Intravenous fluid ther enous fluid therapy in children and y in. One mlkg of 3% sodium chloride will normally raise the serum sodium by 1mmoll. Patient has complex fluid or electrolyte replacement or. Traditionally, the first step in determining the hourly fluid requirements for a child described by holliday and segar and coined as the 421 rule. Algorithms for iv fluid therapy in children and young people. Hyponatraemic seizures respond poorly to anticonvulsants initial management is to give an infusion of 3% nacl sol. Serious morbidity can result from fluid and electrolyte imbalance. Fluid resuscitation is an integral part of critical care and forms part of many resuscitation guidelines 1, 2. By paying close attention to the fluid needs of pediatric patients and monitoring response to fluid therapy, the pediatric pharmacist can have a positive influence on the health of the child. Maintenance therapy replaces the ongoing daily losses of water and electrolytes occurring via physiologic processes urine, sweat, respiration, and stool, which normally preserve homeostasis. Recent literature has emerged in which researchers describe the contextdependent use of ivfs, which should be prescribed, ordered, dosed, and delivered like any other drug.
A practice of anesthesia for infants and children, cote, ch 11. Paediatric intensive care clincial practice guideline fluid therapy introduction. Look for clinical dehydration and hypovolaemic shock. Managing hyponatraemia that develops during intravenous fluid therapy. Paediatric fluid management tutorial for medical s youtube. The causes of catastrophic events, such as cardiac arrest, are.
Hydration status can affect the dose needed to achieve therapeutic concentrations, and dehydrated patients may be at risk for toxicity if standard doses of drugs with high volumes of distribution are used. Perioperative intravenous fluid therapy in children. Intravenous fluid therapy is a high risk activity in the paediatric population. Paediatric haematologyoncology ward officers handbook. Intravenous fluid therapy in children and young people in hospital ng29. Water and electrolyte homeostasis in newborn infants is influenced by numerous factors, including gestational age, postnatal physiological changes in renal function, altered response to hormones, redistribution of total body water, and water loss secondary to environmental factors. Management of acute gastroenteritis, fourth edition summary the infants and children, management of acute gastroenteritis, clinical practice guideline, reflects what is currently regarded as a safe and appropriate approach to the. Evidence for technical update of pocket book recommendations. Filston, md division of pediatric surgery and pediatric trauma, department of surgery, university of tennessee medical center, knoxville, tennessee division of pediatric surgery and. Children who are unable or unwilling to drink or who have repetitive vomiting can receive fluid replacement orally through.
Invasive and noninvasive pediatric mechanical ventilation. Feb 19, 2019 fluid management of the pediatric surgical patient represents an important aspect of medical care, particularly for initial treatment of the ill child. Fluid therapy can also have an impact on drug therapy. Intravenous fluid therapy in children and young people in. If you continue browsing the site, you agree to the use of cookies on this website. Organizing fluid needs into maintenance, deficit, and replacement therapy can provide a systematic, understandable approach to determining fluid therapy. The force of an impact is transmitted widely through a childs body, resulting in multisystem injuries in almost 50% of children with. It was research initially performed in the pediatric critical care setting that triggered. Monitoring fluid and electrolyte therapy is an important role of the pediatric. Children have less fat, more elastic connective tissue, and a pliable skeleton protecting tightly packed abdominal and thoracic structures. Maintenance intravenous fluids in children american academy of. Pdf managing fluids and electrolytes in children is an important skill for pharmacists, who can play an important role in monitoring therapy.
Best practices for iv safety in pediatrics photo courtesy of cardinal every institution caring for neonates, infants, andor children must perform an evaluation of systems and resources utilized in medication use processes. Fluid and electrolyte management in the pediatric surgical. Perioperative fluid replacement for children and infants is a complex and somewhat controversial topic. Pdf fluid and electrolyte management in term and preterm. Fluid and electrolyte management in term and preterm neonates article pdf available in the indian journal of pediatrics 753. Guidance for fluid requirements for patients over one month of age is outlined in box 1 see pdf. Wide practice variation exists in the provision of maintenance fluids for pediatric patients admitted to the general ward. Hala alnahrain universitycollege of medicine iraqbaghdad. Principles of fluid management for paediatric patients. His new textbook handbook of fluid and electrolytes in pediatrics is to be published by humana press springer. For children in body appearance related to the planned cranial surgery. Fluid management for the pediatric surgical patient. Pediatric emergency medicine, dschool of medicine, university of. Second, a team approach involving physicians, nurses, and respiratory therapists is essential.
Diagnosis and management of dehydration in children. The american academy of pediatrics recommends oral rehydration therapy ort as the preferred treatment of fluid and electrolyte losses caused by diarrhea in children. The goal of the pediatric patient assessment process is similar to that of the adult patient. Recommendations for management of common childhood conditions. The resuscitative phase is the acute presentation window, when ivfs are needed to restore adequate tissue. Filston, md, department of surgery, box u11, university of tennessee medical center, 1924 alcoa highway, knoxville, tn 37920 fluid and electrolyte management in the pediatric surgical patient howard c. Pdf the world health organization recommendations on management of common childhood illnesses affect the lives of millions of children admitted to. Fluid management for the pediatric surgical patient powerpoint. Witt l, osthaus wa, bunte c et al 2010 a novel isotonicbalanced solution with 1% glucose for perioperative fluid management in childrenan animal experimental study. Fluid and electrolyte administration in children sickkids. Csw maintenance iv fluid management pathway seattle childrens. Evidence for recommendations on the choice of intravenous. Maintenance fluid requirements are calculated based on a childs body weight.
