1
Pediatrics
6
th
stage
Tutorial Notes
د.اوس حازم
Maintence and replacement therapy
Maintence : to live
Ongoing : is the loss
Deficient : ongoing loss + the rest loss
Maintence depends on body weight :
100 ml/kg
>10 - 1000 + ( weight x 50 )
>20 1500 +
Maintenance for 24 h
Practically calculated for current weight
Type of fluid :
G/S 1/2 , G/S 1/3 , G/S 1/5
0.9
BINT ( 500 ML )
1 CC = 2 mEq kcl 2 bottle 20 mEq
ADH increase in pnemonia , asthma , CNS infection
Use D5 NS ( full stength )
Renal impairement shouldnt use KCL
Avoid KCL until voiding occur
Persistent ADH not give full maintanance
1/2 or 1/4 of maintainance
Because ADH cause water absorption and lead to water excess
In fever every 1 degree increase 10%
Insesible water loss ( 24- 40 % ) of maintanance + DS 1/2 NS
2
1
st
+ 2
nd
day of life not use NS can use D5
AFTER 2 days use NS with fever Na ( 18 % ) + D5 1/5
-ongoing loss ( urine , stool )
-deficent therapy
Sign of dehydration
8 % 80 ml/kg , 5 % 50 ml/kg
Deficient in 24 h like maintenace
Loss of bicatbonate
Lactic acidosis
Some sort of renal impairment kussmul respiration
Hypotension ( late sign )
Shooting NS ( restoration of blood volume rapidly )
D5 in dehydration ?
No , D5 is will not restore child , going to tissue and not expand to circulation
Improved perfusion ( good capilliary , refill , no muttled skin )
Hypernatremia from adiminsytration of conctreated formula , from sweating
Lead to ccerebral edema ( shifting of Na )
Increase K renal impairement can affect the heart
Oral rehydration solution
75 mEq of sodium, 64 mEq of chloride, 20 mEq of potassium, and
75 mmol of glucose per liter, with total osmolarity of 245 mOsm/L, is
now the global standard of care and more effective than home fluids
ORS is given during 4 hours
3
Case :
6 months infants presented with diarrhea , vomiting for 3 days , depressed fontanelles , BP
normal , there is tachycardia , Capillary refill time > Sec , the weight is 7 kg .. calculate the
fluid needed for this child ?
7 x 1oo = 700 ml ........ maitainance
Deficiet is 10 %
So
7 x 10 x 10 = 700 ml
Then 700 + 700 = 1400
20 X 70 = 140
1400 – 140 = 1360
140 ml is the shooting
D5 NS + 20 KCL mEq