Gas and Maths Lecture Flashcards
(30 cards)
Calculating IV fluids for 18kg child (has to be after 28 days old)
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
Neonatal prescription fluids - up to 28 days old
- 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
Which weight to use for neonatal fluid prescribing?
- Use birth weight until current weight exceeds it
- Always use highest weight
What types of fluids for neonates?
- 10% glucose (instead of 5%)
- Electrolytes different
Just acknowledge they are different - don’t need to know specific values now
Maintenance fluid type children
- Sodium chloride 0.9%
- 5% glucose
Resuscitation fluid prescribing in children
10ml/kg - 0.9% sodium chloride
When to consider parenteral nutrition?
- If expect to be on fluids for more than 5 days
Dehydration correction
- Weight x percentage dehydration x 10 -
- 1kg loss = 1000mls replacement needed
- Give in addition on top of maintenance
Calculating deficit correction over 48hrs
- Need to include two days of maintenance
- Add that onto deficit
- Divide by 48hrs for rate
Childhood obesity cut offs
- Over 85 - overweight
- Over 95 centile - obese
Medications which need body surface area prescription
- Chemotherapy
- Aciclovir for certain ages
Body surface area prescribing in children
- calculations already in BNF in medicines guidance
- Table called body surface area
Normal Hb for neonates - children
- Hb neonates - should be high
- Then starts to drop at around 8-10 weeks - physiological anaemia
- Then bone marrow should kick in - check reticulocytes
When to correct calcium in children?
1 is cut off
If having seizures and less than 1.2 - correct
1 is acceptable if no symptoms
Classic presentation hirschsprungs
Distended abdomen - obstruction is low down
Differentials for 6 week baby vomitting, poor weight gain, sleeping more but still feeding
- Sepsis
- Reflux
- Pyloric stenosis - projectile vomitting
- Cows milk allergy
- UTI
Meaning of ‘handles well’ on exam
- Means experienced clinician is not concerned is unwell child when holding them
Features of pyloric stenosis
- Visible peristalsis from L to R
- Projectile vomitting
Diagnosing pyloric stenosis
- Test feed
- Feed and palpate pylorus to see if thickened
- Do US to see if thickened
Blood gas for pyloric stenosis
Metabolic alkalosis - hypochloraemic hypokalaemic
CHLORIDE FIRST
When do you need arterial gas in children?
- If CBG bad after birth - respiratory problem? - time critical may benefit from therapeutic cooling
- ECMO needed - eg if meconium aspirated and unwell?
ARDs
- 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)
Neonatal seizure management
- Buccal midazolam/IV lorazepam
- If not stopping - do IV phenobarbital
Risk factor for neonatal sepsis - must consider in fever in under 3 months
- Maternal GBS in HVS
- Prolonged rupture of membranes (>18hrs)
- Maternal pyrexia in labour more than 38.5
- Chorioamnionitis - maternal pyrexia + foul smelling liqour
