Pediatric Critical Care — MCQs

Q: Which of the following is the recommended treatment for iron poisoning in a 4-year-old child?

Deferoxamine IV at a dose of 15 mg/kg/hour. ***Deferoxamine IV at a dose of 15 mg/kg/hour*** - **Deferoxamine** is a chelating agent specifically used to bind free iron, forming a complex that can be excreted renally. - An intravenous infusion at 15 mg/kg/hour is the recommended dose for severe iron poisoning, particularly when serum iron levels are high or symptoms indicate significant toxicity. *Stomach lavage* - **Stomach lavage** is generally not recommended for iron poisoning due to the risk of pushing iron tablets further into the intestine, potential for perforation, and limited efficacy in removing large, unabsorbed iron tablets. - Iron tablets are often **large** and **poorly soluble**, making lavage ineffective for complete removal. *Blood transfusion* - **Blood transfusion** is not a primary treatment for iron poisoning because iron toxicity is due to free iron in the body, not a deficiency that would be corrected by transfused blood. - It would only be considered in cases of severe anemia or significant blood loss, which are not direct treatments for iron overload. *Observation and supportive care* - While supportive care is crucial in managing complications of iron poisoning, **observation alone is insufficient** for moderate to severe cases of iron poisoning. - Significant iron overdose requires active intervention to prevent systemic toxicity, organ damage, and potentially fatal outcomes.

Q: A 4-year-old child is brought to the emergency department with severe dehydration due to diarrhea. What is the initial management for severe dehydration?

Intravenous fluids. ***Intravenous fluids*** - For **severe dehydration**, rapid correction of fluid and electrolyte imbalances is critical, and **intravenous fluids** (normal saline or Ringer's lactate) are the **first-line treatment**. - As per **WHO and IAP guidelines**, children with severe dehydration require **IV fluid resuscitation** at 100 mL/kg over 3-6 hours (or 30 mL/kg bolus initially). - Signs of severe dehydration include **lethargy, sunken eyes, absent tears, very dry mucous membranes, poor skin turgor**, and inability to drink. - IV route ensures **rapid intravascular volume expansion** when oral intake is compromised or inadequate. *Oral rehydration therapy* - **ORT** is the treatment of choice for **mild to moderate dehydration only** (Plan B as per WHO). - In severe dehydration, children often have **altered consciousness, persistent vomiting**, or **circulatory compromise**, making oral intake ineffective or impossible. - ORT can be initiated once the child is alert and able to drink after initial IV resuscitation. *Antidiarrheal medication* - **Not recommended** in children with acute diarrhea, especially under 5 years. - Medications like loperamide can cause **ileus, drowsiness**, and may worsen outcomes. - They do **not address fluid and electrolyte deficits**, which is the immediate life-threatening concern. *Antibiotics* - Only indicated for **specific bacterial causes** (e.g., cholera, shigellosis with blood in stool, or proven invasive bacterial infection). - **Not part of initial management** for severe dehydration. - Indiscriminate use contributes to **antibiotic resistance** and delays critical rehydration.

Practice by Chapter

Respiratory Failure

Practice Questions

Shock

Practice Questions

Cardiopulmonary Resuscitation

Practice Questions

Acute Respiratory Distress Syndrome

Practice Questions

Mechanical Ventilation in Children

Practice Questions

Sedation and Analgesia

Practice Questions

Status Epilepticus

Practice Questions

Diabetic Ketoacidosis

Practice Questions

Pediatric Trauma

Practice Questions

Poisoning and Toxidromes

Practice Questions

Near-Drowning

Practice Questions

Multiple Organ Dysfunction Syndrome

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Scan to download app