Fluids and Electrolytes Overview
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Questions and Answers

How do children under 2 years lose fluid compared to older children?

  • They lose fluid through fecal output primarily.
  • They maintain a higher amount of intracellular fluid.
  • They have a lower metabolic rate leading to less fluid loss.
  • They lose a greater proportion of fluid each day. (correct)

    • What is a significant factor that increases fluid demands in children?

  • Higher fluid retention capacity of kidneys.
  • Lower metabolic waste production.
  • Smaller body surface area in infants.
  • Higher metabolic rate fueling growth. (correct)

    • Which of the following is a component of extracellular fluid?

  • Cytosolic fluid.
  • Nuclear fluid.
  • Intracellular fluid.
  • Interstitial fluid. (correct)

    • What calculation is used to determine daily fluid maintenance for a child weighing 35 kg?

    <p>$100ml/kg for first 10 kg, then $50ml/kg for next 10 kg, and $20ml/kg for remaining weight.</p> Signup and view all the answers

    What characteristic of kidney function contributes to fluid loss in children under 2 years?

    <p>Immature glomeruli and nephrons with ineffective conservation of water.</p> Signup and view all the answers

    What factor contributes to the greater insensible losses in children?

    <p>Higher body surface area relative to their body volume.</p> Signup and view all the answers

    What is the primary cause of isotonic dehydration?

    <p>Vomiting and diarrhea</p> Signup and view all the answers

    What is NOT a reason why infants and children are at higher risk for fluid and electrolyte imbalance?

    <p>Mature renal function allowing conservation.</p> Signup and view all the answers

    Which serum sodium concentration indicates hypotonic dehydration?

    <p>&lt; 130 meq/l</p> Signup and view all the answers

    Which treatment is typically recommended for isotonic dehydration?

    <p>Isotonic solution</p> Signup and view all the answers

    What is a common symptom of hypotonic dehydration?

    <p>Confusion and lethargy</p> Signup and view all the answers

    What indicates that the body is experiencing hypovolemic shock due to dehydration?

    <p>Severe fluid loss from ECF</p> Signup and view all the answers

    Which condition may lead to hypotonic dehydration due to pressure on the posterior pituitary?

    <p>Bacterial meningitis</p> Signup and view all the answers

    What could be the first sign of rapid shifts in fluid compartments when administering hypertonic solutions?

    <p>Changes in level of consciousness</p> Signup and view all the answers

    What type of solution is administered initially in cases of hypotonic dehydration?

    <p>Isotonic solution</p> Signup and view all the answers

    What condition is characterized by electrolyte losses exceeding water deficits?

    <p>Hypotonic dehydration</p> Signup and view all the answers

    What is a common cause of chronic non-specific diarrhea in children aged 6-54 months?

    <p>Too much concentrated juices</p> Signup and view all the answers

    Which method is NOT indicated for assessing fluid and electrolyte imbalance?

    <p>Daily weight measurements</p> Signup and view all the answers

    When managing mild dehydration, how much Oral Rehydration Therapy (ORT) solution should be administered over four hours?

    <p>50 mL per kg</p> Signup and view all the answers

    Which organism is NOT typically associated with chronic diarrhea caused by infectious etiologies?

    <p>Listeria monocytogenes</p> Signup and view all the answers

    Which of the following symptoms is not indicative of chronic non-specific diarrhea?

    <p>Presence of blood in the stool</p> Signup and view all the answers

    What is the primary characteristic of hypertonic dehydration?

    <p>H2O losses exceed electrolyte losses</p> Signup and view all the answers

    Which of the following is a potential cause of hypokalemia?

    <p>Osmotic diuresis</p> Signup and view all the answers

    What symptoms are most commonly associated with hyperkalemia?

    <p>Abdominal cramping and irregular pulse</p> Signup and view all the answers

    Which of the following treatments is appropriate for managing severe hypokalemia?

    <p>Monitoring heart rhythm continuously</p> Signup and view all the answers

    Which serum sodium level indicates hypertonic dehydration?

    <p>Greater than 150 meq/l</p> Signup and view all the answers

    What is a common treatment for hyperkalemia?

    <p>IV bicarbonate therapy</p> Signup and view all the answers

    In the case of oliguria caused by hypertonic dehydration, what underlying factor should be addressed?

