Resuscitation and Fluids & Electrolytes

Question 1

How to manage a lethargic and unconscious patient with SM and Shock and increased HR during infusion x2

Answer 1

1. 15ml/kg Ringers lactate with 5% dextrose over 60 minutes
2. Stop IV fluids and give frusemide 1mg/kg

Question 2

Management of a conscious patient with SM and shock

Answer 2

5ml/kg resomal every 30 minutes for 2 hours PO/NGT

Question 3

Maintenance fluids for shock and severe malnutrition x2

Answer 3

PO/NGT
1. 5ml/kg hourly alternating resomal with F75
2. If they do not tolerate give RL + 5% dextrose at IV maintenance rate

Question 4

Management of shock and trauma x2

Answer 4

1. Give 10ml/kg whole blood over 20 minutes, give the other 10ml/kg blood or NS/RL over 20 minutes if no improvement
   (Max 40ml/kg for RL NS)
2. If there’s improvement give the other 10ml/kg over 2-3hours

Question 5

Describe Plan C for infants

Answer 5

NS/RL 30ml/kg over 1 hour then 70ml/kg over 5 hours

Question 6

Describe Plan c for children > 1 year

Answer 6

NS/RL 30ml/kg over 30 minutes and then 70ml/kg over 2.5 hours

Question 7

Describe plan c for all patients x2

Answer 7

ORS 5ml/kg PO
Continue breastfeeding

Question 8

Management of severe anemia and shock

Answer 8

20ml/kg while blood over 3-4 hours

Question 9

Management of shock and severe infection

Answer 9

1. Give 10-20ml/kg RS or NS over 30-60 minutes
2. If not improvement give 10ml/kg over 30 minutes

Question 10

Coma recovery position x3

Answer 10

Leg bent to support position
Arm bent to prevent rolling
Hand under chin to keep mouth open

Question 11

Signs of seizures x4

Answer 11

Increased tone
Eyes deviated
Facial twitching
Abnormal repetitive movement

Question 12

Describe plan A of dehydration x4

Answer 12

Increase frequency and volume of breastfeeding
2yrs: 50-100ml ors after loose stools
2yrs+: 100-200ml ors after loose stools
Give zinc

Question 13

Describe plan B for dehydration

Answer 13

Breastfeeding and additional fluids
Give ors in 4 hours
4M: 200-450ml
4M to 12M: 450-800ml
12M to 2Y: 800-960ml
2Y to 5Y: 960-1600ml

Question 14

State ions found in majority in ECF x3

Answer 14

Na, Cl, HCO3-

Question 15

State ions found in majority in ICF x4

Answer 15

K, Mg, PO4-, organic anions

Question 16

Causes of hypernatremia x4

Answer 16

Excessive salt intake
Diabetic insipidus
Volume losses
Poorly prepared formula

Question 17

What causes the difference in ionic content between ECF and ICF x2

Answer 17

1. Intracellular molecules do not cross the cell membrane ie barrier separating ECF and ICF
2. Activity of the Na/K ATPase pump 3:2 ratio

Question 18

When is ADH released and what is its function

Answer 18

Released when plasma osmolality is high and helps in reabsorption of fluid from the renal tubules

Question 19

Contents of maintenance fluids x5

Answer 19

Na, K, Cl, water and glucose

Question 20

When are replacement fluids given x2

Answer 20

Deficit replacement
Ongoing losses

Question 21

Define acidemia and its 3 causes

Answer 21

Blood ph < 7.35
Primary metabolic- decrease in HCO3-
Primary respiratory - increase in pCO2
Mixed acid base disorder

Question 22

Causes of metabolic acidosis x5

Answer 22

DKA
RTA - renal tubular acidosis
Medications eg salicylates
Diarrhea or other GI causes
Inborn errors of metabolism

Question 23

2 causes of respiratory acidosis

Answer 23

Obstruction or lung parenchymal disease
Neuromuscular disease > respiratory muscle weakness

Question 24

Signs and symptoms of hypernatremia x3

Answer 24

Thirst
Neurologic symptoms eg confusion, seizures, lethargy
Signs of hypovolemia

Question 25

5 causes of hyponatremia

Answer 25

DM
Renal failure
Pseudohyponatremia
Water intoxication
Hypervolemic states
Syndrome of inappropriate ADH secretion

Question 26

Signs and symptoms of hyponatremia x4

Answer 26

Nausea and vomiting
Altered mental state
Seizures
Musculoskeletal cramps and weakness

Question 27

2 functions of potassium and effect of aldosterone

Answer 27

Excitability of nerves
Contractility of muscles
Aldosterone causes renal excretion of K

Question 28

Causes of hypokalemia x4

Answer 28

GI loses
Acidosis
Insulin
Catecholamines
B agonists

Question 29

Causes of hyperkalemia x3

Answer 29

Renal disorders
Tissue breakdown - trauma, rhabdomyolysis
Transcellular shifts- metabolic alkalosis

Question 30

4 signs and symptoms of hyperkalemia

Answer 30

Muscle weakness
Parasthesia and paralysis
Narrow peaked T waves
Shortened QT interval

Question 31

Limitations of the Holliday Segar method

Answer 31

Does not take into account excess losses for example children with diarrhea, severe burns or vomiting

Question 32

Describe the Holliday segar method x3

Answer 32

100ml/kg/day for first 10kg
50ml/kg/day for the next 10kg
25ml/kg/day for each kg above 20

Question 33

Anion gap

Answer 33

Na - (Cl + HCO3)