1) Jack is suffering from dehydration. decreased fluid intake or increased fluid loss may cause dehydration. dehydration produces both fluid and electrolyte deficiencies. Treatment of fluid and electrolyte imbalances in children with mild to moderate dehydration should include rapid oral rehydration therapy (ORT) with an ORS in addition to replacing fluid losses. Suggested rehydration for children with mild to moderate dehydration is 50 to 100 mL/kg or ORS over 3 to
4 hours with frequent evaluation of the child’s hydration status. Breastfeeding infants should continue to breastfeed during oral rehydration; an age­appropriate diet should be offered to all other children once the hydration status has improved. the resumption of solid food promotes more rapid resolution of diarrhea. His serum sodium should be 138­145 mEq/L. 2) Acute diarrhea, if left untreated, can lead to dehydration. diarrhea, on the most common disorders in childhood, is defined as the increase i the frequency, fluidity, and volume of stools. it accompanies many childhood disorders. diarrhea in children may be acute or chronic, inflammatory or noninflammatory. Her serum sodium should be between 138­45 mEq/L. She also has been vomiting. Vomiting is the forcible ejection of stomach content through the mouth. it involves a complex reflex associated with sweating, salivation, and often tachycardia.
Dehydration related to diarrhea and vomiting. She will receive IV therapy with a bolus of 20 ml/kg of normal saline or lactated Ringer’s solution; begin ORT for the remaining deficit (100 ml/kg over 4 hr) when child is stable and alert and can take oral fluids. alternatively, infuse 5% dextrose in half­strength normal saline solution at twice maintenance fluid rate. The IV line should be in place until child is drinking well. Zofran (ondansetron) has been shown to to decrease episodes of vomiting when given in a “one time” dose. An ORS should be offered in small, frequent feedings to avoid gastric distention and to continue age­appropriate diet as tolerated. the parent can gradually increase the amount of fluids and foods as vomiting episodes decrease.The parents and child should be educated on avoiding certain foods (fatty, acidified, or seasoned foods) and minimizing stimuli such as stress, anxiety, or unfavorable­smelling foods, which might lead to nausea and subsequent vomiting. Antiemetic medications, decreased stimuli, and avoidance of food or activities that might tend to upset the stomach, either directly or by association, may be helpful in decreasing nausea and vomiting. if the child repeatedly vomits or vomits large volumes, or if the child begins to exhibit signs of dehydration, the parent should notify the physician. 3) Jordan is experiencing hypernatremic dehydration. Since the water loss is greater than the electrolyte loss and the serum sodium concentration is more than 150 mEq/L, he will need to receive a hypotonic solution. Severely dehydrated children may need to have their circulating blood volume restored first with normal saline. The treatment should be given over 2 or 3 days to avoid a rapid fall in serum osmolality which would cause rapid movement of water into cells and potentially lead to cerebral edema. I would expect to see metabolic acidosis. 4) IV therapy: bolus of 20 mL/kg of normal saline or lactated Ringer’s solution; begin ORT for the remaining deficit (100 mL/dg over 4 hr) when child is stable and alert and can take oral fluids; alternatively, infuse 5% dextrose in half­stregnth normal saline solution at twice maintenance fluid rate; keep IV line in place until child is drinking well.

5) The ordered potassium needs to be added with the plastic IV bag in the upright noninfusion position rather than in the down infusion position to avoid the risk of inadequate mixing.
(Inadequate mixing could result in the child’s receiving an excessive amount of potassium chloride in the first few