    <p>Inadequate fluid intake</p> Signup and view all the answers

    In what situation might a rapid infusion of 0.45 NS lead to negative outcomes?

    <p>It can result in cell swelling</p> Signup and view all the answers

    Which condition could lead to an increased K+ excretion among patients?

    <p>Prolonged fasting or NPO status</p> Signup and view all the answers

    What percentage weight loss is classified as severe dehydration?

    <p>15%</p> Signup and view all the answers

    What is a sign of dehydration that may indicate a more serious condition?

    <p>Decreased urine output</p> Signup and view all the answers

    Which of the following is NOT considered a nursing assessment for dehydration?

    <p>Body temperature</p> Signup and view all the answers

    In a child who is 5% dehydrated, which symptom is typically observed?

    <p>Ill appearance</p> Signup and view all the answers

    What characterizes acute diarrhea as identified in the content?

    <p>Self-limited duration of less than 14 days</p> Signup and view all the answers

    Which of the following is a common cause of chronic diarrhea in infants?

    <p>Intractable diarrhea of infancy</p> Signup and view all the answers

    What specific characteristic of diarrhea indicates it is acute, rather than chronic?

    <p>Duration less than 14 days</p> Signup and view all the answers

    Which of the following is a potential cause of dehydration in a young child?

    <p>Fluid loss through diarrhea</p> Signup and view all the answers

    What physiological change accompanies dehydration as per the content?

    <p>Increased heart rate</p> Signup and view all the answers

    What is a common finding in the assessment of a child with dehydration?

    <p>Sunken eyes</p> Signup and view all the answers

    What can be a potential complication of prolonged diarrhea in infants?

    <p>Nutritional absorption issues</p> Signup and view all the answers

    What is the primary reason that children under 2 years have an increased risk of dehydration?

    <p>Greater surface area leads to increased insensible losses</p> Signup and view all the answers

    What is a significant factor influencing the fluid intake calculations for a child weighing 35 kg?

    <p>Each 10 kg increment has a fixed fluid requirement</p> Signup and view all the answers

    Which fluid compartment does not include intravascular fluid?

    <p>Intracellular fluid</p> Signup and view all the answers

    What role does kidney immaturity play in fluid balance for children under 2 years?

    <p>It contributes to increased fluid loss</p> Signup and view all the answers

    Why is it crucial to monitor fluid requirements in infants and children under 2?

    <p>They lose a higher percentage of body fluid daily</p> Signup and view all the answers

    Which component of fluid loss is primarily linked to skin and respiratory tract insensible losses?

    <p>Transcutaneous evaporation</p> Signup and view all the answers

    What calculation method is used to determine the fluid requirements for a child weighing 35 kg?

    <p>50 ml/kg for the second 10 kg</p> Signup and view all the answers

    What is a key characteristic of chronic non-specific diarrhea in children aged 6-54 months?

    <p>Presence of undigested food particles in stool</p> Signup and view all the answers

    Which organism is commonly linked to chronic diarrhea as mentioned in the content?

    <p>Giardia</p> Signup and view all the answers

    During the management of mild dehydration, how much Oral Rehydration Therapy (ORT) solution should be given per kilogram?

    <p>50 mL</p> Signup and view all the answers

    What is the most common cause of chronic non-specific diarrhea in children?

    <p>Acute infectious diarrhea that was not managed adequately</p> Signup and view all the answers

    What laboratory test can help determine dehydration in a child?

    <p>Urine specific gravity</p> Signup and view all the answers

    What is the primary form of dehydration characterized by equal losses of electrolytes and fluid?

    <p>Isotonic dehydration</p> Signup and view all the answers

    Which symptom is likely associated with hypotonic dehydration due to excessive fluid retention?

    <p>Confusion and headache</p> Signup and view all the answers

    In cases of hypotonic dehydration, what is the first intervention typically implemented?

    <p>Treating the underlying cause and restricting fluids</p> Signup and view all the answers

    Which of the following is listed as a treatment method for hypotonic dehydration?

    <p>Fluid restriction and Na+ supplementation</p> Signup and view all the answers

    Which sign is most indicative of a 5% level of dehydration in a child?

    <p>Capillary refill greater than 2 seconds</p> Signup and view all the answers

    What defines isotonic dehydration in terms of serum sodium concentration?

