Fluid Therapy

Question 1

Daily fluid plan=

Answer 1

Maintenance+deficit+future losses

Question 2

Maintenance fluid (Holliday-Segar method)
1-10 kg

Answer 2

100 mL/Kg/Day

Question 3

Maintenance fluid (Holliday-Segar method)
11-20 kgs

Answer 3

1000 mL/kcal + 50 mL/kg/day

Question 4

Maintenance fluid (Holliday-Segar method)
>20 kgs

Answer 4

1500 mL + 20 mL/kg/day

Question 5

Exceptions to the maintenance fluid (Holliday-Segar method)

Answer 5

1. ) Neonate, day 1:60-80 mL/Kg/day
2. )Over a week it gradually increases to 150 mLs/Kg/day, this stays the approximate usual need/oral input throughout infancy
3. ) Fever: extra 10% need for each 1 deg. Celsius increase, using average temp for the day

Question 6

Two special special scenarios for fluid therapy

Answer 6

1.) Hyperhydration
A.) Tumor Lysis Syndrome and toxicology cases (2 to 3 to 4 to max 5L/m2/day
B.) Polyuric renal failure, diabetes insipidus: to compensate losses, no upper limit
2.) Fluid restriction
A.) In pneumonia, maintenance at 80%
B.) In certain cardiac malformations: 80-70-60% renal failure with oliguri/anuria

Question 7

Daily requirement of electrolytes for kids

1. ) Na?
2. ) K?
3. ) Cl?
4. ) Ca, Mg, P?
5. ) Bicarbonate?

Answer 7

Daily requirement of electrolytes for kids

1. ) Na=3-5 mmols /kg/day
2. ) K= 2 mmols/kg/day
3. ) Cl= 2 mmols/kg/day
4. ) Ca, Mg, P= abundant in own stores
5. ) Bicarbonate= usually not needed

Question 8

Signs of dehydration in a child

Answer 8

3-15% decrease in body weight, dry tongue, sunken fontanelle, sunken skin tugor, tachycardia, drop in blood pressure, capillary refill time increased

Question 9

Oral rehydration contraindications

Answer 9

Acute surgical abdomen, severe dehydration/shock

Question 10

Oral rehydration pros

Answer 10

Safer than IV

Question 11

How to give a kid sodium and potassium

Answer 11

Salty sticks and fruits

Question 12

When is it best to give oral rehydration

Answer 12

Most beneficial when ongoing substantial losses, especially diarrhea

Question 13

Oral rehydration in vomiting in children

Answer 13

5-10 mL each 5-10 min for 2-4 hours

Question 14

Oral rehydration in diarrhea

Answer 14

50-100 mL or 10mL/kg after each stool passed

Question 15

Rapid enteral rehydration

Answer 15

Full deficit (even 100 mL/kg) over 4 hours

Question 16

IV bolus given in which solutions

Answer 16

1. ) Salsol
2. ) Ringer Lactate
3. ) Ringerfundin
4. ) Isolyte

Question 17

New born is given which IV solution

Answer 17

5 or 10% glucose (dextrose)

Question 18

Infant, toddler, child, adult are given which IV fluid

Answer 18

0.9% NaCl+10 mmol KCl/500mL

or balanced solutions with 2.5-10% glucose

Question 19

Rule of thumb in IV hydration

Answer 19

For fluid bonuses (large volumes to infuse fast) only iso-osmotic, potassium, and sugar free (max. Equal to the normal plasma concentration) solutions are allowed!

Question 20

Potassium rule of thumb for IV hydration

Answer 20

Potassium: max 80 mmol/L is allowed IV
Some more strict guidelines advise max 40 mmol/L for peripheral veins
You must asses renal functions before giving potassium

Question 21

Can you give hypo-osmotic fluids parenterally?

Answer 21

No, never.