Lecture 02 Care of child with fluid & Electrolyte disturbance

Question 1

What is water balance in infants and young children like?

Answer 1

1. —Increased vulnerability to fluid/electrolyte fluctuations
2. —Greater fluid intake and output relative to their size
3. —Disturbances occur more frequently and rapidly than adults
4. —Children adjust less rapidly than adults

Question 2

What is the Total Body Water like in newborn like?

Answer 2

Total Body Water (TBW) greater than adult

—Newborn (80) %

—Two year old (adult) (60) %

Question 3

What’s the extracellular concentration of fluid like in peds?

Answer 3

Extracellular Concentration of Fluid (ECF) greater than adult

—Newborn (50) %, 2 year Old (30) %, maturity (20)%

—ECF = intravascular and interstitial fluid

—ECF loss can occur quickly in infants & young children

—ECF loss usually caused by gastroenteritis is one of most common problems in infant & children

Question 4

Peds have a greater body SA, how does this effect fluid balance?

Answer 4

1. —Larger amounts of water lost via evaporative process
2. —Larger Body Surface Area (BSA)
3. —Larger GI tract (proportionately)

Question 5

Peds have greater metabolic rate, how does this affect fluid balance?

Answer 5

Greater Metabolic Rate

1. —Increased heart and respiratory rates
2. —Caloric and fluid requirements
3. —Increased heat production
4. —Increased metabolic wastes

Question 6

What is the kidney function like in peds?

Answer 6

Kidney Function

• —Kidneys immature & inefficient in excreting metabolic waste products
• —Inability to concentrate or dilute urine, conserve or excrete sodium or acidify urine (immature buffer system)
• —Infant vulnerable to dehydration when given concentrated formula
• —Infant vulnerable to over-hydration when given excessive water of dilute formula

Question 7

Wha tare fluid requirements like for infants?

Answer 7

Fluid Requirements

1. —Infant ingests & excretes greater amount fluid/kg/weight than older children/adult because of needed nutrients
2. —Infant daily exchange ECF greater than older children/adults
3. —Infant with little fluid volume reserve in dehydrated states

Question 8

What are expected findings for infants with gastroenteritis?

Answer 8

Expected Findings

• Decreased consciousness
• Loss of weight
• Fontanel would be sunken
• Lungs would be clear
• Tachycardia in CV initially. Later can be bradycardia.
• Distension, gassy child, hyperbowel sounds
• Decreased urinary status. Sometimes have to tell parent to quantify it.
• Know the norm of the bowel status. Is there blood or mucus in the bowels?
• Activity level decrease
• Is the child able to intake fluids? If able to tolerate it PO feeds, then continue.
• Less elasticity is expected. There’s the skin pinch from less elasticity.

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Question 9

What assessments would you do for an infant with gastroenteritis?

Answer 9

Assessment

—Level of Consciousness

—Weight (Most accurate assessment of dehydration extent)

—Fontanel/ Tears/Mucous Membranes

—Lung Fields

—Cardiovascular

—Abdomen

—Urinary Status

—Bowel Status

—Activity Level

—Nutrition/fluid intake

—Skin Turgor/Elasticity

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Question 10

How do you calculate fluid maintenace for infants and children?

Answer 10

FORMULA

100 ml/kg for 1st 10kg (0 to 10 kg)

50 ml/kg for 2’d 10 kg (11-20 kg)

20 ml/kg for each additional kg afterwards > 20 kg

Question 11

What’s the minimal values for Urine Output Normal?

Answer 11

—Older Child/Adult Normal UOP = 0.5 mL/minute or 30mL/hr

—Infant/Young Child Normal UOP = 1-2 mL/kg/hr

Question 12

What are 4 common causes of dehydration in children?

Answer 12

1. Vomiting
2. Diarrhea
3. DKA
4. Burns

Question 13

What’s the number 1 cause of acute renal failure in children?

Answer 13

Number 1 cause of acute renal failure is severe dehydration

Question 14

When is oral rehydration used for?

Answer 14

mild dehydration infants; mild to moderate may attempt with older children

• Child able to take po
• Can continue to give po frequently in small amounts with occasional vomiting
• Stable without signs of shock (systemic perfusion compromise)

Question 15

WHen is IV rehyrdation used?

Answer 15

moderate to severe dehydration

•Shock or Signs of Impending Shock

—Ped Bolus 20 mL/kg of NS (repeat as needed)

• IV Fluids based on % dehydration and type
• Monitor administration of IV infusions carefully

Question 16

How would you calculate hypotension in children?

Answer 16

Hypotension or low BP: Minimum systolic BP by age:

—< 1 month : 60 mmHg

—1 month to 10 years: 70 + (2 × age in years)

— ≥ 10 years: 90 mmHg