Fluid management in a dehydrated child Flashcards
are maintenance fluids related to weight or metabolism?
metabolism
metabolism creates what two byproducts?
- heat
- solute
metabolic rate is expressed in what units?
calories
why is heat lost through evaporation and the respiratory tract known as “insensible”?
we cannot measure it
is the BMR higher in an infant or an adult?
infant
who has more water weight - an infant or an adult?
infant
for a child who just needs hydration (dehydrated) and weighs 3-10 kg, how much fluid do they need per day?
100 mL / kg / day
for a child who just needs hydration (dehydrated) and weighs 10-20 kg, how much fluid do they need per day?
1000 mL +50 mL / kg / day
for a child who just needs hydration (dehydrated) and weighs over 20 kg, how much fluid do they need per day?
1500 mL + 20 mL / kg / day
for an infant (less than a year) who is mildly dehydrated, what % dehydrated are they? moderately? severely?
- mildly: 5%
- moderately: 10%
- severely: 15%
for an older child (over a year) who is mildly dehydrated, what % dehydrated are they? moderately? severely?
- mildly: 3%
- moderately: 6%
- severely: 9%
does “irritable” relate to mild, moderate, or severe dehydration?
moderate
capillary refill over 3s relates to what degree of dehydration?
severe
bolus administration is about what physiological parameter?
cardiovascular stability
what are the effects of administering a bolus of fluid in a dehydrated child?
- rapid recruitment
- restores intravascular volume
- diminishes myocardial work
- promotes an improves sense of well-being
what is the bolus amount for neonates?
10 mL / kg
what is the bolus amount for infants and children?
20 mL / kg
what is the bolus amount for adolescents?
10 mL / kg
what are the fluid types for bolus?
NS or LR
what is combined deficit / maintenance replacement model?
- subtract bolus
- divide remaining deficit in half and give 1st half over 8 hr and 2nd half over next 16 hr + constant maintenance rate
what is the sequential deficit / maintenance replacement model?
- subtract bolus
- give remaining deficit over 8 hr
- next 16 hour give maintenance at 1.5 rate
what are the potassium needs at rest?
1 meq / kg / day
what are the sodium needs at rest?
2 meq / kg / day
what are the chloride needs at rest?
3 meq / kg / day
what is a top sign that indicates severe dehydration? would this indicate maintenance fluid or a bolus? why?
- low BP
- bolus due to cardiovascular instability
if you are 15% dehydrated, what is the fluid deficit? 9% dehydrated? 3% dehydrated?
- 150 mL / kg
- 90 mL / kg
- 30 mL / kg
add a zero!
when do you add potassium?
after first void
for hypernatremic dehydration
- add deficit
- add maintenance for 48 hours (instead of 24)
hypernatremic dehydration must be corrected slowly to avoid what?
avoiding brain edema
