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What is the therapy for diaper rash?
- zinc oxide (Desitin, Balmex)
- Petrolatum/white petrolatum
- Talc
- calamine, allantoin, mineral oil, lanolin, kaolin, cod liver oil, dimethicone, corn starch, glycerin, colloidal oatmeal, hard fat, zinc carbonate, zinc acetate (approved)
- Vitamin A+D, vitamin E, witch hazel, peruvian balsam, silicone, aluminum hydroxide, aluminum acetate, microporous cellulose, sodium bicarb, aloe vera, tea tree oil (unapproved)
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What agents are generally not recommended for use in diaper rash?
- antimicrobials
- external analgesics/anesthetics
- external anti-inflammatory agents
- antifungals
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Who should be referred to the physician for diaper rash?
- > 7d duration
- rash outside of diaper area
- skin erosion or pustules
- significant diarrhea present
- fever or behavioral changes
- atypical lesions
- other fungal infections present (thrush)
- severe or recurrent diaper rash
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What is the nonpharmacologic tx for teething?
- gum massage
- chewing devices
- cold, wet washcloth
- teething biscuits/crackers or teething toys
- vaseline if drooling significant
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What are the drugs used for teething relief?
- benzocaine (don't use this)
- acetaminophen
- ibuprofen
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What sx are not attributed to teething?
- vomiting
- diarrhea
- nasal congestion
- fatigue
- fever
- rash
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Who should be referred to a physician for pediatric gastroenteritis?
- under 6mo old
- chronic conditions
- fever over 38-39C
- bloody stools
- frequent and substantial volumes of diarrhea
- persistent vomiting
- sx of dehydration
- mental status changes
- poor response to oral rehydration tx
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What is the initial therapy for dehydration?
Oral rehydration solution
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What is the treatment for patients with diarrhea who are not dehydrated?
- continue age-appropriate diet
- complex carbs, lean meat, yogurt, fruits, and vegetables may be better tolerated than fatty foods or foods high in simple sugar
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What is the treatment for mild dehydration?
- 50 mL/kg ORS plus replacement of continuing losses over a 4h period
- Reevaluate and replace losses at least every 2h
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What is the treatment for moderate dehydration?
- 100 mL/kg ORS plus replacement of continuing losses over a 4h period
- Reevaluate and replace losses every hour
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How much fluid should be replaced for each stool in dehydrated patients?
10 mL/kg
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How much fluid should be replaced for each emesis in dehydrated patients?
2 mL/kg
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How do you give oral therapy to children who are vomiting?
- frequent small sips of 1-2tsp q 1-2 min
- gradually increase amount as tolerated
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What is the tx for severe dehydration?
- Normal saline or Lactated Ringer's 20 mL/kg IV
- Reassess and repeat if needed
- Switch to ORS when stable and mental status has improved
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Why shouldn't cola, ginger ale, apple juice, chicken broth, or tea be used for rehydration in young children?
- too many carbs w/high osmolality increases diarrhea and dehydration
- kids are less able to equilibrate electrolyte imbalances
- broth has too much sodium also, possibility of hypernatremia
- tea has no sodium, possibility of hyponatremia
- Kids 5 and up can have sports drinks w/additional sodium if mildly dehydrated and refuse ORS
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What role do probiotics play in diarrhea?
- some utility for viral-induced GE
- can reduce duration of diarrhea by 1/2 to 1 day
- reduce frequency of stools by 1-2 stools/d by day 2 of tx
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What are the nonpharmacologic tx for constipation in kids?
- increase fluids and bulk content
- regular toilet habits
- prompt response to urge
- don't rush child in bathroom
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What is DOC for constipation in kids?
PEG 3350
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What is the tx for constipation in kids?
- PEG 3350
- Glycerin
- Saline laxatives (avoid rectal in < 2yo, and oral in < 5yo)
- Mineral oil (never in < 6yo)
- Emollients in 6 and up
- Bulk laxatives in 6 and up
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What is the tx for impaction in kids?
- Glycerin or enema for < 1yo
- Bisacodyl, Mg citrate, PEG, enemas in > 1yo
- Caution with electrolyte abnormalities with saline agents
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What is the maintenance tx for constipation in < 5yo?
- glycerin suppositories
- barley malt extract
- avoid stimulants and phosphate enemas
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What is the maintenance tx for constipation in 5 and up?
- Milk of magnesia
- PEG 3350
- avoid stimulants and excessive enemas
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