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Pediatrics > Fluid And Electrolytes > Flashcards

Fluid And Electrolytes Flashcards

1
Q

Transcellular space

A

Fluid in specialized cavities like CSF and pericordal area

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2
Q

Intravascular space

A

Fluid in the vascular space

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3
Q

Interstitial fluid

A

Fluid surrounding the cell

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4
Q

Developmental differences btwn kids and adults

A
  • inc body surface area to BMI
  • higher metabolic rates
  • higher body water content
  • inc fluid intake and output relative to size
  • larger quantities of ECF
  • immature kidney rxn
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5
Q

3 elements of water balance

A
  • maintenance—normal ongoing losses of fluids and electrolytes
  • deficit—total amt of fluids and electrolytes lost from an illness
  • on-going losses—requirement of fluids and electrolytes to replace ongoing losses (from third space loss, blood loss, diarrhea)
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6
Q

What should the amount of water ingested equal roughly…

A

The amount of urine excreted in a 24h period

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7
Q

Water in food and from oxidation closely approximates…

A

The amount lost in feces and thru evaporation

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8
Q

Holliday-Segar method

A

Body weight method to determine fluid requirements–100 mL/first 10 kg, 50 mL/second 10 kg, 20 mL/each kg after; divide by 24 to get hourly requirements

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9
Q

Factors inc maintenance fluid requirements

A

 Fever-temp above 99
 Tachypnea
 Increased temp of the environment
 Burns
 Ongoing losses-diarrhea, vomiting, NG tube
output, high output kidney failure.
 Diabetic ketoacidosis, diabetes insipidus
 Shock
 Radiant warmer, phototherapy, under lights
 Postop bowel surgery

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10
Q

Factors dec maintenance fluid requirements

A

• Skin: Mist tent, incubator, swamp bed (premature infants)
• Lungs: Humidified ventilator
• Renal: Oliguria, anuria
• Misc.: Hypothyroidism
• Congestive Heart Failure
• Increased intracranial pressure
• Syndrome of inappropriate antidiuretic hormone (SIADH)

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11
Q

Symptoms of fluid excess

A

Edema, slow bounding pulse, crackles in lungs, lethargy, hepatomegaly, weight gain, seizures, coma

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12
Q

Causes of excretion failure

A
  • Renal failure
  • CHF
  • malnutrition
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13
Q

Causes of excess water intake

A
  • excessive oral intake
  • hypotonic overload
  • plain water enemas
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14
Q

NC for fluid excess

A
  • limit intake
  • diuretics
  • monitor VS
  • monitor neurological status
  • seizure precautions
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15
Q

Causes of fluid depletion

A
  • lack oral intake
  • abnormal losses from diarrhea, vomit, hyperventilation, burns, hemorrhage
  • these causes can dehydrate much faster in kids that adults (ECF is lost first when fluid loss occurs)
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16
Q

Isotonic dehydration

A
  • Electrolyte loss=water loss
  • Serum Na in normal range
  • about 80% of all dehydration patients
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17
Q

Hypertonic dehydration

A
  • water loss is greater than electrolyte loss
  • serum Na is greater than 145 mEq/L (correct slowly)
  • about 15% of all dehydration patients
  • physically dry rough skin, inc muscle tone
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18
Q

Hypotonic dehydration

A
  • electrolyte loss greater than water loss
  • serum Na less than 135 mEq/L
  • about 5% of all dehydration pts
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19
Q

Are labs needed for dehydration?

A

No, look at physical appearance

20
Q

Oral rehydration therapy

A
  • only for when child is alert, awake, not in shock
  • rapid losses over 4-6h, replacement for continuing losses, providing maintenance fluid requirements
21
Q

Parenteral fluid therapy

A

Occurs when fluids can’t be orally digested; 3 phases—
1. Initially used to increase ECF quickly
2. Replace, maintain, catch up with fluid losses
3. Introduce oral feedings and gradual correction of total body deficits

22
Q

Electrolyte amounts

A

Na 135-150
K 3.5-5
Ca 8.5-10.5

23
Q

Hyponatremia CM

A
  • Neurogenic (Na < 125
    meq/L):Behavior change,
    irritability, lethargy,
    headache , dizziness,
    apprehension
  • Cardiovascular: Increased
    heart rate, decreased
    blood pressure, cold,
    clammy skin
  • Muscle cramps
    (especially abdomen)
  • Nausea
24
Q

Hyponatremia etiologies

A
  • fever
  • inc water intake w/o electrolytes
  • dec Na intake
  • diabetic ketoacidosis
  • burns and wounds
  • SIADH
  • malnutrition
  • CF
  • renal disease
  • V/D/nasogastric suction
25
Q

Hypernatremia CM

A
  • Intense thirst
  • Oliguria
  • Agitation
  • Flushed skin
  • Peripheral and pulmonary
    edema
  • Dry, sticky mucous
    membranes
  • Nausea and vomiting
  • Severe CNS symptoms (Serum
    Na >150 meq/L):
    disorientation, seizure,
    hyperirribility when at rest
26
Q

