Dehydration Flashcards

1
Q

What are the risk factors for dehydration in children

A

<1yo
Low birthweight
6 or more diarrhoeal stools in 24h
3 or more vomits in 24h
Not able to tolerate fluids
Stopped breastfeeding during illness
Signs of malnutrition

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2
Q

What are the causes of dehydration

A

Excessive loss:
- Diarrhoea e.g. Gastroenteritis
- Urine loss e.g. Diabetes mellitus, DKA, diabetes insipidus
- Vomiting e.g. DKA, Pyloric stenosis, gastroenteritis
- Sweat e.g. high fever, cystic fibrosis, hot climate, extended exercise
- Body fluids e.g. surgical loss, burns

Decreased intake: stomatitis, tonsilitis

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3
Q

What are the signs of dehydration on examination

A

Dry mucous membranes, mouth
Reduced skin turgor
Depressed fontanelle
Altered mental state, lethargic
Poorly perfused (prolonged CRT)
Tachycardia
Sunken eyes
Mottled skin

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4
Q

How is dehydration measured

A

Clinical signs
Weight:
- Water loss can be estimated from the difference between actual weight and a recent weight
- 1g of body weight is roughly equivalent to 1ml of water

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5
Q

How should dehydration be assessed

A

History
Examination
Height and weight
Estimate the severity of dehydration: mild (<5% loss), moderate (5-10%), severe (>10%)
Type of dehydration: hyponatraemic, isotonic, hypernatraemic
Is it significant?
- Reduced fluid intake but have produced wet nappies (albeit less than usual), a period of observation is recommended
- Ask the parent to increase the effort and persistence with feeds and keep in (but do not admit) until the child has passed a wet nappy or taken a whole feed without vomiting

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6
Q

What are the features of hyponatraemic dehydration

A

Serum sodium <130mmol/L
Commonly seen when fluid loss has been replaced with hypotonic solutions e.g. water, fizzy drinks
Lethargic with dry skin and poor turgor

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7
Q

What are the features of hypernatraemic dehydration

A

Hypernatraemic dehydration

Serum sodium >150mmol/L
Commonly seen in breast-fed babies in the first 2 weeks of life if there is difficulty establishing feeds OR concentrated formula feeds
Initially appears hungry but few clinical signs of dehydration
Skin feels doughy
Metabolic acidosis common

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8
Q

What is the management for mild dehydration

A

Treat at home using oral rehydration therapy
First line: Dioralyte or Rehidrat (oral solution, effervescent tablets or powders, reconstituted with freshly boiled and cooled water)
+ continue to breastfeed OR return to normal bottle milk feed once diarrhoea has settled

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9
Q

What is the management for moderate-severe dehydration

A
  1. Admit: Those who have fluid intake below threshold (calculate exactly) AND had no wet nappies in the last 24h
  2. Calculate the fluid replacement required:
  3. Start fluid replacement: 0.45% saline with 5% dextrose
    - Shock: colloid or bolus
    - Non-shock: slow rehydration over 24h
    - Hypernatraemia: correct over 48h (risk of cerebral oedema)
  4. Start an input-output chart
  5. Weight the child 2x daily
  6. Frequent serum electrolyte measurement
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10
Q

How is fluid loss calculated

A

Ascertain the difference between most recent/normal weight and their current weight and use clinical signs to estimate the % dehydration

Deficit (mL) = (actual weight in grams × 110%) − actual weight

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11
Q

What are the maintenance fluid requirements for children

A

100 ml/kg/day for the first 10kg of weight
50 ml/kg/day for the next 10kg of weight
20 ml/kg/day for weight over 20kg

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12
Q

How is fluid maintenance calculated

A
  1. Calculate deficit
    - Deficit (mL) = (actual weight in grams × 110%) − actual weight
  2. Assess the maintenance fluids required
  3. Maintenance + deficit
  4. Assess any continuing losses
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13
Q

Why should fluids be given slowly in hypernatraemic dehydration

A

Risk of cerebral oedema if sodium falls to quickly
Given over 48h

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14
Q

Why may you use less maintenance fluids in bronchiolitis, meningitis etc.

A

Due to SIADH

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15
Q

What is the management for shock

A

bolus fluids (these don’t need to be subtracted from the dehydration corrections):
- 20mL/kg 0.9% NaCl over 10 minutes: most situations, new DKA guidelines
- 10mL/kg 0.9% NaCl over 60 minutes: trauma, fluid overload, heart failure

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