Fluid Therapy
Neonates
Paediatrics
Note: ↓ BP occurs only in severe dehydration in children
www.rch.org.au
Dr Megan Corp 2014
- Ill newborns: 10% dextrose, no electrolytes
- due to physiological diuresis when <48h old
- Fluid requirements:
- Day 1: 60ml/kg/d
- Day 2: 80ml/kg/d
- Day 3: 100ml/kg/d
- Day 4: 120ml/kg/d
- Day 5: 150ml/kg/d
Paediatrics
- Patients with mild (<4%) dehydration have no clinical signs. They may have increased thirst.
- Moderate dehydration (4-6%)
- Delayed CRT
(Central Capillary Refill Time) > 2 secs - Increased respiratory rate
- Mild decreased tissue turgor
- Severe dehydration (≥ 7%)
- Very delayed CRT > 3 secs, mottled skin
- Other signs of shock (tachycardia, irritable or reduced conscious level, hypotension)
- Deep, acidotic breathing
- Decreased tissue turgor
Note: ↓ BP occurs only in severe dehydration in children
- Types of fluids and indications
- "Normal pathology" : 1/2 saline + 5% dex
- hypoNA/ SIADH : N saline + 5% dex
- Burns: Hartmann's (1st line)/ N saline (2nd line)
- DKA: Add KCL
- Bolus for Volume loss/ hypoglycaemia
- To ↑ vol: 10-20ml/kg bolus N saline
- To ↑glu: 2-3ml/kg bolus 10% dextrose
- IV rehydration
- Add 20mmol/L KCL
- NGT
- Use in 3-4y
- Easier to insert
- Safer rehydration mtd
- Break vomiting cycle
- Maintenance therapy:
- 3-10 kg: 4ml/kg/h
- 10-20 kg: 2ml/kg/h (+40ml/h)
- >20 kg: 1ml/kg/h (+40ml/h + 20ml/h)
- ** adjust lower for illness due inactivity**
- **Non dehydrated pneumonia, use 2/3 maintenance**
- ***Max: 100ml/h or 2400ml/d***
www.rch.org.au
Dr Megan Corp 2014