Paediatric GI - Colic and Dehydration

Question 1

How do children with infantile colic appear?

Answer 1

Inconsolable high pitch crying

Draw up knees

Flatus

Normal weight gain

Typically cry in evening

Red face

Question 2

How long/often do children with infantile colic cry?

Answer 2

3 hours a day crying

3 days a week

3 weeks

Question 3

By what age do most cases of infantile colic resolve?

Answer 3

3-4 months

Question 4

What is the aetiology of infantile colic?

Answer 4

Very poorly understood

Thought to be due to abnormal GI motility and pain signals

Question 5

What risk factors are associated with infantile colic?

Answer 5

Smoking in pregnancy

Pre-term and Small for Gestational Age

Food/milk allergies

Attachment/anxiety issues

Question 6

What differentials must you rule out for an inconsolable crying baby?

Answer 6

GORD
Cows milk protein allergy
Otitis media
Incarcerated hernia
UTI
Intussusception

Question 7

How is a diagnosis of infantile colic made?

Answer 7

Diagnosis of exclusion

Question 8

How is infantile colic managed?

Answer 8

Reassure and explain

Advice to share childcare to avoid maternal exhaustion

Can try hypoallergenic diet for breast feeding mothers

Short trial of hydrolysed formulae?

Question 9

What broad factors cause dehydration?

Answer 9

Reduced intake
Increased output
Fluid shift
Capillary loss
Insensible loss

Question 10

What can cause a decreased intake of fluid?

Answer 10

Pain in mouth

GI obstruction

Question 11

What can cause increased output of fluids?

Answer 11

Gastroenteritis

Renal - DKA, diabetes insipidus

Question 12

What can cause a fluid shift?

Answer 12

Effusion

Ascites

Question 13

What causes capillary loss of fluid?

Answer 13

Burns
Sepsis
Bowel Ischaemia

Question 14

What causes an increase of insensible loss of fluid?

Answer 14

Thyrotoxicosis
Fever
Heat stroke
CF

Question 15

What types of dehydration can you get?

Answer 15

Isonatraemic
Hypernatraemic
Hyponatraemic

Question 16

What happens in hypernatraemic dehydration?

Answer 16

Salts lost from intravascular space less than water

Water shift from extravascular space to help lessen fluid loss

Happen in DKA

Question 17

What happens in hyponatraemic dehydration?

Answer 17

Salts lost in intravascular space less than water but water shift out exaggerating the intravascular water loss

Question 18

How is hypernatraemic dehydration managed?

Answer 18

Fluids replaced slowly - over 48 hours

Sodium closely monitored

Question 19

What can be used to assess level of dehydration?

Answer 19

Skin turgor
Cap refill
Resp pattern
Body weight loss
Activity level
Thirst
Mucous membranes
Tears
Fontanelle

Question 20

What investigations can you carry out for dehydration?

Answer 20

Urine analysis and specific gravity

Bloods - U&E, glucose

ECG - arrhythmia due to electrolyte disturbance?

Question 21

How do you manage dehydration?

Answer 21

Oral intake
Oral rehydration solution
IV if severe weight loss/shock imminent
Intraosseous infusion if circulatory collapse

Question 22

What fluid challenge is given?

Answer 22

20ml/kg 0.9% NaCl

Can give 2 bags before contacting ICU

Question 23

How is replacement fluid calculated?

Answer 23

Predehydration weight x % weight loss x 10

Add this to ongoing losses - Urine output, drains

Add maintenance