Peds Exam 2 - F&Ls Flashcards
holliday segar formula
need to have memorized
-first 10kg add 100 ml/kg/d
-next 10kg add 50 ml/kg/d
->20kg add 20 ml/kg/d
ex) 7kg child would get 700 ml
ex) 12kg (10x100)+(2x50) = 1100 ml
ex) 30kg (10x100)+(10X50)+(10x20) = 1700 ml
divide by 24 to get per hr
factors increasing maintenance fluid requirements
-fever over 99
-tachypnea
-increased environment temp
-burns
-V/D
-DKA
-shock
-radiant warmer, phototherapy
-post opt bowel surgery
factors decreasing maintenance fluid requirements: skin
mist tent, incubator, swamp bed
factors decreasing maintenance fluid requirements: lungs
humidified ventilator
factors decreasing maintenance fluid requirements: renal
oliguria, anuria
factors decreasing maintenance fluid requirements: misc.
hypothyroidism
factors decreasing maintenance fluid requirements
-CHF
-increased intracranial pressure
-syndrome or inappropriate antidiuretic hormone (SIADH)
types of dehydration: isotonic
-lytes = water
-serum Na 135-145
-80% of all dehydration pts
no need to correct slowly
types of dehydration: hypertonic
-water loss > lyte loss
-Na > 145
-15% of all dehydration pts
-dry doughy skin
-if lowered too quickly causes massive cerebral edema or seizure
correct Na slowly
types of dehydration: hypotonic
-lyte loss > water loss
-Na <135
-5% all dehydration pts d/t GI loss
-shift from ECF to ICF
-child appears ill
correct very slowly
what do you have to have the child do before giving K+ in IV fluid
urinate
water balance - maintenance
normal ongoing losses of fluid and electrolytes
water balance - deficit
total amount of fluids and electrolytes lost from an illness
water balance - on going losses
requirement of fluids and electrolytes to replace ongoing losses
how much do you increase fluid needs by for a fever
by 7ml/kg/d
if you have fluid excess, what precaution do you put them in
seizure
how do you diagnosis dehydration
clinical signs: abnormal turgor, respiratory pattern & prolonged cap refill
labs not needed
oral rehydration therapy
-rapid replacement of fluid loss over 4-6hrs, replacement for continuing losses, and providing for maintenance fluid requirements
when child is alert, awake & not in shock, if not then IV fluid
clinical manifestation of mild dehydration:
wt loss, appearance, cap re, pulse, res, BP, muc mem, tears, eyes, skin, fontanel, urine flow
3-5%, active/alert, normal, normal, normal, normal, moist, present, normal, springs back, normal, normal
clinical manifestation of moderate dehydration:
wt loss, appearance, cap re, pulse, res, BP, muc mem, tears, eyes, skin, fontanel, urine flow
6-9%, irritable/alert/thirsty, >/3, slightly inc, slight tachy, normal or low ortho, dry, less than expected, normal, tents briefly, normal or slightly sunken, reduced
clinical manifestation of severe dehydration:
wt loss, appearance, cap re, pulse, res, BP, muc mem, tears, eyes, skin, fontanel, urine flow
> /10%, lethargic/sick, delayed >4, fast & thready, fast & deep, ortho to shock, parched, absent, sunken, prolonged, sunken significantly, severely reduced
parental fluid therapy
initiated when the child is unable to ingest sufficient amounts of fluid & lytes to
1) meeting daily losses
2) replace previous deficits
3) replace ongoing abnormal losses
three phases of parental fluid therapy
1) expand ECF volume quickly and to improve circulatory and renal function
2) replacement of lytes deficits, provide maintenance water & lyte requirements, and catch up w/ ongoing losses
3) introduction of oral feeding and gradual correction of total body deficits
rehydration therapy for mild dehydration
ORS 50ml/kg within 4hrs + add fluid for each stool (10ml/kg) & emesis (5-10ml every 5min)
rehydration therapy for moderate dehydration
ORS 100 ml/kg within 4 hrs + add fluid for each stool (10ml/kg) & emesis (5-10ml every 5min)
rehydration therapy for severe dehydration
IV fluids 40ml/kg/hr until pulse & consciousness return (after kidney function verified may add K+) then 50-100 cc/kg of ORS
maintenance therapy for mild/moderate/severe dehydration
continue breast feeding and formula if tolerated, if receiving solid food, continue regular diet
how to treat hyponatremia
administer IV fluids w/ appropriate saline concentration
what is a key sign of low Na
abdominal cramping & think brain
what is a key sign of low K+
leg cramping & think heart -> weaker irregular pulses, tachy, low BP, irritability & fatigue
hyperNa treatment
-fluids
-measure I&Os
-monitor labs & neuro status
key signs of hyperNa
thirsty, flushed skin, agitated, dry sticky membranes & seizures
treatment of hypoK
-monitor vitals, including EKG
-administer supplemental K+ (assess renal output first)
treatment of hyperK
-monitor vitals including EKG
-administer IV fluids
-may give IV insulin or cation exchange resin
key signs of hyperK
N/d, bradycardia
treatment of HypoCa
-administer Ca supplements as prescribed
-monitor IV site as Ca may cause IV irritation
key signs of hypoCa
poor feeding in neonate, tetany, trousseau and chvostek, hypotension, cardiac arrest, hyper reactive reflexes, muscle cramps
treatment of HyperCa
-monitor serum Ca levels
-monitor EKG
key signs of hyperCa
bradycardia, N/V, itching, lethargy, weakness
when giving IV fluids we do…
LR boluses until they urinate and then we can add K+
infants we give K+ and dextrose if they are NPO and need glucose
what type of gauge do we put in for IV fluids
smallest possible (22-24 G) unless surgery then 18-20 G
