Fluid/Electrolyte Imbalance and GI Disease Objectiv Flashcards
Calculate daily maintenance fluid requirement
Allow 100 ml/kg for first 10 kg body weight
Allow 50 ml/kg for second 10 kg body weight
Allow 20 ml/kg for remaining body weight
Divide by 24
Increased fluid requirement
When does the child need increased fluilds?
6
FTR-VSB
Fever (fluid loss through skin, tachypnea)
Tachypnea (insensible loss)
Radiant warmer (preemies)(blue heater in NICU)
Vomiting and diarrhea
Shock
Burns
Decreased fluid requirements
Heart failure
Renal failure
Increased ICP (fluids can cause H20 shifts to brain->cerebral edema)
Identify and calculate normal expected urine output for a child
Normal urine output: 1-2cc/kg/hour
Minimum urine output = 1 cc/kg/hour
Identify the signs and management of dehydration in children
MILD
Slightly thirsty
Decreased urine
everything else is normal
Identify the signs and management of dehydration in children
MODERATE
9
ITT DDS MPO
-irritable
-tachycardia
-tachypenia
-dry mucous membrane
-decreased tears
-sunken anterior fontanel (15-18 months)
-moderate thirst
-prolonged cap refill (>2-4 seconds)
-oliguria (decreased urine)
Identify the signs and management of dehydration in children
SEVERE
LTTH-PTA-IPA
-lethargic, confused
-tachycardia
-tachypenia
-hypotension
-parched mucous membrane
-tears are absent
-anterior fontanel is deeply sunken
-intense thirst
-prolonged cap refill (>4 seconds)
-anuria (absence of urine)
Therapeutic Management of dehydration
Mild to moderate Dehydration? give when via what? continue to what?
Severe Dehydration?
Pedialyte for Mild to moderate Dehydration
Give small amounts frequently (teaspoon, cup, syringe every 5-10 minutes or via NGT)
Continue to breastfeed
Severe Dehydration- Hypovolemic Shock
Give Intravenous Bolus NS or LR
Hypovolemic shock
Most common cause of what?
Can be caused by?
Decreased fluid leads to what?
Most common cause of shock in pediatric patient:
Reduction in circulating blood volume r/t blood loss and extracellular fluid (ECF) loss.
Can be caused by:
Trauma
Burns (3rd spacing)
Gastroenteritis- vomiting/diarrhea
- Decreased blood/fluid volume
- decreased cardiac output
- decreased oxygenation and tissue perfusion
- organ failure
- death
Signs/symptoms of Hypovolemic shock
8
late sign?
Mental status- lethargic, unresponsive
Bradycardia
tachypnea
HYPOTENSION (late sign)
prolonged cap refill (3-4 seconds)
decreased peripheral pulse
skin is pale and cool
anuria
Management of hypovolemic Shock
two
-Stop the loss
-Replace fluid through IV fluid replacement NS or LR
Septic shock management
What’s crucial for survival?
What to do within 1 hour of arrival?
How do you correct hypovolemia?
How do you correct Vasodilation?
Labs?
Early Identification of Septic Shock is crucial for survival
Broad spectrum antibiotic administration (IV) within one hour of arrival
IV fluids 0.9 Normal Saline or Ringers Lactate (Correct Hypovolemia)
Epinephrine or norepinephrine (vassopressors) (Correct Vasodilation)
Labs: Blood culture, CBC, PT/PTT, Electrolytes, Urine culture & sensitivity (before we start antibiotics)
Rotavirus
How is it transmitted?
Most common cause of what?
Is it vaccine preventable?
Fecal-oral.
Most common cause of diarrhea in children 5 yrs.
VACCINE PREVENTABLE (e.g. Rotarix).
E. Coli
Transmission?
how/where can you get it?
E. Coli OH157:H7 linked with what?
bacteria
Fecal-oral
UNDERCOOKED BEEF
LETTUCE
PETTING ZOOS
produce
E. coli OH157:H7 linked with acute renal failure!!!!*
C.Diff
Transmission?
Results in what?
Not killed by what?
Most effective way to get rid of them?
bacteria
Adverse effect of antibiotic use.
Can also be fecal-oral. Results in severe colitis!
NOT KILLED BY ALCOHOL
Most effective way to remove them from hands is through WASHING HANDS - Probiotics
Meconium
What does it look like?
Should be passed when?
Should assess for what? 3
First stool
Sticky, greenish-black stool
Amniotic fluid and cells swallowed in utero
**Should be passed within 24 hours of life; if not, assess for:
1) Hirschsprung disease-lack of ganglion cells
2) Hypothyroidism-metabolism slow
3) Cystic Fibrosis -thick mucus
Hirschsprung disease
Also called?
Absense of what?
Colon does what?
Also called congenital aganglionic megacolon
Absence of ganglion (nerve) cells in colon and rectum
Colon expands - accumulation of stool with distention *surgery needed
Signs and symptoms of Hirschsprung disease
How is it diagnosed? three
Confirm diagnoses with what?
Delayed meconium passing,
Bilious vomiting
Large stools (older children)
X-ray, barium enema,
Confirm diagnosis with rectal biopsy
Gastroesophageal reflux (GER)
healthy baby
Common in who?
How does it reslove?
Regurgitation of gastric contents into the esophagus (healthy babies)
Common-50% of infants < 2 months old are reported to have GER
Usually resolves spontaneously by age 1 year (88%)
GERD (Gastroesphageal Reflux Disease)
Concern when?
What develops?
Tissue damage to esophagus
Concern when Failure to Thrive (FTT)
decreased growth
dysphagia develop
Therapeutic Management of GER/GERD
- Feeding alterations in infant?
- Pharmacologic?
- Surgical intervention?
Step-approach
- Feeding alterations in infant
Thickening feedings (rice)
Upright positioning
Frequent burping during feeds - Pharmacologic : H2 receptor antagonists (Cimetidine, Pepcid)-reduce gastric hydrochloric acid secretion.
- Surgical intervention—Nissen fundoplication
(upper portion of stomach (fundus) is wrapped around bottom of esophogus, creates sphincter to prevent acid reflux)
Acute appendicitis
Obstruction of what?
1st two pains?
symptoms?
Suspect appendix has ruptured when?
Obstruction of appendix
1st intermittent periumbilical crampy pain
2nd - Moves to McBurney’s point (RLQ)
Fever, nausea, diarrhea, vomiting, decreased appetite
Suspect appendix has ruptured if patient has a sudden relief of pain.
How is acute appendicitis diagnosed?
two
Ultrasound
CT Scan
Treatment of acute appendicitis
Non-ruptured?
Ruptured?
Non-Ruptured- laparoscopy surgery, IV antibiotics, can go home same day.
Ruptured- Can result in peritonitis - open abdominal surgery- substantial IV antibiotics, longer hospitalization
