Peds Fluid Management Flashcards by Brooke Harris

T/F Children have small surface area to volume ratio

False

Large surface area to volume ratio

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T/F kids have immature homestasis mechanisms

true

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What electrolyte abnormalities are common in kids?

Hyper and hyponatremia

Hyper and hypokalemia

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Why is pediatric intraop fluid mgmt especially important?

Children overload and dehydrate easily

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Considerations if giving large amounts of IV fluids

Need to warm them

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Consideration with patient on TPN

Continue perioperatively to prevent hypoglycemia

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What age group should you always use volumetric chambers, micro-drips and/or pumps?

Children <10 years old

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What two IV fluids can you use with blood products?

NS or plasmalyte

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What fluids should you use for maintenance and 3rd space losses?

Non-glucose crystalloids

(LR, NS, plasmalyte)

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What electrolyte abnormality can occur with “old” PRBCs?

Hyperkalemia

More common if giving more than one blood volume

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Is it appropriate to give platelets if your patient looks a bit oozy but you don’t have any labs?

Give for dilutional thrombocytopenia or documented decreased platelet count

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What blood product do you give for dilutional coagulopathy or surgical “oozing”?

FFP

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What all is considered a colloid?

Albumin

Hetastarch

Blood products

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What are some other options besides banked blood for high blood loss procedures that you would prob have to prepare in advance for?

Autologous donation
Directed donors
Cell saver
Deliberate hypotension
Normovolemic hemodilution

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Is is okay to ride out a low Hct in a healthy, hemodynamically stable patient if they are done losing blood?

Yas

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Signs of acute hypernatremia

Irritability
Coma
Seizures

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Treatment for hypernatremia

Colloid or NS bolus with slow correction of Na+

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Signs of acute hyponatremia

HA
Nausea
Weakness
Confusion
Irritability
Seizures

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Signs of advanced hyponatremia

Respiratory arrest
Irreversible neurologic injury

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Treatment for hyponatremia

Slow correction for asymptomatic cases

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Treatment for acute hyponatremia

Rapid correction

~except this causes central pontine myelonolysis?? so SOS~

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Causes of acute hyperkalemia

Renal insufficiency
Massive tissue trauma
Acidosis
Succinylcholine with myopathies, burns, motor neuron disease
Sepsis
Massive transfusion
MH

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EKG changes with hyperkalemia

Peaked T waves
Prolonged PR
Wide QRS
Eventual sinusoidal

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Treatment for hyperkalemia

IV Ca⁺⁺
Bicarb for acidosis
Glucose/insulin

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Causes of acute hypokalemia

* Vomiting * Diarrhea

Signs of hypokalemia

* muscle weakness * Prolonged QT * Dampened T waves * U waves

Treatment for hypokalemia

oral supplements if possible or slow IV correction

What are some reasons for fluid loss intraop?

* Surgical blood loss * Surgical trauma/capillary leaking protein movement into interstitial space (3rd space) * Anesthesia--\> vasodilation --\> relative hypovolemia * Direct evaporation

If your patient loses 300 ccs of blood how much crystalloid would you give to replace it? How much colloid would you give?

450-900 crystalloid 300 colloid

Excessive amounts of NS given can cause what electrolyte/ acid base imbalance? Would this occur with LR also?

Hyperchloremic acidosis Does not occur with LR

What is a situation where excessive amounts of NS may be given because LR is not an option? What other fluid could you use in this situation?

With massive transfusion You can use plasmalyte with blood to avoid hyperchloremic acidosis

Why cant you use LR with blood products?

Ca⁺⁺binds to citrate and causes emboli

Two definitions of massive blood transfusion in children

1. Replacement of one or more blood volumes 2. Replacement of \>30 ml/kg in \<4 hours

What type of blood should you use in emergency until crossmatched blood is available?

O^- Or O⁺in males???

Do you use damage control approach in children

Idk but it has not been fully studied

What is the usual reason for MBT-induced coagulopathy?

Dilution Other causes: fibrinolysis, DIC

Do you use the fixed ratio of 1:1:1 for blood products on children?

Also not fully researched in children so unsure

What occurs to platelets when 2-2.5 blood volumes are lost? How to prevent?

**Significant thrombocytopenia and further bleeding** * Consider platelet transfusion after 1-1.5 blood volumes

What is a good determinant of platelet needs?

Starting platelet count

What occurs when replacing 1-1.5 blood volumes lost with PRBCs and fluids? Recommendations to prevent?

