Fluid Replacement Therapy (FTP) in Children: Diagnosis

by Brian Alverson, MD

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    00:01 So if we see a child with dehydration, it’s indicated to get a Chem-7, especially for severe dehydration because we’re concerned about imbalance of electrolytes.

    00:15 And the electrolyte that gets children in trouble the most is actually sodium.

    00:21 It is not necessary to get a Chem-7 for a child who has mild dehydration unless you have other concerns about the child.

    00:29 Because those children, once their fluids have been replenished, will normalize their Chem-7.

    00:35 So this is how a Chem-7 on your slide here is organized when we draw it out shorthand on a piece of paper.

    00:42 Sodium, potassium, chloride, bicarb, BUN and creatinine, and glucose.

    00:47 Let’s go through some examples.

    00:50 Here are normal values for your Chem-7.

    00:53 The sodium is 140, the potassium is around 3.8.

    00:57 In this child, the chloride is normal at 110, and a normal bicarb is 24.

    01:02 That 24 and that 140 are usually fairly carefully constricted at that normal value.

    01:10 The next numbers, the 5 and 0.2, are the BUN and creatinine.

    01:13 Those will herald signs of dehydration if the BUN is very high.

    01:18 But the creatinine will remain normal unless the child is in renal failure or very severely dehydrated.

    01:25 Glucose may be not so important in adults, but in children, it’s critical.

    01:30 Because young children, when they get dehydrated, often get hypoglycemic.

    01:35 This is because children’s liver stores of glycogen are much smaller than adults.

    01:42 That means that without being fed for a period of time, they’re at much more risk for hypoglycemia and potentially even seizure from a prolonged period of dehydration.

    01:54 So here’s what a mild dehydration may look like.

    01:58 You can see our patient’s sodium, potassium, chloride and bicarb are all doing okay.

    02:04 The BUN has started coming up a little bit and you can see the glucose has come down to 70, starting to drift down.

    02:11 You might even see a slightly low bicarbonate, 19 or 20 wouldn’t be surprising.

    02:17 But those are the key things that you’re going to see first.

    02:20 Here’s a child with moderate dehydration.

    02:23 The sodium is starting to creep up.

    02:25 In this case, this child is just not drinking.

    02:28 If the child were eating, say some liquid, but losing more liquid than she were drinking, that child might have a low sodium even in the face of dehydration.

    02:40 You can see that now, the child’s bicarbonate is low.

    02:45 It’s significantly acidotic all the way down to 13.

    02:49 And the chloride is starting to creep up as a compensatory method.

    02:54 But there’s something special about this that we have to note and it has to do with the sodium, the chloride and the bicarb.

    03:01 Remember your equation for calculating a gap.

    03:05 In this case, this child has large anion gap, which is a sign that this child is also having a metabolic acidosis.

    03:14 I’m guessing this child either has ketones or this child has lactic acidosis, which might be driving that gap.

    03:22 Again, the BUN is coming up and now the creatinine is coming up and look how low that glucose is getting.

    03:27 Not surprising at all for a child with moderate dehydration.

    03:31 So all these numbers are starting to become pretty significant and the anion gap is 20, 145 minus 112 minus 13.

    03:42 In severe dehydration, now we’re really getting into trouble.

    03:46 This child’s sodium is still high.

    03:48 It might get much higher and we have to do some very fancy calculations to fix.

    03:53 But of note, the chloride’s coming up.

    03:56 The bicarb’s coming way down and the BUN and creatinine are significantly elevated.

    04:00 Look how hypoglycemic this child is.

    04:02 You can see how this will happen

    About the Lecture

    The lecture Fluid Replacement Therapy (FTP) in Children: Diagnosis by Brian Alverson, MD is from the course Pediatric Gastroenterology.

    Included Quiz Questions

    1. Hypoglycemia
    2. Transaminitis
    3. Metabolic alkalosis
    4. Hypokalemia
    5. Hyperkalemia
    1. Sodium, potassium, bicarbonate, chloride, BUN, creatinine, and glucose
    2. Sodium, potassium, bicarbonate, chloride, BUN, creatinine, and pH
    3. Sodium, phosphate, bicarbonate, chloride, BUN, creatinine, and glucose
    4. Sodium, potassium, bicarbonate, magnessium, BUN, creatinine, and glucose
    5. Sodium, potassium, bicarbonate, chloride, urea, creatinine, and glucose

    Author of lecture Fluid Replacement Therapy (FTP) in Children: Diagnosis

     Brian Alverson, MD

    Brian Alverson, MD

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