Paediatric fluid prescribing

Question 1

What fluids to prescribe to child

Answer 1

0.9% NaCl + 5% dextrose (come in 500ml bags)

Question 2

Steps to fluid prescribing

Answer 2

Step 1: Calculate maintenance for the child

Step 2: calculate Losses requirements

Question 3

fluid requirements in paediatric based on

Answer 3

100ml/kg for the first 10kg
50ml/kg for the second 10kg
20ml/kg for the third 10kg

Question 4

Step 1: Calculate maintenance for the child

Answer 4

e.g. before or after surgery, when child is nill by mouth

1. Weigh the child
2. Calculate fluid requirements based on
   - 100ml/kg for the first 10kg
   - 50ml/kg for the second 10kg
   - 20ml/kg for the third 10kg
3. Calculate total requirements and divide by 24 hours to find rate for prescription

Question 5

Step 2: Calculate losses requirements

Answer 5

(%dehydration) x (weight of child) x 10 (correction factor)

Question 6

example of fluid prescribing:

2- year old old child weighing 12kg is assessed to be 7.5% dehydrate. He requires iV fluids. What would you prescribe if he has a capillary Na =134 mEq/L (normal)?

Answer 6

1) Maintenance calculation
- 12kg therefore:
- 10kg x 100ml= 1000ml
- + 2kg x 50ml= 100ml
- In total = 1,100ml
- Over 24 hours = 1,100/24= 48.8ml/h
-
2) Losses calculation
- 7.5 x 12 x 10= 900ml

3) Total requirements = 1,100ml +900ml = 2000ml/24
4)
4) Rate- 2,000/24= 83ml/h

Question 7

Hypernatraemic dehydration

Answer 7

The hypernatremia dehydration defined by a serum sodium concentration> or = to 150 mmol/l, is a particular form of acute dehydration and constitutes a medical emergency requiring a prompt and adequate diagnosis and management.

Question 8

causes of hypernatraermic dehyradtion

Answer 8

e.g diabetes inspidus

Question 9

pathophysiology of hypernatraemic dehydration

Answer 9

• losing more fluids than electrolytes
• causes fluid to shift into the interstitium and cells begin to shrink- patient may not look that dehydrated due to fluid being in interstitium
• cells respond by producing idiogenic osmoles
• if rehydration is too rapid it can cause cerebral swelling

Question 10

manageemnt of hypernatraemic dehydration

Answer 10

• Give fluid at a slower rate e.g. over 48 hours instead of 24 hours

Question 11

example fluid prescribing for hypernatraemic dehydration:

2- year old old child weighing 12kg is assessed to be 7.5% dehydrate. He requires iV fluids. What would you prescribe if he has a capillary Na =151 mEq/L (normal)?

Answer 11

Need to consider fluid prescribing in context of the 48 hours

- Day 1: maintenace is 1,100
- Losses are still 900ml
- Day 2: 1,1000
- (Day 1) 1,100+ 900 + (Day 2)1,100 = 3,100 ml

Therefore:
- 3,100/ 48= 64.5 ml

Question 12

how to do fluid resus in a very unwell child e.g. in shock

Answer 12

• Give 10ml/ kg boluses of 0.9% NaCl + 5% dextrose (come in 500ml bags)