Fluid Therapy 24 April, 2009 review

Ⅰ Ⅰ fluid balance in child 1. The total amount of body fluids in children ： The younger, The younger, the greater the proportion of water the greater the proportion of water 80% Neonate 80% 175% 1 month 75% 70% Infant 70% 65% Child 65% 60% ． Adult 60% ．

2. The distribution of body fluids ： The younger, The younger, the volume of extracellular fluid more relatively the volume of extracellular fluid more relatively ： body fluids ： Intracellular Fluid Extracellular Fluid ： Interstitial fluid, plasma, lymph fluid, cell secretion

The distribution of Body fluids in all ages （ accounted for Weight % ） 血 5% 间质 40% 细胞内 35% 间质 20% 间质 10~ 15% 间质 25% 细胞内 40% 血 5% 血 5% 血 5% 细胞内 40% 细胞内 40~45% 新生儿 80% ~1 岁 70% 2~14 岁 65% 成人 55~60%

3. Water demand volume Children need a large number of water, poor of Regulatory function, Prone to disorders of water metabolism In a period of rapid growth and development, Daily intake of water to retain the 0.5%~3% for the physical growth In a period of rapid growth and development, Daily intake of water to retain the 0.5%~3% for the physical growth Relatively more water loss is not dominant: about 2 times of adults Relatively more water loss is not dominant: about 2 times of adults Fluid exchange of the digestive tract faster Fluid exchange of the digestive tract faster Water metabolism is high ： Water metabolism is high ： – infant: Accounted for half of the total liquid volume ； – Adult : compared with 1 / 7 Water metabolism regulatory function of poor: kidney, lung 。 Water metabolism regulatory function of poor: kidney, lung 。

Ⅱ E Ⅱ Electrolyte Component ◆ Pediatric electrolyte Component of body fluids similar to adults. Extracellular Fluid Na + 、 Cl - 、 Hco 3 - Intracellular Fluid K + 、 Mg  、 Hpo 4 = protein ◆ Neonatus characteristic ： ◆ A few days after birth, serum potassium, chlorine, phosphorus and lactate Higher, Sodium, calcium, bicarbonate lower ◆ A few days after birth, discharge hydrogen poor, prone to acidosis

Ⅲ Ⅲ balance and adjustment Humoral regulation of acid-base balance  Buffer system Humoral regulation of acid-base balance  Buffer system NaHCO 3 /H 2 CO 3 =20:1 NaHCO 3 /H 2 CO 3 =20:1 Na 2 HPO 4 /NaH 2 PO 4 Na 2 HPO 4 /NaH 2 PO 4 plasma proteins buffer system  Lung ： Discharge or accumulate CO 2 （ Respiratory ）  Kidney ： Discharge hydrogen accumulate Sodium （ Metabolism ） （ Metabolism ） HCO 3 - NaHCO 3 /H 2 CO 3 =20:1 regulated HCO 3 - NaHCO 3 /H 2 CO 3 =20:1 There is a limit compensatory adjustment

Ⅳ Ⅳ acid-base balance marker ： () blood gas analysis ： ( normal value ) PH ： 7.4(7.35~7.45) PH ： 7.4(7.35~7.45) PaCO 2 ： 40(34~45)mmHg (respiratory) PaCO 2 ： 40(34~45)mmHg (respiratory) HCO 3 - ： 24(22~27)mmol/L (SB) (Metabolism) HCO 3 - ： 24(22~27)mmol/L (SB) (Metabolism) BE ： -3~+3mmol/L (Metabolism) BE ： -3~+3mmol/L (Metabolism) CO 2 CP ： 22(18~27)mmol/L CO 2 CP ： 22(18~27)mmol/L

Disturbance of acid-base balance respiratory acidosis respiratory alkalosis metabolic acidosis metabolic alkalosis （ Compensatory, Decompensatory ） （ Compensatory, Decompensatory ）

Fluid Therapy Treatment

Ⅰ Purpose Fluid Therapy Ⅰ Purpose of Fluid Therapy Restore and maintain blood volume, osmolality, pH and electrolyte composition To restore normal physiological function Correct to the body of water, electrolyte disturbance (Already exists)

