CLIPP 15 Flashcards
most accurate way to determine dehydration
weight before ilness-current weight because any acute weight loss can be attributed to water loss
Weight loss (in grams) = Weight loss (in kg) =
Weight loss (in grams) = water loss (in milliliters) or Weight loss (in kg) = water loss (in liters)
% dehydration
Percent dehydration is the percent of total euvolemic body weight lost as water. (from random webiste: rcentage dehydration (%) = Well weight (kg) - Current weight (kg) / Well weight (kg) x100)w
what is oral rehydration therapy and when is it used
commercially prepared oral rehydration solutions (ORS) that contain glucose and electrolytes is used in cases of mild–moderate dehydration. Can be effective even if kid is still having vomiting
- have sodium of 45-50mmol/L
- things like pedialyte, etc
- safer cheaper than IV and effective
what types of drinks to avoid in gastroenteritis type pictures
soda, apple juice, ginger ale - high sugar and not enough sodium
Children who have vomiting and diarrhea and are not dehydrated __should/should not___ continue to be fed age-appropriate diets.
should
best prevention of transmission of viral gastroenteritis
hand washing
what is the primary tx of severe dehydration
iv bolus therapy in 20ml/kq aliquots of NS or LR
infant GERD
hard to distinguish from spitting up sometimes, can have forceful vomiting if reflux due to overfeeding, can have bloody streaks (mallory weiss tears due to forceful vomiting, or esophagitis/gastirits), can lead to esophagitis, feeding aversion, dehydration, FTT
viral GI in geenral, and hallmark
hallmark of enteritis is diarrhea, can have some vomtiing, will have dehydration likely,
when is bilious emesis seen and not seen
can be seen in repetitive vomiting, not seen if the enteritis/obstruction is above the level of ligament of tretiz
malrotation +/- volvulus
can be see without volvulus or can result in volvulus (obstruction due to gut twitting on self–>obstruction–>vomiting). bilious emesis common, maybe bloody stool but not vomitus. volvulus can –>ischemia–>abd pain
if infant is in shock, must be distinguished from __and__, and is likely due to
dehydration or IBEM , malrotaiton w volvulus
IBEM
rare, can have repetitive vomiting, lethargy, iirritabiliy, decrease PO. can sometimes be triggered by intercurrent illness like an enteritis
pyloric stenosis
An escalating pattern of forceful (projectile), non-bilious vomiting is a hallmark of pyloric stenosis.
Bilious emesis is not typical because the obstruction is above the ligament of Treitz.
Infants with pyloric stenosis can have rapid dehydration due to inadequate fluid absorption, but they typically have a vigorous appetite until late in the clinical course.
Infants with pyloric stenosis often present with mild-moderate dehydration due to persistent vomiting.
The presence of hypochloremic, hypokalemic metabolic alkalosis with dehydration is another hallmark of pyloric stenosis.
Bloody emesis is sometimes seen in pyloric stenosis and other causes of forceful emesis due to the development of Mallory-Weiss tears in the esophagus.
Infants with pyloric stenosis may demonstrate a visible peristaltic wave (particularly just after eating.)
A palpable “olive” (the hypertrophic pyloric muscle) in the epigastric region very strongly suggests the diagnosis but is not uniformly perceptible.