Week 3

Question 1

Definition of dehydration

Answer 1

harmful reduction in overall fluid/water in the body which occurs when intake of fluid/electrolytes is less than loos of fluid/electrolytes

Question 2

Causes of dehydration

Answer 2

Fever
*viral gastroenteritis

Question 3

mild percents of dehydration and symptoms

Answer 3

infant 1-5%
older children 1-3%
mostly normal presenting, slightly dry mucosa, dec urine, normal or elevated HR

Question 4

moderate percents of dehydration and symptoms

Answer 4

infant 6-9%
older children 4-6%
tachycardia, norm/low BP, urine output <1ml/kg/hr , sunken/dry membranes, thirsty

Question 5

severe percents of dehydration and symptoms

Answer 5

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

Question 6

severity of dehydration equation

Answer 6

((pre-illness kg)-(illness kg))/(pre-illness kg) x 100

Question 7

who gets oral rehydration and how much

Answer 7

• 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

Question 8

who gets IV fluids and how much

Answer 8

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)

Question 9

Monitoring parameters for fluid

Answer 9

• blood pressure
• output for age/weight
• clinical signs and symptoms of dehydration
• serum electrolytes/laboratory parameters

Question 9

components of iv fluid

Answer 9

Sodium: NS (isotonic), 1/2NS (hypotonic)
Dextrose: 5%, 10% (neonates or infants w/ hypogylcemia)
Potassium: 20mEq/L
*Standard neg anion: chloride

Question 10

Maximum rates for maintenance fluids

Answer 10

max of 100 ml/hr or 1.5-2x

Question 11

who should not recieve KCL in IVF

Answer 11

renal failure/ AKI pts, possibly neonates

Question 12

gastroenteritis 1st line treatment and dose, weight and age requirements, ae

Answer 12

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

Question 13

gastroenteritis alternate treatment options

Answer 13

• 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

Question 14

weight gain in neonates, infants, 2-10 years

Answer 14

• neonates experience diuresis after birth causing decrease in weight
• infants grow 20-30 grams/d
• 2-10 yo gain 2-3kg/yr

Question 15

failure to thrive criteria

Answer 15

inadequate growth or inability to maintain growth in early childhood
- below 5th percentile on multiple occasions
- most common cause inadequate caloric intake

Question 16

failure to thrive treatment

Answer 16

• breastfed infants: more often, lactation support, formula supplementation
• formula fed: concentrated formulas
  ** avoid juice or cow milk consumption
  add rice cereal to food

Question 17

kcal/oz in breast milk, recommendation, benefits

Answer 17

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

Question 18

how much vit D

Answer 18

400 IU/Day in breast fed babies and formula if <1000 ml a day (4oz)

Question 19

how much and who gets fluoride

Answer 19

0.5mg/day in infants >6months
*only for exclusively breastfed infants
- no flouride toothpaste until 2 yrs

Question 20

how much iron
breatfed vs formula
preterm vs full

Answer 20

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

Question 21

diets for infants and toddlers

Answer 21

• infants: solid starts at 4-6 months, veggie, fruits and meats start at 8-9 months
• toddlers: limit fruit juice

Question 22

which formulation to avoid in infants

Answer 22

avoid enteric coated, modified release products, viscous suspensions

Question 23

GER what is it and treatment

Answer 23

• 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

Question 24

GERD what is it, symptoms, risk factors

Answer 24

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

Question 25

GERD diagnosis

Answer 25

• Esophageal pH monitoring; pH<4 for 15-30 seconds
• upper gastrointestinal endoscopy

Question 26

GERD non pharm treatment

Answer 26

**acid suppression not recommended as diagnostic test
- non-pharm: lifestyle modification, surgery (last line)

Question 27

GERD mild symptoms treatment

Answer 27

• H2RA: famotidine, nizatidine, cimetidine
• quick onset, tolerance over time

Question 28

GERD maintenance treatment

Answer 28

PPIs - Prazoles
- aes, costly, infections, rebound
- also first line for erosive esophagitis, other option is sucralfate

Question 29

GERD treatment for pts w/ delayed gastric emptying

Answer 29

Prokinetics (metoclopramide, erthyromycin, bethanechol)
significant AEs

Question 30

GERD prn treatment

Answer 30

Antacids

Question 31

PPI metabolism, how long

Answer 31

• 2c19 and 3a4
• 2c19 activity elevated between age 1-4years. children would need more frequent dosing
• 12 week therapy
• taper over 4 weeks

Question 32

growth charts

Answer 32

<2 years : who
>2 years: cdc