T2 - Fluid & Electrolyte (Josh) Flashcards
A Popsicle is —- mL
45 mL (half)
the double is 90 mL
—- is second to URI as a cause of illness in children.
Gastroenteritis
What is the largest single cause of death of children in 3rd world countries?
Gastroenteritis
GI Motility is —- in younger children.
faster
Digestive enzymes are not present until —-
4-6 mths
- infant is susceptible to gas and abdominal distention
What is one reason that infants and young children are more vulnerable to alterations in Fluid & Electrolytes?
They have greater surface are in relation to body mass
Infants have a significantly higher —- than adults, leading to…
metabolic rate
increased heat production
increased fluid loss
increased need for water excretion
Infants’ kidneys are —
functionally immature
Infants —- a greater amount of fluid.
ingest and exrete
Urine Volume/24 hrs
- Neonate (30-60)
- Week old (100-300)
- 10-60 days (250-450)
- 2-12 mths (400-500)
- 1-3 yrs (500-600)
- 3-5 yrs (600-700)
- 5-8 yrs (650-1000)
- 8-14 yrs (800-1400)
- Adults (600-1600)
Normal routes of fluid excretion from infants and children?
Lungs
Urine
Feces
Skin
Formula for Calculating I’s and O’s
Output: 1-2 mL/kg hr
Intake:
- up to 10kg = 100mL/kg
- 10-20 kg = 1000mL + 50mL/kg for anything over 10kg
- >20 kg = 1500mL + 20 mL/kg for anything over 20kg
Child weighs 8 kg. Calculate I and O.
Intake = 100 * 8 = 800mL Output = 1*8 or 2*8 = 8-16 mL/hr
Child weighs 16 kg.
Calculate I and O.
Intake = 1000mL + 50*6 = 1300 mL
Output = 116 or 216 = 16-32mL/hr
Child weighs 24 kg.
Calculate I and O.
Intake: 1500 + 20*4 = 1580 mL
Output: 124 or 224 = 24-48 mL/hr
Viruses that cause Fluid/Electrolyte Imbalances:
Rotavirus
Norwalk Virus
Bacteria that cause Fluid/Electrolyte Imbalance:
- E. Coli
- Salmonella
- Shigella
- Yersinia Enterocolitica
- Campylobacter jejuni
- Vibrio Cholera
- C. diff
Most common cause of diarrhea in children less than five years old?
Rotavirus (unless they get RV vaccine)
- 6-12 mths greatest risk
Appropriate diet for Oral Rehydration from diarrhea.
- Ricelytes
- Pedialyte
- Unsweetened Jello
- NO FRUIT JUICE
- progress to soft complex carb foods, no greasy/spicy foods and progress as tolerated for older child
General Diet Guidelines for Infants w/ vomiting/diarrhea.
No milk or milk products for 24-28 hours
unless ordered by doctor
Day 2:
infants may have soy formula for 2 days then return to regular formula
may begin with 1/2 strength formula for 24 hours and then back to regular
Day 3
infant–full strength formula
Calculate percentage of weight loss
- subtract child’s present weight from original weight
- divide the loss by the child’s original weight
Shock Stages:
Warm (fever)
Cool (skin)
Cold (extremities)
Why is an infant more susceptible to gas and abdominal distention?
smaller stomach and digestive enzymes not present until 4-6 mths
T/F: Infants/Young Children have greater surface area in relation to body mass.
True
Can babies concentrate urine well?
no, they have immature kidneys
Infants excrete a — amount of fluid per kg of body weight.
greater
With children, we want — to be almost equal.
Intake and Output
Minimum fluid output is —
1-2 mL/kg/hr
Infant is —- fluid
1 yr old is — fluid
Adult is — fluid
70-80%
60%
60%
Infants have more fluid in —
1 yrs and up have more fluid in —
ECF
ICF
—- become dehydrated faster because…
infants
higher amts of ECF
Why can high carb foods cause diarrhea?
pulls water into GI tract
—- —- causes malabsorption syndrome.
Cystic Fibrosis
Starvation Diarrhea is…
If they’ve had NV or been NPO…
then, first PO intake is not well accepted by the body and moves quickly through the GI tract
Formula too diluted or too concentrated can cause…
diarrhea
Which virus mimics appendicitis?
Yersina eneroclitica
Sodium is —
Potassium is —
ECF
ICF
If dehydrated, sodium levels —
rise
Stool Description:
Color
Consistency
Odor
Frequency
Instead of BRAT diet for diarrhea, give them…
- Ricelytes
- Pedialyte
- Unsweetened Jello
- NO FRUIT JUICE
- NO GREASY/SPICY FOOD
Check skin tugor where?
inner thigh
abdomen
If patient is not voiding, avoid what when hanging IV?
KCl
— dehydration is most common in kids.
Isotonic
—- dehydration is when electrolyte deficit exceeds water deficit.
Hypotonic
— dehydration is when water loss exceeds electrolyte loss.
Hypertonic
—- dehydration is when electrolyte and water losses are in balanced proportions.
Isotonic
- most common in children
Child weighed 12 kg. he was weighed again and was 11 kg.
What is his percentage weight loss?
Mild/Moderate/Severe?
12-11 = 1 1/12 = 0.83
8.3% weight loss
Moderate (6-9%)
Mild Dehydration =
Moderate Dehydration =
Severe Dehydration =
3-5%
6-9%
10% or more
Cap refill for dehydration?
Mild = >2 secs
Moderate = 2-4 secs
Severe = >4 secs
Diarrhea causes…
metabolic acidosis b/c you lose bicarb
Blood Pressure for CV assessment.
Lower limit of SBP = 70 + (2*age in years)
ex: SBP lower limit of 8 yr old should be 86
Renal Perfusion should be minimally —
urinary output > 1mL/kg/hr
Shock signs
- Skin – cool, to cold, clammy
- Mottling
- Poor capillary refill
- Reduced urinary output
- Anaerobic metabolism –acidosis
- Increased blood viscosity
- Tachycardia, tachypnea
- Level of consciousness changes
