FLUID AND ELECTROLYTES

things that increase fluid maintence requirements

• Fever

• Vomiting/Diarrhea

• Diabetes Insipidus

• Diabetic Ketoacidosis

• Burns

• Shock

• Tachypnea

• wawrmer/phototherapy

things that decrease fluid maintence requirements

• Heart Failure

• SIADH

• Mechanical Ventilation (intubation) 

• Increased Intracranial Pressure

• Post Operatively

how do we know if a pt is adequtely hydrated

• urine output

• monitor i’s and o’s

dehydration management

• Monitor is and os every hour + balance sheet

  • 1 g of diaper = 1 mL

s/s of dehydration

• tachypnea

• altered LOC

• dry skin and mucous membranes

• no tears

• sunken fontannels

• prolonged cap refill

• decreased urine

• no tears (late sign)

levels of dehydration include

• mild

• moderate

• severe

mild dehydration s/s

• <5% of body weight

• Vital signs normal and pt presents normal

  • normal BP

• Urine output decreased

mild dehydration treatment

• oral fluid intake

• continue regular diet

• monitor loss

moderate dehydration s/s

• 6-9% weight loss

• Pulse increased

• irritable

• moderate thirst

• dry mucous membranes

• decreased skin turgor

• sunken fontanelle

• Oliguria

moderate dehydration treatment

• If unable to take po or cant get enough fluids orally, IV rehydration

• Resume diet as soon as dehydration corrected

severe dehydration s/s

• 10% weight loss

• Tachycardia

• if they have bradycardia super severe

• hyperpnea

• decreased BP

• lethargic to hyperirritable

• intense thirst

• unable to drink

• sunken eyes

• no tears

• sunken fontanelle

• Anuria

severe dehydration treatment

• IV rehydration

  • ONLY NS OR LR, no electrolytes

    • Bolus 20 ml/kg

      • Evaluate in between

    • MAX 3 (then will have to give blood products)

  • Then dextrose .45 NS (because pancreas making insulin but does not have sugar)

    • for maintence

  • Do not rehydrate with sports drinks (WORSEN DIARRHEA) or water on its own

  • No potassium until good urine output

  • Oral rehydration solution= pedialyte

    • Not a lot of sugar, but yes electrolytes 

types of shock

• hypovolemic shock

• cardiogenic shock

• distributive shock

• obsturctive

hypovolemic shock

• Common in children

• Decrease in blood/fluid volume

hypovolemic shock examples

• Trauma

• bleeding

• burns

• dehydration

• surgery

• Vomiting

• Diarrhea

• Glycosuric diuresis

• Heat stroke

hypovolemic shock treatment

• GIVE FLUID

cardiogenic shock

• More common in adults

• Impaired cardiac muscle function

• Cardiac output is not enough to meet body's metabolic function 

  • Congenital heart disease

  • After cardiac surgery

cardiogenic shock treatment

• Cardiovascular Support

distributive shock

• Anaphylaxis 

  • Extreme allergy or hypersensitivity to foreign substance

• Sepsis

  • Overwhelming sepsis and circulating bacterial toxins

  • babies fight off infecgtion

• Loss of neuron control

  • Interruption of neuronal transmission

• myocardial depression and peripheral dilation

  • Exposure to anesthesia or ingestion of barbiturates

  • Tranquilers

  • Opioids

  • Antihypertensive agent

  • Ganglionic blocking agents

obstructive shock examples

• Tension pneumothorax

• Cardiac tamponade

• Pulmonary embolism

• Congenital cardiac defects with left ventricular outflow tract obstruction

shock treatment

• Ventilation 

  • Lungs are the most sensitive

  • oxygen

  • non rebreather

• Fluid administration

  • NS or LR

  • IV bolus

    • 10-20ml/kg over 10-15 minutes

• Colloids

  • Often given to children

  • Albumin

• Cardiovascular Support

what is anaphylaxis

A severe, immediate hypersensitivity reaction to an excessive release of chemical mediators, increases capillary permeability and causes fluid to leak into interstitial spaces and the airway

anaphylaxis s/s

• Symptoms usually occur within seconds or minutes (food, bee sting, etc)

• Angioedema

• Urticaria (hives)

• Flushing

• Difficulty breathing

• Increased swallowing

• Rhinitis

anaphylaxis treatment

• Epinephrine 

  • 1st line therapy

  • Single dose usually effective

  • May repeat if needed

• Diphenhydramine (benadryl), histamine inhibitor, or corticosteroids

• Total avoidance of cause

• Preventative measure

  • Medical alert bracelet/necklace

  • Have an epi pen, epi pen jr (just have half of normal dose but in two pens)

    • Keep pens together 

    • Epi has short half life, so may need second dose before help arrives 

  • Check medication

    • No cloudy

    • Don't leave in cars