Council on Medical Student Education in Pediatrics

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COMSEP Clinical Cases

FLUID AND ELECTROLYTE MANAGEMENT

  1. A six-year-old girl admitted for elective surgery and she is made NPO. She weighs 21 kg and is 135 cm. tall. Write the orders for her IV fluids prior to surgery. Click here to view the Teacher's Guide for this case
  2. A two-year-old has sustained a severe closed head injury and is comatose. He weights 14 kg. What factors need to be considered when calculating his daily water requirements? How will you follow this patient's clinical course to adjust fluids appropriately? Click here to view the Teacher's Guide for this case
  3. A seven-month-old infant has had fever, vomiting and diarrhea for the past 24 hours. What are the symptoms and physical findings to help you decide if the infant is dehydrated?
  4. An infant weighing 8 kg is estimated to be 12% dehydrated. What fluids should you start initially? What laboratory tests should be ordered immediately? What is the calculated fluid deficit and how should it be replaced? What IV solution(s) should be used? Click here to view the Teacher's Guide for this case
  5. A two-month-old infant is brought to the Emergency Department because of seizures. He has had diarrhea for five days and has been fed only water and diluted apple juice. What might be the cause of the seizures and how should they be treated? Click here to view the Teacher's Guide for this case
  6. A nine-month-old infant has diarrhea and signs of moderate dehydration. His electrolytes are Na+ 162, K+ 5.6, Cl- 122, and bicarbonate 12. During IV rehydration the patient has a generalized seizure. What is the probable cause of the seizure? How should it be treated? How could this complication have been avoided? Click here to view the Teacher's Guide for this case
  7. A nine-month-old infant has vomiting and diarrhea. He has dry mucous membranes and decreased tearing and urination. After your assessment, you would like to try oral rehydration. What liquids, what quantity, and how often should the mother give the fluids to the infant? Click here to view the Teacher's Guide for this case
  8. A nine-year-old child with diabetic ketoacidosis has the following electrolytes: Na+ 132, K+ 5.4, Cl- 103 and Bicarb 9. What is the anion gap? As the fluid deficit is corrected what is likely to happen for the serum K? How should this be managed? Click here to view the Teacher's Guide for this case
  9. A nine-month-old girl present with two days of vomiting and diarrhea. She is listless and her heart rate is 210. What is the most appropriate initial management of this child? Click here to view the Teacher's Guide for this case

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