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Pediatrics Exam 2 > Fluids & Acid-Base Imbalance > Flashcards

Fluids & Acid-Base Imbalance Flashcards

1
Q

What percentage of newborns is composed of water?

A

75%

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2
Q

What percentage of infants are composed of water?

A

65%

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3
Q

What percentage of children / adolescents are composed of water?

A

50%

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4
Q

What factors contribute to electrolyte imbalance in children?

A
  • body surface area
  • ↑ RR
  • ↑ respiratory & metabolic demands
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5
Q

What is different about the daily water need of newborns?

KNOW THIS!!!!!

A

4-5 times GREATER daily water need per kg

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6
Q

What 3 factors in children can lead to insensible fluid loss, dehydration, & electrolyte imbalance?

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A
  • ↑ body surface area
  • ↑ metabolic demands
  • ↓ systemic regulation
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7
Q

Clinical Assessment of Fluid Imbalances - Vascular Volume

KNOW THE BOLD!!!!!

KNOW THIS!!!!! ↑ ↓

A
  • Capillary refill
  • ↓ pulse
  • ↓ BP (= late sign)
  • Central venous pressure (CVP)
  • sunken fontanelles
  • I/Os
  • ↓ tears
  • urine specific gravity
  • mucous membranes
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8
Q

Clinical Assessment of Fluid Imbalances - Interstitial Volume

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A
  • Skin turgor
  • Presence or absence of edema
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9
Q

What is 1 L of fluid lost equal to in terms of weight?

KNOW THIS!!!!!

A

1 kg lost (weight loss)

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10
Q

Normal Urine Output in Children

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A

0.5 - 1 mL/kg/hr

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11
Q

Normal Urine Output for an INFANT

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A

2 mL/kg/hr

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12
Q

What are the 3 main causes of dehydration in children?

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A
  • ↓ intake
  • ↑ output (GI loss, renal loss)
  • translocation (burns, edema, etc.)
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13
Q

What are causes of dehydration?

KNOW THE BOLD!!!!!

A
  • Diarrhea
  • Vomiting
  • Gastroenteritis
  • Stomatitis or pharyngitis
  • Fever
  • DKA
  • DI
  • Burns
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14
Q

Isoctonic

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A
  • Fluid loss cannot be compensated by fluid intake
  • Na+ & water are lost in proportion to each other
  • Na+ is normal

H2O = Na

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15
Q

Hypotonic

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A
  • Na+ loss is greater than water loss
  • Na+ is low
  • Fluid shifts from ECF to ICF to attempt to correct worsening dehydration

H2O < Na+

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16
Q

Hypertonic

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A
  • Water loss is greater than Na+ loss
  • Na+ is HIGH
  • Fluid moves from ICF to ECF & thus s/s appear late

H2O > Na+

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17
Q

Mild Dehydration

KNOW THIS!!!!!

A

< / = 5% (40-50 mL/kg) loss of body weight

  • Difficult to detect

S/S:
* Slightly ↓ urine output
* Moist mucous membranes

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18
Q

Moderate Dehydration

KNOW THIS!!!!!

A

6 - 10% (60 - 90 mL/kg) loss of body weight

S/S:
* sleepy / lethargic
* ↓ skin turgor
* ↓ urine output
* dark urine
* dry mucous membranes

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19
Q

Severe Dehydration

KNOW THIS!!!!

A

> / = 10% (100 mL/kg) loss of body weight

S/S:
* ↑ irritability
* lethargy
* non-responsive
* tachycardia (↑ HR)
* tachypneic (↑ RR)
* ↓ / absent urine output

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20
Q

How to Calculate IV Fluid Replacement

KNOW THIS!!!!!

A

1.) Calculate deficit for 24 hours

2.) Calculate Hourly Maintenance IV Fluids (MIVF)

3.) IV Rate = Deficit + MIVF
* Replace 50% in first 8 hours
* Replace 50% in the next 16 hours

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21
Q

Jimmy is a 4 year old boy brought to the pediatric ED by his mom. He has been vomiting & having diarrhea for 4 days. You determine that he has mild dehydration & your hospital recommends a fluid deficit of 40 mL/kg/24hr for this type of dehydration. He weighs 37 kg.

