paediatrics tutorials Flashcards
A child with a fever but no focus and is under 2 months- what is the septic screen?
FBE, CRP, CSF, SPA/clean catch urine, blood cultures +/- CXR
what fluid and how much do we use for a fluid bolus in kids with moderate dehydration?
normal saline 0.9%
general bolus 10-20mls/kg
what are some normal maintenance IV fluids that we use for kids?
hartmann’s
plasma-lyte
normal saline 0.9% + 5% dextrose
half normal saline 0.45% + 5% dextrose
what is the 4, 2, 1 rule for calculating IV/NG fluid requirements in a child?
4mls/kg for the 1st 10kg
2mls/kg for the 2nd lot of 10kg (e.g. 10-20kg)
1mls/kg for >20kg
what is the fluid maintenance requirements for a 16kg child
4 x 10= 40
6 x 2 = 12
40+12= 52mls/hour
what is the fluid maintenance requirements for a 25kg child?
4 x 10= 40
2 x 10= 20
1 x 5= 5
65mls/hour
what is the best way to rehydrate a child?
oral or nasogastric
what are the paracetamol requirements for a child
15mg/kg every 6 hours
what are the nurofen requirements for a child
10mg/kg every 8 hours
What antibiotics do we use for a child with UTI
bactrim for about 1 week
a patient under 6 months with confirmed UTI needs what consideration?
need to order renal tract ultrasound
a 11kg child has vomiting and diarrhoea (gastro + moderate dehydration) how do you resuscitate them? ***
NGT resuscitation:
-replace the 5% deficit FIRST over the first 6 hours using gastrolyte
+
-total daily maintenance weight over 24hrs (so 42mls/L x 24), given in the next 18 hours
how do we calculate the fluid deficit in a child with moderate dehydration?
5% x kg
or 5 x kg of child x 10
they equal the same thing
–> note that 5% is an estimate. in severe dehydration, the deficit can be up to 10% or more.
what do we need to monitor in a patient who is undergoing fluid resuscitation and maintenance?
Output/losses
Fluid Intake
Body weight!!
Vitals
an unwell child is admitted to hospital. the child is NOT dehydrated. what are their fluid maintenance requirements and why?
2/3 of their normal maintenance requirements as they may be secreting ADH at higher levels as they are unwell
what are the signs of severe dehydration in a child?
floppy child sunken fontanelles/eyes reduced conscious state deep acidotic breathing dry mucous membranes slow cap refill cool peripheries signs of shock muscle weakness
what is the risk of NGT?
pulmonary aspiration
why are hypotonic solutions like 0.18% saline or 4% dextrose NOT used in fluid resus?
can cause cerebral oedema and hyponatremia
how might we manage reflux in a baby?
you can try thickening the breast milk or formula with thickeners
or you can try esomeprazole (but no good evidence for this)
What is the most common presentation of a child with anaemia?
Child with pallor or child with reduced exercise tolerance , child with poor concentration and lethargy
Megaloblastic anaemias in children are caused by —- and —-need to be treated (fill in gaps). Why?
Megaloblastic anaemias in children are caused by B12 or folate deficiency and DO need to be treated.
Need to correct because can cause neurological defects
Which children are at risk of B12 deficiency?
Those born from maternal b12 deficient mothers, those with pernicious anaemias, those raised on vegan diets and those who do not have ileum where b12 is absorbed
How might a child become iron deficient?
Poor diet, cows milk excess and intolerance, menorrhagia, pr bleeding, occult blood in faeces due to bowel disorders
what are the key features of HUS on investigation results?
Anaemia Thombocytopenia DCT -ve (not immune mediated) Raised fibrinogen AKI
Fragments of RBC in the blood film