Fluids and Electrolytes in Pediatrics
Download
Report
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
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