**Loss of clotting factors** * Consider FFP after 1 BV * Give FFP after 1 BV loss than 1 FFP: 2 PRBCs * Check coags after ever BV loss

Recombinant Factor VII (Novo VII) is FDA approved for Hemophilia and congenital factor VII deficiency... Considerations for off label use in children?

Caution in use for children with surgery or trauma induced bleeding Should only be used for life-threatening bleeding

Is TXA an early or late choice for bleeding in children?

Early

What should you suspect in children with ongoing bleeding with normal pre-op coags and platelet count? How to treat?

DIC Treat the cause (shock, acidosis, sepsis)

What increases risk of hyperkalemia with PRBCs admin?

* Increased PRBC shelf time * Irradiation * Fast rate of admin

T/F hyperkalemia is less likely to occur if blood given at slow rate through peripheral IV

True

Most common reasons for hyperkalemia during massive blood transfusion

* Tissue injury * Rapid transfusion * Acidosis (poor perfusion) * Hypothermia * Hypocalcemia

EKG signs of hyperkalemia in massive blood transfusion

* Ventricular dysrhythmias * Peaked T waves

Treatment of hyperkalemia

* Calcium * Hyperventilation * Bicarb * Albuterol * Glucose/insulin

Major considerations for large blood loss

* Anticipate blood loss * Transfuse early * PIV if possible * Minimize use of "old" blood especially if irradiated

EKG signs of hypocalcemia and/or citrate toxicity

* Widened QRS * Prolonged QT * Peaked T waves

How to treat documented acidosis?

Bicarb duh

Idk how to word this but dont let your patient get cold when youre giving them all these blood products- treat hypothermia aggressively

What two POC tests are growing in popularity?

TEG and ROTEM

Maintenace IV fluids need for patient under 10 kg?

4 ml/kg/hr

Maintenance IV fluids need for a 4 kg babe

16 ml/hr

Maintenance fluids needed for 10-20 kg kid

40 + 2 ml/kg for each kg over 10

Maintenance fluids needed for a 14 kg tot

48 mls/hr

Maintenance fluids for kid \>20 kg

60 + 1 ml/kg for each kg \> 20 | (or just weight in kg + 40 = mL/hr)

Maintenance fluids for a 35 kg kid

75 mls/hr

How to calculate fluid deficit?

Deficit = Hours NPO x Maintenance rate

What is the fluid deficit for a 32 kg kid that has been NPO for 6 hours?

432 mls

How much fluid is lost to 3rd space in mild level of tissue trauma? Aka insensible, small incision, scopes

3-4 ml/kg/hr

How much fluid is lost to 3rd space in moderate level of tissue trauma? AKA ortho, large incision

5-7 ml/kg/hr

How much fluid is lost to 3rd space in extensive level of tissue trauma? AKA open abdominal or spinal case

\>10 ml/kg/hr

EBV for preterm bby

100 ml/kg

EBV for full-term baby to 12 month old

90 ml/kg

EBV for 12 months to 3 years

80 ml/kg

EBV for toddler to 8 years

75 ml/kg

EBV for \> 8 years old

70 ml/kg

How much does 10-15 ml/kg PRBCs increase your Hgb

2-3 g/dL

How much blood would it take to raise a 30 kg kids Hgb from 22 to 25?

~450 mls of PRBCs 30 kg x 15 = 450 (can use 10-15 ml/kg for 2-3 increase in hgb)

Calculate MABL for a 6 year old that weighs 22 kg and has a starting Hct of 36

~504 mls

How do you divide up the fluid deficit among the hours of surgery?

Replace 1/2 in the first hour 1/4 in the second and third hour

What is the max amount of fluid the patient should recieve in an hour? Exception? What do you do with the leftover?

Do not exceed 20 ml/kg/hour Exception is if you are replacing blood loss Roll over the leftover that you couldnt replace to next hour

What is the max amount of fluid a 22 kg patient can get in 1 hour if they arent bleeding?

440 mls

the EKG shows the following: * peaked T waves * long PR interval * widened QRS what do you suspect?

hyperkalemia

the EKG shows the following: * prolonged QT * dampened T waves * U waves what do you suspect?

hypokalemia

the EKG shows the following: * prolonged QT * dampened T waves * U waves what do you suspect?

hypokalemia

the EKG shows the following: * wide QRS * prolonged QT * peaked T waves what do you suspect? hint you're giving bunches of blood

hypocalcemia and/or citrate toxicity w/ MTP

Peds Fluid Management Flashcards

(79 cards)