Lecture 15 - Pediatric Topics

• Fluid Management in Infants and Children:
• Developmental factors:

  • Higher proportion of total body water composition at birth, slowly decreasing to 60% by one year
  • Adult rates are 50-60%
  • Greater proportion of fluid in extracellular spaces, with newborns having 45% compared to adults' 20%
  • Increased Vd for water-soluble drugs
  • Increased insensible water losses through skin and respiratory tract
• Higher metabolic rate due to growth and development

  • Newborns lose weight after birth and gradually increase back to birth weight by day 14
  • Weight doubles in the first 4-5 months and triples by 1 year
  • Immature kidneys and homeostatic regulation systems
  • Inability to shiver or sweat to control temperature
• Disease states factors:

  • Many disease states or chronic conditions can lead to dehydration, more serious in hospitalized patients
  • Examples include septic shock, burn patients, asthma or respiratory conditions, GI disorders, and hypermetabolic states
• Phases of fluid management:

  • Maintenance fluids
  • Ongoing losses
  • Replacement fluids
  • Dehydration prior to medical care
  • Deficit fluids
• Maintenance fluids requirement:

  • Calculation based on body weight using the Holliday-Segar Method
  • Sample calculation provided for a patient weighing 27 kg
• Replacement fluids:

  • Fluid needs due to losses prior to medical care
  • Signs of dehydration include weight loss, increased thirst, dry mucous membranes, decreased urine output, and significant diarrhea
  • Classification of dehydration into mild, moderate, and severe based on various parameters
• Management of dehydration:

  • Differentiation between mild to moderate and moderate to severe cases
  • Various treatment options including oral therapy, IV boluses, and specific fluid formulations based on the type of dehydration
• Nutrient Deficiencies in Pediatrics:
• Growth and development:

  • Monitoring growth charts and measurements in the first 5 years of life
  • Deviations from norm due to various factors like abnormal rate, chronic diseases, endocrine/metabolic disorders, and nutrient deficiencies
• Nutrient deficiencies:

  • Information on Vitamin A, B12, C, D, E, Folate, and K including sources, deficiencies, and formulations for treatment
• Teething Pain Management in Infants:
• Teething pain:

  • Overview of teething process and common symptoms in infants
  • Non-pharmacological options like teething rings, cold washcloths, and dietary precautions
  • Pharmaceutical options including acetaminophen and ibuprofen with recommended doses
  • Caution against using benzocaine due to the risk of methemoglobinemia in infants and children
• Orajel has labeling for

  - 2 - 12 years of age
• Baby orajel


  - discontinued and did not contain benzocaine
• How do you treat sudden cyanosis and hypoxemia?

  - methylene blue and/or ascorbic acid
• Benzocaine can cause a risk of

  - methemoglobinemia

  - sudden cyanosis

  - hypoxemia
• Management of teething pain (pharmacologic)

  - benzocaine (orajel)
• Ibuprofen recommended dose

  - 10 mg/kg/dose every 6 - 8 hours
• Ibuprofen concentration (infants vs children)

  - infant = 50mg/1.25ml

  - children = 100mg/5ml
• Acetaminophen dosing


  - 10-15mg/kg q4-6h
• Acetaminophen concentration


  - 160mg/5mL
• Ibuprofen not recommended for


  - under 6 months of age
• Acetaminophen not recommended for

  - under 2 years of age
• Are dietary options safe for under 2 years of age?

  NO

  - food = choking

  - honey = not given to less than 1 year of age
• Caution for teething rings

  - should be refrigerated (not frozen)

  - should not be sterilized in boiling water or dishwater
• What is the best way to manage teething pain?

  Non-pharm

  - teething rings or cold washcloths
• Vitamin K deficiency causes, name, and formulation

  Phytonadione

  - coagulation cascade

  - oral, IV, IM, SQ
• Folate deficiency

  - anemia
• Vitamin E deficiency causes and name

  Tocopherol

  - lack of antioxidants

  - nerve damage
• Vitamin D deficiency causes, name and formulation

  Cholecalciferol

  - rickets

  - oral
• Vitamin C deficiency causes and name

  Ascorbic Acid

  - skin, oral and musculoskeletal problems

  - SCURVY
• Vitamin B12 deficiency causes and name

  Cyanocobalamin -> MAIN

  - muscle weakness

  - anemia

  - intestinal problems

  - nerve damage
• Vitamin A deficiency causes and name

  Retinol

  - vision impairment

  - immune system problems
• How is deficit fluids usually replaced?

  - NS or LR
• For moderate to severe dehydration, how do you manage?

  - most = isonatremic dehydration

  - next = hypernatremic dehydration

  - least = hyponatremic dehydration
• For mild to moderate dehydration, how do you manage it?

  - oral therapy or IV bolus (10-20 ml/kg)

  - pedialyte
• 1 kg weight loss =

  1 L of fluid loss
• Classification of dehydration (severe)

  - sunken fontanelle

  - capillary refill = > 8 seconds
• Classification of dehydration (moderate)

  - reduced fontanelle

  - capillary refill = > 5 seconds