INTRAVENOUS FLUIDS IN PEDIATRICS Dr Pankaj Sharma MD(Pediatrics)

HOW TO GIVE ? HOW MUCH TO GIVE ? WHAT TO GIVE?

HOW TO GIVE Electronic Devises. Infusion Sets Pediatric drip set Macro drip set Blood set

Macro set Pedia drip set Blood set

Pedia drip Set: 60 drops – 1 ml Macro drip Set: 15 drops – 1 ml Blood Set: 10 drops – 1 ml

No of dr/min = vol of infusion(ml) × Drop factor ——————— Durtn of infusion(min)

# NEVER CATCH UP WITH THE IV FLUIDS

Pedia drip set ml /hr = Dr / min Macro drip set ml/hr ÷ 4 = Dr / min Blood set ml/hr ÷ 6 = Dr /min

HOW MUCH TO GIVE 0 – 10 kg 100ml/kg in a day 11 – 20 kg 1000ml + 50ml/kg for each kg above 10 kg >20 kg 1500ml + 20ml/kg for each kg above 20 kg # max fluid we can give is 100 ml/hr or 2400 ml/day

Daily electrolyte requirement Na ⁺ 2-3 mEq/kg/day. K ⁺ 1-2 mEq/kg/day. Cl ⁻ 2 mEq/kg/day.

Na ⁺ K ⁺ Cl ⁻ mOsm/L Type of fluid 154 308 77 406 34 346 26 21 368 39 0.9% NaCl Normal Saline 154 308 0.45% NaCl 77 ½ DNS 5%D+ 0.45NaCl 406 0.2 %DNS 34 346 Isolyte -P 26 21 368 Isolyte-M 39 35 36 410 Ringer lac tate 130 4 109 272

Iso-p Iso-M 0.2DNS 0.3DNS

Appropriate Na⁺ in fluid. In hospitalized patient Vol depletion Inc ADH (respiratory infns, CNS infns, stress, pain etc) Hypotonic fluids increase risk of hyponatremia 0.2 NS is no longer recommended as standard maintenance fluid & its use is restricted in many hospitals.

Ideal maintenance fluids Children with NPO. 1/2 DNS + 20 mEq /L of KCl Children with risk of Inc ADH/Hypo Na⁺ DNS + 20 mEq /L of KCl During Surgery and Recovery 6-8 hrs DNS / RL * Inc ADH cond: RTIs –bronchiolitis, pneumonia/ CNS infectn.

D5 sol osmolality: 278 20 mEq/L KCl osmolality: 62 .2 NS osm : 68 .45 NS osm : 154 .9 NS osm : 308 Blood osm 285-295

KCl (Potassium chloride) KCl : 15% w/v 2 mEq of K⁺ = 1 ml Vial of 10 ml. Hence 1 vial = 20 mEq of K ⁺ Should be diluted atleast 50 times.

Replacement fluids for Diarrhoea Avr composition of diarrhoea Na ⁺ : 55 mEq/L K ⁺ : 25 mEq/L Bicarb : 15 mEq/L Replace stool each ml by ml Depending on wether the loss is rapid or slow : replace every 1-6 hrs. Solution for replacement: ½ DNS + 20mEq/L(10ml) KCl +30 mEq/L of Bicarbonate(30ml)

Bicarbonate NaHCO₃ NaHCO₃ : 7.5 % 1ml = 1 mEq of Na ⁺ 1 ml = 1 mEq of HCO₃⁻ 10 ml vial IS NOT COMPATIBLE WITH DOPA / DOBUTA Calcium MgSO₄ Atropine Cefotaxime.

10 kg baby maintanence Fluid : 1000 ml Na ⁺ : 20 -30 mEq K ⁺ : 10-20 mEq i.e 1000 ml of 0.2 DNS + 10 ml of KCl/ day. or 1000 ml of Iso-P/day @ 41 ml/hr or 41 dr/min in pedia drip set.

Maintenance fluids for 20 kg baby Maintainance fluid = 1500 ml. Na ⁺ requirement = 40 - 60 mEq. K ⁺ requirement = 20 – 40 mEq. Fluid : 1500 ml of 0.2 dNS + 15 ml of kcl. or Iso-p 1500ml /day i.e 500 ml of 0.2 dNS + 5 ml of kcl × 3

Replacement of fluids for Gastric fluids Avr composition of gastric fluids Na⁺ : 60mEq/L K⁺ : 10 mEq/L Cl⁻ : 90 mEq/L Replacement Fluid : NS + 10 mEq/L KCl ( 5ml) Replace output ml by ml every 1-6 hrly

KEY POINTS Fluids : 100 ml × upto 10Kg 50 ml × next 10 kg 20 ml × next every kg upto 2400ml Maintenance fluid : 500ml ½ DNS + 5 ml KCl 500 ml DNS + 5 ml KCl Gastric replacement : 500 ml NS + 2.5ml KCl Diarrhoea replacement : 500 ml ½ DNS + 5ml KCL + 7.5ml HCO₃ Pedia set ml/ hr = dr/min