This page intentionally left blank Nelson Essentials of Pediatrics www. wfhm.info This page intentionally left blank Nelson Essentials of. The topics covered in Current Essentials: Pediatrics are based on chap- ters from the eighteenth edition of Current Diagnosis & Treatment: Pediatrics, edited by. Past President Royal College of Paediatrics and Child Health. Edinburgh London practices, or medical treatment may become necessary. Practitioners and.
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Nelson essentials of pediatrics / [edited by] Karen J. Marcdante, Robert M. .. huspdf#) provide information about many of these issues. PDF | On Oct 1, , Neil Marlow and others published Nelson Essentials of Pediatrics. Download Nelson Essentials of Pediatrics, 8th Edition PDF Free. Part of the highly regarded Nelson family of pediatric references, Nelson Essentials of.
The potential for hyponatremia or hypernatremia emphasizes the need for close monitoring of serum sodium in hospitalized children receiving intravenous fluid therapy, particularly in the post-operative period. This is generally given over a few hours, with serum sodium checks done throughout in order to avoid hypernatremia. If the blood came from a heel stick, as is frequently done in infants, cell lysis due to the trauma of the needle can cause intracellular potassium to enter the serum locally, leading to falsely elevated serum potassium.
Hyperkalemia can be treated with a variety of medications.
There are multiple mechanisms for decreasing serum potassium, and medications are chosen based upon their mechanism and the level of urgency of the clinical situation. In emergencies, agents which cause a rapid influx of potassium intracellularly are useful as they provide an acute decrease in serum levels. These medications include insulin and beta adrenergic agonists such as albuterol. Sodium polystyrene sulfonate is an exchange resin which exchanges sodium for potassium in the gut; 19 its use is generally for less emergent situations.
Diuretics such as furosemide can also be used to increase potassium excretion into the urine, however, diuretics should be used cautiously, as the resultant volume depletion can cause decreased potassium excretion.
However, once therapy is begun, appropriate monitoring is necessary due to the frequently changing needs of a hospitalized patient.
The first parameter for monitoring is oral intake Table 6. Generally speaking, the oral route for providing fluid therapy is preferred as soon as it is clinically indicated, as any intravenous administration brings with it the risk of infection. Patients who are not allowed anything by mouth for a short time, such as for an uncomplicated surgery, and for whom only maintenance fluids are required, may have their fluids decreased and eventually stopped once they tolerate oral hydration.
When monitoring patients who are being treated with maintenance and deficit fluids for dehydration, the most important monitoring parameters are those which defined the dehydration in the first place, such as skin turgor, urine output, and thirst see Table 4 for a complete list. Monitoring patients' weights can be especially important, particularly in infants, as younger patients tend to present with more significant weight loss when dehydrated.
Urine specific gravity can also be used to assess hydration status. Another monitoring parameter which the pharmacist can impact is the amount of fluid used in the patient's medications. For example, if a parenteral antibiotic is being mixed in mL and given four times per day, this could provide a significant amount of fluid to the patient. Ensuring that the patient is not getting an excessive amount of fluids in medications can help prevent overhydration.
The fluid in which the medication is being mixed should also be taken into account.
OP Ghai Essential of Pediatrics Textbook PDF Download [Direct Link]
Monitoring serum electrolytes is necessary if the patient has electrolyte abnormalities, but when examining hydration, the most important indices to watch are the clinical parameters mentioned earlier. Pharmacists are in a unique position to make a positive impact by applying physiological fluid differences and basic pharmacokinetics to pediatric pharmacotherapy. As mentioned previously, the large percentage of total body water in neonates has a great impact on therapy with water-soluble drugs, such as aminoglycosides.
The increased volume of distribution necessitates a large dose. However, if the infant presents in a dehydrated state, and therefore has a smaller volume of distribution, giving a standard dose for the patient's age may result in a toxic serum concentration.
The opposite problem may happen after a patient has been given multiple fluid boluses. In this situation, the volume of distribution may temporarily be increased, and thus a standard dose may lead to subtherapeutic serum concentrations.
Hydration status can have an important impact on drug therapy, and should be considered when using medications with large volumes of distribution. By paying close attention to the fluid needs of pediatric patients and monitoring response to fluid therapy, the pediatric pharmacist can have a positive influence on the health of the child.
Pharmacists should always pay particular attention to the hydration status of patients, as the volume of distribution for water soluble drugs can be drastically affected by a change in volume status. Applying the principles of pharmacokinetics to a working knowledge of fluid and electrolytes in children can help pharmacists individualize medication therapy to the specific needs of the patient.
Footnotes Data from Rusconi F, et al.
Neonatal-Perinatal Medicine. Louis, MO: Mosby, Inc.
OP Ghai Essential of Pediatrics Textbook PDF Download
Friis-Hansen B. Body water compartments in children: Changes during growth and related changes in body composition. Fluid, electrolytes, and acid-base homeostasis. Young TE, Mangum B, editors.
Montvale, NJ: Thomson Healthcare; Pediatric Dosage Handbook. Hudson, OH: Lexi-Comp; The maintenance need for water in parenteral fluid therapy. Fluid therapy; Relation to tissue composition and the expenditure of water and electrolyte. Reference values for respiratory rate in the first 3 years of life. Treatment of burns in children. Pediatr Clin North Am. Practice parameter: The management of acute gastroenteritis in young children.
OP Ghai Pediatrics is the most recommended and widely used textbook. The free book has over pages and is the 8th edition of the series.
Nelson Textbook of PEDIATRICS - Mosby
If you need OP Ghai Pediatrics 7th or 9th edition, check the page updates. There are 31 chapters in the Ghai Pediatrics with an Index. Some of the chapters in book are as follows:. The book has superb illustrated tables, diagrams and flowcharts. Explanations are easy to understand and there is no error spotted yet. The images used are clear-cut, and the standard set by Ghai Pediatrics is worth noting.
If the link is not working, do let us know using the comments section, we will readily update it. If you are unable to locate the links, please refresh the page.Like if you wish to see a patient with Cerebral palsy, you can read the notes, and then make key-points of what you are going to question the patient and spot the clinical features.
Treatment of burns in children. Learn how your comment data is processed.
Apart from that, 5-year question papers for your university are enough, you can try to do 10 years if you want. Sodium polystyrene sulfonate is an exchange resin which exchanges sodium for potassium in the gut; 19 its use is generally for less emergent situations. The potential for hyponatremia or hypernatremia emphasizes the need for close monitoring of serum sodium in hospitalized children receiving intravenous fluid therapy, particularly in the post-operative period.
The fluid in which the medication is being mixed should also be taken into account.
Relation of electrolyte disturbances to cardiac arrhythmias. Monitoring serum electrolytes is necessary if the patient has electrolyte abnormalities, but when examining hydration, the most important indices to watch are the clinical parameters mentioned earlier.
Frequently asked questions which follow some of the chapters will help the student to consolidate the knowledge.
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