Electrolyte Imbalance FAQs - Pediatric Oncall

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Electrolyte Imbalance

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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	Specialist Answers
Question Category : Electrolyte Imbalance
I am totally confused now after certain new recommendations about management of hypernatremic dehydration. We all knew that during correction of the dehydration in hypernatremic setting one has to go slow to avoid cerebral oedema as , neuronal cells make their own osmolar substances and even before the intervention in form of infusion of the fluids is done , osmlality is restored to some extent , by fluid moving in to cells .there are some recommendations that relatively hypertonic fluid ( eg half strength saline in a 2 weeks old child ) should be given to prevent cerebral oedma during correction of dehydration. While this will further increase serum sodium level to my best understanding . Can you please explain management of Hypernatremic dehydration to me? Check Out the Answer
Question Category : Electrolyte Imbalance
How do I manage normally looking children with excessive sweating of palms? Their thyroid functions normally? Check Out the Answer
Question Category : Electrolyte Imbalance
A 2 month old child was investigated for repeated convulsions which were tonic,clonic in nature,responding to IV Calcium gluconate dramatically. Sr.Calcium 5.6mg%, Sr.Magnesium 1.4mg%, Alkaline Phosphatase760iu, Hb. 7.8Gm%, Sr.Phospherous 7.1mg%, CBC Not specific, Repeated Sr.Calcium levels were below 6 mg%. CT scan and Sr.Parathormone levels not done. Treated with Iv calcium gluconate IM Magsulf.What should be the probable diagnosis? Please suggest any additional investigations. Check Out the Answer
Question Category : Electrolyte Imbalance
Dear sir I frequently come across lots of cases of diarrhea from which some of them are hypertonic dehydration. We have no investigation facility, and most of the cases will have repeated fits then died despite the following regime 1- i.v fluid 1\5 glucose saline 80ml\kg weight slow infusion in two days after combating shock to avoid rapid correction of Na level 2- Ca in drip to avoid fit 3- antibiotic cover 4- antiepileptic measures 5- no investigation in all Iraq because of the war what will you do if you are in my place. Check Out the Answer
Question Category : Electrolyte Imbalance
How to differentiate from clinical signs and symptoms, hypo, hyper or normonatremia dehydrated in diarrhea's patient without checking for their electrolyte status, and how to correct it? What kind of infuse should we use? Check Out the Answer
Question Category : Electrolyte Imbalance
What is the normal spot urine sodium potassium level in children? Check Out the Answer
Question Category : Electrolyte Imbalance
At what age can we give ORS? Check Out the Answer
Question Category : Electrolyte Imbalance
A 2 year male child had episodes of hypercarbia, the range of PCO2 was about 120 to 130 -is ventilated - lungs are not that bad but he does not breathe adequately. CNS is good if CO2 falls but if it rises he becomes drowsy. Lungs seem grossly ok . How do we make him breathe better on his own ? Does CCHS behave like this ? If so what do we do to help him - chronic ventilation is something they cannot afford. Check Out the Answer
Question Category : Electrolyte Imbalance
Please tell me how does one manage some and severe dehydration in neonates? Are there different protocols and fluids for managing them, given their electrolyte values and renal immaturity? Check Out the Answer
Question Category : Electrolyte Imbalance
What is meant by central pontine myelinosis? Q.2 What happens to Na in DKA. Please give me some information regarding corrected sodium also. Check Out the Answer
Question Category : Electrolyte Imbalance
A 3 month male child weighing 3.3 kg, was repeatedly admitted after every 7 days from the age of 2 months of life with complaints of vomiting, fits or respiratory distress. He is on exclusive mother's feed. He has been found to have persistent hyponateramia, hyperkalemia and metabolic acidosis AND was HYPOTENSIVE. His serum ACTH value was 17, OH-progesterone and plasma renin was sent after 12 hours of commencement of normal saline. results are following Serum --ACTH -----135 mg\dl (normal-46 mg/dl) , -plasma renin------0.29 mg/dl -17, OH- Progesterone ---12 mg/dl ( age adjusted < 2mg/dl) ---SERUN ANION GAP ------25 TREATMENT GIVEN: 1-I/V FLUID NORMAL SALINE FOR INITIAL two DAYS 2-TREATMENT FOR HYPERKALEMIA 3-HYROCORTISONE on stress dose(40mg/m2/day in three divided doses continued for 7days ,and was then shift to 20 mg/m2/day in divided doses) 4- FLORINEF 0.2 MG/DAY IN TWO DIVIDED DOSES. Serum CORTISOL, ALDOSTERONE TESTOSTERONE could not be sent initially due to financial constrained. Later when patient remain hyponateremic ( plasma Na ranges between 129----131mmol/l) on 0.2mg Florinef , diagnosis was re evaluated and following investigation was sent , note patient is continuously taking medication when investigation was sent ---TESTOSTERONE LEVEL---- LOW NORMAL -SERUM CORTISOL ------- LOW NORMAL -ALDOSTERONE ---REPORT AWAITED MY QUESTIONS ARE: 1- WHAT ARE THE DIFFERENTIAL DIAGNOSIS 2- WHAT IS THE FURTHER MANAGEMENT REQUIRED? Check Out the Answer

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