PAEDIATRICS

ResponseIntussusception - Recurrent episodes of severe distress, associated pallor, and red current jelly stools
Incarcerated hernia - known hernia, tender mass palpable in inguinal region
Appendicitis - Fever, rebound tenderness in RIF, Rovsings sign
Malrotation - Known midgut issue/meckels
Biliary problems - Jaundice

ResponseVomiting child without diarrhoea
<6 months age
Bilious vomiting
Past GI/surgical history (Short gut, hirschsprungs, ileostomy
Complex medical history (renal/cardiac disease)
Blood or mucous in the stool - ? inflammatory
Recurrent presentations for similar disease

ResponseAlert and responsive, Obs normal, Eyes not sunken, normal skin turgur

ResponseSigns mildly to moderately abnormal
Lethargic, irritable,
Normal - mildly increased HR, RR, Cap refil time
Normal BP, colour, warm extremities, pulses
Dry MM, sink turgur mildly decreased

ResponseSigns markedly abnormal
Reduced conscious state
Tachycardia
Increased RR, Deep acidotic breathing
Hypotension
Pale/mottled
Cold
Weak
Deeply sunken eyes/fontanelle
Dry MM
Decreased skin turgur
Marked prolognation in central cap refil time.

ResponseClinical assessment of hydration status (including signs of overload - puffy face etc.)
Current weight
Pre-morbid weight (if available)
Intake/output
Electrolytes
BSL

ResponseMetabolic alkalosis - acid loss due to vomiting
Secondary - HAGMA (ketosis)
? respiratory compensation

ResponseSmall amounts frequently
Oral rehydating solution - Gastrolyte/hydralyte
Slow: 10-20 mL/kg//h, rapid 25 mL/kg/hr
Duration ~ 4 hours
+/- ondansetron

ResponseIndication: Failed oral rehydration
Use Oral rehydration solution - Hydralyte/gastrolyte

Advantages:
Demonstrates intact gut function
More “physiologic” - allows body to balance need for fluids/electrolytes
Risk of fluid bolus with IV fluids not present with NG reehydration
Avoids negatives of IV fluids - IVC tissue etc.

Rapid rehydration - >6 months, discharge anticipated (Eg: Gastroenteritis)
10 mL/kg/h (for 4% deficit) -25 mL/kg/h (for 10% deficit) for 4 hours
Note most NG fluid pumps max out at 300 mL/h so if over this prolonged duration may be required

Responseindications:
Shock
Ongoing frequent vomiting of enteral fluids
Failure to improve despite PO/NG therapy

IV rapid rehydration - 10 mL/kg/h for 4-6 hours - 0.9% N/S + 5% glucose
Or maintenance + Deficit over 24 hours

ResponseRCH:
All children requiring IV fluids before commencing infusion
Severe dehydration, profuse or prolonged losses, altered conscious states
Inappropriate hypertonic fluids (eg: Sports drink) or hypotonic fluids (Eg: diluted formula)
Complex medical or surgical comorbidities or diuretic use

Answer:
Renal disease/diuretic use
Altered conscious state
Doughy skin (Suggesting hyponatraemia)
Home therapy with excessively hypertonic fluids “homemade solutions”
Profuse losses
Losses >24h duration
Ileostomy
Septic/toxic child
Hypoglycaemia
Any child

ResponseChildren with mild dehydration and no serious underlying cause can be discharged with advice on continuing rehydration at home
Consider a review within 48 hours for young infants - RCH
Child has normal vitals/markers of dehydration/looks well
Parental satisfaction and confidence
Time of day
Follow up and plan in place
Documentation (? - really)