Dehydration Flashcards
The most common cause of dehydration in children is?
simple gastroenteritis
List some signs of dehydration?
- Sunken eyes
- Sunken fontanelles
- Dry mucous membranes (lips, tongue and eyes)
- Tearless eyes
- Reduced level of consciousness
- Oliguria
- Mottling of hands and feet, cool peripheries
- Skin turgor – tug on skin, if it stays loose for more than a second they are probably dehydrated
- Capillary refill time may increase
- Weight loss compared to a recent weighing
- Signs of peripheral shutdown in general
Explain what pyloric stenosis is?
- Pylorus = tissue between stomach and duodenum
- Baby’s pylorus grows narrowing the opening between the stomach and duodenum
- This obstructs pathway of food
Who gets pyloric stenosis?
- This occurs in infants aged 2-8 weeks
- It is more common in males
- More common in first borns
Presentation of pyloric stenosis?
- Onset of non-bilious vomiting (bile secretion happens after the pyloric sphincter in the duodenum)
- Vomiting increases in frequency and intensity progressing to projectile vomiting
- Slight haematemesis may occur
- Persistent hunger, weight loss, dehydration and lethargy
- Infrequent or absent bowel sounds
- Stomach wall peristalsis may be visible
- An enlarged pylorus classically described as an “olive” may be palpated in the RUQ
Investigations for pyloric stenosis?
- Serum electrolytes – metabolic alkalosis and severe potassium depletion (as a result of dehydration which has caused sodium and water retention with potassium excretion)
- Ultrasound is reliable at identifying the condition
Management of pyloric stenosis?
- Pre-operative have to correct fluid deficiency and electrolyte imbalance
- Surgery – Ramstedt’s pyloromyotomy
Brief overview of neonatal hypernatraemic dehydration?
- This can occur in neonates – in particular preterm babies and can be fatal
- Essentially the kidneys cannot compensate for dehydration by maintaining water and sodium in the right proportions so get an imbalance
- Generally occurs in breast feeding babies where breast feeding has been difficult to establish
- May also occur due to diarrhoea
- Can also be caused by incorrect formula use
- The baby is drowsy
- They do not appear dehydrated because of the high sodium so may not have sunken eyes or fontanelle or reduced skin turgor
- Usually treated with fluids, moving to ones with less sodium in them
What is diabetic ketoacidosis?
Metabolic emergency occurring in T1DM characterized by:
1. Acidosis- blood pH below 7.3 or plasma bicarbonate below 15mmol/litre and
2. Ketonaemia- blood ketones above 3mmol/litre
3. Blood glucose levels are generally high above 11mmol/litre although children with known T1DM can develop it with normal glucose levels
- Essentially because you cannot utilize your glucose there is break down of adipose tissue resulting in rising levels of acidic ketone bodies – this causes metabolic acidosis
- The hyperglycaemia and glycosuria results in osmotic diuresis and patient becomes polyuric resulting in dehydration
3 complications of DKA that account for the majority of deaths in children?
cerebral oedema, hypokalaemia, aspiration pneumonia
Risk factors for diabetic ketoacidosis?
- May be a first presentation of diabetes
- May be due to non-compliance with insulin or changing insulin requirements e.g. in puberty
- May be due to intercurrent illness – cortisol raises blood glucose
- May be due to increased ingestion of glucose
Clinical features of diabetic ketoacidosis?
- General malaise and lethargy
- Nausea and vomiting
- Abdominal pain
- If no current diagnosis of DM – weight loss, polyuria and polydipsia may be preceding symptoms
Examination for DKA?
- Kussmaul breathing (rapid deep breathing), tachypnoea, subcostal and intercostal recession
- Shock - tachycardia, hypotension, increased cap refill and cool peripheries
- Dehydration – dry mucous membranes, reduced skin turogor, sunken eyes/ fontanelle
- Abdominal pain which may mimic a surgical acute abdomen
- Potential signs of neurological compromise e.g. papilloedema if cerebral oedema, reduced consciousness etc.
- Fruity ketotic breath
Investigations for DKA?
- Blood gas – venous or capillary
- Laboratory samples for blood glucose, U and Es, FBC and creatinine
- 12 lead ECG – cardiac monitoring for signs of hyper or hypokalaemia
Management of DKA?
- Fluids to rehydrate
- Insulin a couple of hours after fluid therapy has begun as this reduces the chance of cerebral oedema
- Replace and monitor potassium levels
- Look for underlying cause – check they don’t have something such as an underlying infection which triggered the DKA
