Peds Fluid Administration and GI Cases Flashcards
Isonatremia/Isotonic dehydration
Most common type of dehydration
Proportional loss of Na and water
Na 130-150
Physical signs of mild dehydration
Normal: turgor, skin feel, eyes, pulse rate, pulse quality, cap refill, urine output
Mucosa: moist
Fontanelle: flat
CNS: consolable
When is oral rehydration therapy used?
It is the preferred treatment of fluid and electrolyte losses caused by diarrhea in children with mild to moderate dehydration
What is the initial dosing of oral rehydration therapy?
50-100cc/kg over 4 hours
Steps for fluid replacement in dehydration for water
- Restore intravascular volume for hemodynamic stability –> bolus
- 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
Bolus therapy
- Rapid infusion of relatively isotonic fluid
- Normal saline or lactated ringers
Holliday-segar method (maintenance)
Slide 12. Know how to do calculations
How to calculate fluid deficit
= % dehydration of pre-illness wt (kg) x 1000 ml/kg
slide 13, 23-25
Little kid maintenance
D1/4 NS with 20-40 mEq KCl or K acetate added per liter
Bigger kid maintenance
D1/2 NS with 20-40 mEq KCl or K acetate added per liter
Double bubble sign of x-ray
Duodenal atresia
Viral causes of gastroenteritis
- Rotavirus- most common cause, very contagious
- Caliciviruses
- Astroviruses
- Adenoviruses
- Noroviruses- food borne
Bacterial causes of gastroenteritis
Camplybacter Salmonella Shigella Yersinia Enterohemorrhagic E. coli C. diff- due to abx
Work up for gastroenteritis
Vast majority of cases do not require work up
- Electrolyte disturbances are rare in children with moderate dehydration
Treatment of gastroenteritis
- 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!
Symptoms and signs that may be associated with gastroesophageal reflux
- Recurrent regurgitation with/without vomiting
- Cough- which can be mistaken for URI
First line therapy for GERD
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
Intusussception
- Telescoping of the intestine
- Intermittent episodes of severe abdominal pain
- Between episodes patients are active and asymptomatic
- Currant jelly stools
How to diagnose intussuception
Air contrast enema
Functional abdominal pain
- 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
When should there be urgent intervention for an esophageal foreign body?
- When the object is sharp, long, or consists of magnets
- When the object is a disc battery in the esophagus
Coin in the esophagus
Easily pass
Where do most esophageal foreign bodies go?
They are retained in the thoracic inlet, the level of the aortic arch, or the gastroesophageal junction
Causes of morbidity due to esophageal foreign bodies?
Esophageal erosion and perforation, esophageal stenosis, or fistula
Less than 1%
