Fluids and developmental milestones Flashcards
maintenance fluids neonates
10% dextrose
Day 1 – 60 mls/kg/day
Day 2 – 90 mls/kg/day
Day 3 – 120 mls/kg/day
Day 4 – 150 mls/kg/day
From day 2
Na 3 mmol/kg/day
K 2 mmol/kg/day
Ca 1 mmol/kg/day (rarely)
estimating weight ?
(Age + 4) x2 = weight in kg
maintenance fluids children
0.9% sodium chloride + 5% glucose (+/- KCl)
Weight Daily (ml/24h)
First 10 kg 100 ml/kg
Next 10 kg 50 ml/kg
Every other kg 20 ml/kg
Rate (ml/h): Total (ml) / 24
Sodium: 2-4mmol/kg/day
Potassium: 1-2mmol/kg/day
signs of shock
% defecit?
Reduced consciousness
Cold, mottled peripheries
Low blood pressure (decompensated shock)
Prolonged capillary refill time
Weak peripheral pulses
Anuria
tachycardia
tachypnoea
10%
signs of dehydration
%defecit?
Irritable, lethargic, altered response*
appears unwell*
sunken eyes*
reduced skin turgor*
tachycardia*
tachypnoea*
Thirst
Dry lips
Decreased urine output
Normal blood pressure
Normal CRT
Skin colour normal
5%
*indicates at risk of progression to shock
calculating fluids to correct deficit
Deficit(%) x 10 x Wt(kg)
+ maintenance
hydration if can tolerate oral
give 50 ml/kg low osmolarity oral rehydration solution (ORS) solution over 4 hours, plus ORS solution for maintenance, often and in small amounts
continue breastfeeding
consider supplementing with usual fluids (including milk feeds or water, but not fruit juices or carbonated drinks)
what bolus would you give in shock
10 mls/kg of 0.9% sodium chloride bolus
If they were shocked and in DKA then you would not minus the initial bolus when calculating full regime
signs of hypernautraemic dehydration?
jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma
Gross motor referrals
Can’t sit without support at 12 months
Can’t walk unsupported at 18 months
no head lag on being pulled to sit
3 months
rolling over
5 months
sits without support
7-8 months
crawl (+pull to stand)
9 months
walking (cruising, with hand held)
12 months
run
2 years
walk up stairs with no rail
3 years
hops on one leg
4 years
reaches for object, hold briefly
3 months
palmar grasp, transfer object from one hand to another
6 months
early pincer grip, points with finger
9 months
good pincer grip
12 months
Ages for stacking bricks
15 months - tower of 2
18 months - tower of 3
2 years - tower of 6
3 years - tower of 9
ages for drawing
18 months - circular scribble
2 years - straight line
3 years - circle
4 years - cross and RvL
4.5 years - square
5 years - triangle
Fine motor referral
Hand preference before 12 months is indicative of cerebral palsy
Quietens to parents voice
Turns towards sound
Squeals
3 months
Double syllables ‘adah’, ‘erleh’
6 months
Says ‘mama’ and ‘dada’
Understands ‘no’
9 months
Knows and responds to own name
12 months
Knows about 2-6 words
Understands simple commands - ‘give it to mummy’
12-15 months
Combine two words
Points to parts of the body
2 years
Vocabulary of 200 words
2.5 years
Talks in short sentences (e.g. 3-5 words)
Asks ‘what’ and ‘who’ questions
Identifies colours
Counts to 10 (little appreciation of numbers though)
3 years
Language referral
If not 2-6 words by 18 months, refer
Smiles (Refer at 10 weeks)
Eye tracing
6 weeks
Laughs
Enjoys friendly handling
3 months
Not shy
6 months
Shy
Takes everything to mouth
9 months
points with finger/waving bye bye
10 months
Plays contentedly alone
18 months
Plays near others, not with them
2 years
Plays with other children
4 years
Drinks from cup + uses spoon, develops over 3 month period
12 -15 months
Competent with spoon, doesn’t spill with cup
2 years
Helps getting dressed/undressed
12-15 months
Can dress and undress independently except for laces and buttons
4 years
corrected age
The corrected age of a premature baby is the age minus the number of weeks he/she was born early from 40 weeks
type 1 hypersensitivity
IgE mediated
anaphylaxis
allergy
atopy
type 2 hypersensitivity
Cytotoxic reaction mediated by IgG or IgM antibodies
eg rheumatic fever, ITP
type 3 hypersensitivity
Immune complex-mediated reaction
post-streptococcal glomerulonephritis, systemic lupus erythematosus, farmers’ lung (hypersensitivity pneumonitis), and rheumatoid arthritis.
type 4 hypersensitivity
T cells that provoke an inflammatory reaction against exogenous or endogenous antigens
DELAYED
eg contact dermatitis, drug hypersensitivity
Over how long do you give fluid resusciation?
15 mins if shocked
30 mins if dehydrated
when do you minus bolus from defecit?
when dehydrated, not shocked
Over how long do you correct defecit?
over 24 hours
Over 48 hours If DKA or electrolyte stuff
When do you give bolus
- DKA, trauma, shocked,
Calculating drop rate
( mls / minutes ) x drop factor (on packet)
Eg (210mls/1440 mins) x 20 = 2.9 = 3 drops per minute
