Fluid and Electrolyte Flashcards
What are the three types of fluid loss?
- Insensible loss (2/3 skin, 1/3 respiratory tract)
- Urinary
- Fecal
What are the two major fluid compartments?
- Intracellular
- Extracellular
The extracellular fluid (ECF) is divided into what subcompartments?
- Intravascular fluid (fluid within blood vessels)
- Interstitial fluid (fluid surronding cells)
What are the five reasons children < 2 lose a greater proportion of fluid each day?
- Greater amount of body surface area.
- Children maintain larger amount of ECF until 2.
- Increased metabolic rate.
- Greater amount of metabolic wastes excreted by kidneys.
- Glomeruli tubules & nephrons of kidneys are immature and unable to conserve H2O effectively.
Newborns have ____ total body water
ECF = ? %
ICF = ? %
Newborns have 75% TBW
ECF = 45%
ICF = 30%
Infants have ____ total body water
ECF = ? %
ICF = ? %
Infants have 65% TBW
ECF = 25%
ICF = 30-40%
Child/Adolesecent have ____ total body water
ECF = ? %
ICF = ? %
Newborns have 50% TBW
ECF = 10-15%
ICF = 40%
What are the steps to calculating the “daily maintence for ECF requirements”?
- Weight is in kg.
- 100 ml/kg for first 10 kg.
- 50 ml/kg for second 10 kg
- 20 ml/kg for remainder of weight in kg.
- Divide total amount by 24 hours and obtain rate in ml/hr
What is the normal urine output for infants and toddlers?
0-3 years old
> 2 to 3 ml/kg/hr
What is the normal urine output for preschool and young school age?
> 1 to 2 ml/kg/hr
What is the normal urine output for olderschool age and adolescents?
0.5 to 1 ml/kg/hr
What is the most common type of dehydration in pediatrics?
isotonic dehydration
Isonatremic
Sodium (Na+) is greater in which fluid?
Extracellular or Intracellular
Extracellular Fluid
Potassium (K+) is greater in which fluid?
Extracellular or Intracellular
Intracellular
Which solute is the primary osmotic force that controls fluid movement b/w the major fluid compartments?
Sodium (Na+)
What type of dehydration is occuring when H2O and electolyte loss is equal ?
Isotonic dehydration
Isonatremic
What are the common causes of isotonic dehydration?
Isonatremic
vomiting and diarrhea
Isotonic dehydration involves fluid loss in which fluid compartment?
Isonatremic
Extracellular fluid
The greatest concern with isotonic dehydration is what?
Isonatremic
hypovolemic shock
Decrease in plasma volume
What are two common types of isotonic solution?
Isonatremic
- Normal saline
- Lactated Ringer
what is the normal serum Na+ level in isotonic dehydration?
Isonatremic
135 to 145 mEq/l
(lecture = 130 to 150)
Sodium = remember first three odd numbers 1, 3, 5 = 135
What type of dehydration is occuring when electrolyte loss > H2O?
Hypotonic dehydration
(hyponatremia)
What is the expected serum Na+ level with hypotonic dehydration?
Serum Na+ < 130mEq/l
When the ICF is more concentrated than the ECF it is indicative of what type of dehydration?
Hypotonic Dehydration
(Hyponatremia)
What is the treatment for hypotonic dehydration?
- Treat underlying cause
- Adminster Na+
- Hypertonic solution
When the ECF is more concentrated than the ICF it is indicative of what type of dehydration?
Hypertonic Dehydration
(Hypernatremia)
Diabetes insipidus and Type 1 Diabetes is associated with which type of dehydration?
Hypertonic dehydration
(Hypernatremia)
What are the following signs and symptoms assoicated with?
- Possible seizures
- Nausea and vomiting
- Headache
- Lethargy
- agitation
- Decreased deep tendon reflexes and Weakness
- Confusion
- Anorexia
Hypotonic dehydration
(hyponatremia)
What type of solution would be most appropriate to infuse into a patient with dehydration first?
whether they are isotonic, hypotonic, or hypertonic dehydration
Try an Isotonic solution first
What may occur if you infuse a treatment IV solution to quickly into a patient that is experiencing hypotonic or hypertonic dehydration?
Changes in neurological status due to rapid shifts in the ICF or ECF.
What type of dehydration is occuring when H2O losses > electrolyte?
Hypertonic Dehydration
(Hypernatremia)
What is the expected serum Na+ level for Hypertonic Dehydration (Hypernatremia)?
