Paediatric fluids

Question 1

Learning objectives

Answer 1

Assessment of hydriaito
Fluid requirements/
Common electrolyte imbalances

Question 2

How do you assess fluid status?

Answer 2

Hx: urine output, thirst, vomit? diarrhoea?
O/E: Skin turgor/mucous membranes, tachycardia/tachypnoea
Ix: blood glucose, electrolytes

Question 3

how do you calculate resus volume

Answer 3

Usually weight, but sometimes surface area (when)

Question 4

Signs of increasing severity of dehydration

Answer 4

[fill in from NICE]

Question 5

Calculating maintenance fluids in adults (NICE guidelines)

Answer 5

Daily maintenance fluid requirements (as per NICE guidelines):

25-30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride and
approximately 50-100 g/day of glucose to limit starvation ketosis (however note this will not address the patient’s nutritional needs)
Weight-based potassium prescriptions should be rounded to the nearest common fluids available. Potassium should NOT be manually added to fluids as this is dangerous.

Question 6

Calculating fluids in children - what is used in shock

Answer 6

20mL/Kg bolus (maybe given 2nd time), term neonates 10mL/kg over 10m
Cautions: DKA, cardiac

Question 7

Maintenance fluid: holliday-segar formula

How much would this be for a 23kg child?

Answer 7

100ml/kg/day for first 10kg
50ml/kg/day for next 10kg
20ml/kg/day for > 20kg
23kg child: 1560ml/24h

Question 8

In a neonate

Answer 8

Capillary/venous gas

Question 9

Normal neonatal glucose level?

Answer 9

> 2.6mmol/L

Question 10

What is kernicterus?

Answer 10

When severe jaundice goes untreated for too long, it can cause a condition called kernicterus. Kernicterus is a type of brain damage that can result from high levels of bilirubin in a baby’s blood. It can cause athetoid cerebral palsy and hearing loss.

Question 11

What could rarely cause hyponatraemia in a person (or child) with pneumonia

Answer 11

SIADH can sometimes happen for unknown reasons