Fluids and electrolytes

Question 1

Sources of fluid loss

Answer 1

• Insensible losses
• Urinary
• Fecal

Question 2

Insensible losses in kids: %

Answer 2

2/3 through skin (kids skin is a higher % than of their body mass
1/3 through respiratory tract (kids have an increased RR)

Question 3

Why are kids more susceptible to rapid fluid depletion before age 2? What kind of fluid are kids more likely to lose?

Answer 3

Children maintain a larger amount of ECF until about 2 years

Kids are more likely to lose ECF

Question 4

Why do infants and children less than 2 lose a greater proportion of fluid each day? (4)

Answer 4

• Greater amount of BSA causes increase in insensible losses
• Increased metabolic rate: More fluid needed for metabolism
• Greater amount of metabolic wastes excreted by kidney
• Glomeruli tubules and nephrons of kidney are immature and unable to conserve H20

Question 5

% H20:

• Infants
• Adults

Answer 5

75% in infants

55-65% in adults

Question 6

Solutes in ECF (4)

Answer 6

Sodium
Bicarbonate
Cloride
Calcium

Question 7

Solutes in ICF (4)

Answer 7

Potassium
Magnesium
Calcium
Phosphorus

Question 8

How do you calculate the daily requirements for a kid?

Answer 8

Weight in kg:

• 100 mL/kg for first 10kg
• 50 mL/kg for second 20 kg
• 20 mL/kg for remainder of weight in kg

(To obtain rate per hour, divide total amount by 24 hours)

Question 9

Urine output:

• Infants and toddlers
• Preschool / young school age
• Older school age / ados:

Answer 9

• Infants and toddlers
  >2-3 mL/kg/hr
• Preschool / young school age
  >1-2 mL/kg/hr
• Older school age / ados:
  0. 5-1.0 mL/kg/hr

Question 10

Serum sodium:

• Hypotonic Dehydration
• Isotonic Dehydration
• Hypertonic Dehydration

Answer 10

HYPO: 150 mEq/L

Question 11

What should you watch for with isotonic dehydration?

Answer 11

Hypovolemic shock

Question 12

What should you watch for with hypotonic dehydration?

Answer 12

SIDAH: Syndrome of inappropriate ADH secretion

Question 13

Four causes of SIDADH

Answer 13

• Bacterial meningitis
• Head injury
• Tumor
• Lasix meds

** Associated with hypotonic dehydration

Question 14

Indication of isotonic solution

Answer 14

Treatment of vascular dehydration; replaces sodium chloride

Question 15

Action of hypotnoic solution

Answer 15

Hydrates cells, pulls fluid from vascular space into cellular space.

Question 16

Action of Hypertonic solution

Answer 16

Draws fluid into interstitial space, leading to increased extracellular volume both in vascular and interstitial space

Question 17

Action of isotonic solution

Answer 17

Hydrates extracellular compartment, replaces fluid volume without disrupting the intracellular and interstitial volumes

Question 18

Indication of hypotonic solution

Answer 18

Tx Hypertonic dehydration

Question 19

Indication of hypertonic solution (2)

Answer 19

Tx of hypotonic dehydration

Tx of circulatory collapse

Question 20

What happens to vital signs with isotonic dehydration? (2)

Answer 20

• Elevation in Temp

* Elevation in HR-

Question 21

What happens to vital signs with Hypertonic Dehydration? (2)

Answer 21

• Elevation in Temp

* Elevation in HR

Question 22

What happens to vital signs in Hypotonic Dehydration? (2)

Answer 22

• Hypertension (fluid retention) Edema

* Might not see huge increase in CO

Question 23

Why is Pedialyte a better choice than cola, apple juice, gatorade or chicken broth to re-hydrate? (5)

Answer 23

• Lower carbs than other bevs listed
• Lower sodium than chx broth
• Good source of potassium
• Most basic
• Lowest osmolarity

Question 24

Serum Potassium…

• in Hypokalemia
• in Hyperkalemia

Answer 24

• Hypo: Less than 3.5 mmol/L

* Hyper: Greater than 5.8 mmol/L

Question 25

Causes of Hypokalemia (4)

Answer 25

- Increased K+ excretion - Decreased K+ intake - Loss of K+ - Metabolic Alkalosis

Question 26

Causes of Hyperkalemia (4)

Answer 26

- Massive cell death (sickle cell, leukemia, cancers) - Excessive or too rapid K+ infusion - Metabolic acidosis - Decreased K+ excretion (renal failure)

Question 27

What disorder causes hyperkalemia initially, then hypokalemia

Answer 27

- Diabetes (Type I): Causes HYPERkalemia initially, then HYPOkalemia because of diuresis

Question 28

What are hypokalmic patients at risk for? What should you watch for?

