Therapeutics - Pediatrics: Fluid
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Daily Fluid requirements for pediatric patient <10 kg?
Daily Fluid replacement for pediatric patient 10-20 kg
1000 mL + 50 mL/kg over 10 kg (but NMT 20kg)
Daily Fluid replacement for pediatric patient >20 kg?
1500 mL + 20 mL/kg over 20 kg
Fever increases Fluid loss by what amount?
10-15%/ degree C above normal (37-38 degrees C)
% dehydration equation is:
(Normal weight – current weight)/normal weight
What type of dehydration is managed at home?
What are the characteristics of Mild dehydration?
- <5% dehydration
- Thirst: mild
- Mucus membranes: moist-dry
- Anterior fontanel: flat (normal)
- Tears: present
- Skin: normal
- Urinary SG: slightly increased or about the same
What are the characteristics of moderate dehydration?
- 6-9% dehydration
- Thirst: moderate
- Mucus membranes: dry
- Anterior fontanel: +/-
- Skin: +/-
- Tears: +/-
- Urinary SG: increased
What are the characteristics of severe dehydration?
- 10-15% dehydrated
- Hyperirritable or lethargic
- Thirst: strong
- Mucus membranes: parched
- Anterior fontanel: sunken
- Skin: tenting
- Tears: absent
- Urinary SG: significantly increased
- Can be tachycardia and/or hypotensive
Na is supplied in what form when the patient is alkylotic?
Na is supplied in what form when the patient is acidotic?
Na acetate (or Nabicarb)
What ion is dependent of serum pH?
What is the Vd for Na?
What is the Vd for Bicarb?
What is the Vd for Cl?
What is the electrolyte adjustment equation?
- (CD-CO) x Vd x Kg = mEq required
- CD = Conc. desired
- CO = conc. observed
What are the parenteral daily electrolyte requirements for Na?
What are the enteral daily electrolyte requirements for Na?
Why are clear liquids, like apple juice, not appropriate for dehydration?
Hyper-osmolar and lack electrolytes
Name the oral rehydration solutions available for pediatrics?
- WHO salts
When should you call your doctor about dehydration?
- High risk individual
- <6 months or <8kg
- Fever of > or = to 38 C for <3 months
- Fever of > or = to 39 for 3-36 months
- Blood in stool or high output
- Persistent vomiting
- Change in mental status
How much and how often should pediatrics be taking oral rehydration solution when diarrhea begins?
5-10 mL Q1-2minutes
How is Mild-moderate dehydration treated?
- In the home
- Maintain normal diet/reintroduce slowly/avoid simple sugars
- Mind lactose intolerance
- Oral rehydration solution
- 50-100 mL/kg over 3-4 hours
- For every diarrhea or vomiting episode:
- <10 kg: 60-120 mL/kg
- >10 kg: 120-240 mL/kg
When must a pediatric patient be orally rehydrated by IV?
- Severe dehydration (>10%)
- High stool output of >10 mL/kg/hr
- Intractable vomiting
- Intestinal ileus
How do you calculate the fluid deficit for a pediatric patient?
1L fluid/kg lost (minus any fluid given in a bolus)
How much fluid should be provided in a fluid bolus?
- 20 mL/kg provided over 10-30 minutes
- May repeat as needed until hemodynamically stable
When should you give a fluid bolus?
When hemodynamically unstable
How rapidly should fluid be replaced in a pediatric patient?
- 1/2 over the first 8 hours
- ½ over next 16 hours
- Over 48 hours if hypernatremic, Na should decrease at NMT 12 mEq/day
How should Na deficiency be replaced in a pediatric patient?
- ½ deficit over 8 hours
- Symptomatic: increase Na by 5 mEq/L/dose
- Asymptomatic: increase Na by 10 mEq/L/day
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