Download Free Medical Dehydration PowerPoint Presentation

Dehydration PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Dehydration, which is titled "Dehydration", to know about dehydration, the causes of dehydration, the clinical manifestaions of dehydration, the investigations required, and the management of dehydration.

Tags : Dehydration, causes, clinical manifestaions, management

Published on : Jul 07, 2021 | Views : 5747 | Downloads : 55

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

DEHYDRATION Dr Nadeem Zubairi
Slide 2-

Dehydration 2 million infants and children die every year in the developing countries
Slide 3-

Case Study-- Basim is 4 years old and his brother, Ahmad, is 5 months old. Both children are brought to the clinic by their mother because of diarrhea and fever of 4 days duration. Basim has also vomited thrice.Doctor assesses the children and determines that Basim is severely dehydrated but Ahmad is only mildly dehydrated. Basim`s serum sodium is 170 mEq/L while that of Ahmad is 142 mEq/L
Slide 4-

Case Study- AbdulAziz is a 40 days old first born child who is having vomiting since second week of life. He tends to vomit almost all of the milk taken immediately after the feed and gets hungry again. Examination reveals that he is moderately dehydrated and there is an olive size mass in epigastric region. CBC is unremarkable. Electrolytes: Na 131, K 3.0, Cl 95, bicarb 32. PH 7.45.
Slide 5-

AbdulRahman,A 14-year-old male is brought to the Emergency Department via ambulance with a report of the patient being found unresponsive. He is a known case of Type 1 DM and is on Insulin since last 7 years. Lately he was running fever and mother is not sure about regularity of doses during this illness. On examination AbdulRahman has altered consciousness level, acidotic breathing and has severe dehydration. Labs: TLC……… high Sugar……402 mg/dl PH……… 7.15 Ketone bodies ++++ Case Study-
Slide 6-

Case Study- Rehana is a 5 year old child who had 60% burns following spillage of boiling water on trunk and lower limbs 02 days back. She is in the hospital. Lately she is febrile, intake is less, tongue is dry. Her urine output is less and she is hypotensive.
Slide 7-

WHAT IS COMMON IN ALL ? DEHYDRATION
Slide 8-

OBJECTIVES At the end of this lecture you will able to know the followings: *What is dehydration? *What are the causes of dehydration? *The clinical manifestaions of dehydration. *The investigations required. *Management of dehydration.
Slide 9-

Distribution of Body Water Intravascular Interstitial Intracellular ICF ECF Na+ K+ Cl-
Slide 10-

Fluid composition varies at different ages
Slide 11-

ppt slide no 11 content not found
Slide 12-

% of Water in the Body
Slide 13-

Fluid Maintenance Body Wt Fluid per day 0 – 10 kg 100 ml/kg 11 -20 kg 50 ml/kg 20 kg 20ml/kg
Slide 14-

e.g. a child of 25kg First 10 kg = 1000 ml Second 10 kg = 500 ml Remaining 5 kg = 20 ml Total = 1700 ml/ pay i.e. per hr = 70 ml/ hr
Slide 15-

Fluid Losses in Infants LUNGS URINE, FECES SKIN
Slide 16-

Differences between children & adults Surface Area (BSA) Metabolic Rate Kidney Function Fluid Requirements
Slide 17-

Reasons why infants & children are at > risk for developing fluid & electrolyte imbalance Increased % of body weight is H2O Large volume of ECF Increased BSA (insensible loss) Increased Metabolic rate Immature Kidneys
Slide 18-

Dehydration is a condition that can occur with excess loss of water and other body fluids. Dehydration results from decreased intake, increased output (renal, gastrointestinal or insensible losses), a shift of fluid (e.g. ascites, effusions), or capillary leak of fluid (e.g. burns and sepsis).
Slide 19-

CAUSES OF DEHYDRATION
Slide 20-

Conditions causing Fluid Imbalances Phototherapy Increased RR Fever Vomiting Diarrhea *(Gastroenteritis)* Drainage tubes, blood loss Burns
Slide 21-

Diarrhea Metabolic Acidosis loss of HCO3 from G.I. Tract pH HCO3 Treatment: Correct base defecit, replace losses of with NaHCO3
Slide 22-

Vomiting Metabolic Alkalosis Loss of acid from stomach pH HCO3 H+ Treatment: Prevent further losses and replace lost electrolytes Example: Pyloric Stenosis
Slide 23-

Heat stroke
Slide 24-

Fever Each degree of fever increases basal metabolic rate (BMR) by 10%, with a corresponding fluid requirement
Slide 25-

Phototherapy Infant under phototherapy. Note that the eyes are shielded and a diaper is used to contain the diarrheal stools. Copyright © 1999, Mosby, Inc.
Slide 26-

Mouth ulcers, stomatitis, pharyngitis, tonsillitis: pain may severely limit oral intake
Slide 27-

Burns Fluid loss is 5-10 X greater than from undamaged skin Abnormal exchange of electrolytes between cells and interstitial fluid
Slide 28-

Burns: fluid losses may be extreme and require aggressive fluid management
Slide 29-

