1. INTRAVENOUS FLUIDS IN PEDIATRICS
Dr Pankaj Sharma
MD(Pediatrics)

3. HOW TO GIVE ?
HOW MUCH TO GIVE ?
WHAT TO GIVE?

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

5. Macro set Pedia drip set Blood set

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

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

8. # NEVER CATCH UP WITH
THE IV FLUIDS

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

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

11. Daily electrolyte requirement
Na ⁺ mEq/kg/day.
K ⁺ mEq/kg/day.
Cl ⁻ mEq/kg/day.

12. 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

13. Iso-p Iso-M DNS DNS

14. 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.

15. 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.

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

17. 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.

18. 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)

19. 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.

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

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

22. 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

23. 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