FLUIDS AND ELECTROLYTES

Question 1

Sources of fluid loss

Answer 1

Insensible losses – 2/3 through skin & 1/3 through respiratory tract

Urinary

Fecal

Question 2

Major Fluid compartments

Answer 2

Intracellular ( fluid inside cell )
Extracellular ( fluid outside cell )
* intravascular fluid
* interstitial fluid
Children maintain larger amount of ECF until about 2 yrs. of age so they are more susceptible to rapid fluid depletion
Neonates & young children have larger Body Surface Area ( BSA )
Child more likely to loose ECF first with fluid loss

Question 3

Infants and children less than 2 years lose a greater proportion of fluid each day – WHY?

Answer 3

Greater amount of BSA causes ↑ in insensible losses
Increased metabolic rate - ↑ fluid demand to fuel metabolic process
Greater amount of metabolic wastes to be excreted by kidneys
Glomeruli tubules & nephrons of kidney are immature & unable to conserve H2O effectively

Question 4

Fluid compartment components

Answer 4

H2O
75% in infants, 55-60% in adults

Solutes
ECF ( Na+),
ICF ( K+)

Question 5

Fluid Requirements

Answer 5

Daily Maintenance
1. wt. in kg.
2.100ml/kg for first 10 kg.
3. 50ml/kg for second 10 kg.
4. 20 ml/kg for remainder of wt in kg.
5. divide total amt. by 24 hrs. & obtain rate
in ml/hr

Question 6

Urine output
Infants and toddlers
Preschool and young school age
Older school age and adolescents

Answer 6

Infants and toddlers: > 2-3ml/kg/hr

Preschool and young school age: >1-2ml/kg/hr

Older school age and adolescents: 0.5-1ml/kg/hr

Question 7

Dehydration

Isotonic

Answer 7

Classified according to serum Na+ concentration & osmolarity

Isotonic

 * primary form of dehydration
 * H2O losses = electrolyte deficits
 * fluid loss mostly from ECF
 * shock greatest threat
 * replace with isotonic solution
 * serum Na+ (130 – 150 meq/l)

Question 8

Hypotonic dehydration (hyponatremia)

Answer 8

Electrolyte losses > H2O deficits
ICF more concentrated than ECF
Causes
Decreased osmolarity of blood
Serum Na+

Question 9

Hypertonic Dehydration - hypernatremia

Answer 9

H2O losses > electrolyte losses
ECF more concentrated than ICF
Causes
Give hypotonic solution
Serum Na+ > 150 meq/l

Question 10

Hypokalemia

Causes

Answer 10

Serum K+ ↓ 3.5 mmol/l 
Causes 
     increased K+ excretion
     decreased K+ intake
     loss of K+
Symptoms
Nursing

Question 11

Hyperkalemia

Answer 11

Serum K+ ↑ 5.8 mmol/l
Symptoms
Causes 
    * massive cell death
    * excessive or too rapid K+ IV infusion
    * metabolic acidosis
    * diabetes
    * ↓K+ excretion

Question 12

Hyperkalemia continued

Treatment

Answer 12

Treatment – manage underlying condition
   * medications – K+ wasting diuretics,
                            Kayexalate, IV bicarbonate,
                            IV insulin 
    * peritoneal dialysis
    * diet
Nursing

Question 13

Diagnostic evaluation of Dehydration

Answer 13

Weight loss
    * 5% mild
    * 10% moderate
    * 15% severe
    * calculate (original wt – present wt.
                       ÷  original wt.)

Question 14

Diagnostic evaluation of dehydration continued

Answer 14

Changing level of consciousness
Response to stimuli
Decreased skin elasticity & turgor
Prolonged capillary refill
Increased heart rate
Sunken eyes & fontanels
Dry mucus membranes
Absent tears
Decreased urine output

2 of the following factors→5% dehydrated
    > capillary refill > 2 seconds
    > absent tears
    > dry mucus membranes
    > ill appearance

Question 15

NURSING - dehydration

Answer 15

I & O
Vital signs
Skin
Mucus membranes
Body weight
Fontanel
Sensory

Question 16

Diarrhea

CHRONIC VS. ACUTE

Answer 16

Caused by abnormal intestinal H2O & electrolyte transport
Acute
~ leading cause ↓ 5 yrs.
~ sudden ↑in frequency & change in
consistency of stool
~ causes
~ usually self limited (↓14 days)
~ acute infectious diarrhea ( gastroenteritis)

Chronic
    ~ ↑ 14 days
    ~ causes 
Intractable diarrhea of infancy
    ~ occurs in first few months of life
    ~ longer than 14 days
    ~ most common cause is acute infectious
      diarrhea that was not managed adequately

Question 17

Chronic non-specific diarrhea

Answer 17

Chronic non-specific diarrhea
    ~ cause of chronic diarrhea in children
       6-54 months
   ~ loose stools with undigested food
      particles ↑ 14 days
   ~ grow normally & not malnourished
   ~ no blood in stool or infection
   ~ causes

Question 18

Etiology of Diarrhea

Answer 18

Fecal - oral route
Contaminated food or water
Organisms
    ♦ viral – Rotavirus
    ♦ bacterial- Salmonella, Shigella,
                       Campylobacter
    ♦parasite – Cryptosporidium
Antibiotics

Question 19

Dx of CNS diarrhea

Answer 19

History
Lab data – stool specimens
Urine specific gravity
CBC, serum electrolytes, creatinine, BUN

Question 20

management of diarrhea

Answer 20

Assessment of fluid & electrolyte imbalance

Rehydration

Maintenance of fluid therapy

Reintroduction of adequate diet

Question 21

Nursing - Diarrhea

Answer 21

Assessment
Implementation & education regarding oral rehydration
Accurate weight
Monitor I&O – urine output must be sufficient to add K+ to IV solution
Skin care
Prevention