Fluid and Electrolyte Therapy in the Pediatric.PPTVIP

Fluid and Electrolyte Therapy in the Pediatric Patient Steve Piecuch MD, MPH Department of Pediatrics Lincoln Medical Center Maintenance Requirements Introduction to the Principles of Fluid and Electrolyte Therapy Important to understand the underlying physiologic principles of a therapy commonly employed in pediatrics Understanding basic principles essential for the understanding of the management of more complex disorders such as: Cholera Dengue Pyloric stenosis DKA Hyperosmotic non-ketotic coma Crystalloid and Colloid Crystalloid: Water and electrolyte solution Does not remain within the intravascular space but rather distributes to the entire extracellular space Only impacts on the intracellular space if it causes a change in extracellular osmolarity E.g.: 0.9% NaCl, D5 0.3% NaCl Colloid: Contains large particles which tend to remain within the blood vessels Colloid preferentially expands the intravascular space because the particles exert oncotic force which retains water within the intravascular space E.g.: 5% albumin, blood, dextran solution Isotonic Saline Solution Isotonic saline solution: Solution such as 0.9% NaCl or Ringer’s lactate with a Na concentration similar to that of plasma water Crystalloid distributes throughout the extracellular space Infusion of crystalloid will cause a fluid shift into or out of the intracellular space only if it creates an osmotic gradient between the extracellular and intracellular space Isotonic saline does not change the osmolarity of the extracellular space Therefore: Isotonic saline solution remains within and expands the extracellular space and has minimal effect on the intracellular space Maintenance Fluid and Electrolyte Requirements Maintenance: The replacement of normal ongoing losses Normally serum Na concentration is approximately 140 meq/l and serum K concentration is approximately 4 meq/l Maintenance solution replaces normal losses Maintenance solution does not have an electrolyte concentration equal to