pediatria manual cto 7 edici n

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POE0dS, DUEOE OdDE|OUE|dI|IlS. ||EVE|Cl |. LVlId| E| DdSC d I|dVCSOE| Cd|dl OE| Dd|IC,0EO|dDIE |d |Ed|lZdCl| OE U|d CESd|Ed. LS\d l |O| CdOdESDECld| 0E|IE Sl | d OESId|IE SU|E U|d D|l 0C| DECCl |OE|DCIlCd. L| |dS |EClO|VdS, E| |E|Ol 0|EDIC OE |d CESd|EdDd|ECE SE|0E|C|. 1|dId0l EDIC. dC|C|CV|| |V.! ...l0OOl0 D0| V||U8 0l8hD8llll8 Ld 0dO|EES l|ECId|IESl SU |bSPO ES DCSlIlVC |OEDdIlIlSO dOUOd,DC|IdOC|dC||lCd, 0EDdIlI|S C|D|CddCI|Vd). LCS |l |DECIdOCS SUE|E| DE|0dDECE| dSl DIC0dI|CCS,DE|C U| dBd% OE E| | CS SE CCDVlE|IED ED DC|IdOC|ESC|D|CCS,CCDE| ||ESOCDCSIE||C|OUE E||C SUDC|ElOEDdIlIlS C|DlCd,C|||CS|S, 0EDdICCd|Cl|C0d). ||EVEDC|D.LCS0l|CSOE0dO|ESCC| MbSPO DCSlIlVCOEDED |ECl Dl | lO CC|I|d0EDdIl Il S b OU|d|IE | dS l Z D||0E|dSOC|dSOE V|Od.PSUVEZ, SE | ESOEDEdO0| D|SI|d||d D|l0E|dOCSlSOEVdCU|dOEVMO.1|dS|Ed|lZd|ESIdS0dD| CD|dS,ESICS |l |CS DUEOED |EC| Dl ||qCIdDC|d 0dIE|Dd.1 . 1 .10X|00800|0l00|000|t0.b|00|0000008l|0000|! . ! .! .UDl8O08 h|0|08 V0l8008 T .b|nd|omC dCO$t|CnC| dC| hC|o|n. PDd|ECE d |dS '44B O OE V|Od. LU|Sd CCD 0dDl ESIdC| C|ES |EU|C| Ol CdS l0| DE|EXClIdDl | l OdO, IE0D| C|ES,Ol DE|IC||d, Ol DE||EEXld, CC|VU| Sl C|ES, | | d|IC dOUOC),OdSI|ClDIESIlDd|ES lV0lICS, |EC0dZC OE| d| l 0E|IC, O|d||Ed), |ESDl|dIC|ldS |IdOUl DDEd, |l |C||Ed) V ED||CU|d. LdSlIUdClD OEESI|CSd | dOUE SE VED dDCCdOCS OU|d|IE E|E0Dd|dZC dCE|E|d | d 0dOU|dC| | DU| 0CDd|, DC| | COUEI|EDED UDd 0EDC| l |C| OE|Cl d OE EDE|0EOdO OE 0E0D|dDd 0l d| | |d.2.b|nd|omC dC O$t|CnC| dC |mCtdon. LCS S|DIC0dSSCD 0UV Sl 0| | d|ES d |CS OESC|lICS dDIE|lC|0E|IE, dU|OUE SUE|ED | || C| d|SEOE 0d|E|d 0dS Id|O|d,VES 0dS |ECUEDIE |d dDd||C|DOECC|VU|SlCDES.