Diabetic ketoacidosis (DKA) .
Slide 30-

Congenital adrenal hyperplasia: may have associated hypoglycaemia, hypotension, hyperkalaemia, and hyponatraemia.
Slide 31-

Cystic fibrosis: excessive sodium and chloride losses in sweat. Diabetes insipidus: excessive output of very dilute urine. Thyrotoxicosis: increased insensible losses and diarrhoea.
Slide 32-

Drainage Tubes/ Blood loss
Slide 33-

ASSESSING DEHYDRATION IN CHILDREN
Slide 34-

Manifestations of ECF Deficit (Dehydration) S & S Weight loss Blood pressure drop Delayed capillary refill Oliguria Sunken fontanel Decreased skin turgor Physiologic Basis Decreased fluid vol. Inadequate circ. Blood Decreased vascular volume Inadequate kidney circ. Decreased fluid volume Decreased interstitial fluid
Slide 35-

Degree of Dehydration Mild dehydration (3-5%) Moderate dehydration (6-10%) Severe dehydration (10-15%)
Slide 36-

ppt slide no 36 content not found
Slide 37-

ppt slide no 37 content not found
Slide 38-

Earliest Detectable Signs Tachycardia Dry skin and mucous membranes Sunken fontanels Circulatory Failure (coolness, mottling of extremities) Loss of skin elasticity Delayed cap refill
Slide 39-

Skin turgor is assessed by pinching the skin of the abdomen or thigh longitudinally between the thumb and the bent forefinger. The sign is unreliable in obese or severely malnourished children. Normal: skin fold retracts immediately. Mild or moderate dehydration: slow; skin fold visible for less than 2 seconds.
Slide 40-

Mild or moderate dehydration: slow; skin fold visible for less than 2 seconds. Severe dehydration: very slow; skin fold visible for longer than 2 seconds. Other features of dehydration include dry mucous membranes, reduced tears and decreased urine output. Additional signs of severe dehydration include circulatory collapse (e.g. weak rapid pulse, cool or blue extremities, hypotension), rapid breathing, sunken anterior fontanels
Slide 41-

ppt slide no 41 content not found
Slide 42-

Loss of Skin Elasticity due to dehydration is not a reliable sign in malnourished children
Slide 43-

What is considered oliguria in an infant or child? <1ml/kg/hr
Slide 44-

How would you measure U.O. for a child who is not toilet trained? Weigh diaper 1 gram = 1 cc
Slide 45-

TYPES OF DEHYDRATION
Slide 46-

Dehydration = Total Out > Total In Types: Isotonic Electrolyte = Water Hypotonic Electrolyte > Water Hypertonic Water > Electrolyte
Slide 47-

The most common type of dehydration in children is….. Isotonic
Slide 48-

Hypernatremic dehydration Dehydration, characterized by increased concentrations of sodium and chloride in the extracellular fluid, it results from diarrhea in infants. The occurrence of the hypernatremia and hyperchloremia lies in the relatively greater expenditure of water than electrolyte via skin, lungs, stool and urine. The water deficit in these infants is primarily intracellular. The majority of infants with this type of dehydration show varying degrees of depression of central nervous system varying from lethargy to coma. Convulsions are frequently observed. Dilute solutions of electrolyte are indicated in rehydration. Rapid adjustment, however, appears to accentuate the CNS disturbance. Rehydration is best carried out slowly over a 2- to 3-day period.
Slide 49-

HYPERNATREMIC DEHYDRATION Major danger due to condition: Brain hemorrhage...shrinkage of brain leading to tearing of vessels Major danger due to treatment: Brain edema due to movement of water into the brain cells. Occurs if treatment is too rapid
Slide 50-

What lab tests provide useful information when the concern is dehydration? Usually no tests are needed if child is clinically stable CBC, Urea Electrolytes, Blood gases Stool RE and C/S
Slide 51-

MANAGEMENT OF DEHYDRATION
Slide 52-

Management of Mild to Moderate Dehydration Oral Rehydration Pedialyte Infalyte Rehydralate Rules regarding rehydration 50-100ml/kg within 4 hours
Slide 53-

Home Management
Slide 54-

Oral Rehydration Oral fluids commonly given to children when sick: Apple juice (low Na, High K) Coke (Low Na, Low K, High sugar) Pepsi (Na—little better than Coke, no K) 7-Up (sugar, small Na, no K) Gatorade (high Na, sugar) Grape juice (low Na, high K) Orange juice (low Na, High K) Milk (has Na, K, Cl, HCO3)
Slide 55-

ORAL REHYDRATION SOLUTION (ORS)
Slide 56-

ppt slide no 56 content not found
Slide 57-

ORS Developed 1940s in Dhaka Bangladesh
Slide 58-

ORS Most important medical discovery of the 20th century
Slide 59-

ORS 5 million deaths / year After ORS 2 million deaths / year
Slide 60-

ORS components WHO/UNICEF Na = 90 mmol/l k = 20 mmlo/l cl = 80 mmol/l glucose = 111mmol/l Osmol = 311 mmol/l
Slide 61-