A

1.) Calculate the fluids needed to correct the deficit.
* 40 mL x 37 kg = 1480 mL

2.) Calculate the Bolus Amount (bolus is given 20 mL/kg over 30-60 minutes)
* 37 kg x 20 mL = 740 mL

3.) Calculate the MIVF Rate
* (10 kg x 4 mL/kg/hr) + (10 kg x 2 mL/kg/hr) + (17 kg x 1 mL/kg/hr) =
* 40 mL + 20 mL + 17 mL = 77 mL

  • First hour he will receive 1 NS bolus of 740 mL (20 mL/kg bolus x 37 kg = 740 mL)

Then he will receive the remaining 740 mL (1480 - 740 = 740) deficit over the next 23 hours
* 740 mL / 23 hr = 32.17 mL/hr
* 32.17 mL + 77 mL = 109 mL/hr

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22
Q

Oral Rehydration Solution (ORS)

A

Product given for dehyration that contains complex carbs, sodium (Na+) & potassium (K+)

  • avoid pop = increased diarrhea
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23
Q

Oral Rehydration

KNOW THIS!!!!!

A

1-2 tsp fluid every 10-15 minutes

24
Q

4-2-1 Rule for Fluid Maintenance (holiday-segar method)

KNOW THIS!!!!!

A
  • First 10 kg = 4 mL/kg/hr
  • Next 10 kg = 2 mL/kg/hr
  • Above 20 kg = 1 mL/kg/hr
25
Q

4-2-1 Rule Example:

  • Child’s Weight is 8.5 kg
A

8.5 kg x 4 mL/kg/hr = 34 mL / hr

multiply by 4 because the child is under 10 kg

26
Q

4-2-1 Rule Example

  • Child’s weight is 12 kg
A
  • weight = 12 kg

1.) First 10 = (10 kg x 4 mL/kg/hr) = 40 mL/hr
2.) Second 10 = (2 kg x 2 mL/kg/hr) = 4 mL/hr
3.) Add –> 40 mL/hr + 4 mL/hr = 44 mL/hr

27
Q

4-2-1 Rule Example:

  • Child weighs 30 kg
A
  • Child weighs 30 kg

1.) First 10 kg = 10 kg x 4 mL/kg/hr = 40 mL/hr

2.) Second 10 kg = 10 kg x 2 mL/kg/hr = 20 mL/hr

3.) Above 20 kg = 10 kg x 1 mL/kg/hr = 10 mL/hr

4.) ADD –> 40 mL/hr + 20 mL//hr + 10 mL/hr = 70 mL/hr

28
Q

IV Fluid Bolus

KNOW THIS!!!!

A

NS or LR to expand vascular space & correct electrolyte changes

  • 20 mL/kg over 30-60 minutes
29
Q

Normal Sodium (Na+) level

KNOW THIS!!!!!!!

A

135 - 145

30
Q

Normal Potassium (K+) levels

KNOW THIS!!!!!

A

3.5 - 5

31
Q

Normal Calcium (Ca+) levels

KNOW THIS!!!!!

A

2.8 - 2.86

32
Q

Normal Magnesium (Mg) levels

KNOW THIS!!!!!

A

1.6 - 2.4

33
Q

Respiratory Acidosis

KNOW THIS!!!!!

A

↓ pH & ↑ CO2

  • Causes: severe asthma, pneumonia, hypoventilation
34
Q

Respiratory Alkalosis

KNOW THIS!!!!

A

↑ pH & ↓ CO2

  • Causes: hyperventilation, panic attack, aspirin toxicity
35
Q

Metabolic Acidosis

KNOW THIS!!!!!

A

↓ pH & ↓ HCO3

  • Causes: DKA, lactic acidosis, EtOH
36
Q

Metabolic Alkalosis

KNOW THIS!!!!!

A

↑ pH & ↑ HCO3

  • Causes: vomiting = loss of acid
37
Q

Causes of Hyponatremia

KNOW THIS!!!!!

A
  • Diarrhea
  • Vomiting
  • Inadequate salt intake
  • GI suctioning
  • Diuretics
  • CHF
  • Forced excessive oral intake of tap water
  • Excessive IV D5W

↓ Na+

38
Q

Signs & Symptoms of Hyponatremia

KNOW THIS!!!!!

A
  • Headache
  • Poor skin turgor
  • NEURO CHANGES!!!!!
  • ↓ BP
  • Dry mucosa
  • Lethargy
  • Confusion
  • Seizures
  • muscle weakness
  • decreased deep tendon reflexes

↓ Na+

39
Q

Causes of Hypernatremia

KNOW THIS!!!!!

A
  • Inadequate breastfeeding intake w/ normal output
  • Diabetes insipidus
  • Diarrhea or vomiting
  • Excessive sweating
  • ↑ aldosterone

↑ Na

40
Q

Signs & Symptoms of Hypernatremia

KNOW THIS!!!!!

A
  • Thirsty
  • ↓ urine output (unless ↑ Na is caused by DI)
  • ↓ LOC (confusion, lethargy, coma)
  • Seizures
  • NEURO CHANGES!!!!

↑ Na

41
Q

Causes of Hypokalemia

KNOW THIS!!!!!

