Fluid and Electrolyte Flashcards
Newborns are comprised of ______ TBW
75%
When there are fluid imbalances with newborns, we are worried about…
Temperature regulation
What are the three components of ECF?
Intravascular, interstitial, transcellar
What is sensible water loss?
water loss we can track.
What is insensible water loss?
Water loss we cannot track.
What are examples are sensible water loss?
UOP, stool, emesis, NG tube output
What are examples of insensible water loss?
sweat, resp. secretions.
If a newborn is admitted with RSV and a RR of >60, what are the considerations for rehydration?
- hold feeds. 2. rehydrate with IV fluids (or PO if RR is down.
what is important to know about water balance in infants? (5 things)
- greater fluid intake and output relative to size. 2. disturbances occur more frequently and rapidly. 3.body surface area: larger quantities of fluid lost through the skin. 4. Greater production of metabolic wastes. 5. kidneys are immature and inefficient excreting waste
ECF electrolyte and there normal values
Sodium: 135-145
Chloride: 96-106
ICF electrolyte and there normal values
Potassium: 3.5-5
Magnesium: 1.5-2.5
Internal control mechanisms influencing fluid balance (4 things)
- Thirst (children will forget or not pay attention to it)
- Antidiuretic hormone
- Aldosterone
- Renin-angiotensin system
DAILY maintenance fluid requirements for a child weighing 1-10kg
100 ml/kg/day
DAILY maintenance fluid requirements for a child weighing 11-20 kg
1000 ml (for the first 10 kg) plus 50 ml/kg/day
DAILY maintenance fluid requirements for a child weighing above 20 kg
1500 ml (for the first 20 kg) plus 20 ml/kg/day
HOURLY maintenance fluid requirements for a child weighing 1-10 kg
4 ml/kg/hour
HOURLY maintenance fluid requirements for a child weighing 11-20 kg
40 ml (for the first 10) plus 2 ml/kg/hour
HOURLY maintenance fluid requirements for a child weighing above 20 kg
60 ml (for the first 20) plus 1 ml/kg/hour
a fever will increase:
insensible water loss (remember children will become febrile more than adults)
NORMAL URINE OUTPUT
infants and toddlers (0-2 years): 2-3 ml/kg/hr
preschool to young school age (3-5 years): 1-2 ml/kg/hour
school age to adolescents (6 and up): 0.5-1 ml/kg/hour
what are the three types of dehydration relating to plasma sodium concentration
isonatremic-isotonic
hyponatremic-hypotonic
hypernatremic-hypertonic
what is the most common cause of isotonic dehydration?
vomiting and diarrhea -major loss from the ECF.
what is a child with isotonic dehydration at risk for?
shock
what is a big concern for hypotonic dehydration?
cerebral edema
what are some causes for hypotonic dehydration?
- gastroenteritis with improper fluid replacement (plain water)
- Inappropriate IV therapy (giving a fluid they didn’t need)
- SIADH
- gastric suction that has not been replaced
what are some signs of hypertonic dehydration?
alteration in consciousness, poor ability to focus, lethargy, hyperreflexia, hyper irritability, seizures
what is happening during hypertonic dehydration and what are we concerned for?
water from the brain cells is coming out- we are worried about permanent brain damage
what are causes hypertonic dehydration?
over concentrated formula, DKA, high protein NG tube feeds
hypertonic dehydration requires special fluid treatment, what is it?
a way slower rate, over 48 hours (its over 24 hours for iso and hypo)- this is to avoid rapid fall in serum sodium. a rapid fluid shift could cause cerebral edema.
what Is the earliest sign of dehydration?
tachycardia- if we wait for BP changes; we waited too long.
