Pediatric IV Fluids/Meds Dosing Newman

Question 1

Under normal conditions how much water do kids need to drink?

Answer 1

100 mL for every 100kcal/kg of energy expended

Question 2

How many calories per day does each child burn?

• 10 kg
• 10-20 kg
• 20-80 kg
• over 80 kg

Answer 2

• 100 kcal/kg
• 1000 kcal for first 10 kg plus 50 for any increment of weight above 10 kg
• 1500 kcal for firsst 20 kg of bobdy weight plus 20 for any over 20kg
• 2700 kkcal with adjustments made for metabolic needs

Question 3

What is insensible water loss?

Answer 3

• Respiratory and skin water Loss not perceived by individual and can’t be easily measured
  
  • does not include sweat

Question 4

What is sensible water loss

Answer 4

• urine stool sensible perspiration

Question 5

What is the Holiday Segar method?

Answer 5

• Most common method used to calculate fluids
• assumes 100 mL of exogenous water is needed to replace insensible and sensible losses for every 100 kcal of energy burned
• uses weight alone

Question 6

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

Answer 6

• A way to calculate maintenance hourly fluid requirement

Question 7

Under Holliday Segar method is Dextrose needed?

Answer 7

• Yes if patient is fasting for a period of tinme or specific concerns about hypoglycemia
• 5%-10% dextrose solution at maintenance rate is safe

Question 8

Hourly maintenance rate of IV fluid for a healthy 25 kg child?

Answer 8

• 10 (first 10 kg) X 100 cc/kg= 1000 cc
• 10 (second 10 kg) X 50 cc/kg=500 cc
• 5 ( remaining 5 kg) X 20 cc/kg=100 cc
• =1600cc/24 hours → 67 cc/hr

Question 9

Calculate the hourly IV fluid rate for a healthy 25 kg child.

Answer 9

• 10 kg X 4cc/kg= 40 cc
• 10 kg X 2 cc/kg= 20 cc
• 5 kg X 1 cc/kg = 5 cc
• = 65 cc/ hour

Question 10

Maintenance fluid for an 8 kg infant?

Answer 10

• 8 kg X 4cc= 32 cc/hr
• OR 8kg X 100 cc/24 hr= 800 cc / 24 hr = 33 cc/hr

Question 11

Fluid calculation for 17 kg child?

Answer 11

Question 12

What fluid do you use for fluid boluses (rehydration)?

Answer 12

Lactated ringers or normal saline

always use isotonic fluid

Question 13

What type of maintanence fluid should those between 28 days and 18 yo receive and why?

Answer 13

Isotonic solutions with appropriate KCL and dextrose bc they significantly decrerase risk of developing hyponatremia

Question 14

What is electrolyte composition of NS, ½ NS, and ¼ NS?

Answer 14

• 154 mEq/L for NS of Cl and Na
• ½ NS has 77
• ¼ has 34

Question 15

What % makes up NS?

Answer 15

0.9% NaCl is normal

Question 16

Describe HR, RR, pulses, cap refill, BP, tears/mucous mem/ skin turgor, urine output in mild moderate and severe dehydration.

Answer 16

• HR: normal, tachy, marked tachy
• RR: normal, increased, increased & deep
• Pulses: normal, nl to deep, poor quality
• cap refill: normal <2sec, prolonged 2-4 sec, >4 sec
• BP: nl, nl, hypotensive
• Tears: nl, decreased, absent
• MM: moist, tacky, dry
• Urine: normal, decreased, minimal

Question 17

What are the most reliable ways to determine kids dehydration status?

Answer 17

• dry mucous membranes
• cap refill >2sec
• absent tears
• abnormal general appearance

Question 18

What is standard of care, first line, rehydration therapy?

Answer 18

ORT (oral rehydration therapy)

Question 19

Gold standard for detecting degree of dehydration?

Answer 19

Body weight

Question 20

Answer 20