Exam 2 Fluid and Electrolytes Flashcards
Dehydration : Developmental differences
- Higher % of total body fluid
- Immature renal/GI system
- Higher % of ECF
- Higher metabolic rate
- Higher body surface area
- Unable to communicate thirst
Dehydration: Early Signs
-Tachycardia
Dehydration: Most Reliable Signs
Weight: Same time. same day, same scale NAKED
Dehydration: Other Signs
- Low BP
- Decreased skin turgor
- Decreased tear and saliva production
- Dry mucus membranes
Bolus: Stable patient
- Moderately dehydrated
- RAPID Negative
- Give bolus over 5-20 min, 20ml/kg
Bolus: Severe Patient
- Severe Dehydration
- RAPID +
- Give bolus over 5-10min, 20ml/kg
- Cardiac issues give 10-20 min, 5-10ml/kg
24hr Maintenance
First 10kg = _kg x 100 ml
Next 10 kg = _kg x 50 ml
Rest of the kg = _kg x 20 ml
Isotonic Dehydration
- Na+ and water = loss
- most common type of dehydration
- loss is from ECF
- No fluid shift
- Due to = N/V/D, lack of oral intake when hot, excessive sweating, hemorrhage
Isotonic Dehydration S/S
- Dry Skin/mucus membranes
- Decreased skin turgor
- Orthostatic hypotension
- Thirsty
- Dizzy
- Constipated
- Decreased urine
- Decreased tears
Isotonic Dehydration Causes
- Nausea, Vomiting
- Lack of oral intake when hot
- excessive sweating
- hemorrhage
Isotonic Dehydration Lab Values
- Serum Na+ Normal (130-150)
- Serum Osmolality Normal
- High Hematocrit
- High (K+, Ca+)
Isotonic Dehydration Treatment
Isotonic fluids: NS
Hypotonic Dehydration
- Serum Na+ low (<130)
- Serum osmolality low
- Fluid shifts from ECF to ICF (into cell - swelling)
Hypotonic Dehydration Causes
- Rehydration with tap water only
- Diuretics
- Loss of gastric secretions
Hypotonic Dehydration Labs
- Serum Na+ <130
- Serum osmolality: Low <275
- High Hematocrit
- High (K+, Ca+)
Hypotonic Dehydration S/S
- Confusion
- Drowsiness/Dizziness
- Decreased BP
- Decreased urine
- Decreased skin turgor
- Thirsty
Hypotonic Dehydration Treatment
NS
Hypertonic Dehydration
- Serum Na+ high >150
- Serum osmolality high
- Fluid shift from ICF to ECF (cells shrink)
Hypertonic Dehydration Causes
- excessive diarrhea
- Increased osmotic diuretics (removes too much water)
- Increased electrolytes/solutes PO
- Increased Na in IVF
- Increased NG Feeds
Hypertonic Dehydration Labs
- Serum Na+ high >150
- Serum osmolality high >295
Hypertonic Dehydration S/S
- Decreased altered mental status
- Decreased skin turgor
- Dry skin/mucus membranes
- increased HR
- Decreased BP
- Confusion/drowsiness/Dizziness
- Decreased tears
Hypertonic Dehydration Treatment
-Give NS until hypotension is corrected, then give hypertonic fluids
Normal Urine Output
Infants/Young kids
-1.5-2ml/kg/hr
Older Kids/Adolescents
-1ml/kg/hr
Mild Dehydration
- Normal HR, BP, RR
- Normal anterior fontanelle
- Normal Behavior
- Normal mucus membraned
- Cap refill >2 sec
- Decreased urine output
Weight loss:
- Infant 3-5%
- Children 3-4%
Moderate Dehydration
- Normal BP to orthostatic
- Normal anterior fontanelle
- HR mildly increased
- Slight tachypnea
- Cap refill 2-4 sec
- Decreased skin turgor
- oliguria
- irritable, dry mucus, thirsty
Weight loss:
- Infant 6-9%
- Child 6-8%
Severe Dehydration
- BP Orthostatic to shock
- Sunken anterior fontanelle
- Tachycardic
- Hyperpnea (deep/rapid)
- cap refill >4 sec
- Skin tenting, cool, mottled
- hyperirritable - lethargic
- parched
Weight loss:
- Infant >10%
- child >10%
Mild (5-6%) Rehydration Therapy
ORS 50ml/kg within 4-6hrs
Moderate (7-9%) Rehydration Therapy
ORS: 100ml/kg within 4-6hrs
Severe (>9%) Rehydration Therapy
IV Fluids: 20ml/kg over 5-10 min
-until pulse and mental status return to normal
RAPID+
R= rapid heart rate A= altered color or altered capillary refill P= Peeing nonexistent I= inability to engage in the environment D= decreased blood pressure
Fluids used for Oral Rehydration
- breast milk/formula
- pedialyte
- infalyte
- rehydrolyte
