Week 6 Clin Flashcards
Fundamentally, what three things can cause dehydration?
- More water going out (bleeding, vomiting, burns etc)
- Less fluid going in (stuck in a desert, quinsy)
- Third spacing (e.g. ascites, oedema)
Why are kids more likely to get dehydrated than adults?
- Larger SA:V ratio (also why they get cold)
- Less likely to be able to access fluids independently
Clinical features of mild/moderate/severe dehydration
- Mild: usually none; increased thirst, fatigue
- Moderate: lethargy/irritability, tachycardia, ↑RR, sunken eyes/fontanelle, slightly decreased skin turgor
- Severe: Reduced conscious state, hypo/tachy, cold extremities, weak pulses, markedly prolonged cap refill
History signs of dehydration
- Less food/fluid intake
- Increased urine/stool output, or vomiting
- Cystic fibrosis, diuretic use, diabetes
Dehydration investigations (when are these required?)
- Only required if dehydration is severe
- EUC and BGL, plus investigating cause of dehydration
Management of mild/moderate vs severe dehydration
- Mild/moderate, oral or NG fluids
- Severe, IV fluid rehydration
Indications for hospitalisation of a dehydrated person
- Persistent fluid loss
- Clinical signs of severe dehydration (what are these?)
- Latered mental status
- Cardiovascular symptoms/temp change
- High risk (young infants, elderly), kidney disease
Dehydration prevention strats for children
- Encourage regular fluid intake
- Increase fluids during heat, exercise etc
- Avoid sugary/caffeinated drinks
What are three resources that can be used to aid medication dosing in children?
- AMH Children’s Dosing Companion
- AMH
- eTG
What three ways can we determine dosing of childrens’ medications? Which is most common
- Actual body weight
- Ideal body weight (= organ maturation)
- Body surface area (heat loss etc)
Actual body weight is most common.
What’s one scenario where we might not use weight-based dosing in children’s prescribing?
Obese children.
How much normal saline do we give to children (in volume/weight of child)?
10-20ml/kg
How do we calculate fluid requirements in a dehydrated child? How does this differ if the child is severely dehydrated?
- Maintenance to meet normal needs
- Plus deficit to replace lost fluid
- Plus extra lost (such as vomiting/diarrhoea)
- In severe, fluids should be given immediately, then the should be replaced more slowly (prevent cerebral oedema and electrolyte imbalance)