    <p>Serum Na+ between 130 to 150 meq/l</p> Signup and view all the answers

    What is a common symptom associated with chronic diarrhea that lasts more than 14 days?

    <p>Intractable diarrhea of infancy</p> Signup and view all the answers

    Which condition is NOT a common cause of hypotonic dehydration?

    <p>Dehydration due to vomiting</p> Signup and view all the answers

    When assessing a dehydrated child, which condition is a sign of more severe dehydration?

    <p>Absent tears</p> Signup and view all the answers

    What is the correct course of action when administering a hypertonic solution after isotonic solutions fail?

    <p>Start low and slow to monitor for complications</p> Signup and view all the answers

    What would be an expected vital sign change in a child experiencing dehydration?

    <p>Increased heart rate</p> Signup and view all the answers

    Which treatment is safest for replacing fluid lost in isotonic dehydration?

    <p>Using isotonic solutions like 5% dextrose in water</p> Signup and view all the answers

    What is a potential consequence of rapidly administering hypertonic solutions in older children?

    <p>Seizures due to rapid osmotic shifts</p> Signup and view all the answers

    Which of the following would not be used to assess dehydration in a patient?

    <p>Pulse pressure calculation</p> Signup and view all the answers

    Which of the following symptoms is least likely to be associated with hypertonic dehydration?

    <p>Elevated T wave on EKG</p> Signup and view all the answers

    Which condition is least likely to contribute to dehydration in infants?

    <p>Adequate hydration practices</p> Signup and view all the answers

    What is the primary treatment for severe hypokalemia?

    <p>IV potassium solution</p> Signup and view all the answers

    Which of the following causes is most directly related to metabolic alkalosis leading to hypokalemia?

    <p>Prolonged vomiting</p> Signup and view all the answers

    What common characteristic is found in acute diarrhea compared to chronic diarrhea?

    <p>Sudden increase in stool frequency</p> Signup and view all the answers

    What physiological change often accompanies dehydration?

    <p>Dry mucous membranes</p> Signup and view all the answers

    What consequence can arise from administering 0.45 NS too rapidly in a patient with hypertonic dehydration?

    <p>Cell swelling</p> Signup and view all the answers

    What is a critical nursing assessment for evaluating a child's dehydration status?

    <p>Monitoring input and output</p> Signup and view all the answers

    Which electrolyte imbalance is most likely to lead to digoxin toxicity symptoms?

    <p>Hypokalemia</p> Signup and view all the answers

    Which of the following factors is NOT typically associated with acute diarrhea in children?

    <p>Prolonged fasting</p> Signup and view all the answers

    In a state of hyperkalemia, which of the following physiological changes is expected?

    <p>Elevated serum potassium levels</p> Signup and view all the answers

    What condition could directly lead to an increase in potassium excretion in the body?

    <p>Renal disease</p> Signup and view all the answers

    Which weight loss percentage would be classified as moderate dehydration?

    <p>10%</p> Signup and view all the answers

    Which treatment modality is primarily used to manage hyperkalemia in end-stage renal failure?

    <p>Peritoneal dialysis</p> Signup and view all the answers

    Which of the following is a common symptom of hypokalemia?

    <p>Muscle weakness</p> Signup and view all the answers

    Study Notes

    Fluids and Electrolytes

    • Fluids are essential for bodily functions.
    • Fluid loss occurs through insensible losses (2/3 through skin, 1/3 through respiratory tract), urine, and feces.
    • Major fluid compartments include intracellular fluid (inside cells) and extracellular fluid (outside cells), which includes intravascular fluid (in blood vessels) and interstitial fluid (surrounding cells).
    • Infants and children under 2 lose a greater proportion of fluid daily due to a larger body surface area (BSA), higher metabolic rate, greater metabolic waste production, and immature kidney function unable to effectively conserve water.

    Major Fluid Compartments

    • Intracellular fluid is the fluid inside cells.
    • Extracellular fluid is the fluid outside cells. It contains intravascular (blood) and interstitial (surrounding cells) fluids.

    Fluid Requirements

    • Daily maintenance requirements are calculated based on weight, with higher fluid needs for younger children.

    Urine Output

    • Fluid loss through urine varies based on age: Infants and toddlers (>2-3 mL/kg/hr), Preschool and young school age (>1-2 mL/kg/hr), Older school age and adolescents (0.5-1 mL/kg/hr).

