Pediatric Fluids and Electrolytes

Question 1

Causes of Dehydration

Answer 1

Fever
Gastrointestinal losses (viral gastroenteritis most common)
Sweating/excessive heat/burns
Polyuria (DKA)
imbalance in regulation of sodium/water (DI, SIADH- hormonal)

Question 2

Mild % severity of dehydration

Answer 2

Infants: 1-5%
Older children: 1-3%

Question 3

Moderate % severity of dehydration

Answer 3

Infants: 6-9%
Older children: 4-6%

Question 4

Severe % severity of dehydration

Answer 4

Infants: >10% (15% = shock)
Older children: > 6% (9% = shock)

Question 5

Signs and Sx of mild dehydration

Answer 5

Pulse: normal-increased
decreased urine output
buccal mucosa slightly dry

Question 6

Signs and Sx of Moderate dehydration

Answer 6

Tachycardia
systolic blood pressure: normal-low
little to no urine output (< 1 mL/kg/hr)
dry buccal mucosa
sunken eyes and anterior fontanelle
Skin turgor/cap. refill: delayed, cool, pale
Skin: cool
decreased tears
mental status: normal- listless
thirsty

Question 7

Signs and Sx of severe dehydration

Answer 7

Rapid and weak pulse
decreased systolic blood pressure
oliguria (&laquo_space;1mL/kg/hr)
Parched buccal mucosa
Eyes and anterior fontanelle very sunken
Skin turgor/ cap refill: very delayed, cool and mottled
Skin: acrocyanosis
No tears
mental status: normal to lethargic/comatose
drinks poorly / unable to drink

Question 8

Severity of dehydration (% estimated) calculation

Answer 8

[ (pre illness weight kg - illness weight kg) / pre-illness weight kg] x 100%

Question 9

Fluid deficit (L) calculation

Answer 9

% dehydration x pre-illness weight / 100

Question 10

Treatment strategy for mild to moderate dehydration

Answer 10

Oral rehydration therapy (ORT)

Question 11

Treatment strategy for severe dehydration

Answer 11

IV fluids (IVF)

Question 12

Oral Rehydration Therapy Dosing (Mild)

Answer 12

50 mL/kg over a 4 hour period, reassess status every 2 hours

add 10 mL/kg for each loose stool/vomiting episode

Question 13

Oral Rehydration Therapy dosing (Moderate)

Answer 13

100 mL/kg over a 4 hour period, reassess status hourly

add 10 mL/kg for each loose stool/vomiting episode

Question 14

IV Fluid Phase I Dosing

Answer 14

Initial replacement- provided as bolus

10-20 mL/kg/dose of NS or LR over 30-60 minutes (may repeat up to 3 times)

Question 15

IV Fluid Phase II Dosing

Answer 15

Maintenance replacement
First 8 hrs: calculate and replace fluid deficit
Next 16 hrs: calculate and provide maintenance rate

Question 16

patients age 28 days to 18 years of age requiring maintenance fluids should receive ____________ solutions with appropriate ________ and _________

Answer 16

Isotonic solutions
potassium chloride
dextrose

Question 17

Available Dextrose formulations

Answer 17

D5W- 5%
D10W- 10% (used in neonates and infants with hypoglycemia)

Question 18

Standard potassium concentration

Answer 18

20 mEq/L
caution in renal failure and neonates

Question 19

Negative anions

Answer 19

standard: chloride

can compound with acetate under certain circumstances such as DKA

Question 20

Maintenance IVF Rate Calculations (< 10 kg)

Answer 20

4-2-1 Method (hourly rate requirement)
- 4 mL/kg/hr

24hr method
- 100 mL/kg (divide by 24 hrs)

Question 21

Maintenance IVF Rate Calculations (10-20 kg)

Answer 21

Hourly rate requirement
- 40 mL/hr + 2 mL/kg/hr x (weight - 10 kg)

24 hr requirement
- 1000mL + 50 mL/kg for each kg > 10kg

Question 22

Maintenance IVF Rate Calculations (> 20kg)

Answer 22

Hourly rate requirement:
- 60 mL/hr + 1mL/kg/hr x (weight - 20kg)

24hr requirement:
- 1500mL + 20 mL/kg for each kg > 20 kg

Question 23

Ondansetron for outpatient treatment

Answer 23

single dose PO or IV to assist patient in tolerating ORT

Question 24

Zinc

Answer 24

helpful in patients with nutrient deficiencies as a cause for diarrhea/malnutrition

dosage forms 23% elemental zinc

Question 25

In patients with gastroenteritis avoid:

Answer 25

loperamide
bismuth subsalicylate
metoclopramide