Consensus guidelines for iv fluid management ucsf benioff. Pdf pediatric fluid and electrolyte therapy researchgate. Newborn conditions, dysentery, pneumonia, oxygen use and delivery, common causes of fever, severe acute malnutrition and supportive care. Ban slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Maintenance requirements vary depending on the patients underlying clinical status and setting, especially in postoperative or hospitalized children.
A free powerpoint ppt presentation displayed as a flash slide show on id. Pdf who guidelines on fluid resuscitation in children. Standardize care of pediatric patients who require maintenance iv fluids in the hospital. Algorithms for iv fluid therapy in children and young people in hospital algorithm 2. Fluid management in pediatric patients springerlink. Replace deficit boluses 50% over 1st 8 hours, then 50% over next 16 hours. Intravenous fluid therapy in children and young people in hospital. Fluid and electrolyte management in the newborn university. Critically ill patients usually are admitted with already electrolyte imbalance or conditions where fluid therapy can improve their outcome. Likewise, it would be optimal to have a brief understanding of the water and electrolyte distribution in children at differs ages.
Demonstrate a thorough understanding of oral rehydration therapy ort by designing a treatment plan to manage, at home, a child with moderate dehydration due to an acute diarrheal illness. Aug 21, 2015 how to manage dehydartion in children. Fluid management and dehydration texas tech university. Apr 05, 2014 fluid therapy in paediatrics prepared by. Ppt fluids and electrolytes in pediatrics powerpoint. The pediatric anesthesia handbook,bell,kain, hughes,ch 4. Children with severe dehydration eg, evidence of circulatory compromise should receive fluids iv. Maintenance requirements vary depending on the patients.
The goals of maintenance intravenous fluid management are to preserve adequate effective circulating volume, maintain normal electrolytes, and avoid fluid overload. Dec 15, 2009 his new textbook handbook of fluid and electrolytes in pediatrics is to be published by humana press springer. A service of the national library of medicine, national institutes of health. Fluid management for the pediatric surgical patient powerpoint free download as powerpoint presentation. An understanding of the physiology of fluid requirements is essential for care of these children. In the face of significant illness or injury or in the setting of an invasive surgical procedure, fluid balance becomes even more precarious. Fluid management and dehydration national pediatric nighttime curriculum written by dr. Fluid and electrolyte requirements are also influenced by a variety of medical conditions that affect preterm infants e. Fluid management of the pediatric surgical patient represents an important aspect of medical care, particularly for initial treatment of the ill child.
The american academy of pediatrics and the who both recommend oral replacement therapy for mild and moderate dehydration. Fluid resuscitation use glucosefree crystalloids that contain sodium in the range 1 154 mmollitre, with a bolus of 20 mlkg over less than 10 minutes for children and young people, and 1020 mlkg over less than 10 minutes for term neonates. Intravenous fluid management in pediatrics authorstream presentation. Neonatal fluid requirements should be calculated by a neonatologist, since both volume and glucose concentration can vary depending on a neonates clinical condition. Fluids and electrolytes ucsf benioff childrens hospital. You can access the worksheet and quiz any time to see how much knowledge you have about fluid replacement in pediatrics. Fluid overload in a south african pediatric intensive care. The goals of maintenance intravenous fluid management are to preserve adequate effective circulating. Feb 07, 2016 the best seminar in pediatric fluid therapy on slideshare.
The goal of fluid therapy is to preserve the normal body water volume and its electrolyte composition. Incorrect prescription or administration of intravenous fluids has caused harm and deaths in children. Algorithms for iv fluid therapy in children and young. Professor, department of pediatrics sapthagiri hospital, bangaluru. Calculation fluid electrolyte management in pediatrics youtube. Intravenous fluid management in pediatrics authorstream. Poor fluid management can result in very devastating results, even death. Mph inpatient pediatrics jan 2011 case 2 a 4 year old male presents with a history of vomiting and diarrhea.
Use the enteral route for fluid replacement where possible. Intravenous fluid guidelines paediatric and neonatal. Managing fluids and electrolytes in children is an important skill for pharmacists, who can play an important role in monitoring therapy. David is a pediatric nurse in a busy intensive care unit. Fluid resuscitationtreatment of dehydration for dehydration,shock,blood lossisotonic normal saline or lactated ringers give 20mlkg as bolus. Northern california pediatric hospital medicine consortium. Smiths anaesthesia for infants and children 7 th edition. The normal newborn is particularly prone to developing derangements in fluids and electrolyte concentrations. Careful fluid and electrolyte management is essential for the well being of the sick newborn infant. However, an increasing body of evidence shows that fluid overload fo after patient stabilization impedes organ oxygenation and can lead to increased morbidity. Various physiologic and hormonal effects must be considered in order to deliver rational management of fluid and electrolyte therapy in term and preterm neonates. The goal of fluid and electrolyte management is to replace losses of water and electrolytes so as to.
Fluid balance management in pediatric critically ill patients is a challenging task, since fluid overload fo in the pediatric icu is considered a trigger of multiple organ dysfunction. He is currently working with jason a 16monthold infant with fluid volume deficiency related to dehydration. Jan 03, 2018 fluid electrolyte management in pediatrics. Fluids management and transfusion therapy in pediatrics.
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