A 3-year-old child is receiving dextrose 5% in water and half-normal saline solution at 100 ml/hour. Which sign or symptom suggests excessive I.V. fluid intake?
A. Temperature of 102°F (38.9°C)
B. Worsening dyspnea
C. Gastric distension
D. Nausea and vomiting
Correct Answer: B. Worsening dyspnea
Dyspnea and other signs of respiratory distress signify fluid volume excess (overload), which can occur quickly in a child as fluid shifts rapidly between the intracellular and extracellular compartments. The excess fluid circulating around the body can cause waterlogging of the lungs, leading to breathlessness. If fluid overload goes on for a long term it eventually leads to heart failure.
Option A: An elevated temperature may indicate a fluid volume deficit. Hypohydration increases heat storage by reducing sweating rate and skin blood flow responses for a given core temperature. Hypertonicity and hypovolemia both contribute to reduced heat loss and increased heat storage.
Option C: Gastric distention may suggest excessive oral fluid intake or infection. Abdominal distension occurs when substances, such as air (gas) or fluid, accumulate in the abdomen causing its outward expansion beyond the normal girth of the stomach and waist. It is typically a symptom of an underlying disease or dysfunction in the body, rather than an illness in its own right.
Option D: Conditions that cause blood or body fluid loss can cause hypovolemia, as can inadequate fluid intake. If persistent or severe, diarrhea and vomiting can deplete body fluids. All living organisms must maintain an adequate fluid balance to preserve homeostasis. Water constitutes the most abundant fluid in the body, at around 50% to 60% of the body weight.