dehydration
how do you classify dehydration in pediatrics in patients more than 1 mo
Mild <5%
Moderate 5-10%
Severe >15%
of bodyweight
oral fluids in dehydration. what is advised?
Fluid: dilute juice or oral rehydration solutions. à Continue age-appropriate diet as tolerated.
what is the dose of ondansetron for kids with vomiting?
0.15mg/kg dose (max dose 8mg) of Ondansetron for vomiting.
when to initiate IV in Non severe dehyrdration?
If oral ineffective, move to IV hydration
An 18 kg child is 9 % dehydrated. calculate maintenance fluids?
Maintenance fluid = 40mL + 2(8kg) = 56mL/h
what is 4-2-1 rule
4-2-1 Rule
The "421 rule" is used to calculate the hourly infusion rate for maintenance fluids, generally for pediatrics for ALL children
how much boluses you give if severe dehydration?
Bolus = NS 10-20mL/kg or 5-10mL/kg if worried about myocardial or renal dysfunction.
how to calculate deficit in dehydration
Calculate deficit= % dehydrated x weight in kg.
how to calculate maintenance IV fluids
Calculate maintenance fluids in mL/hr with 4-2-1 rule.
what is the maximum K can you put in IV fluids
40 mEQ
calculate maintenance rate upto 10 kg
Up to 10 kg 4mL/kg
what IV fluids are used for correction of severe dehydration
IV Fluid Selection – Typically D5NS +/- 20mEq/L KCl
Urine output and Electrolytes and kidney function
What should you be careful of before adding KCL to fluids
why do you need monitoring ins and outs after you initiate fluids in severe dehydration?
: Measure ongoing losses (i.e. vomit, diarrhea, sweat etc.) and replace as needed.
A 18kg child is 9% dehydrated. calculate bolus?
Bolus= 20mL/kg x 18kg = 360mL
calculate maintenance rate from 10-20 kg
10-20 kg 40mL + 2mL/kg for every KG above 10 kg
How many times can we give bolus
3 times
why is dextrose added in pediatric IVF for dehydration correction?
Because kids have a smaller glucose reserve in their liver
what are signs of hypernatremic dehydration?
lethragy
seizures
doughy skin
capillary fill maybe normal
A 18 kg child is 9% dehydrated, calculate deficit?
Deficit = 0.09 x 18 = 1.62L
Calculate maintenance rate above 20 kg
>20 kg 60mL + 1mL/kg for every KG above 20 kg. MAx 100 ml/hr
How much Sodium is present in NS and LR
NS - 154 mEq/l
LR - 130 mEq/l
how to calculate total fluid replacement in severe dehydration?
: Calculate Total Fluid Replacement Over 24h = deficit + maintenance – bolus
Alternatives to children with difficult IVS in severe dehydration are?
NG tube
IO
An 18 kg child is 9% dehydrated. calculate 24h total fluids replacement and fluid rate per hour.
24h Total Fluid Replacement Required = 1620 + (56 x 24) - 360 = 2604mL ü Divide over 24 hours = 2604/24 hr = 108.5 mL/hr