|d|dI|dId|E| S||O|C0E OE dDSIlDE|CldOECDldCECS,C|dSlCd0E|IE SE Od USdOCE|CDd|Dl Id| . L| | ddCIUd| |OdO,ESIEd|0dCC 0d S|OCOESD|dZdOC DC| |dS SC|UCl C|ESOE 0C|Dd C|d|,d| SE|CSIdS0dSSEOU|dS.! . ! ..0O8l08 Ld CCCd||d DC SUE| E D|COUCl| S||O|C0E OE dDSIl |E|Cl d,dUDOUE S| DUEOE D|CVCCd| CC0D|l CdC|C|ES OU|d|IE | dOESIdCl ||D|E0dIU|l OdO,OESD|EDOl0|EDIC OE D|dCE|Id,EIC)V |l DdIC|OlCCSCC| L||, 0l C|CCEd||d,OE0C||dOldS|DI|dC|dDEd|ES,d|C0d| |dSO| OESIlVdSV|EDd|ES,0UE|IESD|IdVd|IE|dClC|ES |EU|C|OlCdSVOECC|OUCId.! . ! .J.bl00|00 8lO00||O0 Bl8l bE Cd|dCIE||Zd DC| |d D|ESE|Cld OE d|IE|dClCDES d|I|CDC0CI|lCdS ||EI|dSC OE| DESC, Id| | dV DE||0EI|C CEd||CC),dC|ES DECU||d| |D| Ed|C0CS|S, EDlCd|IC, 0|C|CODdIld,O| DCD| dSl d 0dX| | d|, |dD|C SUDE||C| HDC), 0d|C|0dC|C|ESKLLULKUAI1ate que o$ opceo$ no dan malmrmacIone$, y $ un $Indrome de ab$tnencIa Cd|O|dCdS lOEECICS OE| SEDIC),d|C0d| |dS OE |dS d|I|CU| dClC|ESV EXI|E0lOdOES l| l OE|d | l 0lIdC|D OE | d 0CV|||OdO V d|IE|dmuy orIdu a contrarIo C|C|ES OE | CS SU|CCS V D| |EOUESque a cocaIna y e $'ndro~Dd| 0d|ES) V |EI|dSC DS|CC0CIC|me acohlco fe1a. M| K VVV|,T V3). OO||6|c8p|6tt|\N|j224. KCC|n nC|do dC3$Cmn$ dC Cdd MdC gn, Con / d|$ dC V|d, quC dC$dC C| Wp|C$Cntun |CtC||C| quC h|do Cn umCnto.Lmd|CC$p||m|gC$t,t|CnCun g|upo $ngu|nCo A |Kh nCgt|Vo) yC| n|o C$ |Kh po$|t|Vo). L| / d| t|CnC un O|||||uO|n tot| dCT2 mdL, CXpCn$$ de| UCC|n |nd||CCt.L|n|ot|CnCOuCnegCnC|| y|o$wk dChCmtoC||to,hCmog|oO|n y |Ct|Cu|oC|to$ $onno|m|C$. Ln qu Cu$ dC h|pC|O|||||uO|nCm|, Cnt|C |$$|gu|CntC$, hy quC pCn$| Cnp||mC| |ug|!: T)|CtC||C| h$|o|g|C. 2) HCpt|t|$ nCont|. 3) LnC|mCdd hCmo||t|C Kh. 4) At|C$| dC V|$ O||||C$. 5) LnC|mCdd hCmo||t|C Ab. M|KT VVV-2000 KL:\ T 20.Unn|onC|doCon3\$Cmn$dC gC$tC|n t|CnC ho| mC$C$ dC Cdd y $C CnCuCnt|no|m|,$|np|oO|Cm$ y gnndo pC$omuyO|Cn.Lnunn||$|$|ut|n||o, p|CCCunhCmog|oO|ndCT 2gld|v3.200.000hCmt|C$lmm3.A|C$1ud||$u nCm|,Cu|dC|$$|gu|CntC$nom||$ Con$|dC| m$ p|oOO|C CnCont|| y |C$u|tnm$ d0n|to||dC $uCnM|mCdd!: T )NmC|o dC p|quCt$ d|$m|nu|do. 2) |$og|ut|n|n$ nt|A o nt|b. 3) Vo|umCn Co|pu$Cu|| C||mCntC C|CVdo. 4) L||$ dC C||t|opoyCt|n dC$CCnd|d$, p| $u Cdd. 5) N|VC|C$ O|o$ dC C|||t|n $||C. M|KT VV/T VV KL:\ T 0.Unn|onC|doCon42$Cmn$dC gC$tC|n y || mCntdo |pCCho,$|guCCl|mCntC|Ct||Co|o$T 5 d|$dC V|d.Ln| CXp|o|C|n5oO$C|VunhC|n|umO|||C|, tonomu$Cu|| d|$m|nu|do yun OntnC|ntC||o| g|ndC.bC|C C|d|gn$t|Co m$ p|oOO|C. T )|Cto$Cm|. 