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Peds: Fluid and Electrolytes > Fluid and Electrolyte > Flashcards

Fluid and Electrolyte Flashcards

1
Q

Newborns are comprised of ______ TBW

A

75%

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2
Q

When there are fluid imbalances with newborns, we are worried about…

A

Temperature regulation

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3
Q

What are the three components of ECF?

A

Intravascular, interstitial, transcellar

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4
Q

What is sensible water loss?

A

water loss we can track.

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5
Q

What is insensible water loss?

A

Water loss we cannot track.

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6
Q

What are examples are sensible water loss?

A

UOP, stool, emesis, NG tube output

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7
Q

What are examples of insensible water loss?

A

sweat, resp. secretions.

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8
Q

If a newborn is admitted with RSV and a RR of >60, what are the considerations for rehydration?

A
  1. hold feeds. 2. rehydrate with IV fluids (or PO if RR is down.
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9
Q

what is important to know about water balance in infants? (5 things)

A
  1. 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
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10
Q

ECF electrolyte and there normal values

A

Sodium: 135-145
Chloride: 96-106

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11
Q

ICF electrolyte and there normal values

A

Potassium: 3.5-5
Magnesium: 1.5-2.5

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12
Q

Internal control mechanisms influencing fluid balance (4 things)

A
  1. Thirst (children will forget or not pay attention to it)
  2. Antidiuretic hormone
  3. Aldosterone
  4. Renin-angiotensin system
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13
Q

DAILY maintenance fluid requirements for a child weighing 1-10kg

A

100 ml/kg/day

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14
Q

DAILY maintenance fluid requirements for a child weighing 11-20 kg

A

1000 ml (for the first 10 kg) plus 50 ml/kg/day

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15
Q

DAILY maintenance fluid requirements for a child weighing above 20 kg

A

1500 ml (for the first 20 kg) plus 20 ml/kg/day

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16
Q

HOURLY maintenance fluid requirements for a child weighing 1-10 kg

A

4 ml/kg/hour

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17
Q

HOURLY maintenance fluid requirements for a child weighing 11-20 kg

A

40 ml (for the first 10) plus 2 ml/kg/hour

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18
Q

HOURLY maintenance fluid requirements for a child weighing above 20 kg

A

60 ml (for the first 20) plus 1 ml/kg/hour

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19
Q

a fever will increase:

A

insensible water loss (remember children will become febrile more than adults)

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20
Q

NORMAL URINE OUTPUT

A

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

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21
Q

what are the three types of dehydration relating to plasma sodium concentration

A

isonatremic-isotonic
hyponatremic-hypotonic
hypernatremic-hypertonic

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22
Q

what is the most common cause of isotonic dehydration?

A

vomiting and diarrhea -major loss from the ECF.

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23
Q

what is a child with isotonic dehydration at risk for?

A

shock

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24
Q

what is a big concern for hypotonic dehydration?

A

cerebral edema

25
Q

what are some causes for hypotonic dehydration?

A
  • 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
26
Q

what are some signs of hypertonic dehydration?

A

alteration in consciousness, poor ability to focus, lethargy, hyperreflexia, hyper irritability, seizures

27
Q

what is happening during hypertonic dehydration and what are we concerned for?

A

water from the brain cells is coming out- we are worried about permanent brain damage

28
Q

what are causes hypertonic dehydration?

A

over concentrated formula, DKA, high protein NG tube feeds

29
Q

hypertonic dehydration requires special fluid treatment, what is it?

A

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.

30
Q

what Is the earliest sign of dehydration?

A

tachycardia- if we wait for BP changes; we waited too long.

31
Q

Mild Dehydration (3-5%): signs and symptoms

A

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

32
Q

moderate dehydration (6-9%): signs and symptoms:

A

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

33
Q

severe dehydration (10%): signs and symptoms:

A

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.

34
Q

management of mild dehydration:

A

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

35
Q

management of moderate dehydration:

A

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

36
Q

management of severe dehydration

A

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

37
Q

define diarrhea

A

3 or more stools that take shape of their container in a 24 hour period

38
Q

what to do if a child has c. diff

A

stop all antibiotics, give probiotics, metronidazole is a drug of choice, contact isolation, soap and water

39
Q

acute diarrhea management

A
  1. rehydrate the child
  2. continue breastfeeding or lactose-free formula infants
  3. regular diet with older childern-encourage as soon as they tolerate
  4. replace stool loss with 10 ml/kg of ORS after every diarrheal stool
40
Q

can you give antidiarrheal medication to a pediatric patient?

A

no.

41
Q

what is contraindicated in children with diarrhea?

A

caffeinated beverages, BRAT diet, clear liquids alone, soda, fruit juice, gelatin, broth

42
Q

common foods well tolerated with diarrhea

A

rice, wheat, potatoes, cereal, yogurt, cooked veggies, lean meat

43
Q

prevention of diarrhea

A

spread by the fecal-oral route, teach personal hygiene, hand washing, clean water supply and careful food preparation

44
Q

rehydration during vomiting

A

5 ml ORS every 5 minutes, oral administration fo ondansetron, popsicles

45
Q

water intoxication signs and symptoms

A

elevated urinary output, HA, vomiting, seizures, irritability, sleepiness

46
Q

causes of water intoxication

A

inappropriate IV therapy, tap water enemas, incorrectly mixed formula, excess water ingestion, too rapid dialysis, too rapid reduction of glucose levels in DKA

47
Q

what are the types of shock?

A

hypovolemia, cariogenic, distributive shock, obstructive

48
Q

three stages of shock

A
  1. compensated
  2. hypotensive
  3. irreversible
    Determined by degree of tachycardia and perfusion to extremities, LOC, BP
49
Q

what are the signs of compensated shock?

A

mild tachycardia is the first sign, apprehension, irritability, pallor, diminished UOP, thirst (RAS starting), narrowing pulse pressure, normal BP

50
Q

what are the signs of hypotensive shock?

A

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

51
Q

what is the definition of hypotension in infants

A

systolic BP of <70

52
Q

what is the definition of hypotension in children 1-10 years?

A

systolic BP of < 70 + (age in years x 2)

for examples: a 8 year old child would be 86

53
Q

what is the definition of hypotension in children over 10

A

systolic BP <90

54
Q

signs of decreased cardiac output due to shock

A

comatose, poor perfusion with mottled skin, extremities cool to touch, weak thready pulses, poor cap refill, acidosis, high lactate, poor UOP

55
Q

what are the signs irreversible shock or impending cardiac arrest

A

hypotension, coma, anuria

56
Q

treatment of shock

A

airway (O2), fluid resuscitation, vasopressor, positioning: child flat with legs raised above heart, keep child warm, monitor and treat pain.

57
Q

what is hypovolemic shock?

A

most common in burn patients. reduction in circulation blood volume-related to blood loss, plasma losses, extracellular fluid losses

58
Q

management of non-hemorrhagic shock:

A

20 ml/kg of NS or LR; repeating as needed

59
Q

management of hemorrhagic shock

A

control external bleeding
20 ml/kg NS/LR bolus, repeat 2-3 times as needed
transfuse with PRBCs as indicated

Peds: Fluid and Electrolytes (2 decks)

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