????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
