paediatric IV fluid prescribing

Question 1

types of shock and their underlying causes

Answer 1

hypovolaemic
- gastroenteritis, burns, DKA, heatstroke, haemorrhage

distributive
- sepsis, anaphylaxis, neurological injury (neurogenic)

cardiogenic
- congenital heart disease, arrhythmi

obstructive
- cardiac tamponade, tension pneumothorax, congenital heart disease

Question 2

clinical features suggesting dehydration

Answer 2

• appears unwell/deteriorating
• altered responsiveness (irritable, lethargic)
• sunken eyes
• tachycardia
• tachypnoea
• reduced skin turgor
• dry mucous membranes
• decreased urine output

Question 3

clinical features indicating shock

Answer 3

• decreased level of consciousness
• pale or mottled skin
• cold extremities
• pronounced tachycardia
• pronounced tachypnoea
• weak peripheral pulses
• prolonged CRT
• hypotension

Question 4

routine maintenance fluid - choice of fluid depending on age

Answer 4

child>28 days of age:
- isotonic crystalloids + 5% glucose (e.g., 0.9% sodium chloride + 5% glucose)

term neonate <28 days of age:
- no critical illness: 10% dextrose +/- additives
- critical illness: seek expert advice (use fluids with no/minimal sodium initially)

Question 5

Holliday-Segar formula - maintenance fluids

Answer 5

first 10kg: 100 ml/kg/day
next 10kg: 50 ml/kg/day
remaining kg: 20 ml/kf/day

Question 6

how to calculate the percentage dehydration by weight

Answer 6

[well weight (kg) - current weight (kg)] / well weight

multiply x 100