Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
2 Peds Dehydration
| Question | Answer |
|---|---|
| Factors that make children more susceptible to dehydration (in addition to being unable or unlikely to communicate thirst) | high surface area to weight ratio, infants decrease oral intake when ill, renal concentrating mechanisms do not maximally conserve water in early life, fever may increase fluid needs |
| Physiologic effects of dehydration | decreased ECF volume, leading to decreased tissue perfusion, impaired renal function, compensatory tachycardia and lactice acidosis |
| Clinical evaluation of a child with dehydration | focus on the composition of volume of fluid intake, the frequency and amount of vomiting, diarrhea and ruine output; the degree and duration of fever, the nature of administered meds, an underlying medical conditions |
| Important clinical features used to estimate the degree of dehydration | capillary refill time, postural blood pressure, hear rate changes, dryness of the lips and mucous membranes, lack of tears, sunken fontanelle in an infant, sunken eyes, oliguria, lack of EJVenous filling when supine |
| A late sign of shock in children | low or falling blood pressure |
| Notable lab parameters include: high urine specific gravity (in the absence of an underlying renal concentrating defect), a relatively greater elevation in blood urea nitrogen than in creatinine, | a low urinary (Na) excretion (<15mEq/L), and an elevated hematocrit or serum albumin level secondary to hemoconcentration |
| Most common cause of dehydration in children | acute diarrhea. Other causes: acute vomiting |
| ______is the leading cause of child morbidity and mortality | dehydration. In developing nations, >4million deaths/yr. |
| In the first five years of life, the average child has ___ episodes of diarrhea | 7-15 |
| How many deaths per year in the US are due to dehydration? | 400 |
| Causes of acute diarrhea in pediatric patients | Infectious gastroenteritis, antibiotic associated, food intoxication, systemic infection, rare: toxic ingestion, hypothyroidism (infants) |
| Viral causes of gastroenteritis | rotavirus, norovirus, enteroviruses |
| Bacterial causes of gastroenteritis | Salmonella, Shigella, Campylobacter |
| Parasitic causes of gastroenteritis | Giardia, Cryptosporidium |
| Common causes of vomiting in pediatric patients | infectious gastroenteritis, infants: obstruction, reflux, children: toxic ingestion, systemic infection. Teens: migraine, medications, pregnancy |
| Common presenting signs of dehydration in teens | Worsening allergies, asthma, acne. Fatigue, headaches. This is b/c when the body is trying to conserve water, there is an overproduction of histamine. Water is taken from the skin and oil from sebaceous glands increase, increasing acne |
| In vigorous exercise, how much water should a person be drinking? | 2/3 of their body weight in ounces. Ex: 130 lb athlete needs 87 ounces in water |
| Calculating degree of dehydration | ((pre-illness weigt - illness weight)x100%)/pre-illness weight |
| Things to ask a mother of her infant | how many diapers, and are they wet? When crying, are they making tears? |
| Features of mild dehydration | body weight loss is 3-5%. Estimated fluid deficit: 30-50ml/kg. Sx: increased thirst, moist to slightly dry mucous membranes, nl prod of tears and urine |
| Features of moderate dehyration | body weight loss:6-9%, est. fluid def. 60/90ml/kg. Sx:postural hypotn, sunken eyes, sunken ant font, decreased prod of urine and tears, decreased capillary refill |
| Severe Dehydration Features | body weight loss:>/=10%, est fluid def 100ml/kg or more, sx: lethargy, weak and rapid pulse, marked hypotn with poor peripheral perfusion, very dry mucous membranes; anuria or severe oliguria, absent tear prod. MEDICAL EMERGENCY |
| Orthostatics | Lay down (2min), stand up (1min). Decline of 10mmHg or increase of HR by 20. |
| Where is a good place in babies to checking for tenting of the skin? | abdomen |
| PE in dehydration: Vital signs (weight, temp, HR, RR), General survey (level of distress), HEENT (fontanelle in infants, appearance of eyes, tears, membranes), | Abdomen (bowel sounds, distention), Extremities (capillary refill, turgor), Dehydration scale |
| When are labs indicated | in severe dehydration |
| Which lab test is most useful in determining the level of dehydration? | serum bicarbonate. Also check serum electrolytes and a CBC |
| An Na level of <130mEq/L is what type of dehydration? | hypotonic/hyponatremic. 130-135mEq/L is isotonic/isonatremic. >150mEq/L is hypertonic/hypernatremic. |
| 90% of dehydration secondary to acute vomiting and diarrhea is | isotonic (mild to moderate is usually isotonic dehydration) |
| Hyperglycemic Hyperosmolar Syndrome | Complication of Type 2 DM delayed diagnosis can be fatal. This may be the initial presentation. Triad: hyperglycemia, hyperosmolaltiy, mild metabolic acidosis. Sx: N/V. No ketones or abdominal pain. Kid overweight with N/V, check sugar |
| Once you rehydrate a child, educate the parents that | they can eat whatever they want. Throw the BRAT diet out. The more restricted the diet, the more dehydrated they will be. Minimize fats |
| Contraindications to ORT | Shock, Intractable vomiting, stool losses>10ml/kg/hr, severe gastric distention/abdominal ileus. Worrisome sx: pain, blood in stool, <6months old, change in mental status, |
| If a child has gastroenteritis, once the child has a BM, the | cramping and pain should typically subside. If it doesn't, it may rule out gastroenteritis |
| In assessing a patient for ORT, quantify the following: | duration of illness, number ot output episodes, amount of fluid with each episode |
| What are the two phases of ORT? | Rehydration (over 3-4 hours) and maintenance (administration of maintenance calories and fluids) |
| ORT: No/minimal dehydration | Children<10kg: 2-4 oz of ORS for each loose stool or episode of emesis. Children>10kg: 4-8 oz of ORS for each loose stool or episode of emesis |
| ORT: Mild/Mod Dehydration | Rehydration: 50-100ml of ORS/kg of body weight. Given in small increments (5ml/1tsp) |
| Tx for Severe Dehydration | medical emergency, IV therapy always warranted, monitor closely until vital signs nl, lab testing required but should not delay rehydration, when level of consciousness has normalized, change to oral hydration |
| cholera | high output diarrhea |
| WHO ORS: | 90mmol/L of sodium, 20mmol/L of potassium, 111 mmol/L of glucose |
| Which liquids should you inform parents not to use? | broth, teas, soft drinks, apple juice |
| AAP sodium recommendations | 75-90mEq/L for rehydration; 40-60 mEq/L for maintenance prevention |
| Foods to encourage after ORT | Starches: rice, baked potatoes, plain pasta, toast. Clear soups or soups with rice, noodles or veggies. Yogurt, veggies, fresh fruits. Meats. Limit fats b/c they are harder to digest |
| Ingredients for Homemade electrolyte solution | water, baking soda, salt, sugar |
| Ondansetron therapy | results showed a single dose reduced vomiting, facilitated the administration of ORT, reduced need for IV hydration and hospital admission. |
| Emergent IV therapy to rapidly expand plasma volume and prevent circulatory collapse | 20mL/kg bolus of isotoni fluid should be given IV as rapidly as possible. Either colloid or crystalloid may be used. If no IV site is available, the IO through the marrow space of the tibia. If no response to first bolus, give a second. |
| Isotonic dehydration may be treated by | providing half of the remaining fluid deficit(after bolus) over 8 hours and the second half over the ensuing 16 hours in the form of 5% dextrose with .2-.45% saline containing 20mEq/L KCl |
Created by:
ltm12