Fluids and Electrolytes in Pediatrics Final
-
Upload
arun-george -
Category
Documents
-
view
215 -
download
0
Transcript of Fluids and Electrolytes in Pediatrics Final
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 1/41
Kathleen Asas, MD.MPH
Inpatient Pediatrics
Jan 2011
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 2/41
Objectives T revie! basics " #aintenance $%id and
electrl&te re'%ire#ents
T (ain c#"rt in classi)catin "deh&dratin and ptins "r $%id s%pprt
T per"r# case*based practice+
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 3/41
Back to Basics….Fluid compartments Ttal bd&
!ater I- /-
Ttal bd& !ater
0*3 4 " 5d&!ei(ht
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 4/41
I#prtant -nceptsPlas#a Os#lalit& -ncentratin " sl%tes in
bld
Plas#a Os#lalit& 2 6 plas#a 78a9
Change in plasma osmolality --> change in ECFosmolality with water movement across cell
membranes
Remember: The body has an immediate need torestore intravascular volume over osmolality.
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 5/41
Ttal 5d& :ater
-#psitin b& A(e
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 6/41
-nceptsMaintenance; 8r#al n(in( lsses " $%ids
and electrl&tes
De)cit; <sses " $%ids and electrl&tesres%ltin( "r# an illness
On*(in( <sses; =e'%ire#ent " $%ids andelectrl&tes t replace n(in( lsses
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 7/41
Factors IncreasingMaintenance FluidRequirements
Factors DecreasingMaintenance FluidRequirements
ever*each 1 de(ree-elci%s ver >? de(reesincreases #aintenance
$%id re'%ire#ents b&124
H&perventilatin
Increased te#perat%re "the envirn#ent
5%rnsOn(in( lsses*diarrhea,
v#itin(, 8@ t%be %tp%t
Bin; Mist tent, inc%batr7pre#at%re in"ants9
<%n(s; H%#idi)edventilatr
Mist tent
=enal; Oli(%ria, an%ria
Misc; H&pth&ridis#
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 8/41
@al " l%id Therap& T prevent deh&dratin
T prevent electrl&te abnr#alities
T prevent prtein de(radatin T prevent acidsis and circ%latr& cllapse
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 9/41
Calculation of MaintenanceFluid Requirements…the
Holliday!egar Method
Example:
A 30-kg child would require (100 × 10) + (50 × 10) + (20 × 10) 1!"00 cc#da$
or (% × 10) + (2 × 10) + (1 × 10) "0 cc#h&
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 10/41
Maintenance "lectrolyteRequirements
8a and K are the pri#ar& electrl&tes that (vern -and I- s#lalit&.
#$a% in "CF & '()'*) m"q+,- negligile in ICF#/% in ICF & ')0 m"q+,- negligile in "CF
Maintenance "lectrolyte Requirements18a; 2( #'C100#l !ater Cda&
O= 2*> #'CB(Cda&K; '2 #'C100#l " !aterCda&
O= 1*2#'CB(Cda&-hlride; 2 #'C100#l " !ater Cda&
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 11/41
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 12/41
1. ?B( in"ant; ?B( 6 #lCB(Chr >2#lChr
8a; 13*>0#'C< K; ?*13#'C<
D3 E 8 / 10#e' K-lC< F >2#lChr
2. :t*33 B(; =ate G3#lChr
8a; 3*? #'C< K; 22*3 #'C<
I; D3 8 / 20 #' K-lC< FG3#lChr
>. :t*?0B(; =ate 120#lChr
8a; 3.*?3 #'C< K; 2?.?*3?#'C<
I; D3 8 / 20#' K-lC< F120#lChr
tandard 8a cntent in I; 8 70.G4 8a-l9 13 #'Cl 8a
8 70.34 8a-l9 #'Cl8a
1C> 8 70.>>4 8a-l9 31
#'Cl 8aE 8 70.234 8a-l9 >G #'Cl
8a
1C3 8 70.24 8a-l9 >1 #'Cl8a
tandard K cntent in I;
10#' K-lC<
20 #' K-lC<
0 #' K-lC<
-hsin( MI..these are best
esti#ates
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 13/41
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 14/41
Concepts in Dehydration
Initial lss " $%id "r# the bd& depletes thee6tracell%lar $%id 7-9.
