Pediatric GI issues

  1. do neonates have more water or fat
    • water
    • they have less fat
    • 50% of their water is in the extracellular fluid, making them more suceptable to fluid loss/dehydration
  2. should you rapidly hydrate hypertonic kids
    • no
    • solutes dont go in and out of cells easily so dont rapidl hydrate
    • can lead to cerebral edema
  3. daily pediatric fluid requirements
    • 1-10kg: 100ml/kg
    • 11-20kg: 1000mL + 50ml/kg for each kg over 10kg
    • >20kg: 1500mL + 20mL kg for each kg over 20kg
  4. scenarios where children need more fluids
    • fever
    • burn
    • vomiting
    • diarrhea

    they also dont recognize that they are dehydrated and their thirst mechanism isnt activated
  5. dehydration
    • 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
  6. physiological differences that increase dehydration in infants KNOW THIS
    • 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
  7. causes of dehydration
    • inadequate oral intake
    • vomiting
    • diarrhea
    • fever
    • phototherapy for jaundiced babies
    • enteral feeds
    • drainage tubes
    • blood loss
    • DKA
    • drugs
    • burns
    • diseases (ie kidney)
  8. types of dehydration
    • 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
  9. how to evaluate dehydration severity
    • body weight
    • % weight loss= (pre illness kg- current kg)/ pre illness kg
    • every kg of weight lost = 1 liter fluid loss
  10. mild dehydration weight loss
    • infants: 3-5% weight loss
    • children: 3-4% weight loss
  11. moderate dehydration weight loss
    • infants: 6-9%
    • children: 6-8%
  12. severe dehydration weight loss
    • infants: 10% or more
    • children: 10%
  13. skin signs of dehydration
    • dry lips and mucous membranes
    • sunken eyes (dark circles)
    • little to no tears
    • poor turgor
    • depressed fontanelles
  14. neurologic signs of dehydration
    • changes in sensorium (not interactive/participating)
    • irritable (suddenly wimpering when they were full crying)
    • less vigorous crying in infants
    • lethargy
  15. cardiovascular signs of dehydration
    delayed cap refil, cool extremities, mottling (red purple marbling of skin)
  16. other signs of dehydration
    • tachypnea
    • anorexia, poor po intake, vomiting diarrhea
    • decreased/no urine
    • flaccidy- wet noodle appearance
  17. mild dehydration symptoms
    • 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
  18. Moderate dehydration symptoms
    • 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
  19. severe dehydration symptoms
    • 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
  20. treatment of dehydration
    • 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
  21. oral replacement therapy
    • 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
  22. why might a child refuse to drink
    • 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
  23. parenteral fluid therapy
    • begins immediately, as dehydration is life threatening
    • bolus: 20ml/Kg isotonic solution over 5-20 min followed by maintenance fluid
  24. should you add potassium to ivf
    yes if lost and ordered, BUT, Must wait until they void to ensure that kidneys are functioning
  25. how to calculate maintanence IVF

    • 4ml/kg/hr for the first 10kg
    • 2ml/kg/hr for the secont 10kg
    • 1ml/kg/hr for each additional kg
  26. monitoring dehydration KNOW THIS
    • 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
  27. rotavirus
    • 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
  28. e.coli
    • watery diarrhea for a few days followed by severe abdominal cramping and bloody diarrhea
    • from contaminated food
    • can lead to hyperuremia
  29. salmonella
    • lives on raw chicken
    • can be in turtles
    • dont usually treat with abx- self limiting
  30. food poisoning
    • usually from something like staph
    • hits hard and fast with profuse diarrhea, nausea and vomiting
    • worship the toilet then better after
  31. acute diarrhea
    • leading cause of illness in kids under 5
    • rotavirus most common
    • infecious diarrhea often spread thru fecal oral route
  32. what can cause diarrhea
    • acute and chronic digestive disorders
    • infection
    • abx therapy (c.diff)
    • laxatives
  33. consequences of diarrhea
    • dehydration
    • electrolyte imbalances
  34. care management of diarrhea
    • perianal skin care
    • prevention
    • DONT use antimotility drugs for infectious
    • pedialyte
  35. foods to avoid with diarrhea
    • juice
    • caffeine
    • sugar
    • soda
    • jello
    • chicken/beef broth (high sodium, not always good)
  36. constipation
    • alteration in the frequency, consistancy or easy of passing stool for more than 2 weeks
    • in kids dont use frequency as a diagnostic
  37. causes of constipation
    • diet
    • toilet training
Card Set
Pediatric GI issues
Exam of 1/27/2020