Clinical points

Question 1

In what circumstances is an accurate calculation of insensible losses in a child important?

Answer 1

When their weight is above the 91st centile, AKI, known CKD or cancer

Question 2

How regularly should a child’s bloods be monitored when they are on IV fluids?

Answer 2

Their plasma electrolyte concentrations should be measures AT LEAST when IV fluids are started and at least every 24 hours.
If electrolyte disturbances exist plasma electrolyte concentrations should be measured more regularly

Question 3

How regularly should blood glucose be measured?

Answer 3

At least every 24 hours, more frequently is there is a risk of hypoglycaemia

Question 4

If a child DOESN’T have a pre-existing condition (e.g cardiac or kidney disease) how should IV fluids for FLUID RESUS be administered?

Answer 4

Glucose free crystalloids should be used
(Ones that contain Na+ 131-154)

BOLUS:
Children and young people: 20ml/kg over less than 10 minutes
Neonates: 10-20ml/kh over less than 10 minutes

Question 5

What formula do you use to calculate how much IV fluids should be given to a child or young person?

Answer 5

Holliday-Segar formula:
100ml/kg/day for the first 10kg of weight
50ml/kg/day for the second 10kg of weight
20ml/kg/day for the weight over 20kg

Question 6

How do you calculate how much fluid to give as routine IV maintenance fluid for a term neonate?

Answer 6

From birth to day 1: 50–60ml/kg/day

Day 2: 70–80 ml/kg/day  Day 3: 80–100 ml/kg/day  Day 4: 100–120 ml/kg/day Day 5–28: 120–150ml/kg/day

Question 7

In a child <5 presenting with a fever there is a risk stratification tool that can be used.
What features with regards to circulation and hydration are considered to be red flags (high risk) and therefore require admission?

Answer 7

Reduced skin turgor

Question 8

In a child <5 presenting with a fever there is a risk stratification tool that can be used.
What features with regards to the respiratory system are considered to be red flags (high risk) and therefore require admission?

Answer 8

• Grunting
• Tachypnoea: respiratory rate >60 breaths/minute
• Moderate or severe chest indrawing

Question 9

In a child <5 presenting with a fever there is a risk stratification tool that can be used.
What features with regards to their activity are considered to be red flags (high risk) and therefore require admission?

Answer 9

• No response to social cues
• Appears ill to a healthcare professional
• Does not wake or if roused does not stay awake
• Weak, high-pitched or continuous cry

Question 10

In a child <5 presenting with a fever there is a risk stratification tool that can be used.
What features with regards to their colour/other general features are considered to be red flags (high risk) and therefore require admission?

Answer 10

• Pale/mottled/ashen/blue
• Age <3 months, temperature >=38°C
• Non-blanching rash
• Bulging fontanelle
• Neck stiffness
• Status epilepticus
• Focal neurological signs
• Focal seizures