| GENERAL GUIDANCE ON ESTIMATING SEVERITY GRADE |
|---|
| Characterization of symptoms and general guidance on management | Symptoms causing no or minimal interference with usual social and functional activities:a
no therapy needed, monitor | Symptoms causing greater than minimal interference with usual social and functional activities: may require minimal intervention and monitoring | Symptoms causing inability to perform usual social and functional activities: requires medical care and possible hospitalization | Symptoms causing inability to perform basic self-care functions:c requires medical or operative intervention to prevent permanent impairment, persistent disability or death |
| HAEMATOLOGY (Standard international units are listed in italics) |
|---|
| Absolute neutrophil count | 750 − <1000/mm3
0.75 × 109− < 1 × 109/L | 500 – 749/mm3
½ × 109 − 0.749 × 109/L | 250 − 500/mm3
0.25 × 109 − ½ × 109/L | <250/mm3
<0.250 × 109/L |
Haemoglobin
(child >60 days of age) | 8.5–10.0 g/dl
1.32 − 1.55 mmol/L | 7.5−<8.5 g/dl
1.16 −<1.32 mmol/L | 6.5 − <7.5 g/dl
1.01 −<1.16 mmol/L | <6.5 g/dl
<1.01 mmol/L
Or severe clinical symptoms attributable to anaemia (e.g. cardiac failure), refractory to supportive therapy |
| Platelets | 100000−<125000/mm3
100 × 109 − 125 × 109/L | 50000−<100000/mm3
50 × 109 − <100 × 109/L | 25000–<50000/mm3
25 × 109 − <50 × 109/L | <25000/mm3
<25 × 109/L
Or bleeding |
| GASTROINTESTINAL |
|---|
| Laboratory |
|---|
| ALT (SGPT) | 1.25–2.5 × ULN | 2.6–5.0 × ULN | 5.1–10.0 × ULN | >10.0 × ULN |
| AST (SGOT) | 1.25–2.5 × ULN | 2.6–5.0 × ULN | 5.1–10.0 × ULN | >10.0 × ULN |
| Bilirubin (>2 weeks of age) | 1.1–1.5 × ULN | 1.6–2.5 × ULN | 2.6–5.0 × ULN | >5.0 × ULN |
| Lipase | 1.1–1.5 × ULN | 1.6–3.0 × ULN | 3.1–5.0 × ULN | >5.0 × ULN |
| Pancreatic amylase | 1.1–1.5 × ULN | 1.6–2.0 × ULN | 2.1–5.0 × ULN | >5.0 × ULN |
| Clinical |
|---|
Diarrhoea
≥1 year of age
<1 year of age | Transient or intermittent episodes of unformed stools OR increase of ≤3 stools over baseline per day
Liquid stools (more unformed than usual) but usual number of stools | Persistent episodes of unformed to watery stools OR increase of 4 – 6 stools over baseline per day
Liquid stools with increased number of stools OR mild dehydration | Grossly bloody diarrhoea OR increase of ≥7 stools per day OR intravenous fluid replacement indicated
Liquid stools with moderate dehydration | Life-threatening consequences (e.g. hypotensive shock)
Liquid stools resulting in severe dehydration with aggressive rehydration indicated OR hypotensive shock |
| Nausea | Transient (<24 hours) or intermittent nausea with no or minimal interference with oral intake | Persistent nausea resulting in decreased oral intake for 24 – 48 hours | Persistent nausea resulting in minimal oral intake for >48 hours OR aggressive rehydration indicated (e.g. intravenous fluids) | Persistent nausea with no or minimal oral intake resulting in dehydration with aggressive rehydration indicated |
| Pancreatitis | Not applicable | Symptomatic AND hospitalization not indicated (other than emergency treatment) | Symptomatic AND hospitalization not indicated (other than emergency treatment) | Life-threatening consequences (e.g. circulatory failure, haemorrhage, sepsis) |
| Vomiting | Transient or intermittent vomiting with no or minimal interference with oral intake | Frequent episodes of vomiting with no or mild dehydration | Persistent vomiting resulting in orthostatic hypotension OR aggressive rehydration indicated (e.g. intravenous fluids) | Life-threatening consequences (e.g. hypotensive shock) |
| ALLERGIC/DERMATOLOGICAL |
|---|
