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. (B)</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. (C)</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. (B)</p> Signup and view all the answers

What is the primary cause of isotonic dehydration?

<p>Vomiting and diarrhea (A)</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. (D)</p> Signup and view all the answers

Which serum sodium concentration indicates hypotonic dehydration?

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

Which treatment is typically recommended for isotonic dehydration?

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

What is a common symptom of hypotonic dehydration?

<p>Confusion and lethargy (B)</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 (A)</p> Signup and view all the answers

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

<p>Bacterial meningitis (C)</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 (A)</p> Signup and view all the answers

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

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

What condition is characterized by electrolyte losses exceeding water deficits?

<p>Hypotonic dehydration (A)</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 (C)</p> Signup and view all the answers

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

<p>Daily weight measurements (A)</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 (B)</p> Signup and view all the answers

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

<p>Listeria monocytogenes (B)</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 (C)</p> Signup and view all the answers

What is the primary characteristic of hypertonic dehydration?

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

Which of the following is a potential cause of hypokalemia?

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

What symptoms are most commonly associated with hyperkalemia?

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

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

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

Which serum sodium level indicates hypertonic dehydration?

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

What is a common treatment for hyperkalemia?

<p>IV bicarbonate therapy (B)</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 (C)</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 (D)</p> Signup and view all the answers

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

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

What percentage weight loss is classified as severe dehydration?

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

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

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

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

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

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

<p>Ill appearance (A)</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 (A)</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 (B)</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 (D)</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 (C)</p> Signup and view all the answers

What physiological change accompanies dehydration as per the content?

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

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

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

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

<p>Nutritional absorption issues (B)</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 (A)</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 (D)</p> Signup and view all the answers

Which fluid compartment does not include intravascular fluid?

<p>Intracellular fluid (C)</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 (D)</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 (C)</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 (D)</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 (B)</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 (D)</p> Signup and view all the answers

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

<p>Giardia (A)</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 (A)</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 (D)</p> Signup and view all the answers

What laboratory test can help determine dehydration in a child?

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

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

<p>Confusion and headache (B)</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 (A)</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 (B)</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 (A)</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 (A)</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 (A)</p> Signup and view all the answers

Which condition is NOT a common cause of hypotonic dehydration?

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

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

<p>Absent tears (A)</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 (C)</p> Signup and view all the answers

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

<p>Increased heart rate (C)</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 (A)</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 (C)</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 (D)</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 (D)</p> Signup and view all the answers

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

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

What is the primary treatment for severe hypokalemia?

<p>IV potassium solution (D)</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 (A)</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 (C)</p> Signup and view all the answers

What physiological change often accompanies dehydration?

<p>Dry mucous membranes (A)</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 (A)</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 (C)</p> Signup and view all the answers

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

<p>Hypokalemia (C)</p> Signup and view all the answers

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

<p>Prolonged fasting (B)</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 (C)</p> Signup and view all the answers

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

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

Which weight loss percentage would be classified as moderate dehydration?

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

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

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

Which of the following is a common symptom of hypokalemia?

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

Flashcards

Insensible fluid loss

Fluid lost through the skin and respiratory tract without being noticed.

Intracellular fluid

Fluid inside the body's cells.

Extracellular fluid

Fluid outside the body's cells.

Fluid needs in children (under 2)

Children under 2 require more fluids per kilogram of body weight due to factors like higher metabolic rates and immature kidneys.

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Dehydration risk in children

Children under 2 are at higher risk for dehydration and electrolyte imbalances because of a larger proportion of fluid loss daily compared to older children and adults, and less efficient kidney water conservation mechanisms.

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Fluid maintenance calculation (children)

A formula for calculating the daily fluid needs of a child. (100ml/kg for the first 10 kg, 50ml/kg for the second 10 kg, and 20ml/kg for remaining weight, distributed equally across the day.)

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Urinary, Fecal Fluid Losses

Fluid lost through urine and feces.

