Exam 2 - Dehydration, Rehydration, Burns, IVF + AGE Flashcards
Most common cause of dehydration
GI - vomiting, diarrhea or GE
Other causes - fever, tachypnea, infection.
Adults are about _____ TBW
Peds are _____
50-60%
60% - more!
Fluid loss always has ____ Na than plasma which leads to _____
Less
Hypernatremia.
A HypOnatremic child looks ______ but has ____ VS. The fluid is shifting from _______ to _______
A HypERnatremic child looks ______ but has ____ VS. The fluid is shifting from _______ to _______
Less severe; worse; inter vascular space into tissues.
Worse; better; interstitial to inter vascular.
1kg of weight loss = ______ fluid loss
1L
Mild dehydration is _______ % fluid loss
Moderate is ______% with ______
Severe is _______% with ______
5 for infants, 3 for adolescents
10 for infants, 5-6 for adolescent with tachycardia
15 for infants, 7-9 for adolescent with hypotension and impaired perfusion
What will UA show in dehydration?
Specgrav elevated
May see casts, WBC, RBC and protein that improves with rehydration
What labs should you get to assess moderate and severe dehydration?
Serum BUN and creatinine - there should be an increase in BUN with no change in Cr.
If change in Cr, then very worried for renal damage.
What does an elevated BUN tell us about what is going on with the kidneys?
Reflects a decrease in GFR and in increase in Na and H2O reabsorption and urea recycling.
Treat mild and moderate dehydration with ORS. Reserve IVF rehydration for severe cases only.
ORT - 2% glucose and 50-90mEq/L of Na. No juices or sports drinks.
ORS intake for Mild = ________
Moderate = ________
Mild = 50ml/kg in 4 hours
Moderate = 100ml/kg in 4 hours.
In vomiting, urine and diarrhea, replace new losses at ______ for each episode.
10ml/kg
IVF resuscitation bolus use ____
At rate of _______
Severe dehydration may require ____ or _____
NS or LR
20ml/kg over 20 mins
Up to 3 boluses or faster rate.
The end point of fluid resuscitation should see____
Cap refill, HR and BP restored
How to calculate maintenance fluid
First 10kg = ______ ml/kg/day or ___ ml/kg/hr
Second 10kg = _____ ml/kg/day or ____ ml/kg/hr
Each additional kg = 20ml/kg/day or ____ml/kg/hr
100/4
50/2
20/1
If a child has more than ______ BSA burned, then refer to Burn center!! Or burns on ______.
Burns over _____ require IVF rehydration!
10%
Hands, genitals, face
10%
What is the MARCH primary survey for assessing Burns in children?
M - massive bleeding?
A - airway status?
R - respiration?
C - circulation? Pulses?
H - head injury? Hypothermia?
UOP should be ______ml/kg/hr
1
Other management considerations for burns?
Pain control
Ionized Ca > 1.1mmol/L
IV PPI
Thermoregulation
Tetanus
Erythromycin ointment and moisture shield for eyes
What is the most common bacterial cause of AGE? Others?
E Coli
Salmonella, shigella, campylobacter jejuni.
Diarrhea is ____ or more ______ stools in a _____
3
Loose, watery
Day
Course of AGE:
Typically starts getting better in 3-5 days and usually doesn’t last longer than 5-7 days.
What are some red flags with AGE?
Bloody diarrhea, protracted vomiting, severe pain.
What are some DDX to consider in a child with N/V?
bowel obstruction, AOM, UTI, appendicitis, food allergy, lactase deficiencies,
Ondansetron can ____ diarrhea but improve _____
Increase
Improve ORT
After a viral illness, there is a chance of developing ____. It is usually _______ but may be permanent. Gradual re-introduction.
Lactose/gluten intolerance.
Temporary (weeks-months)
What is a great lab to consider drawing in acute diarrhea? Why?
Serum bicarb - <15mEq/L can help differentiate between moderate and severe hypovolemia from those with mild hypovolemia.