Answer 28

Dig toxicity - Bradycardia - Cardiac arrythmias - Vomiting

Question 29

How to treat Hyperkalmia (7)

Answer 29

* Manage underlying condition * Lasix (K+ wasting) * Kayexalate * IV Bicarbonate * Peritoneal dialysis (if renal failure) * Manage diet

Question 30

How does Kayexalate work?

Answer 30

PO, binds to K+ and excreted in stool

Question 31

How does IV bicarbonate work?

Answer 31

Drives K+ back into cell

Question 32

What should you be careful of in administering K+ by IV?

Answer 32

*Make sure patient has good urine output before adding K+ to bag. (80% of K+ is lost through urine, so lack of urine output could cause hyperkalemia.) *Also, concentrated potassium causes a person to go into VTach.

Question 33

What type of patient is at risk for hyperkalemia?

Answer 33

Burn patients

Question 34

What might be the cause of a high K+ count in a baby?

Answer 34

Squeezing heel on a heel stick --> Lyse cells --> Inaccurately high K+ count

Question 35

5% weight loss is ___ dehydration 10% weight loss is ____ dehydration 15% weight loss is ____ dehydration

Answer 35

Mild Moderate Severe

Question 36

How do you calculate a patient's dehydration weight loss?

Answer 36

Original weight minus present weight Divided by original weight

Question 37

Two of the following factors indicate >5% dehydration:

Answer 37

* Capillary refill > 2 seconds * Absent tears * Dry mucus membranes * Ill appearance

Question 38

Treatment of mild dehydration (<5%) * 3 things

Answer 38

* Rehydrate with ORS (50mL/kg over 4 hours) * Replace ongoing losses with ORS * Age-appropriate diet after rehydration

Question 39

Treatment of moderate dehydration (5-10%) * 3 things

Answer 39

* Rehydrate with ORS (100mL/kg over 4 hours) * Replace ongoing losses with ORS * Age-appropriate diet after rehydration

Question 40

Treatment of severe dehydration (>10%) * Four things

Answer 40

* IV resuscitation with normal saline or Ringer Lactate (20-40 mL/kg for one hour) -- re-assess and repeat if necessary * Begin Oral Replacement Therapy when pt is stable * Replace ongoing losses with ORS * Age-appropriate diet after rehydration

Question 41

What causes diarrhea?

Answer 41

Abnormal intestinal H20 and electrolyte transport

Question 42

Acute diarrhea:

Answer 42

* Most common in kids under 5 years | * Less than 14 days (self-limiting)

Question 43

Acute diarrhea: 5 causes

Answer 43

* Bacterial infection (eg food poisoning) * Gasteroenteritis * Abx * Laxatives 2/2 anorexia nervosa * Upper Resp Tract infections

Question 44

Chronic Diarrhea

Answer 44

Longer than 14 days

Question 45

5 causes of chronic diarrhea

Answer 45

* Irritable Bowel Syndrome * Inflammatory Bowel Disease (Chrones, Ulcerative Colitis) * Food allergy * Lactose intolerence * Malabsorption syndrome

Question 46

What is the name for Chronic diarrhea in an infant? What is the cause?

Answer 46

Intractable diarrhea of infancy | * Acute infectious diarrhea that was not managed adequately

Question 47

What is the name for chronic diarrhea in children? Most common cause?

Answer 47

Chronic non-specific diarrhea | ** Common cause: Apple juice! (Also diet soda, food sensitivities)

Question 48

Four etiologies that cause diarrhea:

Answer 48

* Rotavirus (immunization possible) * Bacteria (Salmonella, Sigella, Campylobacter) * Parasite: Cryptosporidium * Abx

Question 49

Labs to check w diarrhea:

Answer 49

* Urine specific gravity * CBC * Serum electrolytes * Creatinine and BUN (elevated with dehydration)