Fluids & Transfusion in Peds Population

Question 1

weight 0 - 10 kg

Answer 1

4 mL/ kg / hr

Question 2

10 - 20 kg

Answer 2

2 mL/kg/hr (+ 40 mL)

Question 3

> 20 kg

Answer 3

1 mL/kg/hr ( + 60 mL)

Question 4

what’s your fluid bolus dose

Answer 4

10 - 20 mL/kg

Question 5

buretrol holds

Answer 5

150 mL

fill it up to 10 mL/kg

Question 6

hypoglycemia risk patients - what do you give

Answer 6

D5 in 0.45% NS

1/2 the MIV rate

Question 7

fluid overload

Answer 7

be careful - the neonate kidney cannot excrete large amounts of excess water or electrolytes

Question 8

PRBCs

Answer 8

always filter

always warm

Question 9

estimating blood replacement

Answer 9

(desired hct - current hct) x EBV / 0.6

Question 10

MABL

Answer 10

ebv x (starting hct - target hct)/starting hct

Question 11

premie EBV

Answer 11

100 mL/kg

Question 12

term EBV

Answer 12

90 mL/kg

Question 13

6 mo EBV

Answer 13

80 mL/kg

Question 14

< 1 yo EBV

Answer 14

75 mL/kg

Question 15

> 1 yo

Answer 15

70 mL/kg

Question 16

adult EBV

Answer 16

55 - 65 mL/kg

Question 17

when do you administer FFP

Answer 17

when EBL is greater than 1-1.5 EBV
observed coagulopathy
PT/PTT or rotem prolonged

FILTER N WARM

Question 18

Platelet

Answer 18

ITP or chemo pt are ok if plt >15k
dilution causing thrombocytopenia?? tx if <50k

FILTER ONLY
NO WARMING

Question 19

cell saver adr

Answer 19

coagulopathy b/c dilution of coags

Question 20

calcium supplements?

Answer 20

head trauma or MTP will cause hypocalcemia d/t rapid transfusions

FFP + PRBCs contain calcium citrate

Question 21

neonates + calcium

Answer 21

decreased ability to mobilize calcium to metabolize citrate

Question 22

irradiate

Answer 22

prevent tx related graft vs host disease

important in ca and immunocompromised patients

Question 23

filtered blood products

Answer 23

eliminate CMV infection (important for CA and sickle cell pt)

Question 24

washed products

Answer 24

life-threatening allergic reactions - unforunately decreases life span of RBC and its effectiveness

bye bye WBC and K

Question 25

wake up safe recommendations hyperK & PRBCs

Answer 25

tx before significant HD compromise
PIV > CVC
large bore catheeters > 23 G
fresh RBC and wash RBC

maybe keep PRBCs < 5 days old

Question 26

how do we treat hyperK?

Answer 26

1. hyperventilate
2. ca cl (20 mg/kg) or caglu (60 mg/kg)
3. insulin 0.1 u/kg and dextrose 0.25 - 1 g/kg
4. bicarb 1 - 2 meq/kg
5. albuterol
6. lasix 0.1 mg/kg

Question 27

when do we start ECMO

Answer 27

if arrest > 6 m

Question 28

PRBC dosing, the indication

Answer 28

I: 30 - 40% for infants
25% for child

10 - 15 mL/kg

Question 29

how much does 10 - 15 mL/kg increase hgb

Answer 29

2 - 3 g/dL

Question 30

FFP dosing, the indication

Answer 30

I: MTP

10 - 15 mL/kg

Question 31

FFP bolus increases factor levels by

Answer 31

15 - 20%

Question 32

platelet dosing, the indication

Answer 32

I: < 100 k

5 - 10 mL/kg

Question 33

plt bolus increases by

Answer 33

50 - 100 k

Question 34

cryo indication, dose

Answer 34

I: peersistent bleeding
dose: 10 - 20 mL/kg

Question 35

cryo increases ____

Answer 35

fibrinogen by 60 - 100 mg/dL