V/d/dehydration Children Tintin Chap 123

Front 1

A 3 week old newborn presents with vomitting.
What is your ddx?

Back 1

Newborn
OBSTRUCTIVE : Esophageal or intestinal stenosis/atresia, Pyloric stenosis, malrotation+/- volvulus, incarcerated hernia, meconium ileus/plug, Hirschprung, imperforated anus, enteric duplications
NEURO: ICH/ICmass, hydrocephalus, cerebral edema, kernicterus
RENAL : UTI, Obstructive uropathy, RI
INFECTIOUS: Viral illness, Gastro, meningitis, sepsis
METABOLIC : Inborn errors of metabolism, CAH
MISC: Ileus, GERD, NEC, milk allergy, GI perforation.

Front 2

Name 5 causes of diarrhea in children that may result in significant morbidity

Back 2

Infection : Salmonella gastroenteritis, Shigella, C. difficile (pseudomembranous colitis)
Anatomic abnormalities : Intussusception, Hirschsprung disease w toxic megacolon, partial obstruction, appendicits
IBD w toxic megacolon
HUS

Front 3

What triad caracterizes HUS?

Back 3

Hemolytic microangiopathic anemia
Thrombocytopenia
Renal Insufficiency

Front 4

What three clinical signs have been found to have significant positive LR for 5% dehydration?

Name 5 other signs which may be evaluated for dehydration in children?

Back 4

Prolonged capillary refill time
Abnormal skin turgor
Abnormal respiratory pattern

Front 5

What are the indications for measuring serum electrolytes and glucose in chidren with gastroenteritis?

Back 5

Moderately dehydrated children whose history and PE findings are incnsistent with acute gastroenteritis
All severely dehydrated chidren
All children requiring IV rehydration, or those with potential hyper-or hyponatremia

Front 6

How does ORT (oral rehydration therapy) work?

Recette maison?

What do we aim for ORT?

Back 6

ORT is based on the coupled transport of Na and glucose molecules at the brush border of intestinal epithelial cells, which provides a gradient for the passive absorption of water.
1 L eau + 4 c. à thé de sucre + 1/2 c. à thé de sel
aim for about 30 cc / kg / h

Front 7

Is vomitting a contraindications to ORT?

Back 7

NO.
Odansetron (serotonin R antagonist) may be used as an adjunct.
0.15 mg/kg / dose IV or PO
Dopamine R agonists (metoclopramide) should not be used in children.

Front 8

When should antibiotc therapy should be considered for acute gastroenteritis?
What antibio?

Back 8

In patients with sx of invasive (inflammatory) infection : acute onset of bloody diarrhea w mucus and high fever.
Most common bacterial causes of this presentation : Shigella, Campylobacter, S. enterica
Azithromycin is an appropriate 1st line agent (salmonelle, campylobacter). Ceftriaxone is the treatment of choice for parenteral therapy.

Front 9

For which bacterial causes of diarrhea are antibiotics not indicated?

Back 9

Shiga-toxin-producing E.coli
- do not affect clinical course
- possible increased risk of HUS
Salmonella unless specific RF (underlying immune deficiencies, sickle cell, immunosuppressive, IBD, less 3 months old)
Indicated : V. cholera, campylobacter, shigella

Front 10

Which probiotics strain have proven to be somewhat effictive in diarrheal illnesses?

Back 10

Lactobacillus GG and Saccharomyces boulardii
Couteux.
Doses importantes (donc yaourt n'est pas efficace).
Contre indications : immunocompromis
Diminution durée diarrhée de 24 heures.

Front 11

What antibiotics are most associated with C.difficile diarrhea?

Back 11

Clindamycin
Cephalosporine
Penicillins

Front 12

What is the leading cause of acute intestinal obstruction in infants?

Back 12

Intussusception
Present 3 m - 12 months of age most commonly.
(Pyloric stenosis appears 2wks - 8 wks of life and malrotation can present at an age but nearly all present in 1st wk of life, 2/3 within first months)

Front 13

Nommer 4 pathogènes de diarrhée sanglante et leur traitement

Back 13

(SECSY)
Salmonella poulet mal cuit, produits laitiers non pasteurisés, mayonnaise, reptile (tortue)
Shigella Day care, condition de mauvaise hygiène
E. Coli Eau/bouffe contaminé par selles
Campylobacter poulet, l'eau non traité, lait non pasteurisé
Yersinia porc mal cuit, lait non pasteurisé, eau non

Front 14

Indications pour traitement de diarrhée

Back 14

Indications pour traitement :
Majorité des patients non traités
Patients immunocomprimés (sickle cell, immunosuppressive therapy, IBD, infants less 3 months old)
Salmonella Typhi
Patient malade +++
Jeune enfants
Si rappelés une fois résultats obtenus et sx persistant

Front 15

Effet secondaires connu Zofran

Back 15

Augmentation du QT
Si considère donner maintes doses : attention aux patients à risques
Majorité des patients avec arythmies rapportés : patients sous chimie (plusieurs doses de zofran)

Front 16

Trois indications de traiter le RGO chez le nourrisson

Back 16

''Failure to thrive''
Pneumonie d'aspiration, wheezing, ALTE
Oesophagite

Traitement : prokinétique (césaride)

Front 17

Pathophysiologie du volvulus, âge de présentation et la présentation clinique

Back 17

At the 4 wk of gestation, the GI system is a straight tube centrally located in the abdomen. During the ensuing 8 wks, the midgut rotates and becomes fixed to the posterior abdominal wall. Arrest of development at any stage narrows the mesenteric base and impairs fixation, leaving the bowel at high risk for volvulus
âge = majorité dans le premier mois de vie
Présentation = vomissement bileux (obstruction secondaire à volvulus ou bandes fibreuses)

Front 18

À quoi réfère le ''double bubble'' à la PSA?

Back 18

Volvulus
Atrésie duodénale

Front 19

Réhydratation de maintenance?
Nouveau né vs plus âgé?

Back 19

moins qu'un mois
1/2 NS avec D5

Plus qu'un mois
NS avec D5

Front 20

What is the composition of different Crystalloids?normal saline (0.9% NS) =
½ normal saline (0.45% NS) =
⅔⅓ (⅔ D5W with ⅓ NS) =
0.2 normal saline (0.2% NS) =
D5W = 5% dextrose sol’n =
D10W = 10% dextrose sol’n =
⅔⅓ has ⅔ D5W =

Back 20

based on sodium concentration
normal saline (0.9% NS) = 154 mEq/L
½ normal saline (0.45% NS) = 77 mEq/L
⅔⅓ (⅔ D5W with ⅓ NS) = 51 mEq/L
0.2 normal saline (0.2% NS) = 34 mEq/L
we can also add sugar to solutions
D5W = 5% dextrose sol’n = 50 g/L
D10W = 10% dextrose sol’n = 100 g/L
⅔⅓ has ⅔ D5W = 33 g/L

Front 21

A patient presents with characteristic purpura associated with HSP. What is the basic laboratory tests?

Back 21

FSC
Coag
Urine Analysis