Pharm2 10 Peds Fluids pt3 Flashcards
30 kg Child Profoundly Dehydrated
save this kid!!!
Resuscitative 20 cc/kg = 600 cc bolus
10% loss = 3 kg = 3,000 cc lost
Balance of deficit = 2,400 cc
1,200 cc over first 8 hrs = 150 cc/hr
Balance of 1,200 cc over next16 hours = 75 cc/hr
MTCE 4-2-1- = 70 cc/hr
Order 600 cc bolus NS, then 220 cc/hr x 8 hours, then 145 cc/hr for 16 hours`
Name each of the categories of fluid replacement:
Which is largely ignored in reality? Why?
resuscitative, deficit, maintenance, ongoing fluid losses
ongoing losses is largely ignored in reality b/c we’re totally making up for everything through this method
Who gets the Resuscitative IV bolus?
Only kids in shock (severely dehydrated) get that IV bolus.
Burns and the Parkland Formula
Utilize normal saline as a fluid
4 cc/kg/%BSA for deficit plus maintenance
give 1/2 of deficit in first 8 hours
give 1/2 over next 16 hours
don’t forget to subtract initial fluid bolus
Don’t forget to add maintenance fluids
(1 to 4 cc/kg/% of body surface; but everyone uses 4)
3 1/2 yo male, 25 kg w/ 37% TBSA 2º burn
Treat ‘em!
20 cc/kg x 25 kg bolus = 500 cc bolus
4 cc x 25 kg x 37% TBSA = 3,700 cc total deficit
3,700 cc less 500 cc bolus = 3,200 cc deficit remaining
Give ½ deficit in 8 hrs, balance over next 16 hrs
Give 1,600 cc in first 8 hours = 200 cc/hr x 8 hrs
Give 1,600 over next 16 hours = 100 cc/hr
Now you must add maintenance (4,2,1 method) –> Overall 265 cc/hr
To write this:
500 cc IV bolus RL then
265 cc/hour IV RL for 8 hours, then
165 cc/hour IV RL for 16 hours
What’s different with replacing fluids in a kid with DKA? why?
Due to significant osmotic shifts that occur in diabetic ketoacidosis, calculate deficits and then replace those deficits over 48 hours
w/ the 8 hour 16 hour method you’d kill the kid. Why? If their serum glucose is 1000 (dramatically higher), it’s also that high in their brain cells. If I give them water w/o glucose in large quantities, it’ll go into their brain, into the individual cells, which will go from raisins to grapes. As they go to grapes, their brain will swell & the only opening they have is the foramen magnum. The brain will go through there.
Same thing will happen is they’re hypernaturemic and you use free water.
31 kg child in DKA, 10% decrease in weight
3100 cc of fluid loss
20 x 31 = 620 cc IV bolus
Now the fluid loss is 2480 cc, replaced over 48 hours. 2480/48 = 52 cc/hr
This + 4,2,1, maintenance method: 71 cc. 52 + 71 = 123 cc/hour for next 48 hours.
Besides fluid replacement in a DKA patient, what else must they get?
When you’re correcting DKA, which serum level won’t be reliable in this patient? Whaddya do about it?
Insulin IV bolus, then insulin in a drip.
Use terascon on how to calculate the actual serum Na, because now the Na levels you get will be unreliably high.
One use for Hot Salt (although it’s Very very dangerous to use. Really have to know what you’re doing to use it.)
Cerebral edema
BQ - kid with sodium of 102 who starts to seize. What is the drug of choice?
Hot salts
(but you’ll likely never give it in reality)
If you give Benzodiazepines – 3 mg of Lorazepam, but they’re still seizing. Now u increase dose to 6, then 10, and they’re still seizing. NO matter how much of these antiepileptic drugs you give, it won’t get this patient out of their seizure b/c it’s due to the low sodium.
