Paracetamol syrup (120 mg/5 mL)", "7.5 mL (180 mg)", "Q6h when temp >38.5°C", "Until afebrile 24 h", "Calpol 120 mg/5 mL"],
      ["Ibuprofen syrup (100 mg/5 mL) — alternate with PCM", "6 mL (120 mg)", "Q8h with food (alternate with PCM)", "Until afebrile", "Ibugesic 100 mg/5 mL"],
      ["ORS", "Ad lib", "After each loose stool if any", "Ongoing", "Electral sachet"],
    ],
    [25, 25, 20, 15, 15]
  ),
  para([bold("Advice: ", 20), normal("Sponging with lukewarm water if >39°C. Return if: seizure, rash, refuses feeds for >12 h, temp >5 days, looks very unwell.")]),

  heading2("RX 2: URTI / Pharyngitis — Child 3 yr, 14 kg"),
  para([bold("Diagnosis: ", 20), normal("Viral pharyngotonsillitis — most URTI in children is viral; antibiotics NOT indicated unless strep suspected (exudate, tender cervical nodes, fever, no cough = Centor ≥3)")]),
  makeTable(
    ["Drug", "Dose", "Frequency", "Duration", "Brand"],
    [
      ["Paracetamol syrup", "9.4 mL (225 mg)", "Q6h PRN", "As needed", "Calpol"],
      ["Levocetirizine syrup 2.5 mg/5 mL", "2.8 mL", "OD at night", "5–7 days", "Xyzal, Levocet"],
      ["Saline nasal drops", "2 drops each nostril", "Before feeds + QID", "5–7 days", "Nasivion, Otrivin Baby"],
      ["Amoxicillin (if bacterial Strep suspected)", "80 mg/kg/day TID = 5.6 mL of 250 mg/5 mL per dose", "TID", "10 days", "Novamox 250 mg/5 mL"],
    ],
    [25, 22, 18, 15, 20]
  ),

  heading2("RX 3: Acute Otitis Media — Child 2 yr, 12 kg"),
  makeTable(
    ["Drug", "Dose (12 kg)", "Frequency", "Duration", "Brand"],
    [
      ["Amoxicillin (high dose) 250 mg/5 mL", "7.7 mL per dose (384 mg = ~80 mg/kg/day TID)", "TID", "10 days (<2 yr) or 5–7 days (>2 yr)", "Novamox, Mox"],
      ["Paracetamol syrup", "7.5 mL", "Q6h PRN", "As needed", "Calpol"],
      ["Xylometazoline nasal drops (0.05%)", "1 drop each nostril", "BD–TID max 3 days", "≤3 days", "Otrivin 0.05%"],
    ],
    [25, 22, 18, 20, 15]
  ),
  para([bold("Return if: ", 20), normal("No improvement after 72 hours, or if worsening (persistent fever, hearing loss, swelling behind ear = mastoiditis).")]),

  heading2("RX 4: Acute Diarrhea (non-bloody) — Child 10 kg, 1 year"),
  makeTable(
    ["Drug", "Dose", "Frequency", "Duration", "Brand"],
    [
      ["ORS (WHO/UNICEF standard)", "500–800 mL over 4–6 h (50–100 mL/kg)", "After each loose stool + 50–100 mL/kg deficit", "Until diarrhea stops", "Electral"],
      ["Zinc sulfate 20 mg/5 mL", "5 mL (20 mg)", "OD", "14 days", "Zinctus, Z&D"],
      ["Saccharomyces boulardii", "250 mg BD", "BD", "5–7 days", "Econorm, Enterogermina"],
      ["Ondansetron syrup 2 mg/5 mL (if vomiting)", "2.5 mL (1 mg)", "Q8h PRN vomiting", "Max 48 h", "Emeset, Zofer"],
    ],
    [25, 20, 18, 17, 20]
  ),
  para([bold("ADMIT if: ", 20), normal("Severe dehydration, unable to take ORS orally, bloody stool + toxicity, age <3 months.")]),

  heading2("RX 5: Skin Infections — Impetigo / Superficial Pyoderma"),
  makeTable(
    ["Drug", "Dose", "Route/Frequency", "Duration", "Brand"],
    [
      ["Mupirocin 2% ointment", "Apply thin layer", "TID topically", "7 days", "Bactroban, Ciplox-Mup"],
      ["Cephalexin syrup 125 mg/5 mL (if extensive)", "12.5–25 mg/kg/dose", "QID", "7 days", "Sporidex"],
      ["Chlorhexidine wash (0.05%)", "Clean wound daily", "OD", "Until healed", "Savlon, Cipla Hexidine"],
    ],
    [25, 25, 20, 15, 15]
  ),
);

