Pediatric GI issues

• water
• they have less fat
• 50% of their water is in the extracellular fluid, making them more suceptable to fluid loss/dehydration

• no
• solutes dont go in and out of cells easily so dont rapidl hydrate
• can lead to cerebral edema

• 1-10kg: 100ml/kg
• 11-20kg: 1000mL + 50ml/kg for each kg over 10kg
• >20kg: 1500mL + 20mL kg for each kg over 20kg

• fever
• burn
• vomiting
• diarrhea

they also dont recognize that they are dehydrated and their thirst mechanism isnt activated

• fluid loss exceeds intake regardless of the cause
• a dynamic condition- so you hydrate them and bolus them. dont be fooled if they perk up, if they are still loosing you need to intervene again
• fluid loss is related to distribution of water and solutes in the body

• greater proportion of their weight is water and that water is in the extracellular fluid
• ratio of body surface area to weight is greater in infants so more fluid loss
• immature kidneys are less effective at concentrating urine and maintaining the acid-base balance
• thrirst mechanism not well developed
• infants have a higher bmr

• inadequate oral intake
• vomiting
• diarrhea
• fever
• phototherapy for jaundiced babies
• enteral feeds
• drainage tubes
• blood loss
• DKA
• drugs
• burns
• diseases (ie kidney)

• isotonic: main form. clinical signs of hypovolemia
• hypotonic: lose more electrolytes than water. low sodium
• hypertonic: lose more water than electrolytes. hypernatremia. less common. cns disturbances

dehydration can also be mild, moderate or severe

• body weight
• % weight loss= (pre illness kg- current kg)/ pre illness kg
• every kg of weight lost = 1 liter fluid loss

• infants: 3-5% weight loss
• children: 3-4% weight loss

• infants: 6-9%
• children: 6-8%

• infants: 10% or more
• children: 10%

• dry lips and mucous membranes
• sunken eyes (dark circles)
• little to no tears
• poor turgor
• depressed fontanelles

• changes in sensorium (not interactive/participating)
• irritable (suddenly wimpering when they were full crying)
• less vigorous crying in infants
• lethargy

delayed cap refil, cool extremities, mottling (red purple marbling of skin)

• tachypnea
• anorexia, poor po intake, vomiting diarrhea
• decreased/no urine
• flaccidy- wet noodle appearance

• normal vital signs
• normal behavior
• slight thirst (older kids)
• mucous membranes not dry
• tears often present
• fonantels soft and flat
• normal turgor and cap refl
• urine output is adequate but CONCENTRATED

• mild tachypnea and tachycardia (higher if theres a fever)
• normal bp at rest
• irritable
• dry mucous membranes
• decreased tears and turgor
• fontanelles slightly depressed
• delayed cap refil
• decreased urine

• significant tachycardia
• hyperpnea (deep rapid breathing)
• hypotension
• lethargy
• severly dry mucous membranes
• no tears, sunken eyes and fontanels
• cap refill more than 4 sec
• tenting
• cool mottled extremities
• oliguria/aneuria

• mild: oral replacement if child awake/alert and willing to take fluids
• moderate: oral replacement therapy in conjunction with IVF
• severe: RAPID replacement of fluid loss with ivf

• common replacement solution is pedialyte
• clear liquids, but be mindful of na, k and glucose content
• encourage fluids often and as much as they can tollerate

• fatigued and weak
• fear of vomiting again
• belly pain/retching
• not thirsty
• they want control. theyve lost control when sick and drinking is the only thing thye have left to chose

• begins immediately, as dehydration is life threatening
• bolus: 20ml/Kg isotonic solution over 5-20 min followed by maintenance fluid

yes if lost and ordered, BUT, Must wait until they void to ensure that kidneys are functioning

4/2/1

• 4ml/kg/hr for the first 10kg
• 2ml/kg/hr for the secont 10kg
• 1ml/kg/hr for each additional kg

• Protect the IV- check IT EVERY HOUR
• strict is and os (1g wet diaper weight =1ml urine)
• specific gravity 1.005-1.025 (the higher the dryer)
• daily weights
• weigh all diapers

• vomiting followed by watery, foul smelling diarhea
• the most common gastroenteritis in kids under 5
• starts with lowgrade fever and puking followed by very watery stool for 5-7 days

• watery diarrhea for a few days followed by severe abdominal cramping and bloody diarrhea
• from contaminated food
• can lead to hyperuremia

• lives on raw chicken
• can be in turtles
• dont usually treat with abx- self limiting

• usually from something like staph
• hits hard and fast with profuse diarrhea, nausea and vomiting
• worship the toilet then better after

• leading cause of illness in kids under 5
• rotavirus most common
• infecious diarrhea often spread thru fecal oral route

• acute and chronic digestive disorders
• infection
• abx therapy (c.diff)
• laxatives

• dehydration
• electrolyte imbalances

• perianal skin care
• prevention
• DONT use antimotility drugs for infectious
• pedialyte

• juice
• caffeine
• sugar
• soda
• jello
• chicken/beef broth (high sodium, not always good)

• alteration in the frequency, consistancy or easy of passing stool for more than 2 weeks
• in kids dont use frequency as a diagnostic

• diet
• toilet training