Dehydration and IVF Flashcards
Considerations when assessing dehydration (3)
Deficit
Maintenance
Ongoing losses
Fluid bolus when shocked, is this included in subsequent calculations of hydration
10-20ml/kg bolus
Not included
Senior medical assessment in red flag children
Short gut Ileostomy Kidney transplant/insufficiency, severe CVD Fortified feeds Suspect hypertonic solution
Best assessment of level of hydration
Comparison of bare weight with premorbid weight
Clinical signs in mild
No clinical signs
May be thirsty
Clinical signs in moderate
4-7%
Delayed CRT
+RR
Mildly decreased skin turgor
Clinical signs in severe
=/>7% >3 second CRT, mottled skin Poor perfusion \+RR TachyC, hypotenive, -ve LOC Deep acidotic (Kussmauls breathing)
Calculating fluid deficit
Body weight %
10kg child with 5% loss= 500ml deficit
1kg = 1000ml
When can replacement of deficit be rapid, slower and very slow
Rapid in most cases of gastroenteritis
Slower in DKA and meningitis
Slow in hypo/hypernatremia
Maintenance amount in non-dehydrated, unwell children and in particular with which diseases
Consider 2/3 maintenance, particularly with meningitis and pneumonia, risk of SIADH
Good fluid solutions in sick children: fluid and use
Normal saline: Bolus, deficit and ongoing losses
NS + 5% glucose (+20mmol KCL): Maintenance
1/2 NS + 5% glucose (+20mmol KCl): Maintenance
What must you not forget to do before fluids and request on fluid order forms
Check weight prior to commencing fluids
Re-check daily weights
How often to weight child if ongoing losses
6 hourly
When to assess electrolytes and glucose
Initially prior to fluids then in 24 hours if IVF are going to continue
What fluids should rarely be used outside the neonatal period
10% dextrose
15-20% dextrose
25-50% dextrose
