Fluid balance

Question 1

```

~~~

How does water get into the body

Answer 1

Drinking
Produced by body in oxidative metabolism
IV fluids
NG tube
PEG fed

Question 2

How does water get out of the body

Answer 2

Urine- 60%
Skin and lungs- 35%
Stool-5%

Question 3

Fluid requirements in young infants, toddlers and adults

Answer 3

Young infants ~150ml/kg
Toddler ~100ml/kg
Adult ~50ml/kg

Question 4

Signs of mild dehydration in infants and older children

Answer 4

Thirsty, alert, restless,
↓urine

Question 5

signs of moderate dehydration in infants and older child

Answer 5

Infants:
Lethargic, drowsy,
sunken eyed,
↓ urine

Older child:
Alert,
postural dizziness,
sunken eyed,
↓ urine

Question 6

Severe dehydration in infants and older child

Answer 6

Infant:
Limp, cold, urine
↓ consciousness

older child:
Apprehensive, cold, urine
cramps

Question 7

Risk of having too much water

Answer 7

Neonate:
* cannot efficiently excrete water load

Infants and toddlers
Small stomach volume
Decreased appetite
Inadequate energy and nutrients
Faltering growth

Question 8

Excessive milk drinking in toddlers

Answer 8

Decreased appetite for foods
Iron deficiency anaemia associated with milk intake > 500ml/d
Increased saturated fat intake

Question 9

Fluid balance is important. If too much fluid goes out:

Answer 9

-Gut:
Acute gastroenteritis, Enteropathy, Stomas
-lungs:
Cardiorespiratory disease,congenital heart disease , cystic fibrosis,
-Skin:
Pyrexia, eczema, burns, CF, phototherpay
-kidney:
Renal dyplasia, nephrohenic diabetes,

Question 10

Fluid balance is important

If not enough fluid comes in

Answer 10

Dysphagia – cerebral palsy, neurodisability
Vomiting – chemotherapy, GORD
Behavioural – fussy feeders and eaters
Carer – child neglect or abuse

Question 11

Revise this just for the practical session

What does fluid do

Answer 11

• Carries nutreints and oxygen to cells
• Regulates body temp
• Protects organs and tissues
• Prevent constipation

Question 12

Revise this just for the practical session

How is fluid stored

Answer 12

1. Intracellular
2. Interstitial
3. Intravascular (within blod)

Question 13

Calculation for fluid maintenance

Answer 13

First 10kg : 100ml/kg/day
second 10kg: 50ml/kg/day
Remaining weight (over 20kg): 20ml/kg/day

Max flluid maintenance for males= 2500mls and females = 2000ml

Question 14

What should maintenance fluids consist of

Answer 14

Isotonic cyrstalloids

Maintenance fluids in children always contains dextrose (unless contraindicated)

Question 15

Fluid maintenance for neonates

Answer 15

From birth- day 1: 50-60ml/kg/d
Day 2: 70-80ml/kg/d
Day 3:80-100ml/kg/day
day 4: 100-120 ml/kg/day
day 5-28: 120-150ml/kg/day

Question 16

Resuscitation fluid

Answer 16

Emergency fluid

Glucoe free crysatlloids

Medical: bolus 20ml/kg over less than 10 mins

Surgical/trauma: bolus 10ml/kg over less than 10 mins

Question 17

Calculating urine output

Answer 17

mls/kg/hr

Question 18

Normal urine output for an hour

Answer 18

Neonates - 2-3mls/kg/hr
Infants- 2ml
child- 1-2ml
adolescent- 0.5-1mls

Question 19

What influences the amount of urine passed

Answer 19

• Amount patient drunk
• fever
• pregnancy
• alcohol
• Nausea, vomiting and diarrhoea
• Excessive sweating
• Time of day (largest vol 1st thing in morning)

Question 20

Capacity of child bladder

Answer 20

38+(2.5x age in months)

Older children (agex30) + 30

Question 21

Urine output in nappies

Answer 21

weight of dry nappy- wet nappy