Ⅱ The way of Fluid Therapy Oral Injection of vein

Ⅲ Fluid therapy  1 ） accumulated loss volume accumulated loss volume accumulated loss volume  2 ） Continued loss volume Continued loss volume Continued loss volume  3 ） Physiological needs Physiological needs Physiological needs The amount of liquid, the composition and completion time The amount of liquid, the composition and completion time

Cumulativelosssupplement To determine the volume mild ： 50ml/kg moderate ： 50~100ml/kg severe ： 100~120ml/kg According to the degree of dehydration, decision rehydration volume, composition, speed ( Ⅰ ) Cumulative loss supplement

To determine the component Isotonic dehydration ： 2/3~1/2 张 Hypotonic dehydration ：等张 ~2/3 张 Hypertonic dehydration ： 1/3~1/8 张 To determine the speed Principle ： first quickly, then slow Severe ： fluid expansion ： 20ml/kg within30’~1h the rest ： completed in 8~12h Cumulativelosssupplement

Common:1/2~1/3 张 10~40ml/kg.d ( Ⅱ ) Continued loss supplement To determine the volume To determine the component To determine the speed Continued loss losssupplement  Should be instillation evenly within 24 hours  Should be instillation after end up a cumulative loss within 14 ~ 16h

Common: 1/5 张 60~80ml/kg.d （ Including oral ） ( Ⅲ ) Physiological needs supplement To determine the volume To determine the component To determine the speed Physiological needssupplement  Should be instillation evenly within 24 hours  Should be instillation plus continued loss within 14 ~ 16h

( Ⅲ ) To correct acidosis ： deal with to cause mild ： deal with to cause ： Moderate, severe ： (40 - 所测 CO 2 CP Vol%) (40 - 所测 CO 2 CP Vol%) =(22 - 所测 CO 2 CP mmol/L)  0.6  kg =(22 - 所测 CO 2 CP mmol/L)  0.6  kg = BE  0.3  kg = BE  0.3  kg =  0.6  kg  Usually use half the amount 需碱性液 mmol mmol

Ⅳ Principles of Therapy 1 、先快后慢 2 、先浓后淡 3 、见尿补钾 4 、随时调整

Supplement Potassium Notes Give potassium after get urine Supplement Potassium in Concentration of Supplement Potassium in veins<0.3% Supplement Potassium speed: Supplement Potassium speed: >4~6 hours Potassium supplement should be continued 4 to 6 days Severity hypokalaemia ： Potassium supplement should be continued 4 to 6 days

Conversion the solution used 10%NaCl ： 1ml=1.7mmol 10%NaCl ： 1ml=1.7mmol 5%NaHCO3 ： 1ml=0.6mmol 5%NaHCO3 ： 1ml=0.6mmol 11.2%NaL ： 1ml=1mmol 11.2%NaL ： 1ml=1mmol 10%KCl ： 1ml=1.34mmol 10%KCl ： 1ml=1.34mmol

Oral Rehydration Salts ( ORS ) sodium chloride ： 3.5g sodium chloride ： 3.5g sodium bicarbonate() ： 2.5g(2.9g) sodium bicarbonate(sodium citrate) ： 2.5g(2.9g) potassium chloride ： 1.5g potassium chloride ： 1.5g glucose ： 20g glucose ： 20g Add water to 1000ml ， 2/3 张． Add water to 1000ml ， to become2/3 张． （ Na + 90mmol/L ， K + 20mmol/L ） child Should be diluted

ORS 机制 Na + - glucose coupling, transfer of small intestine Na + - glucose coupling, transfer of small intestine Na + – 葡萄糖 载 体 小肠上皮细胞 刷状缘 Na + 葡萄糖 Na + 葡萄糖 转运 细胞内  细胞间隙  血液 促进 Na + 、 水吸收  Na + ( 钠泵 )  细胞间隙 (Cl - )  渗透压   水分进入血液

ORS Characteristics of ORS ： Advantage ： –Close to plasma osmolality –Content of the concentration of Na + 、 K + 、 Cl - can correct the amount of loss –Children easily accept the taste –Sodium citrate to correct metabolic acidosis –2% glucose to promote sodium and water absorption maximum

ORS Characteristics of ORS ： Disadvantage ： –Liquid Tension higher （ 2/3 张） –Can not be used as supplementary to maintain the liquid –For newborns and infants, concentration of sodium is higher (Should be an appropriate dilution) (Should be an appropriate dilution)