Infantile Liquid Therapy

Objective

Summary

Characteristic of Infantile Body Fluid Balance

Fluid, Electrolyte, & Acid-base Disorders

Common Solution of Liquid Therapy

Infantile Diarrhea Liquid Therapy

Objective• Characteristic of Infantile Body Fluid Balance ——Realized

• Pathophysiology of Infantile Fluid, Electrolyte & Acid-base Imbalance ——Be familiar with

• Clinical menifestations of Infantile Fluid , Electrolyte & Acid-base Disorders ——Mastered

• Common Solution Component of Liquid Therapy ——Be familiar with• Liquid Therapy of Infantile Diarrhea ——Mastered

Summary

Body fluid is important component of human body and the physiological equilibrium of body fluid is an important factor for human living. The dynamic equilibrium of fluid, electrolyte, acid-base, osmotic pressure depends on normal regulating function of nerve, incretion, lung and kidney. Because of the infantile physiologic peculiarity, These systematic functions are easily affected by diseases and/or environment and are maladjusted. Therefore, the disorder of water, electrolyte and acid-base is common in pediatric clinic.

Characteristic of Infantile Body Fluid BalanceA. Total body water & its distributionBody water compartments related to age (total body mass%)

 

Age TBWECF

ICFPlasma ISF

Newborn infant 78 6 37 35

1 year 70 5 25 40

2 ～ 14 years 66 5 20 40

Adult 55 ～ 66 5 10 ～ 15 40 ～ 45

TBW: total body water ECF: extracellular fluid ICF: intracellular fluid ISF: interestitial fluid

Characteristic of Infantile Body Fluid Balance

B. Electrolyte composition of body fluid

ECF: Na+ 、 Cl- ， HCO3 -

ICF: K + 、 Mg 2+ 、 HPO4 2- 、 Protein

C. Water metabolism

a. Large water requirements, swift water exchange, unobvious water loss (double adult’s amount ). Infant’s water exchange amount is 1 / 2 of ECF , the adult’s is just 1 / 7.

b. Immature body liquid regulating function , immature concentration and dilution function of infantile.

Fluid, Electrolyte & Acid-base DisordersA. Degree of dehydration

Dehydration Mild Moderate SevereDecrease in

body weight5 ％

(50ml / kg)5 ～ 10 ％

(50 ～ 100ml / kg)>10 ％

(100 ～ 120ml / kg)

