A child with secondary enuresis who reports of dysuria or urgency should be evaluated for what condition? (Select all that apply.)

The correct answer is choice C: Oral rehydration solution (ORS).

Choice A rationale:

Clear liquids, 1 to 2 ounces at a time, might not be sufficient to adequately rehydrate a child with severe dehydration. Clear liquids lack the necessary electrolytes and glucose content to effectively combat dehydration and replace lost fluids.

Choice B rationale:

Administration of antidiarrheal medication is not the initial step in managing severe dehydration caused by acute diarrhea and vomiting. Antidiarrheal medications can slow down the gastrointestinal motility, which may exacerbate the problem by delaying the elimination of the causative agent and prolonging the dehydration.

Choice C rationale:

Oral rehydration solution (ORS) is the recommended initial intervention for managing severe dehydration caused by acute diarrhea and vomiting. ORS contains the appropriate balance of electrolytes (sodium, potassium, chloride) and glucose to replace lost fluids and electrolytes, thereby helping to rehydrate the child effectively. It is absorbed even when digestion is impaired due to the illness.

Choice D rationale:

Intravenous fluids might be necessary if the child's condition is very severe and oral intake cannot be maintained. However, it's not the first-line intervention. Oral rehydration is preferred whenever feasible because it is less invasive and can be administered even in mild to moderate dehydration cases.

Choice A rationale:

Calcium carbonate is often given with meals to individuals with chronic renal disease, especially those on dialysis. One of the primary purposes is to bind dietary phosphorus in the gastrointestinal tract. In chronic renal disease, the kidneys are less effective at filtering out excess phosphorus from the blood, leading to elevated phosphorus levels (hyperphosphatemia). Elevated phosphorus levels can contribute to bone and mineral disorders in these patients. Calcium carbonate forms insoluble calcium phosphate complexes with dietary phosphorus, preventing its absorption and facilitating its elimination from the body through the feces.

Choice B rationale:

While calcium carbonate can interact with fat-soluble vitamins like vitamin D, the primary reason for administering it to individuals with chronic renal disease is to manage phosphorus levels. Calcium carbonate can bind phosphorus and prevent its absorption, which is particularly important for patients with compromised kidney function.

Choice C rationale:

Stimulating appetite is not a primary purpose of administering calcium carbonate to children with chronic renal disease. The main focus is on managing phosphorus levels and preventing complications associated with hyperphosphatemia.

Choice D rationale:

Preventing vomiting is not a primary purpose of giving calcium carbonate to children with chronic renal disease. Calcium carbonate is typically used to manage phosphorus levels and complications related to hyperphosphatemia in this population.