Dehydration Management in Pediatrics

Dehydration

• Clinical Manifestations: Lethargic/unconscious, weak/absent radial pulse, sunken eyes, slow skin pinch return (>2 seconds), drinks poorly
• Severe Dehydration Treatment:
  • Treat shock (if present), administer oral rehydration solution (ORS) while with IV access
  • Insert peripheral IV line using large IV catheter (g24)
  • Administer Lactated Ringer's and monitor infusion rate, watch for peri-orbital edema (sign of overhydration)
  • Observe child within 2 hours, continue ORS if able to drink
  • Monitor ongoing losses closely, reassess degree of dehydration and continue IV rehydration if needed, switch to ORS if IV is no longer required
• Some Dehydration Treatment:
  • Administer ORS for 4 hours, especially for every loose stool or vomiting
  • Encourage additional age-appropriate fluid intake, including breastfeeding
  • Monitor ongoing losses closely, assess clinical condition and degree of dehydration at regular intervals

Urinary Tract Infection (UTI)

• Etiology:
  • Cystitis (infection of urethra and bladder)
  • Pyelonephritis (infection of ureters up to the kidneys)
  • Anatomical abnormality of the urinary tract
  • Vesicoureteral reflux (VUR)
  • Poor toilet and hygiene habits
  • Use of bubble baths or irritating soaps
  • Family history of UTIs
  • Infrequent urination
  • Incomplete emptying of the bladder
  • Constipation
  • Catheterization
  • Previous UTIs
  • Children who receive antibiotics
  • Tight clothing or diapers
  • Sexual intercourse
  • Altered urine and bladder chemistry

Burns

• Etiology:
  • Acids (pH less than 7)
  • Bases/alkali compounds (pH greater than 7)
  • Friction (contact with flames or hot objects)
  • Radiation (overexposure to the sun or ionizing radiation)
• Pathophysiology:
  • Burns disrupt the skin's barrier, increasing risk of infection
  • Three skin layers: epidermis (regenerates), dermis (contains nerves, blood vessels, etc.), hypodermis (temperature regulation)
  • Temperatures greater than 44°C (111°F) damage proteins and cells
  • Disrupted skin function: sensation loss, water loss, temperature control
  • Cell membrane disruption causes fluid and electrolyte imbalance
  • Large burns (over 30% body surface area) cause significant inflammatory response, fluid leakage, and blood volume loss
  • Hypermetabolic state, increased cardiac output, metabolism, heart rate, and impaired immune function
• Types of Burns:
  • Superficial (First-degree): Mildest form, inflammation of superficial skin, redness, pain, minor swelling, dry skin without blisters, healing in 3-6 days
  • Partial-thickness (Second-degree): Involves deeper skin layers, blisters, severe pain, redness, wet-looking appearance, healing in 3 weeks or more
  • Full-thickness (Third-degree): Destroys all skin layers, charred or white appearance, little to no pain (nerve endings destroyed), may require skin grafts, healing can take months
• Assessment of Burn Severity:
  • Rule of Nines: Body is divided into areas representing 9% (or multiples of 9%) of total surface area
  • Lund and Browder Chart: Takes into account different body proportions in adults and children
• Therapeutic Management:
  • Remove from burning area, prioritize rescuer safety
  • Remove clothing from burned area immediately
  • Do not break blisters
  • Clean wound with lukewarm water
  • Early cooling (within 30 minutes) with cool water (10–25 °C) or cold compress for 3-5 minutes
  • Elevate burned area
  • Remove jewelry and clothing around the burn
  • Apply topical antibiotic ointment (Bacitracin, Neosporin, Silvadene)
  • Manage first-degree burns without dressings
  • Call for emergency medical care for second and third-degree burns
• Flame Burn Management:
  • Extinguish flames by rolling on the ground
  • Stop, Drop, and Roll: Stop what you're doing, drop to the ground, and roll to smother the flames