Dehydration - Fluid & Electrolytes Flashcards
Difference between children & adults r/t fluid & electrolytes
children can enter into dehydration much quicker
what makes children more susceptible to dehydration - physiological differences (5)
larger body surface area in relationship to their weight
increased baso-metabolic rate
inability to concentrate urine (urine is very diluted)
higher respiratory rate - (child resp. rate = 40)
under 3, body fluids aren’t stored as efficiently (stored in extracellular compartment) - insensible fluid lose
urine specific gravity increases or decreases in a child with dehydration
increases (eg: 1.020)
normal range of urine specific gravity (1.003-1.030)
THE HIGHER THE DRYER
what is an insensible fluid lose
fluid lost at the surface
infants
no
when does posterior fontanel close
8 weeks
when does anterior fontanel close
12-18 months
a sunken fontanel is consistent with dehydration, t or f
true
% of extracellular vs intracellular fluids by age (e/i)
infant 40/40
toddler (3 yr) 30/40
adult 20/40
water balance is regulated by
ADH - anti-diuretic hormone = acts on kidney tubules to reabsorb h20
formula for fluid bolus when dehydrated
20ml/kg of isotonic solution infused over 4 hours
reevaluate dehydration symptoms (diaper, eyes, fontanel)
what does ORS stand for?
oral re-hydration solutions (pedialyte)
Cardiac symptoms r/t dehydration
increase in pulse rate (hr); then a decrease with later stage of dehydration
weak/thready pulse
Blood pressure r/t dehydration
bp drops - late sign - severe dehydration
resp failure - hypo-volemic shock
fluid overload s/s
cough
moist breath sounds
water intoxication
fluid for children is a delicate balance, t or f
true
95% of your potassium (k) is excreted via your
kidneys
Don’t add K to iv fluids until wet diaper if oliguria or anuria. Too much K can build up in intravascular fluid.
Too much K (hyperkalemia) can lead to
arrhythmia’s
cardiac arrest
Potassium values
PANIC (7.0 mEq/L)
infant 3.6-5.8
child 3.5-5.5
adult 3.5-5.3
classified hyperkalemia with value above
5
can lead to heart arrhythmia (can be seen on ekg)
hypokalemia value k is less than
risk for hypokalemia
child on diuretics
ingesting lg amounts of ASA
A child w/an NG tube should have what monitored closely
potassium levels
Dehydration types (3)
hypertonic dehydration (hypernatremic) = more fluid loss than sodium (sodium >150) isonatremic dehyrdation (isotonic) = lose equal parts water and sodium (sodium levels in norm. range) hyponatremic/hypotonic = more sodium loss than water, generally sodium is
most frequent dehydration we will run into
isotonic/isonatremic dehydration
body weight and dehydration
10% body loss = severe dehydration
5% body loss = mild dehydration
5-9% body loss = moderate dehydration
norm sodium levels
135-148 mEq/L
kids with cystic fibrosis experience which type of dehydration - particularly in summer
hyponatremic/hypotonic - loose more salt than water; salt tablets given to replace the loss
taste salty
2 different ways to classify dehydration
weight
serum sodium levels
most abundant cation & chief base of blood
sodium
children with hypernatremia are almost always
dehydrated
re-hydration solutions are made up of what?
75-90 mEq Na+ per liter - electrolyte solution
for severely dehydrated patients bolus with what?
20ml/kg of isotonic solution over 20 minutes (bolus)
for re-hydration follow this formula (after bolus)
calc. maint. fluids add additional fluids based on weight loss as follows:
50ml/kg for mild
100ml/kg for moderate
150ml/kg for severe
2/3 of fluids within 8 hours of admission
BRAT diet is not recommended t or f
true
If no urine output teach parent to
call the Dr
if child is admitted to the hospital with dehydration what should be part of your care plan
daily weights - same time/scale each day
accurate i/o
daily weights is the best indicator of what
fluid status
never give k in an iv push, t or f
true
whats d5 1/2?
dextrose 5%, .45 Na+
whats d5 1/3?
dextrose 5%, .33 Na+
whats d5 1/4?
dextrose 5%, .225 Na+
