Week 5 Pediatrics: Fluid electrolyte imbalance, Renal and genitourinary dysfunction, Cerebral dysfunction and CNS
malformations Ball: 18, 26, 27 ATI: 12, 13, 14, 24, 25, 26 1
Week 5 Pediatrics: Fluid electrolyte imbalance, Renal and genitourinary dysfunction, Cerebral dysfunction and CNS
malformations Ball: 18, 26, 27 ATI: 12, 13, 14, 24, 25, 26
I.Fluids, Electrolytes and Acid-base Balance a.Pediatric Considerations i.Infants have a larger extracellular fluid volume than older children and adults
1.Increased risk for dehydration
a.Therefore, younger children would get priority b.Their body is mostly made up of water 2.Sensible loss
a.n/v/d
b.wound drainage
3.Insensible loss a.Sweat/perspiration
b.Tachypnea ii.Kidneys immature in children under 2 years old
1.Ineffective secretion
2.NI: Check trough and peak levels because of immature kidneys
iii.Difficulty regulating electrolytes
1.Normal Values: a.Potassium: 3.5 - 5 mmol/L
b.Sodium: 135 – 146 mmol/L
c.Calcium: 9.5 – 10.5
d.Magnesium: 1.3 -2.1
e.Chloride: 98-106
b.Dehydration
i.Types of Dehydration (water and sodium)
1.Isotonic
a.Same Proportionate loss of fluid and sodium at the same time
b.Extracellular loss
2.Hypotonic
a.Greater loss of sodium than water
b.Extracellular shift to intracellcular to compensate
c.Causes:
i.prolonged vomiting, diarrhea, renal disease, burns
3.Hypertonic a.Greater water loss than sodium
b.Intracellular shift into extracellular to compensate
c.Causes
i.diabetes insipidus, fluid volume overload
ii.Risk Factors 1.Occurs due to vomiting, diarrhea, burns, hemorrhage, wound drainage
2.Radiant warmers
a.Spend too much time under warmers
3.Third spacing
a.Adrenal insufficiency
b.overuse of diuretics
c.Renal Problems 2
iii.How does the patient look? 1.Mild a.3 -5 % weight loss b.Pulse is regular and strong
2.Moderate a.6 – 9% weight loss
b.Rapid pulse 3.Severe a.>10% weight loss b.Rapid and weak pulse
iv.Treatment 1.Oral Rehydration Therapy
a.Prevent dehydration if possible
i.Recover patient with IV fluid resuscitation
ii.oral rehydration therapy
iii.change environmental factors when applicable b.Oral rehydration best for mild or moderate loss
i.No diarrhea/dehydration
ii.Rehydration complete
c.IV fluid resuscitation see 18-7 used for Severe dehydration
i.Complete calculations
1.Up to 10kg 100ml/kg
2.11-20 kg 50ml/kg
3.>20kg 20ml/kg
v.Fluid Volume Excess 1.Too much fluid in vascular and interstitial compartment.
i.Serum sodium normal
2.Due to aldosterone
a.Adrenal tumors
b.CHF
c.Liver cirrhosis
d.Chronic renal failure
3.May also be attributed to low socioeconomic families that over dilute formula and fluid overload children
vi.Treatment
1.Edema and Care Management a.Assess for
i.Weight gain
ii.Increased input vs output
iii.Infusion rate and ensure patient is not being overloaded
1.Must reset the IV pump q2h
iv.Conditions that Cause Edema 1.Increased blood hydrostatic pressure
2.
Increased Interstitial fluid
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