@rad%all&, !ater shi"ts "r# the intracell%lar
space t #aintain the -, and this $%id islst i" deh&dratin persists.
3cute Illness 45( days 61 708 of the 9uidloss is from the "CF and 208 is from the
intracellular 9uid 4ICF6.:rolonged Illness 4; ( days61 <08 9uid
loss from "CF and *08 loss from ICF.
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 15/41
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 16/41
Pre*Illness :ei(ht sti#ate "Deh&dratin
cenari 1 7i" pre*illness !tBn!n9
8eed t acc%ratel& #nitrpatient !ei(hts "re'%entl&
l%id de)cit 7<9 PI: 7B(9
I: 7B(9
7@enerall& 100ccCB(9
PI: Pre*illness !ei(ht
I: Illness !ei(ht
4 Deh&dratin PI: 7B(9 I: 7B(9 61004
PI: 7B(9
cenari 2; 7In =9 8eed illness !t
4 DH8 based n e6a#
tep 1;
-alc%late pre*illness !t 7PI:9;
-%rrent !t PI: !t71*4 DH89
tep 2; -alc%late !t lss andrespective de)cit $%idvl%#e
PI:*I: !t lss
8te;
1B( L 1000#l $%id de)citDe)cit l%id vl%#e 100ccCB( !t lss
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 17/41
Maintenance lectrl&tes
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 18/41
Oral =eh&dratin vs Ithe
5i( Debate
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 19/41
=ral Rehydration1 /ey
ConceptsMild t #derate deh&dratin #a& be#ana(ed s%ccess"%ll& !ith ral reh&dratin inthe #ajrit& " cases.
Oral reh&dratin sl%tins sh%ld cntainglucose and sodium in a ratio not toe>ceed 21'
A#%nt " reh&dratin sl%tin t be (iven is
based n the esti#ated percenta(e "deh&dratin b& !ei(ht.
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 20/41
Oral =eh&dratinPatient v#itin(
3*10#< 3*10 #in%tes and increase as
tleratedMild Deh&dratin
De)cit replace#ent; 30 #<CB( ver h%rs
Mderate Deh&dratin
De)cit replace#ent; 100 #<CB( ver h%rs
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 21/41
Develpin( a Plan "ActinDeter#ine de(ree " deh&dratin
stablish phases 7ttal " > phases*
=es%scitatin, =eplace#ent, and tabiliNatin9
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 22/41
Phase I; =es%scitatin %sin(Istnic l%ids 78C<=9 at
20#lCB(.=e*eval%atin %ntil %rine
%tp%t and deh&dratin si(ns
i#prved
Phase II; -alc%late#aintenance de)cit $%id
Deter#ine i" Istnic,H&ptnic r H&pertnic
Deh&dratin
H&ptnic8a 1>0
Istnic1>0 8a
130
H&pertnic8a Q130=eplace
$%ids ver?hrsRR
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 23/41
:hase I ? Resuscitationphase@al; =estre circ%latin, re*per"%se brain,
Bidne&s
Mild*Mderate
20 #<CB( bl%s (iven ver >0 0 #in%tes
evere
Ma& repeat bl%s as needed 7ideall& %p t0#lCB(9
l%ids s#ethin( istnic s%ch as 8 rlactated rin(ers 7<=9
ase ; ep ace#ent ase
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 24/41
ase ; ep ace#ent asePhase III; tabiliNatin Phase
7r IstnicCH&ptnicDeh&dratin9
@al; =eplace de)cit " $%ids and electrl&tes
Replacement:hase'st 7 hrs
!taili@ation:hase$e>t '< hrs
MI andMaint 8a 1C> 2C>
De)cit l%id De)cit 8a
1C2 1C2
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 25/41
H&pertnic Deh&dratin
Phase 2; =eplace#ent Phase@al; =eplace de)cit " $%ids and electrl&tes
and dail& #aintenance