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Infant/Toddler Urine Output

More than 2-3 ml/kg/hr is considered normal for infants and toddlers

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Preschool/Young School-Age Urine Output

More than 1-2 ml/kg/hr is considered normal for preschool and young school-age children.

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Older School-Age/Adolescent Urine Output

Normal output is 0.5-1 ml/kg/hr for older school-age and adolescents.

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Isotonic Dehydration

A type of dehydration where fluid and electrolyte loss are equal; fluid loss mostly from ECF. Causes include vomiting and diarrhea.

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Isotonic Dehydration Treatment

Treatment involves replacing fluids with isotonic solutions (e.g., 5% dextrose in water) to hydrate ECF without disrupting ICF.

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Hypotonic Dehydration (Hyponatremia)

Electrolyte losses exceed water deficits; ICF is more concentrated than ECF. Causes include excessive ADH, excessive sweating, burns, diuretics, and certain diseases.

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Hypotonic Dehydration Symptoms

Symptoms include confusion, headache, weakness, decreased reflexes, agitation, and potentially seizures.

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Hypotonic Dehydration Treatment

Treatment focuses on addressing the underlying cause, restricting fluids, and administering sodium and appropriate IV solutions.

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Chronic diarrhea in children

A condition where a child has loose stools with undigested food particles for at least 14 days, but grows normally and isn't malnourished.

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Common causes of chronic diarrhea

These include food sensitivities, excessive concentrated juices, and diet sodas.

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Viral cause of diarrhea

Rotavirus is a common viral infection that can cause diarrhea in children.

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Bacterial causes of diarrhea

Salmonella, Shigella, and Campylobacter are bacteria that can cause diarrhea.

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Parasitic cause of diarrhea

Cryptosporidium is a parasite that can cause diarrhea in children.

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Hypertonic Dehydration (Hypernatremia)

A condition where water loss exceeds electrolyte loss, making the extracellular fluid (ECF) more concentrated than the intracellular fluid (ICF).

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Causes of Hypertonic Dehydration

Inadequate fluid intake, decreased antidiuretic hormone (ADH), diarrhea, vomiting, excessive sweating, high solute intake without enough water, renal disease, and osmotic diuresis (like in Type 1 Diabetes).

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Symptoms of Hypertonic Dehydration

Agitation, low-grade fever, thirst, rapid heartbeat (tachycardia), low blood pressure (hypotension), decreased urine output (oliguria), and jaundice in newborns. Changes in consciousness level may also occur.

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Hypokalemia

A condition where serum potassium levels are below 3.5 mmol/L.

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Causes of Hypokalemia

Increased potassium excretion (from diuretics, osmotic diuresis, renal disease, diarrhea, high aldosterone/cortisol), decreased potassium intake (NPO, anorexia, prolonged IV therapy without potassium), or potassium loss (vomiting, NG tube drainage, metabolic alkalosis).

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Symptoms of Hypokalemia

Muscle weakness, leg cramps, decreased reflexes, EKG changes, constipation, and potential digoxin toxicity (if on digoxin). Irregular or weak pulse and orthostatic hypotension may also be observed.

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Hyperkalemia

A condition where serum potassium levels are above 5.8 mmol/L.

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Causes of Hyperkalemia

Massive cell death (e.g., from leukemia, crushing injury, sickle cell), rapid potassium IV infusion, metabolic acidosis, reduced potassium excretion (renal disease), and some illnesses (like diabetes).

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Treatment for Hyperkalemia

Treat the underlying cause plus potential medications (such as potassium-wasting diuretics), possibly Kayexalate, IV bicarbonate, IV insulin, and peritoneal dialysis. Diet can also play a part.

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Dehydration Severity

Dehydration is categorized by degree of weight loss: mild (5%), moderate (10%), and severe (15%). Calculations should be made in relation to original weight versus current weight.

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Dehydration Sign: Sunken Eyes

Sunken eyes are a sign of dehydration, indicating fluid loss and a decrease in tissue volume.

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Dehydration Sign: Decreased Skin Elasticity

When skin is pinched and slowly returns to its original position, it indicates dehydration.