A
  • GI losses (vomiting, diarrhea)
  • Medications
  • Poor dietary intake (starvation)
  • ↑ aldosterone (hyperaldosteronism, CHF, nephrotic syndrome, cirrhosis)
  • ↑ cortisol (cushing disease)
  • alkalosis

↓ K+

42
Q

Signs & Symptoms of Hypokalemia

KNOW THIS!!!!!

A
  • Muscle weakness & cramps
  • Fatigue
  • Anorexia
  • Abdominal distension / constipation
  • Nausea / Vomiting
  • Dysrhythmias

↓ K+

43
Q

Causes of Hyperkalemia

KNOW THIS!!!!

A
  • Impaired renal function
  • Crush injury
  • Burns
  • metabolic acidosis

↑ K+

44
Q

Signs & Symptoms of Hyperkalemia

KNOW THIS!!!!!

A
  • Cardiac changes & dysrhythmias
  • Lethargy
  • Muscle weakness
  • GI symptoms (cramping & diarrhea)
  • ↓ BP
  • Dysrhythmias

↑ K+

45
Q

Causes of Hypocalcemia

KNOW THIS!!!!!

A
  • Malabsorption (poor diet, vitamin D deficiency)
  • Alkalosis
  • Chronic diarrhea

↓ Ca+

46
Q

Signs & Symptoms of Hypocalcemia

KNOW THIS!!!!!

A
  • NEUROMUSCULAR EXCITABILITY
  • Laryngospasm
  • Dyspnea
  • Trousseau’s sign
  • Chvostek’s sign
  • Cardiac arrhythmias
  • Seizures

↓ Ca+

47
Q

Causes of Hypercalcemia

KNOW THIS!!!!!

A
  • ↑ calcium absorption
  • Vitamin D overdose
  • Infants w/ very low birth weight who have inadequate phosphorus intake
  • Children receiving TPN
  • Bone tumors & other cancers

↑ Ca+

48
Q

Signs & Symptoms of Hypercalcemia

KNOW THIS!!!!!

A
  • Muscle weakness/ ↓ Neuromuscular excitability
  • Incoordination
  • Constipation, N/V
  • Polyuria
  • ↑ thirst
  • Confusion, lethargy, & ↓ attention span
  • Dysrhythmias

↑ Ca+

49
Q

Causes of Hypomagnesemia

KNOW THIS!!!!!

A
  • GI Losses
  • Enteral or parenteral feeding deficient in magnesium
  • ↓ Mg Absorption (due to chronic diarrhea, short bowel syndrome, malabsorption syndromes, & teatorrhea)
  • Prolonged NG Suction
  • Can also be caused by DKA, sepsis, burns, & hypothermia

↓ Mg+

50
Q

Signs & Symptoms of Hypomagnesemia

KNOW THIS!!!!!

A
  • ↑ NEUROMUSCULAR EXCITABILITY
  • Hyperactive reflexes
  • muscle cramps
  • twitching / tremors
  • cardiac arrhythmias

↓ Mg+ = ↑ Neuromuscular excitability

51
Q

Causes of Hypermagnesemia

KNOW THIS!!!!!

A
  • Renal Failure (oliguric renal failure & adrenal insufficiency)
  • DKA
  • Excessive administration of Mg
  • Apsiration of sea water (drowning)
  • Adisson Disease

↑ Mg+

52
Q

Signs & Symptoms of Hypermagnesemia

KNOW THIS!!!!!

A
  • ↓ NEUROMUSCULAR EXCITABILITY
  • Drowsiness / lethargy
  • Hypotension (↓ BP)
  • Weak / absent deep tendon reflexes
  • Bradycardia (↓ HR)

↑ Mg+ = ↓ Neuromuscular Excitability

53
Q

What does a depressed fontanelle indicate?

KNOW THIS!!!!!

A

Dehydration

54
Q

What does a full or bulging fontanelle indicate?

KNOW THIS!!!!

A

Fluid overload or ↑ ICP

55
Q

What percentage of weight loss is conidered mild, moderate, and severe in children?

KNOW THESE!!!!!

A
  • Mild: < 5%
  • Moderate = 6 - 9%
  • Severe: >/= 10%
56
Q

Calculate Daily Fluid Maintenance

KNOW THIS!!!!

A
  • Usual Weight: up to 10 kg → 100 ml/kg/24 hr
  • Usual Weight: 11 - 20 kg → 1000 mL + (50 ml/kg for weigth above 10 kg)/24 hr
  • Usual Weight: > 20 kg → 1500 mL + (20 ml/kg for weight above 20 kg)/24hr

Pediatrics Exam 2 (8 decks)

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