Pediatrics: Fluid & Electrolytes

Front 1

What are the four key physiological factors responsible for the fluid and electrolyte differences between children and adults?

Back 1

Percentage and distribution of body water. Body surface area. Rate of basal metabolism. Status of kidney function.

Front 2

What is the percentage of body water in a neonate?

Back 2

70 to 75%

Front 3

Intracellular fluid is body fluid located where?

Back 3

Inside the cells

Front 4

Extracellular fluid which includes interstitial fluid is fluid found where?

Back 4

Fluid found between the cells and outside the blood and lymph vessels

Front 5

What is intravascular fluid?

Back 5

Fluid found within the blood vessels, such as plasma

Front 6

Infants have a higher proportion of their total body water in which compartment?

Back 6

Extracellular

Front 7

Why do signs of cardiovascular compromise become evident more quickly in dehydrated infants than in dehydrated older children and adults?

Back 7

Because a majority of the total body water of an infant is in the extracellular fluid

Front 8

At approximately what age, does the extracellular and intracellular fluid distribution becomes similar to that of an adult?

Back 8

Three to six months

Front 9

During illness states, such as vomiting, diarrhea, or hemorrhage, fluid that is located in which compartment is lost first?

Back 9

Extracellular

Front 10

What is osmotic pressure?

Back 10

A force within the capillary beds that tends to pull water into the capillaries

Front 11

What is oncotic pressure?

Back 11

It is caused by the amount of plasma proteins present in the vascular system and holds fluids in the capillaries. A decrease in plasma proteins would allow fluid to escape into interstitial spaces

Front 12

In what situations or illnesses, is capillary permeability increased, allowing proteins to move into interstitial spaces along with water, resulting in the formation of Edema?

Back 12

Sepsis and Burns

Front 13

What is hydrostatic pressure?

Back 13

Pressure of blood against the capillary walls generated when the heart contracts

Front 14

What is osmosis?

Back 14

Fluid moving across a semipermeable membrane from a lower solute concentration to a higher solute concentration

Front 15

What is diffusion?

Back 15

Particles moving through a solution or gas from a high concentration area to a lower concentration area until equilibrium is reached.

Front 16

What is the serum level of sodium for someone diagnosed with hyponatremia?

Back 16

Less than 135

Front 17

When serum sodium decreases, how does water shift between the compartments?

Back 17

Water ships from extracellular fluid to intracellular fluid to equalize the osmolality between compartments

Front 18

What are side effects of hyponatremia?

Back 18

Generalized edema and cerebral edema, which can result in brain herniation and death. Other signs and symptoms include irritability, disorientation, lethargy, seizures, headache, muscle cramps, abdominal cramps, oliguria

Front 19

What are some causes of hyponatremia?

Back 19

Excessive administration of sodium bicarb or baking soda, diarrhea, vomiting, nasogastric suctioning, diuretics, water intoxication, malnutrition, excessive sweating, Burns, diabetic ketoacidosis, renal disease, and cystic fibrosis

Front 20

What is the care required for a patient with hyponatremia?

Back 20

Careful replacement of fluid with a hypertonic saline IV fluid, frequently assessing the patient neurological status, and monitoring sodium levels

Front 21

What is the serum sodium level for a patient diagnosed with hypernatremia?

Back 21

Greater than 145

Front 22

How does fluid move between compartments in a patient with hypernatremia?

Back 22

Fluid moves from the intracellular fluid to the extracellular fluid, causing cells to shrink

Front 23

What are symptoms of hypernatremia in infants and children?

Back 23

Extreme thirst, agitation, high-pitched cry, flushed skin, lethargy, muscle weakness and twitching, seizures, and coma

Front 24

What are causes of hypernatremia?

Back 24

Excessive intake of sodium or an increase water loss

Front 25

What diseases or conditions are related to hypernatremia?

Back 25

Diabetes mellitus, diabetes insipidus, diarrhea, increase insensible water loss, and dehydration

Front 26

What care is required for a patient with hypernatremia?

