FluidsElectrolytes-BostonUniversity.pptVIP

Fluids Electrolytes Pediatric Emergency Medicine Boston Medical Center Boston University School of Medicine Objectives To discuss: Maintenance Fluids and Electrolyte Requirements Types of Dehydration Management of Dehydration Electrolyte Abnormalities Composition of Body Compartments Total Body Water TBW 50-75% of Total Body Mass TBW Intracellular Fluid ICF + Extracellular Fluid ECF ICF 2/3 of TBW ECF 1/3 of TBW -- 25% of body weight ECF Plasma intravascular + Interstitial fluid Body Water Compartments Related to Age Regulation of Body Fluids and Electrolytes Mechanism to Regulate ECF volume Anti-Diuretic Hormone ADH Kidney Increase water reabsorption ADH secretion is regulated by tonicity of body fluids Thirst Not physiological stimulated until plasma osmolality is 290 Regulation of Body Fluids and Electrolytes Aldosterone Released from the adrenal cortex Decrease circulating volume Stimulation by Renin-Angiotensin Aldosterone axis Increase plasma K Enhanced renal reabsorption of Na in exchange for K Na expansion of ECF Atrial Natriuretic Factor Secreated by the cardiac atrium in response to atrial dilatation regulates blood volume Inhibits Renin secretion Increase GFR and Na excretion Daily Maintenance Requirements 4cc, 2cc, 1cc rule 4 cc for the first 10 kg 2 cc for the next 10 kg 1 cc for each kg after Example: 27 kg child 4 cc for the first 10 kg 40cc 2 cc for the next 10 kg 20cc 1 cc for each kg after 7 cc 67 cc/hr Maintenance Requirements Maintenance Fluids: weight dependent age dependent: NS 0.9% Saline 154 meq Na/liter age 2 -3 years: D5 0.5 NS + 20 meq KCl/liter Up to age 2-3 years: D5 0.2 NS + 20 meq KCl/liter D5 50 gm/liter 5 g/dl Newborns often require D10 100 gm/liter 10 gm/dl Dehydration Epidemiology: One of the most common medical problems In the U.S. - 10% of all pediatric admissions Worldwide, over 3 million children under 5 years die from dehydration Estimation of Dehydration Dehydration Class