Pediatric Fluids and Electrolytes Flashcards
Causes of Dehydration
Fever
Gastrointestinal losses (viral gastroenteritis most common)
Sweating/excessive heat/burns
Polyuria (DKA)
imbalance in regulation of sodium/water (DI, SIADH- hormonal)
Mild % severity of dehydration
Infants: 1-5%
Older children: 1-3%
Moderate % severity of dehydration
Infants: 6-9%
Older children: 4-6%
Severe % severity of dehydration
Infants: >10% (15% = shock)
Older children: > 6% (9% = shock)
Signs and Sx of mild dehydration
Pulse: normal-increased
decreased urine output
buccal mucosa slightly dry
Signs and Sx of Moderate dehydration
Tachycardia
systolic blood pressure: normal-low
little to no urine output (< 1 mL/kg/hr)
dry buccal mucosa
sunken eyes and anterior fontanelle
Skin turgor/cap. refill: delayed, cool, pale
Skin: cool
decreased tears
mental status: normal- listless
thirsty
Signs and Sx of severe dehydration
Rapid and weak pulse
decreased systolic blood pressure
oliguria («_space;1mL/kg/hr)
Parched buccal mucosa
Eyes and anterior fontanelle very sunken
Skin turgor/ cap refill: very delayed, cool and mottled
Skin: acrocyanosis
No tears
mental status: normal to lethargic/comatose
drinks poorly / unable to drink
Severity of dehydration (% estimated) calculation
[ (pre illness weight kg - illness weight kg) / pre-illness weight kg] x 100%
Fluid deficit (L) calculation
% dehydration x pre-illness weight / 100
Treatment strategy for mild to moderate dehydration
Oral rehydration therapy (ORT)
Treatment strategy for severe dehydration
IV fluids (IVF)
Oral Rehydration Therapy Dosing (Mild)
50 mL/kg over a 4 hour period, reassess status every 2 hours
add 10 mL/kg for each loose stool/vomiting episode
Oral Rehydration Therapy dosing (Moderate)
100 mL/kg over a 4 hour period, reassess status hourly
add 10 mL/kg for each loose stool/vomiting episode
IV Fluid Phase I Dosing
Initial replacement- provided as bolus
10-20 mL/kg/dose of NS or LR over 30-60 minutes (may repeat up to 3 times)
IV Fluid Phase II Dosing
Maintenance replacement
First 8 hrs: calculate and replace fluid deficit
Next 16 hrs: calculate and provide maintenance rate
patients age 28 days to 18 years of age requiring maintenance fluids should receive ____________ solutions with appropriate ________ and _________
Isotonic solutions
potassium chloride
dextrose
Available Dextrose formulations
D5W- 5%
D10W- 10% (used in neonates and infants with hypoglycemia)
Standard potassium concentration
20 mEq/L
caution in renal failure and neonates
Negative anions
standard: chloride
can compound with acetate under certain circumstances such as DKA
Maintenance IVF Rate Calculations (< 10 kg)
4-2-1 Method (hourly rate requirement)
- 4 mL/kg/hr
24hr method
- 100 mL/kg (divide by 24 hrs)
Maintenance IVF Rate Calculations (10-20 kg)
Hourly rate requirement
- 40 mL/hr + 2 mL/kg/hr x (weight - 10 kg)
24 hr requirement
- 1000mL + 50 mL/kg for each kg > 10kg
Maintenance IVF Rate Calculations (> 20kg)
Hourly rate requirement:
- 60 mL/hr + 1mL/kg/hr x (weight - 20kg)
24hr requirement:
- 1500mL + 20 mL/kg for each kg > 20 kg
Ondansetron for outpatient treatment
single dose PO or IV to assist patient in tolerating ORT
Zinc
helpful in patients with nutrient deficiencies as a cause for diarrhea/malnutrition
dosage forms 23% elemental zinc
In patients with gastroenteritis avoid:
loperamide
bismuth subsalicylate
metoclopramide
