Pediatrics 6
Management
medications: insulin (regular, NPH); glucagon (hypoglycemic emergency only) other: diet (carbohydrate counting, age-appropriate), activity levels blood glucose monitoring
Concerns: "honeymoon period" and insulin regulation, compliance, sick day management, ketones Complications:
DKA ( diabetic ketoacidosis ) or extreme hyperglycemia (blood sugar > 350 mg/dl)
etiology: not enough or no insulin findings
fruity breath, decreased level of consciousness nausea/vomiting, abdominal pain 10 percent dehydration increased urine output Kussmaul's respirations
management
fluids; control the level of serum osmolality regular insulin (IV drips and then subcutaneous) frequent monitoring of blood glucose frequent monitoring of electrolytes; neuro checks
Hypoglycemia:
etiology: most common occurrence of insulin therapy and bursts of physical activity, without additional food or with missed meals. findings
fatigue nervousness pallor sweating palpitations funger loss of coordination seizures coma
management
10 to 15 mg of simple carbohydrate followed by complex carbohydrate such as slice of bread or crackers occasionally glucagon is prescribed
Pediatric Gastrointestinal ( illustration )
Dehydration ( illustration )
Occurs when total output of fluid exceeds total intake Compared to adults, children
are less able to concentrate urine as infants, they have immature kidney and immune-regulatory systems have a higher metabolic rate have more body surface in relation to body mass because more of body weight is fluid, children need more fluid and lose more urine per Kg of body weight
Types of dehydration (serum sodium determines type)
isotonic: occurs in conditions in which electrolyte and water deficits occur in balanced proportions hypotonic: occurs in conditions in which electrolyte deficit exceeds the water deficit hypertonic: occurs in conditions in which water loss exceeds electrolyte loss
Pathophysiology
decreased fluids and electrolytes from ECF (extracellular fluid) leads to eventual loss of fluid from ICF (intracellular fluid) cellular dysfunction, shock
Complications
fluid losses: monitor urine output and specific gravity electrolyte losses: monitor sodium, potassium, chloride, calcium acid-base disturbance: metabolic acidosis
Findings of dehydratio
Management of pediatric dehydration
monitor the 4 first signs and 3 second signs of dehydration
administer fluids (oral, NG, IV)
Edema
Definition: excess fluid swells interstitial tissues Etiology
defect in homeostasis renal disease; liver disease; nephrotic syndrome starvation burns decreased colloidal oncotic (swelling) pressure
Pathophysiology: increased venous pressure - increased capillary permeability, decreased plasma proteins; contributing to the edema may be obstructed lymph flow or sodium retention
findings: pitting edema, increased heart rate
can be localized or generalized swelling pitting edema - more common with localized increased heart rate
management - treat underlying cause
Vomiting
Definition: forceful ejection of gastric contents through the mouth Etiology: infection, obstruction, allergy, psychological causes, motion sickness, neurologic lesions Pathophysiology
cause stimulates emetic center of brain mechanism of vomiting involves antonomic nervous system:
salivation, sweating pallor, increased heart rate contraction of stomach antrum & duodenum
types of vomiting: regurgitation, forceful, projectile
Management
detect and treat the underlying cause prevent dehydration, electrolyte loss and acid-base disturbance provide anti-emetic medications
