Feeding and fluids Flashcards
How is a term baby different to adults?
Term baby = 75% water
Increased surface/mass, metabolism, and RR
Decreased response to thirst, independence to drink, and glomerular filtration
What fluids to children take in?
Eating/feeding
Drinking
What fluids do children lose?
Urine 60%
Skin and lungs 35%
Stool 5%
What is the fluid requirements of an infant?
150ml/kg/day
What is the fluid requirements of a toddler?
100ml/kg/day
What is the fluid requirement of a 4-8 year old girl?
1000-1400ml/day
What is the fluid requirement of a 4-8 year old boy?
1000-1400ml/day
What is the fluid requirement of a 9-13 year old girl?
1200-2100ml/day
What is the fluid requirement of a 9-13 year old boy?
1400-2300ml/day
What is the fluid requirement of a 14-18 year old girl?
1400-2500ml/day
What is the fluid requirement of a 14-18 year old boy?
2100-3200ml/day
What are the 2 big factors that can cause dehydration?
Reduced intake
Increased losses
What can cause reduced intake?
Dysphagia/neurodisability - cerebral palsy, developmental delay
Vomiting - gastroenteritis, GORD, URTI, chemotherapy
Behavioural/psychiatric - food refusal, anorexia
Social - child neglect
What can cause increased losses?
Gut - gastroenteritis, IBD, stoma, short gut syndrome
Kidneys - renal tubular disease, renal dysplasia, nephrogenic DI
Skin - burns, CF, sepsis/fever
Lungs - cardiorespiratory disease, CF, tracheostomy
What are the symptoms of dehydration?
Vary by severity of dehydration
Lots of symptoms - as a general rule the more symptoms you have, the more dehydrated you are
What percentage dehydrated is mild dehydration?
5%
What percentage dehydrated is moderate dehydration?
5-10%
What percentage dehydrated is severe dehydration?
> 10%
What are the symptoms of mild dehydration?
Thirst
Dry lips
Restlessness
Irritability
What are the symptoms of moderate dehydration?
Fewer wet nappies
Sunken eyes
Reduced skin turgor
Decreased urine output
What are the symptoms of severe dehydration?
Reduced consciousness
Cold
Mottled peripheries
Anuria
What are the symptoms of chronic deprivation of fluids or feeds?
Failure to thrive Malnutrition Developmental delay Constipation UTIs
What are the treatment options for dehydration?
Natural - best
Enteral feeding
IV fluids - last resort
Why is natural rehydration best?
Can regulate electrolytes themselves
Why are IV fluid last resort?
Difficult to get access
Difficult to get electrolyte balance correct
Give if at high risk of aspiration
What questions is it important to ask in a feeding history?
Determine whether breast or bottle fed?
Latching?
Duration? How often feeding?
Has mother’s milk come in? - c-section? Mother unwell? (takes longer for milk to come in) Can ask mother to express milk to see volume
Teet right sized hole? Volume in bottle feed?
What is normal breast feeding like?
In first few weeks need to feed every couple of hours, no more than 4 hours
For about 15/20 minutes
20-30 mins every 3 hours
Time between feeds gets longer as get older
What are the NICE guidelines for treating children who aren’t dehydrated?
Maintenance fluids
What are the NICE guidelines for treating children who are dehydrated?
Maintenance + deficit 50ml/kg
What are the NICE guidelines for treating children who are shoked?
Maintenance + deficit 100ml/kg + bolus
What maintenance fluid should you give to a neonate and why?
10% glucose - need to be careful with babies and sugar levels dropping as don’t have a lot of reserve
What is the rate of fluids for a neonate?
Day 1 of life - 60mls/kg/day
Day 2 of life - 90mls/kg/day
Day 3 of life - 120mls/kg/day
Day 4 of life - 150mls/kg/day
When can you give a neonate electrolytes?
48 hours after birth
If significantly low can give before then
What are the electrolytes requirements for neonates?
Na 3mmol/kg/day
K 2mmol/kg/day
Ca 1mmol/kg/day (rarely)
When can you start giving fluids for ‘older children’?
Around 2/3 months
How much fluid can you give up to in boys?
2500ml
How much fluid can you give up to in girls?
2000ml
What is the formula for working out a child’s weight?
(Age + 4) x2 = weight in kg
What do you do if a child is clearly over or underweight for their age?
Work on ideal body weight
What fluid should you give older children?
0.9% NaCl + 5% glucose (+/- KCl)
How do you work out the rate at which you give fluids to older children?
First 10kg - 100ml/kg
Next 10kg - 50ml/kg
Every other kg - 20ml/kg
How long do you correct a fluid deficit over?
24 hours
What fluid bolus should you give?
20mls/kg of 0.9% NaCl
10ml/kg more appropriate on some occasions
What are the electrolyte requirements for older children?
First 10kg - water 4ml/kg, Na 2-4mmol/kg/day, K 1.5-2.5mmol/kg/day
Second 10kg - water 2ml/kg, Na 1-2mmol/kg/day, K 0.5-1.5mmol/kg/day
Subsequent kg - water 1ml/kg, Na 0.5-1mmol/kg/day, K 02.-0.7mmol/kg/day
How do you treat DKA with fluids if shocked?
20ml/kg 0.9 NaCl over 15 mins then 10ml/kg 0.9% NaCl
How do you treat DKA with fluids if not shocked?
10ml/kg 0.9% NaCl over an hour
What are the differential diagnoses for unwell neonates?
THE MISFITS
- Trauma - birth trauma, NAI
- Heart disease/hypovolaemia
- Endocrine emergencies - congenital adrenal hyperplasia/congenital hypothyroidism
- Metabolic - electrolyte abnormalities
- Inborn errors of metabolism
- Seizures
- Formula problem - diluting/concentrating formula
- Intestinal disasters - necrotising enterocolitis, Hirschprung’s
- Toxins - maternal medication/ingestion, glucose
- Sepsis
How might a baby with congenital adrenal hyperplasia present?
Adrenal crisis Acidotic Hyponatraemia Hyperkalaemia Metabolic acidosis
How might baby girls present with congenital adrenal hyperplasia?
Ambiguous genitalia - clitoris enlarged and genitals look more like those of male child
How can you treat congenital hyperplasia antenatally?
Dexamethasone to mother - suppresses foetal adrenal androgen over secretion and prevention of genital malformations
