Drug and Fluid Prescription

Question 1

How can you take urine in paeds?

Answer 1

Suprapubic
Clean catch
Catheter take

Question 2

How do you ask about feeding?

Answer 2

Are they waking to feed?
Are they emptying the breast
How many ml’s in the last 24 hours

Question 3

Fluid status on hx?

Answer 3

Intake
Wet nappies
Vomiting

Question 4

Fluid status on examine?

Answer 4

Weight
Mucous membranes
Capillary refill - central (under 2s is normal)
HR, BP
Fontanels - bulging, normotensive, or sunken
Tissue turgor
Sunken eyes

Question 5

What is the normal urine output rate?

Answer 5

3-4ml/kg/hour

Question 6

What are the rating of dehydration?

Answer 6

Mild: no signs, just hx
Mod: prolonged cap refill, tachy
Severe: flat, poorly responsive, altered conscious state

Question 7

What is the septic screen for fever with no focus?

Answer 7

FBE, CRP, UEC, blood cultures
Urinalysis
CSF
CXR - usually only if signs in chest

Question 8

How do you give bolus’? Who gets it?

Answer 8

10-20ml per kg of n/saline

Moderate and above dehydration

Question 9

What are the standard maintenance fluids for children?

Answer 9

0. 9% N/saline and 5% dextrose/glucose
1. 45% N/saline and 5% dextrose/glucose

Plasma-lyte 148 (Special at RCH)

Question 10

How do you calculate maintenance fluids for children? How much does a 45kg child get?

Answer 10

4/2/1 rule
4ml/kg for the first 10kg
2ml/kg for the next 10kg
1ml/kg for over 20kg 
= ml/hr 

eg 45kg child gets 85ml/hr

Question 11

What are the options for administration of fluids?

Answer 11

Oral
Nasogastric
IV

Question 12

What might you Ix after a UTI in a boy in outpatient?

Answer 12

UT US

Question 13

How do you rehydrate in gastroenteritis?

Answer 13

Replace deficit (5% of total weight if moderate dehydration)
Then give 24 hour maintenance dose over 16 hours

Question 14

What must you do with patients on fluids?

Answer 14

Monitor UECs daily