| Acute systemic allergic reaction | Localized urticaria (weals) lasting a few hours | Localized urticaria with medical intervention indicated OR mild angioedema | Generalized urticaria OR angioedema with medical intervention indicated OR symptomatic mild bronchospasm | Acute anaphylaxis OR life-threatening bronchospasm or laryngeal oedema |
| Cutaneous reaction – rash | Localized macular rash | Diffuse macular, maculopapular, or morbilliform rash OR target lesions | Diffuse macular, maculopapular, or morbilliform rash with vesicles or limited number of bullae OR superficial ulcerations of mucous membrane limited to one site | Extensive or generalized bullous lesions OR Stevens –Johnson syndrome OR ulceration of mucous membrane involving two or more distinct mucosal sites OR toxic epidermal necrolysis (TEN) |
| NEUROLOGICAL |
|---|
| Alteration in personality, behaviour or moodb | Alteration causing no or minimal interference with usual social and functional activitiesb | Alteration causing greater than minimal interference with usual social and functional activitiesb | Alteration causing inability to perform usual social and functional activitiesb AND intervention indicated | Behaviour potentially harmful to self or others OR life-threatening consequences |
| Altered mental status | Changes causing no or minimal interference with usual social and functional activitiesb | Mild lethargy or somnolence causing greater than minimal interference with usual social and functional activitiesb | Onset of confusion, memory impairment, lethargy, or somnolence causing inability to perform usual social and functional activitiesb | Onset of delirium, obtundation or coma |
| Neuromuscular weakness (including myopathy and neuropathy) | Asymptomatic with decreased strength on examination OR minimal muscle weakness causing no or minimal interference with usual social and functional activitiesb | Muscle weakness causing greater than minimal interference with usual social and functional activitiesb | Muscle weakness causing inability to perform usual social and functional activitiesb | Disabling muscle weakness causing inability to perform basic self-care functions OR respiratory muscle weakness impairing ventilation |
| Neurosensory alteration (including painful neuropathy) | Asymptomatic with sensory alteration on examination OR minimal paraesthesia causing no or minimal interference with usual social and functional activities | Sensory alteration or paraesthesia causing greater than minimal interference with usual social and functional activities | Sensory alteration or paraesthesia causing inability to perform usual social and functional activities | Disabling sensory alteration or paraesthesia causing inability to perform basic self-care functionsc |
| OTHER LABORATORY PARAMETERS (Standard international units are listed in italics) |
|---|
| Cholesterol (fasting, paediatric <18 years old) | 170–<200 mg/dl
4.40 – 5.15 mmol/L | 200–300 mg/dl
5.16–7.77 mmol/L | >300 mg/dl
>7.77 mmol/L | Not applicable |
| Glucose, serum, high: non-fasting | 116 – <161 mg/dl
6.44–<8.89 mmol/L | 161 – <251 mg/dl
8.89–<13.89 mmol/L | 251–500 mg/dl
13.89–27.75 mmol/L | >500 mg/dl
>27.75 mmol/L |
| Glucose, serum, high: fasting | 110–<126 mg/dl
6.11–<6.95 mmol/L | 126–<251 mg/dl
6.95 –<13.89 mmol/L | 251–500 mg/dl
13.89–27.75 mmol/L | >500 mg/dl
>27.75 mmol/L |
| Lactate | <2.0 × ULN without acidosis | >2.0 × ULN without acidosis | Increased lactate with pH <7.3 without life-threatening consequences or related condition present | Increased lactate with pH <7.3 with life-threatening consequences (e.g. neurological findings, coma) or related condition present |
| Triglycerides (fasting) | Not applicable | 500 – <751 mg/dl
5.65–<8.49 mmol/L | 751 – 1 200 mg/dl
8.49–13.56 mmol/L | >1 200 mg/dl
>13.56 mmol/L |
