Flashcards in Pharm2 10 Peds Fluids pt1 Deck (20)
World Health Organization - Oral Rehydration Solution (WHO-ORS) is a salty solution that proved effective in 1971 ___ outbreak during Bangladeshi war.
What is the ideal rehydration or maintenance solution?
Currently there is no ideal rehydration or maintenance solution available!
commercial solution. Like gatorade for kids, and exists as ice pops too.
__ rehydration > all other modes of rehydration. But, we freq don’t explain this well to parents.
oral. Unless you really can't (in shock), you'd want to try oral rehydration before resorting to anything else.
Mom says the baby throws up everything
How to judge if the kid is a candidate for oral rehydration (in general)
For a week?: Most likely no
For a day?: Most likely yes
Oral rehydration in peds/babies. How much? How fast?
What if they throw up during this process?
What if they still throw up??
What if they still fail???
Ex: coke in 5 cups. Teaspoon in the first, second, 2 tsp in 3rd-5th. One of these cups every 5 minutes and no sooner as long as they haven’t vomited.
If the kid throws up during this process, I stop, wait 30 minutes, and start again. (make sure regimen is correct)
still throwing up: Consider Zofran ODT (Ondansetron)
still: Consider ice pops, lollypops, etc. then try again
What is the adult fluid rate?
Establish an IV whenever.....
The child is in shock, severely dehydrated, or whenever, in spite of good oral intake, the child just can’t keep up with ongoing losses
The baby/kid is pooping 5 times in an hour, soaking wet from diarrheal stool. What should you do?
Need to start IV fluids.
won't be able to keep up orally at this point.
Calculating fluid deficits
Child presents to clinic with step-father, poor historian, stating 2-3 day history of nausea and vomiting, amount unknown
Child was seen last week in clinic and weighed 15 kg, today weighs 13.5 kg
1.5 kg weight loss / 15 kg ideal body weight equals .10 loss = 10% total fluid deficit
define fluid deficit
how much are they down from vomiting, diarrhea, lack of intake.
Calculating fluid deficits
New foster mother presents to clinic with child stating unknown length of N/V/D
15 kg child, alert, makes eye contact, cries with scant tears, mucosa barely moist
This implies they are mildly dehydrated aka 5% deficit.
15 kg x 5% = .75 kg wt loss = 750 cc deficit
Normal saline (0.9% NS) is closest to sea water. This weighs __ per 1 cc.
_ Liters weighs: 1kg
1g per 1cc
1 liter weighs 1 kg
What is D5W? Why is that in there?
plain water with 5% dextrose added. Why is that in there? You catabolize your own tissue if you don’t have glucose to burn.
The bottom line: if you were to live off just IV solution, it should have some sugar, electrolytes, and volume to keep up w/ basic metabolic needs if you were laying in a bed unconscious
What's the most deadly fluid to give a patient? Why? How would it kill them?
“free water.” – distilled water without electrolytes. It kills them b/c cells swell across the membrane all over the body. This in the foramen magnum = herniation. Free water has the potential to cause brain herniation.*
What is hot salt?
3.0% sodium. Raises Na too quickly. Won’t see this too often.
When the child is in shock, when the child is severely dehydrated, our when you are in doubt, start your IV with
What's the resuscitative bolus for Normal Saline?
A child comes in profoundly dehydrated (AKA shock!). They weigh 10 kg.
What fluid should they get?
Then what do we do?
What if that doesn't work???
200 cc (20 cc/kg x 10 kg = 200)
Then we assess them! If they’re not responsive and still in shock, then repeat the 20 cc per kg
any kid who requires more than 2 boluses…consider giving whole blood.