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Dehydration Sign: Prolonged Capillary Refill

If it takes more than 2 seconds for blood to return to the capillary bed after pressure is applied, it could suggest dehydration.

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Dehydration Sign: Decreased Urine Output

Reduced urine production is a sign of dehydration, as the body conserves fluids when it's low.

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What is Dehydration?

Dehydration is a state of fluid loss that occurs when the body loses more fluids than it takes in.

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Dehydration: 5% Dehydrated

A child is considered 5% dehydrated if they have two or more of these signs: capillary refill greater than 2 seconds, decreased tears, dry mucous membranes, and an ill appearance.

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Diarrhea: Acute

Acute diarrhea is characterized by a sudden increase in stool frequency and a change in consistency, lasting less than 14 days.

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Diarrhea Cause: Gastroenteritis

Acute infectious diarrhea caused by viruses, bacteria, or parasites, often referred to as gastroenteritis.

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Diarrhea: Chronic

Chronic diarrhea lasts longer than 14 days, and can be caused by various factors like malabsorption issues or inflammatory bowel diseases.

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Diarrhea: Intractable Diarrhea of Infancy

A severe form of diarrhea in infants, often related to absorption issues like celiac disease or cystic fibrosis.

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Insensible Loss

Fluid lost through the skin and respiratory tract without being noticed. This occurs through evaporation and respiration, making it invisible.

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Why are children under 2 at higher risk for dehydration?

Children under 2 years old are at a higher risk for dehydration because they lose a larger proportion of their body fluid each day compared to adults. This is due to a combination of factors including a higher metabolic rate, a larger body surface area, and immature kidneys.

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Fluid Maintenance Calculation for Kids

A simple formula to calculate the daily fluid needs of a child. It's based on their weight in kilograms and includes three steps: (1) 100 ml/kg for the first 10 kg, (2) 50ml/kg for the second 10 kg, and (3) 20ml/kg for any remaining weight.

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What is Body Surface Area?

Body Surface Area (BSA) is the total area of your skin. Children under 2 years old have a larger BSA compared to their weight, which makes them more prone to heat loss and fluid loss through evaporation.

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What are the common causes of chronic diarrhea in children?

The most frequent causes are food sensitivities, excessive concentrated juices, and diet sodas.

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What are the common causes of acute diarrhea in children?

The most frequent cause is acute infectious diarrhea, often due to a viral infection like Rotavirus or bacterial infections like Salmonella, Shigella, or Campylobacter. Giardia is also a common cause.

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How is dehydration assessed in a child with diarrhea?

Evaluation includes assessing the child's history, reviewing lab data (like urine specific gravity and stool samples), and monitoring their intake and output. Additional lab work like CBC, electrolytes, creatinine, and BUN can be used to assess for infection and kidney function.

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What is the primary treatment for mild to moderate dehydration in children with diarrhea?

Oral rehydration therapy (ORT) with solutions like Pedialyte is the first-line treatment for mild to moderate dehydration. This involves administering 50 mL of ORT solution per kilogram of body weight over four hours.

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Isotonic Solution Example

5% Dextrose in Water (D5W) is an example of an isotonic solution. It's used to safely hydrate the ECF without disrupting ICF volumes.

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Treatment for Hypotonic Dehydration

Focus on the underlying cause, restrict fluids, administer sodium, and give IV solutions if needed. Start with isotonic solutions; if needed, transition to hypertonic solutions slowly.

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Hypovolemic Shock

A life-threatening condition that can occur due to severe fluid loss (e.g., from isotonic dehydration). The body's blood volume decreases, leading to decreased blood pressure and inadequate organ perfusion.

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What is the Safest Solution for Isotonic Dehydration?

Isotonic solutions are the safest for treating isotonic dehydration because they hydrate the ECF without disrupting ICF volumes.

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Why Start Slow with Hypertonic Solutions

Rapid changes from hypertonic solutions can cause a shift from ICF to ECF, potentially leading to changes in LOC, seizures, and other complications in older children.

