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Flashcards in Dehydration and IVF Deck (17):
1

Considerations when assessing dehydration (3)

Deficit
Maintenance
Ongoing losses

2

Fluid bolus when shocked, is this included in subsequent calculations of hydration

10-20ml/kg bolus
Not included

3

Senior medical assessment in red flag children

Short gut
Ileostomy
Kidney transplant/insufficiency, severe CVD
Fortified feeds
Suspect hypertonic solution

4

Best assessment of level of hydration

Comparison of bare weight with premorbid weight

5

Clinical signs in mild

No clinical signs
May be thirsty

6

Clinical signs in moderate

4-7%
Delayed CRT
+RR
Mildly decreased skin turgor

7

Clinical signs in severe

=/>7%
>3 second CRT, mottled skin
Poor perfusion
+RR
TachyC, hypotenive, -ve LOC
Deep acidotic (Kussmauls breathing)

8

Calculating fluid deficit

Body weight %
10kg child with 5% loss= 500ml deficit
1kg = 1000ml

9

When can replacement of deficit be rapid, slower and very slow

Rapid in most cases of gastroenteritis
Slower in DKA and meningitis
Slow in hypo/hypernatremia

10

Maintenance amount in non-dehydrated, unwell children and in particular with which diseases

Consider 2/3 maintenance, particularly with meningitis and pneumonia, risk of SIADH

11

Good fluid solutions in sick children: fluid and use

Normal saline: Bolus, deficit and ongoing losses
NS + 5% glucose (+20mmol KCL): Maintenance
1/2 NS + 5% glucose (+20mmol KCl): Maintenance

12

What must you not forget to do before fluids and request on fluid order forms

Check weight prior to commencing fluids
Re-check daily weights

13

How often to weight child if ongoing losses

6 hourly

14

When to assess electrolytes and glucose

Initially prior to fluids then in 24 hours if IVF are going to continue

15

What fluids should rarely be used outside the neonatal period

10% dextrose
15-20% dextrose
25-50% dextrose

16

Calculating maintenance

Patients wt Full MainT mls/day mls/hour
3 to 10kg 100 x wt 4 x wt
10 - 20kg 1000 plus 50 x (wt-10) 40 plus 2 x (wt-10)
>20kg 1500 plus 20 x (wt-20) 60 plus 1 x (wt-20)

17

Normal maximum amount of IVF

2400

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