The child with a fluid and electrolyte atlertation.

• Higher
• percentage of body weight is water

• More
• fluids are extracellular

• Higher
• metabolic rate

• Faster
• peristalsis

• ¢Can’t
• communicate thirst

• ¢Cannot
• concentrate urine

• ¢More
• prone to gastrointestinal infections

Extracellular fluid is located in teh interstitial spaces ( surrounding the cells) 

intracellular space- this more difficult to dehydrate.

• Mild—suffering
• from 4-5% losses, child will be fussy, thirsty, and vital signs are stable.

• Severe—suffering
• from > 10% fluid loss—at risk for impending hypovolemic shock

40% compared to 20% in adults

• History
• of nausea, vomiting, diarrhea

• Sunken
• fontanels

• Dry
• mucous membranes

• Decreased
• urinary output

• Changes
• in tears, salivation

• Weight
• loss

• Abnormal
• electrolytes

• Changes
• in

• Heart
• rate

Sensorium

Skin

• (early
• indicators of impending shock

• Correct
• underlying cause

• Replace
• fluids/electrolytes

• Rehydrate
• according to child’s
• weight

• Recommend
• preparations such as pedialyte

• AVOID
• SPORTS DRINKS, WATER, OR SUGARY DRINKS

• IV
• therapy—solution depends on sodium needs

sodium < 135 meq/l

sodium >150 meq/l

Potassium <3.5 meq/L

• No
• evidence of dehydration—replace up to 10ml/kg for ongoing losses—continue AAD

• Mild
• dehydration—10-50 ml/kg over a 4 hour period + replace estimated losses*

• Moderate
• dehydration—10-100 ml/kg over 4 hours + replace estimated losses*

• Severe
• dehydration—IV therapy bolus of 20ml/kg of solution*

*start age-appropriate diet once dehydration is corrected

Maximum dose is 40meq/liter. 

• Rate
• is 1 meq/kg/hour
• or less

• Mix
• well into IV bag—upright position

• If
• solution is > 30 meq/liter
• do not give in peripheral
• vein

• Be
• sure of age-appropriate dose

• DC
• if urinary output inadequate

40 meq/L

Do not give in peripheral vein.

In urinary output is inadequate

• The treatment of metabolic acid-base distrubance is oriented towared correcting the underlying problem. 
• The treatment of respiratroy imbalanc is directed toward reestablishing alveolar ventilation.

• No
• wet diapers within 6-8 hours

• No
• tears if older than 2-4 months

• Change
• in mucous membranes

• Irritable
• high-pitched cry

• Difficult
• to rouse

• Increased
• respiratory rate or difficulty breathing

• Skin
• mottled, unusual color, or cool to touch

• Skin
• very dry

• Decreased
• turgor

• Most
• common childhood disorder

• 25-30
• million cases annually

• 200,000
• hospitalizations yearly

• Presents
• with dehydration, changes in stool patterns

Potassium >5meq/L

• Calcuim <8.5 mg/dl 
• ionized calcuim <4.5 mg/dl

• Calcium >11.0 mg/dl
• ionized calcium >5.5 mg/dl

• Acute
• infections

• >50%
• due to bacterial or viral—rotavirus

• Parasitic
• infections

• Fungal
• infections

• Malabsorption,
• food intolerance

Medications

• Obstructions,
• bowel disorders, IBS

• Restore
• fluid/electrolytes

• Past
• use of BRAT (banana-rice-applesauce-toast) diets—not preferred since this diet
• is low in energy, density, fat, and protein

• Current
• management--rehydration solutions, then resume formula or breast feeding—age
• appropriate diet

• Emphasis
• on frequent feedings

• Anti-diarrheal
• medications are contraindicated

Not preferred since this diet is low in enegy, density fat and protein.

• Forceful
• ejection of stomach contents

• Not
• “spitting
• up” or
• GER due to overfeeding

• Severe
• form is “projectile”

• Undigested
• food or formula

• Free
• of bile, fecal odor, or blood

• Not
• projectile---indicates obstruction, tumor, pyloric stenosis, or increased
• intracranial pressure

• Treat
• underlying cause

• Prevent
• dehydration

• Use
• oral replacement therapy per formula

• Prevent
• aspiration

• Proper
• positioning

• Gradual
• re-introduction of food