Gastrointestinal Dysfunction Flashcards
In infants what is different compared to an adult when it comes to imbalances of water and electrolyte
It occurs more frequently and rapidly
In normal conditions amount of water consumed should be
Amount of urine excreted in a 24 hour period
Total water in full term new born
75%
Total water in adolescents
Decreases to 45%
Premature total water
> 75%
Factors in water loss
Insensible fluid loss
Body surface area
Basal metabolic rate
Kidney function
Fluid requirements
Insensible fluid loss
Fluid loss that can’t be measured or we are not aware of.
Perspiration, fluid in feces and respiratory
Sensible fluid loss
Can be measured
(Urine out put)
2/3 of insensible fluid loss happens where?
Through the skin (perspiration)
1/3 of insensible fluid loss happens where?
Respiratory
Body surface area
Infants and children have a higher body surface area
The smaller the body the higher the body surface area
And the more fluid loss that takes place
Basal metabolic rate
Higher in children than adults to to larger body tissue area and increase heat production = increase insensible fluid loss.
BMR ^ to support tissue growth
Fluid requirements
Ensuring that the fluids given to child include both water and electrolytes
That also include maintenance fluid requirements that also must have electrolytes and water
Water intoxication causes
Not correctly mixing formula,
adding more water and less formula ,
Ingesting too much water and not enough electrolytes,
consistent tap water enemas
Hypotonic solutions
In pediatrics we see dehydration more. What are the causes?
Losing water quickly due to virus and not replacing in time
Incorrectly mixing formula
Types of dehydration
Isotonic
Hypotonic
Hypertonic
Isotonic dehydration
Water and electrolytes are decreased in balance proportions
If pt is showing signs of dehydration but electrolytes are normal this is how we know it is isotonic solution
sodium is normal
Hypotonic dehydration
Electrolyte deficit exceeds the water
^ water= decrease electrolyte)
Sodium is decreased
Hypertonic dehydration
Water loss in excess electrolytes
decrease water=^electrolytes
Sodium is increased >145
Out of the 3 types of dehydrations which ones are you able to bolus fluids?
Isotonic because sodium is normal.
Hypotonic becuase sodium is <135.
Which out of the 3 types of dehydration do you rehydrate slowly and why?
Hypertonic. Due to the sodium being >145
If we were to bolus fluids we would cause cerebral edema
What is the most important determinant of fluid loss in infants and young children
Daily weights
What is the earliest detectable sign in dehydration?
Tachycardia
What is a late sign of dehydration and why?
Drop in BP.
Since they become tachycardia when dehydrated heart eventually gets tired and the child’s heart will slow down because it is tired.
If a chid comes in with a late sign of dehydration ( drop in BP ) what will you do?
They will be a priority
Clinical manifestations of dehydration
Dry mucous membrane
Low energy, lethargic
Dark urin
Sunkey Fontanne’s
Skin tumor decrease
Extremities cool to touch
Increase hr
No tears
Cold hands and feet (inaccurate pulse ox due to decrease blood flow)
Mottled skin
Capillary refill slow
Treatment for severe isotonic and hypotonic dehydration
Initial phase of iv therapy is rapid fluid replacement
May need a bolus or 2
Hypertonic dehydration treatment
Rapid infusion of iv fluid is a no no
Slow infusion due to increase NA + level
Can cause central poutine myelinolysis
Central poutine myelinolysis
Cerebral edema due to rapid fluid correction
For mild / moderate dehydration
Oral replacement therapy over 4-6hours but depends on the pt size may even be every 2 hours
Replacement of continuing losses
Provide at least minimum fluid requirements
How do you know if someone who is getting rehydrated for dehydration is getting enough fluid
Calculate minimum acceptable urine output
Severe dehydration rehydration
Given when child is vomiting too much and can’t keep anything down or if child is lethargic
Goal is to meet physiological needs
Replace previous deficits
Replace ongoing abnormal loss
Gastrointestinal dysfunction
Diarrhea
Constipation
Hirshsprung disease
Gastroesophageal reflux (GER)
Diarrhea
Acute
Self limiting
< 14 days
Usually what we see w/ viral infections
Chronic
> 14 days
Related to chronic conditions like lactose intolerance or IBD
What is the biggest to worry about for kids when it comes to diarrhea ?
Dehydration
We want to replace fluids and meet minimal urine output firstly
Secondly return child to normal diet because nutrition is important . It may result in larger stool output but nutrition is better.
Constipation
A decrease in a bowel movement frequency of trouble defecating for more than 2 wks
What can cause constipation?
Hypothyroidism
Imperforiated anus
Anal fissures&strictures
Switching milks
Stress
Schoolage not poopin at chocolate
What can cause failure to pass meconium
Hypothyroidism
Dietary modifications to help constipation
Increase cereal
Increase veggies
Increase fruit
Increase grains
Avoid cheeses
Long term - over the counter stool softener
