Complications
Vascular access in children is sometimes difficult to obtain.
Infiltrates occur frequently. Depending on the fluid being infused, can significantly damage tissue.
Can be part of the primary presentation or result from treatment interventions. Hyper- or hyponatraemia can complicate volume depletion.
Patients ill enough to require intravenous hydration may require a basic chemistry screen. After initial resuscitation with isotonic crystalloid, full volume repletion should be tailored to replete water and sodium losses independently.
Hypernatraemia is more common in diabetes insipidus and sweat losses. Hypernatraemia can result from giving inappropriately low sodium solutions during rehydration.
Infants are at risk for hypernatraemia if given hypertonic (improperly mixed formula) fluids or at risk for hyponatraemia if given hypotonic fluids due to immature filtering and reabsorption of solutes in the kidney.
Hypokalaemia is seen with enteric losses, whereas hyperkalaemia is more common with burns and trauma.
Hyperchloraemic metabolic acidosis can result from aggressive resuscitation with sodium chloride.
Placing a nasogastric tube is generally safe and uncomplicated. Proper measurement (nose to tragus and down to inferior border of xyphoid) ensures proper depth.
Auscultation while rapidly injecting air into the nasogastric tube can confirm placement. A misplaced tube is associated with coughing or spluttering when used, or the patient may have worsening vomiting.
Normally, healthy children have intact airway reflexes to prevent aspiration, but chronically ill or obtunded children may not be able to protect their airway.
Results from hypoperfusion of the kidney.
Typified by decreased urine output, granular casts, and tubular cells in the urine, and elevated fractional excretion of sodium.
Recovery can take several weeks. Some patients need long-term dialysis.
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