Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
How should oral rehydration solution be given to a child with mild to moderate dehydration who is vomiting?
Which finding in an infant with suspected reflux needs prompt medical review?
Practice exercise (made-up values, not clinical guidance). A bag contains 10 000 units of heparin in 250 mL. The order is 18 units/kg/h for a patient who weighs 105 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
Practice exercise (made-up values, not clinical guidance). A patient who weighs 94 kg has an order for nitroglycerin at 5 mcg/min. The bag contains 25 mg in 250 mL. Find the pump rate R in mL/h. Round to one decimal place.
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss). Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 12:00 at 80 mL/h. After 2 hours the rate is changed to 200 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
Answer: C · In small amounts, frequently, for example with a spoon or syringe
Small, frequent sips are usually tolerated even with vomiting. Juice and fizzy drinks contain too much sugar and too little salt and can worsen diarrhoea.
Answer: A · Poor weight gain, refusing feeds and blood in the vomit
Many babies regurgitate small amounts and grow well; this needs only reassurance. Faltering growth, feed refusal, blood in the vomit, bilious vomiting or breathing problems suggest complications or another diagnosis.
Answer: R = 47.3 mL/h
Heparin and insulin infusions: concentration = units in the bag/bag volume (units/mL). Pump rate (mL/h) = units per hour/concentration, and units per hour = mL/h × concentration. For a weight-based order, units/h = units/kg/h × weight first. A bolus volume = units needed/vial strength. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Answer: R = 3 mL/h
Titrated drips: first find the concentration in mcg/mL (mg × 1000/mL). For a weight-based order, mcg/min = mcg/kg/min × weight. Then mL/h = mcg/min × 60/concentration. Working backwards, mcg/kg/min = mL/h × concentration/(60 × weight). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
The order is per minute for the whole patient, so the weight is not needed.
Answer: B = −350 mL
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Negative: the patient lost more fluid than went in.
Answer: t = 6.2 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
That is about 6 h 12 min, so the bag runs out at about 18:12.
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