Vaccination Schedule according to WHO and EPI

*just remember the only difference between both of these schedules is that in EPI, you cannot administer DPT after 2 years in a child.
In WHO, DPT can be given to children up to the age of 6 years.

*if measles is an epidemic, a child can be given the measles vaccination at 6-7 months. It is not recommended to give before this age mainly because the child has preformed antibodies from the mother. Do remember to make a note on giving the child measles vaccination, and make sure to still follow up with vaccinating with measles at 12 and 18 months.

*if a child is malnourished, measles vaccination is allowed to be administered at around 5 and a half to six months. But again, do make a note on giving the child this vaccination, and make sure to follow up with administering measles at 12 and 18 months.

The schedule thus is as follows:


Birth- OPV0, BCG
6 weeks- OPV1, Pentavalent 1 (DPT1, HepB1,Hib1)
10 weeks- OPV2, Pentavalent 2(DPT2, HepB2,Hib2)
14 weeks- OPV3, Pentavalent 3 (DPT3, HepB3,Hib3)
12 months-measles
18 months-measles.

*pentavalent vaccine consists of DPT, Hep B and Hib.


Examples:

1- A mother comes with 18 month daughter with no vaccinations, except for NID.
-start with BCG, give OPV1 and Pentavalent 1, and measles 1. Follow child as according to schedule, after every 4 weeks. only give measles 2 after 6 months of having recieved measles 1.

*Remember to still give OPV as EPI and WHO do not clash with the NID.

2-3 years according to EPI schedule?
-first contact, BCG, OPV1, Measles 1. Do not give Pentavalent as according to EPI DPT cannot be given to the child who is above the age of 2 years. Parents will have to get Hep B, Hib and DT seperately.

NOTE- Diarrhea does not contraindicate vaccinations. If OPV is administered at 4 weeks and a child has diarrhea, ask the mother to bring the child back 2 weeks later for another does of OPV. The child should be followed up for next vaccinations after 2 more weeks as scheduled for following vaccinations. Also, always make a note of vaccinations adminstered.

DIABETIC KETOACIDOSIS (DKA)

DEFINITION:

• Diabetic keto-acidosis (DKA) is a state of inadequate insulin levels resulting in high blood sugar and accumulation of organic acids and ketones in the blood. It is also common in DKA to have severe dehydration and significant alterations of the body’s blood chemistry.
  
  WHO’S THE PATIENT: usually a type I diabetic
• Could be a yet undiagnosed diabetic
• or a known diabetic non-compliant on drugs
• or a known diabetic who skipped his insulin because of history of diarrhea and vomiting
  
  SIGNS AND SYMPTOMS:
  
  Systems affected : CNS, respiratory, gastrointestinal and excretory
  
• CNS:
  1. lethargy
  2. anorexia
  3. coma
  
• RESPIRATORY:
  1. Ketotic breath
  2. Air Hunger / Kussmall breathing
  
• GASTROINTESTINAL:
  1. Vomiting (in 2/3rds of patients)
  2. abdominal pain, severe enough to be called pseudoappendicitis of DKA
  3. polydipsia
  
• EXCRETORY:
  1. dehydration
  2. polyuria
  
  DIAGNOSTIC INVESTIGATIONS:
  
  Hyperglycemia, ketonemia and hypercapnea are the significant findings. So we do the following laboratory investigations:
  
• blood and urinary glucose, urinary ketones
• urea, creatinine and electrolytes
• HCO3
• ABG
• osmolality
• serum lipid profile
• CBC
• serum amylase
• culture and sensitivity (if signs of infection)
  
  DIFFERENTIAL DIAGNOSIS:
  
• Insulin reaction – exclude by administering 50ml of 50% glucose, condition will improve if it is an exogenous insulin reaction, if not then too no harm is done by the administered glucose.
• salicylate poisoning – there will be history of aspirin (or some other salicylate) overdose.
• lactic acidosis
• hyperglycemia
• hyper osmolar state
• non – ketotic coma
• advanced renal failure
  
  TREATMENT:
  1. Infuse normal saline through the same vein that’s used for taking blood sample, as this is an emergency. Replace 4-8 L in first 24 hours of onset. When glucose levels are 200mg, start orange juice and/or 5% saline to the normal saline.
  2. Administer insulin, both subcutaneously and IV, giving 200 units in first 3 hours. You may give up to 10,000 units in first 24 hours.
  if the patient has low potassium levels, demonstrated by a flattened or inverted T wave and prolonged QT interval, start potassium infusion in the 2nd or 3rd hour. Do not exceed 20 mEq/hr, giving up to 80 mEq in the first 24 hours.
  3. Gastric lavage may be done, to prevent any aspiration.
  
  If the DKA is severe, then monitoring of glucose, carbondioxide and acetone levels should be done every 2 hours, otherwise every 4 hours.
  
  THE STABLE PATIENT:
  The patient is said to be stabilized when his blood glucose is <200mg/100ml,>

Never Be Sick Again!