Pediatrics - Fluids & Electrolytes Flashcards
What is the most common cause of dehydration in pediatrics?
viral gastroenteritis
What percents indicate mild dehydration in infants and older children?
1-5%, 1-3%
What percents indicate moderate dehydration in infants and older children?
6-9%, 4-6%
What percents indicate severe dehydration in infants and older children?
> 10% (15 or more = shock), >6% (9% or more = shock)
What are characteristics of mild dehydration?
mostly normal, buccal mucosa slightly dry, decreased urine output, drinks normally
What are characteristics of moderate dehydration?
tachycardia, little/no urine output, dry mucosa, sunken eyes/anterior fontanelle, delayed capillary refill, cool/pale, listless, thirsty
What are characteristics of severe dehydration?
rapid/weak pulse, decreased SBP, parched mucosa, very sunken eyes/anterior fontanelle, delayed capillary refill, cool/mottled, acryocyanosis, lethargic/comatose, drinks poorly/unable
What is the formula for dehydration estimation?
severity of dehydration = [(pre-illness weight (kg) - illness weight (kg))/pre-illness weight (kg)] x 100%
What is the formula for fluid deficit?
fluid deficit (L) = % dehydration x pre-illness weight (kg) / 100
What is used for mild-to-moderate dehydration treatment?
oral replacement therapy (ORT)
What is used for severe dehydration treatment?
intravenous fluid (IVF)
What is the ORT treatment for mild dehydration?
50 mL/kg over 4hrs, reassess q2hrs
What is the ORT treatment for moderate dehydration?
100 mL/kg over 4hrs, reassess qhr
How much ORT should be added for each loose stool/vomiting episode?
10 mL/kg
What is the IVF treatment for severe dehydration (Phase I/initial replacement)?
10-20 mL/kg of 0.9% NS or LR over 30-60min, repeating up to 3 times
What is the IVF treatment for severe dehydration (Phase II/maintenance replacement)?
first 8 hours = replace fluid deficit, following 16 hours = provide maintenance rate
When is D10W used in pediatric dehydration?
neonates or infants with hypoglycemia
What is the standard potassium concentration?
20 mEq/L
What is the standard negative anion?
chloride
What is the maximum MIVF?
100 mL/hr and 1.5-2x MIVF
What is the maintenance IVF fluid requirement for non-neonates <10 kg?
4 mL/kg/hr
What is the maintenance IVF fluid requirement for non-neonates 10-20 kg?
40 mL/hr + 2 mL/kg/hr x (weight - 10 kg)
What is the maintenance IVF fluid requirement for non-neonates >20 kg?
60 mL/hr + 1 mL/kg/hr x (weight - 20 kg)
What is the dose for ondansetron in patients >6 months of age?
0.15-0.3 mg/kg/dose
What is the dose for ondansetron in patients weighing 8-15 kg?
2 mg once
What is the dose for ondansetron in patients weighing 15-30 kg?
4 mg once
What is the dose for ondansetron in patients weighing >30 kg?
8 mg once
What are AEs of ondansetron?
QTc prolongation, arrhythmias
What probiotics are not recommended though sometimes used in gastroenteritis? (2)
lactobacillus rhamnosus GG and saccharomyces boulardii
When is zinc useful for gastroenteritis in pediatrics?
patients with nutrient deficiencies (malnutrition)
What is the dose for elemental zinc in those <6 months? 6 or more?
10 mg/day for 10-14 days; 20 mg/day for 10-14 days
Which antidiarrheal agents should be used cautiously in children with gastroenteritis? (3)
antimotility (loperamide), anticholinergic (hyoscyamine), and antisecretory (bismuth subsalicylate)