// ── CHAPTER 10: RED FLAGS & REFERRAL ─────────────────────────────────────────
children.push(
  heading1("CHAPTER 10 — RED FLAGS & REFERRAL CRITERIA"),
  heading2("IMMEDIATE REFER / CALL 108 — Any of the following:"),
  alertBox("DANGER SIGNS (WHO IMCI):", "Unable to drink/breastfeed | Vomits everything | Convulsions | Lethargic or unconscious | Stiff neck | Bulging fontanelle | Grunting | Severe respiratory distress | Central cyanosis", C.lightRed, C.red),
  makeTable(
    ["System", "Red Flag", "Likely Diagnosis", "Action"],
    [
      ["Respiratory","Grunting + severe retractions + SpO2 <90%","Respiratory failure / severe pneumonia","O2 → admit/transfer immediately"],
      ["Respiratory","Stridor at rest + drooling + refusal to lie down","Epiglottitis (H. influenzae)","Do NOT examine throat — immediate ENT + airway team"],
      ["Neurological","Seizure >5 min or focal seizure","Status epilepticus / meningitis","IV Benzodiazepine + LP + Ceftriaxone"],
      ["Neurological","Bulging fontanelle + fever + irritability","Bacterial meningitis","Ceftriaxone 100 mg/kg IV STAT + LP (after CT if papilloedema)"],
      ["Cardiac","HR >220 bpm or <60 bpm + poor perfusion","SVT / complete heart block","ECG + cardiology referral / adenosine for SVT"],
      ["GI","Bilious vomiting in neonate","Malrotation / volvulus","Surgical emergency — refer immediately"],
      ["GI","Sudden screaming + current jelly stool","Intussusception","Immediate surgical/radiological referral"],
      ["Trauma","Altered consciousness + head injury","Intracranial bleed","CT head + neurosurgery referral"],
      ["Allergy","Swollen lips + stridor + hypotension after trigger","Anaphylaxis","Adrenaline IM STAT"],
      ["Fever","Petechial rash + high fever + shocked","Meningococcemia","Ceftriaxone 100 mg/kg IV STAT + emergency transfer"],
    ],
    [12, 22, 22, 44]
  ),
  heading2("Referral Criteria to Pediatrician / Hospital"),
  bullet("Any child <3 months with fever ≥38°C — always refer (occult bacteremia risk)"),
  bullet("Prolonged fever (>7 days without diagnosis)"),
  bullet("Persistent vomiting or refusing feeds >12 hours"),
  bullet("First febrile seizure in child <18 months (LP needed to rule out meningitis)"),
  bullet("Suspected congenital heart disease (abnormal murmur, failure to thrive, central cyanosis)"),
  bullet("Growth failure — weight <3rd percentile or dropping ≥2 major centile lines"),
  bullet("Developmental delay or regression at any age"),
  bullet("Suspected abuse or non-accidental injury"),
  bullet("Diabetic ketoacidosis or new-onset T1DM"),
  bullet("Immune deficiency (recurrent severe infections, unusual organisms)"),
  heading2("Clinical Pearls for General Practitioners"),
  bullet("In children under 5, always count respiratory rate for a FULL 60 seconds — 30 seconds doubled is inaccurate"),
  bullet("SpO2 <94% in any child = supplemental oxygen needed. <90% = emergency"),
  bullet("Wheeze in a child under 6 months is NOT asthma — think bronchiolitis, GERD, or congenital cause"),
  bullet("Avoid cough suppressants (dextromethorphan, codeine) in children under 2 years — no evidence + risk"),
  bullet("Nimesulide and aspirin are BANNED in children under 12 in India — NEVER prescribe"),
  bullet("Fluoroquinolones (ciprofloxacin, ofloxacin) should be avoided in children <18 yr except for specific indications (UTI by resistant organism, typhoid)"),
  bullet("Always document and plot weight + height on a growth chart at every visit — this is your most sensitive monitoring tool"),
  bullet("The FASTEST way to confirm sepsis in a resource-limited setting: CRP >50 + WBC <4 or >20 + Lactate >2"),
);

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