Transcript Fluids and Electrolytes in Pediatrics

Nadin Abdel Razeq, PhD
Objectives
 To gain awareness of the proper procedure of
peripheral IV access in pediatrics
 To review types of IV fluids used in children
 To review basics of maintenance and deficit fluid and
electrolyte requirements
 To gain awareness of the proper procedure of IVformula preparation and administration in pediatrics
 To review basics of IV medications administration in
children!
Proper Procedure of Peripheral
IV Access in Children
 Let us watch a Video First …
 Then Let us Focus on Some Important
Concepts
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All procedures at a treatment room
Scalp Site and Arterial insertion
To Get Better IV access you can…
Number of IV access Attempts…
Basic Concept :Osmotic Pressure
Basic Concept :Osmolality of the blood
Isotonicity of Blood = 275-295 mOsm/L
 Solutions having the same osmotic pressure as that
of blood are said to be isotonic with blood.
 Solutions with a higher osmotic pressure than
body fluids are called hypertonic
 Solutions with a lower osmotic pressure are called
hypotonic.
Types of IV fluids in children
 0.9% NaCl (Normal
Saline)
 5% glucose in water
Types of IV fluids in children
 10% glucose in water
 25% or 50% glucose in
------------------------- 15% or 20% glucose in
water
 Give only via a central
line as a 1-2ml/kg bolus
for hypoglycaemia.
Monitor blood glucose
water Never as an
infusion
 Only used in NICU and
at low vol eg. 1-2mls/hr
via central line
Types of IV fluids in children
 0.9% NaCl with 5% dextrose (Normal saline
with glucose)
Osmolarity: 560
Types of IV fluids in children
 0.45% NaCl with 5%
dextrose
 (1/2 Normal saline
with glucose and no
potassium
 0.18% NaCl and 4%
dextrose (4% and 1/5th
normal saline)
Types of IV fluids in children
 Ringer Lactate :
0-10 gram glucose/100cc
Na 130 mEq/L
NaHCO3 28 mEq/L as lactate
K 4 mEq/L
273 mOsm/L
 Water for injection
Maintenance Electrolyte Requirements
 Maintenance K
Requirements:
IV: 1-2 mEq/100ml of
water/day
OR 1-2mEq/kg/day
Indications :
Administration: Added only once
the urine output is established.
Strength:
Calculate :
• Side effect: ECG monitoring
Frequent testing
Maintenance Electrolyte Requirements
 Maintenance Ca
Requirements:
IV: 60 to 100 mg/kg/day
Indications :
Administration:
Strength:
Calculate :
Side effect:
IV formulas – Practice
 100ml 0.9% NaCl + 20 ml 10% G/W + 5mEq KCL / 8 hrs
 Microdropper
Calculation of Maintenance Fluid
Requirements…the Holliday-Segar Method
Class activity:
A 30-kg child would require???
Kathleen Asas, MD.MPH
Calculation of Maintenance Fluid
Requirements… A 30-kg child would require
(100 × 10) + (50 × 10) + (20 ×
10) = 1,700 cc/day
or (4 × 10) + (2 × 10) + (1 × 10)
= 70 cc/h.
Kathleen Asas, MD.MPH
Oral Rehydration: Key Concepts
 Mild to moderate dehydration may be managed
successfully with oral rehydration in the majority of
cases.
 Oral rehydration solutions should contain glucose
and sodium in a ratio not to exceed 2:1
 Amount of rehydration solution to be given is based on
the estimated percentage of dehydration by weight.
Kathleen Asas, MD.MPH
Oral Rehydration
 Patient vomiting
– 5-10mL Q 5-10 minutes and increase as tolerated
 Mild Dehydration
– Deficit replacement: 50 mL/kg over 4 hours
 Moderate Dehydration
– Deficit replacement: 100 mL/kg over 4 hours
Kathleen Asas, MD.MPH
Phase I: Resuscitation using Isotonic
Fluids (NS/LR) at 20ml/kg.
Re-evaluation until urine output
and dehydration signs improved
Phase II: Calculate maintenance &
deficit fluid
Hypotonic
Na <130
Determine if Isotonic, Hypotonic or
Hypertonic Dehydration
Hypertonic
Na >150
Replace fluids
over 48hrs**
Isotonic
130< Na <150
Kathleen Asas, MD.MPH
Resuscitation phase
 Goal: Restore circulation, re-perfuse brain, kidneys
 Mild-Moderate
 20 mL/kg bolus given over 30 – 60 minutes
 Severe
May repeat bolus as needed (ideally up to 60ml/kg)
 Fluids – something isotonic such as NS or lactated
ringers (LR)
Kathleen Asas, MD.MPH
Replacement Phase
Stabilization Phase
(For Isotonic/Hypotonic Dehydration)
 Goal: Replace deficit of fluids and electrolytes
Replacement
Phase
1st 8 hrs
Stabilization Phase
Next 16 hrs
MIVF and
Maint Na
1/3
2/3
Deficit Fluid &
Deficit Na
1/2
1/2
Kathleen Asas, MD.MPH
IV Medications
IV Medications - basic Concepts
 Correct :
Patient
Drug
Dose
Rout,
 IV or
Oral ----- check IV site ,
Time, Time of Other Medications
Documentation
IV Medications - basic Concepts
 Administration :
Micro-dropper for each Med
Minimum dilution of drugs
What to Do with the extra fluids
Type of solution and computability
Meds
Never with blood product
Duration of administration – Time of
Other Medication