Exam 2

• What is considered mild dehydration in terms of weight?

  Loss of less than 5% in infants and 3% in children.
• What is considered moderate dehydration in terms of weight?

  Loss of 5 - 10% in infants and 3 - 6% in children.
• What is considered severe water loss in terms of weight?

  Loss of more than 10% in infants and 6% in older children.
• What is the earliest detectable sign of dehydration in pediatrics?

  Tachycardia, followed by dry skin and mucous membranes, sunken fontanels, signs of circulatory failure (coolness and mottling of extremities), loss of skin elasticity, and prolonged capillary refill time.
• What lab tests are done to assess for dehydration?

  Serum bicarbonate, plasma sodium concentrations, serum potassium.
• What lab tests are done for dehydration but are unreliable?

  Urine specific gravity and BUN.
• What treatment is given for mild to moderate dehydration?

  Oral rehydration over 4 - 6 hours.
• How much oral rehydration is given for mild dehydration?

  50 mL/kg.
• How much oral rehydration is given for moderate dehydration?

  100 mL/kg.
• How much oral rehydration is given for children suffering from diarrhea?

  10 mg/kg for each stool.
• What is the criteria for IV rehydration?

  Severe dehydration.
• What kinds of fluids are given for rehydration?

  Normal saline 0.9% or lactated ringer.
• What are the three phases of parenteral rehydration?

  Initial, replenishment, and correction.
• What happens in the initial phase or parenteral rehydration?

  Expand extracellular fluid volume quickly and improve circulatory and renal function.
• What is given during initial therapy for parenteral dehydration?

  20 mL/kg as an IV bolus over 5 - 20 minutes.
• What happens during the replenishment phase of rehydration?

  Replace deficits, meet maintenance water and electrolyte levels to catch up with ongoing losses.
• What happens during the final phase of parenteral rehydration?

  Begin oral feedings with gradual correction of total body deficits.
• Why does water intoxication cause CNS symptoms?

  Hyponatremia.
• What is the most common cause of water intoxication for children?

  Inappropriately prepared formula.
• What is it called when diarrhea involves the intestines and stomach?

  Gastroenteritis.
• What is it called when diarrhea involves the small intestines?

  Enteritis.
• What is it called when diarrhea involves the colon?

  Colitis.
• What is it called when diarrhea involves the colon and intestines?

  Enterocolitis.
• How long does diarrhea have to last to be considered chronic?

  Longer than 14 days.
• What is the leading cause of vaccine preventable diarrhea in children under 5?

  Rotavirus.
• What is the best intervention for diarrhea?

  Prevention.
• What is the criteria to be diagnosed with constipation for children?

  Fewer than 3 stools per week.
• What can be causes of constipation in children?

  Structural disorder, systemic disorders, medications, and spinal cord lesions.
• What can be done to manage constipation?

  High fiber diets, exercise, regular toileting habits after meals, stool softeners, emotional support to help the child feel in control.
• What is Hirschsprung's disease (HD)?


  Lack of innervation usually in the lower bowel that causes inadequate motility in that part of the intestine.
• Who is more likely to get HD?

  Neonates and 4 times more common in males.
• What causes the low motility in HD?

  Absence of ganglion cells in the rectum or colon.
• With HD does the internal sphincter relax not?

  Does not relax.
• Within the first 24 - 48 hours after birth, is it normal to not pass a meconium stool?

  No, this is an indication of HD.
• What are other signs aside from failure to pass meconium that indicate HD?

  Abdominal distension, bilious vomiting, failure to thrive, ribbon-like stools.
• What is the definitive way to diagnose HD?

  Rectal biopsy to detect absence of ganglion cells.
• What treatments are there for HD?

  One stage surgical treatment such as transanal pull-through or a temporary colostomy followed by removal of aganglionic section.
• How long does it take for the hypertrophied and dilated bowel to regain normal tone and size when having surgery for HD?

  3 - 4 months.
• How old will the infant be when the colostomy is closed and a pull thru is done?

  6 - 12 months old.
• What age is the peak incidence of GERD for children?

  4 months and usually resolves spontaneously by 1 year.