Peds and IV Flashcards
dehydration tonicity
look at salt
Na 15 - hyper
normal saline
154 mEq Na/L
D5W
dextrose in water
lactated ringers
NaCl, KCl, CaCl, Na lactate in water
deficit
half given over 8 hours
half given over next 16 hours
deficit Na and K
important in hypo or hypernatremic dehydration
bolus therapy
isotonic
20mL/kg
normal saline or LR
vomiting
no lactated ringers
exacerbates metabolic alkalosis
maintenance
daily water needs based on energy expenditure
holliday segar method
for maintenance
hourly calc - 4-2-1
4 mL/kg/hr - first 10kg
2 - 11-20kg
1 - >21kg
24 hour calc
100 mL/kg/day - first 10 kg
50 - 11-20kg
20 - >21 kg
fluid deficit
%dehydration of pre-illness weight x 1000mL/kg
child mild to severe
-3/6/9%
infant mild to severe
-5/10/15%
clammy skin
severe dehydration
tenting skin
moderate dehydration
sunken fontanelle
severe dehydration
<2sec cap refill
mild dehydration
maintenance of Na and K
3Na x 100mL of water
2K x 100mL of water
Na - extracellular
K - intracellular
illness < 3 days
80% ECF deficit
20% ICF
illness > 3 days
60% ECF deficit
40% ICF
Na deficit
fluid deficit X
proportion from ECF X
Na concentration in ECF
K deficit
fluid deficit X
proportion fro ICF X
K concentration in ICF
K
150
Na
145
less than 10kg
give 0.25 NS
10-20kg
give 0.3 NS
> 20kg
give 0.5 NS
little kid maintenance
D1/4 NS with 20-30 mEq KCl or K acetate added per liter
bigger kid maintenance
D1/2 NS with 20-20 mEq KCl or K acetate added per liter
pre-illness weight calculation
determine weight loss - and replace with bolus of that much
20mL/kg
double bubble X-ray
duodenal atresia
congenital obstruction of 2nd portion duodenum
failure of recanalization of bowel segment
below ampulla of vater
with polyhydramnios, down syndrome, CHD
type 1 duondenal atresia
mucosal web with normal muscular wall - most common
type 2 - short fibrous cord connecting two atretic ends of duodenum
type 3 - complete separation of atretic ends
oral rehydration therapy
5cc every 2 minutes
dose timing for 24 hour day
first 8 hours
- 1/3 maintenance
- 1/2 total deficit
next 8 hours
- 1/3 maintenance
- 1/4 deficit
next 8 hours
-1/3 maintenance
1/4 deficit
gastroenteritis
viral
- rotavirus
- norovirus - 50% cases in developed cases
watery diarrhea
viral
bloody bowel movements, cramping, fecal leukocytes
bacterial
GERD
most common esophageal disorder in children
recurrent regurgitation with or without vomiting
GERD
esophagitis
recurrent pneumonia
dental erosion
sandifer syndrome
weird neck posture
sandifers syndrome
CN IX
glossopharyngeal
altered tone - increased salvation
occipital condylar release
MFR to free up vagus, hypoglossal, accesory nerves
forceful vomiting
pyloric stenosis
olive like mass in RUQ abdomen
bilious vomiting
green vomit
think obstruction - atresia, hirschsprung, malrotation, ileus
