n304 fluid & electrolytes
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why are children more susceptible to f/e imbalance?
- higher portion of water content
- inable to shiver or sweat
- greater proportion of fluid in teh ECF
- higher metabolic rate
- immature kidneys and GFR
urine output in infants?
1 - 2 ml/kg/hr
anterior fontanel palpable up until what age?
16 - 18 months
why does tachypnea increase fluid needs?
insensible loss via lungs
heart failure, renal failure, increased ICP, inappropriate secretion of ADH... fluid needs?
less than average. fluid restriction.
why is urinalysis ineffective in determining F/E balance?
infants cannot concentrate urine appropriately
follows sodium - extracellular
K+ affected by what?
intenstinal losses. diarrhea, NG drng, vomiting
when do you NOT give K+ to a child?
if they are not urinating
causes of hypokalemia?
diuretics, meds, CHF, GI losses, nephrotic syndrome
causes of hyperkalemia?
hemolysis, reduced kidney fx, acidosis, blood transfusions
danger of hyperkalemia?
cardiac symptoms, possible cardiac arrest
what serum replacement should never be pushed IV?
treatments for hypo/hyperkalemia?
- hypo - replacement
- hyper - diuretics, regular IVF (increased extracellular volume)
most abundant electrolyte in ECF? levels?
- < 130
- water moves from intra to extracellular, dilutes ECF, decreased Na+
- most common cause: dilute formula
calcium normal values
8.5 - 11
- decreased intake/absorption, increased excretion
- causes: inadequate diet, vit D deficiency, cow's milk given inappropriately
increased absorption or intake, shift from bones to ECF, decreased excretion
treatment for hypo/hyper calcemia?
- hypo: oral or IV calcium gluc
- hyper: increased fluids, lasix
glucose needs of infants?
higher than adults due to higher BMR
acidosis results from
accumulation of an acid OR a loss of a base
alkalosis results from..
accumulation of base OR loss of an acid
can evaluate acid-base balance by what tests?
ABG, electrolytes, protein/albumin, urine pH
components of blood gas?
- pH, pCO2, paO2, BE, HCO3
- ph, carbon dioxide, oxygen, base excess, bicarb
normal pH range?
7.35 - 7.45
three mechanisms that operate to keep pH in normal range?
- chemical buffers
- respiratory control of CO2
- renal regulation of bicarb and secretion of H+ ions
which mechanism usually used first in children to regulate ph?
chemical buffers used for ph maintenance?
- high pH, low CO2.
- decrease in pH
- decrease in bicarb
- high lactic acid
high pH, high bicarb, base excess
tachypnea does what to compensate?
faster breathing = blowing off CO2 = trying to correct acidosis
where is the fluid loss in early dehydration?
extracellular fluid loss
where is fluid loss in late dehydration?
intracellular fluid loss
first compensatory mechanism to dehydration?
dehydration is defined according to what electorlyte
losing water and Na+ same rate
- losing salt faster than fluids.
- Na+ will be low
- losing fluid faster than salt.
- Na+ will be high
- most dangerous. prone to seizures & neuro damage
treatment of mild - moderate dehydration?
oral rehydration solutions (pedialyte, etc)
treatment for severe dehydration?
- parenteral rehydration
- deficit + maintenance + ongoing losses >> fluid rate
- LR, NSS. adminstered until pulse, perfusion, mental status return to baseline
fluid types for rehydration?
NS or LR.
possible causes of acute diarrhea?
infectious. eg, gastroenteritis
possible causes of chronic diarrhea?
malabsorption, food allergies, lactose intolerance, parasites
we look at diarrhea by what characteristics?
frequency, fluidity, volume
treatment/diagnosis of diarrhea?
stool cx, ova/parasites, give abx if bacterial, assess for dehydration
most common virus causing gastroenteritis?
Norovirus. fecal-oral route, person-to-person via contaminated food/water
- leading cause of infx in children
- common in winter months. 50% of diarrhea cases
usually respiratory illness, but can also cause gastroenteritis
- most common parasite seen in daycare-age children
- spread in water
- stool cultures over several weeks
enterobiasis (pinworms) manifestations
- anal itching, no diarrhea
- hand-mouth ingestion from environment
- scratching causes reinfestation
enterobiasis (pinworms) dx and treatment?
- tape test. tape on anus overnight, scrape onto slide.
- medication can stain stool/emesis red
common interventions for parasite infections?
- monitor other family members
- cut fingernails
- diaper hygience, wash diaper area
- wash fruits and vegs
interventions for impaired skin integrity
- diaper changes and cleansing
- protective ointment
- expose to air
- avoid wipes
why are anti-diarrheals contraindicated?
want to get infection out
rapid replacement of fluids for what types of dehydration?
- isotonic, hypotonic
- *want rapid expansion of intravascular space
rapid replacement contraindicated in what type of dehydration?
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