Perioperative management of fluids and electrolytes in children Flashcards
Clinical signs and symptoms of mild dehydration in children
Weight loss (%): 5
Fluid deficit (ml/kg): 50
BP: Normal
Pulse: Normal
Respiration: Normal
Mucus membranes: Moist
CRT: Normal
Ant fontanelle: Normal
Urine output (ml/kg/hr): <2
Conscious level: Alert and thirsty
Clinical signs and symptoms of moderate dehydration in children
Weight loss (%): 10
Fluid deficit (ml/kg): 100
BP: Low normal
Pulse: High
Respiration: High
Mucus membranes: Dry
CRT: Prolonged
Ant fontanelle: Sunken
Urine output (ml/kg/hr): <1
Conscious level: Alert and thirsty
Clinical signs and symptoms of severe dehydration in children
Weight loss (%): 15
Fluid deficit (ml/kg): 150
BP: Low
Pulse: High and weak
Respiration: slow and deep
Mucus membranes: very dry
CRT: prolonged
Ant fontanelle: very sunken
Urine output (ml/kg/hr): <0.5
Conscious level: Irritable and lethargic
Estimating maintenance fluid requirements in paediatric surgery
4:2:1 rule… 4ml/kg/hr for 1st 10kg, 2ml/kg/hr for 2nd 10kg, 1ml/kg/hr for every kg after this.
Insensible losses:
- Superficial surgery 1-2ml/kg/hr
- Open thorax 4-7ml/kg/hr
- Open abdomen 5-10ml/kg/hr
When to consider adding glucose to perioperative fluids for paediatric surgery and how much to add
- Neonates
- Malnutrition
- Liver disease
- Hypothermia
- B-blocker therapy
- Critical illness
- Prolonged surgery
Add 50% glucose to a normal isotonic crystalloid to create a 1-2% fluid. e.g. if using 200ml of Hartmanns add 4ml of 50% glucose to create a 1% glucose solution
Why is hyponatremic encephalopathy a risk with hypotonic IV fluids in the paediatric patient
- Increased ADH levels due to stress/ surgery/ illness
- Increased free water causes hyponatraemia
- Extrarenal loss of Na through GI losses
- Hyponatraemia causes osmotic stress on neurones and apoptosis
- Leads to cerebral oedema and raised ICP
Treatment of hyponatremic encephalopathy
- NaCl 3% 3ml/kg over 15-30mins
- Repeated boluses until Na >125 or seizure terminates
