Maintenance fluid replacement Obligatory water loss Normal
fluid replacement * urine, sweat,stool Thirst ADH *Insensible water
loss Aldosterone 70% skin 30% lung no solute content Osmotic
Hydrostatic ECF ICF
Slide 3
Some causes of dehydration Vomiting Metabolic alkalosis
Hypokalemia Hyponatremic dehydration Diarrhea Iso,hypo,hyper
natremic dehy DKA Hyper tonic dehydration Cystic fibrosis sweating
diarrhea. Salt loss Fever 1C 10% water loss Intestinal Obstruction
Prolonged gastric aspiration hypo natremic dehydration Diabetes
Insipidus Pure water loss hypernatremic dehydration. Renal disease
Na+water loss Iso OR hyponatromic deh
Slide 4
Dehydration Simple deficit in body water Contraction of body
fluid space Both water and electrolyte contents Loss of ECF
ICF
Slide 5
Deficit : Cumulative body water and electrolyte losses that
occur prior to clinical presentation. Body losses: Absolute amount
of water lost always Exceeds the amount of solute loss. Every
dehydration tend to be hypertonic,Only kidneys prevent
hypertonicity.
Slide 6
Types Isotonic: 70% most common Na 135-145 meq/L
Slide 7
cont Hypertonic: 20% - Na 145 meq /L - Water loss> solute -
Renal circulation impaired kidney can't excrete solute. -? Salt
intake, - May occur in well nourished obese infants follow acute
process with marked anorexia and fulminant diarrhea.
Slide 8
CONT hypertonic - Signs of dehydration less than the actual
degree of dehydration fluid shift ICF ECF Doughy skin Parched
tongue Almost near normal B.P. Complications: Shrinkage of brain
cells hematoma Bleeding Brain edema while treatment Coma Seizure
Associated with acidosis Hypokalemia
Slide 9
HYPOTONIC 10%- - In an infant or a child with diarrhea whose
intake is electrolyte free. Weak tea,, Rice water,, diluted milk -
Chronically malnourished child with bouts of mild to moderate
diarrhea and poor intake. -Fluid shift ECF ICF - Well preserved
intracellular volume. -Collapse and shock with degree of
dehydration decrease Renal flow with milder degree of
dehydration.
Slide 10
HYPOTONIC Complication Convulsion due to hyponatremia
Circulatory collapse and shock even with milder degree of
dehydration Extra cellular fluid losses Intra cellular fluid shift
Volume depletion more than actual water loss Profound volume
depletion will lead to Renal failure -shock
Slide 11
DEGREE 10% Moderate Skin turger elasticity tenting fontanels
depressed Oliguria tears OR absent B.P. Still well maintained
Orthostatic B.P. Sunken eyes Obvious to the parents not to the
physician.
Slide 12
Cont, Moderate - Severe Hypovolemia due to contraction of
plasma volume Hypotension Cold extremities Tachycardia
Slide 13
Severe dehydration 15% Circulatory collapse B.P. Cool cyanotic
sweaty extremities Mottled skin Shock Death
Slide 14
Severe >10%Mild
II. Subsequent therapy. ( maintenance) How 1-10 kgs 100
mls/kg/24 h 10-20 kgs 50 mls/kg/24 h > 20 kgs 20 mls/kg/24 h
Example: Child weight is 25 kg what is his maintenance? 1 st 10 kgs
10 x 100 = 1000 mls 2 nd 10 kgs 10 x 50 = 500 mls > 20 kg 5 x 20
= 100 mls 1600 mls/24 h
Slide 21
2)Deficits *Degree of dehydration: 5% dehydration (mild) 50
mls/kg 10% dehydration ( moderate) 100 mls/kg 15% dehydration
(Severe) 150mIs/kg *Type of dehydration : According to Na level
Rate Type of fluid
Slide 22
A) Isotonic (Isonatremic) dehydration. Loss of isotonic fluid
from the body -No osmotic gradient between Intra + Extra cellular
fluids. -Full deficit correction over 24 hours 1/2 over 1 st 6-8h
1/2 over 16-18h. Type of fluid D 5 in 0.2 N.S. D 5 in 0.45
N.S.
Slide 23
B). Hypo natremic dehydration. -Na loss more than water loss.
ex. * with dysentery *Treatment with low Na fluid - Rate Full
deficit correction over 36h, 1/2over 6-8h.. the rest over16-18hour.
-Depend on... level of Na degree of dehydration
Slide 24
Type of fluids: D 5 IN 0.45 N.S. D 5 IN 0.9 N.S. depend on Na
level Usually no need to add Na to the fluid as correction of
dehydration will correct Na. If after correction of dehydration
still Na loss Add : 6 meq/kg Na cl Max 12ml/kg of 3% Na cl over 6 h
or Calculate Na deficit = (135 actual Na level) x 0.3 x B. W. in
kg.
Slide 25
C) Hyper natremic dehydration: -More serious. -Fluid therapy
replacement can be difficult. -Severe hyper osmolality may result
in cerebral damage and Hge. -Seizures occur during treatment as
serum Na returning to normal due to rapid correction, or the use of
hypotonic fluid. Treatment of convulsion: *Anti convulsant *Na cl
-
Slide 26
*Excess movement of water into cerebral cells during
rehydration with hypotonic saline,or rapid correction will lead to
Cerebral edema May be irreversible or fatal Type of fluid -Slow
rate in more important than type of fluid -Na drop should not be
more than 10 meq/L/ 24 hour D 5 0.45 N.S.
Slide 27
Rate: Very slow Can be done over days Usually 48 - 72 hours
***Example : Child weight 30 kg with 10% dehydration What is his
fluid requirement? 1)Maintenance: 30 kg 10 x 100 = 1000 10 x 50 =
500 1700 mls/ 24 h 10 x 20 = 200 2)Deficit 10% dehydration = 100
mls/kg 100 x 30 = 3000 mIs Type and rate according to type of
dehydration
Slide 28
3). Ongoing losses: --Continuous pathological losses Stool -
diarrhea Vomitus N.G. tube *Small amount 50 mls/time *Moderate
amount 100 mls/time *Large amount 150 mls/time To be added to
deficit, calculated every 6-8h.
Slide 29
ORS To all patient but: 1. Severe dehydration in patient whose
care giver cant administer fluids. 2. If ongoing losses cant be
compensated orally. 3. Severe vomiting. Value: Rapid rehydration
with rapid replacement of ongoing losses during the first 4-6
hours. Once rehydrated oral maintenance solutions.
Slide 30
Home remedies? Decarbonated soda beverages Fruit juices Tea Not
suitable: Inappropriate high osmolarities due to CHO conc. Low Na
content hypo natremia Inappropriate CHO to Na ratio
Slide 31
Oral rehydration solution When to use it? Contraindication ..
Types . Rate.. Types WHO Pedialyte Na meq/L 90 45 K meq/L 20 20 C1
meq/L 80 35 HCO 5 meq/L 30 30 citrate Glucose g/dl 2% 2.7% Rate: 50
ml/kg .within 4 hours for patient with mild dehydration 100 ml/kg
within 6 hours for patient with moderate dehydration Small amounts
+ short intervals
