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Hugh's MD3 Paediatrics > Fluid Management > Flashcards

Flashcards in Fluid Management Deck (20):
1

What is maintenance fluid?

Fluid which replaces insensible losses
Allows excretion of excess solute load in urine

2

What is resuscitation fluid?

Fluid which replaces deficit and ongoing losses (blood, vomit, sweat)

3

In what types of fluid loss is K lost most?

Gastric
Diarrhoea

4

What is the major difference in cation between intra and extracellular fluids?

Potassium
High intra
Loss extra

5

What is tonicity?

The total concentration of solutes that exert an osmotic force across a membrane

6

What is the normal value for [Na]?

135-145

7

What is the normal value for [K]?

3.5 - 5

8

What is the normal value for osmolality?

270-295 mmol/kg

9

Which cation maintains plasma tonicity and ECF volume?

Na

10

What is natriuresis? What mediates it?

Urination of Na and water

Stretch on the atria and release of atrial natriuretic peptide

11

Why are children at risk of hyponatraemia?

Large brain : intra-cranial volume ratio

12

What is the Na threshold at which seizures occur?

120mmol/l
cf to 111mmol/l in adults

13

What is the 4/2/1 rule?

• 4 ml/kg/hr for 0-10 kg
• 2 ml/kg/hr for 10-20 kg
• 1 ml/kg/hr for 20+ kg
• Max 100ml/hr

14

How much energy does 1L of 5% dextrose have in it?

200cal

15

What was the PIMS study?

RCT at RCH comparing plasma-lyte and 5% D with 0.45% in 5% dextrose

- Showed less hyponatraemic in isotonic plasma-lyte

16

What must you consider in prescription of maintenance?

ADH response continues post-op/hospital
4/2/1 rule based on healthy children
Hydration status of children is difficult to assess
Fasting time
Age, nutritional status
Kids eat and drink early

17

How does maintenance change in sick children? Why?

Reduce 4/2/1 rule by 75-50%

Stress response causes retention

18

Which groups are high risk for fluid overload?

Neurological disease
Craniofacial/neurosurg patients, major surgery
Neonates
Children requiring full maintenance fluids
Pneumonia

19

Why do we add dextrose?

Prevent hypoglycaemia and ketosis
Prevent hypotonia induced haemolysis - less of an issue now that we're using isotonic solutions

20

When do you give TPN?

After a few days of no eating and drinking when the liver glycogen stores are depleted