Paediatric GI - Colic and Dehydration Flashcards
How do children with infantile colic appear?
Inconsolable high pitch crying
Draw up knees
Flatus
Normal weight gain
Typically cry in evening
Red face
How long/often do children with infantile colic cry?
3 hours a day crying
3 days a week
3 weeks
By what age do most cases of infantile colic resolve?
3-4 months
What is the aetiology of infantile colic?
Very poorly understood
Thought to be due to abnormal GI motility and pain signals
What risk factors are associated with infantile colic?
Smoking in pregnancy
Pre-term and Small for Gestational Age
Food/milk allergies
Attachment/anxiety issues
What differentials must you rule out for an inconsolable crying baby?
GORD Cows milk protein allergy Otitis media Incarcerated hernia UTI Intussusception
How is a diagnosis of infantile colic made?
Diagnosis of exclusion
How is infantile colic managed?
Reassure and explain
Advice to share childcare to avoid maternal exhaustion
Can try hypoallergenic diet for breast feeding mothers
Short trial of hydrolysed formulae?
What broad factors cause dehydration?
Reduced intake Increased output Fluid shift Capillary loss Insensible loss
What can cause a decreased intake of fluid?
Pain in mouth
GI obstruction
What can cause increased output of fluids?
Gastroenteritis
Renal - DKA, diabetes insipidus
What can cause a fluid shift?
Effusion
Ascites
What causes capillary loss of fluid?
Burns
Sepsis
Bowel Ischaemia
What causes an increase of insensible loss of fluid?
Thyrotoxicosis
Fever
Heat stroke
CF
What types of dehydration can you get?
Isonatraemic
Hypernatraemic
Hyponatraemic
What happens in hypernatraemic dehydration?
Salts lost from intravascular space less than water
Water shift from extravascular space to help lessen fluid loss
Happen in DKA
What happens in hyponatraemic dehydration?
Salts lost in intravascular space less than water but water shift out exaggerating the intravascular water loss
How is hypernatraemic dehydration managed?
Fluids replaced slowly - over 48 hours
Sodium closely monitored
What can be used to assess level of dehydration?
Skin turgor Cap refill Resp pattern Body weight loss Activity level Thirst Mucous membranes Tears Fontanelle
What investigations can you carry out for dehydration?
Urine analysis and specific gravity
Bloods - U&E, glucose
ECG - arrhythmia due to electrolyte disturbance?
How do you manage dehydration?
Oral intake
Oral rehydration solution
IV if severe weight loss/shock imminent
Intraosseous infusion if circulatory collapse
What fluid challenge is given?
20ml/kg 0.9% NaCl
Can give 2 bags before contacting ICU
How is replacement fluid calculated?
Predehydration weight x % weight loss x 10
Add this to ongoing losses - Urine output, drains
Add maintenance
