Fluids and developmental milestones Flashcards
(56 cards)
maintenance fluids neonates
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)
estimating weight ?
(Age + 4) x2 = weight in kg
maintenance fluids children
0.9% sodium chloride + 5% glucose (+/- KCl)
Weight Daily (ml/24h)
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
signs of shock
% defecit?
Reduced consciousness
Cold, mottled peripheries
Low blood pressure (decompensated shock)
Prolonged capillary refill time
Weak peripheral pulses
Anuria
tachycardia
tachypnoea
10%
signs of dehydration
%defecit?
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
calculating fluids to correct deficit
Deficit(%) x 10 x Wt(kg)
+ maintenance
hydration if can tolerate oral
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)
what bolus would you give in shock
10 mls/kg of 0.9% sodium chloride bolus
If they were shocked and in DKA then you would not minus the initial bolus when calculating full regime
signs of hypernautraemic dehydration?
jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma
Gross motor referrals
Can’t sit without support at 12 months
Can’t walk unsupported at 18 months
no head lag on being pulled to sit
3 months
rolling over
5 months
sits without support
7-8 months
crawl (+pull to stand)
9 months
walking (cruising, with hand held)
12 months
run
2 years
walk up stairs with no rail
3 years
hops on one leg
4 years
reaches for object, hold briefly
3 months
palmar grasp, transfer object from one hand to another
6 months
early pincer grip, points with finger
9 months
good pincer grip
12 months
Ages for stacking bricks
15 months - tower of 2
18 months - tower of 3
2 years - tower of 6
3 years - tower of 9
ages for drawing
18 months - circular scribble
2 years - straight line
3 years - circle
4 years - cross and RvL
4.5 years - square
5 years - triangle