Mild Dehydration (3-5%): signs and symptoms
slight thirst, normal pulse, BP and RR, irritable but can behave normally, cap refill >2 seconds, alert, mildly decreased UOP, normal turgor, normal to sticky mucous membranes, tears are present, anterior fontanel normal
moderate dehydration (6-9%): signs and symptoms:
moderate thirst, slight increases in pulse, normal to orthostatic BP, slightly tachypnea, lethargic but arousable, sucked fontanels, sucked eyes, decreased UOP (1.020-1.030), cap. refill 2-4 secs, decreased turgor, dry mucous membranes, tears decreased, anterior fontanel normal to sunken
severe dehydration (10%): signs and symptoms:
intense thirst, tachycardia, weak, thready pulse, orthostatic to shock, rapid, deep RR, not arousable, gray and clammy, marked sucked fontanels and eyes, no UOP (>1.030), cap refill >4 seconds, tenting, mottled skin, parched membranes.
management of mild dehydration:
managed at home, ORS, 50 ml/kg over 4-6 hours (work with small sips or popsicles), continue breastfeeding/diet, give 10 ml/kg with every stool or emesis
management of moderate dehydration:
home or ER until rehydrated, oral rehydration, 100ml/kg over 4-6 hours, keep breastfeeding, age appropriate diet when hydration status has improved, they do not get potassium
management of severe dehydration
use isotonic solutions (0.9% sodium chloride or LR ) at 20ml/kg over 20 minutes.
3 phases:
1. boluses until there is a response from the child
2. maintenance rate+catch up+ongoing losses: calculated for 8 hours
3. patient begins to take oral fluids and potassium is added because UOP is increased enough it won’t harm the kidneys
define diarrhea
3 or more stools that take shape of their container in a 24 hour period
what to do if a child has c. diff
stop all antibiotics, give probiotics, metronidazole is a drug of choice, contact isolation, soap and water
acute diarrhea management
- rehydrate the child
- continue breastfeeding or lactose-free formula infants
- regular diet with older childern-encourage as soon as they tolerate
- replace stool loss with 10 ml/kg of ORS after every diarrheal stool
can you give antidiarrheal medication to a pediatric patient?
no.
what is contraindicated in children with diarrhea?
caffeinated beverages, BRAT diet, clear liquids alone, soda, fruit juice, gelatin, broth
common foods well tolerated with diarrhea
rice, wheat, potatoes, cereal, yogurt, cooked veggies, lean meat
prevention of diarrhea
spread by the fecal-oral route, teach personal hygiene, hand washing, clean water supply and careful food preparation
rehydration during vomiting
5 ml ORS every 5 minutes, oral administration fo ondansetron, popsicles
water intoxication signs and symptoms
elevated urinary output, HA, vomiting, seizures, irritability, sleepiness
causes of water intoxication
inappropriate IV therapy, tap water enemas, incorrectly mixed formula, excess water ingestion, too rapid dialysis, too rapid reduction of glucose levels in DKA
what are the types of shock?
hypovolemia, cariogenic, distributive shock, obstructive
three stages of shock
- compensated
- hypotensive
- irreversible
Determined by degree of tachycardia and perfusion to extremities, LOC, BP
what are the signs of compensated shock?
mild tachycardia is the first sign, apprehension, irritability, pallor, diminished UOP, thirst (RAS starting), narrowing pulse pressure, normal BP
what are the signs of hypotensive shock?
tachypnea, moderate metabolic acidosis, oliguria, cool, pale extremities, decreased LOC, pronounced tachycardia, poor cap refill, developing hypotension. call a rapid response, EMS to the hospital-this is NOT a good sign
what is the definition of hypotension in infants
systolic BP of <70
what is the definition of hypotension in children 1-10 years?
systolic BP of < 70 + (age in years x 2)
for examples: a 8 year old child would be 86
what is the definition of hypotension in children over 10
systolic BP <90
signs of decreased cardiac output due to shock
comatose, poor perfusion with mottled skin, extremities cool to touch, weak thready pulses, poor cap refill, acidosis, high lactate, poor UOP
what are the signs irreversible shock or impending cardiac arrest
hypotension, coma, anuria
treatment of shock
airway (O2), fluid resuscitation, vasopressor, positioning: child flat with legs raised above heart, keep child warm, monitor and treat pain.
what is hypovolemic shock?
most common in burn patients. reduction in circulation blood volume-related to blood loss, plasma losses, extracellular fluid losses
management of non-hemorrhagic shock:
20 ml/kg of NS or LR; repeating as needed
management of hemorrhagic shock
control external bleeding
20 ml/kg NS/LR bolus, repeat 2-3 times as needed
transfuse with PRBCs as indicated
