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Pediatrics > Dehydration > Flashcards

Dehydration Flashcards

1
Q

What is maintenance fluid

A

Volume of daily fluids needed to replace insensible water loss (stool, urine, evaporation)

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2
Q

What are the components of maintenance fluid?

A
  • Na
  • K
  • water
  • glucose
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3
Q

Is maintenance fluid rich in calories or not?

A

No, patient on maintenance fluid lose 0.5% to 1% of their weight

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4
Q

What is the goal of maintenance therapy?

A

Prevent:

  • dehydration
  • electrolyte Disorders
  • ketoacidosis
  • protein degeneration
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5
Q

What is the commonest method to use for calculating maintenance fluid

A

Holliday segar method

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6
Q

What is the most accurate way to calculate maintenance fluid?

A

Body surface area

Used in renal failure\oncology

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7
Q

How does the caloric expedenture method work?

A

The amount of calories needed= amount of fluids given

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8
Q

How to preform the holiday-segar method on fluid?

A

First 10Kg: 100ml\kg\d “4ml in hr”
Second 10: + 50ml\kg\d “2ml in hr”
Third 10: +20ml\kg\d “1ml in hr”

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9
Q

How to preform the holiday-segar method on electrolyte?

A
  • Na: 3meq\100 ml “range of 2-4”

- K: 2meq\100ml

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10
Q

What are the available IVF for hydration

A
  • normal saline (0.9Nacl - half - quarter)

- ringer lactate (balanced)

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11
Q

What is the Na and cl values in 0.9Nacl

A

154
Then for the half (you half)
Then for the quarter (you half\half)

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12
Q

What is the Na and Cl and K concentration in ringer lactate

A

Na: 130
Cl: 109
K: 4

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13
Q

In hospitalized patient, what can we use from the following solutions?

  • 0.9NaCl
  • 0.45 NaCl
  • 0.2 NaCl
A

0.9 and 0.45 but not 0.2

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14
Q

Change in urine (by renal failure) or stool by (enterostomy\colestomy) changes the maintenance fluid in that it:

A

Will make us eliminate it from the insensible water loss

“Urine 60%, evaporation 35%, stool 5%”

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15
Q

Who shows signs of dehydration first, infant or older children?

A

Older children due to low ECF

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16
Q

What happens to ECF as infant gro

A

Decreased

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17
Q

Why are younger children more susceptible to dehydration?

A

1- large body water content
2- renal immaturity
3- inability to meed their needs “breastfed”

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18
Q

How does Cystic fibrosis cause dehydration?

A

Due to the increased sweating

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19
Q

What are the 3 questions to ask in dehydration assessement?

A

1- how much
2- how fast
3- what route

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20
Q

How much is the dehydration is answered by:

A

Severity (weight loss - clinical mainfestations)

“%: preillness weight - illness weight\peillness weight X 100”

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21
Q

What is the percentage of dehydration, for mild, moderate and severe?

In infant <10kg

A

Mild: 5%
Moderate: 10%
Severe: 15%

22
Q

What is the percentage of dehydration, for mild, moderate and severe?

In children >10kg

A

Mild: 3%
Moderate: 6%
Severe: 9%

23
Q

How to measure the deficit of dehydration assessment

A

The percentage of weight loss X 100 X Kg

24
Q

Concentrated urine indicates

A

Moderate to severe dehydration

25
Q

What will you obtain from the dehydration history?

A 
1- weight loss 
2- intake of fluid\appetite
3- urine output
4- stool output 
5- emesis 
6- activity level 
7- underlying illness
26
Q

What’s the benefit of asking about emesis if it’s not associated with dehydration

A

It will determine if it’s oral intake or IV

27
Q

What is the capillary refill for mild moderate and severe dehydration

A

Mild: 2sec
Mod: 2-4sec
Severe: >4 sec

28
Q

What is the mucus membrane in mild, moderate and severe dehydration

A

Mild: normal
Mod: dry
Severe: parched and cracked

29
Q

Tears in severe dehydration is

A

Absent

30
Q

What is the BP in moderate dehydration

A

Normal but orthostasis

31
Q

Thready pulse is characterstic for which scale of severity?

A

Moderate.

Severe is faint or impalpable

32
Q

A common finding in examination of skin in severe dehydration is called

A

Tenting

33
Q

Sunken fontanelle indicate

A

Severe dehydration

34
Q

Name the 3 signs that are most predictive of moderate to severe dehydration

A

1- prolonged capillary refill
2- delayed skin turgor
3- increase respiratory rate

35
Q

Labratory investigations in dehydration:

A
  • Serum Na
  • blood gas
  • BUN\creatinine
  • urine analysis
  • potassium
  • HCT
36
Q

What is the creatinine\BUN ratio that indicate dehydration instead of renal failure?

A

20:1 anything less than this is renal failure

37
Q

What are the findings in moderate to severe dehydration in blood gas?

A

Metabolic acidosis w\low HCO3 meq

38
Q

Potassium is indicated in the workup for dehydration because it’s associated with

A

Gasteroenteritis

39
Q

What are the finding of urine analysis in dehydration

A

High specific gravity

Low sodium

40
Q

What is HCT in dehydration?

A

Hight

41
Q

How to answer the how fast question in dehydration?

A

According to the type

“Plasma Na level”

42
Q

Major determinant of serum osmolality is

A

Sodium “as long as there is no renal failure”

43
Q

Differentiate isonatermic, hyponatermic, and hypernatermic dehydration

A

130-150

More is hypernatermic, less is hypo

44
Q

What happens to the cell in hypo vs hypernatermic dehydration?

A

Hypo: swells
Hyper: shrink

45
Q

Differentiate between clinical presentation of hyponatermic and hypernatermic:

A

Hypo: cold, clammy skin, lethargy
Hyper: irritble, doughy, BP elevated
Both seizures

46
Q

Doughy skin is associated with

A

Hypernatermia

47
Q

What is the best route for rehydration? “Mild to mod”

A

Oral

“Lower cost, no need of IV, done at home”

48
Q

What is ORS composed of “solutes”?

A

1 glucose 2sodium

49
Q

How to make ORS?

A

1l water + 6 ts sugar + 1\2 ts salt + 1\4 ts baking soda

50
Q

How long should ORT be given?

A

Over 4 hours in small volume

51
Q

What are the contraindication of ORT?

A

Severe dehydration - altered mental state - intestinal ileus - severe electrolyte imbalance - care giver can’t provide ORT

52
Q

What happens in hypotonic dehydration and when it’s treated rapidly

A
  • hypotonic: swelling of the cell in the brain (edema)

- treatment (rapid): shrinkage leasing to osmolar demylination (central pontine myelnolysis)

Pediatrics (41 decks)

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