Back 26

Strictly monitoring intake and output, frequently assessing the patient's neurological status, slowly correcting the fluid deficit, and monitoring serum sodium levels

Front 27

What is the normal level of potassium in a newborn?

Back 27

3 to 6

Front 28

What is the normal level of potassium in infants and adults?

Back 28

3.5 to 5

Front 29

What is the serum potassium level for a patient diagnosed with hypokalemia?

Back 29

Less than 3.5

Front 30

How can hypokalemia occur?

Back 30

It can be a true potassium deficit such as with a loss of gastric or intestinal fluids, excessive renal secretion, extreme diaphoresis, or inadequate intake. Or, it can occur from a potassium shift from the intravascular space to the intracellular fluid which happens as a result of alkalosis, excess secretion, or the administration of insulin

Front 31

What are the symptoms of hypokalemia?

Back 31

Lethargy, irritability, nausea and vomiting, abdominal distension, paralytic ileus, arrhythmias, decrease blood pressure, and ECG changes consisting of a flattened T wave, ST wave depression, and premature ventricular contractions

Front 32

What care is required for the treatment of hypokalemia?

Back 32

Replacing potassium loss, monitoring serum potassium levels and serum pH, monitoring ECG, and frequently assessing neuromuscular changes

Front 33

What is the potassium serum level of a patient with hyperkalemia?

Back 33

Greater than 5

Front 34

How can hyperkalemia occur?

Back 34

Crushing injuries, Burns, tissue necrosis, hemolysis, renal failure, severe dehydration, or a rapid infusion of IV potassium. Metabolic acidosis can shift potassium from intracellular fluid to extracellular fluid, creating a hyperkalemic state in the serum

Front 35

What are clinical manifestations of hyperkalemia?

Back 35

Abdominal cramps, nausea, vomiting, diarrhea, muscle weakness, hyperreflexia, confusion, hafnia, arrhythmias, and ECG changes including tall peaked t-waves and widened QRS complex, which can lead to Cardiac Arrest if not treated quickly

Front 36

What care is required for a patient with hyperkalemia?

Back 36

Treating the underlying cause. Holding medications and fluids that contain potassium. Monitoring ECG changes. Carefully administering insulin and glucose to move potassium into the cell, IV calcium, or kayexalate. And monitoring serum pH and potassium levels

Front 37

What blood pH is incompatible with life?

Back 37

Less than 6.80 or higher than 7.80

Front 38

How is respiratory acidosis caused?

Back 38

Any condition that decreases a child's respiratory effort. Slowed or shallow respirations will result in a build-up of carbon dioxide, which combined with water forms carbonic acid and leads to acidosis

Front 39

What specific clinical conditions are associated with respiratory acidosis?

Back 39

Head trauma. General anesthesia. Drug overdose. Brain tumor. Sleep apnea. Mechanical underventilation. Asthma. Croup or epiglottis. Cystic fibrosis. Atelectasis. Muscular dystrophy. Pneumothorax

Front 40

Acidosis causes central nervous system depression. Knowing that, what are some signs and symptoms of respiratory acidosis?

Back 40

Lethargy, confusion, and disorientation. The patient may also complained of a headache, and may become comatose if not treated.

Front 41

Conditions causing a child to hyperventilate such as anxiety, pain, meningitis, gram-negative septicemia, early response to salicylate poisoning, or mechanical over ventilation, will likely cause what?

Back 41

Respiratory alkalosis

Front 42

What are signs and symptoms of respiratory alkalosis?

Back 42

Numbness or tingling in the toes and fingers, lightheadedness, confusion, fainting

Front 43

Metabolic acidosis is most commonly caused by what?

Back 43

A loss of bicarbonate in the stool or an increase in Ketone bodies in the blood. These conditions most frequently result from diarrhea, and diabetic ketoacidosis

Front 44

What are signs and symptoms of metabolic acidosis?

Back 44

Confusion, lethargy, and tachycardia

Front 45

What is the body's response, or compensatory mechanism when responding to metabolic acidosis?

