Pediatric IV Fluids Flashcards
How much water is lost for every 100kcal/kg of energy expended?
100 ml
What is the Daily caloric expenditure for healthy children weighing less than 10kg?
100 kcal/kg
What is the Daily caloric expenditure for healthy children weighing between 10 and 20kg?
1000kcal for first 10kg and then add 50kcal/kg for every kg after 10kg.
What is the Daily caloric expenditure for healthy children weighing between 20-80kg?
1500kcal for first 20kg plus 20kcal/kg above 20kg
What is the Daily caloric expenditure for healthy children weighing over 80kg?
2700 kcal/day with adjusting as necessary
What are the two ways to have insensible water loss?
Respiratory and skin (not sweat)
2 ways to have sensible water loss?
Urine and stool
What 6 skin conditions increases sensible or insensible water loss?
Burns, fever, phototherapy, prematurity, radiant heater, sweat
What 2 lung conditions increases sensible or insensible water loss?
Tachypnea and tracheostomy
What 4 GI conditions increases sensible or insensible water loss?
Diarrhea
Emesis
Ileostomy
Nasogastric suction
What 1 renal condition increases sensible or insensible water loss?
Polyuria
What 2 misc. conditions increases sensible or insensible water loss?
Surgical drain
Increased activity
What does the Holliday Segars method assume?
100 ml of exogenous water is needed to replace insensible and sensible losses for every 100 Kcal/kg of energy expended
What is the Holliday segar 4-2-1 rule?
Hourly:
Less than 10 kg = 4 ml/kg/hr
10-20 kg = 40 ml + 2ml/kg for every kg over 10
Greater than 20kg = 60 ml + 1ml/kg for every kg over 20kg
Daily:
Less than 10kg = 100ml/kg a day
10-20 kg = 1000 ml + 50 ml/kg/day for every kg over 10
Over 20kg = 1500 ml + 20 ml/kg/day for every kg over 20
How do you calculate daily chloride, sodium and potassium needs for a normal healthy child?
sodium and chloride is 3 mEq per 100 cc of water
Potassium is 1-2 mEq per 100 cc water
What type of fluid do we use for rehydration of a child And give 2 examples?
Isotonic
NS and LR
4 best fluids for maintenance fluid?
What not to give for fluid management and why?
LR with 5% dextrose
Sodium chloride .45% with glucose 5%
Sodium chloride .45% with glucose 2.5%
.9% sodium chloride with glucose 5%
Low sodium solutions because it can cause hyponatremia in ped patients
What is the key actin statement from the AAP regarding what fluid to use for maintenance fluid?
In kids 18 days to 18 years, use isotonic solutions with appropriate KCL and dextrose to avoid hyponatremia
What is the electrolyte composition of NS, 1/2 NS and 1/4 NS?
In all three glucose is 5 g/DL
Sodium: 154, 77, 34
Chloride: 154, 77, 34
What are 3 abnormal physcial signs of a child who is mildly dehydrated?
Tacky or slightly dry buccal mucosa
Normal or mildly reduced urine output
Increased thirst
What are the two systemic signs of moderately dehydrated and severely dehydrated?
Listlessness and irritable
Grunting, lethargic and coma
What are the 4 items with the highest predictive value for dehydration and what will those 4 things be in mild dehydration, moderate dehydration and severe dehydration?
General appearance, breathing pattern, capillary refill and skin turgor
Mild: well, normal, normal, instant recoil
Moderate: ill, increased, 2-4, delayed by 2 seconds
Severe: lethargic/toxic, increased and deep, very prolonged, very prolonged so greater than 2 seconds
What 4 clinical signs did they say could be a diagnostic set for dehydration in kids?
Cap refill greater than 2, dry mucous membranes, absent tears, and abnormal general appearance.
What are the 3 phases of oral rehydration therapy for kids and how quickly should rehydration occur?
Rehydration, maintenance and prevention of dehydration, and realimentaiton
When we are given a 10% of dehydration of a child, how do we calculate how much fluid replacement to give?
Pre illness - post illness = kg of fluid lost so just convert it to mg and you get ml lost. Or just take 10% of their wight in kg and convert it to mg and that’s your ml lost.
What are the important points to remember about rehydration in a kid?
Fluid loss must be replaced
This is on top of maintenance fluid
Replace fluid loss over 24 hours
It’s done in bolus which will be 10-20 cc/kg at a time of isotonic fluid.
How do you replace the fluid in the 24 hour period?
1/2 in the first 8 hours and the other 1/2 in the next 16 hours