A#%nt; De)cits / dail& #aintenance l%id;
@ive ver 2*? h%rs
IMPO=TA8T; <!er ser%# 8a b& n #re than
10*12 #'C< per da& r 0.3#'C<Chr
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 26/41
H&pertnic Deh&dratin
Phase >; tabiliNatin Phase
@al; =eplace n(in( lsses and transitin
t!ards #aintenance therap&A#%nt; =eplace#ent / dail& #aintenance
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 27/41
• er%# 8a 120, -8 s&#pt#sA#%nt " >S 8a-l; 7Desired 8a*bserved 8a9 6 !t 6 0.<CB(
0.3#'C<
=e#e#ber >4 8a-l 70.3#' 8aC#l9
The in"%sin sh%ld be (iven at a rate t increase the ser%#
sdi%# b& n #re than 3 #'C<Ch and is "ten (iven #resl!l& ver the c%rse " > h
• Do not replace $a faster than '0'2 meq+, per 2*hrs.Ahy
Central pontine myelinosis: rapid brain cell shrinkage withrapid increase in ECF a
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 28/41
!teps in Fluid Replacement3. :hase I1 Rapid :hase
Restore intraascular olume
a6 se Istnic l%id 78C<=9b9 =eplace ther c#pnents 7-aC(l%cse9 separatel& based n dc%#entedde)cit
c9 l%#e; 10*20ccCB(U repeat %p t 0ccCB( then re*eval%ate
B. :hase 21 Replacement :hase
Determine type of dehydration ased on $aleel 4Isotonic-Hypotonic- or Hypertonic6
a6 Calculate 2*hr ater needs -alc%late #aintenance !ater
-alc%late de)cit !ater
6 Calculate 2*hr electrolyte needs
-alc%late #aintenance sdi%# and ptassi%#
-alc%late de)cit sdi%# and ptassi%#
c6 !elect an appropriate 9uid 4ased on total ater and electrolyteneeds6
!ypotonic and "sotonic #ehydration: $dminister % calculated &uid during the'st ( hrs. $dminister remainder over the ne)t '* hrs.
C. :hase (1 !taili@ation Replace ongoing losses as they occur 7e6;diarrhea9
a9 Meas%re ever& * hrs and replace !ith apprpriate $%ids
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 29/41
">ceptions1 Ereatment ofHypernatremic Dehydration
=estre intravasc%lar vl%#e. Deter#ine ti#e "r crrectin based n initial V8aW;
V8aW 13*13 #'C< ; 2 hr
V8aW 13?*10 #'C<; ? hr
V8aW 11*1?> #'C<; 2 hr
V8aW 1?*1G #'C<; ? hr
Ad#inister $%id at a cnstant rate ver the ti#e "r crrectin
T&pical $%ids; D3E 8 r D3 8 7!ith 20#'C< K-l %nlesscntraindicated9
ll! ser%# 8a
di%# decreases t rapidl&* Increase V8aW " I r decrease rate" I
di%# decreased t sl!l&*Decrease V8aW " I r increase rate" I
RRR<!er ser%# 8a b& n #re than 10*12 #'C< per da&
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 30/41
TaBe H#e Messa(e
Oral reh&dratin is a sa"e and eXectiveinterventin in patients !ith #ild*t*#deratedeh&dratin !h are able t tlerate ral re(i#en.
l%id calc%latins are Ybest esti#ates.Z Al!a&s#nitr the eXects " &%r interventins.
De)cit $%id re'%ire#ents are based nclassi)catin " deh&dratin.
H&ptnic and istnic deh&dratin are crrectedin ?*hr and 1*hr blcBs.
H&pertnic deh&dratin is crrected based n 8alevel 7%s%all& ver ?hrs9.
l! crrectin " bth h&pnatre#ia andh&pernatre#ia.
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 31/41
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 32/41
-ase;A 12 #nth ld #ale is #ade 8PO "r s%r(er&,
!t*10 B(.
