Pediatric Dehydration and Shock

Mild dehydration

Less than 5% fluid loss; the child looks mostly normal with slightly less urine.

Oral rehydration for mild dehydration

Give 50 mL/kg of Pedialyte over four hours.

Moderate dehydration

A 5-9% fluid loss; the child is irritable and restless.

Moderate dehydration: vital signs

Fast heart rate and breathing; capillary refill exceeds two seconds.

Moderate dehydration: physical signs

Dry mouth, fewer tears and a sunken fontanel.

Severe dehydration

A fluid loss of 10% or more, with lethargy and low blood pressure.

Severe dehydration: physical signs

Very dry mouth, no tears, tented skin and capillary refill over four seconds.

Severe dehydration: initial IV fluid

Give normal saline or lactated Ringer's: 20 mL/kg over 5-10 minutes, up to three times.

Lung assessment after a bolus

Listen to lung sounds after each fluid bolus.

Giving oral fluids

Offer small amounts by teaspoon or syringe every 5-10 minutes.

Breastfeeding during dehydration

Keep breastfeeding.

When to use IV fluids

Use IV fluids if the child cannot keep fluids down.

Blood glucose in dehydrated infants

Check blood sugar; low glucose can cause seizures.

Hypovolemic shock

Shock caused by fluid loss, including from vomiting, diarrhea, trauma or burns.

Effect of hypovolemic shock

Reduced blood volume decreases blood pumped out, so organs receive less oxygen.

Hypovolemic shock treatment

Give oxygen, then fluid boluses.

Septic shock

A severe infection triggers an immune response that can lower blood pressure and damage organs.

Causes of septic shock

Pneumonia, urinary tract infection and meningitis.

Septic shock testing

Obtain blood culture, CBC, lactate, procalcitonin, CRP, clotting tests and blood gas.

Blood culture and antibiotics

Draw the blood culture before giving antibiotics.

Antibiotics for septic shock

Give antibiotics within one hour; examples include ceftriaxone, ampicillin and vancomycin.

Additional septic shock treatment

Give IV fluids; use epinephrine or norepinephrine if needed.

Signs shared by both shock types

Fast heart and breathing rates, cool pale skin, weak pulses and slow capillary refill.

Other shock signs

Lethargy and low urine output occur in both types; septic shock may cause temperature changes and mottling.

Blood pressure in pediatric shock

Low blood pressure is a late sign; normal pressure does not rule out shock.

Response to fluid boluses

Recheck perfusion, alertness, urine output and breathing after every bolus; watch for overload.

Precautions for infectious diarrhea

Contact precautions.

Rotavirus

Most common cause of diarrhea under age 5; preventable with Rotarix vaccine.

E. coli O157:H7 complication

Acute renal failure.

Salmonella transmission and treatment

Spread by raw chicken and turtles; avoid antibiotics unless infection is severe.

C. diff hand hygiene

Wash hands with soap and water; alcohol does not kill spores.

Infectious diarrhea management

Continue breastfeeding, give oral rehydration, and avoid antidiarrheals like loperamide.

Hirschsprung disease cause

Colon and rectum lack ganglion cells, preventing peristalsis and causing obstruction.

Hirschsprung disease clinical findings

Meconium not passed within 24 hours, abdominal distention, and bilious vomiting.

Late meconium passage differentials

Hirschsprung disease, hypothyroidism, and cystic fibrosis.

Pyloric stenosis clinical findings

Nonbilious projectile vomiting, constant hunger, and an olive-like mass in the right upper abdomen.

Pyloric stenosis acid-base imbalance

Metabolic alkalosis.

GER vs. GERD

GER is normal regurgitation; GERD involves tissue damage to the esophagus.

Infant GERD management steps

Thicken formula with rice, keep upright for 30 minutes, or use PPIs/H2 blockers.

Cleft lip and palate risk factors

Smoking, substance use, low folic acid, diabetes, and isotretinoin.

Cleft lip and palate post-op restrictions

Avoid pacifiers, spoons, straws, and sucking toys; use elbow restraints.

Intussusception clinical findings

Intermittent colicky pain (knees to chest), bilious vomiting, and red currant jelly stools.

Intussusception management order

Air enema first, then contrast enema, then surgery.

Short bowel syndrome complications

Central line infection and TPN-related liver failure.

Crohn's disease key characteristics

Affects any part of GI tract, skip lesions, and cobblestone appearance.

Ulcerative colitis signature complication

Toxic megacolon, which can lead to sepsis.