Fluid/Electrolyte Imbalance and GI Disease (WEDNESDAY)

Question 1

Identify the signs and management of dehydration in children

MILD

Answer 1

Slightly thirsty
Decreased urine

everything else is normal

Question 2

Identify the signs and management of dehydration in children

MODERATE
9
ITT DDS MPO

Answer 2

-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)

Question 3

Identify the signs and management of dehydration in children

SEVERE
LTTH-PTA-IPA

Answer 3

-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)

Question 4

Therapeutic Management of dehydration

Mild to moderate Dehydration? give when via what? continue to what?

Severe Dehydration?

Answer 4

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

Question 5

Hypovolemic shock
Most common cause of what?
Can be caused by?
Decreased fluid leads to what?

Answer 5

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

1. Decreased blood/fluid volume
2. decreased cardiac output
3. decreased oxygenation and tissue perfusion
4. organ failure
5. death

Question 6

Signs/symptoms of Hypovolemic shock
8

late sign?

Answer 6

Mental status- lethargic, unresponsive

Bradycardia

tachypnea

HYPOTENSION (late sign)

prolonged cap refill (3-4 seconds)

decreased peripheral pulse

skin is pale and cool

anuria

Question 7

Management of hypovolemic Shock
two

Answer 7

-Stop the loss

-Replace fluid through IV fluid replacement NS or LR

Question 8

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?

Answer 8

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)

Question 9

Crohns disease (FISTULA)
what is it?
Symptoms?
Complication?

Ulcerative Colitis (NO FISTULA)

both have same symptoms

Answer 9

Inflammation is from from Mouth to anus.

‘skip lesions’

diarrhea
bloody stool
abdominal pain
fatigue
weight loss-malabsorption
growth retardation

Complication: fistula

Question 10

Ulcerative colitis (NO FISTULA)
what is it?

Answer 10

Diffuse inflammation of rectum and colon

Question 11

Management: Crohn’s and Ulcerative Colitis

Medication and pain management?

Answer 11

Medication:
Anti-inflammatory agents corticosteroids
chemotherapeutic
autoimmune
immunosuppressant
antibody treatment
tumor-necrosing factor
probiotics.

Pain management:
Nutritional supplements
Exercise
Hydration
Quality of life (hospitalizations, separation from family friends)