A 4-year-old girl presents with her parents to the emergency room you work at. Her parents explain that the flu is going around her daycare and that their daughter began to feel sick 4 days ago. She has been unable to eat since then, with prolonged vomiting for 3 days. She is admitted to the hospital for rehydration and correction of her acid–base disturbance.

  1. Her parents are highly concerned about how she could have developed an acid–base disturbance from the flu. How do you respond to this concern by the parents?
  • The reason this 4-year-old girl developed an acid-base imbalance as a result of the flu is because she had uncontrolled vomiting for 3 days. The excess loss of hydrogen ions also known as fixed acids that occur with prolonged vomiting caused her to develop metabolic alkalosis (Grossman & Porth, 2014).
  1. Her parents tell you they tried to give their daughter a pediatric hydrating drink they found at the store, but she was unable to keep it down. They ask you in the future if this would have helped their daughter from developing an acid–base disturbance. How do you respond to this question by the parents?
  • Children require different amounts of fluids to replenish the electrolytes lost from vomiting. In deciding what kind of fluid and what amount, body weight, surface and calorie expenditure must be considered (Meyers, 2009). The amount necessary to correct deficits may vary from one child to another. Commercial drinks although able to replenish lost electrolytes during vomiting may also contain large amounts of sugars which can worsen or cause diarrhea in the already weakened child. This can potentially cause other problems and severe dehydration may require intravenous hydration rather than oral which may not be tolerated as in the case of the patient (Meyers, 2009). The use of Pedialyte which is a well-known pediatric hydrating drink for example, has shown some efficacy in cases of mild dehydration (Rao, Summers, Rao & Ramana, 2006). Ultimately the effectiveness of the store bought drink may be correlated with the degree of dehydration experienced by the child.

Reference

Grossman, S. C., & Porth, C. (2014). Porth’s pathophysiology: concepts of altered health states. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Meyers R. S. (2009). Pediatric fluid and electrolyte therapy. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG14(4), 204–211. https://doi.org/10.5863/1551-6776-14.4.204

Rao, S. S. C., Summers, R. W., Rao, G. R. S., Ramana, S., & al, e. (2006). Oral rehydration for viral gastroenteritis in adults: A randomized, controlled trial of 3 solutions. JPEN, Journal of Parenteral and Enteral Nutrition, 30(5), 433-9. Retrieved from https://search.proquest.com/docview/230235102?accountid=158399

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