Fluids and Electrolyte
Management
Ali Hassan 202454
Javeria Hussain 202436
ISOTONIC FLUIDS
HYPERTONIC FLUIDS
HYPOTONIC FLUIDS
Types of Fluid Replacement
Maintenance fluids: needed in children who cannot feed enterally
(normal ongoing losses of fluids and electrolytes)
Replacement fluids: Children may require concurrent replacement
fluids, along with maintenance fluids if they have excessive ongoing
losses (e.g. vomiting, diarrhea or excessive drainage from a nasogastric
tube)
Plan A (No dehydration)
Replacement of ongoing fluid and electrolyte losses
<5% Body weight loss
Breastfeed more frequently and longer
Give ORS after each stool
Under 2 years: 50-100mL
Over 2 years: 100-200mL
Watch for any signs of dehydration
Plan B (Some dehydration)
5-10% of body weight lost
Correction of existing deficits of fluid and electrolytes
Continue breastfeeding
Give ORS (75mL/kg) for the next 4 hours
Give 100-200mL of fresh water
Re evaluate after 4 hours
Plan C (Severe Dehydration)
>10% of body weight lost
Urgent replacement of fluids and electrolyte deficits
Start IV fluid immediately
Start giving ORS by mouth if child is able to drink (5mL/kg/hour)
IV fluid should be Ringer’s Lactate, if not available normal saline
Reassess after IV drip
Types of dehydration
Isotonic
Most common and suggests that either compensation has occurred or sodium losses have occurred in parallel
Hypotonic (hyponatremic)
Serum sodium less than 130 meq\L. Children who loose water in stool and\or those who are given water or
dilute juices can present with hyponatremic dehydration.
The initial goal in this is to replenish the intravascular vol with isotonic fluid(normal saline or ringer's
lactate)
Hypertonic dehydration
This will be hypernatremic , Na+ more than 150 mEq\L.
This represents an excessive loss of free water as compared to electrolyte
loss(e.g diabetes insipidus). 5% dextrose with 1\2 NS is an appropriate starting
solution.
This type is very common with gastroenteritis in children.
A child with mild dehydration will be generally asymptomatic or will
have few signs.
A patient with moderate dehydration has demonstrable signs (eg dry
mucous membranes , dry lips, sunken eyes)
A patient with severe dehydration will be ill. There may be low BP
indicating that vital organs are not being adequately perfused. Such
patients need immediate IV therapy.
Replacement Therapy
Normal water loss
Skin 60%
Lungs 35%
Stool 5%
Water loss from skin increases for neonates on warmers or phototherapy
Severe burns can cause excess water and electrolyte loss
Fever and tachypnea increases water loss from lungs
Excessive water loss through urine happens in diabetes mellitus and
diabetes insipidus
GI losses can be rapidly fatal
Maintenance Fluids
Composed of a solution of water, glucose, sodium, potassium, and chloride
Needed in children who cannot feed enterally (normal ongoing losses of fluids and
electrolytes)
Daily water losses are urine, stool, and insensible losses from the skin and lungs
Failure to replace these losses leads to dehydration
Glucose in maintenance fluids provides approximately 20% of the normal caloric
needs
Maintenance fluids do not provide adequate calories, protein, fat, minerals, or
vitamins
Maintenance Fluids
Maximum total fluid per day is normally 2400 ml; maximum fluid rate is normally 100
ml/hour
Sodium and potassium are given in maintenance fluids to replace losses from urine and
stool
For each 100 ml of maintenance fluids, a child needs 3 mEq of sodium and 2 mEq of
potassium
First, calculate the water and electrolyte needs.
Then, give either 5% dextrose (D5) in normal saline (NS) plus 20 mEq/L of
potassium chloride (KCI)
Children weighing < 10 kg are best treated with the solution containing ½ NS
(38.5 mEq/L) because of their high water needs per kilogram
Children with renal failure may have hyperkalemia or unable to excrete
potassium and may not tolerate 20 mEq/L of KCI → adjust the electrolyte
composition and rate of maintenance fluids
Fluid management for deficits
% dehydration x weight (kg) x 10
Example
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