Chapter 22: The Child with Gastrointestinal Dysfunction

What are the factors that increases water requirements

• fever

• vomiting, diarrhea

• high-output kidney failure

• diabetes insipidus

• diabetic ketoacidosis

• burns

• shock

• tachypnea

• radiant warmer (preterm infants)

• phototherapy (infants)

• Postoperative bowel surgery (gastroschistis)

What are the factors that decreased water requirements

• heart failure 

• syndrome of inappropriate antidiuretic hormone 

• mechanical ventilation

• after sugery

• oliguric renal failure 

• increased intracranial pressure

what are the maintence fluid requirement based on body weight?

• 1-10 kg = 100 mL/kg 

• 11-20 kg = 1000 mL/kg plus 50 mL/kg for each kg > 10 kg 

• >20 kg = 1500 mL/kg puls 20 mL/kg for each kg > 20 kg

what is water depletion? 

• failure to absorb or reabsorb water

• complete or sudden cessation if intake or prolonged diminished intake

• disturbed body fluid chemistry

• Excessive renal excretion 

• Loss through skin or lungs

• Iatrogenic 

what are the clinical manifestation of Water depletion?

• thirst

• dry skin and mucous

• poor skin turgor

• poor perfusion (decreased pulse, slow capillary refill time)

• weight loss

• fatigue

• diminished urinary output

• irritability and lethargy

• tachycardia

• tachypnea

• altered LOC or disorientation

what are the laboratory findings for water depletion?

• high uring specific gravity

• increased hematocrit

• variable serum electrolytes

• variable urine volume

• increased blood urea

• nitrogen

• increased serum osmolality

what are the management of water depletion?

• provide replacement of fluid losses commensurate with volume depletion 

• provide maintenance fluids and electrolytes 

• determine and correct cause of water depletion

• measure fluid intake and output 

• monitor vital signs 

• monitor urine specific gravity 

• monitor body weight

• monitor serum electrolytes 

what is water excess?

• water intake in excess of output:

A. excessive oral intake

B. Hypotonic fluid overload

C. Plain water enemas

• Failure to excrete water in presence of normal intake:

A. Kidney disease

B. Congestive Heart Failure

C. Malnutrition

What are the clinical manifestation of water excess? 

• Edema: 

A. Generalized 

B. Pulmonary (moist rales or crackles) 

C. Intracutaneous (noted espically in loose areolar tissue) 

D. Elevated central venous pressure 

E. Hepatomegaly

F. Slow, bounding pulse 

G. Weight gain 

H. lethargy 

I. Increased spinal fluid pressure 

J. Central nervous system manifestations (seizures, coma) 

what are the laboratory findings for water excess?

• low urine specific gravity

• decreased serum electrolytes

• decreased hematocrit

• variable urine volume

what are the management for excess water?

• limited fluid intake

• administer diuretics

• monitor vital signs

• determine and treat cause of water excess

• Analyze serum electrolytes frequently

• Implement seizure precautions

what is sodium depletion (hyponatremia) 

• prolonged low- sodium diet 

• decreased sodium intake 

• fever

• excess sweating 

• increased water intake without electrolytes 

• tachypnea (infants) 

• Cystic fibrosis 

• Burns and wounds 

• Vomiting, diarrhea, nasogastric suction, fistulas

• Adrenal insufficiency

• renal disease 

• diabetic ketoacidosis 

• malnutrition 

what are the clinical manifestation of sodium depletion?

• weakness, dizziness, nausea, abdominal cramps, appr