Hypernatremia etiologies

A
  • Water loss or deprivation
  • High sodium intake
  • Diabetes insidipus
  • Diarrhea
  • Fever
  • Hyperglycemia
  • Renal disease
  • Increased insensible loss
27
Q

Hypokalemia CM

A
  • Muscle: cramps(leg),
    weakness
  • CVS: weak or irregular
    pulse, tachycardia,
    bradycardia, cardiac
    arrythmias, hypotension
  • GI: ileus or decrease of
    bowel movement
  • CNS symptoms:
    irritability, fatigue,
    paralysis, weakness
28
Q

Hypokalemia etiologies

A
  • Stress
  • Starvation
  • Malabsorption
  • Excess loss of fluids
    through vomiting,
    diarrhea, sweat, n/g tube
  • Diuretics (furosemide,
    ethacrynic acid, thiazide)
  • IV fluid without
    potassium
  • Corticosteroids
  • Diabetic ketoacidosis
29
Q

Hyperkalemia etiologies

A
  • Increase intake of
    potassium
  • Decrease urine excretion
  • Kidney failure
  • Metabolic acidosis
  • Hyperglycemia
  • Potassium-sparing
    diuretics
  • Dehydration (severe)
  • Rapid IVF of potassium
  • Burns
30
Q

Hyperkalemia CM

A
  • Irritability, Anxiety
  • Twitching
  • Hyperreflexia
  • Weakness
  • Flaccid paralysis
  • Nausea, Diarrhea
  • Bradycardia
  • Cardiac arrest (K >8.5
    meq/L)
  • Apnea, respiratory arrest
31
Q

Hypocalcemia etiologies

A
  • Inadequate calcium intake
  • Vitamin D deficiency
  • Renal insufficiency
  • Calcium loss (infection,
    burns, loop diuretics)
  • Alkalosis
  • Hypoparathyroidism
32
Q

Hypocalcemia CM

A
  • Nervous system: numbness,
    tingling of fingers, toes, nose,
    ears, and circumoral area
  • Hyperactive reflexes, seizure
  • Muscle cramps/tetany
  • Laryngosplasm
  • Lethargy
  • Poor feeding in neonates
  • Positive Trousseaus and Chvostek’s sign
  • Hypotension, Cardiac arrest
33
Q

Hypercalcemia etiologies

A

• Milk alkali syndrome (chronic
intake of calcium carbonate,
or milk)
• Excessive IV or oral calcium
administration
• Acidosis
• Prolonged immobilization
• Hypoproteinemia
• Renal disease
• Hyperparathyroidism
• Hyperthyroidism

34
Q

Hypercalcemia CM

A

• Lethargy, weakness
• Anorexia, thirst
• Itching
• Behavior changes
• Confusion, stupor
• Nausea, vomiting, constipation
• Bradycardia, cardiac arrest

35
Q

What are most pediatric maintenance solutions made of?

A

Dextrose and NaCl

36
Q

Hypotonic solution

A
  • fewer solutes than Intracellular fluid
  • fluid shifts into cells
  • for cellular hydration
  • 0.45NS, 2.5D5W, .33NS
  • watch for dec BP d/t dec blood volume
  • not for low BP, inc ICP, stroke, neuro pt, liver, trauma, surgery, burns
37
Q

Isotonic fluids

A
  • same tonicity as ICF
  • NS, LR, D5W
  • no fluid shifts
  • for fluid and Lyte replacement
  • watch from fluid overload, edema, diluted lab values
  • no volume overload pts
38
Q

Hypertonic fluids

A
  • more solutes than ICF
  • D51/2, D5NS, D5LR
  • fluid shifts OUT of cells
  • used for hypovolemia/vascular expansion, inc urine output (postoperative), 3rd spacing, DKA
  • watch for hypervolemia, inc NaCl, extravasations, cell dehydration, hyperglycemia
  • NO renal or cardiac pts (d/t pulmonary edema), dehydration
39
Q

Peds infusion pumps

A
  • check rate/amt infused every hour
  • never teach kids how to turn off alarms
40
Q

Mild Dehydration

A

All looks good but 3-5% weight loss

41
Q

Moderate dehydration

A

6-9% wt loss, irritable, alert, thirsty, cap refill slow, slightly inc pulse and RR, normal or low orthostatic hypotension, dry membranes, less than expected tears, small tenting, normal or lightly sunk fontanelle, dec urine flow

42
Q

Severe dehydration

A

over 10% wt loss, lethargic, looks sick, delayed cap refill, very fast, thready pulse, fast and deep RR, orthostatic to shock BP, parched membrane, absent tears, sunken eyes, mottled, cool skin, sunken fontanelle, severely dec urine flow

43
Q

Mild dehydration tx

A

oral rehydration, add fluid for each stool they have, also maintenance therapy

44
Q

Moderate dehydration therapy

A

Same as mild but more fluids

45
Q

Severe dehydration

A

IV fluids bolus plus maintenance, can give oral when they are alert

46
Q

IV Notes

A
  • can put it in the scalp
  • can use numbing cream
  • get labs when start IV if possible
  • always use pump bc safer–less drip factor issues
47
Q

Normal urine output in kids

A

1-2 mL/kg/hr

Pediatrics (26 decks)

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