F LUID AND E LECTROLYTES B ALANCE IN C HILDREN

F LUID REPLACEMENT Replacing the fluid deficit, maintenance requirements and replacement of losses. Vital in infants and young children because of their high total body water, basal metabolic rate, and daily turn-over of water. Should children experience excessive fluid losses, they may become dehydrated. And if left untreated  may altered level of consciousness, vascular collapse, renal failure and death.

D ISTRIBUTION OF TOTAL BODY FLUID Adult 60% of adult body weight is fluid. Intracellular fluid (ICF), within the cells = 40% of body weight. Extracellular fluid (ECF) = 20% of body weight. Developmental Differences (Children) Infants and young children 4 areas of immature functioning Increased fluid I/O relative to size (Total body fluid in children is 20% more than adult) Greater surface area relative to size - > water loss through skin Increase metabolic rate up to 2 years Immature kidney function – requires more fluid to excrete wastes

Causes of fluid loss Excessive vomiting or diarrhea Hemorrhage Some medications – diuretics Surgery Fasting over night prior to surgery

Signs and Symptoms Thirsty Dry mouth Lethargy and irritable to touch Sunken fontanel Decrease blood volume (Hypotension, tachycardia, oliguria) Decrease tissues perfusion - cyanosis (check capillary refill time) Tissue dehydration (loss of skin turgor)

Management Divided into 3 phases:- Deficit therapy Maintenance therapy Replacement therapy Deficit therapy – refers to the management of fluid and electrolytes losses that occur prior to presentation for surgery and itself has 3 components: a.) estimation of dehydration severity (from history and clinical evaluation

b.) determination of fluid deficit type (due to overnight fasting) c.) deficit repair Maintenance fluid therapy On going fluid and electrolytes requirement therapy during the course of surgery Replace the losses from insensible losses (evaporative loss) and urinary loss. Replacement therapy Replace ongoing abnormal fluid and electrolytes losses [from third space loss, blood loss]

Obtain history from parents to assess the state of hydration Recognize the physical findings Information giving of – importance of initial fluid replacement and maintenance to parents and child accordingly Explain the consequences of electrolytes imbalance Explain the used of oral rehydration therapy [GE] I/O updates regularly