Peds Fluid and Electrolyte Balance

fluid per day for 1-10 kg

100ml/kg

fluid per day for 11-20 kg

100ml + 50ml/kg for each > 10 kg

fluid per day for >20 kg

1500 ml + 20 ml/kg for each over >20 kg

minimum output for infants

1-2ml/kg/hr

minimum output for child

1ml/kg/hr

minimum output for older child

.5-1/ml/kg/hr

signs of dehydration in infants

sunken eyes, grayish/dry skin, lethargic, poor skin turgor, sunken fontenelle

causes of dehydration

fluid loss, decreased renal excretion, gi dysfunction, ketoacidosis, burns

isotonic dehydration

water and salt are lost in equal parts, primary form in children

hypotonic dehydration

electrolyte deficit exceeds water deficit

hypertonic dehydration

water loss exceeds electrolyte deficit

vitals of dehydration

increased HR, RR

nursing management of dehydration

I & O by weighing diapers, vitals, daily weights, and assessment of skin, membranes, and fontanel

mild pediatric dehydration treatment

oral rehydration solution and add volume of stool lost

moderate pediatric dehydration treatment

oral rehydration solution and add volume of stool lost

severe pediatric dehydration treatment

IV fluids until stable, then oral rehydration solution

gastroenteritis

inflammation of the stomach lining

signs and symptoms of gastroenteritis

nausea, vomiting, abdominal cramping, and diarrhea

predisposing factors

poor sanitation, improper handling of food, antibiotics, presence of other infections

viral agents more common in winter

rotavirus and norovirus

rotavirus

most common cause of diarrhea on children

rotavirus symptoms

usually begin 2-3 days after exposure, diarrhea can be severe and last 3-9 days

norovirus

common in schools, daycares and cruiseships from contaminated ice, water, and mishandled food

norovirus symptoms

begin 12-24 hrs after exposure, lasts 1 day- 2 weeks

bacterial agents common in summer

salmonella, shigella, e-coli

salmonella

most common type of food poisoning, high incidence in children under 5, pets like turtles, baby chicks, and contaminated food

salmonella symptoms

N/V shorter, diarrhea for longer duration, most cases clear up without use of antibiotics

shigella

younger children most vulnerable to, fecal-oral, contaminated food/water, and touching contaminated objects

shigella symptoms

usually last 5-10 days

e-coli

undercooked beef, eater, juice, petting zoos, daycare settings

e-coli symptoms

can begin in 3-4 days, then usually lasts a week, antibiotics not effective

management of gastroenteritis

assess dehydration, oral rehydration, nursing mothers should continue to nurse, protect skin with desitin

oral rehydration methods

increase PO fluids if diarrhea continues, Pedialyte or gatorade

IV fluid replacement if child continues to vomit

fluid bolus (normal saline .9% or LR) given for severe dehydration

when are maintenance IV fluids started?

after bolus is complete with dextrose 5% in .45 or .2 NS

when is potassium added to IV fluids?

only after the child has voided

when should parents follow up

if D/V increases, no improvement of hydration, no urine output

how to prevent diarrhea

two rotavirus vaccines, personal hygiene, clean water and food, and encourage hand washing