WHO vs. Hypo-osmolar ORS WHO/UNICEF Hypo-osmolar Na = 90 mmol/l Na = 60 mmol/l k = 20 mmlo/l k = 20 mmlo/l cl = 80 mmol/l cl = 50 mmol/l glucose = 111mmol/l glucose = 84 mmol/l Osmol = 311 mmol/l Osmol = 224 mmol/l
Slide 62-

Hypo-osmolar ORS Many studies support the use of reduced osmolarity ORS but the debate is not resolved. It is preferred in severely malnourished (marasmic) child as the standard (old) WHO ORS may cause hypernatremia
Slide 63-

ORT vs. I/V Therapy ORT is as effective as I/V fluid for rehydration of moderately dehydrated children due to G/E in the E/D. ORT Demonstrated no inferiority for successful rehydration at 4 hours and hospitalization rate. A randomized controlled trial by P Spandorfer et al Pediatrics Feb.2005
Slide 64-

ORT vs. I/V Therapy Although no clinically important differences between ORT and IVT, the ORT group did have a higher rate of paralytic ileus, and the IVT group exposed to risk of intravenous therapy. For every 25 children treated with ORT one fail and require IVT L Hartlig The Cochrane Database of Systematic Reviews 2006 Issue 4
Slide 65-

Reluctance to use ORT ?
Slide 66-

Reluctance to use ORT People do not consider ORT high-tech enough. Physicians prefer I/V fluids. It takes time to educate parents re ORT. Time consuming for busy parents.
Slide 67-

Moderate to Severe Dehydration Management
Slide 68-

Goals of IV Therapy Expand ECF volume and improve circulatory and renal function (Isotonic solution .9%NS,LR, D5W) K+ after kidney function is assessed Begin oral feedings
Slide 69-

MANAGEMENT OF DEHYDRATION -Replace Phase 1: Acute Resuscitation : Give Lactated Ringer OR Normal Saline at 10-20 ml/kg IV over 30-60 minutes. May repeat bolus until circulation stable -Calculate 24 hour maintenance requirements Formula: First 10 kg: (100 cc/kg/24 hours) Second 10 kg: (50 cc/kg/24 hours) Remainder: (20 cc/kg/24 hours) Example: 35 Kilogram Child Daily: 1000 cc + 500 cc + 300 cc = 1800 cc/day -Calculate Deficit: Mild Dehydration: (40 ml/kg) Moderate Dehydration: (80 ml/kg) Severe Dehydration: (120 ml/kg)
Slide 70-

MANAGEMENT Continue --------- -Calculate remaining deficit: Substract fluid resuscitation given in Phase 1 -Calculate Replacement over 24 hours: First 8 hours: 50% Deficit + Maintenance Next 16 hours: 50% Deficit + Maintenance Determine Serum Sodium Concentration Hypertonic Dehydration (Serum Sodium > 150) Isotonic Dehydration Hypotonic Dehydration (Serum Sodium < 130) Add Potassium to Intravenous Fluids after patient voids urine Potassium source Potassium Chloride Potassium Acetate for Metabolic Acidosis Potassium dosing Weight <10 kilograms: 10 meq KCl /liter glucose Weight >10 Kilograms: 20 meq KCl /liter glucose
Slide 71-

Table of Commonly Used IV Solutions
Slide 72-

Lactated Ringer’’s (RL): Isotonic, 273 mOsm/L. Contains 130 mEq/L Na+, 109 mEq/L Cl--, 2mEq/L lactate, and 4 mEq/L K+. Lactate is used instead of bicarb because it’’s more stable in IVF during storage. Lactate is converted readily to bicarb by the liver. Has minimal effects on normal body fluid composition and pH. More closely resembles the electrolyte composition of normal blood serum. Does not provide calories. Contra-indication: Pyloric stenosis(metabolic alk)
Slide 73-

Why is it necessary to use a pump or other volume control when infusing Ivs into children? Avoid overload Specifically monitor input
Slide 74-

When to resume normal diet?
Slide 75-

Special Considerations Antibiotics Anti- emetics Anti-diarrheal agents Antimotility drugs, slow intestinal transit but have little effect on the total stool volume and may have serous side effect including ileus. They are not advised for infants or children
Slide 76-

Case Study-- Basim is 4 years old and his brother, Ahmad, is 5 months old. Both children are brought to the clinic by their mother because of diarrhea and fever of 4 days duration. Basim has also vomited thrice.Doctor assesses the children and determines that Basim is severely dehydrated but Ahmad is only mildly dehydrated. Basim`s serum sodium is 170 mEq/L while that of Ahmad is 142 mEq/L
Slide 77-

Ahmad….. Mild dehydration Weight….. 7 kgs Isonatremic ORS Basim……. Severely dehydrated Weight……. 15 kgs Hypernatremic Total deficit: 15 X 100-120=1500- 1800 ml Type of fluid:0.45% Normal Saline Duration of therapy:48 to 72 hours Frequent check
Slide 78-

ppt slide no 78 content not found