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  • Dehydration FINAL

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    Shir Maor
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    This document discusses screening and treatment for dehydration in pediatrics. It covers blood and urine tests that can detect dehydration including electrolyte and acid-base panel abnormalities. It describes the normal physiology of water intake in children and how they are more prone to water loss due to factors like lower water storage and underdeveloped thirst sensors. The document lists common causes of dehydration like vomiting, diarrhea, excessive sweating, and medications. It provides guidelines for treating light, medium, and severe dehydration based on fluid replacement orally or intravenously depending on the severity.

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    This document discusses screening and treatment for dehydration in pediatrics. It covers blood and urine tests that can detect dehydration including electrolyte and acid-base panel abnormalities. It describes the normal physiology of water intake in children and how they are more prone to water loss due to factors like lower water storage and underdeveloped thirst sensors. The document lists common causes of dehydration like vomiting, diarrhea, excessive sweating, and medications. It provides guidelines for treating light, medium, and severe dehydration based on fluid replacement orally or intravenously depending on the severity.

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    22 views8 pages

    Dehydration FINAL

    Uploaded by

    Shir Maor
    This document discusses screening and treatment for dehydration in pediatrics. It covers blood and urine tests that can detect dehydration including electrolyte and acid-base panel abnormalities. It describes the normal physiology of water intake in children and how they are more prone to water loss due to factors like lower water storage and underdeveloped thirst sensors. The document lists common causes of dehydration like vomiting, diarrhea, excessive sweating, and medications. It provides guidelines for treating light, medium, and severe dehydration based on fluid replacement orally or intravenously depending on the severity.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    of 8

    Dehydration

    Screening and blood testing for dehydration

    Blood work
    1. Biochemistry urinalysis
    a. electrolyte disturbances (Na+, K+, Cl-, HCO3-, 2. ↑ osmolality
    Ca++) 3. Dark color
    b. acid base panel (pCO2, pO2, BE, pH, ↑BUN) 4. ↑ urine specific gravity
    c. ↑ glucose (in DM)
    d. ↑ osmolality Others
    5. Skin turgor
    2. Complete blood count
    6. Hypotension
    a. ↑ hematocrit
    7. Stool culture (C.difficile toxin, ONP)
    b. ↑ albumin
    8. Cortisol and Aldosterone (Addison disease)
    9. ADH levels
    Physiology of normal water intake in
    pediatrics
    • Children are more resistant to water-balance variations than adults.
    • Water is constantly being lost, therefore it is crucial to have proper intake amounts

    • Methods for calculating daily maintenance fluid volume


    1. Body weight method (maximum 2.4L\day)
    a. 0-10kg: 100ml\kg\day
    b. 11-20kg: 1,000ml+50ml\kg\day
    c. >20kg: 1,500ml + 20ml\kg\day

    2. Hourly maintenance water rate


    a. 0-10kg: 4ml\kg\h
    b. 10-20kg: 40ml\h + 2ml\kg\hr X (weight -10kg)
    c. >20kg: 60ml\h + 1ml\kg\hr X (weight -20kg)
    Water-loss physiology in pediatrics

    • Children are more prone to water loss


    a. Lower water storage
    b. Increased surface-area: body-mass
    c. Underdeveloped thirst sensors
    d. Dependence on care-givers

    • Sources of water loss


    a. Through urine (60%)
    b. Through insensible-losses (35%, skin and lungs)
    c. Through stool (5%)
    Etiology of dehydration
    8. Substances (e.g. alcohol or
    medication)
    1. Vigorous exercise
    a. diuretics
    2. Not drinking enough
    b. alpha-blockers (Cardura)
    3. Vomiting
    c. anti-depressants
    4. Diarrhea
    d. laxatives
    5. excessive sweating
    e. chemotherapy
    6. Inability sweating
    f. anti-histamines
    7. Inability to swallow
    g. ectasy
    Treatment

    • According to etiology of dehydration

    1. Light dehydration:
    -Standard home solutions (salted rice water, salted yogurt )
    - Oral water-replacement

    2. Medium dehydration (with paused vomiting)


    - Give water orally in a slower pace (5-10 minutes interval)
    - might consider IV-solution
    ( normal-saline + 30mEq\L-Sodium-bicarbonate + 20mEq\L-KCL ) for every ml loss every 1-6h

    3. Severe dehydration
    - Provide fluids according to urine output (similar formula as medium dehydration)
    Bibliography

    1. Kliegman, Stanton, St Geme, Schor. Nelson- Textbook of


    Pediatrics, 20th edition, Elsevior, 2016

    2. Rehydration project- http://rehydrate.org/

    3. The National academies of sciences engineering medicine-


    Dietary reference intakes- 2004
    4. John E. Elleshaw, Jane M Sutcliffe, Cicely M, saunders.
    Dehydration and the dying patient, St. Chrisopher’s Hospice,
    London, England, 1995
    THANK YOU!

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