Metabolic Disturbances

Question 1

signs of dehydration in paeds

Answer 1

sunken fontanelle
sunken eyes, tearless
reduces level of consciousness
dry mucous membranes
reduced capillary refill time
tachypnoea
tachycardia
hypotension
peripheral vasoconstriction
reduced skin trugor
sudden weight loss 
oliguria

Question 2

which children are at risk of dehydration?

Answer 2

children younger than 1 year especially <6 months

infants who have a low birth weight

> 6 diarrhoea stools in 24hrs

> 3 vomiting in 24 hours

not offered or have been able to tolerate supplementary fluids

stopped breastfeeding during the illness

sings of malnutrition

Question 3

oral dehydration

Answer 3

diorylate

50mg/kg over 4 hours

Question 4

gastroenteritis in children

Answer 4

virus most common cause- rotavirus, calicivirus

bacteria: campylobacter, salmonella, e.coli, shigella
protozoa: giardia, cryptosoridium

vomiting, diarrhoea, no blood, sleepy, lethargic, dry/dehydrated, jittery

Question 5

pyloric stenosis

Answer 5

what is it?
hypertrophy of the muscular layers of the pylorus. presents 3-12 weeks.

non-bilous vomiting (then becomes bilous?)
projectile
hungry afterwards
stopped gaining weight

hypokalaemic hypochloraemic metabolic alkalosis

ix: test feed, abdominal USS
mx: Ramstedt pyloromyotomy

Question 6

DKA in paeds management

Answer 6

ABC approach
HDU/PICU
fluid bolus if shocked
fluids
potassium
insulin

Question 7

hypernatraemai dehydration

Answer 7

Na >150
consider in any baby with >12.5% weight loss
can progress to cerebral oedema and seizures
avoid over rapid correction (not more than 0.5mmol/L/hr)

O/E dry mucus membranes, reduced skin turgor (doughy), hyper reflex, sunken fontanelle

Question 8

cerebral oedema in paeds

Answer 8

neurological deterioation- headache, irritability, slowing of HR, reduced GCS

tx with hypertonic saline, mannitol, restrict IV fluids, PICU

Question 9

DKA

Answer 9

Maintenance:
< 10kg, give 2ml/kg/hour
10to 40kg, give 1ml/kg/hour
> 40kg, give a fixed volume of 40ml/hour.
Deficit:
Assume 5% if mild/moderate (pH>7.1)
Assume 10% if severe (pH<7.1)
Replace over 48 hours
If >20ml/kg bolus given then subtract additional from total
Calculate for patient

??

Question 10

fluid maintanence

Answer 10

body weight:

0-10 kg give 100ml/kg/day

if 10-200kg give 100ml + 50ml/kg/day above 1kg

> 20kg give 1500ml + 20ml/kg day above 20kg

Healthy breast fed children
For 1 kCal used 1ml of water was required
Electrolytes from milk feeds
Sodium 2-3mmol/kg/day
Potassium 1mmol/kg/day
Glucose 4-8mg/kg/minute

Question 11

don’t understand this

Answer 11

Answers:
700ml over 4 hours
(50ml/kg)
50ml/hr
(100x10 + 50x4/24)
79ml/hr
(1200+700/24)
64ml/hr
(1200x2+700/48)