Question 15

Examples of causes of HT in: - Infants (0-1y) - Toddler/child (1-10y) - prepubertal/teen (>11Y)

- renal (RA thrombosis/stenosis, vascular), coractation, PDA - renal (disease, Stensois, tu), catecholamine (pheo, neuroblast), CAH, cushing, CS therapy, essential, incr sex hromones, hyperthyroid - renal diseas,e primry HT, any of above

Dehydration - definition - why are infants more suseptible - eti - what can cause mild or severe dehydration? - which compartment causes physical signs , shock - symp of lightad - additional symp of mod - additional symp of severe - 3 imp dx questions?

- significant depeltion of body water, and to avrying degree electrolytes - higher fluid req + inability to communicate thirst - incr fluid loss or decr fluid inatke - fever, DI - physical ECF, shock ICF --> severe hypertonic dehr might have milder signs - thirst, oliguria, dry skin, decr turgor - + oligovolemia in cir - + CNS - previous weight, intake of fluid, wet diapers/prod of urine

Fluid requirements: - young infant - toddler - adult

- 150 ml/kg (milk) - 100ml/kg -50 ml/kg

Tuberculosis - how many currently has latent infection in world? - Mycobac tb some characteristics - What is primary focus? - 2 clinical presentations? - mention some common extrapulmonary manifestations? -dx? - What is positive induration in tuberculin test?

- 2billion - G+, strictly aerobic, waxy capsule, red on ZN - site of entry + regional LN - latent (asymp) and active (symp) - peripheral LA, miliary, meningitis, skeletal - gastric washing to see /culture in children, Mantoux test (tuberculin = purified protein derivative) - >10 mm in non-vacc, >15 in vaccinated

Total body water: - Who has higest? decrease to ___ when? - % in preterm - How much does it decr 1st yr? - decr after puberty? - ECF in newborns /fetus? - Level of ECF and ICF after 1y - Why does males get higher ICF during puberty?

- fetus, newborns --> gradual decr to 75-80% in term -90% - 60% (pubertal F 50%) - larger than ICF --> decr w first postnatal diuresis - 30-40% ICF, 20-25% ECF - adult lvls -muscle growth

5 Reasons why infants/child need more fluids than adults? urinar production: - newborn - adult

1) larger TBW 2) higher surface to mass ratio (incr water loss through skin, more sens to temp) 3) higher respiratory and metabolic rate (water lost in lungs, dramatic growth 1st yr) 4) immature renal function (lower conc capacity, max urine osm newboen 400 msom /kg - >1y 1200-1400) 5) thirst sensitivity is learned behavior - dont have same sensation fo thirst as adylts - 2-4ml/kg/h - 1-2 ml/kg/h

Basal need for maintaing mtb (mantenance fluid iV) Max total fluid pr day is? and max rate?

2400 mL 100ml/h

HT in pediatrics is defined as? - major RF for? (3) - Symptomatic HT in children is usually primary or secondary? origin? - What is an important rare cause of HT in children? - mc symp in infants? -tx

BP >95% for age, gender and height - cerebral, cardiac and renal events - secondary, renal parenchymal orgin - coarctation of aorta - FTT and cardiac failure - underlying cause, lifestyle in primary, meds (ACEI, CCB, BB, diuretics)

Primary vs secondary HT? who gets it?

Primary = essential - no identifiable cause, familial inheritance, adolsecnet and adults, predispoing factors (salt, stress, obesity, genetics) Secondary - caused by ass disease - mc infant and young child - mcc: renal disease (75-80%) - esp umbilical a. catetherization of newborn --> RA thrombosis or prior UTI (25-50%)

Degree of dehydration in children

described as percentage of body weight dehydrated Mild - 3- 5% - fluid deficit infant: 50 ml/kg Moderate - 6-10% - fluid deficit infant: 100 ml/kg Severe - 9-15% - fluid deficit infant:150 ml/kg

How do you control good treatment of dehydration? and how often?

diuresis, electrolytes, blood count, glycemia, urea, cretinine, pH every 2 h

Baseline estimates for maintenance fluids are affected by 3?

fever, hypothermia, activity (inc hyperthyroid, status epileptics, decr for coma)

How do we tx tb? how long

quadruple therapy: Rifampicin, isoniazid, pyraziamide, ethambutol 6m (Q 2, R+I 4m - except R+P in adults)

Principle of treating dehydration in children? - Oral or IV? -What solution? - How quickly? - steps of tx?

Intake = basal + running losses + supplementation of deficit - -> only supplemntation = rehydration , rest is to tx dehydr - Oral if poss (mild-mod), iV if severe - WHO solution, if hypoperiosn = isotonic (saline, Ringer), -50-100 ml/kg/4-6h and later + 100 ml/kg/d (Infants) Steps 1) fluid resuscitation - hypoperfusion --> restore circ + HR - should reduce deficit to<8% - isotonic (saline-ringer) 2) deficit replacement - deficit should only be 8% BW --> remianing replaced over period of 8 h (10ml/kg/h) - 0.45% saline good choice 3) ongoing loss - measured direct (stool amount, catheter) or estimated (10ml/kg per diarrheal stool) 4) maintenance (fluid req for basal mtb) -use Holliday segar formula (tabell) + Na 30 , K 20 all groups