Back 45

The body compensates by increasing the depth and rate of respirations in order to blow off carbon dioxide

Front 46

What dangerous electrolyte balance is caused by metabolic acidosis?

Back 46

Hyperkalemia

Front 47

Children with prolonged vomiting May develop what acid base imbalance?

Back 47

Metabolic alkalosis

Front 48

What are some other causative factors of metabolic alkalosis?

Back 48

Ingestion of large quantities of bicarbonate antacids, massive blood transfusions, loss of nasal gastric fluids due to gastric suction, and hypokalemia

Front 49

What are signs and symptoms of metabolic alkalosis?

Back 49

Weakness and dizziness. The patient may complain of muscle cramps. The respiratory response would be to decrease the rate and depth of respirations in order to increase the P CO2

Front 50

What is the most common type of dehydration?

Back 50

Isotonic

Front 51

What is isotonic dehydration?

Back 51

A state of dehydration in which serum sodium values are normal because water and sodium are lost in equal proportions, such as the case with a short bout of diarrhea

Front 52

What is hypotonic dehydration?

Back 52

This occurs when sodium loss is greater than water loss, resulting in the serum sodium falling below 130. This can occur with a substantial loss of water and salt in stool, and only water is ingested.

Front 53

What is hypertonic dehydration?

Back 53

This occurs when water loss is greater than sodium loss. This can occur when infants or children experience vomiting and diarrhea with reduced water intake or when they have diabetes insipidus or are treated for diarrhea with fluids containing high concentrations of electrolytes. In hypertonic dehydration, serum sodium rises above 150

This is the most dangerous type of dehydration

Front 54

What is the most common cause of dehydration?

Back 54

Gastroenteritis

Front 55

What body systems are activated with a drop in blood pressure?

Back 55

Sympathetic nervous system which activates the fight or flight response or the release of epinephrine. And the renin-angiotensin system

Front 56

When caring for children with dehydration the focus is on correcting fluid and electrolyte imbalances and treating underlying cause. So, if nausea and vomiting are the cause of dehydration, what can be given to reduce vomiting and improve the chances of success with oral rehydration?

Back 56

Oral ondansetron

Front 57

What is the first line therapy for mild to moderate dehydration?

Back 57

Oral rehydration solution, ORS. Some children will tolerate ORS better if it is frozen

Front 58

If a child with moderate to severe dehydration refuses to drink or are not tolerating oral fluids, and intravenous therapy is unobtainable, and a nasogastric tube cannot be done, what other option is there?

Back 58

Intraosseous (IO) administration of fluids

Front 59

The volume of fluid to be given in dehydration is based on the child's weight and clinical signs and symptoms. What bolus volume is usually recommended?

Back 59

20 ml per kilogram

Front 60

How is each form of dehydration treated?

Back 60

Isotonic dehydration with isotonic fluids. Hypotonic dehydration with hypertonic fluids. Hypertonic dehydration with hypotonic fluids.

Front 61

Acute gastroenteritis is a disease that causes what?

Back 61

Inflammation of the mucous membranes of the stomach and intestines

Front 62

What are signs and symptoms of gastroenteritis?

Back 62

Symptoms May somewhat vary depending on the causative agent, but generally include nausea, vomiting, diarrhea, fever, abdominal pain, headache, and electrolyte imbalances. More severe or prolonged illnesses can result in dehydration with significant morbidity and mortality

Front 63

What is the most common cause of diarrhea in children throughout the world, and generally causes gastroenteritis more severe than when it is caused by other pathogens?

Back 63

Rotavirus

Front 64

What three viruses can cause acute gastroenteritis?

Back 64

RAN

Rotavirus

Adenovirus

Norwalk

Front 65

What six types of bacteria can cause acute gastroenteritis? SSECCY

Back 65

Shigella

Salmonella

Escherichia coli

Campylobacter

Clostridium difficile

Yersino

Front 66

The history obtained when diagnosing a patient with gastroenteritis should include what five things?

Back 66

Recent exposure to infectious agents. Travel history. Exposure to contaminated food and water. Exposure to turtles, reptiles, roaches, flies, and mice. Attendance at a daycare center

Front 67

Treatment for acute gastroenteritis focuses on what?

