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Y4: Paediatrics > Dehydration > Flashcards

Dehydration Flashcards

1
Q

most common cause of dehydration in the UK?

A

simple gastroenteritis (i.e. a stomach bug)

Most commonly caused by viruses such as rotavirus.

vomiting > diarrhoea

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2
Q

In a normal child diarrhoea or vomiting has to be severe or prolonged to cause serious dehydration. This is more likely if they have an infection such as ____. Alternatively if a child has a chronic disease such as ___ ___ or has an ____, they can run into trouble.

A

Salmonella

cystic fibrosis

ileostomy

Beware of putting diarrhoea/ vomiting down to gastroenteritis; things like UTI or some of the red flag diagnoses will also cause vomiting.

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3
Q

which organism tends to cause gastroenteritis with

  1. abdominal cramps
  2. bloody stool

in children.

A
  1. Campylobacter
  2. Salmonella or Shigella (NB: could also be a symptom of intussusception)
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4
Q

It is worrying if there has been no wet nappy for __ hours

A

12

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5
Q

If there is abdominal pain present in a potential gastroenteritis be very careful. There may be a surgical cause.

A

In the early stages of appendicitis or bowel obstruction the gut is hyper-motile and diarrhoea can occur.

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6
Q

One thing worth noticing in small babies is whether they are jittery. This is a commonly used phrase and one of the key causes of jitteriness is what?

A

hypoglycaemia.

Can occur if baby has been feeding poorly or vomiting.

BM Stix test - may need oral or IV dextrose if low

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7
Q

what clinical signs may be seen in a child with dehydration?

A
  • sunken eyes (ask parent to compare to normal)
  • slightly sunken fontanelle (will bulge rather than by sunken if the baby is crying)
  • dry mucous membranes (lips, tongue and eyes)
  • cool hands and feet
  • mottling of arms and legs
  • reduced skin turgor (more floppy skin)
  • increased CRT
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8
Q

Pyloric stenosis

  1. age?
  2. what is it?
  3. symptoms?
A
  1. 4-6 weeks
  2. muscular swelling at the outlet of the stomach, which stops food going into the duodenum
  3. abdominal distension and sudden projectile vomiting towards the end of, or just after, a feed.
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9
Q

pyloric stenosis

  1. diagnosis?
  2. management?
A
  1. typical findings on a VBG and USS
  2. urgent operation to release the constriction - get dehydrated quickly
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10
Q

what is this describing: a special kind of dehydration which happens in babies, which is serious and can be difficult to spot.

A

hypernatraemic dehydration

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11
Q

why does hypernatraemic dehydration occur in babies?

A

immature kidneys - if dehydrated, they can’t compensate by retaining water in the right proportions. There is then an imbalance between sodium and water, resulting in high blood sodium concentration.

The sodium level may be very high, such as 160

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12
Q

when is hypernatraemic dehydration most likely to occur?

A

in the first couple of weeks of life when breastfeeding has been difficult to establish. It can also be seen in bottle fed babies if the feeds have been made up incorrectly, or in babies with profuse watery diarrhoea. The high sodium levels in the blood cause the baby to be drowsy and not wake up to feed, worsening the situation.

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13
Q

why is hypernatraemia dehydration difficult to diagnose?

A

the high sodium levels prevent the skin and fontanelle and eyes from appearing dehydrated

It may well present as a baby with difficulty in feeding. On closer questioning they will probs be drowsy with a fast HR and RR

The infant will need urgent paediatric referral for an immediate blood test and treatment.

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14
Q

what causes dehydration in DKA?

A

The high levels of glucose and ketoacids in the blood cause dehydration, which can be so severe that it’s life-threatening.

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15
Q

how to diagnose DKA?

A
  • check the blood glucose level and do urine dipstick - glucose and ketones
  • can be aided by spotting the degree of dehydration is moderate or severe (should trigger you to think of diabetes)
  • high RR (caused by the acidosis)
  • NB: an intercurrent illness often precipitates DKA
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16
Q

most common cause of dehydration in the UK?

