Fluid prescribing children

Question 1

estimating weight ?

Answer 1

(Age + 4) x2 = weight in kg

Question 2

signs of shock

% defecit?

Answer 2

Reduced consciousness
Cold, mottled peripheries
Low blood pressure (decompensated shock)
Prolonged capillary refill time
Weak peripheral pulses
Anuria
tachycardia
tachypnoea

10%

Question 3

signs of dehydration

%defecit?

Answer 3

Irritable, lethargic, altered response*
appears unwell*
sunken eyes*
reduced skin turgor*
tachycardia*
tachypnoea*

Thirst
Dry lips
Decreased urine output
Normal blood pressure
Normal CRT
Skin colour normal

5%

*indicates at risk of progression to shock

Question 4

hydration if can tolerate oral

Answer 4

give 50 ml/kg low osmolarity oral rehydration solution (ORS) solution over 4 hours, plus ORS solution for maintenance, often and in small amounts

continue breastfeeding

consider supplementing with usual fluids (including milk feeds or water, but not fruit juices or carbonated drinks)

Question 5

signs of hypernautraemic dehydration?

Answer 5

jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma

Question 6

Calculating drop rate

Answer 6

( mls / minutes ) x drop factor (on packet)

Eg (210mls/1440 mins) x 20 = 2.9 = 3 drops per minute

Question 7

How to decide what indication to give fluid to children eg do they need resus, maintenance, somthing else?

Answer 7

Is the pt shocked/haemodynamically compromised? –> yes –> resus fluids

can the pt meet their fluid requirements enterally? –> no –> are there signs of clinical dehydration?
–> yes –> calculate fluid defecit + routine maintenance
–> no –> calculate routine maintenance

Question 8

when a child is on iv fluids what tests need to be reviewed every 24 hours

Answer 8

U&Es and plasma glucose

Question 9

child resus fluids

Answer 9

10ml/kg sodium chloride 0.9% over <10 minutes

Question 10

neonate resus fluids

Answer 10

10-20ml/kg sodium chloride 0.9% over <10 mins

Question 11

how to calculate fluid defecit

Answer 11

fluid defecit (%) = %dehydration x weight (kg) x 10

dehydration = 5%
shock = 10% (but youd be doing resus in this scenario anyway)

fluid defecit + routine maintenance = total to be given in 24 hours

Question 12

maintenance fluids children

Answer 12

isotonic crystalloid - unclear if this includes glucose
0.9% sodium chloride (+ 5% glucose (+/- KCl))

First 10 kg 100 ml/kg
Next 10 kg 50 ml/kg
Every other kg 20 ml/kg

Rate (ml/h): Total (ml) / 24

Sodium: 2-4mmol/kg/day
Potassium: 1-2mmol/kg/day

Question 13

maintenance fluids neonates ie <28 days

Answer 13

10% dextrose
Day 1 – 60 mls/kg/day
Day 2 – 90 mls/kg/day
Day 3 – 120 mls/kg/day
Day 4 – 150 mls/kg/day

From day 2
Na 3 mmol/kg/day
K 2 mmol/kg/day
Ca 1 mmol/kg/day (rarely)

Question 14

in terms of maintenance fluids what is your upper limit children

Answer 14

over a 24‑hour period, males rarely need more than 2,500 ml and females rarely need more than 2,000 ml of fluids.

Question 15

prescribe an iv fluid for children for hypoglycaemia

Answer 15

“500mg/kg to be administered as glucose 10%”

500 x kg = xmg
glucose 10% = 10g=100ml
= 0.1g = 1ml
100mg =1ml
xmg = yml

(x x 1)/100 = yml

Question 16

first step in DKA management

Answer 16

fluid resuscitation