Fluid Management In Children Flashcards
what is maintenance fluid?
To replace insensible losses
Allows excretion of excess solute load in urine
What is resuscitation fluid?
Replacement fluid for losses (blood, vomit, sweat)
Diarrhoea, lose what?
K+, can lose a lot
Major cation intra cellularly?
K+
Major cation extracellular ly?
Na+
What is tonicity?
Concentration of solutes that exerts an osmotic force across a membrane
Does Glucose exert osmotic force?
Nope, usually not, no tonic force
Normal Values of osmolality?
270-295mmol/kg
~280
Role of sodium in fluids?
Most important ECF cation
Maintains plasma tonicity and ECF volume
USUALLY reflects water balance.
Problems with fluids in children that come up?
Hyponatraemia
Encephalopathy
ADH does what?
Water retention at kidneys
Moves from ECF to ICF
Purpose of stress response?
Glucagon gets mobilized
What is natriuresis?
Losing Na+ in urine
What causes natriuresis? Mechanism?
ANPeptide
Stretch at atrium
Due to volume loading
Why children at risk for hyponatraemia?
Large brain:, increase ICP
When do seizures occur in adults/children?
Children :Na:
THings to consider when prescribing fluid?
Volume/rate
Na
K
Energy
How much energy in 5% dextrose. 1000ml?
200cal
Paediatric IV maintenance Study (PIMS)
Plasma-lyte vs. 0.45% NaCL in 5%D
Less ppl became hyponatraemic on Plasmalyte
Stress response causes?
Water retention
Remember what when give fluids to kids?
Kids eat and drink early. Need to adjust
give What fluids to really sick kids?
Relative fluid restriction 2/1/1. Or 2/3 maintenance Plasma review daily electrolytes Reduce once drinking
High risk groups that retain more fluid? How to maintain?
Meningitis
Neonate S
Craniotomy-facial/neurosurg/Major surg
Anyone who needs full maintenance
Daily electrolytes
Role of dextrose solution?
- Prevent hypoglycaemia, prev. Ketosis
2. To give free water into a peripheral vein: prev. Haemolysis
When give TPN?
When not eating or drinking for more than a few days. Liver glycogen stores depleted.
