1. Fluid Therapy 24 April, 2009 review

2. 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% ．

3. 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

4. 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%

5. 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 。

6. 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

7. 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

8. 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

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

10. Fluid Therapy Treatment

11. 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)

12. Ⅱ The way of Fluid Therapy Oral Injection of vein

13. 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

14. 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

15. 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

16. 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

17. 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

18. ( 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%) 2.2 2.2 =(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

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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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)