Calculate a bolus rate (mL/kg/hour) to be given to a severely dehydrated child with diarrhea weighing 23 kg over 60 minutes. The pulse will be checked after the bolus.

Choice A reason:

Facial edema is a common clinical manifestation of nephrotic syndrome in children. This occurs due to the retention of fluid in the tissues, which is a result of the kidneys leaking protein into the urine (proteinuria). The loss of protein reduces the oncotic pressure in the blood vessels, leading to fluid accumulation in the interstitial spaces, particularly noticeable around the eyes and face.

Choice B Reason:

Cloudy smoky brown-colored urine is not typically associated with nephrotic syndrome. This symptom is more indicative of hematuria, which is the presence of blood in the urine. Hematuria is more commonly seen in conditions such as glomerulonephritis rather than nephrotic syndrome.

Choice C Reason:

Weight loss is not a characteristic symptom of nephrotic syndrome. In fact, children with nephrotic syndrome often experience weight gain due to fluid retention. The accumulation of fluid in the body can lead to an increase in weight, rather than a loss.

Choice D Reason:

Frothy appearing urine is a hallmark sign of nephrotic syndrome. The frothiness is due to the high levels of protein being excreted in the urine (proteinuria). When protein is present in the urine, it can cause the urine to appear foamy or frothy.

Choice A reason:

Decreased abdominal distention is not typically a sign of appendicitis perforation. In fact, perforation often leads to increased abdominal distention due to the release of intestinal contents into the abdominal cavity, causing inflammation and swelling. Therefore, this choice is incorrect.

Choice B reason:

Anorexia, or loss of appetite, is a common symptom of appendicitis but not specifically indicative of perforation2. While anorexia can be present in cases of perforation, it is not a definitive sign. The sudden relief of pain is a more critical indicator of perforation, as it suggests the appendix has ruptured, temporarily relieving pressure.

Choice C reason:

Bradycardia, or a slow heart rate, is not a typical sign of appendicitis perforation. In fact, appendicitis and its complications, such as perforation, are more likely to cause tachycardia (an increased heart rate) due to pain and infection. Therefore, this choice is incorrect.

Choice D reason:

Sudden relief from pain is a classic sign of appendicitis perforation. When the appendix ruptures, the pressure inside the appendix is relieved, leading to a temporary decrease in pain. However, this is followed by a rapid onset of severe pain as the contents of the appendix spread throughout the abdominal cavity, causing peritonitis. This sudden change in pain is a critical indicator that the appendix has perforated and requires immediate medical attention.