Dehydration and fluids

Question 1

What is the most accurate marker of dehydration?

Answer 1

Weight loss

<5% loss = no clinical symptoms
5-10% loss = clinical symptoms
>10% = shock

Question 2

What investigations may be done for dehydrated child?

Answer 2

U&E
FBC

Stool MC&S only if bloody diarrhoea. (CHESS)

Question 3

What are the CHESS organisms

Answer 3

Campylobacter
Haemorrhagic e coli
Entamoeba histolytica
Shigella
Salmonella

Question 4

When are IV fluids indicated?

Answer 4

Shock
Deterioration
Persistent vomiting
Sick child

Question 5

What bolus is used for shock?

Answer 5

20mL/kg 0.9% NaCl over 15 mins

Question 6

If a child has lost fluids through dehydration add this to maintenance fluids (over 24 hrs)

How is the correction fluid decided?

Answer 6

1. Weigh child
2. calculate weight lost from fluids

e.g.

3% weight lost in 20kg child:
20kg = 20,000ml fluid
3% weight lost = 600mL fluid

Question 7

What is the general approach for maintenance fluids?

Answer 7

4:2:1 approach:

4mL/kg/hr for the first 10kg
2mL/kg/hr for the next 10kg
1mL/kg/hr for remaining

e.g. for 12kg child
(4x10) + (2x2) = 44mL/hr

( fluids : 5% dextrose + 0.9% NaCl )

Question 8

How are maintenance fluids prescribed to neonates on

Day 0
Day 1
Day 2

Answer 8

Day 0 : 60ml/kgday
Day 1 : 90ml/kg/day
Day 2 : 120ml/kg/day

Use isotonic cystalloids with 10% dextrose!

Question 9

if the child has hypernatraemic dehydration?

Answer 9

fluid deficit replaced over 48 hours to avoid cerebral oedema

Question 10

why are antidiarrhoeals (loperamide) and antiemetics not used in children?

Answer 10

• ineffective
• side effects

Question 11

ABX are avoided in children with gastroenteritis
when is it given?

Answer 11

SEPSIS

Salmonella
gastroenteritis

C diff with pseudomembranous colitis

Cholera, shigella, giardiasis