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Paediatrics > Feeding and fluids > Flashcards

Feeding and fluids Flashcards

1
Q

How is a term baby different to adults?

A

Term baby = 75% water
Increased surface/mass, metabolism, and RR
Decreased response to thirst, independence to drink, and glomerular filtration

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2
Q

What fluids to children take in?

A

Eating/feeding

Drinking

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3
Q

What fluids do children lose?

A

Urine 60%
Skin and lungs 35%
Stool 5%

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4
Q

What is the fluid requirements of an infant?

A

150ml/kg/day

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5
Q

What is the fluid requirements of a toddler?

A

100ml/kg/day

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6
Q

What is the fluid requirement of a 4-8 year old girl?

A

1000-1400ml/day

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7
Q

What is the fluid requirement of a 4-8 year old boy?

A

1000-1400ml/day

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8
Q

What is the fluid requirement of a 9-13 year old girl?

A

1200-2100ml/day

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9
Q

What is the fluid requirement of a 9-13 year old boy?

A

1400-2300ml/day

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10
Q

What is the fluid requirement of a 14-18 year old girl?

A

1400-2500ml/day

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11
Q

What is the fluid requirement of a 14-18 year old boy?

A

2100-3200ml/day

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12
Q

What are the 2 big factors that can cause dehydration?

A

Reduced intake

Increased losses

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13
Q

What can cause reduced intake?

A

Dysphagia/neurodisability - cerebral palsy, developmental delay
Vomiting - gastroenteritis, GORD, URTI, chemotherapy
Behavioural/psychiatric - food refusal, anorexia
Social - child neglect

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14
Q

What can cause increased losses?

A

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

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15
Q

What are the symptoms of dehydration?

A

Vary by severity of dehydration

Lots of symptoms - as a general rule the more symptoms you have, the more dehydrated you are

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16
Q

What percentage dehydrated is mild dehydration?

A

5%

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17
Q

What percentage dehydrated is moderate dehydration?

A

5-10%

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18
Q

What percentage dehydrated is severe dehydration?

A

> 10%

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19
Q

What are the symptoms of mild dehydration?

A

Thirst
Dry lips
Restlessness
Irritability

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20
Q

What are the symptoms of moderate dehydration?

A

Fewer wet nappies
Sunken eyes
Reduced skin turgor
Decreased urine output

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21
Q

What are the symptoms of severe dehydration?

A

Reduced consciousness
Cold
Mottled peripheries
Anuria

22
Q

What are the symptoms of chronic deprivation of fluids or feeds?

A 
Failure to thrive
Malnutrition
Developmental delay
Constipation
UTIs
23
Q

What are the treatment options for dehydration?

A

Natural - best
Enteral feeding
IV fluids - last resort

24
Q

Why is natural rehydration best?

A

Can regulate electrolytes themselves

25
Q

Why are IV fluid last resort?

A

Difficult to get access
Difficult to get electrolyte balance correct
Give if at high risk of aspiration

26
Q

What questions is it important to ask in a feeding history?

A

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?

27
Q

What is normal breast feeding like?

A

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

28
Q

What are the NICE guidelines for treating children who aren’t dehydrated?

A

Maintenance fluids

29
Q

What are the NICE guidelines for treating children who are dehydrated?

A

Maintenance + deficit 50ml/kg

30
Q

What are the NICE guidelines for treating children who are shoked?

A

Maintenance + deficit 100ml/kg + bolus

31
Q

What maintenance fluid should you give to a neonate and why?

A

10% glucose - need to be careful with babies and sugar levels dropping as don’t have a lot of reserve

32
Q

What is the rate of fluids for a neonate?

A

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

33
Q

When can you give a neonate electrolytes?

A

48 hours after birth

If significantly low can give before then

34
Q

What are the electrolytes requirements for neonates?

A

Na 3mmol/kg/day
K 2mmol/kg/day
Ca 1mmol/kg/day (rarely)

35
Q

When can you start giving fluids for ‘older children’?

A

Around 2/3 months

36
Q

How much fluid can you give up to in boys?

A

2500ml

37
Q

How much fluid can you give up to in girls?

A

2000ml

38
Q

What is the formula for working out a child’s weight?

A

(Age + 4) x2 = weight in kg

39
Q

What do you do if a child is clearly over or underweight for their age?

A

Work on ideal body weight

40
Q

What fluid should you give older children?

A

0.9% NaCl + 5% glucose (+/- KCl)

41
Q

How do you work out the rate at which you give fluids to older children?

A

First 10kg - 100ml/kg
Next 10kg - 50ml/kg
Every other kg - 20ml/kg

42
Q

How long do you correct a fluid deficit over?

A

24 hours

43
Q

What fluid bolus should you give?

A

20mls/kg of 0.9% NaCl

10ml/kg more appropriate on some occasions

44
Q

What are the electrolyte requirements for older children?

A

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

45
Q

How do you treat DKA with fluids if shocked?

A

20ml/kg 0.9 NaCl over 15 mins then 10ml/kg 0.9% NaCl

46
Q

How do you treat DKA with fluids if not shocked?

A

10ml/kg 0.9% NaCl over an hour

47
Q

What are the differential diagnoses for unwell neonates?

A

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
48
Q

How might a baby with congenital adrenal hyperplasia present?

A 
Adrenal crisis
Acidotic
Hyponatraemia
Hyperkalaemia
Metabolic acidosis
49
Q

How might baby girls present with congenital adrenal hyperplasia?

A

Ambiguous genitalia - clitoris enlarged and genitals look more like those of male child

50
Q

How can you treat congenital hyperplasia antenatally?

A

Dexamethasone to mother - suppresses foetal adrenal androgen over secretion and prevention of genital malformations

Paediatrics (21 decks)

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