Fluid/Electrolyte Imbalance and GI Disease
Chapters 24 and 26
Chapter 24 Objectives
● Discuss the physiologic characteristics of infants and young children that affect
adjustments to alterations in fluid and electrolyte balance.
○ infants and young children
■ relatively greater body surface area→ larger quantities of
fluid lost through the skin
■ higher respiratory rate→ higher insensible losses from
respiratory tract
■ higher rate of metabolism→ higher fluid requirements
■ immature kidneys unable to concentrate of dilute urine→
unable to conserve or excrete sodium and also inefficient
in excreting wastes
● Identify increased and decreased demands on water balance.
○ water needed to replace insensible water losses, urine, stool
○ increased demands: fever, tachypnea, radiant warmer, vomiting, diarrhea,
diabetes insipidus, acidosis, shock, burns
○ decreased demands: heart failure, increased ICP, renal failure
● Calculate daily maintenance fluid requirements.
○ first 10 kg x 100 ml/kg
○ second 10 kg x 50 ml/kg
○ remaining kg x 20 ml/kg
● Identify and calculate normal expected urine output.
○ typically: output > input= dehydration
○ normal output: 1-2 ml/hg/hour
● Assess the degree of dehydration in infants and children.
○ very common in infants and young children; earliest sign is tachycardia
○ weight is the most important determinant of % of total body fluid loss
○ diagnostic evaluation: physical symptoms, plasma sodium concentrations,
serum bicarb concentration, electrolytes (potassium), ABG
● Recognize clinical manifestations of water intoxication and factors contributing to
, water intoxication in young children.
○ occurs less frequently than dehydration
○ may occur after ingestion of large amounts of fluid: inappropriately
prepared formula
○ decreased serum Na→ CNS symptoms: irritability, somnolence,
headache, vomiting, diarrhea, seizures
● Complete a nursing assessment and provide nursing interventions for children being
treated for fluid and electrolyte imbalances.
○ assessment: history, clinical observations (vitals, weight, skin turgor, cap.
refill, neuro/behavioral), measure Is and Os
○ oral rehydration fluid: pedialyte, infalyte
■ mild: 50 ml/kg within 4 hours
■ moderate: 100 ml/kg within 4 hours
■ replace ongoing stool losses 1:1 w/ ORS
■ give in small amounts frequently (tsp, cup, syringe, NGT)
■ continue to breastfeed
○ intravenous for severe dehydration: 40 ml/kg/hour LR
● Review the types of shock including clinical signs or shock, diagnostic evaluation,
and management.
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