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What are Common Signs of Hypotonic Dehydration?

Common signs include confusion, headache, weakness, decreased reflexes, agitation or lethargy, anorexia, nausea, vomiting, and potentially seizures.

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What is the Significance of Serum Sodium Level in Dehydration?

Serum sodium levels are important indicators of fluid balance. Normal levels are 130-150 mEq/L. Values below 130 indicate hypotonic dehydration.

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What is Hypertonic Dehydration?

Hypertonic dehydration occurs when water loss exceeds electrolyte loss, making the ECF more concentrated than the ICF.

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What are some causes of Hypertonic Dehydration?

Causes include insufficient fluid intake, decreased ADH production, diarrhea, vomiting, excessive sweating, high solute intake without enough water, renal disease, and osmotic diuresis.

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What are some symptoms of Hypertonic Dehydration?

Symptoms include agitation, low-grade fever, thirst, tachycardia, hypotension, oliguria, and jaundice in newborns. Changes in consciousness may also occur.

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What is Hypokalemia?

Hypokalemia is a condition where the serum potassium level is below 3.5 mmol/L.

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What are some causes of Hypokalemia?

Causes include increased potassium excretion (e.g., diuretics, renal disease, diarrhea), decreased potassium intake (e.g., NPO, anorexia), and potassium loss (e.g., vomiting, NG tube drainage).

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What are some symptoms of Hypokalemia?

Symptoms include muscle weakness, leg cramps, decreased reflexes, EKG changes, constipation, and potential digoxin toxicity. An irregular or weak pulse and orthostatic hypotension may also occur.

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What is Hyperkalemia?

Hyperkalemia is a condition where the serum potassium level is above 5.8 mmol/L.

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What are some causes of Hyperkalemia?

Causes include massive cell death (e.g., leukemia, crushing injury), rapid potassium IV infusion, metabolic acidosis, reduced potassium excretion (renal disease), and some illnesses (e.g., diabetes).

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What is the treatment for Hyperkalemia?

Treatment includes managing the underlying cause, using medications (e.g., potassium-wasting diuretics, Kayexalate, IV bicarbonate, IV insulin), and potentially peritoneal dialysis. A modified diet may also be needed.

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How is Dehydration Severity Classified?

Dehydration severity is classified based on weight loss: mild (5%), moderate (10%), and severe (15%).

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What are sunken eyes a sign of?

Sunken eyes are a common sign of dehydration, indicating that the body has lost fluids and the tissues surrounding the eyes are beginning to shrink.

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How is skin elasticity related to dehydration?

Decreased skin elasticity, or turgor, is a dehydration sign. When you pinch the skin and it slowly returns to its original position, it indicates fluid loss.

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Capillary refill

Capillary refill time is a measure of how long it takes for blood to return to the capillary bed after pressure is applied to the skin. A prolonged capillary refill time (greater than 2 seconds) can indicate dehydration.

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What does decreased urine output indicate?

Decreased urine output is a strong sign of dehydration as the body conserves fluids when it's low.

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Acute diarrhea

Acute diarrhea refers to a sudden increase in the frequency and change in the consistency of stool, lasting less than 14 days.

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What is gastroenteritis?

Gastroenteritis is an infection of the digestive system, commonly caused by viruses, bacteria, or parasites. It's a common cause of acute diarrhea.

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What is chronic diarrhea?

Chronic diarrhea persists for more than 14 days and can be caused by various factors, such as malabsorption issues or inflammatory bowel diseases.

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What is intractable diarrhea of infancy?

Intractable diarrhea of infancy is a severe form of diarrhea in infants, often linked to absorption issues like celiac disease or cystic fibrosis.

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5% Dehydration

A child is considered 5% dehydrated if they exhibit two or more of these signs: capillary refill greater than 2 seconds, decreased tears, dry mucus membranes, and an ill appearance.

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What are the signs of dehydration?

Common signs of dehydration include sunken eyes, decreased skin elasticity, prolonged capillary refill, decreased urine output, dry mucus membranes, increased heart rate, and absent tears.

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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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