小儿输液与输血__培训课件.pptVIP

* * * * * * The physiologic defi-cits from urine output and insensible losses of the skin and respiratory tract are equal to approximately 100 mL per 100 kcal metabolized per day. Simply stated, 1 mL of “water” is required for every 1 kcal of energy expended. * * * they recommended 2 mEq / 100 kcal/day of both potassium and chloride and 3 mEq mEq / 100 kcal/day It is beyond the scope of this paper to consider repair of deficits or replacement of continu- ing abnormal losses of water.”7 Unfortunately, clini- cians may often extrapolate the “4-2-1 rule” and the accompanying hypotonic solutions to clinical situa- tions where they may not be appropriate and could, in fact, be harmful. * considerable debate has occurred re- garding the amount of deficit generated by the nil per os (NPO) status and the existence of “third space losses.” As a result of the fasting state, children are pre- sumed to develop preoperative fluid deficits second- ary to continuing insensible losses and urine output. In 1975, Furman et al.9 proposed calculating the pre- operative deficits by multiplying the hourly rate, as dictated by the Holliday and Segar method, by the number of hours the patient was NPO. They then in 1986, Berry10 simplified the method of Furman et al. by delivering a bolus of basic salt solution to otherwise healthy children over the first hour of surgery. Berry concluded that children 3 years and younger should receive 25 mL/kg, whereas children 4 years and older should receive 15 mL/kg. In 1999, the American Society of Anesthesiologists published new fasting guidelines for elective surgery. Current recommendations allow administration of clear liquids up to 2 h before procedures requiring anesthesia. Whereas there are no data to determine the exact amount of fluid deficit that occurs in normal fasting children, strong evidence suggests that healthy adult patients will maintain normal intravascular volumes despite a prolonged fast. 12 * * The more recent studies on this