Paed Fluids

Question 1

How to give fluids

Answer 1

-Orally (unless vomiting)
-Nasogastric tube (resus)
-IV (very unwell, needs resus quickly)

Question 2

Why give fluids

Answer 2

-NMB
-Deficit of fluids (dehydrated, 24 hour N&V)
-Ongoing losses
-Pure: fever, dehydration, hyperventilation
-Stoma, fistula, drains
-Polyuria

Question 3

What to replace based on what is lost

Answer 3

-Gastric fluid
=Contains chloride and K

-Diarrhoea
=Na, K, bicarbonates

-Insensible losses
=Hypernatremia due to water loss

-Blood loss
=Blood/blood products

Question 4

Maintenance fluid and electrolyte requirement for 1 month-16 years

Answer 4

-Calculated using patient weight

-First kg: 100ml/kg/day, 4mmol/kg Na, 2.5 K
-Second 10kg: 50ml/kg/day, 2 Na, 1.5K
-Ever kg over 20kg: 25ml/kg/day, 1 Na, 0.7K (max 60Kg)

N+4 x 2 (estimated weight)
Hourly rate: /24 per hour

Question 5

Other considerations for fluid maintenance calculations

Answer 5

-Obesity (use ideal body weight)
-Neonates (up to 1 month)
=Day 1 50-60 ml/kg/day
=Day 2 70-80 ml/kg
=Day 3 80-100 ml/kg
=Day 4 100-120 ml/kg
=Day 5+ 120-150 ml/kg
-May escalate to 200ml/kg/day if enteral (for calories)- high insensible losses

-Max rates
=Usually 2.5L in males (100ml/hr)
=Usually 2L in females (80)

-Body surface area used in some clinical situations (renal failure)
=Insensible losses + UO/ 300- 400ml/m2/24 hours

Question 6

Which fluid to use

Answer 6

ISOTONIC FLUID

-Maintenance
=Glucose containing (except in early DKA) as break down own fat
==Plasmalyte (+5% glucose)
=NaCl 0.9% (+5% glucose)
-Resus
=Do not contain glucose
=Plasmalyte (more balanced)/ NaCl (default)- can get acidotic on too much saline
=Hartmann’s solution (compound sodium lactate)

Question 7

Fluid resuscitation

Answer 7

-Hypotensive shock, drowsiness and irritably suggest dehydration
-10-20ml/kg (give 10ml/kg fluid bolus for shock and then reassess)
=If >40 ml/kg: PICU referral, consider blood

Question 8

Correction of fluid deficit

Answer 8

-Fluid deficit (mls)
=% dehydration x weight x 10
=Moderate 5%, severe 10%
=Usually replaced over 48 hours

-Total fluids for child in 24 hours:
=Fluid deficit/ 2 + maintenance requirements in 24 hours