Pediatric IV Fluids

Question 1

How much water is lost for every 100kcal/kg of energy expended?

Answer 1

100 ml

Question 2

What is the Daily caloric expenditure for healthy children weighing less than 10kg?

Answer 2

100 kcal/kg

Question 3

What is the Daily caloric expenditure for healthy children weighing between 10 and 20kg?

Answer 3

1000kcal for first 10kg and then add 50kcal/kg for every kg after 10kg.

Question 4

What is the Daily caloric expenditure for healthy children weighing between 20-80kg?

Answer 4

1500kcal for first 20kg plus 20kcal/kg above 20kg

Question 5

What is the Daily caloric expenditure for healthy children weighing over 80kg?

Answer 5

2700 kcal/day with adjusting as necessary

Question 6

What are the two ways to have insensible water loss?

Answer 6

Respiratory and skin (not sweat)

Question 7

2 ways to have sensible water loss?

Answer 7

Urine and stool

Question 8

What 6 skin conditions increases sensible or insensible water loss?

Answer 8

Burns, fever, phototherapy, prematurity, radiant heater, sweat

Question 9

What 2 lung conditions increases sensible or insensible water loss?

Answer 9

Tachypnea and tracheostomy

Question 10

What 4 GI conditions increases sensible or insensible water loss?

Answer 10

Diarrhea
Emesis
Ileostomy
Nasogastric suction

Question 11

What 1 renal condition increases sensible or insensible water loss?

Answer 11

Polyuria

Question 12

What 2 misc. conditions increases sensible or insensible water loss?

Answer 12

Surgical drain

Increased activity

Question 13

What does the Holliday Segars method assume?

Answer 13

100 ml of exogenous water is needed to replace insensible and sensible losses for every 100 Kcal/kg of energy expended

Question 14

What is the Holliday segar 4-2-1 rule?

Answer 14

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

Question 15

How do you calculate daily chloride, sodium and potassium needs for a normal healthy child?

Answer 15

sodium and chloride is 3 mEq per 100 cc of water

Potassium is 1-2 mEq per 100 cc water

Question 16

What type of fluid do we use for rehydration of a child And give 2 examples?

Answer 16

Isotonic

NS and LR

Question 17

4 best fluids for maintenance fluid?

What not to give for fluid management and why?

Answer 17

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

Question 18

What is the key actin statement from the AAP regarding what fluid to use for maintenance fluid?

Answer 18

In kids 18 days to 18 years, use isotonic solutions with appropriate KCL and dextrose to avoid hyponatremia

Question 19

What is the electrolyte composition of NS, 1/2 NS and 1/4 NS?

Answer 19

In all three glucose is 5 g/DL
Sodium: 154, 77, 34
Chloride: 154, 77, 34

Question 20

What are 3 abnormal physcial signs of a child who is mildly dehydrated?

Answer 20

Tacky or slightly dry buccal mucosa
Normal or mildly reduced urine output
Increased thirst

Question 21

What are the two systemic signs of moderately dehydrated and severely dehydrated?

Answer 21

Listlessness and irritable

Grunting, lethargic and coma

Question 22

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?

Answer 22

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

Question 23

What 4 clinical signs did they say could be a diagnostic set for dehydration in kids?

Answer 23

Cap refill greater than 2, dry mucous membranes, absent tears, and abnormal general appearance.

Question 24

What are the 3 phases of oral rehydration therapy for kids and how quickly should rehydration occur?

Answer 24

Rehydration, maintenance and prevention of dehydration, and realimentaiton

Question 25

When we are given a 10% of dehydration of a child, how do we calculate how much fluid replacement to give?

Answer 25

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.

Question 26

What are the important points to remember about rehydration in a kid?

Answer 26

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.

Question 27

How do you replace the fluid in the 24 hour period?

Answer 27

1/2 in the first 8 hours and the other 1/2 in the next 16 hours