fluid and electrolytes

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fluid and electrolytes
2010-04-08 21:22:41

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  1. amt of water in ECF
  2. amt of water in ICF
  3. ecf breaks into
    interstitial and intravascular(plasma)
  4. fluid req 3-10kg wt
  5. fluid req 11-20 kg wt
    1000ml plus 50ml/kg for each kg above10 kg
  6. fluid req >20kg
    1500 ml plus 20ml/kg for each kg above 20 kg
  7. pts with decreased fluid req
    CHF, patent ductus arteriosus(shuts closed after birth, harder to shut if fluid overloaded, 1st couple days can fluid restrict), renal dysfunction, increased ICP
  8. Na electrolyte req
    2-6 mEq/kg/d
  9. K electrolyte req
    1-3 mEq/kg/d
  10. common causes of dehydration in peds
    gastroenteritis, GI sx occuring w other disease states, infnts cannot respond independently
  11. signs of dehy in peds
    decreased UOP, tachy, sunken fontanelles, increased capillary refill time, altered mental status, decreased level of cons, hypotension (late sign)
  12. mild dehydration
    3-5%, normal HR, BP, fontanelle, slightly dry mucus, warm, normal capilary reill, slight inc in thirst slight dec in UOP
  13. mod dehy
    6-9%, increase HR, normal BP, sunken font, dry mucus, delayed capillary refill, mod inc in thirst, less than 1ml/kg/hr UOP
  14. severe dehy
    10% or greater, inc HR, slight dec or normal BP, sunken fontanelle, dry mucus, cool, mottled extremities, sign inc in thirst, minimal UOP
  15. oral rehydration
    consider in mild-mod dehy, vomiting is not a CONTRA, 50-100ml/kg over a three to four hour period
  16. contraindications to oral rehydration
    hemodyn instability, serum Na<120 or >160, acute surgical abdomen, altered mental status, severe respiratory distress, ileus, continued vomiting despite attempts at oral rehydration(can admit to hospital)
  17. IV rehydration (5)
    • 1. assess degree of dehydration
    • 2, calc replacement fluids
    • 3. calc main fluids
    • 4.calculate ongoing losses
    • 5. determine how quickly to admin the replacement and main fluids