fluid therapy

Question 1

How much fluid input is ideal for a child

Answer 1

as much as they want
Breast milk / formula ≠fluid

Question 2

How to calculate the fluid intake for a dehydrated / sick child?

Answer 2

• maintenance
• estimated deficit
• future losses (High fever +10%, Special: photo therapy in the NICU)

Question 3

calculate maintence fluid plan

Answer 3

holliday -segar method
1-10 kgs: 100 mL/kg/day
11-20 kgs: 50 mL/kg/d
> 20 kgs:20 mL/kg/d

if 22kg :
( 1000 for first (10100) 10 kg,
(1050) 500 ,
2x20 (40) ) total 1450

Question 4

What is the problem with holliday segar method

Answer 4

overestimates the need of a healthy child too!

doesn’t take into account that the sick child is inactive

Best way to monitor output from patient (Drains, urine) and input from fluids
also from weight of patient

Question 5

signs of dehydration

Answer 5

Question 6

mild dehydration value

Answer 6

3-5% of body weight

Question 7

moderate dehydration level value

Answer 7

6-10% of body weight

Question 8

severe dehydration value

Answer 8

9-15% of body weight

Question 9

signs in mild dehydration

Answer 9

tongue - dry
fontanel- normal or sunken

Question 10

sign of moderate dehydration

Answer 10

eyes sunken
UO=0.5-1 ml/kg/hr
tachycardia

Question 11

severe dehydration signs

Answer 11

turgor decreased
cold skin
UO<0.5 ml/kg/hr
BP decreased
CRT>2 sec
lethargic behavior

Question 12

ways of managing rehydration

Answer 12

Oral rehydration ( safer)
Parenteral rehydration

Question 13

ORAL REHYDRATION

Question 14

BOLUS how much is given

Answer 14

10 ml/kg

(give 5 ml/kg if they have cardiac di)

Question 15

fluid overload

Answer 15

edema
crackles
distended JV
hepatosplenomegaly
increase WOB

Question 16

what shouldnt be in bolus

Answer 16

extra electrolytes, sugar

give sugar ONLY incase of hypoglycemia

(sugar takes out fluid from intravascular space, glucose absorbed ; wont have normal conc. grad)

Question 17

what can be given in bolus solution

Answer 17

balanced Crystalloids,

colloids(5% albumin)- stays in IV space; if someone in shock we want to increase IV volume

blood products - if anemic (RBC)

Question 18

what is the only case where we give sugar in bolus ??

Answer 18

in hypoglycemia

(NOOOT to increase IV volume)

Question 19

pH guided resusitation logarithm

Answer 19

Question 20

maximum dose of glucose in peripheral/central line

Answer 20

12.5%

Question 21

types of glucose solutions

Answer 21

hypotonic fluids+ 5% Gl

Balanced solutions + 5/10 %

5/10/20-25/40-50% glucose

Question 22

electrolyte requirement of Na

Answer 22

3-5 mmol/kg/day

Question 23

electrolyte requirement of K

Answer 23

2mmol/kg/day

Question 24

electrolyte requirement of Chloride

Answer 24

2mmol/kg/day

Question 25

electrolyte requirement of Ca, Mg, P

Answer 25

abundant in own stores

Question 26

electrolyte requirement of Bicarbonate

Answer 26

usually NOT needed

Question 27

The level of dehydration (means deficit) is still estimated based on ……

Answer 27

vital signs (3-6-9%, 5-10-15% rules)

When you estimate a maintenance fluid plan, pay attention the level of activity of the child

Question 28

what should be checked during infusion therapy

Answer 28

important to check
* blood sugar
* electrolytes (daily-48hrs)

Question 29

first choice in fluid therapy

Answer 29

balanced crystalloids
* PL, Lactated Ringer’s, etc
* PL + 5% glucose

Question 30

You can give colloidesolutions (4.5-5% Human Albumine) if

Answer 30

• the effective blood volume is low
• the albumin level is low

Question 31

what is preferred oral or parenteral?

Answer 31

oral preferred

limit the duration of parenteral rehydration

Question 32

10 year old 30 kg child
2-day history of vomiting
HR 124 / min, CRT 3 sec, NIBP 92/35 Hgmm
No urine output since morning
Normal behaviour

Answer 32

calculate maintence
3000ml severe dehydration (10%)
we minus 50-80%
to calculate deficit

then check future losses