Gas and Maths Lecture

Question 1

Calculating IV fluids for 18kg child (has to be after 28 days old)

Answer 1

100ml x 10kg = 1000ml
8kg x 50ml =400 ml
Divide by 24 hrs - prescribe 1 digit after decimal

10-20 = 50ml/kg, 20kg + –> 20ml /kg

Question 2

Neonatal prescription fluids - up to 28 days old

Answer 2

• Day 0-1 - 60ml/kg/day
• Day 2 - 80ml/kg/day
• Day 3 - 100ml/kg/day
• Day 4 - 120ml/kg/day
• Day 5 - 150ml/kg/day

Question 3

Which weight to use for neonatal fluid prescribing?

Answer 3

• Use birth weight until current weight exceeds it
• Always use highest weight

Question 4

What types of fluids for neonates?

Answer 4

• 10% glucose (instead of 5%)
• Electrolytes different

Just acknowledge they are different - don’t need to know specific values now

Question 5

Maintenance fluid type children

Answer 5

• Sodium chloride 0.9%
• 5% glucose

Question 6

Resuscitation fluid prescribing in children

Answer 6

10ml/kg - 0.9% sodium chloride

Question 7

When to consider parenteral nutrition?

Answer 7

• If expect to be on fluids for more than 5 days

Question 8

Dehydration correction

Answer 8

• Weight x percentage dehydration x 10 -
• 1kg loss = 1000mls replacement needed
• Give in addition on top of maintenance

Question 9

Calculating deficit correction over 48hrs

Answer 9

• Need to include two days of maintenance
• Add that onto deficit
• Divide by 48hrs for rate

Question 10

Childhood obesity cut offs

Answer 10

• Over 85 - overweight
• Over 95 centile - obese

Question 11

Medications which need body surface area prescription

Answer 11

• Chemotherapy
• Aciclovir for certain ages

Question 12

Body surface area prescribing in children

Answer 12

• calculations already in BNF in medicines guidance
• Table called body surface area

Question 13

Normal Hb for neonates - children

Answer 13

• Hb neonates - should be high
• Then starts to drop at around 8-10 weeks - physiological anaemia
• Then bone marrow should kick in - check reticulocytes

Question 14

When to correct calcium in children?

Answer 14

1 is cut off
If having seizures and less than 1.2 - correct
1 is acceptable if no symptoms

Question 15

Classic presentation hirschsprungs

Answer 15

Distended abdomen - obstruction is low down

Question 16

Differentials for 6 week baby vomitting, poor weight gain, sleeping more but still feeding

Answer 16

• Sepsis
• Reflux
• Pyloric stenosis - projectile vomitting
• Cows milk allergy
• UTI

Question 17

Meaning of ‘handles well’ on exam

Answer 17

• Means experienced clinician is not concerned is unwell child when holding them

Question 18

Features of pyloric stenosis

Answer 18

• Visible peristalsis from L to R
• Projectile vomitting

Question 19

Diagnosing pyloric stenosis

Answer 19

• Test feed
• Feed and palpate pylorus to see if thickened
• Do US to see if thickened

Question 20

Blood gas for pyloric stenosis

Answer 20

Metabolic alkalosis - hypochloraemic hypokalaemic

CHLORIDE FIRST

Question 21

When do you need arterial gas in children?

Answer 21

• If CBG bad after birth - respiratory problem? - time critical may benefit from therapeutic cooling
• ECMO needed - eg if meconium aspirated and unwell?

Question 22

ARDs

Answer 22

• Lack surfactant - give this to them (endotracheal)
• = acute respiratory distress syndrome
• –> ventilate invasively
• Then switch to CPAP as soon as possible (minimise trauma to airways that causes chronic disease)
• Often tend to accept hypercapnia - as pockets of air trapping occurs - to allow to come of ventilation
• This can persist - don’t worry about them if present to ED and have history of this (permissive hypercapnia)

Question 23

Neonatal seizure management

Answer 23

• Buccal midazolam/IV lorazepam
• If not stopping - do IV phenobarbital

Question 24

Risk factor for neonatal sepsis - must consider in fever in under 3 months

Answer 24

• Maternal GBS in HVS
• Prolonged rupture of membranes (>18hrs)
• Maternal pyrexia in labour more than 38.5
• Chorioamnionitis - maternal pyrexia + foul smelling liqour

Question 25

Management of neonatal sepsis with neurological signs

Answer 25

* Ceftriaxone + amoxicillin * IV aciclovir - herpes encephalitis very high mortality

Question 26

Gases post seizure

Answer 26

* CO2 will always be raised - ineffective respiration * Check calcium - can cause seizure * Lactate will rise - perfusion not great * Hb appears normal for adults but can be low for neonate and signify brain bleed

Question 27

Normal Hb in neonates

Answer 27

140 to 240

Question 28

What intracranial bleeding can occur in babies?

Answer 28

* Typically intraventricular bleeds - resolves by itself, when blood solidifies can obstruct CSF outflow --> post obstructive hydrocephalus

Question 29

Imaging for ?brain bleed in neonate

Answer 29

* US - open fontanelles allows them to see * If needed - CT

Question 30

# 590588 Prognosis of seizures caused by previous ischaemia to white matter

Answer 30

* Do not know * Will need to be followed up * Some fully resolve, others do not