Fluid balance Flashcards
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How does water get into the body
Drinking
Produced by body in oxidative metabolism
IV fluids
NG tube
PEG fed
How does water get out of the body
Urine- 60%
Skin and lungs- 35%
Stool-5%
Fluid requirements in young infants, toddlers and adults
Young infants ~150ml/kg
Toddler ~100ml/kg
Adult ~50ml/kg
Signs of mild dehydration in infants and older children
Thirsty, alert, restless,
↓urine
signs of moderate dehydration in infants and older child
Infants:
Lethargic, drowsy,
sunken eyed,
↓ urine
Older child:
Alert,
postural dizziness,
sunken eyed,
↓ urine
Severe dehydration in infants and older child
Infant:
Limp, cold, urine
↓ consciousness
older child:
Apprehensive, cold, urine
cramps
Risk of having too much water
Neonate:
* cannot efficiently excrete water load
Infants and toddlers
Small stomach volume
Decreased appetite
Inadequate energy and nutrients
Faltering growth
Excessive milk drinking in toddlers
Decreased appetite for foods
Iron deficiency anaemia associated with milk intake > 500ml/d
Increased saturated fat intake
Fluid balance is important. If too much fluid goes out:
-Gut:
Acute gastroenteritis, Enteropathy, Stomas
-lungs:
Cardiorespiratory disease,congenital heart disease , cystic fibrosis,
-Skin:
Pyrexia, eczema, burns, CF, phototherpay
-kidney:
Renal dyplasia, nephrohenic diabetes,
Fluid balance is important
If not enough fluid comes in
Dysphagia – cerebral palsy, neurodisability
Vomiting – chemotherapy, GORD
Behavioural – fussy feeders and eaters
Carer – child neglect or abuse
Revise this just for the practical session
What does fluid do
- Carries nutreints and oxygen to cells
- Regulates body temp
- Protects organs and tissues
- Prevent constipation
Revise this just for the practical session
How is fluid stored
- Intracellular
- Interstitial
- Intravascular (within blod)
Calculation for fluid maintenance
First 10kg : 100ml/kg/day
second 10kg: 50ml/kg/day
Remaining weight (over 20kg): 20ml/kg/day
Max flluid maintenance for males= 2500mls and females = 2000ml
What should maintenance fluids consist of
Isotonic cyrstalloids
Maintenance fluids in children always contains dextrose (unless contraindicated)
Fluid maintenance for neonates
From birth- day 1: 50-60ml/kg/d
Day 2: 70-80ml/kg/d
Day 3:80-100ml/kg/day
day 4: 100-120 ml/kg/day
day 5-28: 120-150ml/kg/day
Resuscitation fluid
Emergency fluid
Glucoe free crysatlloids
Medical: bolus 20ml/kg over less than 10 mins
Surgical/trauma: bolus 10ml/kg over less than 10 mins
Calculating urine output
mls/kg/hr
Normal urine output for an hour
Neonates - 2-3mls/kg/hr
Infants- 2ml
child- 1-2ml
adolescent- 0.5-1mls
What influences the amount of urine passed
- Amount patient drunk
- fever
- pregnancy
- alcohol
- Nausea, vomiting and diarrhoea
- Excessive sweating
- Time of day (largest vol 1st thing in morning)
Capacity of child bladder
38+(2.5x age in months)
Older children (agex30) + 30
Urine output in nappies
weight of dry nappy- wet nappy
