As we mention above there was a high incidence of malaria and severe anaemia in this population.This study has a couple of weaknesses preventing generalisability or application to our paediatric population and it certainly hasn’t changed my practice: In the resource-limited setting, fluid bolus significantly increased mortality of children with severe febrile illness and impaired perfusion. □ Halfway protocol change alert! Increased to 40ml/kg and 60ml/kg when preliminary results were showing no differenceĤ8 hr mortality significantly worse in bolus groups vs control: 6% (Albumin) vs 10.5% (Saline) vs 7.3% control With severe hypotension: 40ml/kg normal saline or 5% albumin.Without severe hypotension: 20ml/kg normal saline or 5% albumin.Key exclusions: gastroenteritis, non-infectious causes impaired consciousness and/or respiratory distress.P: Children 60d – 12y with (all three of): Replace deficit in addition to ongoing maintenance fluids over 24 to 48 hours.Our strategy for fluid replacement can be summarised as follows: The ACEM Part 2 exam is typically riddled with paediatric fluid calculation MCQs… which is why it’s good to nail down a quick strategy to answering questions that won’t cause you too much of a headache during the exam when you’re already under pressure.It is an evolving area of medical research and as such there can be a lack of consistency in the guidelines across states, hospitals and sometimes departments.It’s true what they say: kids have brains like a sponge… excessive or incorrect fluid administration (and subsequent hyponatramia) can lead to cerebral oedema, seizures and death.it has associated benefits, side effects, indications, contraindications and complications). The resident hasn’t had much paediatric experience and asks you to instruct them how best to tackle ongoing rehydration. On your assessment, the child is unwell, but not shocked, so you ask the resident to commence IV benzylpenicillin 60 mg/kg and IV gentamicin 7.5 mg/kg and IV fluids. They have a RR 30, SBP 100, HR 150, & CRT 2 seconds centrally. On exam, the child is alert but miserable, flushed, with dry oral mucosa. Bedside urine confirms leukocytes, nitrates, blood and ketones. They have been vomiting continuously despite 4 mg of ondansetron. I know this is a big big ask, however any guidance, especially with what formulas to begin with would be greatly appreciated.You’re on night shift and your short stay resident is concerned that their 3 year-old patient has pyelonephritis. This is my own project, not that of my employers. Pediatric Maintenance Fluid is based on weight in kg: Here is an table to hopefully illustrate what I'm mean: I want a sheet in which a clinician can input a weight, and a blood sugar and then the amount of maintenance fluid per solution is calculated automatically based on those to variables inputted manually by the clinician. The total maintenance dose (amount of IV fluid given per hour) changes between two types of solutions on an hourly basis dependent upon the changing blood sugar. I can to create a sheet to assist hospital clinicians in accurately calculating the total dose of fluids to give a pediatric patient in diabetic ketoacidosis (DKA).
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