PsycheDepressed,

hyperirritableDepressed,

hyperirritableLethargic,

coma

Orbit, Fontanel Sunken ± Sunken Severely sunken

Skin turgor Normal ± Decrease Markedly decreaseMucous

membranes Dry ± Dry Severely dry

Tears Decrease ± Decrease Absent

Urine Mild oliguria oliguria Anuria

Blood pressure Normal Normal Low

Type of dehydration

PathogenySerum sodium

Pathophysiology &

clinical characteristic

IsosmoticAcute

gastrointestinal fluid lose

130 ～ 150

mmol / L

ECF: decrease, Osmotic pressure

(intracellular = extracellular)Dehydrant volume accord with

dehydrant physical sign

HypotonicChronic

gastrointestinal fluid lose

<130

mmol / L

ECF: severely decrease,

Easily shock ， Severer dehydrant sign than the other

two kinds

Hyperosmotic High grade

fever, Infection>150

mmol / L

ICF: severely decrease,

Milder dehydrant sign than the other two kinds

Fluid, Electrolyte & Acid-base DisordersB. Property of dehydration

C. Metabolic acidosisPathogeny

1. The lose of large amount of basic substances （ gastrointestinal tract, kidneys ）

2. Too much Acid metabolite （ hungriness, diabetes, renal failure, hypoxia ）

3. Too much acid substance intake （ long time to take calcium chloride, ammonium chloride, amino acid etc. ）

Degree

Mild HCO3- 18~13 mmol / L

Moderate HCO3- 13~9 mmol / L

Severe HCO3- <9 mmol / L

Fluid, Electrolyte & Acid-base Disorders

D. Hypokalemia

Pathogeny

1. Lack of intake

2. Loss of kalium from kidneys or gastrointestinal tract

3. Burn, dialysis etc.

4. Abnormal kalium distribution inside or outside cells

（ alkalosis, insulin therapy 、 periodic anesthesia ）

Fluid, Electrolyte & Acid-base Disorders

Clinical menifetation 1. Nervous system ——depressed

2. Muscle——inertia of limbs ， muscular tension down ， severely

retardant paralysis ， respiratory muscle paralysis

3. Heart —— heart rate increasing, arrhythmia, Adams － Stokes

syndrome, heart rate decreasing ， atrioventricular block,

heart sound lowering,

cardiogram: U wave appearing ， U≥T ， flattened T

wave

4. Kidney—— concentrating function lowering, urine volume increasing

Fluid, Electrolyte & Acid-base Disorders

Common Solution of Liquid Therapy

A. Nonelectrolyte solution5 ％、 10 ％ glucose

B. Electrolyte solution 0.9 ％ NaCl 、 1.4 ％、 5 ％ NaHCO3 、 10 ％ KCl

C. Mixed solutions refer to the following table

Common mixed solution

0.9% NaCl 1.4% NaHCO3 5~10%G.S

2:1 2 1 －

3:2:1 2 1 3

4:3:2 4 2 3

6:2:1 2 1 6

Common Solution of Liquid Therapy

Infantile Diarrhea Liquid Therapy

A. Volume

Degree

Total volume

Cumulated losing volume

Keep transfusing period

（ physiological need, losing continuing ）

Mild 90 ～ 120ml/kg 45 ～ 60ml/kg 45 ～ 60ml/kg

Moderate 120 ～ 150ml/kg 60 ～ 75ml/kg 60 ～ 75ml/kg

Severe 150 ～ 180ml/kg 75 ～ 90ml/kg 75 ～ 90ml/kg

B. Quality

Dehydrant categoryCumulated losing

volume

Keep transfusing period

（ physiological need, losing continuing ）

Hypotonic dehydration 4:3:2 1/3 ～ 1/4

Sodic solution

Isosmotic dehydration 3:2:1 1/3 ～ 1/4Sodic solution

Hyperosmotic

dehydration

1/3

Sodic solution1/3 ～ 1/4

Sodic solution

Infantile Diarrhea Liquid Therapy

C. Speed

Total volumeCumulated losing

volume

Keep transfusing period

（ physiological need, losing continuing ）

24 h 8 ～ 12 h 12 ～ 16 h

－ 8 ～ 10ml / kg /h 5ml / kg /h

Infantile Diarrhea Liquid Therapy

D. Shock volume expansion

Volume Solution Speed

20ml/kg2:1 or 1.4 ％ NaHCO3 30 ～ 60min

Infantile Diarrhea Liquid Therapy

Total volume ≤ 300ml

E. Treatment of metabolic acidosis Mild or moderate metabolic acidosis metabolic acidosis:

No special treatment

Severe metabolic acidosis ： 1.4%NaHCO3 3ml/kg ， [HCO3-]

level can increase about 1 mmol.

F. Treatment of hypokalemiaSupply kalium after urination (urination 6 hours of preadmission,

bladder percussing － dull note)

Kalium supplement concentration: 0.2 ～ 0.3 ％ (>H0.3 ％ )

Venoclysis period of total Kalium supplement per day <H8 hours.

Infantile Diarrhea Liquid Therapy

Case analysis Infant, male, 9 months, diarrhea 2 days, admission date

1998-08-10. After eating un-boiled bean curd 2 days ago, yellow waterish stools, bulky, no blood, no tenesmus, defecation 10 ～ 15/day; one stool 6 hours of preadmission, a little, yellow urine. Physical examination ： T38ºC, R32/min, P120/min, dyspyoria, Fontanel 1.5×1.5cm2, sunken, orbit sunken, decreased Skin turgor, dry lip, dry periglottis, pharynx ( － ), heart rate 120/min, no arrhythmia, mild dull heart sounds, lungs( － ), mild abdomen swelling, soft abdomen, liver 1.5cm below ribs, bowel sounds 10 ～ 12/min, no high notes ， two lower limbs patellar reflex (negative)

Infantile Diarrhea Liquid Therapy