小儿补液(英文修).pptVIP

Fluid requirement at post operation Include potassium glucose and sodium 1/4~1/5 tension 10% GS 500ml 10%NaCl 10ml 10% KCl 15ml ( 9.5%GS、0.19%NaCl、0.29%KCl ) An 8 – month boy had diarrhea and vomited for 3 days, urine stream reduced, irritability. PE: Pulse rate 150/min, weight loss was 10%, blood pressure 65/40mmHg, skin color showed grey and skin turgor looked like tents. Mucous membranes were very dry; eye ball was sunken greatly, anterior fontanel depressed greatly. Abdomen extended, bowel sound diminished. Answer question 2 How to administer the fluid therapy? The first day fluid infusion ： Dehydration Fluid replacement=losses (Accumulation + ongoing + daily ) Accumulation ongoing daily total amount (ml/Kg) mild 50 10~30 60~80 90~120 moderate 50~100 10~30 60~80 120~150 Severe 100~120 10~30 60~80 150~180 Accumulation: accumulation losses Ongoing: Ongoing losses daily: Physiological requirement Step 1：Plan supplementary fluid. First body weight is calculated by formula of growth and development section. ——(6+8×0.25=8kg) ——2:1 sodium :20ml×8=160ml ——finished intravenously within 30min. Step 2：Acute loss be always isotonic dehydration, so we choose ： ——2:3:1 (2:glucose , 3: sodium, 1: 1.4% bicarbonate ) ——that belong to 1/2 tonicity. ——Repair of water and sodium deficits ● first 8-10 hours 8-10 ml/(kg·h) ● half of total loss volume (160×8)ml/2=640 ml. Step 3.：4:1 sodium ● be taken next 16 hours 5 ml/(kg·h) ● 80 ml/kg×8kg=640 ml (another half) Step 4：Potassium supplement 8kg×0.4g=3.2g/d. That means about 10% potassium chloride solution 32ml will be used b