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peds 1 > Fluids and electrolytes > Flashcards

Fluids and electrolytes Flashcards

1
Q

Sources of fluid loss

A
  • Insensible losses
  • Urinary
  • Fecal
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2
Q

Insensible losses in kids: %

A

2/3 through skin (kids skin is a higher % than of their body mass
1/3 through respiratory tract (kids have an increased RR)

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3
Q

Why are kids more susceptible to rapid fluid depletion before age 2? What kind of fluid are kids more likely to lose?

A

Children maintain a larger amount of ECF until about 2 years

Kids are more likely to lose ECF

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4
Q

Why do infants and children less than 2 lose a greater proportion of fluid each day? (4)

A
  • Greater amount of BSA causes increase in insensible losses
  • Increased metabolic rate: More fluid needed for metabolism
  • Greater amount of metabolic wastes excreted by kidney
  • Glomeruli tubules and nephrons of kidney are immature and unable to conserve H20
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5
Q

% H20:

  • Infants
  • Adults
A

75% in infants

55-65% in adults

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6
Q

Solutes in ECF (4)

A

Sodium
Bicarbonate
Cloride
Calcium

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7
Q

Solutes in ICF (4)

A

Potassium
Magnesium
Calcium
Phosphorus

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8
Q

How do you calculate the daily requirements for a kid?

A

Weight in kg:

  • 100 mL/kg for first 10kg
  • 50 mL/kg for second 20 kg
  • 20 mL/kg for remainder of weight in kg

(To obtain rate per hour, divide total amount by 24 hours)

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9
Q

Urine output:

  • Infants and toddlers
  • Preschool / young school age
  • Older school age / ados:
A
  • Infants and toddlers
    >2-3 mL/kg/hr
  • Preschool / young school age
    >1-2 mL/kg/hr
  • Older school age / ados:
    0. 5-1.0 mL/kg/hr
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10
Q

Serum sodium:

  • Hypotonic Dehydration
  • Isotonic Dehydration
  • Hypertonic Dehydration
A

HYPO: 150 mEq/L

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11
Q

What should you watch for with isotonic dehydration?

A

Hypovolemic shock

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12
Q

What should you watch for with hypotonic dehydration?

A

SIDAH: Syndrome of inappropriate ADH secretion

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13
Q

Four causes of SIDADH

A
  • Bacterial meningitis
  • Head injury
  • Tumor
  • Lasix meds

** Associated with hypotonic dehydration

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14
Q

Indication of isotonic solution

A

Treatment of vascular dehydration; replaces sodium chloride

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15
Q

Action of hypotnoic solution

A

Hydrates cells, pulls fluid from vascular space into cellular space.

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16
Q

Action of Hypertonic solution

A

Draws fluid into interstitial space, leading to increased extracellular volume both in vascular and interstitial space

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17
Q

Action of isotonic solution

A

Hydrates extracellular compartment, replaces fluid volume without disrupting the intracellular and interstitial volumes

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18
Q

Indication of hypotonic solution

A

Tx Hypertonic dehydration

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19
Q

Indication of hypertonic solution (2)

A

Tx of hypotonic dehydration

Tx of circulatory collapse

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20
Q

What happens to vital signs with isotonic dehydration? (2)

A
  • Elevation in Temp

* Elevation in HR-

21
Q

What happens to vital signs with Hypertonic Dehydration? (2)

A
  • Elevation in Temp

* Elevation in HR

22
Q

What happens to vital signs in Hypotonic Dehydration? (2)

A
  • Hypertension (fluid retention) Edema

* Might not see huge increase in CO

23
Q

Why is Pedialyte a better choice than cola, apple juice, gatorade or chicken broth to re-hydrate? (5)

A
  • Lower carbs than other bevs listed
  • Lower sodium than chx broth
  • Good source of potassium
  • Most basic
  • Lowest osmolarity
24
Q

Serum Potassium…

  • in Hypokalemia
  • in Hyperkalemia
A
  • Hypo: Less than 3.5 mmol/L

* Hyper: Greater than 5.8 mmol/L

25
Q

Causes of Hypokalemia (4)

A
  • Increased K+ excretion
  • Decreased K+ intake
  • Loss of K+
  • Metabolic Alkalosis
26
Q

Causes of Hyperkalemia (4)

A
  • Massive cell death (sickle cell, leukemia, cancers)
  • Excessive or too rapid K+ infusion
  • Metabolic acidosis
  • Decreased K+ excretion (renal failure)
27
Q

What disorder causes hyperkalemia initially, then hypokalemia

A
  • Diabetes (Type I): Causes HYPERkalemia initially, then HYPOkalemia because of diuresis
28
Q

What are hypokalmic patients at risk for? What should you watch for?

