Peds Fluid Administration and GI Cases

Question 1

Isonatremia/Isotonic dehydration

Answer 1

Most common type of dehydration
Proportional loss of Na and water
Na 130-150

Question 2

Physical signs of mild dehydration

Answer 2

Normal: turgor, skin feel, eyes, pulse rate, pulse quality, cap refill, urine output

Mucosa: moist

Fontanelle: flat

CNS: consolable

Question 3

When is oral rehydration therapy used?

Answer 3

It is the preferred treatment of fluid and electrolyte losses caused by diarrhea in children with mild to moderate dehydration

Question 4

What is the initial dosing of oral rehydration therapy?

Answer 4

50-100cc/kg over 4 hours

Question 5

Steps for fluid replacement in dehydration for water

Answer 5

1. Restore intravascular volume for hemodynamic stability –> bolus
2. Calculate 24 hour water requirements:
   part 1- maintenance- give a constant rate over 24 hours
   part 2- deficit- divided so that 1/2 is given over the first 8 hours, then 1/2 over the next 16 hours

Question 6

Bolus therapy

Answer 6

• Rapid infusion of relatively isotonic fluid

- Normal saline or lactated ringers

Question 7

Holliday-segar method (maintenance)

Answer 7

Slide 12. Know how to do calculations

Question 8

How to calculate fluid deficit

Answer 8

= % dehydration of pre-illness wt (kg) x 1000 ml/kg

slide 13, 23-25

Question 9

Little kid maintenance

Answer 9

D1/4 NS with 20-40 mEq KCl or K acetate added per liter

Question 10

Bigger kid maintenance

Answer 10

D1/2 NS with 20-40 mEq KCl or K acetate added per liter

Question 11

Double bubble sign of x-ray

Answer 11

Duodenal atresia

Question 12

Viral causes of gastroenteritis

Answer 12

• Rotavirus- most common cause, very contagious
• Caliciviruses
• Astroviruses
• Adenoviruses
• Noroviruses- food borne

Question 13

Bacterial causes of gastroenteritis

Answer 13

Camplybacter
Salmonella
Shigella
Yersinia
Enterohemorrhagic E. coli
C. diff- due to abx

Question 14

Work up for gastroenteritis

Answer 14

Vast majority of cases do not require work up

- Electrolyte disturbances are rare in children with moderate dehydration

Question 15

Treatment of gastroenteritis

Answer 15

• ORT with electrolyte solution
• If pt has been vomiting, then small sips of electrolyte solution until emesis stops then slow reintroduciton of liquids/bland solids (labor intensive)
• Ideally 5 cc every 1-2 min, but commong 5 cc (one teaspoon) every 10 min or 30 cc (one ounce) every 15 min

Do not use antimotility agents in children!

Question 16

Symptoms and signs that may be associated with gastroesophageal reflux

Answer 16

• Recurrent regurgitation with/without vomiting

- Cough- which can be mistaken for URI

Question 17

First line therapy for GERD

Answer 17

Nonpharmacologic

• Advise on appropriate amounts of formula
• Thickening of feedings by adding rice cereal to formula
• Prone position at 30 degrees while awake
• Elevating HOB and placing on hack while asleep
• Hold upright for 30 min after feeding

Question 18

Intusussception

Answer 18

• Telescoping of the intestine
• Intermittent episodes of severe abdominal pain
• Between episodes patients are active and asymptomatic
• Currant jelly stools

Question 19

How to diagnose intussuception

Answer 19

Air contrast enema

Question 20

Functional abdominal pain

Answer 20

• Diagnosis of exclusion that present b/w 6-14 years
• Normal PE findings
• Symptoms present for more than 3 months
• Pain awakens child at night

Question 21

When should there be urgent intervention for an esophageal foreign body?

Answer 21

• When the object is sharp, long, or consists of magnets

- When the object is a disc battery in the esophagus

Question 22

Coin in the esophagus

Answer 22

Easily pass

Question 23

Where do most esophageal foreign bodies go?

Answer 23

They are retained in the thoracic inlet, the level of the aortic arch, or the gastroesophageal junction

Question 24

Causes of morbidity due to esophageal foreign bodies?

Answer 24

Esophageal erosion and perforation, esophageal stenosis, or fistula

Less than 1%

Question 25

What is the most common cause of serious lower GI bleeding in children?

Answer 25

Meckel diverticulum

May see currant jelly stool or bright red blood

Question 26

Currant jelly stool is seen in?

Answer 26

Meckel diverticulum

Intussusception

Question 27

When do symptoms of pyloric stenosis present?

Answer 27

Between 3-5 weeks of age, and very rarely occur after 12 weeks of age

Question 28

Projectile vomiting immediately after feeding

Answer 28

Pyloric stenosis

Infant remains hungry

Question 29

Olive like mass that is palpable in the RUQ of the abdomen

Answer 29

Pyloric stenosis