Fluid and electrolyte imbalance Emad Al Khatib, RN,MSN,CNS

Distribution of body fluid *TBW *ICF *ECF ( intravascular, interstitial &trancelluler) Fluid % in child body ( 75%-80%) *keep balance of water & electro ( Bwt, age,activity level,&body temp)

Pediatric Fluid Therapy Principles Maintenance H 2 O needs: Weight in KgH 2 O fluid needs cc /kg /day cc/kg/day > cc/kg/day Add 12 % for every 0 C

Na + & K + Daily Needs Na+ = 3 meq / kg / day K+ = 2 meq / kg / day Notice: Daily fluid maintenance in pediatrics: 0.18% saline ( 30 meq Na+ ) + 2 meq kcl / 100 cc.

Nursing requirements of FLUID Increased requirement : Fever Vomiting Renal failure Burn Shock Tachypnea Gastroenteritis Diabetes (Insipidus, mellitus - DKA)

Decreased requirement CHF oliguric ( RF ) Increase ICP

Physical Signs of Dehydration

Correction of Dehydration Moderate to severe dehydration: IV push cc / Kg Normal saline (5 % albumin). Half deficit over 8 hours, and half over 16 hours.

Nursing Intervention 1. Assessment 2. History 3. Clinical observation 4. Intake & output measurement 5. Replace orally or IVF ( 1g wet diaper wt =1 ml urine )

Disturbance of F&E balance 1. Na 2. K 3. Ca ( Na is the primary osmatic farce ) Serum Osmolality Defined as the number of particles per liter. May be approximated by: 2(Na) + Glucose (mg/dl)/18 + BUN(mg/dl)/2.8 Normal range: mOsm/L.

Type of Crystalloid Fluids 1. Isotonic 2. Hypotonic 3. Hypertonic

Types of I.V solutions Solutions are three types - Isotonic it's total osmolality (TO) = TO of blood - Hypotonic: It's TO  TO of blood - Hypertonic: it's TO  TO of blood. * Electrolyte solutions considered isotonic If total electrolyte content (TEC)  310mEq/L. and hypotonic if TEC  250 meq/L and hypertonic if TEC  375 Meq/L