What are the admitting orders for an 8-year-old female with moderate dehydration and UTI?

Admitting Orders for 8-Year-Old Female with Moderate Dehydration and UTI

Initiate oral rehydration therapy immediately with 100 mL/kg (2,450 mL) of oral rehydration solution over 2-4 hours, and begin parenteral antibiotic therapy promptly to prevent renal scarring. 1, 2, 3

Immediate Rehydration Protocol

For moderate dehydration (6-9% fluid deficit), administer 100 mL/kg ORS over 2-4 hours as first-line therapy. 2, 3

• Calculate total rehydration volume: 24.5 kg × 100 mL/kg = 2,450 mL ORS over 2-4 hours 2, 3
• Use reduced osmolarity ORS containing 50-90 mEq/L sodium (commercially available formulations include Pedialyte, CeraLyte, or Enfalac Lytren) 4, 3
• Administer using small, frequent volumes initially if vomiting is present, starting with 5 mL and gradually increasing as tolerated 2
• Replace ongoing losses continuously: 10 mL/kg (245 mL) for each watery stool and 2 mL/kg (49 mL) for each vomiting episode 2, 3

Reassess hydration status after 2-4 hours of oral rehydration therapy. 2 If still dehydrated, reestimate the fluid deficit and restart rehydration. If the patient cannot tolerate oral intake or appears toxic, switch to intravenous rehydration with 20 mL/kg boluses of lactated Ringer's or normal saline. 4, 2

Antibiotic Therapy for UTI

Initiate parenteral antibiotics immediately given the combination of moderate dehydration and UTI, as this patient may have difficulty retaining oral intake. 1

• Preferred initial regimen: Ceftriaxone 50-75 mg/kg IV/IM once daily (maximum 2 grams) 1
• Alternative if oral intake is tolerated: Amoxicillin-clavulanate 45 mg/kg/day divided every 12 hours 5
• Base initial antibiotic choice on local antimicrobial sensitivity patterns 4, 1
• Treatment duration: 7-14 days of antimicrobial therapy 4, 1
• Adjust antibiotics according to urine culture and sensitivity results when available 4, 1

The parenteral route is strongly indicated here because this patient has moderate dehydration and may not retain oral medications reliably. 1 Oral and parenteral routes are equally efficacious once the patient is adequately hydrated and can tolerate oral intake. 1

Diagnostic Orders

Obtain urine culture via urethral catheterization before initiating antibiotics. 4, 1

• Catheterization is the preferred collection method in this age group to avoid contamination (bag specimens have false-positive rates of 12-83%) 4, 1
• Diagnosis requires pyuria and at least 50,000 CFUs/mL of a single pathogen 1
• Order urinalysis with microscopy for immediate assessment 1
• Obtain complete blood count, basic metabolic panel, and blood culture if patient appears toxic 1

Imaging Studies

Order renal and bladder ultrasound after initiating treatment to detect anatomic abnormalities. 1

• This is recommended after the first febrile UTI to identify urinary tract abnormalities or obstruction 1
• Ultrasound findings may influence admission duration and follow-up planning 1

Monitoring and Maintenance

Once rehydration is achieved (typically 2-4 hours), resume age-appropriate normal diet immediately. 4, 2, 3

• Do not withhold feeding once rehydration is complete 2, 3
• Continue maintenance fluids and replace ongoing losses with ORS until diarrhea and vomiting resolve (if present) 4, 3
• Monitor vital signs every 2-4 hours initially, then every 4-6 hours once stable 1
• Monitor urine output closely (should be >1 mL/kg/hour once rehydrated) 1
• Reassess clinical response to antibiotics at 48 hours; failure to improve warrants imaging and consideration of resistant organisms 4, 1

Critical Pitfalls to Avoid

• Do not delay rehydration while awaiting diagnostic results—begin oral rehydration immediately based on clinical assessment 2
• Do not use bag-collected urine specimens for culture—the high false-positive rate (12-83%) leads to overtreatment and misdiagnosis 4, 1
• Do not delay antibiotic initiation—prompt treatment within the first 48 hours limits renal damage, as renal scarring occurs in approximately 15% of children after their first UTI 1
• Do not use antimotility agents (loperamide) if diarrhea is present, as these are contraindicated in children <18 years 3
• Do not rely solely on oral antibiotics initially in a moderately dehydrated patient who may not retain oral medications 1

Admission Criteria Met

This 8-year-old meets admission criteria based on: 1

• Moderate dehydration requiring structured rehydration therapy 2, 3
• UTI requiring parenteral antibiotics due to inability to reliably retain oral intake 1
• Need for close monitoring of hydration status and clinical response to antibiotics 1