Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

pediatrics > ????Characteristics of the water-electrolyte and acid-base balance in childhood. > Flashcards

????Characteristics of the water-electrolyte and acid-base balance in childhood. Flashcards

1
Q

in chich compartment s fluid higher intracellular or extracellular ?

A

intracellular - 67 percent

extracellular - 
interstitial fluid 26 percent 
blood plasma - 7 percent 
cerebrospinal fluid - less than 1 percent 
=34 percent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what the cations and anions found intracellular

A

cations (+) = POTASSIUM
sodium
mg

balances with

anions (-)
PHOSPHATES
proteins- 
HCO3
chlorin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the cations and anions found extracellularly int he plasma ?

A

cations
SODIUM
little bit of potassium , calcium , magnesium

what are the anions
CHLORIDE
hco3
proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the main ways of water loss ?

A

60 percent through urine

35 percent through perspiration and lungs

5 percent = through stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the causes for dehydration

A

gastroenteritis = vomiting diarrhoea

DKA 
diabestes mellitus 
burns 
psycho states
temperate 
poor oral intake - stomatitis , pharyngitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is important when assesing dehydration pediatrics ?

A

degree of dehydration - mild , moderate or sevrere

OSMOLARITY OF BLOOD - isotonic , hypotonic , hypertonic ( hypernatermeic )

the age of the child

how quickly the dehydration developed

concomitant disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

in infants what percentage of water loss relates to the degree of of dehydration

A

mild = 5 percent water loss
in infancy
3% adolescent

moderate = 10 pecrent water loss in infancy
6 percent adolescent

severe 15 percent water loss in infancy
9 percent adolescent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

in adolescencewhat percentage of water loss relates to the degree of of dehydration

A

mild = 3 percent of water loss

moderate = 6 percent

severe 9 percent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

in infants if there is mild dehydration what are the mild symptoms and signs

A

thirsty
alert
restless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

in infants and young what are the moderate signs and symptoms

A

thirsty
restless / lethargic
irritable
drowsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

in infants and young what are the severe signs and symptoms

A 
drowsy 
limp 
cold 
sweaty 
cyanotic extremities 
comatose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

in older children what are the symptoms

A

mild - thirsty , alert , restless and excitement

moderate - thirsty , alert , irritable

severe - reduced conciseness but still conscious 
cold 
sweaty 
cystic extremities 
wrinkled skin 
muscle cramps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the further signs of dehydration in relation to its degree

A

presence of tallest 3 or more of this indicate moderate dehydration

mild = mucous membrane moist
decreased urin output - EARLY INDICATOR

moderate 
orthstatic tachycardia 
weak palpable pulse
orthostatic hypotension 
slightly reduction in skin poor turgor 
fontanel slightly depressed
mucous membranes dry 
respirations deep and may be rapid 
oliguria 
ANTERIOIR FONTANEL SUNKEN
sunken eyes
decrease amount of tears 
marbled perfusion 
3-4 s capillary refill 
INCREASED UREA
decrease in PCO2 levels 
severe - tachycardia 
palpable pulses 
hypotension 
cutaneous perfusion reduced 
skin turgor reduced 
fontanel sunken 
mucous membrane dry 
tears absent 
deep and rapid breathing 
anuria and oliguria
more than 4 sec capillary refill
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

dehydration has three phases when curing what are they

A

oral rehydration solution

should contain glucose and sodium in a ration not to exceed 2:1

use isotonic solution in the beginning because most electrolyte balances disappear that way

containing 5 percent dextrose in 1/4 normal saline
15mEq/l bicarbonate
25mEq/l potassium chloride

50ml/kg within 4 hours = mild

100ml/kg over 4 hours = moderate

additional 10ml/kg is given for each stool

it relies on the transporters of sodium and glucose in the intestinale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

breast feeding should only be allowed when during this oral rehydrtion therapy

A

AFTER IT - breast milk or formula mils should not be delayed for more than 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is maintencae therapy of the mild to moderate dehydration through diarrhea ?

A

0-10kg
dehydration is complete - 100ml of ORSL/kg/24 until diarrhea stops or for each diarrhoea stool
hourly rate of 4ml/kg/hr

11-20kg
1000ml + 50ml/kg for each 1kg
40ml/hr

more than 20kg
1500ml + 20mL/kg for each 1 kg
60ml/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

the volume of ORS ingested should be equal to the volume of ?

A

stool loss through diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the equation to calculate water deficit and electrolyte deficit

A

water :
dehydration percentage x weight

sodium deficit 
water deficit (l) X 80Meq/L
potassium deficit 
water deficit (l)x 30mEq/L
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the fluid management for dehydration ?

A

norma saline : 20ml/kg over 20 mins (normal saline contains sodium and chloride in equal amounts )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ho w is the fluid therapy adjusted for polyuria ?

A

measure the urine

electrolytes and replace the urine output for ml/ml based on the urine electrolytes

on 5 percent dextrose in 1/2 normal saline with 20mEq/L potassium chloride 20ml/kg over 20 mins until intravascular volume is restored

the time period is determined based on the sodium concentration of the initial dignsosi

21
Q

in hypernatremic dehydration or polyuria the time for fluid repleshment is adjusted according to the initial sodium conc , describe it

A

145-157 mEq/l (na+) = 24hr

158-170 mEq/L = 48hr

171 -183 mEq/L = 72 hr

184-196 mEq/L = 84hr

22
Q

whee is the source of water

A

intake

metabolic catabolic breakdown

23
Q

infants younger than 6 weeks do not produce what ?

A

tears

24
Q

in an infant what may indicate dehydration ?

A

sunken fontanel

25
Q

infants ability to dilute and concentrate urine is what ?

