Pharm2 10 Peds Fluids pt2 Flashcards
Holliday-Segar method is for…
How do you do it? ex: 21 kg kid.
IV maintenance rate
100 cc/kg per 24 hours for first 10 kg
50 cc/kg per 24 hours for second 10 kg
20 cc/kg per 24 hours over 20 kg
1500+20 = 1520 1520/24 = 63.3 cc per hour
IV fluids using 4-2-1 Rule is for…
How do you do it? ex: 28 kg kid.
IV maintenance rate
4 cc/hr x 10 kg = 40 cc/hr
2 cc/hr x 10 kg = 20 cc/hr
1 cc/hr x 8 kg = 8 cc/hr
Totals 68 cc/hr maintenance*
Identify a baby that’s minimal-mildly dehydrated
a lot of diarrhea and vomits everything I feed her”
On exam child makes eye contact, cries with tears but is easily consoled by mother, diaper is wet with urine, cap refill is brisk
What’s the easiest way to check if a baby is dehydrated?
Check the diaper
How to handle a baby/kid with Minimal to mild dehydration
Initially supervise parent feeding child
Give frequent (every 5 minutes), small amounts of solution (the 5 little cups with soda or w/e)
Observe for ability to continue regular hydration
Re-evaluate child’s hydration status
Reinforce plan with parents
Identify a baby with moderate dehydration
vomits everything, diarrhea
>10 episodes of watery diarrhea today
Alert child, cries with scant tears, consoled by mother, dry mucosa, water diarrhea in diaper on exam, capillary refill is about 3 seconds
How to handle a baby/kid with Moderate dehydration
Closely supervise parent feeding child avoid lactose products Give 5-10 cc of Pedialyte solution Child takes 240 cc in 2 hour period Re-evaluate child’s hydration status & document Reinforce plan with parents
Identify a baby/kid with Severe shock (and maybe hyponatremic dehydration)
Mother presents to ED with 4 yo male weighing 18 kg. Child was at pediatricians last week and weighed 20 kg.
Mother states having diarrhea > 10/day, vomiting > 6/day, both for 3 days
child taking 7-Up well until today
Child is quiet, eyes sunken, dry mucosa, cries w/o tears, cap refill is about 4 seconds
What’s the problem with treating a baby, young child with severe shock/dehydration? What do you do about it? Last resort?
getting an IV on this kid is going to be a crazy challenge. It’s a fairy tale, you won’t even be able to palpate it.
Check out their external jugular vein. If that’s used, make sure you point the needle DOWN towards heart, not up towards the brain.
Last resort location: intraosseus - tibial plateau line.
How to handle a baby/kid with Severe shock/hyponatremic dehydration
Rapidly establish an IV peripheral sites intraosseous (last resort) Rapidly administer 20 ml/kg bolus Re-evaluate child immediately
A 14 gage needle won’t go into a kid. If it’s used on an adult, how quick will you get a Liter of fluid?
2 minutes. It flows quickly b/c it’s a short needle and a big diameter.
Law of fluid dynamics – there are 2 factors that determine how fast you’ll get fluid into a patient:
What’s most rapid?
What are central lines?
length of IV catheter, and the diameter of the catheter.
Most rapid: So we want a shorter catheter and a wider diameter
Central lines are a huuuuge catheter with a narrow diameter. Therefore this is slower than a 14 gage needle.
Identifying symptoms of Severe Dehydration implies ___% fluid deficit from ideal body weight.
So what if the kid’s ideal body weight is 20 kg?
10% fluid deficit from IBW
20kg x .1 = 2 kg loss.
2 kg = 2000 cc total deficit fluid loss
How much fluid is lost if a kid weighed 20 kg last week, and is now severely dehydrated and weighs 18 kg?
20 kg – 18 kg = 2 kg loss
2 kg = 2,000 cc total deficit fluid loss
Let’s talk through the whole process of correcting fluids in this 4 year old kid who weighed 20 kg a week ago, now weighs 18 kg and is severely dehydrated.
2000 total deficit
20 ml/kg resuscitative bolus: 20 x 20 = 400 cc (1600 cc deficit remaining)
800 cc over 8 hours = 100 cc/hr + 60 cc/hr for maintenance = 160 cc/hr
800 cc over following 16 hours = 50 cc/hr + 60 cc/hr for maintenance = 110 cc/hr
