Intravenous fluids in pediatrics

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Information about Intravenous fluids in pediatrics

Published on July 3, 2016

Author: AdeelAshiq3

Source: slideshare.net

1. Intravenous Fluids In Pediatrics Dr. Adeel Ashiq House Surgeon PSW SHL

2. Objectives • Physiology of Fluid Distribution • Different types of IV fluids • Distribution of IV Fluids in Body Compartments • Maintenance Fluid Calculation • Calculation of Deficits • Phases of Resuscitation • Special circumstances

3. Water Composition by Age

4. Distribution of Fluid in Body Total Body Water ECF(1/3rd) Interstitial (2/3rd) Intravascular (1/3rd) ICF(2/3rd)

5. Diff. In ICF & ECF Component ECF ICF Sodium 142 14 Potassium 4.2 140 Chloride 108 4 Bicarbonate 24 10 Magnesium 0.8 Nutrient O2, Amino acid, Fatty acid Proteins

6. Physiology of fluid compartments Capillary membrane • Between plasma and interstitium • Allows free passage of electrolytes • Restricts passage of protein molecules • Colloid osmotic pressure draws fluid in capillary • Hydrostatic fluid pushes fluid out

7. Physiology of fluid compartments Cell membrane • Barrier between ICF and ECF • Freely permeable to water but not to sodium • Water moves in either direction depending upon osmolarity

8. Types Of Fluids CRYSTALLOIDS: • Contain Na as major osmotically active particle • Will cross a semi-permeable membrane • E.g. Normal Saline, Ringer Lactate COLLOIDS: • Contain high molecular weight substancces • Are largely unable to cross a semi-permeable membrane • Albumin, Dextran, Gelatin

9. Composition of Different Fluids

10. 0.9% Normal Saline (‘Salt and water’) • Iso-osmolar (compared to normal plasma) • Contains: 154 mmol/l of sodium and chloride • Stays almost entirely in the extracellular space, so for 100ml blood loss – need to give 400ml normal saline (only 25% remains intravascular) • Principal fluid used for intravascular resuscitation and replacement of salt loss e.g diarrhoea and vomiting

11. Distribution of N/S & R/L

12. Distribution of N/S & R/L Cell Interstitium Vessel 750 ml

13. 5% Dextrose (D5W) “Sugar and Water” • Commonly used ‘maintenance’ fluid in conjuction with normal saline • Provides some calories (approximately 10% of daily requirements) • Regarded as ‘electrolyte free’ • Distribution: <10% Intravascular; > 66% intracellular • When infused is rapidly redistributed into the intracellular space; Less than 10% stays in the intravascular space therefore it is of limited use in fluid resuscitation. • For every 100ml blood loss – need 1000ml dextrose replacement [10% retained in intravascular space

14. Distribution of Dextrose Water

15. Distribution of Dextrose Water 666 ml 250ml InterstitiumCell Vessel

16. Albumin • natural protein • t1/2 = 20 days in the body but t1/2 = 1.6 hours in plasma • 10% leaves the vascular space within 2 hours, 95% within 2 days • causes 80-90% of our natural oncotic pressure • stays within the intravascular space unless the capillary permeability is abnormal

17. Albumin • 5% solution- isooncotic; 10% and 25% solutions - hyperoncotic • expands volume 5x its own volume in 30 minutes • effect lasts about 24-48 hours • Side Effects- volume overload, fever (pyrogens in albumin), defects of hemostasis

18. Types of Fluid Replacement • Maintenance: Normal ongoing losses of fluids and electrolytes • Deficit: Losses of fluids and electrolytes resulting from an illness • On-going Losses: Requirement of fluids and electrolytes to replace ongoing losses

19. Maintenance Fluid Replacement Holliday-Segar Method

20. Maintenance Electrolyte Requirements • Na: 2-3 mEq/100ml water /day OR 2-3 mEq/kg/day • K: 1-2 mEq/100ml of water/day OR 1-2mEq/kg/day • Chloride: 2 mEq/100ml of water /day

21. Factors Increasing Maintenance Fluid Requirements • Fever-each 1 degree Celcius over 38 degrees increases maintenance fluid requirements by 12% • Hyperventilation • Increased temperature of the environment • Burns • Ongoing losses-diarrhea, vomiting, NG tube output

22. Factors Decreasing Maintenance Fluid Requirements • Skin: Mist tent, incubator (premature infants) • Lungs: Humidified ventilator • Mist tent • Renal: Oliguria, anuria • Misc: Hypothyroidism

23. Deficit Calculation Sodium Deficit: 0.6x Body Weight x (Desired conc. – Current conc.) • Do not replace Na faster than 10-12 meq/L per 24hrs. Why? Central pontine myelinosis: rapid brain cell shrinkage with rapid increase in ECF Na

24. Deficit Calculation Potassium Deficit: 0.4x Body weight x ( Desierd conc – Current Conc. ) • Maximum rate of infusion < 0.5 mEq/L

25. Deficit Calculation Bicarbonate Deficit : mEq =Base deficit x 0.3 x weight in Kg

26. Dehydration and Resucitation Concepts • Initial loss of fluid from the body depletes the extracellular fluid (ECF). • Gradually, water shifts from the intracellular space to maintain the ECF, and this fluid is lost if dehydration persists. • Acute Illness (<3 days ): 80% of the fluid loss is from the ECF and 20% is from the intracellular fluid (ICF). • Prolonged Illness (> 3 days): 60% fluid loss from ECF and 40% loss from ICF.

27. Phases of Resuscitation Phase I: Resuscitation : • Goal: Restore circulation, re-perfuse brain, kidneys • Mild-Moderate  20 mL/kg bolus given over 30 – 60 minutes • Severe May repeat bolus as needed (ideally up to 60ml/kg) • Fluids – something isotonic such as NS or lactated ringers (LR)

28. Phases of Resuscitation • Phase II: Replacement Phase • Phase III: Stabilization Phase Goal: Replace deficit of fluids and electrolytes

29. Special Circumstances Burn : • The Parkland formula for the total fluid requirement in 24 hours is as follows: • 4ml x TBSA (%) x body weight (kg); • 50% given in first eight hours; • 50% given in next 16 hours

30. Special Circumstances Term Neonates : • Day 1: 50ml/kg/day • Day 2: 70-80ml/kg/day • Day3 : 80-100ml/kg/day • Day4: 100-120ml/kg/day • Day5: 120-150ml/kg/day

31. Important Guide Lines • Measure serum electrolyte and blood glucose when starting IV fluids and at least every 24 hours thereafter. • If Term neonate need IV Fluid for routine maintenance give isotonic crystalloid containing sodium 131-154mmol/L with 5- 10% Glucose.

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