Serum Na+ > 150 mEq/l
What is the treatment for hypertonic dehydration?
- Treat underlying cause
- Restrict Na+
- Hypotonic IV solution
Cell swelling/bursting occurs in which type of dehydration?
Hypotonic Dehydration
(Hyponatremia)
What are the following signs and symptoms associated with?
- Agitation
- Low grade fever
- Thirst
- Tachycardia
- Hypotension
- Oliguria
- Jaundice in newborn
- Changes in neurological status
Hypertonic Dehydration
(Hypernatremia)
Cell shrinkage occurs in which type of dehydration?
Hypertonic Dehydration
(Hypernatremia)
How is K+ obtained in the body?
Only obtained by intake.
Body does not make K+ on its own
Most of our bodies K+ is excreted through what method?
urine
What serum K+ is seen with hypokalemia?
Serum K+ < 3.5 mmol/l
What are the three causes of hypokalemia?
- Decreased K+ intake
- Increased K+ excretion (diruetics, osmotic diuresis, renal disease, diarrhea, elevated aldosterone/cortisol)
- Loss of K+ (vomiting, NG tube losses, metabolic alkalosis)
What are the five causes of hyperkalemia?
- Massive cell death
- Excess K+ infusion
- Renal Failure (urine output ↓)
- Metabolic acidosis (K+ shift out of cell in exchange for [H]+ ions
- diabetic ketoacidosis (ketones in blood causes metabolic acidosis)
What must be checked before K+ administration through IV?
Check if patient can void
Failure to void can lead to hyperkalemia
What serum K+ value would you see with hyperkalemia?
BMP Labs
Serum K+ > 5.5 mmol/l
(lectures says 5.8)
What are the following signs and symptoms of?
- Changing level of consciousness
- Decreased response to stimuli
- Decreased skin elasticity & turgor (if tenting occurs)
- Prolonged capillary refill (> 3 seconds)
- tachycardia
- Sunken eyes & fontanels
- Dry mucus membranes
- Absent tears
- Decreased urine output
Dehydration
What type of diarrhea is
most common in children < 5?
Acute diarrhea
When does acute diarrhea change to chronic diarrhea?
> 14 days
What are the five causes of chronic diarrhea?
- Malabsorption abnormalities (Chron’s, celiac, cystic fibrosis)
- Inflammatory bowel disease
- Immunodeficiency
- Food allergies/lactose intolerance
- Unmanaged acute diarrhea.
What type of diarrhea is chacterized
“occurs in first few months of life and lasting > 14 days”
Intractable diarrhea of infancy
Do you expect to find decreased or elevated levels of USG in dehydration?
Urine specific gravity
Elevated
Do you expect to find decreased or elevated levels in Creatinine and BUN for dehydration?
Elevated
What is the most common type of chronic diarrhea in children aged 6-54 months?
54 month = 4.5 years old
Chronic non-specific diarrhea
What are the two common causes of chronic non-specific diarrhea?
- concentrated apple juice
- excess diet soda (due to artificial sweeteners)
Metabolic alkalosis can cause what electrolyte imbalance?
Hypokalemia
Due to loss of K+
Metabolic acidosis can cause what electrolyte imbalance?
Hyperkalemia
Excess K+
How is severity of dehydration calculated by assessing weight loss?
(original wt – present wt.) ÷ original wt.
What are the different percentages associated w/ dehydration for mild, moderate, and severe?
5% mild
10% moderate
15% severe
Newborns have ____ total body water
ECF = ? %
ICF = ? %
Newborns have 75% TBW
ECF = 45%
ICF = 30%
Excessive ADH (SIADH) is associated with which dehydration?
Syndrome of inappropriate antidiuretic hormone secretion
Hypotonic Dehydration
(Hyponatremia)
excess retainment of water
What is the first sign of dehydration?
Tachycardia
Increases cardiac output
Prolonged antibiotic use can cause what to occur in the gastrointestinal system?
Diarrhea
orthostatic hypotensions is associated with hyper or hypokalemia?
Hypokalemia
Elevated T-waves are associated w/ hyper or hypokalemia?
Hyperkalemia
Skeletal muscle weakness, leg cramps and decreased DTR are associated w/ hyper or hypokalemia?
Deep tendon reflexes (DTR)
Hypokalemia
Abdominal cramping and diarrhea are associated w/ hyper or hypokalemia?
Hyperkalemia
