Dehydration (peds)

Treatment

1kg body wt = to 1 liter flluid

Oral rehydration soln should contain 60- 90 meq of Na and 2% dextrose. Can use pedialyte, rehydralyte or infalyte.

Home made solns:

- 1 litre water

- 8 teaspoons sugar

- 1 tsp salt

- can add banana or orange juice for potassium

- give Xcc q 5min

- if vomit, wait 10 min and do again

- try to achieve 50cc/kg over 3- 4 hr for mild- mod dehydration

- if diarrheal stool, add 10cc/kg extra

- for mod to severe dehydration, do 100cc/kg over 3- 4hrs

Can do ngt if refuses to take po's- 150 cc/ hr. If not vomiting can infuse faster at 25cc/kg/hr.

If fail, do IVF at 30- 40 cc/kg at minimum- replaces 3- 4% body wt

Lactobacillus from yogurt may decrease diarrhea by one day.

ABX

- avoid in entrohemorrhagic e coli

- may increase carrie state in non typhoid salmonella

- unless severe or comorbidity or <3 months old, do not tx salmonella, yersinia, aeromonas, campylobacter or c diff.

- tx shigella or vibrio

- Continue to breast feed

- Lactose intolerance rare but if intolerant will have acidic stool with>0.5% reducing substances

- BRAT ok as is complex carbs and lean meat, fruits, veg.

- BRAT has low energy and protein

Source

6/06 MISTRY