Fluid and Electrolytes

Which electrolyte value varies in pediatrics?

Phosphorus

Range for Na

135-145

Range for K+

3.5-5

Range for Cl-

95-105

Range for bicarb

22-26

Range for Ca

8.5-10.3

Range for Mg

1.5-2.4

Pediatric range for phosphorus

4-7

Adult range for phosphorus

2.5-4

What % of body is water in pre term

90%

What % of body is water in full term

75-80%

what % of a newborn’s weight is made up by extracellular fluid

40

What age are kidneys able to concentrate urine?

2

How much sodium is required for infants and children? __mE1/kg/day

3

How much potassium is required for infants and children? __mE1/kg/day

2

What is the average specific gravity for infants and children?

1.010

Other than inadequate diet, what are causes of hypocalcemia?

Underactive parathyroid glands, low vitamin D, kidney failure

How do burns cause f/e imbalance?

Potassium leaks from burned cells increasing potassium levels, fluid leaks out of damaged blood vessels

Does bicarbonate act as an acid or a base?

Base

Does CO2 act as an acid or a base?

Acid

Type of acid/base imbalance where the pH is too low, and the bicarb is too low

Metabolic acidosis

List 3 causes of metabolic acidosis

DKA, diarrhea, kidney failure

What happens to breathing in metabolic acidosis

Gets faster/deeper to blow off CO2

What acid/base imbalance is occurring with low pH, high CO2

Respiratory acidosis

What are 3 causes of respiratory acidosis

COPD, asthma, hypoventilation

Why is bicarb high in respiratory acidosis?

Kidneys try to compensate by retaining more bicarb to balance out acidity

What acid/base imbalance is occurring when pH is high and bicarb is high

Metabolic alkalosis

What are 3 causes of metabolic alkalosis

Vomiting (losing acid from stomach), diuretics (lose too much acid in stool), antacid overuse

What happens to breathing with metabolic alkalosis?

Breathing slows down to retain CO2

What acid/base imbalance is occurring when pH is high and CO2 is low

Respiratory alkalosis

What are two causes of respiratory alkalosis

Hyperventilation, high altitudes

What should be included in pediatric f/e assessment

Diapers, crying, salivation, fontanelles (sunken or bulged), mucous membranes, weight, vital signs, thirst, mood

Hyponatremia is less than ____

130

Hypernatremia is greater than ______

150

What happens when there is too much calcium?

Things get slow

What happens when there is not enough calcium?

Things get hyper

What are infants on cows milk at risk for?

Metabolic acidosis

What kind of relationship does potassium have with pH?

Inverse

When the pH is higher, the potassium is _____

Lower

True or false: respiratory acidosis can be caused by aspiration of foreign body

True

a common viral infection in young children that causes swelling around the voice box and windpipe. This swelling narrows the airway, leading to a distinct, barking cough that sounds like a seal, a hoarse voice, and noisy breathing called stridor.

Croup

What position should pts with respiratory acidosis be placed in

Semi fowlers

Metabolic alkalosis: serum pH is above ____, urine pH is above ___

7.45, 7.0

What acid/base imbalance is caused by hyperventilation/hysteria

Respiratory alkalosis

What happens to PCO2 in respiratory alkalosis

Decreased

In respiratory alkalosis, what measurement of bicarb is expected

Normal

Does skin turgor test work in premature infants?

No

List the relevant labs for dehydration and what they might look like

Specific gravity (increased), HCT (increased), K (can be low/hypokalemia depending on cause of dehydration), Na (increases/hypernatremia), pH (can go either way)

What fluid/electrolyte concern is present with cystic fibrosis patients

Dehydration due to constant diarrhea

What age can be given pepto bismol?

12+

Why is pepto not advised for children under 12?

Reye’s syndrome (brain and liver swelling)

What labs are important for vomiting

UA (to check for infection or dehydration), BMP, abdominal x ray/ultrasound, endoscopy

Why is bowel status monitoring important in pts monitoring

Vomiting can be caused by bowel blockage

What is leading cause of burns for age under 3

hot liquids and electricity

Leading cause of burns for children above 3

Flames

Most pediatric burns are under what age

5

Describe a 1st degree burn

Superficial thickness, localized to the dermis, epidermis only

Describe a second degree burn

Superficial partial thickness, involves epidermis and dermis, thin walled fluid filled blisters

Describe a 3rd degree burn

Deep partial thickness, no blanching, fluid shifts

Describe a 4th degree burn

Full thickness

A major burn is anything greater than ____% BSA

30

A moderate burn is ____% BSA

10-20

A minor burn is less than ___% BSA

Minor

What labs to monitor with burns and what changes might be expected

ABGs, CBC, CMP (potassium increases), BUN (increases with fluid lost), ECG (may show ischemia, injury, arrythmias).

Is aseptic or sterile technique needed for burn treatment?

Sterile

What burn treatment is applied

Silvadene

3 P’s of DM

Polydipsia (thirst), polyuria (excessive urination), polyphagia (excessive hunger)