Week 3 Flashcards
Definition of dehydration
harmful reduction in overall fluid/water in the body which occurs when intake of fluid/electrolytes is less than loos of fluid/electrolytes
Causes of dehydration
Fever
*viral gastroenteritis
mild percents of dehydration and symptoms
infant 1-5%
older children 1-3%
mostly normal presenting, slightly dry mucosa, dec urine, normal or elevated HR
moderate percents of dehydration and symptoms
infant 6-9%
older children 4-6%
tachycardia, norm/low BP, urine output <1ml/kg/hr , sunken/dry membranes, thirsty
severe percents of dehydration and symptoms
infants >10%, 15% is shock
older children 6%, 9% is shock
rapid or weak pulse, oilguria/very little urine output, lethargic, drinks poorly or unable to drink
severity of dehydration equation
((pre-illness kg)-(illness kg))/(pre-illness kg) x 100
who gets oral rehydration and how much
- Mild dehydration: 50 mL/kg over 4-hour period, reassess statue every 2 hours
- Moderate dehydration: 100 ml/kg over 4 hour period, reassess hourly
- add 10ml/kg for every loose stool/vomiting ep
who gets IV fluids and how much
Severe dehydration
- Phase 1: 10-20 ml/kg/dose of NS or LR bolus over 30-60 mins. repeat up to 3 times
-Phase 2: 2.1fluid def (%dehydration x preillness weight over 100)
Monitoring parameters for fluid
- blood pressure
- output for age/weight
- clinical signs and symptoms of dehydration
- serum electrolytes/laboratory parameters
components of iv fluid
Sodium: NS (isotonic), 1/2NS (hypotonic)
Dextrose: 5%, 10% (neonates or infants w/ hypogylcemia)
Potassium: 20mEq/L
*Standard neg anion: chloride
Maximum rates for maintenance fluids
max of 100 ml/hr or 1.5-2x
who should not recieve KCL in IVF
renal failure/ AKI pts, possibly neonates
gastroenteritis 1st line treatment and dose, weight and age requirements, ae
Ondansetron pt >6mons
.15-.3mg/kg/dose
- 8-15kg 2mg/dose once
- 15-30 kg 4 mg/dose once
- over 30kg 8mg/dose
AE: cardiac se: qtc prolongation, arrhythmias *more common with iv and prolong inf times
gastroenteritis alternate treatment options
- Probiotic - low evidence
- Zinc - useful in pts with nutrient deficiencies causing diarrhea/malnutrition; <6 month 10mg/day for 10-14 days, >6 months 20mg/day for 10-14 days
- Caution with antidiarrheal agents
weight gain in neonates, infants, 2-10 years
- neonates experience diuresis after birth causing decrease in weight
- infants grow 20-30 grams/d
- 2-10 yo gain 2-3kg/yr
failure to thrive criteria
inadequate growth or inability to maintain growth in early childhood
- below 5th percentile on multiple occasions
- most common cause inadequate caloric intake
failure to thrive treatment
- breastfed infants: more often, lactation support, formula supplementation
- formula fed: concentrated formulas
** avoid juice or cow milk consumption
add rice cereal to food
kcal/oz in breast milk, recommendation, benefits
20kcal/oz
- recommended exclusive breast milk for first 6 months of life, may continue for first year and beyond
- decreased upper respiratory infections, UTIs, sepsis, sudden infant death
how much vit D
400 IU/Day in breast fed babies and formula if <1000 ml a day (4oz)
how much and who gets fluoride
0.5mg/day in infants >6months
*only for exclusively breastfed infants
- no flouride toothpaste until 2 yrs
how much iron
breatfed vs formula
preterm vs full
breastfed
- full term: 1 mg/kg/day for 4-12 mon
- preterm: 2mg/kg.day for 1-12 mon
Formula fed
- full term: formula with 4-12 mg/L until 12 month
- preterm: additional 1mg/kg/day for daily total of 2mg/kg/day
diets for infants and toddlers
- infants: solid starts at 4-6 months, veggie, fruits and meats start at 8-9 months
- toddlers: limit fruit juice
which formulation to avoid in infants
avoid enteric coated, modified release products, viscous suspensions
GER what is it and treatment
- passage of stomach contents into esophagus, very common, resolves by 12-14 months
- treatment: lifestyle mod- supine position for sleeping, change volume or frequency of feeding, hypoallergenic/ anti-reflux formula, thickening formula to dec density
GERD what is it, symptoms, risk factors
troublesome clinical symptoms with passage of stomach contents into esophagus
- heartburn, excessive regurgitation, food refusal, abdominal pain, poor weight gain
- risk factors: genetics (chromosome 13), neurologic impairment- cerebral palsy, obesity, lung disease, prematurity
GERD diagnosis
- Esophageal pH monitoring; pH<4 for 15-30 seconds
- upper gastrointestinal endoscopy
GERD non pharm treatment
**acid suppression not recommended as diagnostic test
- non-pharm: lifestyle modification, surgery (last line)
GERD mild symptoms treatment
- H2RA: famotidine, nizatidine, cimetidine
- quick onset, tolerance over time
GERD maintenance treatment
PPIs - Prazoles
- aes, costly, infections, rebound
- also first line for erosive esophagitis, other option is sucralfate
GERD treatment for pts w/ delayed gastric emptying
Prokinetics (metoclopramide, erthyromycin, bethanechol)
significant AEs
GERD prn treatment
Antacids
PPI metabolism, how long
- 2c19 and 3a4
- 2c19 activity elevated between age 1-4years. children would need more frequent dosing
- 12 week therapy
- taper over 4 weeks
growth charts
<2 years : who
>2 years: cdc
