MATERNAL - FLUIDS AND ELECTROLYTES (part 1)

GI System

maintains fluid, electrolyte, and acid-base balance

GI System

main route by which substances are taken into the body

Fluids

constitutes a greater fraction of the infant's total weight.

Adolescents

55%-60%

Preschool children

60%-65%

Infants

75%-80%

infants and younger children

have a higher proportion of extracellular fluids than older children and adults, they are more susceptible to rapid fluid depletion.

GI System

often is involved with two severe acid-base imbalances: metabolic acidosis and metabolic alkalosis.

ABG

Whether body serum is becoming acidotic is determined by analyzing a sample of?

7.35 to 7.45

The ph of blood is normally slightly alkaline, ranging from?

Acid

it contains proportionately more H (hydrogen) ions than OH (hydroxide) ions

Alkaline

if the proportion of OH ions exceeds that of H ions.

Metabolic Acidosis

may result from diarrhea where a great deal of sodium is lost with stool.

Metabolic Acidosis

arterial blood gas analysis will reveal a decreased pH (under 7.35) and a low HCO3 value (near or below 22 mEq/L).

Normal level of bicarbonate (HCO3)

22 to 26 mEq/L.

Normal PCO2

35 to 45 mm Hg

Kussmaul Respiration

deep, rapid breathing often induced by acidosis

Metabolic Alkalosis

With vomiting, a great deal of hydrochloric acid is lost.

Metabolic Alkalosis

the serum HCO3 invariably will be high. The higher the value, presumably the more Cl- ions have been lost or the more extensive the vomiting has been.

Metabolic Acidosis

The lower the HCO3 value is, presumably the more Nations that have been lost or the more extensive the diarrhea has been.

Acidemia

Increased [H+] results in decreased pH

Alkalemia

decreased [H+] results in increased pH

Hypoventilation

typical respiratory response to all types of metabolic alkalosis is?

Dehydration

A common body fluid disturbance in infants and children and occurs whenever the total output of fluid exceeds the total intake, regardless of the cause

Sodium

is the chief solute in ECF and is the primary determinant of ECF volume.

Potassium

3.5 to 5

Sodium

135 to 145

Chloride

94 to 106

Isotonic dehydration

is a primary form of dehydration in which electrolyte and water deficits are present in approximately balanced proportions.

Isotonic dehydration

Water and sodium are lost in approximately equal amounts.

Hypotonic dehydration

occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic.

Hypotonic dehydration

Serum sodium concentration is less than 130 mEq/L.

Hypertonic dehydration

results from water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes.

Hypertonic dehydration

This type of dehydration is the most dangerous and requires more specific fluid therapy.

Hypertonic dehydration

Plasma sodium concentration is greater than 150 mEq/ L.

Mild dehydration

less than 3% in older children or less than 5% in infants;

Moderate dehydration

5% to 10% in infants and 3% to 6% in older children

Severe dehydration

more than 10% in infants and more than 6% in older children

Weight

is the most important determinant of the percent of total body fluid loss in infants and younger children.

Tachycardia

earliest detectable sign of dehydration is?

Oral rehydration

is the treatment of choice to treat mild and moderate dehydration in children.

clinical observations

Diagnosis of dehydration is best accomplished by?

identify dehydration

Elevated blood urea nitrogen and low serum bicarbonate

Lactose-free milk, breast milk, or half-strength milk

are allowed to be given in addition to oral rehydration therapy solution.

Oral rehydration

may be accompanied by ondansetron to decrease vomiting in the child and its resultant continued dehydration.

Oral rehydration

solution with zinc added has been effective in diarrhea treatment.

Prebiotics (oral (fiber)

supplements that stimulate growth of probiotic bacteria to positively alter intestinal flora) have also been found to be effective in decreasing the number of diarrheal stools in children with acute gastrointestinal disease.

mildly dehydrated child

may be given 50 ml/kg of oral rehydration solution (ORS)

child with moderate dehydration

may be given 100 ml/kg of ORS.

Diarrhea

caused by a virus is the major cause of infant gastroenteritis in developing countries.

rotaviruses and adenoviruses

most common viral pathogens causing diarrhea

Acute diarrhea

is usually associated with infection

Chronic diarrhea

is more likely related to a malabsorption or inflammatory cause.

Breastfeeding

may actively prevent diarrhea by providing more antibodies and possibly an intestinal environment less friendly to invading organisms and so should be advocated.

Mild diarrhea

Fever of 101° to 102° F (38.4° to 39.0° C) may be present; anorectic and irritable and appear unwell.

Mild diarrhea

Episodes of diarrhea consist of 2 to 10 loose, watery bowel movements per day.

Mild diarrhea

At this stage, diarrhea is not yet serious, and children can be cared for at home.

Mild diarrhea

At the end of approximately 1 hour, parents can begin to offer an oral rehydration solution such as Pedialyte in small amounts on a regimen similar to that for vomiting.

Mild diarrhea

Zinc; measures to decrease temperature

Mild diarrhea

Probiotics (dietary supplements containing potentially beneficial bacteria or yeasts) to change the bacterial flora of the intestine may be administered.

Mild diarrhea

Loperamide or kaolin and pectin (Kaopectate) are too strong for young children

Mild diarrhea

Infants may develop a lactase deficiency after diarrhea that leads to lactose intolerance.

Severe diarrhea

May result from progressive mild diarrhea, or it may begin in a severe form.

Severe diarrhea

Rectal temperature is often as high as 103° to 104° F (39.5° to 40.0°)

Severe diarrhea

Obvious signs of dehydration such as a depressed fontanelle, sunken eyes, and poor skin turgor.

Severe diarrhea

episodes of diarrhea usually consist of a bowel movement every few minutes.

Severe diarrhea

stool is liquid green, perhaps mixed with mucus and blood, and it may be passed with explosive force.

Severe diarrhea

Urine output will be scanty and concentrated.

Severe diarrhea

Elevated hematocrit, hemoglobin, and serum protein levels because of the dehydration.

Severe diarrhea

Electrolyte determinations will indicate a metabolic acidosis.

Severe diarrhea

Focuses on regulating electrolyte and fluid balance by oral or IV rehydration

Severe diarrhea

All children with severe diarrhea or diarrhea that persists longer than 24 hours should have a stool culture taken so definite antibiotic therapy can be prescribed.

Severe diarrhea

Blood specimens need to be drawn

Potassium

cannot be given until it is established that they are not in renal failure.

Vomiting

is the forceful ejection of gastric contents through the mouth.

Vomiting

is common in childhood and is usually self-limiting.

Infection

Fever and diarrhea accompanying vomiting suggest an?

anatomic or functional obstruction

Constipation associated with vomiting suggests an?

appendicitis, pancreatitis, or peptic ulcer disease

Localized abdominal pain and vomiting often occur with?

central nervous system or metabolic disorder

A change in the level of consciousness or a headache associated with vomiting indicates a?

Pyloric stenosis

Forceful vomiting is associated with?

Nausea

is a sensation that may be induced by visceral, labyrinthine (inner ear), or emotional stimuli.

Vomiting

is always potentially serious because a metabolic alkalosis and dehydration may result.

Vomiting

It is characterized by the desire to vomit, with discomfort felt in the throat or abdomen.

Nausea

is often associated with autonomic symptoms such as salivation, pallor, sweating, and tachycardia.

Projectile vomiting

is preceded and accompanied by vigorous peristaltic waves.

Nausea and vomiting

are likely a protective mechanism to remove toxins from the system.