Fluid management in a dehydrated child

Question 1

are maintenance fluids related to weight or metabolism?

Answer 1

metabolism

Question 2

metabolism creates what two byproducts?

Answer 2

• heat

- solute

Question 3

metabolic rate is expressed in what units?

Answer 3

calories

Question 4

why is heat lost through evaporation and the respiratory tract known as “insensible”?

Answer 4

we cannot measure it

Question 5

is the BMR higher in an infant or an adult?

Answer 5

infant

Question 6

who has more water weight - an infant or an adult?

Answer 6

infant

Question 7

for a child who just needs hydration (dehydrated) and weighs 3-10 kg, how much fluid do they need per day?

Answer 7

100 mL / kg / day

Question 8

for a child who just needs hydration (dehydrated) and weighs 10-20 kg, how much fluid do they need per day?

Answer 8

1000 mL +50 mL / kg / day

Question 9

for a child who just needs hydration (dehydrated) and weighs over 20 kg, how much fluid do they need per day?

Answer 9

1500 mL + 20 mL / kg / day

Question 10

for an infant (less than a year) who is mildly dehydrated, what % dehydrated are they? moderately? severely?

Answer 10

• mildly: 5%
• moderately: 10%
• severely: 15%

Question 11

for an older child (over a year) who is mildly dehydrated, what % dehydrated are they? moderately? severely?

Answer 11

• mildly: 3%
• moderately: 6%
• severely: 9%

Question 12

does “irritable” relate to mild, moderate, or severe dehydration?

Answer 12

moderate

Question 13

capillary refill over 3s relates to what degree of dehydration?

Answer 13

severe

Question 14

bolus administration is about what physiological parameter?

Answer 14

cardiovascular stability

Question 15

what are the effects of administering a bolus of fluid in a dehydrated child?

Answer 15

• rapid recruitment
• restores intravascular volume
• diminishes myocardial work
• promotes an improves sense of well-being

Question 16

what is the bolus amount for neonates?

Answer 16

10 mL / kg

Question 17

what is the bolus amount for infants and children?

Answer 17

20 mL / kg

Question 18

what is the bolus amount for adolescents?

Answer 18

10 mL / kg

Question 19

what are the fluid types for bolus?

Answer 19

NS or LR

Question 20

what is combined deficit / maintenance replacement model?

Answer 20

• subtract bolus

- divide remaining deficit in half and give 1st half over 8 hr and 2nd half over next 16 hr + constant maintenance rate

Question 21

what is the sequential deficit / maintenance replacement model?

Answer 21

• subtract bolus
• give remaining deficit over 8 hr
• next 16 hour give maintenance at 1.5 rate

Question 22

what are the potassium needs at rest?

Answer 22

1 meq / kg / day

Question 23

what are the sodium needs at rest?

Answer 23

2 meq / kg / day

Question 24

what are the chloride needs at rest?

Answer 24

3 meq / kg / day

Question 25

what is a top sign that indicates severe dehydration? would this indicate maintenance fluid or a bolus? why?

Answer 25

• low BP

- bolus due to cardiovascular instability

Question 26

if you are 15% dehydrated, what is the fluid deficit? 9% dehydrated? 3% dehydrated?

Answer 26

• 150 mL / kg
• 90 mL / kg
• 30 mL / kg

add a zero!

Question 27

when do you add potassium?

Answer 27

after first void

Question 28

for hypernatremic dehydration

Answer 28

• add deficit

- add maintenance for 48 hours (instead of 24)

Question 29

hypernatremic dehydration must be corrected slowly to avoid what?

Answer 29

avoiding brain edema