Vomiting/Diarrhea Flashcards
What are some of the causes of vomiting in older children?
- Acute infections
- Appendicitis
- Malrotation of the small intestine
- Increased intracranial pressure
- Abdominal migraine
- Inborn errors of metabolism
- Eating disorders
- Cyclic vomiting
What are the causes of vomiting in infants?
-Reflux due to immaturity of GE sphincter is the commonest cause. Usually transient. Thickening feeds can help. -Gastroenteritis -UTI -Meningitis -Pneumonia -Tonsillitis -Otitis media
- Pyloric obstruction: projectile non-bilious vomiting
- Intussuseption : episodic severe abdominal pain
What are the levels of dehydration expressed as a percentage of volume lost?
3-5% volume deficit = mild dehydration
6-9%. “ “. = moderate “
10% +> = = severe dehydration
What are the general guidelines re: fluid replacement ?
Why should one avoid high glucose and high sodium fluids in diarrhea
Rehydration phase – The fluid deficit is replaced quickly over three to four hours, returning the patient to a euvolemic state. avoid accumulation of a large amount of fluid in the stomach that might trigger vomiting. Five mL (one teaspoon), administered every one
to two minutes, allows as much as 150 to 300 mL/hour to be given
During both phases, ongoing losses from diarrhea and vomiting are replaced with ORS. If the losses can be measured accurately, 1 mL of ORS should be administered for each gram of diarrheal stool. Alternatively, 10 mL/kg of body weight of ORS should be administered for each watery or loose stool, and 2 mL/kg of body weight for each episode of emesis.
Oral Rehydration Solution (low osmolarity 240-250 mOsm/l)
Maintenance fluid requirement:
- first 10 Kg = 100 ml/Kg > 4ml/kg/hr
- second 10 Kg = 50 ml/ Kg> 2ml/kg/hr
- each additional Kg = 20 ml/Kg> 1ml/kg/hr
Dehydration: give 50 ml/ Kg of ORS over 4 hours in addition to maintenance requirements
Shock: give 20ml/Kg NSS rapidly and repeat as needed
Hi glucose fluids Will result in residual glucose in the lumen, which raises the osmolality in the lumen. As the osmolality increases the
water absorption decreases.
Fluids with high sodium content will increase diarrhea losses as there is less organic solute(glucose) for facilitated sodium transport. These fluids may also contribute to hypernatremia.
What are the physical findings in mild dehydration?
Examination normal. Maybe a history of reduced urine output.
What are the physical findings in moderate dehydration and children?
Signs and symptoms are now apparent and can include the following: tachycardia, orthostatic falls in blood pressure, especially with orthostatic changes, decreased skin turgor, dry mucous membranes, irritability, decreased peripheral perfusion with a delay in capillary refill between two and three seconds, and deep respirations with or without an increase in respiratory rate. There may be a history of reduction in urine output and decreased tearing and, in infants, an open fontanelle will be sunken on physical examination.
What are the physical findings in severe dehydration in children?
Severe dehydration (≥10 percent volume loss) – Such children typically have a near-shock presentation as manifested by hypotension, decreased peripheral perfusion with a capillary refill of greater than three seconds, cool and mottled extremities, lethargy, and deep respirations with an increase in rate. Severe hypovolemia requires immediate aggressive isotonic fluid resuscitation to restore the ECV and prevent ischemic tissue injury.
How does gastroenteritis with dehydration affect
Serum potassium levels?
Patients with diarrhea often are hypokalemic
because diarrheal fluids contain potassium. However if acidosis is present they may present with hyperkalemia. As the acidosis is corrected they may get severely hypokalemic
Describe how vomiting and diarrhea affect the acid base balance of the body.
Diarrhea leads to a loss of bicarbonate and metabolic acidosis. A bicarbonate less than 17 indicates severe dehydration from diarrhea
Vomiting leads to a loss of hydrochloric acid and a metabolic alkalosis.
Which beverages should not be used in gastroenteritis to replenish fluids?
The following fluids are hyper osmolar and should not be used:
-Apple juice
-gator aid
-chicken broth
-soda
-Ginger Ale
Also do not use plain water or tea as they are both hypo osmolar
What medication is for severe vomiting!
Zofran(odansetron): given as a single dose(do not repeat):Dosing
In our practice, we recommend a single oral dose of odansetron, 0.1 to 0.15 mg/kg (maximum does of 8 mg), to reduce vomiting and facilitate ORT in patients with gastroenteritis [36,50].
What are the BP parameters for children?
Low systolic blood pressure for children is defined as:
Less than 70 mmHg from 1 month to 1 year
Less than (70 mmHg + [2 x age]) from 1 to 10 years
Less than 90 mmHg from 11 to 17 years
