Peds Fluids and Electrolytes

Question 1

NPO guidelines

1. Shorter fasting times lead to lower rates of h., d. and general c.
2. Clear fluids – how many hours?
3. is broth a clear?
4. Breast milk – how many hours?
5. Formula – how many hours?
6. Solids – how many hours?
7. is a spoon of applesauce with morning meds okay?
8. is gum okay?

Answer 1

1. hypoglycemia, dehydration, crankiness
2. 2 hours
3. no
4. 4 hours
5. 6 hours
6. 8 hours
7. yes
8. no

Question 2

IV access

1. Large bore IV access is what? (R)
2. what gauge catheter is usually sufficient access in infants?
3. Term Infants -Saphenous vein can take up to a what gauge IV?
4. Umbilical catheterization is associated with p. h. in childhood – use very cautiously

Answer 2

1. relative
2. 22 g
3. 20 g
4. portal hypertension

Question 3

Intraoperative Fluid Loss:

1. what are 4 sources of fluid loss? (BL, CL, ST, DE)
2. Extravasation of isotonic, protein-containing fluid into nonfunctional third space can be profound in up to what ml/kg in small infants?
3. Anesthetic-induced relaxation of s. tone can cause vasodilation and relative hypovolemia
4. what 2 things can help prevent direct evaporation? (H, WiP)

Answer 3

1. blood loss, capillary leak, surgical trauma, direct evaporation
2. 10 mL/kg
3. sympathetic
4. HME, wrap in plastic

Question 4

Calculate maintenance IVF:
0-10 kg = what ml/kg/hr
10-20 kg = what ml + what ml/kg/hr
>20 kg = what ml + what ml/kg/hr
Examples:
12 kg child = what ml/hr
26 kg child = what ml/hr

Answer 4

1. 4 ml/kg/hr
2. 40 + 2 ml/kg/hr
3. 60 + 1 ml/kg/hr
4. 44 ml/hr
5. 66 ml/hr

Question 5

How much IV fluids should I infused?

1. Healthy children for outpatient procedures with minimal blood loss, consider what range of ml/kg crystalloid?
2. Good hydration helps with what postop?

Answer 5

1. 10-20 ml/kg

2. PONV

Question 6

Buritrol

1. Buritrol for small children and infants helps to regulate IV fluids and prevent what? (EI)
2. Put what range of ml/kg in the buritrol and clamp it to the IV bag?
3. This way you won’t accidentally over infuse at what phase of anesthesia? (I)

Answer 6

1. excessive infusion
2. 5-10 ml/kg
3. induction

Question 7

Dextrose or No Dextrose?

1. Growing consensus to selectively administer intraoperative d. to patients at greatest risk for hypoglycemia and to use a higher or lower dextrose concentration
2. is routine administration of dextrose to otherwise healthy children advised?
3. what 3 populations are at highest risk for hypoglycemia? (N, children on H, E)
4. Barash advocates 1-2% glucose solutions in LR for children < how many months of age, young children who are m., or who tolerate fasting how? (P)
5. she runs D5LR at h. maintenance along with a b. line.

Answer 7

1. dextrose, lower
2. no
3. neonates, children on hyperalimentation, endocrinopathies
4. 6 months, malnourished, poorly
5. half maintenance; bolus line

Question 8

Fluid Compartments

1. Total body water distributed into what 2 compartments?
2. Fetus/Newborn ECF (what %) and ICF (what %)
3. Volumes approach adult about what year of age? – ECF (what%) ICF (what%)
4. This dramatically affects the ability of the child to mobilize body water in response to what? (D)

Answer 8

1. intracellular fluid, extracellular fluid
2. 40%, 20%
3. 1 year; 20%, 40%
4. dehydration

Question 9

Term neonate:

1. Normal neonates lose what % range of body weight in the first few days of life?
2. With appropriate intake, a term infant will regain body weight in what week of life?
3. Urine output initially be high or low?
4. GFR rises rapidly or slowly?

Answer 9

1. 5-15%
2. first week
3. low
4. rapidly

Question 10

Term Newborn Glucose Utilization

1. what month of gestation does the fetus begin to form glycogen stores?
2. at rate does the fetus begin to form glycogen stores in terms of kcal/day ?
3. in unstressed term infant, hepatic glycogen stores are what % of body weight?
4. Glycogenolysis depletes these stores within the first what hour range of life?
5. Gluconeogenesis must then proceed at a rate of what mg/kg/min?

Answer 10

1. 9th
2. 100 kcal/day
3. 5%
4. 24-48 hours
5. 4 mg/kg/min

Question 11

Term Newborn Glucose Management

1. at birth serum glucose is what % range of maternal glucose?
2. Newborn glucose should be maintained above what mg/dl?
3. D10W bolus what ml/kg range followed by a continuous infusion?
4. typical infusion is what ml/kg/day range of D10W?
5. Monitor glucose Q how many mins while infusing?