:hat !%ld be his #aintenance $%id andelectrl&te re'%ire#ent[
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 33/41
-ase 1;
:t; 10B(Phase 1 7res%scitatin9; 8 res%scitatin phase
re'%ired
Phase 2 7replace#ent9; Maintenance l%id; 10 6ccChr 0#lChr 7r 1000#lCda&9
Maintenance 8a;
2*> #'C100cc $%id >0 #' 8aC<D3 E 8
Maintenance K; 1*2 #'C100 cc $%id 10 #'C< K-l
Maintenance $%id chice;D3 E 8 / 10#' K-lC< at 0#lChr
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 34/41
-ase 2A &ear ld #ale presents !ith a histr& " v#itin( and
diarrhea. He has had 10 episdes " v#itin( 7clear then&ell! tin(ed9 and ? episdes " diarrhea. The diarrhea isn! !ater& and the last "e! episdes have been red inclr. The diarrhea dr is ver& "%l. He "eels !eaB.
6a#; T >?.2 de(rees 7ral9, P 110, =3, 5P G0C3,6&(en sat%ratin 1004 in r# air. :t* 1? B(.
He is alert and cperative, b%t nt ver& active. He is ntt6ic r irritable. His e&es are nt s%nBen. TMs are nr#al.His ral #%csa is #ist b%t he j%st v#ited. His necB iss%pple. Tach&cardic, 5!el s%nds are nr#active.
His verall clr is sli(htl& pale, his capillar& re)ll ti#e is 2secnds ver his chest, and his sBin t%r(r "eels s#e!hatdi#inished.
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 35/41
%estins 5ased n clinical criteria, !hat is his 4 deh&dratin[
Optin 1 7-alc%late PI:9 1?B(C71*0.039 1?.G 7PI:9
1?.GB( 1?B( 0.G 7100#l 6 0.G9
:hat #ethd " $%id ad#inistratin !%ld &% chse[
The parents are insistent n I $%ids. :hat !%ld be &%r steps in $%idad#inistratin[
*5l%s " 20#lCB(
*=e*assess#ent
* I vs ral reh&dratin
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 36/41
Oral vers%s I reh&dratin isdisc%ssed !ith his parents
!h indicate that the& havetried ral h&dratin and arent happ& !ith the res%lts sthe& !%ld liBethe I "r hi#.
An I is started and ache#istr& panel is dra!n.
8a 1>3, K>., -l GG, bicarb13.
:t*1?B(.
Phase I; res%scitatin c#pleted !C8 bl%s
Phase II; Deter#ined Istnic Deh&dratin
Maint $%id; 100#l
Maint 8a; > #'C100#l 2 #' 8aC100#l (0m"q+, $a
Maint K; 2 #'C100#l 2?#' KC100#l*Q 20m"q+, /
De)cit $%id in 34 DH8; 1? 6 0.03 6 1000*Q G00#l *>0#l 30#l
5 ( days illness 0.7 4G00ml6 20ml 4loss from "CF6
0.2 4G00lm6 '70ml 4loss from ICF6
Decit $a1 #$a% in "CF J ol decit #"CFK
'() > 0.20, G m"q $a ? ))m"q $a 4receied6 *2 m"q$a
Decit /1 #/% in ICF > proportion of 9uid loss from ICF >decit
')0 > 0.'70 , 2 m"q /
'st :hase1 $! olus 4(<0ml- ))m"q $a receied6
2nd phase1
'st 7 hr1 Replace '+( of maintenance $a L H20 L decit$a and H201
$a1 '0 m"q L 2' m"q; ('m"q+()ml ; *2 m"q $a+,
*<)ml 20ml
/1 m"q L '*m"q 2'm"q+() 27m"q+, /
'st 7hrs1 () ml of D) '+( $! L 2)m"q /Cl+, N G2ml+hr
$e>t '<hrs1 Replace 2+( maint $a L H20 3$D decit $a LH201
$a; 20m"qL 2'm"q; *'m"q $a+'20) ml (*m"q+,$a
D) '+* $!
/1 2<m"q+'20)ml 2'm"q+, /
$e>t '<hrs1 '20) ml of D) '+* $! L 20m"q /+, at )ml+hr
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 37/41
%estin 3;D= is a &ear ld (irl 71B(9 !h presents t
the e#er(enc& r# !ith "ati(%e,headache,(eneraliNed #alaise, and severe
(astrintestinal distress. The = tea# (ets ache#* and discvers her sdi%# t be 11?.
The& !%ld liBe t (ive >4 8a-l and asB &%"r a rec##endatin n h! #%ch t (ive,
and at !hat rate.
