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  #1  
Old 08-04-2013
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Default Peds question #6

An 8 month old infant arrives tot he ED with a 2 day history of diarrhea and poor fluid intake. Your quick examination reveals a lethargic child with sunken fontanelle, his heart rate is 187 beats per minute, his RR is 32 bpm, BP is 60/40. He has poor skin turgor, 6 second capillary refill and cool extremities. Which of the following is the most appropriate INITIAL step for his acute condition?
A. Dextrose 5% in 1/4 normal saline
B. Dextrose 5% in 1/2 normal saline.
C. Normal saline 20 ml/kg fluid bolus + 20 mEq/L K+
D. Normal Saline 20 ml/kg fluid bolus.
E. Whole blood transfusion.
F. Dextrose 10% in water.



With your answer please explain WHY you are giving the particular fluid and the way it will fix the child's condition
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Old 08-04-2013
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Originally Posted by XpaezX View Post
An 8 month old infant arrives tot he ED with a 2 day history of diarrhea and poor fluid intake. Your quick examination reveals a lethargic child with sunken fontanelle, his heart rate is 187 beats per minute, his RR is 32 bpm, BP is 60/40. He has poor skin turgor, 6 second capillary refill and cool extremities. Which of the following is the most appropriate INITIAL step for his acute condition?
A. Dextrose 5% in 1/4 normal saline
B. Dextrose 5% in 1/2 normal saline.
C. Normal saline 20 ml/kg fluid bolus + 20 mEq/L K+
D. Normal Saline 20 ml/kg fluid bolus.
E. Whole blood transfusion.
F. Dextrose 10% in water.



With your answer please explain WHY you are giving the particular fluid and the way it will fix the child's condition

Ans : C , becoz K+ is lost in diarrhea and i think dextrose reduces absorption of other salts but sugar and salt combination is always as ORS for diarrhea ...

have not started with peds and feel dumb solving these Qs ...
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Old 08-04-2013
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[QUOTE=XpaezX;206845]An 8 month old infant arrives tot he ED with a 2 day history of diarrhea and poor fluid intake. Your quick examination reveals a lethargic child with sunken fontanelle, his heart rate is 187 beats per minute, his RR is 32 bpm, BP is 60/40. He has poor skin turgor, 6 second capillary refill and cool extremities. Which of the following is the most appropriate INITIAL step for his acute condition?
A. Dextrose 5% in 1/4 normal saline
B. Dextrose 5% in 1/2 normal saline.
C. Normal saline 20 ml/kg fluid bolus + 20 mEq/L K+
D. Normal Saline 20 ml/kg fluid bolus.
E. Whole blood transfusion.
F. Dextrose 10% in water.



First Eliminating the obvious wrong ( or what I think is definitly wrong) A, B, E and D. Between C and D, I think C makes more sense since K is lost in diarrhea and the infant seems to be deteriorating into a hypotensive shock. Correcting just the hypotension may leave room for a K deficiency cause arrhythmias and such..

So , yeh C would be my choice.
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Old 08-04-2013
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Default long time ahhh

hey guys

happy to see some movement in the step 3 forum...

I think its D= NS is the best fluid to start with given a very low BP. I would just hold back K+ for now. Its true that K+ is lost in diarrhea but that does not justify giving K+ in first place and the standard books do not mention giving K+ with NS as the initial treatment of Hypotension secondary to diarrhea. It might be needed in due course while the child undergoes treatment, depending on the serum K+ levels...
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Matched!!!
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Old 08-04-2013
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I would say C too...i agree with all of his explanation....
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Old 08-04-2013
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The correct answer is D.

This child is showing manifestations of severe dehydration, here the only way to actually help him is to admit and start IV fluids. The fluid of choice is NS 0.9%, given at a standard dose of 20 ml/kg.
Potassium is never replenished until you have the first set of electrolytes, which in the emergency care setting can be quickly obtained via ABG, (the same applies for DKA, you never add K+ unless it is normal or low normal in the first labs).

half normal saline and dextrose are never used during the initial resuscitation of hypovolemia, both in children and adults.

Anomali and Charos are correct
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Old 08-04-2013
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hmmm good one xpaezX....I should've thought further into it....Exhaustion is catching up lol
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Old 08-04-2013
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Originally Posted by XpaezX View Post
The correct answer is D.

This child is showing manifestations of severe dehydration, here the only way to actually help him is to admit and start IV fluids. The fluid of choice is NS 0.9%, given at a standard dose of 20 ml/kg.
Potassium is never replenished until you have the first set of electrolytes, which in the emergency care setting can be quickly obtained via ABG, (the same applies for DKA, you never add K+ unless it is normal or low normal in the first labs).

half normal saline and dextrose are never used during the initial resuscitation of hypovolemia, both in children and adults.

Anomali and Charos are correct

Thanks XpaezX! Overthinking a question always screws things up for me
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Old 08-05-2013
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Thanks XpaezX! Overthinking a question always screws things up for me
Yes overthinking most of the time is a bad thing :s that happens to me a lot and I mean A LOT of time! but thats why if you keep doing questions your brain will be trained to chill and just get the correct answer!
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