Fluid and electrolytes Flashcards
(32 cards)
What is the major cation and anion in intracellular fluid?
Potassium and Phosphate
What is the major cation and anion in extracellular fluid?
Sodium and chloride
What are the signs of intracellular dehydration?
1) Reduced skin turgor
2) Sunken eyeballs
3) Sunken fontanelle
What are the signs of interstitial fluid overload?
Pitting edema
What are the signs of intravascular dehydration?
1) ↑HR
2) ↓BP
3) ↓JVP
4) CRT >3cm
5) ↓tears
6) oliguria
What is the percentage body weight loss in mild, moderate and severe dehydration?
Mild: 3-5%
Moderate: 6-9%
Severe: >10%
What are the red flags for dehydration in a child?
1) S/S of severe dehydration including shock
2) Altered mental state
- dehydration, hypotension, uremia, acidosis, hypona, hypogly
3) Seizures
- hypoNa, hypogly
How is mild dehydration in children managed?
1) Treat cause
2) Volume= maintenance + replacement
- if can, do oral
- if cannot/dont want, consider entered tube feeding
- if cannot oral, IV fluids
3) Monitor hydration status
How is moderate dehydration in children?
1) Check complications:
- AKI
- Acid-base
- electrolytes
- glucose abnormalities
2) Determine type of dehydration
3) IV fluids dependent on type of dehydration and complications
4) Encourage oral fluid intake
5) Monitor hydration and state of complication
How is severe dehydration in children managed?
1) Fluid resus:
- IV 10-20ml/kg 0.9% normal saline and assess response
2) Determine type of dehydration
3) Check complications:
- AKI
- Acid-base
- electrolytes
- glucose abnormalities
4) Give IV fluids depending on type of dehydration of complications
5) Encourage oral fluids
6) Monitor hydration status
What are the 3 volumes of fluid that need to be added to the final fluid replacement in dehydration?
1) Maintenance fluid
2) Correction of deficit
3) Replacement of ongoing fluid loss
What are the 2 phases of treatment in dehydration?
1) Rehydration phase
- water + electrolytes rapidly within 3-4hrs
2) Maintenance phase
- restoration of ongoing losses + calories
When is oral rehydration therapy indicated?
Mild-to-moderate isonatremic dehydration (eg. viral GE)
- NOT appropriate for hypo/hyperNa
How is ORS ordered?
Rehydration: 50-100ml/kg of ORS over 4 hrs
Maintenance: 10ml/kg for each watery stool OR 2ml/kg for each vomitus
When is IV rehydration indicated?
1) Shock/severe dehydration
2) Dehydration with altered level of consiousness or severe acidosis
3) Worsening/refractory dehydration
4) Persistent vomiting
5) Severe abdominal distension and ileus
6) Hypo/HyperNa dehydration
What is the clinical definition of polyuria?
Excessive urine volume
- > 3L/day in adults
- > 2L/m2/day in children
- > 5ml/kg/hour (useful cutoff when reviewing urine output
chart)
When should you suspect a polyuria cause other than primary polydipsia?
When there is thirst but polyuria rather than oliguria
(usually ↓TBW → ↑serum Osm → ↑ADH → ↑thirst and water consumption → normalised)
What are nocturia and enuresis indicative of in polyuria?
Renal causes rather than polydipsia
What are the associated symptoms of DM?
1) Polyuria, polydipsia
2) Polyphagia
3) Weight loss
What are the associated symptoms of hypercalcemia?
1) Anorexia
2) Vomiting
3) Constipation
What are the associated symptoms of central DI?
1) Visual changes
2) Headache
3) Sexual precocity
4) Hx of brain surgery/trauma
What do the findings of weak urinary stream, large kidneys and a palpable bladder indicate?
Obstructive uropathy
What does findings of a precocious puberty, neurological deficits, bitemporal hemianopia, optic atropy, papilloedema
Central diabetes insipidus
What is the top differential for periorbital swelling?
Angioedema 2° to anaphylaxis
