2025 – PAGE 372 – FLUIDS & ELECTROLYTES

GASTROENTERITIS

If the dehydration from gastroenteritis is mild to moderate (dry MM, tachycardic), ORS and a regular diet at home is a great choice as long as the child passes a fluid trial/challenge.

HEAT STROKE

Heat stroke is much more serious than heat exhaustion. Heat stroke results in a very HIGH temperature (> 105°F), altered mentation, hypotension and hot/dry skin. There is end organ damage from cytokine and endotoxin release. Give IVF resuscitation and ICE packs to the groin and axilla for rapid cooling.

HEAT EXHAUSTION

In heat exhaustion, the patient is sweaty. The skin is NOT DRY. There is normal mentation or mild confusion. Temperature is < 104°F. It’s kind of like finding someone at the end of a really long jog (exhausted and sweaty). There can be some overlap with heat stroke, but if there is sweaty skin and a temperature < 104°F, treat with stopping exercise, removing clothing, moving to shade, and giving cold, electrolyte-rich liquids. Give an IVF bolus if at the hospital.

ELECTROLYTES

(DOUBLE TAKE) HYPERCALCEMIA

Hypercalcemia is defined as a calcium level > 12. Hypercalcemia shortens the ST segment; therefore, it also shortens the QT interval. Polyuria occurs due to an osmotic diuresis. Patients can also get nausea, vomiting, a change in mentation, and possibly abdominal pain. Initial treatment for hypercalcemia should be IV HYDRATION. Possible etiologies include:

• ­FAMILIAL HYPOCALCIURIC HYPERCALCEMIA: The disorder is fairly benign, and there is nothing to do.
• ­WILLIAMS SYNDROME (AKA incorrectly as William’s Syndrome)
• ­VITAMIN D and VITAMIN A ingestion
• ­THIAZIDE DIURETICS
• ­SKELETAL DISORDERS: Including dysplasias, skeletal immobilization, and skeletal/body casting.
  • PEARL: For hypercalcemia due to immobilization, treat with IV fluids and loop diuretics
• ­HYPERPARATHYROIDISM
• ­MALIGNANCY
• ­MNEMONIC: “Bones, stones, abdominal groans and psychiatric moans.” This refers to the classic mnemonic used to describe the complications and associations with hypercalcemia.
  • BONES: Osteoporosis, osteomalacia, pathologic fractures, osteitis fibrosis cystica (AKA Von Reck­ling­hausen’s disease)
  • STONES: Nephrolithiasis, nephrocalcinosis and arginine vasopressin resistance (formerly known as nephrogenic diabetes insipidus).
  • ABDOMINAL GROANS: Nausea, vomiting, and constipation.
  • PSYCHIATRIC MOANS (or OVERTONES): Coma, delirium, depression, fatigue, and psychosis.