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VAQ 7 week old

VAQ 7 week old . The one with the high sodium….

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VAQ 7 week old

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  1. VAQ 7 week old The one with the high sodium…

  2. A 7 week old baby is brought in by his parents concerned about the child being very lethargic. On examination the child is floppy and pale, PR 170, RR 50, sats 98% on RA, capillary return 3 seconds, and has a markedly sunken fontanelle. A capillary blood gas is performed and is shown

  3. Key issues • Severe hypernatreamia- high risk coma, seizures • Volume deplete/shocked on capillary results/vital signs and appearance • Risk of rapid volume/sodium shifts- careful resuscitation to avoid cerebral oedema • High risk sepsis

  4. Pass/fail (bold) • Describe pattern adequately • Comment on severity of hypernatremia • Hyperosmolar (no measured osmolarity given) • Comment on volume/shock • Identify high anion gap metabolic acidosis, resp alkalosis

  5. Describe • Hypernatraemia- critical • Low bicarb, hypernatraemia, hyperchloraemia elevated urea, lactate all fit with volume deficit • Capillary bloods- may elevate K, needs IV/IO access repeat bloods and volume bolus.

  6. The sums to do: • Anion gap (pass/fail) • Expected pCO2 • Additional • Delta gap • Osmolarity The base deficit tells you there is a metabolic acidosis Do not do Aa gradient on cap gas.

  7. DDx • Volume deficit- sepsis, ketones(glucose not especially high) • gastroenteritis • interssusception • Not pyloric stenosis, despite age risk • Diabetes insipidus if dilute urine- needs paedsendo consult • Inappropriate milk substitute high sodium • Inborn errors of metabolism usually cause hypoglycaemia- consult

  8. Significance- stem and gas • Picture not explained by these results alone- needs clinical assessment especially volume intake and composition/urine output • Needs urgent volume IV/IO 20 ml/kg N.Saline • Poor immune function age 7 weeks- septic screen and antibiotics • Needs admission and HDU/ICU paeds consult • Correct Na slowly eg no greater than 15 mmol/day to avoid cerebral oedema

  9. And you could also have headings of • Prognosis • Complications • Further Ix needed… • Implications

  10. You must • Describe and interpret the results and how they apply to this patient… • Reread this sentence 3 times • If you forget it you will fail the exam. • Read it again. • Good luck!

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