Peds Fluid and Electrolytes Flashcards
What is difference between sensible and insensible water loss?
Sensible=measurable=urine, vomit
Insensible=immeasurable=breathing, sweating
Why are neonates more susceptible to rapid fluid loss than any other population?
Carry the most fluid in ECF (40%) than any other time of life. This is rapidly lost when sick.
50% of their ECF is exchanged daily. (it is 17% in adults)
Rapid respirations, large body surface area, thin skin make insensible water loss high.
What is gold standard for measuring acid/base balance?
ABGs
Clinical signs of dehydration in peds?
Decreased output
Dry mucous membranes
Cracked lips
Poor turgor
Sunken fontanelles
Dry skin
No tears
Irritable
High pitched cry
Difficult arousing
Increase in rate and depth of respir
When acidosis occurs, what changes will we see in respirations?
Rate and depth will increase to remove excess CO2
Remember: CO2=acid
O2=alkaline
When alkalosis occurs, what changes will we see in respirations?
Rate and depth decrease to hang on to CO2
Remember: CO2=acid
O2=akaline
When acidosis occurs, what changes will we see in renal output?
Kidneys will excrete the excess hydrogen ions and hang on to bicarb
—Takes 1-2 days, slower process than respiratory compensation–
Remember: Bicarb=alkaline
Hydrogen=acid
When alkalosis occurs, what changes will we see in renal output?
Kidneys will excrete bicarb and hang on to hydrogen ions
–Takes 1-2 days, slower process than respiratory compensation–
Remember:Bicarb=alkaline
Hydrogen=acid
What is normal value range for PaCO2?
35——-45 mm/Hg
What is normal value range for pH?
7.35——-7.45
What is normal value range for bicarb?
22——-26 mEq/L
What are common labs ordered in fluid and electrolyte imbalance?
CMP
BUN
Urine specific gravity
A weigh gain/loss of 2.2 lbs is equivalent to how much fluid?
1 liter
What are the 4 components of dehydration scales?
General appearance
Eyes
Mucous membranes
Tears
What changes in pulse will be present in dehydration?
Weak, thready, tachycardic
What changes in respirations will be present in dehydration?
Faster, deeper
What changes to sensorium will be present in dehydration?
Fatigue
Restless
Irritable
Lethargic
What are preferred IV fluids for rehydration?
LR or NS 0.9%
What must be present before potassium can be given?
Must have sufficient renal output-or will become hyperkalemic
What is maximum dose and rate of IV potassium?
No more than 40 mEq/L
No faster than 1 mEq/kg/hr
What is minimum urine output for infants and toddlers?
2—-3 ml/kg/hr
What is min urine output for preschoolers to young school age kids?
1—-2 ml/kg/h
What is min urine output for older kids and adolescents?
0.5——1 ml/kg/h
Diarrhea that is caused by an infection is called…
gastroenteritis
What is the most common cause of gastroenteritis in US?
Norovirus
What are common labs done in diarrheal patients?
Stool sample for: cultures, occult blood, pH
Blood: cultures, CBC, CMP, BUN, glucose
What is the BRAT diet?
Bananas
Rice
Applesauce
Toast
—Used to be recommended diet for pts with diarrhea, but changed to something more nutritious—
What is recommended foods for pts with diarrhea?
Bland but complex carbs, lean proteins, veg
Yogurt, rice, potatoes, cereal, lean protein, cooked vegetables
What vaccine is recommended by CDC to prevent cause of major diarrheal illness in kids?
Rotovirus vaccines:
RV1 and RV5
What is chalasia?
Spitting up
What is go to anti-emetic med for kids?
Zofran
