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Dehydration

Author: RxPG, Posted on Wednesday, October 06 @ 18:13:08 IST by RxPG  

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Paediatrics

A 5 year old boy passed 18 loose stools in last 24 hour and vomited twice in last 4 hour. he is irritable but drinking fluids. The optimal therapy for this child is:

1. Intravenous fluids.
2. Oral rehydration therapy.
3. Intravenous fluid initially for 4 hours followed by oral fluids.
4. Plain water ad libitum.





Answer


2. Oral rehydration therapy.

Reference

OP Ghai 5th Edition Page 249,250

Park

Quality

Reader

Status

Repeat

QTDF

Ghai, Park

Discussion

Dehydration is assessed and managed as follows

1.        No Signs of Dehydration
·         Features
a.         
·         Treatment
a.        Fluids available at Home
b.        ORS packets are given for Use at Home
2.        Some dehydration
·         Features
a.         
·         Treatment
a.        Correction / Rehydration
                                                                i.      ORS 75 ml/KBW in first 4 hours
b.        Maintenance
                                                                i.      ORS 10 – 20 ml/KBW for each liquid stool
3.        Severe Dehydration
·         Features
a.         
·         Treatment
a.        IV Fluids with iv Ringer Lactate / NS (but not dextrose)
                                                                            i.      For Age less than 1 year
1.        30 ml / kg in the first hour and 70 ml /KBW in 5 hours
                                                                           ii.      For Age 1 year to 5 years
1.        30 ml / kg in the first 30 minutes and 70 ml /KBW in 2 ½ hours

Explanation

1. Intravenous fluids is needed for severe dehydration.

2. Oral rehydration therapy Is best suited for this kid.

3. Intravenous fluid initially for 4 hours followed by oral fluids is not needed.

4. Diarhoea is associated with Water as well as Electrolyte loss. Plain water ad libitum.

Comments

Management of Dehydration as well as Pneumonia are important topics (from Paediatrics as well as SPM Point of view) and AIPG 2003 had questions in both of these. First  work out a diagnosis based on the clinical findings and then from the diagnosis go to the Treatment plan

Tips

Ad libitum is a Latin Term which, in most circumstances  literally means

·         At one's pleasure;
·         as one wishes.
·         At the discretion of the performer
·         without advance preparation

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