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Treatments for Kawasaki Disease


Investigations
Blood tests

Other optional tests

                                  TREATMENT FOR KD

Table 2 Treatment of Kawasaki disease.
1. Intravenous gammaglobulin (IVIG) 2 g/kg as a single infusion over 12 h
2. Aspirin 3050 mg/kg/day in four doses (in USA 80100 mg/kg/day in four doses is recommended) until afebrile for 23 days
3. Aspirin 35 mg/kg/day once daily (anti-platelet therapy) for 68 weeks minimum
If fever persists after 48 h or recrudescence of fever within 2 weeksdiscuss with expert. Possible interventions include:
1. Second dose of IVIG 2 g/kg
2. Third dose of IVIG 2 g/kg or
3. Methyprednisolone 30 mg/kg daily for 3 days or prednisolone 2 mg/kg/day orally and tailored based on clinical/inflammatory marker improvement
4. (Cyclophosphamide, Cyclosporin, plasmapheresis and monoclonal antibodies to TNFalpha have been reported)

See Guidelines; http://www.pediatrics.org/cgi/content/full/114/6/1708

                            

                                    
CORONARY ARTERY NOMOGRAM
                            



Coronary artery Echocardiographic evaluation

  • The initial Echocardiographic evaluation will be obtained as soon as the diagnosis of KD is made.
  • The normal coronary artery diameters correlate with BSA. In those with BSA < 0.5 m2, £ 2.5mm; BSA 0.5- 1.0 m2, 2.5-3.0 mm.
  • In children < 5 years of age, a proximal RCA, LMC, LCX and LAD exceeding 3mm and 5mm above 5 years considered dilated. (Japanese Ministry of Health Criteria), Irregularity of lumen also to be evaluated.
Mean and prediction limits for 2 and 3SDs for size of LAD (A), proximal RCA (B), and LMCA(C) according to BSA for children ,18years old. LMCA z scores should not be based on dimension at orifice and immediate vicinity; enlargement of LMCA secondary to KA usually is associated with ectasia od LAD, LCX or both.

    

Proposed Dosage Schedule
 
      

 Table 1: Proposed dosage schedule of antioxidants for the prevention of CAD in KD along with IVIG and Aspirin, is now under     clinical trial
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        AGE                           VIT A                         VIT E                 VIT C
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ROUTES AND                 Once daily               Once daily     Two divided                   
FREQUENCY                   x 4 Days                  x 14 Days       doses x 14
                                         Oral                          Oral                days oral
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>6MONTHS                     25,000 IU                    100 IU                500MG

6MO TO 1-YEAR             50,000 IU                    100IU                 500MG

1 TO 2 –YEAR                 50,000 IU                    200IU                 500MG

ABOVE 2 YEAR              50,000 IU                    400IU               1000MG
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