Paeds Fluids

Question 1

Estimating weight?

Answer 1

0-12 months = (0.5 x age in months) + 4

1-5 years = (2 x age in years) + 8

6-12 years = (3 x age in years) + 7

Question 2

Hypotonic fluids?

Answer 2

Sodium chloride 0.45%

Question 3

Isotonic fluids?

Answer 3

Sodium chloride 0.9%

Glucose 5%

Question 4

Hypertonic fluids?

Answer 4

Glucose 10%

Glucose 5%/Sodium chloride 0.45%

Glucose 5%/Sodium chloride 0.9%

Hartmann’s solution

Question 5

Electrolyte requirements for children?

Answer 5

Na+ = 2-3 mmol/kg/day

K+ = 1-2 mmol/kg/day

Question 6

How to give potassium in paeds fluids?

Answer 6

CHECK U+E FIRST

Add 10mmol K+ to 500ml bag (20 mmol/L)

Question 7

Maintenance fluids in children?

Answer 7

Every kg up to 10kg = 100ml/kg/day
Every kg from 10kg to 20kg = 50ml/kg/day
Every kg over 20kg = 20ml/kg/day

Divide by 24 to give rate in ml per hour

Question 8

How to calculate % dehydration?

Answer 8

Subtract well weight from current weight and divide by well weight –> x 100

Question 9

What you would see if no clinically detectable dehydration? (<5%)

Answer 9

Appears well, alert and responsive, normal urine output, skin colour unchanged, warm extremities

Eyes not sunken
Moist mucous membranes
Normal HR
Normal breathing
Normal peripheral pulses
Normal CRT
Normal skin turgor
Normal BP

Question 10

What would you see if there was clinical dehydration? (5-10%)

Answer 10

Appears to be unwell or deteriorated, altered responsiveness, decreased urine output, skin colour unchanged, warm extremities

Sunken eyes
Dry mucous membranes
Tachycardia
Tachypnoea
Normal peripheral pulses
Normal CRT
Reduced skin turgor
Normal BP

Question 11

What would you see if there was clinical shock? (>10%)

Answer 11

Decreased level of consciousness, pale or mottled skin, cold extremities

Tachycardia, tachypnoea, weak peripheral pulses, prolonged CRT, hypotension

Question 12

How to replace fluid deficit?

Answer 12

Deficit = %dehydration x weight (kg) x 10

Give this plus maintenace fluids over 24 hours (divide by 24 to get hourly rate)

Give as 0.9% saline with 5% dextrose +/- potassium

Question 13

How to give fluid bolus in paeds?

Answer 13

Sodium chloride 0.9% at 20ml/kg

Bolus ASAP IV or intraosseous –> reassess

Question 14

When are 10ml/kg boluses required?

Answer 14

DKA (cerebral oedema)
Trauma
Primary cardiac pathology

Question 15

Should you remove boluses from deficit or maintenance fluids?

Answer 15

NO

Question 16

When should oral rehydration solution be used?

Answer 16

If gut is functioning

Can be oral or NG

Question 17

How should ORS be administered?

Answer 17

Frequently in small volumes (e.g. cup and spoon). Normal feeds in addition, particularly if breastfed.

50ml/kg ORS over 4 hours

If they can do this then they are okay to go home. If not they need IV rehydration therapy.