Dehydration

Question 1

What is maintenance fluid

Answer 1

Volume of daily fluids needed to replace insensible water loss (stool, urine, evaporation)

Question 2

What are the components of maintenance fluid?

Answer 2

• Na
• K
• water
• glucose

Question 3

Is maintenance fluid rich in calories or not?

Answer 3

No, patient on maintenance fluid lose 0.5% to 1% of their weight

Question 4

What is the goal of maintenance therapy?

Answer 4

Prevent:

• dehydration
• electrolyte Disorders
• ketoacidosis
• protein degeneration

Question 5

What is the commonest method to use for calculating maintenance fluid

Answer 5

Holliday segar method

Question 6

What is the most accurate way to calculate maintenance fluid?

Answer 6

Body surface area

Used in renal failure\oncology

Question 7

How does the caloric expedenture method work?

Answer 7

The amount of calories needed= amount of fluids given

Question 8

How to preform the holiday-segar method on fluid?

Answer 8

First 10Kg: 100ml\kg\d “4ml in hr”
Second 10: + 50ml\kg\d “2ml in hr”
Third 10: +20ml\kg\d “1ml in hr”

Question 9

How to preform the holiday-segar method on electrolyte?

Answer 9

• Na: 3meq\100 ml “range of 2-4”

- K: 2meq\100ml

Question 10

What are the available IVF for hydration

Answer 10

• normal saline (0.9Nacl - half - quarter)

- ringer lactate (balanced)

Question 11

What is the Na and cl values in 0.9Nacl

Answer 11

154
Then for the half (you half)
Then for the quarter (you half\half)

Question 12

What is the Na and Cl and K concentration in ringer lactate

Answer 12

Na: 130
Cl: 109
K: 4

Question 13

In hospitalized patient, what can we use from the following solutions?

• 0.9NaCl
• 0.45 NaCl
• 0.2 NaCl

Answer 13

0.9 and 0.45 but not 0.2

Question 14

Change in urine (by renal failure) or stool by (enterostomy\colestomy) changes the maintenance fluid in that it:

Answer 14

Will make us eliminate it from the insensible water loss

“Urine 60%, evaporation 35%, stool 5%”

Question 15

Who shows signs of dehydration first, infant or older children?

Answer 15

Older children due to low ECF

Question 16

What happens to ECF as infant gro

Answer 16

Decreased

Question 17

Why are younger children more susceptible to dehydration?

Answer 17

1- large body water content
2- renal immaturity
3- inability to meed their needs “breastfed”

Question 18

How does Cystic fibrosis cause dehydration?

Answer 18

Due to the increased sweating

Question 19

What are the 3 questions to ask in dehydration assessement?

Answer 19

1- how much
2- how fast
3- what route

Question 20

How much is the dehydration is answered by:

Answer 20

Severity (weight loss - clinical mainfestations)

“%: preillness weight - illness weight\peillness weight X 100”

Question 21

What is the percentage of dehydration, for mild, moderate and severe?

In infant <10kg

Answer 21

Mild: 5%
Moderate: 10%
Severe: 15%

Question 22

What is the percentage of dehydration, for mild, moderate and severe?

In children >10kg

Answer 22

Mild: 3%
Moderate: 6%
Severe: 9%

Question 23

How to measure the deficit of dehydration assessment

Answer 23

The percentage of weight loss X 100 X Kg

Question 24

Concentrated urine indicates

Answer 24

Moderate to severe dehydration

Question 25

What will you obtain from the dehydration history?

Answer 25

``` 1- weight loss 2- intake of fluid\appetite 3- urine output 4- stool output 5- emesis 6- activity level 7- underlying illness ```

Question 26

What’s the benefit of asking about emesis if it’s not associated with dehydration

Answer 26

It will determine if it’s oral intake or IV

Question 27

What is the capillary refill for mild moderate and severe dehydration

Answer 27

Mild: 2sec Mod: 2-4sec Severe: >4 sec

Question 28

What is the mucus membrane in mild, moderate and severe dehydration

Answer 28

Mild: normal Mod: dry Severe: parched and cracked

Question 29

Tears in severe dehydration is

Answer 29

Absent

Question 30

What is the BP in moderate dehydration

Answer 30

Normal but orthostasis

Question 31

Thready pulse is characterstic for which scale of severity?

Answer 31

Moderate. | Severe is faint or impalpable

Question 32

A common finding in examination of skin in severe dehydration is called

Answer 32

Tenting

Question 33

Sunken fontanelle indicate

Answer 33

Severe dehydration

Question 34

Name the 3 signs that are most predictive of moderate to severe dehydration

Answer 34

1- prolonged capillary refill 2- delayed skin turgor 3- increase respiratory rate

Question 35

Labratory investigations in dehydration:

Answer 35

- Serum Na - blood gas - BUN\creatinine - urine analysis - potassium - HCT

Question 36

What is the creatinine\BUN ratio that indicate dehydration instead of renal failure?

Answer 36

20:1 anything less than this is renal failure

Question 37

What are the findings in moderate to severe dehydration in blood gas?

Answer 37

Metabolic acidosis w\low HCO3 meq

Question 38

Potassium is indicated in the workup for dehydration because it’s associated with

Answer 38

Gasteroenteritis

Question 39

What are the finding of urine analysis in dehydration

Answer 39

High specific gravity | Low sodium

Question 40

What is HCT in dehydration?

Answer 40

Hight

Question 41

How to answer the how fast question in dehydration?

Answer 41

According to the type | “Plasma Na level”

Question 42

Major determinant of serum osmolality is

Answer 42

Sodium “as long as there is no renal failure”

Question 43

Differentiate isonatermic, hyponatermic, and hypernatermic dehydration

Answer 43

130-150 | More is hypernatermic, less is hypo

Question 44

What happens to the cell in hypo vs hypernatermic dehydration?

Answer 44

Hypo: swells Hyper: shrink

Question 45

Differentiate between clinical presentation of hyponatermic and hypernatermic:

Answer 45

Hypo: cold, clammy skin, lethargy Hyper: irritble, doughy, BP elevated Both seizures

Question 46

Doughy skin is associated with

Answer 46

Hypernatermia

Question 47

What is the best route for rehydration? “Mild to mod”

Answer 47

Oral | “Lower cost, no need of IV, done at home”

Question 48

What is ORS composed of “solutes”?

Answer 48

1 glucose 2sodium

Question 49

How to make ORS?

Answer 49

1l water + 6 ts sugar + 1\2 ts salt + 1\4 ts baking soda

Question 50

How long should ORT be given?

Answer 50

Over 4 hours in small volume

Question 51

What are the contraindication of ORT?

Answer 51

Severe dehydration - altered mental state - intestinal ileus - severe electrolyte imbalance - care giver can’t provide ORT

Question 52

What happens in hypotonic dehydration and when it’s treated rapidly

Answer 52

- hypotonic: swelling of the cell in the brain (edema) | - treatment (rapid): shrinkage leasing to osmolar demylination (central pontine myelnolysis)