????Characteristics of the water-electrolyte and acid-base balance in childhood. Flashcards
in chich compartment s fluid higher intracellular or extracellular ?
intracellular - 67 percent
extracellular - interstitial fluid 26 percent blood plasma - 7 percent cerebrospinal fluid - less than 1 percent =34 percent
what the cations and anions found intracellular
cations (+) = POTASSIUM
sodium
mg
balances with
anions (-) PHOSPHATES proteins- HCO3 chlorin
what are the cations and anions found extracellularly int he plasma ?
cations
SODIUM
little bit of potassium , calcium , magnesium
what are the anions
CHLORIDE
hco3
proteins
what are the main ways of water loss ?
60 percent through urine
35 percent through perspiration and lungs
5 percent = through stool
what are the causes for dehydration
gastroenteritis = vomiting diarrhoea
DKA diabestes mellitus burns psycho states temperate poor oral intake - stomatitis , pharyngitis
what is important when assesing dehydration pediatrics ?
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
in infants what percentage of water loss relates to the degree of of dehydration
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
in adolescencewhat percentage of water loss relates to the degree of of dehydration
mild = 3 percent of water loss
moderate = 6 percent
severe 9 percent
in infants if there is mild dehydration what are the mild symptoms and signs
thirsty
alert
restless
in infants and young what are the moderate signs and symptoms
thirsty
restless / lethargic
irritable
drowsy
in infants and young what are the severe signs and symptoms
drowsy limp cold sweaty cyanotic extremities comatose
in older children what are the symptoms
mild - thirsty , alert , restless and excitement
moderate - thirsty , alert , irritable
severe - reduced conciseness but still conscious cold sweaty cystic extremities wrinkled skin muscle cramps
what are the further signs of dehydration in relation to its degree
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
dehydration has three phases when curing what are they
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
breast feeding should only be allowed when during this oral rehydrtion therapy
AFTER IT - breast milk or formula mils should not be delayed for more than 24 hours
what is maintencae therapy of the mild to moderate dehydration through diarrhea ?
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
the volume of ORS ingested should be equal to the volume of ?
stool loss through diarrhoea
what are the equation to calculate water deficit and electrolyte deficit
water :
dehydration percentage x weight
sodium deficit water deficit (l) X 80Meq/L
potassium deficit water deficit (l)x 30mEq/L
what is the fluid management for dehydration ?
norma saline : 20ml/kg over 20 mins (normal saline contains sodium and chloride in equal amounts )
ho w is the fluid therapy adjusted for polyuria ?
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
in hypernatremic dehydration or polyuria the time for fluid repleshment is adjusted according to the initial sodium conc , describe it
145-157 mEq/l (na+) = 24hr
158-170 mEq/L = 48hr
171 -183 mEq/L = 72 hr
184-196 mEq/L = 84hr
whee is the source of water
intake
metabolic catabolic breakdown
infants younger than 6 weeks do not produce what ?
tears
in an infant what may indicate dehydration ?
sunken fontanel
infants ability to dilute and concentrate urine is what ?
limited
water balance is regulated by which hormone
ADH released by the pitotory acting on the DCT and collecting ducts
what increases the water needs
anything which raises the metabolic needs = such as fever or sepsis
diabetes
burns
shock
dehydration is further classified into three types depending on the basis of serum sodium concentration such as ?
isotonic - sodium 130-150 mmol/l
hypotonic - na less than 130
hypertonic - na more than 150mmol
how can we diagnose dehydration ?
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
why do infants suffer with dehydration
renal function is still immature and glomerular filtration reaches adult level at 6 months
what are the daily needs in infants
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
what are the daily fluid needs in new borns ?
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
how can we determine the deficit of water ?
difference between the body weight before the disease and admission
and percentage of dehydration
deficiency in L = BW(kg) x %D / 100
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
thirst - moderate
vomiting - possible
skin elasticity - reduced - MARBELED if very bad and acrocyanosis
skin - DRY cool
pulse - DISTINCT
arterial pressure - low
heart tones - different
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
thirst - None vomiting - yes skin elasticity - very bad skin - MOIST cool pulse - BROKEN AND SOFT- filiform arterial pressure - very low heart tones - dEAF
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
thirst - strong
vomiting
skin elasticity - slightly reduced
skin - DRY and WARM
pulse - FAST
arterial pressure - Normal to slightly low
heart tones - CLEAR
what causes isotonic dehydration
vomiting and diarrhea = gastroenteritis
how to describe the water electrolyte in schwartz batter syndrome or syndrome inappropriate adh have ?
euvolumic ( extracellular fluid volume is normal)
hyposmolar (low solutes )
hyponatremia (low sodium conc in blood) - high sodium loss in urine
THERE IS MILD EDEMA
schwartz batter syndrome or syndrome inappropriate adh is caused by ?
lung cell carcinoma - releasing ADH
how to describe the water electrolyte balance in diabetes inspidus
hypernatremia (high sodium in blood) - low sodium in urine
hyperdiuresis
how can we treat hyponatremia ?
infusion of 3 percent NaCl for 1ml/ kg / 20-30min
serum level of sodium would increase with 1 mmol/l
objective of 135mmol/l
how do we calculate sodium deficiency ?
(130- serum na concentration) x0.6 x TT kg
what causes hypernatremia ?
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
which type of dehydration is underestimated ?
hypernateremic dehydration - because water moves from ICF to ECFA and preserve blood volume
what causes hyponateremic dehydration ?
mucovisidosis - cutaneous salt loss
renal insuffienceny - salt loss
hyponateremic dehydration leads to affects which bodily system the most ?
cardiovascular - low blood pressure , tachycardia then nervous system
when there is hyponatremic dehydration why is it important to increase the sodium levels slowly
Central pontine myelinolysis - pulls water from brain cells
hypernateremic dehydration leads to affects which bodily system the most ?
CNS - delirium , hypersensitivity , seizures , agitation, HYPERREFLEXIA
why does correction of hypernatermia have to be slow
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
