5 year-old girl with leukemia. Taken to ED with history of sudden onset of fever, vomiting and increased stool frequency for 6 hours.

1. Dehydration - Leukemia
History
5 year-old girl with leukemia.
Taken to ED with history of sudden onset of fever, vomiting and increased stool
frequency for 6 hours.
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2. Dehydration - Leukemia
Assessment on PICU admission
Mildly dehydrated
Temperature 38.4o C
CVS: HR 121 bpm,
BP 96/51 mmHg
Warm peripheries, capillary refill time 2 sec
RS: RR 26 ipm
SaO2 100% in oxygen
NS: A little agitated
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3. Dehydration - Leukemia
Initial Assessment
USCOM: Slightly elevated MD
Low SV
High SVV
Low SVRI
A) fluid bolus
B) fluid + vasopressor
C) fluid + inotrope
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4. Dehydration - Leukemia
Initial Treatment
Fluid 40 ml/kg
Titrating vasopressor
30 minutes
Temperature 37.8o C
CVS: HR 112 bpm,
BP 98/53 mmHg
Warm peripheries, capillary refill time 2 sec
USCOM: Improved but still low SV
Little elevated SVV
Improved SVRI
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5. Dehydration - Leukemia
Treatment
Fluid 40 ml/kg
30-90 minutes
Temperature 37.0o C
CVS: HR 105 bpm,
BP 105/55 mmHg
Capillary refill time 2-3 sec
Urine output < 1.0 ml/kg/h
USCOM: Adequate SV
www.uscom.com.au The Measure of Life

6. Dehydration – Leukemia
Treatment
Fluid 20 ml/kg
90 minutes
CVS: HR increased 120 bpm,
same BP 105/55 mmHg
Capillary refill time 2-3 sec
Urine output < 1.0 ml/kg/h
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7. Dehydration - Leukemia
90 minutes
USCOM: Decrease in SV
Decrease in CI
Normal SVV
A) more fluid
B) more vasopressor
C) add inotrope
D) remove fluid
E) add inotrope and remove fluid
www.uscom.com.au The Measure of Life

8. Dehydration - Leukemia
90 minutes
USCOM: Decrease in SV
Decrease in CI
Normal SVV
A) more fluid
B) more vasopressor
C) add inotrope
D) remove fluid
E) add inotrope and remove fluid
www.uscom.com.au The Measure of Life

9. Dehydration - Leukemia
Summary
Some subspecialties are loathe to give fluids due to the negative affect of
overloading in the cancer population.
Conclusion
Using USCOM to monitor hemodynamics increased the awareness (and
quantification) of the process.
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