Pharm2 10 Peds Fluids pt3 Flashcards Preview

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Flashcards in Pharm2 10 Peds Fluids pt3 Deck (10)
1

30 kg Child Profoundly Dehydrated

save this kid!!!

Resuscitative 20 cc/kg = 600 cc bolus
10% loss = 3 kg = 3,000 cc lost
Balance of deficit = 2,400 cc
1,200 cc over first 8 hrs = 150 cc/hr
Balance of 1,200 cc over next16 hours = 75 cc/hr
MTCE 4-2-1- = 70 cc/hr
Order 600 cc bolus NS, then 220 cc/hr x 8 hours, then 145 cc/hr for 16 hours`

2

Name each of the categories of fluid replacement:

Which is largely ignored in reality? Why?

resuscitative, deficit, maintenance, ongoing fluid losses

ongoing losses is largely ignored in reality b/c we’re totally making up for everything through this method

3

Who gets the Resuscitative IV bolus?

Only kids in shock (severely dehydrated) get that IV bolus.

4

Burns and the Parkland Formula

Utilize normal saline as a fluid
4 cc/kg/%BSA for deficit plus maintenance
give 1/2 of deficit in first 8 hours
give 1/2 over next 16 hours
don’t forget to subtract initial fluid bolus
Don’t forget to add maintenance fluids

(1 to 4 cc/kg/% of body surface; but everyone uses 4)

5

3 1/2 yo male, 25 kg w/ 37% TBSA 2º burn

Treat 'em!

20 cc/kg x 25 kg bolus = 500 cc bolus
4 cc x 25 kg x 37% TBSA = 3,700 cc total deficit
3,700 cc less 500 cc bolus = 3,200 cc deficit remaining
Give ½ deficit in 8 hrs, balance over next 16 hrs
Give 1,600 cc in first 8 hours = 200 cc/hr x 8 hrs
Give 1,600 over next 16 hours = 100 cc/hr

Now you must add maintenance (4,2,1 method) --> Overall 265 cc/hr

To write this:
500 cc IV bolus RL then
265 cc/hour IV RL for 8 hours, then
165 cc/hour IV RL for 16 hours

6

What's different with replacing fluids in a kid with DKA? why?

Due to significant osmotic shifts that occur in diabetic ketoacidosis, calculate deficits and then replace those deficits over 48 hours

w/ the 8 hour 16 hour method you’d kill the kid. Why? If their serum glucose is 1000 (dramatically higher), it’s also that high in their brain cells. If I give them water w/o glucose in large quantities, it’ll go into their brain, into the individual cells, which will go from raisins to grapes. As they go to grapes, their brain will swell & the only opening they have is the foramen magnum. The brain will go through there.
Same thing will happen is they’re hypernaturemic and you use free water.

7

31 kg child in DKA, 10% decrease in weight

3100 cc of fluid loss
20 x 31 = 620 cc IV bolus
Now the fluid loss is 2480 cc, replaced over 48 hours. 2480/48 = 52 cc/hr
This + 4,2,1, maintenance method: 71 cc. 52 + 71 = 123 cc/hour for next 48 hours.

8

Besides fluid replacement in a DKA patient, what else must they get?

When you're correcting DKA, which serum level won't be reliable in this patient? Whaddya do about it?

Insulin IV bolus, then insulin in a drip.

Use terascon on how to calculate the actual serum Na, because now the Na levels you get will be unreliably high.

9

One use for Hot Salt (although it's Very very dangerous to use. Really have to know what you’re doing to use it.)

Cerebral edema

10

BQ - kid with sodium of 102 who starts to seize. What is the drug of choice?

Hot salts

(but you'll likely never give it in reality)
If you give Benzodiazepines – 3 mg of Lorazepam, but they’re still seizing. Now u increase dose to 6, then 10, and they’re still seizing. NO matter how much of these antiepileptic drugs you give, it won’t get this patient out of their seizure b/c it’s due to the low sodium.