Child Health Pharmacology Flashcards
How would you prescribe maintenance fluids for a child?
- First 10kg = 100ml/kg
- Second 10kg = 50ml/kg • Rest = 20 ml/kg
- E.g. 30 kg child will need: • 10 x 100ml = 1000ml
- 10 x 50ml = 500ml
- 10 x 20ml = 200ml
- Total 1700 ml fluid per 24 hours
- There is a maximum volume/day!! • Females – 2000ml
- Male – 2500ml
Which maintenance fluids should be prescribed for a child?
- Practical guide based on current use in department
- Maintenance fluids – 0.9% normal saline+5% dextrose
- Bolus – 0.9% normal saline
- Dextrose bolus – 10% Dextrose
- Neonates – first 24 hours – 10% Dextrose with no electrolytes
What is the equation to calculate Dehydration correction fluid?
Weight x % dehydration x 10 = amount of fluid required to correct dehydration over 24 hours
TOTAL FLUID CALCULATION:
Maintenance fluid amount + Dehydration correction fluid amount 24
= ml/hr to be infused for next 24 hours
How would you calculate the amount of bolus fluid to be administered to a child?
- Bolus fluid:
- Generally given as 20ml/kg
- Some exceptions where 5-10ml/kg aliquots are used instead • E.g. Neonates, Cardiac pathology, Trauma
- Should be subtracted from the total fluids during calculation
What is anaphylaxis?
- It is a severe, life threatening, generalised or systemic hypersensitivity reaction
- Characterised by rapidly developing, life threatening Airway and/or Breathing and /or circulatory problems
- Associated with skin/and or mucosal changes
Management of anaphylactic reaction
adrenaline establish airway high flow oxygen IV fluid challenge chlorphenamine hydrocortisone
Monitor: pulse oximetry, ECG, BP
IM adrenaline doses for anaphylaxis
IM 1:1000 adrenaline
Less than 6 months: 0.15mL (which is 150 micrograms)
Child 6 month - 6 years (0.15 ml)
Child 6-12 0.3 mL (which is 300 micrograms)
Adult or child more than 12 years 0.5 mL (which is 500 micrograms)
Differential for Upper airway problems in children
- Croup
- Epiglottitis
- Bacterial tracheitis
- Foreign body inhalation
- Trauma and thermal injury
Key Symptoms of croup
- Barking / seal like cough
- Hoarseness of voice
- Stridor
Child most likely has croup. What ‘Red flag signs’ should be looking out for? M
- Rapidly progressive
- Underlying condition
- Toxic appearance
- Tripod position
- Altered level of consciousness
Basic management of croup
- Reduce anxiety by being calm and organised
- Do not move the child from the mother
- observe carefully for signs of hypoxia or exhaustion
- Do not examine the throat with a spatula
Role of steroids in croup (which one to use)
- Dexamethasone and takes 90-120 minutes to work
- Dose 150microgram/Kg (oral or IV, and can be repeated after 12 hours)
- nebulised budesonide
If severe
•Nebulised adrenaline
•Watch for rebound of symptoms
•If deteriorating call for urgent senior help
Differentiate the presentation of croup and epiglottis
epiglottitis has a faster onset, with no preceding coryza, absent or slight cough, not able to drink, drooling saliva, appear toxic
croup onset is longer with preceding coryza, severe parking cough, able to drink, no drooling. Appear unwell but not toxic
Management of epiglottitis
- Life threatening emergency
- Urgent admission
- Senior Anaesthetist, Paediatrician and ENT surgeon summoned
- Intubated
- Blood culture
- IV antibiotics – ceftriaxone
Clues to foreign body in child
- Sudden onset of cough
* Lack of preceding viral illness
Gastroenteritis in children: Additional history to ask
- recent contact with someone with acute diarrhoea and/or vomiting
- exposure to a known source of enteric infection
- recent travel abroad
Parents seeking advice on gastroenteritis in child. How long will it last?
- diarrhoea usually lasts for 5–7 days (max 2 weeks)
* vomiting usually lasts for 1–2 days (max 3 days)
Gastroenteritis in children: when should you Consider stool test?
Consider stool test only if
•Recent travel abroad
•Persisting more than 7 days
•Diagnosis uncertain
Perform stool test if
•Suspicion of septicaemia
•Blood/mucus in stools
•Immunocompromised child
How can you differentiate clinical dehydration from clinical shock?
dehydration: altered responsiveness, normal skin colour, warm extremities
Shock: decreased level of consciousness, pale or mottled skin, cold extremities, peak pulse, prolonged CRT, hypotension
Maximum fluid maintenance in children
MAXIMUM 2 litres in females and 2.5 Litres in males
Primary prevention of dehydration in children
- continue breastfeeding and other milk feeds
- §encourage fluid intake
- discourage the drinking of fruit juices and carbonated drinks
- offer Oral Rehydration Solution (ORS)
Treat dehydration (use ORS over 4 hours) in children
- Maintenance fluids (calculate requirement for 4 hours)
- fluid deficit = 50ml/Kg (over 4 hours)
- give frequently and in small amounts
- consider supplementation with their usual fluids
- consider nasogastric tube if they are unable to drink it
When should Intravenous fluid therapy be used for dehydration in children?
Consider if
•shock is suspected or confirmed
•red flag symptoms or signs
•Deteriorates despite oral rehydration therapy
NB: Treat suspected or confirmed shock
with Rapid intravenous infusion of 20 ml/kg of 0.9% sodium chloride
Treatment of status epilepticus: describe benzodiazepines stage
Midazolam 0.5 mg/kg buccally
or
Lorazepam 0.1 mg/kg if intravenous
access established
In hospital: Lorazepam 0.1 mg/kg intravenously. Start to prepare phenytoin for 4th step
Re-confirm it is an epileptic seizure