Back 67

Fluid replacement and correction of electrolyte disturbances, and is dependent on the degree of dehydration

Front 68

When should a child with suspected gastroenteritis be seen by a healthcare provider?

Back 68

If they are less than 6 months old. If they weigh less than 18 lb. Or if they have an estimated weight loss greater than 5%. Other symptoms that warrant a visit to a healthcare provider include persistent and substantial diarrhea or vomiting, and ability to ingest ORS, mental status changes, or a fever of 100.4 for infants Less Than 3 months old or 102.2 or higher for infants and children 3 to 36 months

Front 69

+0 edema indicates what?

Back 69

No persisting indentation

Front 70

+1 edema

Back 70

1/4" indentation; mild

Front 71

+2 edema

Back 71

1/4-1/2" indentation; moderate

Front 72

+3 edema

Back 72

1/2-1" indentation; severe

Front 73

+4 edema

Back 73

Greater than 1" indentation; very severe

Front 74

What is the treatment for edema?

Back 74

Often includes the use of diuretics and restriction of sodium and fluid intake

Front 75

Edema that is due to an inflammatory response, such as an injury or allergic reaction, can be treated how?

Back 75

Applying cold compresses to reduce blood hydrostatic pressure through decreasing capillary blood flow

Front 76

What are some good sources of potassium if a child is on a potassium depleting diuretic?

Back 76

Bananas, apricots, cantaloupe, dates, tomato juice, orange juice, peaches, potatoes, raisins, and figs

Front 77

Appropriate care of burns is essential, beginning with early stabilization. What are the goals of early stabilisation?

Back 77

Cool the burn with cool water and prevent further burn and contamination

Front 78

On arrival at an acute care facility with a burn, care focuses on what?

Back 78

Assessment and stabilization of Airway, breathing, circulation and Pain Management.

Front 79

When should Health Care Providers alert to the possibility of a non-accidental trauma by burn?

Back 79

When a child is very young and lacks verbal skills. When physical findings are inconsistent with the reported history or are incompatible with the child's motor ability. When the history of the injury is unclear. When care providers delayed seeking treatment. Or when stories conflict about how the burn occurred

Front 80

What happens when a burn covers more than 15 to 20% of a child's body surface area?

Back 80

The inflammatory response extends beyond the injury site, and multiple organs and body systems are affected. If fluids are not administered quickly enough, the child's blood pressure can plunge to a critically low level, and a child can go into shock and die. The risk of death still remains high within the first 48 hours due to the risk of infection

Front 81

Superficial Burns, or first-degree, involve what layer of skin?

Back 81

Only the epidermis

Front 82

Partial thickness Burns, second-degree, affect what layers of skin?

Back 82

They are divided into the superficial partial thickness, which involves the epidermis and superficial dermis. And deep partial thickness Burns, involving the epidermis and deeper dermis

Front 83

Describe a superficial partial thickness burn

Back 83

They blister and are erythematous, moist, and painful. Typically they heal spontaneously without scarring in 1 to 3 weeks

Front 84

Describe deep partial thickness Burns

Back 84

Appear white with less erythema noted as the injury extends deeper into the dermis. Sensation is usually diminished, and capillary refill is prolonged. The amount of scarring is associated with how long it takes the burn wound to heal, usually a minimum of three to four weeks. Skin grafting is often needed for satisfactory healing

Front 85

Full thickness Burns, third degree, involve what layers of skin?

Back 85

The epidermis and the entire dermis and can extend into the subcutaneous tissue

Front 86

Describe the appearance of a full thickness burn

Back 86

They can be white, black, or brown. They do not heal spontaneously unless they are small, and then they heal with contraction. The eschar that develops has a leathery texture and diminished sensation. Skin grafting is usually performed on these Burns

Front 87

Devastating full thickness burns, fourth degree, have what types of dangers, appearance, and affect what layers of skin?

Back 87

They're usually lethal. They extend into the Muscle, fascia, and Bone.