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Fluid Therapy

Fluid Therapy. review. 24 April, 2009. 儿科学 Pediatrics. Ⅰ fluid balance in child. 1. The total amount of body fluids in children ： The younger, the greater the proportion of water Neonate 80% 1 month 75% Infant 70% Child 65%

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Fluid Therapy

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  1. Fluid Therapy review 24 April, 2009 儿科学Pediatrics

  2. Ⅰ fluid balance in child 1. The total amount of body fluids in children： The younger, the greater the proportion of water Neonate 80% 1month 75% Infant 70% Child 65% Adult60%．

  3. 2. The distribution of body fluids： The younger, the volume of extracellular fluid more relatively body fluids： Intracellular Fluid Extracellular Fluid：Interstitial fluid, plasma, lymph fluid, cell secretion 血浆 间质液 细胞内液

  4. The distribution of Body fluids in all ages （ accounted forWeight%） 血 5% 间质 40% 细胞内 35% 血 5% 间质 25% 细胞内 40% ~1岁70% 新生儿80% 血 5% 间质 20% 细胞内 40% 血 5% 间质 10~ 15% 细胞内 40~45% 2~14岁65% 成人55~60%

  5. 3. Water demand volumeChildren need a large number of water, poor of Regulatory function, Prone to disorders of water metabolism • In a period of rapid growth and development, Daily intake of water to retain the 0.5%~3%for the physical growth • Relatively more water loss is not dominant: about 2 times of adults • Fluid exchange of the digestive tract faster • Water metabolism is high： • infant: Accounted for half of the total liquid volume； • Adult: compared with 1 / 7 • Water metabolism regulatory function of poor: kidney, lung。

  6. ⅡElectrolyte Component • Pediatric electrolyte Component of body fluids similar to adults. Intracellular Fluid K+、Mg、Hpo4= protein Extracellular Fluid Na+、Cl-、Hco3- • Neonatus characteristic： • A few days after birth, serum potassium, chlorine, phosphorus and lactate Higher, Sodium, calcium, bicarbonate lower • A few days after birth, discharge hydrogen poor, prone to acidosis

  7. Ⅲ balance and adjustment • Humoral regulation of acid-base balanceBuffer system • NaHCO3/H2CO3=20:1 • Na2HPO4/NaH2PO4 • plasma proteins buffer system • Lung：Discharge or accumulate CO2（Respiratory） • Kidney ：Discharge hydrogen accumulate Sodium （Metabolism） regulated HCO3- NaHCO3/H2CO3=20:1 There is a limit compensatory adjustment

  8. Ⅳacid-base balance marker • blood gas analysis：(normal value) PH：7.4(7.35~7.45) PaCO2：40(34~45)mmHg (respiratory) HCO3- ：24(22~27)mmol/L (SB) (Metabolism) BE：-3~+3mmol/L (Metabolism) CO2CP：22(18~27)mmol/L

  9. Disturbance of acid-base balance • respiratory acidosis • respiratory alkalosis • metabolic acidosis • metabolic alkalosis （Compensatory, Decompensatory）

  10. Fluid Therapy Treatment

  11. Ⅰ Purpose of Fluid Therapy Correct to the body of water, electrolyte disturbance (Already exists) Restore and maintain blood volume, osmolality, pH and electrolyte composition To restore normal physiological function

  12. Ⅱ The wayof Fluid Therapy Oral Injection of vein

  13. Ⅲ Fluid therapy • 1）accumulated loss volume • 2）Continued loss volume • 3）Physiological needs The amount of liquid, the composition and completion time

  14. (Ⅰ) Cumulative loss supplement According to the degree of dehydration, decision rehydration volume, composition, speed mild：50ml/kg moderate：50~100ml/kg severe：100~120ml/kg Cumulative loss supplement To determine the volume

  15. Isotonic dehydration：2/3~1/2张 Hypotonic dehydration：等张~2/3张 Hypertonic dehydration：1/3~1/8张 To determine the component Cumulative loss supplement Principle： first quickly, then slow Severe：fluid expansion： 20ml/kgwithin30’~1h the rest：completed in 8~12h To determine the speed

  16. (Ⅱ)Continued loss supplement 10~40ml/kg.d To determine the volume Continued loss supplement Common:1/2~1/3张 To determine the component • Should be instillation evenly within 24 hours • Should be instillation after end up a cumulative loss within 14 ~ 16h To determine the speed

  17. (Ⅲ)Physiological needs supplement 60~80ml/kg.d （Including oral） To determine the volume Physiological needs supplement Common: 1/5张 To determine the component • Should be instillation evenly within 24 hours • Should be instillation plus continued loss within 14 ~ 16h To determine the speed

  18. (Ⅲ) To correct acidosis • mild： deal withtocause • Moderate, severe： (40 - 所测CO2CP Vol%) 2.2 =(22 - 所测CO2CP mmol/L)  0.6  kg = BE  0.3kg 需碱性液 mmol 0.6  kg = • Usually use half the amount

  19. ⅣPrinciples of Therapy 1、先快后慢 2、先浓后淡 3、见尿补钾 4、随时调整

  20. Supplement Potassium Notes • Give potassium after get urine • Concentration of Supplement Potassium in veins<0.3% • Supplement Potassium speed: >4~6 hours • Severity hypokalaemia：Potassium supplement should be continued 4 to 6 days

  21. Conversion the solution used • 10%NaCl： 1ml=1.7mmol • 5%NaHCO3：1ml=0.6mmol • 11.2%NaL： 1ml=1mmol • 10%KCl： 1ml=1.34mmol

  22. Oral Rehydration Salts(ORS ) • sodium chloride：3.5g • sodium bicarbonate(sodium citrate)：2.5g(2.9g) • potassium chloride：1.5g • glucose：20g Add water to 1000ml，to become2/3张． （Na+ 90mmol/L， K+ 20mmol/L） child Should be diluted

  23. ORS机制 • Na + - glucose coupling, transfer of small intestine Na+ 葡萄糖 转运 Na+–葡萄糖 载 体 Na+ 葡萄糖 细胞内细胞间隙血液 促进 Na+、水吸收 小肠上皮细胞 刷状缘 Na+(钠泵) 细胞间隙(Cl- )渗透压 水分进入血液

  24. Characteristics of ORS • Advantage： • Close to plasma osmolality • Content of the concentration of Na+ 、K+ 、Cl- can correct the amount of loss • Children easily accept the taste • Sodium citrate to correct metabolic acidosis • 2% glucose to promote sodium and water absorption maximum

  25. Characteristics of ORS • Disadvantage： • Liquid Tension higher（2/3张） • Can not be used as supplementary to maintain the liquid • For newborns and infants, concentration of sodium is higher (Should be an appropriate dilution)

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