    Dehydration

    • Dehydration is classified by serum sodium concentration and osmolarity (and in reference to electrolyte balances).
    • Isotonic: Electrolyte and fluid loss is equal. Primary causes of isotonic dehydration are fluid losses mostly from the extracellular fluid compartment (ECF) due to vomiting and diarrhea. Treatment involves isotonic solutions.
    • Hypotonic: Electrolytes lost > H2O. Hyponatremia is a concern. Underlying causes should be rectified to combat this type of dehydration. Treatment includes limiting fluids and administering sodium and fluids in necessary amounts.
    • Hypertonic: H2O losses > electrolyte losses. Hypernatremia. Requires restricting sodium and administering fluids as necessary.

    Electrolytes

    • Electrolyte concentration varies between intracellular and extracellular fluids.

    Hypokalemia

    • Serum K+ < 3.5 mmol/L. This low level can cause several symptoms, which vary from muscle weakness to EKG changes.
    • Causes include diuretics, osmotic diuresis, renal disease, diarrhea, decreased intake, NPO, etc.
    • Treatment involves managing the underlying cause, monitoring cardiac status, ensuring adequate potassium intake, and avoiding adding potassium to any IV while monitoring cardiac output.

    Hyperkalemia

    • Serum K+ > 5.8 mmol/L. Symptoms include cramping, irregular heartbeat, increased deep tendon reflexes, and possible muscle weakness. Causes include massive cell death, excessive potassium IV infusion, metabolic acidosis, and impaired potassium excretion.
    • Treatment involves managing the underlying cause, restricting intake, and in cases with very high concentrations, administering IV fluids, insulin, glucose, diuretics, sodium polystyrene sulfonate ("Kayexalate"), and/or dialysis as needed.

    Diagnostic Evaluation of Dehydration

    • Weight loss is a key indicator.
      • 5% = mild, 10% = moderate, 15% = severe
      • Calculating percentage weight loss is done by dividing the change in weight by the initial weight.
    • Other indicators include changing levels of consciousness, response to stimuli, decreased skin elasticity and turgor, prolonged capillary refill, increased heart rate, sunken eyes and fontanels, dry mucus membranes, and absent tears. Decreased urine output is another key indicator.

    Diarrhea

    • Diarrhea is caused by abnormal intestinal fluid and electrolyte transport.
    • Acute diarrhea is mostly common among young children (under 5) and usually self-limited but there are several causes such as gastroenteritis (caused by infections), antibiotics, laxatives or an underlying intolerance.
    • Chronic diarrhea can have several causes in various age groups, usually lasting over 14 days. Intractable and chronic diarrhea in infants usually have underlying causes such as absorption issues, inflammatory diseases, food intolerances, infections etc.
    • Chronic non-specific diarrhea in children is characterized by 6 until 54 months of age, characterized by loose stools with undigested food and potentially, no signs of blood, infection, or malnutrition.

    Etiology

    • Diarrhea is often caused by contaminated food or water.
    • Viral, bacterial, and parasitic pathogens (Rotavirus, Salmonella, Shigella, Campylobacter, Giardia, Cryptosporidium), are common causes.
    • Antibiotics sometimes can worsen the infection and should be used with caution.

    Diagnosis

    • Thorough history gathering (duration, severity, potential cause).
    • Laboratory tests (stool samples, urine specific gravity, CBC, serum electrolytes, creatinine, BUN)

    Management

    • Assessment for fluid and electrolyte imbalances
    • Rehydration (mild: 50 mL/kg ORT over 4 hrs; moderate: 100 mL/kg ORT over 4 hrs)
    • Maintenance of fluid therapy (consider appropriate diet)
    • Reintroduction of adequate diet

    Nursing

    • Assessment (vital signs, I&O, skin, mucus membranes, fontanel, and weight)
    • Implementation and education regarding oral rehydration
    • Monitoring I&O (adequate urine output)
    • Skin care (preventing breakdown)
    • Prevention (identifying and addressing potential causes)

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    Fluids and Electrolytes PDF

    Description

    This quiz covers the essentials of fluids and electrolytes, focusing on their significance for bodily functions, fluid loss mechanisms, and the major fluid compartments in the body. It highlights the unique fluid requirements for infants and children due to their physiological differences. Test your knowledge on how these factors impact health and hydration.

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