Pediatric Dehydration Management Quiz

Pediatric Dehydration Management and Oral Rehydration Therapy

• Oral rehydration solutions (ORS) like Pedialyte may need flavor enhancement with 5mL of unsweetened flavored drink mix for every 60-90mL of ORS.
• Older children may be given small popsicles instead of oral fluids, containing 40-50mL of fluid and small amounts of sucrose.
• Some children may refuse oral fluids initially due to fear of emesis or decreased strength, and rehydration can begin with 2-5mL of ORS every 2-3 minutes, gradually increasing.
• Oral rehydration therapy (ORT) is effective for mild to moderate dehydration in children, is cost-effective, and has fewer complications than intravenous therapy.
• Parenteral fluid therapy is initiated for severe dehydration, uncontrollable vomiting, or inability to drink, using isotonic solutions such as 0.9% sodium chloride or lactated Ringer’s solution.
• Parenteral rehydration therapy involves three phases: initial therapy to expand volume quickly, subsequent therapy to replace deficits and meet maintenance requirements, and the final phase to allow the patient to return to normal and begin oral feedings.
• Potassium is withheld until kidney function is restored and circulation has improved during parenteral rehydration therapy.
• Rapid fluid replacement is contraindicated in hypertonic dehydration due to the risk of water intoxication and central pontine myelinolysis.
• Nursing observation and intervention are essential for detecting and managing dehydration, with assessment starting with the general appearance and proceeding to more specific observations.
• Ill children usually have dry mucous membranes and lips, loss of appetite, diminished activity level, and a less vigorous cry.
• ORS is available in Canada as commercially prepared solutions and is successful in treating the majority of infants and children with dehydration.
• Parenteral fluid therapy is initiated when the child is unable to ingest sufficient amounts of fluid and electrolytes, and involves three phases of therapy.

Pediatric Dehydration: Assessment and Management

• Compensatory mechanisms maintain fluid equilibrium by adjusting to losses, with interstitial fluid moving into the vascular compartment to maintain blood volume and vasoconstriction of peripheral arterioles helping to maintain pumping pressure.
• When fluid losses exceed the body's ability to sustain blood volume and pressure, circulation is compromised, resulting in tissue hypoxia and accumulation of acid metabolites, leading to metabolic acidosis.
• Renal compensation is impaired by decreased blood flow through the kidneys, leading to little urine formation, and increased serum osmolality stimulates ADH to conserve fluid and initiates the renin-angiotensin mechanisms in the kidneys, leading to further vasoconstriction.
• Shock, a common manifestation of severe depletion of extracellular fluid (ECF) volume, is preceded by tachycardia and signs of poor perfusion and tissue oxygenation.
• Low blood pressure may be a late sign of shock in infants and young children, signaling the onset of cardiovascular collapse.
• Clinical signs such as abnormal capillary refill, skin turgor, and respiratory pattern are useful in predicting dehydration in children.
• Laboratory data are useful only when results are significantly abnormal, with urine specific gravity and blood urea nitrogen measurements being unreliable for determining dehydration in children.
• Shock, tachycardia, and very low blood pressure are common features of severe depletion of ECF volume.
• Therapeutic management involves determining the degree and type of dehydration, initial plasma sodium concentrations, serum bicarbonate concentration, and any associated electrolyte and acid-base imbalances.
• Medical management is directed at correcting the fluid imbalance and treating the underlying cause, with oral fluid administration attempted when the child is alert and not in danger, and IV intervention required for severe dehydration.
• Oral rehydration management involves replacement of fluid loss over 4 to 6 hours, provision for maintenance fluid requirements, and adjusting amounts and rates based on body weight and severity of dehydration.
• A mildly dehydrated child may be given 50 mL/kg of oral rehydration solution (ORS), and a child with moderate dehydration may be given 100 mL/kg of ORS, with amounts and rates increased if rehydration is incomplete or if excess losses continue.