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 38/41
Ans!erA#%nt " >S 8a-l; 7Desired 8a*bserved 8a9 6 !t 60.<CB(
0.3#'C<
=e#e#ber >4 8a-l 70.3#' 8aC#l9@al t increase 8a b& n #re than 3#'C<
-alc%latin; 7123*11?9 6 1 6 0.<CB( 1>#l " >4 8a-lver >* hrs
0.3 #'C<
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 39/41
) kg child ith *day h+o omiting+diarrhea- '08dehydration- #$a% of '27 m"q+,Fluid
olume$a / 4replacement oer
2 days6
Maintenance
3 6 100 300#l >#'C100#l $%id 13 #' 2#'C100#l
10 #' K
De)cit 3 6 0.1 300#l
V-W lss
0.7300#l9 >00#l
V I-W lss 0.
7300#l9 200#l
V$a% in "CF > propor. ,oss > 9uiddecit L
#os $adesired $a > t > prop $aloss%1
1>3 6 0.>< / V1>3*12?6 3 6 0.W0#' / 21 #' 1 #'
#/% in ICF > prop loss> 9uid decit1
130 6 0.2<
>0 #' K
=ngoing,osses
=eplace cc; cc 3dd $a in proportion to e>pectedconcentration in lost 9uid 4e.g.- stool-gastric contents6
3dd / in proportion toe>pected concentrationin lost 9uid 4e.g.- stool-gastric contents
Ttal
1st ?hrs;
8e6t 1hrs;
1000#l
13#l / 230#l;L 00#l00#l
1 / 13 #' 8a
3#' / >0#' >3#' 8aC00#l;
'<) ml 2)0ml 7 m"q$a+,
10#' 8a / >0 #' 8a 0 #'
8aC00#l
<<m"q $a+,
0 #' K
1? #' K-lC<
2> #' K-lC<
1st ?hrs; D3 8 / 20 #' KC< F 30#lChr
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 40/41
Deter#ine ade'%ate $%ids "r *B( child !ith 134,8a10
Fluid olume $a / 4replacement oer2 days6
Maintenance
00#lCda& >#'C100#l $%id 21#' 8a 2#'C100#l 1#' K
De)cit 6 0.13 1030#lD >0#l:D*20 #l
ree H20 de)cit; B( 6 #lCB( 6 Ver%#8a*desired 8aW 20#l
8a; V8a in -W 6 prp 8a lss 6 Vl%te
de)citWV1>3 6 0.W 6 V1030*20W31 #' 8a
#/% in ICF > prop loss> 9uid decit
(7m"q
=ngoing,osses
=eplace cc; cc 3dd $a in proportion to e>pectedconcentration in lost 9uid 4e.g.- stool-gastric contents6
3dd / in proportion toe>pected concentrationin lost 9uid 4e.g.- stool-gastric contents
1st 2hr 2*hr #aint / ree H20 de)cit /D; 00 / 210/ >0
130#l
l%te l%id /lect De)cits
Ttall%id Order;
Maint $a L Def $a2'm"q L )' m"q 2 m"q
2m"q+'.)*, * m"q $a+,
D) '+( $! L (0m"q /Cl+, N <*ml+hr
1#'
>?#'
32#'C1.3<>#'
KC<
8e6t 2hrs 2*hr #aint / 21#' 8aC0.G1< 2>#' 8aC< 1#'C0.G1#l 13#'
7/24/2019 Fluids and Electrolytes in Pediatrics Final
http://slidepdf.com/reader/full/fluids-and-electrolytes-in-pediatrics-final 41/41
=e"erencesleisher, @. et al. 720039. =enal and lectrl&te #er(encies.
In -rnan, K. Kst 7ds9, Te)tbook o+ ,ediatric Emergencyedicine.
Klei(#an, =. et al. 8elsn ssentials " Pediatrics. -hapter>2; l%ids and lectrl&tes. 3th editin. pp.13*1>.
=bertsn, J. hil"sBi, 8. 720039. l%ids and lectrl&tes.The !arriet ane !andbook. 7pp. 2?*>009.
&Bes, =. 72009. ,ediatric Fluids and Electrolytes.VP!erPint slidesW.