2) Lnh|mCdd dC ||OC|t. 3) At|C$| dC V|$ O||||C$. 4) b|nd|omCdC L||g|C|N|||. 5) H|pot||o|d|$mo Congn|to. MIKT VV/T VVKL: 51OSOOO TW14C4W D(|1lt|01M|RTema a|gO cOmp|ejO pOr su dvers|dad.Ha s|dO pregunIadO en |Os u|I|mOs aOs.AprndeIe b|en |as caracIersI|cas de |a|acIanc|a maIerna y |as d|ferenc|as ensu cOmpOs|c|n frenIe a |a |eche devaca|aparIadO ms renIab|e de| I). LsInde mOda |as d|sI|nIas eI|O|Ogas de Ia||abaja, as que nO |as pases pOra|IO Hasde saber d|agnOsI|car cOrrecIamenIe |OsI|pOs de desh|draIac|n med|anIe unaana|I|ca.POru|I|mO,cOnOcee|aqu|I|smO,ya que es una paIO|OgaespecamenIepd|Irca. NOIeObses|OnescOn |Osh|IOsd|desarrO||OmE1t||[||Para ca|cu|are|pesO|dea|segunedad,re-currea|as|gu|enIefrmu|a.|LdadenaOsx 2) + 8. 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CCC lC>) Xz B|M| K000] F, 88. !8|l8 0Hhi ]' ' ' nclnlCnIC.bcm,OCx|nCmCn!C. CCc| n| Cn!C CunIC Cl O|nC C. >uClCn c|CcC unb%CC'!' ' ' nc| n|CnIClunC>zbcn). C>CC 'C>z lC> Iz C>,>C OuCCCcl cu' '!l' ICC|c CC un n| C nC|n' u>nCC ' ICnul . CCC C>).X //. uOl | cn lIllCClnc| mlCn!C.4C> M> l l CCl OCCCC nCCnI', >C |Ol CCIll Oj >| C>! OC|CCO|CCCl OC|cCnIllJ OCCC.>I lC> 4 C>, ' vClCclCC CC c|Cc|mlCn!C C!!u|lC> ' nyC CC cul Cu| C| OCCCC CC l v|C OC>In!' . Al ' ' CO l OuOC!C, >C OCCucC un | ncCnCnIC CC ' vC'Cc|CC CCcCc|n|Cn!C,CuCC>l OCn>OCcCzCn ' >nl >CuCCn' C>vCnC>CnC>I>,>uC' CcC| ncl C| cCnC' l nl cl CCC' CC>C' ' Cnm|lC.Ll lnClcCC n> >Cn>|OlC O| CCICc! O|CcCzmCn!Cl> lICc|CnC> CC' cCc|nlCn!C C> ' vClCc|CC CC c|Ccl nlCnIC.Ln '> ul I| m> OCnC|clCnC>, >C CO>Cv un | mO|InICumCn!CCClIll mCC| OCO' c| Cn' ,CuC >CCCOC, >CO|C!CCC,' nC|COC!Cl l nCn!|lC|M|K98-99, 89.|0||R0|O O08llOO 0Hh! Ll Cl ncln|Cn!CC>CCJb cn, OCxlnCnCn!C,yC>nyC| CuC Cl OCnCIC!C|clcC. 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