Fluids and Electrolytes

Question 1

Outpatient management of gastroenteritis: ondansetron MoA

Answer 1

Selective 5-HT3 receptor antagonist

Question 2

Recommendation for ondansetron

Answer 2

Administer as a single dose, PO or IV, to assist patients in tolerating ORT

Question 3

Ondansetron ADEs

Answer 3

QTc prolongation, arrhythmias

Question 4

Outpatient management of gastroenteritis: probiotics MoA

Answer 4

assists in re-establishing normal intestinal flora, suppresses growth of pathogenic microorganisms through lactic acid, resulting in an acidic environment

Question 5

Probiotic recommendation

Answer 5

Low quality of evidence to support universal recommendation

Question 6

Outpatient management of gastroenteritis: zinc

Answer 6

Not really used in developed countries

Question 7

Dosage forms of zinc are expressed in the _____ form, which is ______% elemental zinc.

Answer 7

Expressed in the salt form, which is 23% elemental zinc

Question 8

Elemental zinc dose: <6 months

Answer 8

10mg/day x10-14 days

Question 9

Elemental zinc dose: ≥6 months and children

Answer 9

20mg/day x10-14 days

Question 10

Avoid what in gastroenteritis treatment in children?

Answer 10

Loperamide, antisecretory agents like bismuth subsalicylate and metoclopramide

Question 11

Dehydration and percent changes in weight: mild dehydration in infants

Answer 11

1-5%

Question 12

Dehydration and percent changes in weight: mild dehydration in older children

Answer 12

1-3%

Question 13

Dehydration and percent changes in weight: moderate dehydration in infants

Answer 13

6-9%

Question 14

Dehydration and percent changes in weight: moderate dehydration in older children

Answer 14

4-6%

Question 15

Dehydration and percent changes in weight: severe dehydration in infants

Answer 15

> 10%, ≥15% is shock

Question 16

Dehydration and percent changes in weight: severe dehydration in older children

Answer 16

> 6%, ≥9% shock

Question 17

Signs of mild dehydration in infants and older children (generally)

Answer 17

Overall, pretty much normal, but may have an increased pulse, decreased urine output, and slightly dry buccal mucosa

Question 18

Signs of moderate dehydration in infants and older children (generally)

Answer 18

Tachycardia, may have low BP, everything else is dry, sunken, cool, thirsty, may have slightly altered mental status

Question 19

Signs of severe dehydration in infants and older children (generally)

Answer 19

Basically, take the moderate dehydration signs and symptoms and make them more sunken, not drinking at all, rapid and weak pulse, almost comatose

Question 20

Formula for severity of dehydration

Answer 20

[pre-illness weight (kg)- illness weight (kg)]/pre-illness weight x 100%

Question 21

Fluid deficit formula

Answer 21

% dehydration x pre-illness weight / 100

Question 22

Components of an IVF bag

Answer 22

Sodium, dextrose, potassium

Question 23

Sodium concentration in IVF bags (typically)

Answer 23

NS!

Question 24

Dextrose concentration in IVF bags (typically)

Answer 24

D5W!

Question 25

Potassium concentration in IVF bags (typically)

Answer 25

20 mEq/L

Question 26

Additional electrolytes in IVF bags

Answer 26

Mg, phosphate, calcium based on individual needs

Question 27

Standard negative anion added to IVF bags

Answer 27

Chloride

Question 28

Formula for MIVF rate calculation: weight <10kg

Answer 28

100ml/kg

Question 29

Formula for MIVF rate calculation: weight 10-20kg

Answer 29

1000mL+50ml/kg (each kg >10kg)

Question 30

Formula for MIVF rate calculation: >20kg

Answer 30

1500ml+20ml/kg(each kg >20kg)

Question 31

Goal of therapy for dehydration treatment

Answer 31

Restore fluid and electrolyte balance in combination with early introduction of appropriate food and PO liquids as directed

Question 32

What will determine the treatment strategy selected?

Answer 32

Degree of dehydration

Question 33

Treatment for mild-moderate dehydration

Answer 33

ORT

Question 34

ORT dosing: mild dehydration

Answer 34

50ml/kg over a 4-hour period, reassess q2h

Question 35

ORT dosing: moderate dehydration

Answer 35

100mg/kg over a 4-hour period, reassess q2h

Question 36

ORT dosing: add an additional ________ per each _________

Answer 36

Add an additional 10ml/kg per each loose stool/vomiting episode for both mild and moderate dehydration

Question 37

Severe dehydration treatment (generally)

Answer 37

IVF

Question 38

Phase I of severe dehydration treatment

Answer 38

Give IV bolus fluids

Question 39

Phase I IVF bolus dose

Answer 39

10-20ml/kg/dose of NS or LR over 30-60 minutes; repeat up to 3 times PRN

Question 40

Phase II of severe dehydration treatment

Answer 40

maintenance replacement

Question 41

Phase II treatment: first 8 hours

Answer 41

calculate and replace fluid deficit

Question 42

Phase II treatment: next 16 hours

Answer 42

calculate and provide maintenance rate

Question 43

Monitoring parameters for dehydration treatment

Answer 43

Normalization of BP Adequate urine output for age/weight Improvement in clinical signs and symptoms of dehydration Normalization of serum electrolytes/laboratory parameters