Podcast
Questions and Answers
How does the total body water (TBW) percentage change with age in children?
How does the total body water (TBW) percentage change with age in children?
- It remains constant throughout childhood.
- It increases to match adult levels by age 12.
- It decreases as the child ages. (correct)
- It fluctuates significantly during the first year.
What is a characteristic of drug pharmacokinetics in children compared to adults?
What is a characteristic of drug pharmacokinetics in children compared to adults?
- The insensible water loss decreases as children get older.
- Children have larger volumes of distribution for lipid soluble drugs.
- Drug elimination half-lives are decreased in children.
- Children exhibit higher free drug concentrations for highly protein-bound drugs due to decreased protein/immature liver function (correct)
At what age do children generally have an estimated blood volume of 80 mL/kg?
At what age do children generally have an estimated blood volume of 80 mL/kg?
- Newborns
- 3 months to 2 years (correct)
- 2 years and older (correct)
- Preterm infants
What aspect of renal function is observed in the first year of life?
What aspect of renal function is observed in the first year of life?
What is the typical gastric emptying time for solid foods compared to clear liquids?
What is the typical gastric emptying time for solid foods compared to clear liquids?
Under what circumstances are preoperative fluids commonly indicated? select 3
Under what circumstances are preoperative fluids commonly indicated? select 3
Which population may require glucose-containing solutions during maintenance?
Which population may require glucose-containing solutions during maintenance?
What is a significant risk for neonates regarding fluid management?
What is a significant risk for neonates regarding fluid management?
What is the appropriate fluid replacement strategy for blood loss in pediatric patients? select 2
What is the appropriate fluid replacement strategy for blood loss in pediatric patients? select 2
Which factor contributes to the greater insensible water loss in neonates compared to older children?
Which factor contributes to the greater insensible water loss in neonates compared to older children?
How does acute hypercarbia affect fluid distribution in the body?
How does acute hypercarbia affect fluid distribution in the body?
What is the expected effect of delivery of cold, dry anesthetic gases via ETT on fluid loss?
What is the expected effect of delivery of cold, dry anesthetic gases via ETT on fluid loss?
What effect do opioids have on fluid retention in pediatric patients?
What effect do opioids have on fluid retention in pediatric patients?
What characteristic of blood volume makes pediatric patients more susceptible to dehydration? select 2
What characteristic of blood volume makes pediatric patients more susceptible to dehydration? select 2
What is a characteristic of water-soluble drugs in pediatric patients?
What is a characteristic of water-soluble drugs in pediatric patients?
What can be expected when administering a water-soluble drug to a pediatric patient?
What can be expected when administering a water-soluble drug to a pediatric patient?
What is expected when administering a fat-soluble drug to a pediatric patient?
What is expected when administering a fat-soluble drug to a pediatric patient?
What are the effects of immature renal function in pediatric patients? (Select all that apply)
What are the effects of immature renal function in pediatric patients? (Select all that apply)
Which two organs have immature function in pediatric patients that directly affect the pharmacokinetics and pharmacodynamics of drugs?
Which two organs have immature function in pediatric patients that directly affect the pharmacokinetics and pharmacodynamics of drugs?
Poiseuille's equation
change in pressure = 8viscositylengthflow/piradius^4
Poiseuille's equation change in pressure = 8viscositylengthflow/piradius^4
According to Poiseuille's law, what is flow directly proportional to?
According to Poiseuille's law, what is flow directly proportional to?
According to Poiseuille's law, what is flow indirectly proportional to? select 2
According to Poiseuille's law, what is flow indirectly proportional to? select 2
When are isotonic fluids indicated?
When are isotonic fluids indicated?
What should glucose levels be maintained above to prevent neurological injury in infants and children?
What should glucose levels be maintained above to prevent neurological injury in infants and children?
Why isn't hypoglycemia commonly seen in healthy surgical patients?
Why isn't hypoglycemia commonly seen in healthy surgical patients?
How should intraoperative glucose be administered?
How should intraoperative glucose be administered?
Which of the following patients should receive glucose-containing solutions? select all that apply
Which of the following patients should receive glucose-containing solutions? select all that apply
If a patient is above 20 kg, you should add 40 to their weight to calculate the hourly maintenance rate.
If a patient is above 20 kg, you should add 40 to their weight to calculate the hourly maintenance rate.
What is third spacing?
What is third spacing?
What is virtual loss in the context of anesthesia?
What is virtual loss in the context of anesthesia?
Why are premature infants more susceptible to volume overload?
Why are premature infants more susceptible to volume overload?
Which of the following compensatory mechanisms occurs in response to acute hypercarbia? select 2
Which of the following compensatory mechanisms occurs in response to acute hypercarbia? select 2
What is the effect of hypocarbia and hyperthermia on fluid shifts in the body?
