Dehydration.pptx in pediatrics( Child Care)

Pediatric based slide
It is explicit and very easy to understand as it explains the definition of dehydration, signs and symptoms and the management. From this u should be able to identify a dehydration case and manage it accordingly.

1. Case base A case of 15months old child female, wt : 10.5kg was brought by relative on account of: - loose watering stool episode 5 x 1/7 - fever X1/7 - generalized body weakness x 1/7 No history of vomiting Immuniz : not fully immunized to age, one take her 6weeks vaccine A to E assessment A – patient B – RR 35c/m, Spo2: 93 – 96%, adequate air entering on both lung fills with vascular breath sound. C- lethargic, sunken eyes, dry lips, warm extremities, CRT<2sec, pulse rate: 152b/m ( regular and full volume), skin pinch return very slowly and normal first and second heart sound. D – AVPU (A) RBS: 8.5mmol/l E – T: 37.4 C

2. LABS: MPS(thick film)- no parasite seen HB: 10.5g/dl Anthropometry: Weight: 10.5kg MUAC: 15cm Length: 84.5cm Scores: -1SD Questions What are you thinking of this child What is the hydration status of this child What is the leading cause of the hydration status of this child What is fluid of choice to be given What is the addition treatment to be consider What advice will you give to the mother

3. Dehydration By Unisa A. Kanu Final year Clinical Pediatric Student

4. Learning Objectives By the end of this lecture you should be able to know Causes of dehydration Classification of dehydration Management based on severity

5. OUTLINE Overview History Physical Examination Management

6. Overview Dehydration is a common complication of illness observed in pediatric patients presenting to the emergency department (ED). Early recognition and early intervention are important to reduce risk of progression to hypovolemic shock and end-organ failure Dehydration describes a state of negative fluid balance that may be caused by numerous disease entities

7. Overview The negative fluid balance that causes dehydration results from Decreased intake increased output (renal, gastrointestinal [GI], or insensible losses), fluid shift (ascites, effusions, and capillary leak states such as burns and sepsis). The decrease in total body water causes reductions in both the intracellular and extracellular fluid volumes. Clinical manifestations of dehydration are most closely related to intravascular volume depletion and the physiologic compensation attempts that takes place.

8. Overview As dehydration progresses, hypovolemic shock ultimately ensues, resulting in end organ failure and death. Young children are more susceptible to dehydration due to: larger body water content, renal immaturity, and inability to meet their own needs independently. Older children show signs of dehydration sooner than infants due to lower levels of extracellular fluid (ECF)

9. Overview Dehydration can be categorized according to: Osmolarity and Severity Osmolarity Isonatremic (isotonic) dehydration Hyponatremic (hypotonic) dehydration Hypernatremic (hypertonic) dehydration  Severity Mild/No Dehydration Moderate/Some Dehydration Severe Dehydration

10. History Intake of fluids, including the volume, type (hypertonic or hypotonic), and frequency Urine output, including the frequency of voiding (last wet diaper), presence of concentrated or dilute urine, hematuria Method of mixing infant formula; volume of water to powder being used Stool output, frequency of stools, stool consistency, presence of blood or mucus in stools Emesis, including frequency volume and whether bilious or nonbilious , hematemesis

11. History Contact with ill people, especially others with gastroenteritis, use of daycare Underlying illnesses, especially cystic fibrosis, diabetes mellitus, hyperthyroidism, renal disease Fever Appetite patterns Weight loss; measure of recent weight versus weight on presentation Travel Recent antibiotic use Possible ingestions

12. Physical Examination Symptom/Sign Mild Dehydration Moderate Dehydration Severe Dehydration Level of consciousness Alert Irritable or restless Lethergy or unconcious Capillary refill 2s 2-3s >3s Mucous membranes normal dry Parched, cracked Tears Normal Decreased absent Heart rate Slightly increased increased Very increased Respiratory rate/pattern Normal increased Increased and hyperpnea Blood Pressure Normal Normal, but orthostasis Decreased Pulse normal thready Faint or impalpable Skin turgor Normal Slow Tenting Fontanel Normal depressed sunken Eyes Normal Sunken (Very) Sunken Urine Output Decreased Oliguria Oliguria/anuria

13. Classification Classification Signs or Symptoms Severe dehydration Two or more of the following signs: ■ lethargy or unconsciousness ■ sunken eyes ■ unable to drink or drinks poorly ■ skin pinch goes back very slowly (≥ 2 s) Some dehydration Two or more of the following signs: ■ restlessness, irritability ■ sunken eyes ■ drinks eagerly, thirsty ■ skin pinch goes back Slowly Mild/No dehydration Not enough signs to classify as some or severe dehydration

14. Management- Severe Dehydration without SAM WHO Plan C: IV Ringer’s Lactate or Normal Saline ORS 5ml/kg/hour as soon child can drink Under 1 year Over 1 year Step 1 30mL/kg over 1 hour IV 30mL/kg over 30minutes IV Step 2 70mL/kg over 5 hours IV 70mL/kg over 2.5 hours IV

15. Management- Severe Dehydration with SAM Step 1 5mL/kg ReSoMal orally Every 30 minutes for 2 hours Step 2 5-10mL/kg ReSoMal orally Every hour for 4-10 hours If possible, alternate F75 with ReSoMal

16. Management- Some Dehydration WITHOUT SAM WHO Plan B ORS 75ml/kg over 4 hours More can be given if the child wants more Child can continue breast-feeding If the child vomits, wait 10 minutes then re-start the ORS a little more slowly If the child becomes puffy, stop ORS and encourage breast-feeding WITH SAM Step 1 5mL/kg ReSoMal orally Every 30 minutes for 2 hours Step 2 5-10mL/kg ReSoMal orally Every hour for 4-10 hours If possible, alternate F75 with ReSoMal

17. Management- No Dehydration Treat the child as an outpatient Give as much extra fluid as the child will take. Tell the mother to: – Breastfeed frequently and for longer at each feed. – If the child is exclusively breastfed, give ORS or clean water in addition to breast milk – If the child is not exclusively breastfed, give one or more of the following: ORS solution, food-based fluids (such as soup, rice water and yoghurt drinks) or clean water. It is especially important to give ORS at home when: – the child has been treated according to plan B or plan C during this visit. – the child cannot return to a clinic if the diarrhoea gets worse. Teach the mother how to mix and give ORS. Give the mother two packets of ORS to use at home. Show the mother how much fluid to give in addition to the usual fluid intake: ≤ 2 years: 50–100 ml after each loose stool ≥ 2 years: 100–200 ml after each loose stool Tell the mother to: – Give frequent small sips from a cup. – If the child vomits, wait 10 min. Then continue, but more slowly. – Continue giving extra fluid until the diarrhoea stops.

18. Additional treatments Give zinc supplements. Tell the mother how much zinc to give: ≤ 6 months: half tablet (10 mg) per day for 10–14 days ≥ 6 months: one tablet (20 mg) per day for 10–14 days Show the mother how to give zinc supplement: – For infants, dissolve the tablet in a small amount of clean water, expressed milk or ORS in a small cup or spoon. – Older children can chew the tablet or drink it dissolved in a small amount of clean water in a cup or spoon. REMIND THE MOTHER TO GIVE THE ZINC SUPPLEMENT FOR THE FULL 10–14 DAYS.

19. Additional treatments Continue feeding. Know when to return to the clinic – drinking poorly or unable to drink or breastfeed – develops a general danger sign – becomes sicker – develops a fever – has blood mixed with the stools or more than a few drops on the outside of the stool

20. Learning Objectives By now you have learnt Causes of dehydration Classification of dehydration Management based on severity

21. THE END