Pharm2 10 Peds Fluids pt2 Flashcards Preview

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Flashcards in Pharm2 10 Peds Fluids pt2 Deck (16)
1

Holliday-Segar method is for...
How do you do it? ex: 21 kg kid.

IV maintenance rate
100 cc/kg per 24 hours for first 10 kg
50 cc/kg per 24 hours for second 10 kg
20 cc/kg per 24 hours over 20 kg

1500+20 = 1520
1520/24 = 63.3 cc per hour

2

IV fluids using 4-2-1 Rule is for...
How do you do it? ex: 28 kg kid.

IV maintenance rate

4 cc/hr x 10 kg = 40 cc/hr
2 cc/hr x 10 kg = 20 cc/hr
1 cc/hr x 8 kg = 8 cc/hr
Totals 68 cc/hr maintenance*

3

Identify a baby that's minimal-mildly dehydrated

a lot of diarrhea and vomits everything I feed her”
On exam child makes eye contact, cries with tears but is easily consoled by mother, diaper is wet with urine, cap refill is brisk

4

What's the easiest way to check if a baby is dehydrated?

Check the diaper

5

How to handle a baby/kid with Minimal to mild dehydration

Initially supervise parent feeding child
Give frequent (every 5 minutes), small amounts of solution (the 5 little cups with soda or w/e)
Observe for ability to continue regular hydration
Re-evaluate child’s hydration status
Reinforce plan with parents

6

Identify a baby with moderate dehydration

vomits everything, diarrhea
>10 episodes of watery diarrhea today
Alert child, cries with scant tears, consoled by mother, dry mucosa, water diarrhea in diaper on exam, capillary refill is about 3 seconds

7

How to handle a baby/kid with Moderate dehydration

Closely supervise parent feeding child
avoid lactose products
Give 5-10 cc of Pedialyte solution
Child takes 240 cc in 2 hour period
Re-evaluate child’s hydration status & document
Reinforce plan with parents

8

Identify a baby/kid with Severe shock (and maybe hyponatremic dehydration)

Mother presents to ED with 4 yo male weighing 18 kg. Child was at pediatricians last week and weighed 20 kg.
Mother states having diarrhea > 10/day, vomiting > 6/day, both for 3 days
child taking 7-Up well until today
Child is quiet, eyes sunken, dry mucosa, cries w/o tears, cap refill is about 4 seconds

9

What's the problem with treating a baby, young child with severe shock/dehydration? What do you do about it? Last resort?

getting an IV on this kid is going to be a crazy challenge. It’s a fairy tale, you won’t even be able to palpate it.

Check out their external jugular vein. If that’s used, make sure you point the needle DOWN towards heart, not up towards the brain.
Last resort location: intraosseus - tibial plateau line.

10

How to handle a baby/kid with Severe shock/hyponatremic dehydration

Rapidly establish an IV
peripheral sites
intraosseous (last resort)
Rapidly administer 20 ml/kg bolus
Re-evaluate child immediately

11

A 14 gage needle won’t go into a kid. If it’s used on an adult, how quick will you get a Liter of fluid?

2 minutes. It flows quickly b/c it’s a short needle and a big diameter.

12

Law of fluid dynamics – there are 2 factors that determine how fast you’ll get fluid into a patient:

What's most rapid?
What are central lines?

length of IV catheter, and the diameter of the catheter.
Most rapid: So we want a shorter catheter and a wider diameter
Central lines are a huuuuge catheter with a narrow diameter. Therefore this is slower than a 14 gage needle.

13

Identifying symptoms of Severe Dehydration implies ___% fluid deficit from ideal body weight.

So what if the kid's ideal body weight is 20 kg?

10% fluid deficit from IBW

20kg x .1 = 2 kg loss.
2 kg = 2000 cc total deficit fluid loss

14

How much fluid is lost if a kid weighed 20 kg last week, and is now severely dehydrated and weighs 18 kg?

20 kg – 18 kg = 2 kg loss
2 kg = 2,000 cc total deficit fluid loss

15

Let's talk through the whole process of correcting fluids in this 4 year old kid who weighed 20 kg a week ago, now weighs 18 kg and is severely dehydrated.

2000 total deficit
20 ml/kg resuscitative bolus: 20 x 20 = 400 cc (1600 cc deficit remaining)
800 cc over 8 hours = 100 cc/hr + 60 cc/hr for maintenance = 160 cc/hr
800 cc over following 16 hours = 50 cc/hr + 60 cc/hr for maintenance = 110 cc/hr

16

8 and 16 hour rules for repleting fluid losses are always done EXCEPT when?

DKA