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23 Cards in this Set

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Fluid Balance Principles
 ECF is lost more readily than ICF
 Since there is more fluid in ECF to lose, dehydration occurs commonly
 Since Na+ and Cl- predominate in the ECF, with fluid losses come electrolyte imbalances
Body Surface Area
Higher BSA leads to more insensible loss by way of the skin by evaporation (2/3) and lungs (1/3)
Children have a higher body surface area than adults and less muscle mass, insensible loss is loss that cannot be seen such as breathing, sensible loss would be sweating, vomiting, diarrhea, urine

A proportionately longer GI tract leads to increased sensible loss of fluids through diarrhea
Factors Affecting Fluid Losses
 Increased insensible water loss
 Radiant warmers (don’t put clothes on them)
 Phototherapy (no clothes or very little)
 Skin defects and skin breakdown (burns), cover the burn with warm, sterile dressings
 Fever, (cool clothes, hydrate, medicine-unless child is acting fine, then the fever can be beneficial)
 Increased respiratory rate (keep child quite, give oxygen, limit activity)
 Elevated room temperature (take clothes off or increase temperature)
Pediatric Basal Metabolic Rate (minimum caloric requirement to make the body work)
 Higher to promote growth

 Higher due to large BSA compared with the mass of active tissue (muscle)

 Higher BMR leads to more insensible fluid losses and more water needed to excrete increased metabolic waste
Immature Kidneys
 Concentrating and diluting urine problems
 Conserving and excreting sodium problems
 Infant less able to handle solute-free liquid
 Over hydrated with dilute formula or plain water (hyponatremic)
 Dehydrated with too concentrated a formula (hypernatremic)
Daily Fluid Requirements
 By child’s body weight:
1-10 kg
100 ml/kg/day
11-20 kg
1000 ml + 50 ml/kg/day each kg >10 kg
>20 kg
1500 ml + 20 ml/kg/day each kg > 20 kg

Divide the total by 24 to get hourly requirement
Increased Dehydration Risks
 More ECF to lose and lost quickly
 Increased BSA
 Increased BMR
 Increased insensible losses through fever
 Immature kidneys
Classification of Dehydration
 Based on osmolality and serum Na+
 Isotonic-Sodium 130-150
 Hypotonic-Sodium <130
 Hypertonic-Sodium > 150
Signs of mild dehydration
alert mental status, soft and flat fontanels, eyes are normal, oral mucosa is pink and moist, skin turgor is elastic, heart rate is normal, blood pressure is normal, extremities are warm, pink, brisk capillary refills, urine output will be slightly decreased
signs of moderate dehydration
mental status ranges from alert to listless, fontanels are sunken, eyes show mildly shrunken orbits, oral mucosa is pale and slightly dry, skin turgor is slightly decreased, heart rate may be increased, blood pressure is normal, delayed capillary refill, urine output is less than 1ml/kg/hr
signs of severe dehydration
mental status ranges from alert to comatose, fontanels are sunken, eyes have deeply sunken, oral mucosa is dry, skin turgor is tenting, heart rate ranges from normal progressing to tachycardia, blood pressure ranges from normal to hypotension, extremieites are cool, mottles or dusky, significantly delayed capillary refill, urine output is significantly less than 1ml/kg/hr
 Oral rehydration solutions (ORS)
 Promote re-absorption of Na+ and water to restore ECF, fluid volume, if severely dehydrated they need an IV
 Reduce vomiting
 Reduce volume loss from diarrhea
 Reduce length of the illness
Sports Drink vs. ORS
ORS Replacement-Practice
Sports drinks have too much sugar and no electrolytes
 50-100 ml / kg over 4 hours (book)
 40-50 ml / kg over 4 hours (AAP)

 13 kg infant

 25 kg child

 40 kg child
Parenteral Rehydration
 When immediate volume replacement is needed:
 Bolus with Normal Saline (NS)
 10-30ml/kg (as ordered by practitioner)
Parenteral Rehydration
 When stable, replacement fluids over 24 hrs
 1 to 1.5 times maintenance
What do you use to rehydrate for burns?
 Albumin for burns
 Urine Output – need to know for test
 Minimum expected
 1-2 ml/kg/hr
 ≤ 0.5 ml/kg/hr is cause for concern
 Oliguria < 500 ml/day
 Anuria <100 ml/day
 Urine specific gravity-normalize to 1.005-1.020
 Check q 8 hrs
 Inflammation of the gastrointestinal tract
 Vomiting – if vomiting a lot, wait an hour before starting rehydration therapy, if vomiting bile it’s from below the stomach, projectile vomiting is only from pyloric stenosis
 Fever
 Diarrhea – can damage lining where nutrients/fluids are absorbed, usually from a virus
Gastroenteritis – age highest risk for severe dehydration
4 months to 23 months
Causes of gastroenteritis
 Viral
 Rotavirus – vaccine is available
 Bacterial
 Shigella, Salmonella, E.Coli 0157.H7 (specific to petting zoos)
 Parasitic
 Giardiasis, Ascariasis
 Antibiotic Induced
 C. difficile
Gastroenteritis – risk factors
include not breastfeeding, daycare, smoking
 Chronic nonspecific diarrhea (CNSD)
 Loose stools with undigested food, normal growth
 Sorbitol, excess juice intake, called toddler diarrhea