A

Dig toxicity

  • Bradycardia
  • Cardiac arrythmias
  • Vomiting
29
Q

How to treat Hyperkalmia (7)

A
  • Manage underlying condition
  • Lasix (K+ wasting)
  • Kayexalate
  • IV Bicarbonate
  • Peritoneal dialysis (if renal failure)
  • Manage diet
30
Q

How does Kayexalate work?

A

PO, binds to K+ and excreted in stool

31
Q

How does IV bicarbonate work?

A

Drives K+ back into cell

32
Q

What should you be careful of in administering K+ by IV?

A

*Make sure patient has good urine output before adding K+ to bag.
(80% of K+ is lost through urine, so lack of urine output could cause hyperkalemia.)

*Also, concentrated potassium causes a person to go into VTach.

33
Q

What type of patient is at risk for hyperkalemia?

A

Burn patients

34
Q

What might be the cause of a high K+ count in a baby?

A

Squeezing heel on a heel stick –> Lyse cells –> Inaccurately high K+ count

35
Q

5% weight loss is ___ dehydration
10% weight loss is ____ dehydration
15% weight loss is ____ dehydration

A

Mild
Moderate
Severe

36
Q

How do you calculate a patient’s dehydration weight loss?

A

Original weight minus present weight

Divided by original weight

37
Q

Two of the following factors indicate >5% dehydration:

A
  • Capillary refill > 2 seconds
  • Absent tears
  • Dry mucus membranes
  • Ill appearance
38
Q

Treatment of mild dehydration (<5%)

  • 3 things
A
  • Rehydrate with ORS (50mL/kg over 4 hours)
  • Replace ongoing losses with ORS
  • Age-appropriate diet after rehydration
39
Q

Treatment of moderate dehydration (5-10%)

  • 3 things
A
  • Rehydrate with ORS (100mL/kg over 4 hours)
  • Replace ongoing losses with ORS
  • Age-appropriate diet after rehydration
40
Q

Treatment of severe dehydration (>10%)

  • Four things
A
  • IV resuscitation with normal saline or Ringer Lactate (20-40 mL/kg for one hour) – re-assess and repeat if necessary
  • Begin Oral Replacement Therapy when pt is stable
  • Replace ongoing losses with ORS
  • Age-appropriate diet after rehydration
41
Q

What causes diarrhea?

A

Abnormal intestinal H20 and electrolyte transport

42
Q

Acute diarrhea:

A
  • Most common in kids under 5 years

* Less than 14 days (self-limiting)

43
Q

Acute diarrhea: 5 causes

A
  • Bacterial infection (eg food poisoning)
  • Gasteroenteritis
  • Abx
  • Laxatives 2/2 anorexia nervosa
  • Upper Resp Tract infections
44
Q

Chronic Diarrhea

A

Longer than 14 days

45
Q

5 causes of chronic diarrhea

A
  • Irritable Bowel Syndrome
  • Inflammatory Bowel Disease (Chrones, Ulcerative Colitis)
  • Food allergy
  • Lactose intolerence
  • Malabsorption syndrome
46
Q

What is the name for Chronic diarrhea in an infant? What is the cause?

A

Intractable diarrhea of infancy

* Acute infectious diarrhea that was not managed adequately

47
Q

What is the name for chronic diarrhea in children? Most common cause?

A

Chronic non-specific diarrhea

** Common cause: Apple juice! (Also diet soda, food sensitivities)

48
Q

Four etiologies that cause diarrhea:

A
  • Rotavirus (immunization possible)
  • Bacteria (Salmonella, Sigella, Campylobacter)
  • Parasite: Cryptosporidium
  • Abx
49
Q

Labs to check w diarrhea:

A
  • Urine specific gravity
  • CBC
  • Serum electrolytes
  • Creatinine and BUN (elevated with dehydration)

peds 1 (5 decks)

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