Gastrointestinal Dysfunction

Question 1

In infants what is different compared to an adult when it comes to imbalances of water and electrolyte

Answer 1

It occurs more frequently and rapidly

Question 2

In normal conditions amount of water consumed should be

Answer 2

Amount of urine excreted in a 24 hour period

Question 3

Total water in full term new born

Answer 3

75%

Question 4

Total water in adolescents

Answer 4

Decreases to 45%

Question 5

Premature total water

Answer 5

> 75%

Question 6

Factors in water loss

Answer 6

Insensible fluid loss
Body surface area
Basal metabolic rate
Kidney function
Fluid requirements

Question 7

Insensible fluid loss

Answer 7

Fluid loss that can’t be measured or we are not aware of.
Perspiration, fluid in feces and respiratory

Question 8

Sensible fluid loss

Answer 8

Can be measured
(Urine out put)

Question 9

2/3 of insensible fluid loss happens where?

Answer 9

Through the skin (perspiration)

Question 10

1/3 of insensible fluid loss happens where?

Answer 10

Respiratory

Question 11

Body surface area

Answer 11

Infants and children have a higher body surface area
The smaller the body the higher the body surface area
And the more fluid loss that takes place

Question 12

Basal metabolic rate

Answer 12

Higher in children than adults to to larger body tissue area and increase heat production = increase insensible fluid loss.
BMR ^ to support tissue growth

Question 13

Fluid requirements

Answer 13

Ensuring that the fluids given to child include both water and electrolytes
That also include maintenance fluid requirements that also must have electrolytes and water

Question 14

Water intoxication causes

Answer 14

Not correctly mixing formula,
adding more water and less formula ,
Ingesting too much water and not enough electrolytes,
consistent tap water enemas
Hypotonic solutions

Question 15

In pediatrics we see dehydration more. What are the causes?

Answer 15

Losing water quickly due to virus and not replacing in time
Incorrectly mixing formula

Question 16

Types of dehydration

Answer 16

Isotonic
Hypotonic
Hypertonic

Question 17

Isotonic dehydration

Answer 17

Water and electrolytes are decreased in balance proportions
If pt is showing signs of dehydration but electrolytes are normal this is how we know it is isotonic solution

sodium is normal

Question 18

Hypotonic dehydration

Answer 18

Electrolyte deficit exceeds the water
^ water= decrease electrolyte)

Sodium is decreased

Question 19

Hypertonic dehydration

Answer 19

Water loss in excess electrolytes
decrease water=^electrolytes

Sodium is increased >145

Question 20

Out of the 3 types of dehydrations which ones are you able to bolus fluids?

Answer 20

Isotonic because sodium is normal.
Hypotonic becuase sodium is <135.

Question 21

Which out of the 3 types of dehydration do you rehydrate slowly and why?

Answer 21

Hypertonic. Due to the sodium being >145
If we were to bolus fluids we would cause cerebral edema

Question 22

What is the most important determinant of fluid loss in infants and young children

Answer 22

Daily weights

Question 23

What is the earliest detectable sign in dehydration?

Answer 23

Tachycardia

Question 24

What is a late sign of dehydration and why?

Answer 24

Drop in BP.
Since they become tachycardia when dehydrated heart eventually gets tired and the child’s heart will slow down because it is tired.

Question 25

If a chid comes in with a late sign of dehydration ( drop in BP ) what will you do?

Answer 25

They will be a priority

Question 26

Clinical manifestations of dehydration

Answer 26

Dry mucous membrane Low energy, lethargic Dark urin Sunkey Fontanne’s Skin tumor decrease Extremities cool to touch Increase hr No tears Cold hands and feet (inaccurate pulse ox due to decrease blood flow) Mottled skin Capillary refill slow

Question 27

Treatment for severe isotonic and hypotonic dehydration

Answer 27

Initial phase of iv therapy is rapid fluid replacement May need a bolus or 2

Question 28

Hypertonic dehydration treatment

Answer 28

Rapid infusion of iv fluid is a no no Slow infusion due to increase NA + level Can cause central poutine myelinolysis

Question 29

Central poutine myelinolysis

Answer 29

Cerebral edema due to rapid fluid correction

Question 30

For mild / moderate dehydration

Answer 30

Oral replacement therapy over 4-6hours but depends on the pt size may even be every 2 hours Replacement of continuing losses Provide at least minimum fluid requirements

Question 31

How do you know if someone who is getting rehydrated for dehydration is getting enough fluid

Answer 31

Calculate minimum acceptable urine output

Question 32

Severe dehydration rehydration

Answer 32

Given when child is vomiting too much and can’t keep anything down or if child is lethargic Goal is to meet physiological needs Replace previous deficits Replace ongoing abnormal loss

Question 33

Gastrointestinal dysfunction

Answer 33

Diarrhea Constipation Hirshsprung disease Gastroesophageal reflux (GER)

Question 34

Diarrhea

Answer 34

Acute Self limiting < 14 days Usually what we see w/ viral infections

Question 35

Chronic

Answer 35

> 14 days Related to chronic conditions like lactose intolerance or IBD

Question 36

What is the biggest to worry about for kids when it comes to diarrhea ?

Answer 36

Dehydration We want to replace fluids and meet minimal urine output firstly Secondly return child to normal diet because nutrition is important . It may result in larger stool output but nutrition is better.

Question 37

Constipation

Answer 37

A decrease in a bowel movement frequency of trouble defecating for more than 2 wks

Question 38

What can cause constipation?

Answer 38

Hypothyroidism Imperforiated anus Anal fissures&strictures Switching milks Stress Schoolage not poopin at chocolate

Question 39

What can cause failure to pass meconium

Answer 39

Hypothyroidism

Question 40

Dietary modifications to help constipation

Answer 40

Increase cereal Increase veggies Increase fruit Increase grains Avoid cheeses Long term - over the counter stool softener