PEDIATRIC FLUID THERAPY

1. Calculate H2O needs (from Nelsons) A. Maintenance -- Use well weight if dehydrated. (see below) Weight in Kg. H2O fluid needs 1 - 10 100cc/Kg/day 11 - 20 1000cc + 50cc/Kg/day > 20 1500cc + 20cc/Kg/day B. Use 2/3 maintenance if pt. has meningitis. C. Add 8% for every F0 of temperature over 1000F. 2. Correction of fluid deficits. A. Assess H2O loss by weight weight loss (Kg) = water loss (L) (within 24 hrs.) H2O loss (100) / total body wt. = % dehydration B. or estimate H2O loss by physical exam: --------------------------------------------------------------------- Signs & Symptoms Mild Dehydration Moderate Severe --------------------------------------------------------------------- gen. appearance thirsty, alert, thirsty, drowsy-limp & condition. restless. irritable or skin cold or drowsy. sweaty, may be comatose. radial pulse normal rate rapid, weak rapid, feeble respiration normal deep deep + rapid ant. fontanelle normal sunken very sunken skin turgor pinch retracts retracts slowly retract 2 sec. immediately eyes normal sunken grossly sunk. tears present absent absent mucous memb. moist dry very dry urine flow normal dark and none passed decreased for some hrs. BUN > 20 > 30 > 40 % Dehydration 4 - 5 6 - 9 10 + ---------------------------------------------------------------------- C. Calculate well weight. well weight = sick wt./(1 - % dehydration as decimal) D. Give 1/2 deficit over 8 hrs. and 2nd 1/2 over 16 hrs. If Hypertonic dehydration, correct over 48 hours. E. If mod. to severe dehydration present, emergency rehydration may be needed (10 - 20cc/Kg Normal Saline - may repeat x 1). 3. Calculate Na+ and K+ needs A. Maintenance is Na = 3 - 4 meq/Kg/day K = 2 meq/Kg/day B. Correction of Na deficit or excess Vd Na (well wt. Kg)(desired Na - actual Na) = 0.6 (wt.)( Na) = meq Na needed 4. HCO3 deficit = (normal HCO3) - (measured HCO3)(.4)(Well Wt.) A. Give 1/2 deficit over 4 - 8 hrs then recheck. B. If TCO2 >= 15meq/L then let kidneys do the rest. C. Empiric if severe dehydration likely: Add 3cc of 7.5% HCO3 to a litre D5.5NS to make emergency rehydration fluid. 5. Calculate actual fluids [(meq Na needed)/total fluid needed] / meq Na in normal saline = % normal saline = (meq Na needed)/154 A. Usually use D5?NS as IV fluids (ie. D5.2NS)