Admission:

Nursing orders:

* Height and weight on admission
* Routine V/S
* Daily wt.
* Up ad lib
* Strict I & O
* Weigh diaper
* Encourage fluid intake as tolerated
* Notify MD:
Temperature > _______, or <___________
BP > __________, or <______________
HR > __________, or <_______________
* Follow IVIG infusion protocol
* Keep skin clean and dry
* Provide parents with Kawasaki Handout

Diet: (order per usual manner)

Consultation:
Cardiology Consultation
Dr. Tede (office ext. 73638)
Dr. Popper (office ext. 73002)

Consider Infectious Disease Consultation

Imaging Test:
EKG - 12 lead
Cardiac Echocardiogram (consider sedation if <3 years old)

Lab:
-CBC with manual diff
-Sed Rate
-Comprehensive Chem Panel (includes albumin and LFT)
-Urine Analysis (Microscopic)

Medications:
Aspirin PO
-High - dose aspirin 80mg/kg/day q 6 hours until afebrile x 24 hours
-Then low dose aspirin 3-5 mg/kg/day once daily

IVIG
-Under 2 years old, Gamimune N 10% 2 gm/kg x 1 dose
-Over 2 years old, Gammagard 5% or10%, 2 gm/kg x 1 dose
-Pre-med with Diphenhydramine Hydrochloride if needed (order per usual manner)

IV fluid: (order per usual manner)

Other:
Medical staff reports case to Department of Public Health

Discharge Criteria (All must be met):
* Improved clinical signs more than 18 hours after IVIG infusion

* Afebrile 18 hours after IVIG infusion completed

* Adequate PO intake

* Cardiac consultation completed

* All tests completed

* Follow up appointments made

* Parents express understanding of medication regime, test results, and follow up plan

Discharge Order/Follow Up:
* No MMR and Varicella vaccines for 11 months

* Follow up with PMD within one week

* Obtain CBC, Platelet count, and ESR at PMD office within one week

* Follow up with cardiologist @ 4-6 weeks for clinic visit and/or cardiac echo (Cardiologist to decide need at time of discharge)

* Continue low dose aspirin for a total of 12 weeks therapy

Specific Notes about Our Clinical Pathway:
* Admit orders are routine for the Ward

Consultation:
-Cardiology consultation is required for getting an ECHO and long term follow up

-ID consult is as needed. Dr. Ponce, Dr. Johnson and Dr. Miller are all available. It is our feeling that for long-term follow up of labs and clinical (non cardiac) course it helps to have ID involved for post-hospital follow up.

-Labs: minimal labs are mentioned, other labs may be obtained for atypical cases as needed.

-Meds: as per national guideline. IVIG preps change depending on age and prior hypersensitivity (use Gamimune)

-Reporting: All cases have to be reported to DPH (forms are available on the ward). Report has to include Echo findings.

-Discharge criteria are per PMD: our recommendations reflect Hospital group preferences.

-For Echos: please consider child age and level of agitation in choosing to do echo w. Sedation. If you choose sedation remember NPO status and pre arrangement w. PICU for sedation and Echo lab for procedure.

Developed by:
Catherine Kyong-Ponce, M.D., Infectious Disease
Robert Popper, M.D. and Nikola Tede, M.D., Pediatric Cardiology
Andree Hest, R.PH. MScPharm
Pediatric Hospitalist Group
Bing Tschai, CNS
David Tejeda, M.D.