Dehydration

Question 1

What are the early and late signs of dehydration?

Answer 1

Early- tachycardia

Late- decreased BP, decreased skin turgor, and bounding pulses

Question 2

5% dehydration

Answer 2

Tachycardia, decreased tear production, low UOP, increased urine concentration

You are 50ml/kg “short”
Take this + mIVF and give half of this total over the first 8 hours and then the rest over 16 hours.

Question 3

10 % dehydration

Answer 3

Tachycardia, sunken eyes, poor skin turgor, sunken fontanelle

You are 100ml/kg “short”
Take this + mIVF and give half of this total over the first 8 hours and then the rest over 16 hours.

*If you give a bolus then take the remaining volume, and give the first half within 7 hours and the last half over 16 hours.

Question 4

15 % dehydration

Answer 4

Shock, delayed cap refill

You are 150ml/kg “short”
Take this + mIVF and give half of this total over the first 8 hours and then the rest over 16 hours.

*If you give a bolus then take the remaining volume, and give the first half within 7 hours and the last half over 16 hours.

Question 5

What is isotonic dehydration?

Answer 5

Na 135-145

Have a symptomatic dehydrated patient

Question 6

What is hyponatremic dehydration?

Answer 6

Na < 135

Causes: diarrhea or water intoxication (Gma fed tea or water to a dehydrated child)

*Free water moves into cells when Na <125- causes cerebral swelling and seizures

Question 7

How do you treat hyponatremic dehydration?

Answer 7

1. NS boluses

2. Hypertonic 3% saline

Question 8

How do you calculate sodium correction?

Answer 8

(Desired Na - measured Na) x weight x 0.6 = A

add A to maintenance sodium (3 mEq/kg/d) and replace over 24 hours.

Question 9

What is hypernatremic dehydration?

Answer 9

Na > 145

Causes: water loss or sodium gain

• look for clue of improperly mixed formula. Can be irritable, lethargic, doughy skin, high-pitched cry, seizures
• One way the body deals with altered mental status is extreme thirst. If you are unconscious, psychotic, or an infant you can’t act on this. You get hypernatremic.

Question 10

Hypernatremic dehydration pearls

Answer 10

• Always assume 10% dehydration in these patients
• Free water leaves ICF to ECF causes cell shrinkage which leads to tearing of bridging blood vessels and intracranial hemorrhage.
• Develop idiogenic osmoles over 1-2 days to lure water back in. Correct Na SLOWLY (over 2-3 days)
• Decrease no more than 10-12 mEq/L per day. If you feel like you are overcorrecting give hypertonic normal saline.