A

simple gastroenteritis (stomach bug.)

commonly caused by viruses such as rotavirus

17
Q

how does gastroenteritis present?

A
  • symptoms usually last only a day or two, although diarrhoea can sometimes go on for a week.
  • usually start with vomiting, then develop diarrhoea.
18
Q

In a normal child diarrhoea or vomiting has to be severe or prolonged to cause serious dehydration.

Why is it more likely that this will happen?

A
  • with an infection such as Salmonella.
  • Alternatively if they have a chronic disease such as CF/ have an ileostomy

Beware of putting diarrhoea or vomiting down to gastroenteritis, since things like a urinary tract infection or some of the red flag diagnoses in this section and the one on abdominal pain will cause vomiting.

19
Q

list some of the common causes of vomiting in childhood

A
20
Q

in healthy children with clear cut gastroenteritis, who do not appear clinically dehydrated, you can usually rehydrate the child how?

A

oral fluid challenge (small sips little and often, keeping a record of intake and output)

Is best to use fluids which replace electrolytes and glucose, but if the child won’t take these, any fluid is OK in this context.

21
Q

T/F: many children will vomit once or twice or have a loose stool or two with virtually any illness

A

true - so a careful run-through of other symptoms such as coughing, difficulty in breathing, fever, rash, sore throat or urinary symptoms may help clarify the situation.

22
Q

The infectious organism ____ tends to cause gastroenteritis with abdominal cramps in children.

A

Campylobacter

23
Q

However if there is abdominal pain present with the diarrhoea what should you consider?

A

may be a surgical cause - early stages appendicitis or bowel obstruction the gut is hyper-motile and diarrhoea can occur.

24
Q

Blood in the stools may be caused by ____ or ____ infection, or can be a symptom of ______.

A

salmonella

Shigella

intussusception

25
Q

T/F: its important to find out how much they are eating and drinking but don’t worry too much about eating if this has only been going on a day or two and the child is over 6 months old.

A

true

26
Q

when asking about wet nappies, what is a worrying number?

A

no wet nappy for 12 hours.

27
Q

If the patient has seen a doctor or been to hospital earlier in the illness they may have a recent measurement of what which is useful in quantifying dehydration?

A

recent weight - useful to see if they have lost significant amounts of fluid

28
Q

what sort of clinical signs indicate dehydration?

A
  • sunken eyes or fontanelle - ask the parents for reference against normal (NB: fontanelle will bulge when crying)
  • cool extremities and mottling are all signs of poor perfusion - happens when the body vasoconstricts, and tries to keep the blood in the core
  • reduced skin turgor (stays loose >1s)
  • CRT>2s
29
Q

what is this describing - a special kind of dehydration which happens in babies, which is serious and can be difficult to spot.

A

Hypernatraemic Dehydration

30
Q

why does hypernatraemic dehydration occur in babies?

A

Babies have immature kidneys - if dehydrated they’re not able to compensate by retaining water in the right proportions.

There is then an imbalance between sodium and water > high blood sodium concentration.

(Na may be v high, such as 160)

31
Q

when does hypernatraemic dehydeation tend to occur?

A

commonly seen in the first couple of weeks of life when breastfeeding has been difficult to establish.

It can also be seen in bottle fed babies if the feeds have been made up incorrectly, or in babies with profuse watery diarrhoea.

32
Q

how does hypernatraemic dehydration tend to present?

A
  • high blood sodium level may cause the baby to be drowsy and not wake up to feed (worsens situation)
  • high sodium prevents the skin and fontanelle and eyes from appearing dehydrated, so it is very easy to miss the diagnosis.
  • It may well present as a baby with difficulty in feeding. On closer questioning the baby will probably have become drowsy, and this causes a vicious circle of poor feeding and worsening dehydration
  • increased HR and RR
33
Q

T/F: hypernatraemic dehydration will often resolve a couple of weeks after birth

A

false - if suspected then the infant will need urgent paediatric referral for an immediate blood test and treatment.

34
Q
A

Y4: Paediatrics (10 decks)

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