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Albert #2 Flashcards

1
Q

When is the liver functional?

A

1-2 Weeks Postnatal

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2
Q

When is the liver mature

A

6-12 months postnatal

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3
Q

Liver enzyme function is a _______ function

A

Postnatal

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4
Q

What are phase 1 liver functions.

A
  • Oxidation
  • Reduction
  • Hydrolysis
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5
Q

What is the phase 2 liver function?

A

Conjugation

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6
Q

What 2 liver functions are functional at birth?

A
  • Hydrolysis

- Sulfonation

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7
Q

Because liver function is still developing, _______ is increased for many drugs.

A

Half Life

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8
Q

Why is it OK to give acetaminophen to PEDS?

A

-Half life remains normal due to sulfonation.

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9
Q

Why is renal function limited at birth?

A
  • ↑ vascular resistance
  • ↓ blood flow
  • ↓ GFR
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10
Q

When does renal function improve after birth?

A

Day 5

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11
Q

How long does obligatory Na loss last?

A

1st month

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12
Q

By the end of month 1 the kidney is ______ mature.

A

70%

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13
Q

biggest difference in PEDS fluid compartments?

A

ECF is 40% total body water

adults 20%

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14
Q

Where does the excess ECF in PEDS come from?

A

Interstitial fluid

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15
Q

Why do PEDS have more total body water 80 vs 60%?

A

Less muscle mass

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16
Q

Why do PEDS have increased metabolic rate?

A

increased fluid metabolism (greater % of TBW is exchanged perday)

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17
Q

Increased fluid metabolism leads to an increased risk of what?

A

Dehydration

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18
Q

What is the most marked electrolyte difference between PEDS and adults?

A

K

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19
Q

What is normal K in peds

A

5-6.5

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20
Q

A PEDS K of 3-3.5 represents a significant need for what?

A

Rehydration and electrolyte replacement

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21
Q

What leads to an increased risk if metabolic acidosis in PEDS?

A

Increased Cl

Decreased Bicarb

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22
Q

How can a slight acidosis be beneficial?

A

increased O2 delivery to tissues

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23
Q

Uptake and distribution in the GI tract is ________ in neonates.

A

Decreased

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24
Q

Why are inhalation agents faster in PEDS than adults?

A
  • ↑ CO
  • ↓ FRC
  • ↑ Tidal volumes
  • ↑ Tissue perfusion
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25
Peds has _______ Plasma binding due to decreased ________.
Decreased | Plasma proteins
26
Increased membrane permeability is due to what?
- Incomplete mylenation | - Incomplete BBB
27
What slows onset of several drugs in peds?
ECF/TBW ratio
28
Renal clearance takes up to 2 years to reach adult levels, but most by when?
3 Months
29
When do enzyme levels mature?
1st 3 months of life
30
Describe basic maintenance fluid calculation for PEDS.
1st 0-10kg = 4ml/kg/hr 11-20kg = 2ml/kg/hr 21+ = 1ml/kg/hr
31
What are the blood volumes for Premie, 0-2, and 2-16 year olds
100 ml/kg 80 ml/kg 70 ml/kg
32
What procedures are 3rd space loss generally replaced?
Thoracic and intra abdominal
33
How much fluid should be given back for 3rd space?
2-10ml/kg over 2nd and 3rd hours
34
Instead of crytaloids, you should consider replacing the last _____ with ______.
25% | Blood
35
Other types of fluid loss.
- Respiratory loss - GI loss - Urine
36
Urine output should be?
1-2ml/kg/hr
37
What 2 things should be minimized?
- Tachycardia | - Hypotension
38
Best monitors for proper fluid intake?
- Urine production | - Proper BP
39
3 types of hydration
- Isotonic - Hypotonic - Hypertonic
40
What 4 things cause Isotonic (most common) dehydration?
- Pyloric obstruction - bowel loss - peritonitis - starvation
41
What 3 things cause hypotonic dehydration?
- Fever - Diarrhea - Starvation
42
What 3 things cause hypertonic dehydration?
- Burns - Sweating - Diarrhea
43
What are the 3 degrees of dehydration in infants and children?
Mild 5 and 3% Moderate 10 and 6% Severe 15 and 9%
44
What type of fluid causes carries the greatest risk in rehydration and why?
Hypertonic fluid due to fluid shifts.
45
If hypertonic fluid is replaced too fast what can happen?
ceberal edema | Seizures
46
What type of acidosis is common in PEDS?
Metabolic
47
What are some common causes of metabolic acidosis in PEDS?
- Cold - Hypoxia - Dehydration - hypotension - poor perfusion
48
What is is about bicarb that warrants caution?
High osmolality
49
Bicarb administration can cause what problems?
Ceberal edema and hemorrhage
50
What is the classic example of metabolic alkalosis?
Pyloric stenosis
51
When is pyloric stenosis considered an emergency?
Never
52
What must be done prior to PEDS surgery?
- Fluid balance - K correction - Metabolic abnormalities fixed
53
Development of alkalosis is from loss of what?
H+
54
Metabolic alkalosis is a result of what, fluid loss from what?
Vomiting
55
Vomiting leads to a loss of what?
- H - Cl - H2O
56
Vomiting is an example of what kind of dehydration?
Isotonic
57
In metabolic acidosis, pH may increase to _______ and K to ______
- 7.5-7.6 | - 3.0-3.5
58
Metabloic alkalosis does what to K?
Decrease
59
What 6 things should be asked about birth history?
- Post conceptions weeks at birth - Length of stay - Respiratory support - Cardiac Problems - Nervous system problems - Muscular problems
60
What is the ongoing rule for when it is safe to do surgery as outpatient?
60 weeks post conception
61
Unique concerns with children in the preop eval
- Birth History - Congenital problems - Developmental milestones - Respiratory infections - NPO status
62
What should you ask about respiratory infections?
- How long - Temperature - Appetite - Activity - Parent assessment
63
What is the 2/4/6/8 NPO rule?
- 2 hours clears - 4 hours Breast milk - 6 hours formula - 8 hours solids
64
How does injury/pain effect NPO status?
Delays gastric emptying

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