7yo w/ abd pain and vomiting Flashcards
gastroenteritis presentation
MCC of vomiting
fever, colick abdominal pain, diarrhea, dehydration
GI obstruction presentation
Bilious vomiting
dehydration
Abdominal pain,
possible distension
AMS if dehydration severe
DKA presents with
enuresis/increased urine output
vomiting
tachypnea (Kussmaul breathing)
cerebral edema can happen during mgmt of DKA. What are some risk factors
Young Age
High BUN @ presentation
Profound acidosis w/ hypocapnia
Attenuated rise in the measured serum Na w/ tx
Administration of Bicarbonate
What do you order for DKA admission?
NPO
continuous vitals
hourly neuro checks
I/Os
Insulin
Serum glucose Q60mins
Serum electrolytes hourly + Cal, Mg, Phos
Check serum pH VBG hourly
Urine dip for ketones
Management of DKA
Insulin drip (0.1 u/kg/hr) after volume expansion
monitor blood glucose every 30-60 minutes
do not give bicarbonate
admit to ICU if: AMS, persistent hypovolemia, increased r/o cerebral edema
anion gap calculation
Serum Na- (Bicarb+Chloride)
MUDPILES
high anion gap:
what age group has a particularly increased r/o dehydration?
under 4 years old
maintenance fluid amount?
first 10kg: 4ml/kg/hour
2nd 10kg: 2ml/kg/hour
additional kg: 1ml/kg/hour
A patient with diabetes and _______ should be assumed to bin DKA until otherwise proven
vomiting
Diagnostic criteria for DKA
Random Blood Glucose of >200mg/dL
Venous pH <7.3 or serum bicarb <15
Moderate or large ketonuria
When does pain related to pelvic inflammatory disease typically present?
post-coital
during or immediately after period
When does a patient w/ ectopic pregnancy typically present?
6-8 weeks after last menstrual period
signs of cerebral edema
irregular respirations, headache, vomiting, 3rd nerve palsy, high blood pressure
