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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?

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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?

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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
**4-2-1 Rule Example:** * Child's Weight is 8.5 kg
8.5 kg **x 4 mL/kg/hr** = 34 mL / hr ## Footnote multiply by 4 because the child is under 10 kg
26
**4-2-1 Rule Example** * Child's weight is 12 kg
* 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
**4-2-1 Rule Example:** * Child weighs 30 kg
* 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
**IV Fluid Bolus** | **KNOW THIS!!!!**
**NS or LR to expand vascular space & correct electrolyte changes** * 20 mL/kg over 30-60 minutes
29
**Normal Sodium (Na+) level** | **KNOW THIS!!!!!!!**
**135 - 145**
30
**Normal Potassium (K+) levels** | **KNOW THIS!!!!!**
**3.5 - 5**
31
**Normal Calcium (Ca+) levels** | **KNOW THIS!!!!!**
**2.8 - 2.86**
32
**Normal Magnesium (Mg) levels** | **KNOW THIS!!!!!**
**1.6 - 2.4**
33
**Respiratory Acidosis** | **KNOW THIS!!!!!**
**↓ pH & ↑ CO2** * **Causes:** severe asthma, pneumonia, hypoventilation
34
**Respiratory Alkalosis** | **KNOW THIS!!!!**
**↑ pH & ↓ CO2** * **Causes:** hyperventilation, panic attack, aspirin toxicity
35
**Metabolic Acidosis** | **KNOW THIS!!!!!**
**↓ pH & ↓ HCO3** * **Causes:** DKA, lactic acidosis, EtOH
36
**Metabolic Alkalosis** | **KNOW THIS!!!!!**
**↑ pH & ↑ HCO3** * **Causes:** vomiting = loss of acid
37
**Causes of Hyponatremia** | **KNOW THIS!!!!!**
* **Diarrhea** * **Vomiting** * Inadequate salt intake * GI suctioning * Diuretics * **CHF** * Forced excessive oral intake of tap water * Excessive IV D5W ## Footnote **↓ Na+**
38
**Signs & Symptoms of Hyponatremia** | **KNOW THIS!!!!!**
* **Headache** * **Poor skin turgor** * **NEURO CHANGES!!!!!** * ↓ BP * Dry mucosa * Lethargy * Confusion * **Seizures** * muscle weakness * decreased deep tendon reflexes ## Footnote **↓ Na+**
39
**Causes of Hypernatremia** | **KNOW THIS!!!!!**
* Inadequate breastfeeding intake w/ normal output * **Diabetes insipidus** * **Diarrhea or vomiting** * Excessive sweating * ↑ aldosterone ## Footnote **↑ Na**
40
**Signs & Symptoms of Hypernatremia** | **KNOW THIS!!!!!**
* **Thirsty** * **↓ urine output** (unless ↑ Na is caused by DI) * ↓ LOC (**confusion, lethargy, coma)** * **Seizures** * **NEURO CHANGES!!!!** ## Footnote **↑ Na**
41
**Causes of Hypokalemia** | **KNOW THIS!!!!!**
* **GI losses** (**vomiting**, diarrhea) * Medications * Poor dietary intake (starvation) * **↑ aldosterone** (hyperaldosteronism, CHF, nephrotic syndrome, cirrhosis) * ↑ cortisol (cushing disease) * alkalosis ## Footnote **↓ K+**
42
**Signs & Symptoms of Hypokalemia** | **KNOW THIS!!!!!**
* **Muscle weakness & cramps** * Fatigue * Anorexia * **Abdominal distension / constipation** * Nausea / Vomiting * **Dysrhythmias** ## Footnote **↓ K+**
43
**Causes of Hyperkalemia** | **KNOW THIS!!!!**
* **Impaired renal function** * Crush injury * Burns * metabolic acidosis ## Footnote **↑ K+**
44
**Signs & Symptoms of Hyperkalemia** | **KNOW THIS!!!!!**
* **Cardiac changes & dysrhythmias** * Lethargy * **Muscle weakness** * GI symptoms (cramping & diarrhea) * ↓ BP * Dysrhythmias ## Footnote **↑ K+**
45
**Causes of Hypocalcemia** | **KNOW THIS!!!!!**
* **Malabsorption** (poor diet, vitamin D deficiency) * Alkalosis * **Chronic diarrhea** ## Footnote **↓ Ca+**
46
**Signs & Symptoms of Hypocalcemia** | **KNOW THIS!!!!!**
* **NEUROMUSCULAR EXCITABILITY** * Laryngospasm * Dyspnea * Trousseau's sign * Chvostek's sign * **Cardiac arrhythmias** * Seizures ## Footnote **↓ Ca+**
47
**Causes of Hypercalcemia** | **KNOW THIS!!!!!**
* ↑ calcium absorption * Vitamin D overdose * **Infants w/ very low birth weight who have inadequate phosphorus intake** * Children receiving TPN * **Bone tumors & other cancers** ## Footnote **↑ Ca+**
48
**Signs & Symptoms of Hypercalcemia** | **KNOW THIS!!!!!**
* **Muscle weakness/ ↓ Neuromuscular excitability** * Incoordination * **Constipation, N/V** * Polyuria * ↑ thirst * Confusion, lethargy, & ↓ attention span * **Dysrhythmias** ## Footnote **↑ Ca+**
49
**Causes of Hypomagnesemia** | **KNOW THIS!!!!!**
* **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 ## Footnote **↓ Mg+**
50
**Signs & Symptoms of Hypomagnesemia** | **KNOW THIS!!!!!**
* **↑ NEUROMUSCULAR EXCITABILITY** * Hyperactive reflexes * muscle cramps * twitching / tremors * **cardiac arrhythmias** ## Footnote **↓ Mg+ = ↑ Neuromuscular excitability**
51
**Causes of Hypermagnesemia** | **KNOW THIS!!!!!**
* **Renal Failure** (oliguric renal failure & adrenal insufficiency) * DKA * Excessive administration of Mg * Apsiration of sea water (drowning) * **Adisson Disease** ## Footnote **↑ Mg+**
52
**Signs & Symptoms of Hypermagnesemia** | **KNOW THIS!!!!!**
* **↓ NEUROMUSCULAR EXCITABILITY** * Drowsiness / lethargy * **Hypotension (↓ BP)** * Weak / absent deep tendon reflexes * **Bradycardia (↓ HR)** ## Footnote **↑ Mg+ = ↓ Neuromuscular Excitability**
53
**What does a depressed fontanelle indicate?** | **KNOW THIS!!!!!**
**Dehydration**
54
**What does a full or bulging fontanelle indicate?** | **KNOW THIS!!!!**
**Fluid overload or ↑ ICP**
55
**What percentage of weight loss is conidered mild, moderate, and severe in children?** | **KNOW THESE!!!!!**
* **Mild: < 5%** * **Moderate = 6 - 9%** * **Severe: >/= 10%**
56
**Calculate Daily Fluid Maintenance** | **KNOW THIS!!!!**
* 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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