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.
intussuception
Infants with intussusception typically have bilious emesis and crampy or severe abdominal pain.
The classic “currant jelly” stools of intussusception may be mis-identified in the history as diarrhea.
The abdominal exam in children with intussusception often shows the presence of a “sausage-like” mass due to the telescoped bowel.
which CNS dz to consider in vomiting kids
hydroceph, mass, trauma, non accidental trauma,
repetitive vomiting without diarrhea or fever
consider cns pathology
presentation of milk allergy
Milk allergy may present with vomiting immediately after eating but more typically will present with a rash or loose stools; it does not typically cause dehydration.
important cause of non GI vomiting in infants
uti
IBD in infant
Inflammatory bowel disease may present with vomiting, but is usually associated with changes in stool pattern and growth and is extremely unlikely in a young infant.
CF in infant
may present with failure to thrive and loose, malabsorptive stools but does not typically present with vomiting unless the infant has bowel obstruction at birth (meconium ileus).
approach to pyloric stenosis dx and tx
dx - typically use US, but can use upper GI contrast study to show string sign (narrow pyloric channel) and delayed gastric emptying
tx - surgery but first, correct electrolyte abnormalities (will see hypoK, hypoCl, alka) via boluses of NS isotonic, and then dextrose, NAcl, KCL
from wiki, upper gi and sb series
aka barium, upper gi and sb serieso/sb follow thru use barium. not same as upper gi endo?
A hypochloremic, hypokalemic metabolic alkalosis is one of the hallmarks of
pyloric stenosis
rimary recommended mode of therapy for severe dehydration is to
IV bolus w/ isotonic saline (or LRs), often 10-20ml/kg aliquots
what to expect for feeding, vomitting and discharge after pylorus surgery
Oral feeding can generally be resumed within 12-24 hours after surgery.
Vomiting in the first few days after surgery is common but not severe.
Most babies can return home within just a couple of days of the surgery.
cdc guidelines for tx severe dehydr
Lactated Ringer’s solution or normal saline in 20 mL/kg boluses until urine output is established and mental status improves, then 100 mL/kg oral rehydration solutions over next 4 hours. Intravenous hydration with 5% dextrose ½ normal saline at twice maintenance fluid rates may be substituted for the oral rehydration solution if the child is not tolerating PO intake. To replace ongoing losses, the CDC recommends 60–120mL of oral rehydration solution per diarrheal/emetic episode (through a nasogastric tube, if necessary).
ork-up for the infectious causes of this patient’s diarrhea
Wright’s stain for fecal WBCs (which would suggest a bacterial cause if this is infectious diarrhea), a Rotazyme test (given the high incidence of rotavirus in the winter months), and a stool sample for culture and sensitivity. Additional studies might include stool guaiac (for occult blood) and a check for stool C. diff toxin.
gatorade for rehydration
high sugar, could cause osmotic diarrhea. consider age of pt, if they have diarrhea already, etc