What is the effect of hypocarbia and hyperthermia on fluid shifts in the body?
What does a narrow pulse pressure indicate?
What does a narrow pulse pressure indicate?
What is a usual cause of reduced stroke volume in pediatric patients?
What is a usual cause of reduced stroke volume in pediatric patients?
What defines a narrow pulse pressure?
What defines a narrow pulse pressure?
How many ml/kg should be administered in a fluid challenge?
How many ml/kg should be administered in a fluid challenge?
Flashcards
Infant TBW/ECF
Infant TBW/ECF
Infants (1-12 months) have a higher percentage of total body water (TBW) and extracellular fluid (ECF) than adults.
Children's Drug Response
Children's Drug Response
Children have different drug responses due to varying body composition and organ function compared to adults. Water-soluble drugs have a greater volume of distribution (Vd) in children due to more body water.
Blood Volume by Age
Blood Volume by Age
Estimates of blood volume vary by age; preterm infants have higher values than older children and adults.
Kidney Function in Infants
Kidney Function in Infants
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Liver Function in Infants
Liver Function in Infants
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Fluid Replacement in Fever
Fluid Replacement in Fever
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Blood Loss Replacement
Blood Loss Replacement
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What is Third Spacing?
What is Third Spacing?
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Virtual Fluid Loss
Virtual Fluid Loss
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Fluid Loss in Neonates
Fluid Loss in Neonates
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Advantages of Limited NPO
Advantages of Limited NPO
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When are Pre-op Fluids Necessary?
When are Pre-op Fluids Necessary?
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Poiseuille's Law and Fluid Choice
Poiseuille's Law and Fluid Choice
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Glucose Containing Solutions: When & Why?
Glucose Containing Solutions: When & Why?
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Neonatal Fluid Management
Neonatal Fluid Management
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Study Notes
Infant (1-12 Months) and Child (1-12 Years) Fluid Management
- Infants and young children have larger total body water (TBW) and extracellular fluid (ECF) compared to adults.
- Fat and muscle increase with age, and body water content decreases.
- Younger children have a higher percentage of total body water than older children.
- Water-soluble drugs have a greater volume of distribution in children due to a dilutional effect.
- A higher drug loading dose may be needed for water-soluble drugs in children to achieve desired plasma concentrations.
- Lipid-soluble drugs have higher plasma concentrations in children due to decreased fat and muscle mass.
Estimating Blood Volume
- Preterm: 90-100 mL/kg
- Newborn: 80-90 mL/kg
- 3 months - 2 years: 80 mL/kg
- 2+ years: 80 mL/kg
Kidney Function
- First-year renal blood flow (RBF) and glomerular filtration rate (GFR) are half of adult values.
- Children have decreased ability to concentrate urine, leading to increased free water loss.
- Preterm infants have increased sodium excretion and elevated serum creatinine.
Liver Function
- Immature liver function in infants
- Hepatic enzyme metabolism and blood flow are reduced (HBF).
- Higher concentrations of highly protein-bound drugs in children.
- Drug elimination half-lives are prolonged in infants.
Advantages of Limited NPO (Nothing by Mouth)
- Less cranky, distressed children
- Some evidence that clear liquids do not differ from gastric emptying comparison studies done (data is unclear, needs more robust studies)
- Gastric emptying time for clear liquids is 10-20 minutes, and for solids it is 77-277 minutes (range difference).
Fluid Management/Replacement
- Fluids are indicated for concurrent illness, poor nutrition states, hyperalimentation, and longer surgical procedures.
- Consider the 4/2/1 rule for fluid replacement in children (age > 20 kg).
- Replace blood loss with blood or colloids.
- Replace blood or colloid loss 1:1 or 1:3 with crystalloid fluids dependent on the situation.
- Third spacing occurs with capillary leak and surgical trauma.
- Anesthetics can cause relative hypovolemia due to sympathetic tone relaxation.
- High insensible water losses in neonates due to transepidermal water loss.
- Exposed neonates have greater evaporative losses.
- Premature infants have low plasma osmotic pressure and can easily develop edema due to fluid overload.
Fluid Choices
- Isotonic fluids are used for surgical losses, deficits, and third spacing.
- Glucose dextrose solutions.
- Monitor for hypoglycemia and hyperglycemia in children (during the surgical procedure and post-op)
- Give secondary IV fluids on a rate-controlled pump.
- High glucose levels help prevent neurological injury.
Neonate Considerations
- More susceptible to dehydration and fluid overload.
- Limited ability to handle sodium loss.
- Appropriate fluid management can prevent/treat issues (e.g., glycemic issues).
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Description
This quiz covers critical concepts in fluid management for infants and children aged 1 month to 12 years. It details total body water composition, the impact on drug dosing, and blood volume estimates based on age categories. Additionally, it explores kidney function in these age groups, emphasizing the differences compared to adults.