Answer 11

1. 60-70%
2. above 45
3. 2-4 ml/kg
4. 70-80 ml/kg/day
5. 30 mins

Question 12

Low and Very Low Birth weight Infants: Three phases of fluid and electrolyte homeostasis

1. Day 1 - a lot or little UO? stable or unstable body weight?
2. Day 2 & 3 - what occurs irrespective of fluid administration? (D)
3. Day 4 & 5 - Urine output begins to vary with changes in what intake and state of what? (F, H)

Answer 12

1. little UO; stable body weight
2. diuresis
3. fluid intake, state of health

Question 13

Hypoglycemia

1. does it occur most frequently in preterm infants and neonates?
2. should you maintain preoperative infusions of dextrose containing solutions and TPN to prevent hypoglycemia from sudden withdrawal?
3. treat with D10W bolus what ml/kg range?
4. Remember hypoglycemia is high in your differential for a patient that is inappropriately what in PACU? (S)

Answer 13

1. yes
2. yes
3. 2-4 ml/kg
4. sedated

Question 14

Hyperglycemia Treatment

1. diabetic patients goal blood glucose should be what range of mg/dl?
2. Work closely with what service to create an appropriate perioperative insulin/glucose management plan? (E)
3. infuse what fluid at maintenance rate?
4. Children < 12 years get 1 unit of insulin per how many grams of dextrose?
5. Children > 12 years get 1 unit of insulin per how many grams of dextrose?
6. what type of fluid should be used to replace insensible losses and blood?

Answer 14

1. 100-200 mg/dl
2. endocrinology
3. D545
4. 5 grams
5. 3 grams
6. isotonic

Question 15

Hypokalemia

1. most commonly caused by what 2 things? (V, D)
2. Potassium between what range needs to be corrected before surgery? (mEq/L)
3. KCL dosing of what range of mEq/kg to be infused at what range of mEq/kg/hour?
4. what is the max dose of KCL mEq?
5. administration rate should not exceed what mEq/kg/hr?
6. Cote recommends concentration of what mEq/ml?

Answer 15

1. vomiting, diarrhea
2. 2.0-2.5 mEq/L
3. 0.25-1 mEq/kg over 0.3-0.5 mEq/kg/hr
4. 40 mEq
5. 1 mEq/kg/hr
6. .04 mEq/mL

Question 16

Hyperkalemia intraop causes:

1. succinylcholine use in what 6 pts? (M, B, UMNL, LMNL, CS, DA)
2. massive and rapid transfusion of what 2 blood products? (P, WB)

Answer 16

1. mypothapthies, burns, upper motor neuron lesions, lower motor neuron lesions, chronic sepsis, disuse atrophy
2. PRBCs, whole blood

Question 17

Treatment of Hyperkalemia

1. giving calcium to reestablish the gradient between what 2 potentials?
2. what range ml/kg of 10% calcium chloride?
3. what range ml/kg of 10% calcium gluconate?
4. what 2 meds can you give and one thing you can do to return potassium to the intracellular space? (SB, BA; H)
5. what is the mEq/kg range of sodium bicarbonate?
6. To maintain potassium in the intracellular space give what g/kg of glucose and what units/kg of insulin?
7. what minute range should you infuse this glucose and insulin over?
8. what are 2 other thing that you can do to treat hyperkalemia? (K, D)

Answer 17

1. resting membrane potential, threshold potential
2. 0.1-0.3 mL/kg
3. 0.3-1.0 mL/kg
4. sodium bicarb, beta agonist; hyperventilate
5. 1-2 mEq/kg
6. 0.5-1 g/kg and 0.1 units/kg
7. 30-60 minutes
8. kayexalate, dialysis

Question 18

hyponatremia:

1. are children more or less prone than adults to cerebral edema?
2. Brain is adult size by what age?
3. skull continues to grow until what age?
4. Brain intracellular concentration of sodium is what % higher in children than adults?
5. is the Na+K+ATPase mechanism increased or decreased?
6. what are 4 symptoms? (L,H,N,V)

Answer 18

1. more
2. 6
3. 16
4. 27%
5. decreased
6. lethargy, headache, nausea, vomiting

Question 19

Management of Hyponatremia

1. does asymptomatic hyponatremia need rapid correct?
2. is symptomatic hyponatremia a medical emergency?
3. rapid limited correction of what ml/kg of 3% saline over how many minutes to halt seizures?
4. subsequent correction shouldn’t exceed what mEq/L/hr or what mEq/L/day?
5. what type of drugs may be useful in fluid overload? (D)

Answer 19

1. no
2. yes
3. 3 mL/kg of 3% saline over 30 min
4. 0.5 mEq/L/hr or 25 mEq/L/day
5. diuretics

Question 20

Hypernatremia

1. is acute hypernatremia more common in children or adults?
2. > what % of dehydrated children will present with hypertonic dehydration Na+ >150?
3. mortality rate of hypertonic dehydration is > what % for this acute disorder?
4. correct chronic fluid deficit over how many hours?
5. should you correct acute fluid deficit of <24hrs more rapidly?

Answer 20

1. children
2. 15%
3. 40%
4. 48 hours
5. yes

Question 21

TPN

1. Can you infuse it through a peripheral IV?
2. should you leave it infusing and start another IV for fluid and blood product administration?
3. Discontinue lipids if possible and do not access the line to prevent what contamination? (B)
4. sudden cessation of glucose containing fluids can cause what? (H)
5. should you be careful leaving IV fluids infusing on a pump to an unmonitored extremity?

Answer 21

1. yes
2. yes
3. bacterial
4. hypoglycemia
5. yes