A

limited

26
Q

water balance is regulated by which hormone

A

ADH released by the pitotory acting on the DCT and collecting ducts

27
Q

what increases the water needs

A

anything which raises the metabolic needs = such as fever or sepsis

diabetes

burns

shock

28
Q

dehydration is further classified into three types depending on the basis of serum sodium concentration such as ?

A

isotonic - sodium 130-150 mmol/l

hypotonic - na less than 130

hypertonic - na more than 150mmol

29
Q

how can we diagnose dehydration ?

A

weight loss

serum sodium

hematocrit

rapid glucose test or serum glucose

urine specific gravity - elevated early in dehydration - not elevated in young children with sickle cell

30
Q

why do infants suffer with dehydration

A

renal function is still immature and glomerular filtration reaches adult level at 6 months

31
Q

what are the daily needs in infants

A

3 months = 150ml/kg

6 months = 120 ml/kg

9 months =110ml/kg

1 year old - 100ml/kg for first 10kg
second 10kg = 50ml/kg
over 20 = 20ml per kg

32
Q

what are the daily fluid needs in new borns ?

A 
more 2500kg 
1st day = 60ml/kg 
2nd = 80ml/kg 
3 = 90 
5-7 = 120 
after 7 = 130-160 
less than 2000 kg 
1st day = 60 
2nd =80
3rd = 100
4 = 110 
5-7 = 130 
after 7 = 150 -200
less than 1500
1st day = 7 
2nd day = 80 
3rd day = 100
4th day = 120 
5-7= 130 
after 7 days = 150- 200
less than 1000 
1st day = 90 
2nd = 100 
3rd = 110 
4th = 120 
5-7 days = 130 
afte 7 days = 150-200
33
Q

how can we determine the deficit of water ?

A

difference between the body weight before the disease and admission

and percentage of dehydration

deficiency in L = BW(kg) x %D / 100

34
Q

relate the type of dehydration to the symptoms in isotonic dehydration - proportionate water and electrolytes

thirst 
vomiting 
skin elasticity 
skin 
pulse 
arterial pressure 
heart tones 
size of the heart
A

thirst - moderate
vomiting - possible
skin elasticity - reduced - MARBELED if very bad and acrocyanosis

skin - DRY cool
pulse - DISTINCT
arterial pressure - low
heart tones - different

35
Q

relate the type of dehydration the symptoms in hypotonic - sodium loss is higher than of water loss

thirst 
vomiting 
skin elasticity 
skin 
pulse 
arterial pressure 
heart tones 
size of the heart
A 
thirst - None
vomiting - yes 
skin elasticity - very bad 
skin - MOIST cool 
pulse - BROKEN AND SOFT- filiform
arterial pressure - very low
heart tones - dEAF
36
Q

relate the type of dehydration the symptoms in hypotonic - water loss exceeding that of sodium

thirst 
vomiting 
skin elasticity 
skin 
pulse 
arterial pressure 
heart tones 
size of the heart
A

thirst - strong
vomiting

skin elasticity - slightly reduced

skin - DRY and WARM
pulse - FAST

arterial pressure - Normal to slightly low

heart tones - CLEAR

37
Q

what causes isotonic dehydration

A

vomiting and diarrhea = gastroenteritis

38
Q

how to describe the water electrolyte in schwartz batter syndrome or syndrome inappropriate adh have ?

A

euvolumic ( extracellular fluid volume is normal)

hyposmolar (low solutes )

hyponatremia (low sodium conc in blood) - high sodium loss in urine

THERE IS MILD EDEMA

39
Q

schwartz batter syndrome or syndrome inappropriate adh is caused by ?

A

lung cell carcinoma - releasing ADH

40
Q

how to describe the water electrolyte balance in diabetes inspidus

A

hypernatremia (high sodium in blood) - low sodium in urine

hyperdiuresis

41
Q

how can we treat hyponatremia ?

A

infusion of 3 percent NaCl for 1ml/ kg / 20-30min

serum level of sodium would increase with 1 mmol/l

objective of 135mmol/l

42
Q

how do we calculate sodium deficiency ?

A

(130- serum na concentration) x0.6 x TT kg

43
Q

what causes hypernatremia ?

A

1) normal hydration and mild hypervolumia
= hypothalamic hypodipisa
= iatrogenic hyperaldosteronism
=cushing syndrome

with dehydration 
= diabetes insipidus , DM, diuretic hypertensive dehydration 
burns , sweating , alcohol and diuretics
fever 
less water intake
drink sea water for survival

children - feeding milk hyperosmolar without giving enough water

44
Q

which type of dehydration is underestimated ?

A

hypernateremic dehydration - because water moves from ICF to ECFA and preserve blood volume

45
Q

what causes hyponateremic dehydration ?

A

mucovisidosis - cutaneous salt loss

renal insuffienceny - salt loss

46
Q

hyponateremic dehydration leads to affects which bodily system the most ?

A

cardiovascular - low blood pressure , tachycardia then nervous system

47
Q

when there is hyponatremic dehydration why is it important to increase the sodium levels slowly

A

Central pontine myelinolysis - pulls water from brain cells

48
Q

hypernateremic dehydration leads to affects which bodily system the most ?

A

CNS - delirium , hypersensitivity , seizures , agitation, HYPERREFLEXIA

49
Q

why does correction of hypernatermia have to be slow

A

when there is hypernatermic dehydration state - the brain cells make idiogenic osmoses to Procters the brain cells from shrinking

with the slow correction to isotonic sates these osmoses tend to dissipate fast correction leads to cerebral edema - seiners , brain herniation

pediatrics (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions