Fluid therapy in dehydrated children according to the degree of dehydration in details.

1. Fluid Therapy in Children
Ali S. Mayali

2. Objectives
• Introductions
• Types of fluids
• Clinical assessment sign of dehydration
• Management of dehydration

3. Introduction
• Dehydration is the loss of water and salts that are essential for
normal body function.
• Fluid therapy is intended to maintain the normal volume and
composition of body fluids and, if needed, to correct any existing
abnormalities.

4. Types of fluid
• Isotonic
• e.g. NS, DW 5% and Albumin 5%.
• Use: Increase circulating plasma volume when red cells are adequate.
• Hypotonic
• e.g. Half NS, One third NS.
• Use: Raises total fluid volume.
• Hypertonic
• DW 10% and 20%, 3% and 5% Sodium chloride solution and Albumin 25%.
• Use: Replaces fluid sodium chloride and calories.

5. Types of fluid

6. Clinical signs of dehydration
The initial assessment of
dehydration in young children
should focus on estimating
capillary refill time, skin turgor,
and respiratory pattern and using
combinations of other signs. The
relative imprecision and
inaccuracy of available tests limit
the ability of clinicians to estimate
the exact degree of dehydration.

7. Clinical signs of dehydration
• Mild dehydration (3% to 5% of body weight dehydrated): Thirsty/ ↓
Urine Output/ History of decreased intake and increased fluid losses.
• Moderate dehydration (7–10%): Intravascular space depletion is
evident by an increased heart rate and reduced urine output. Clear
physical signs and symptoms.
• Severe dehydration (10–15%): Is gravely ill/ The decrease in blood
pressure indicates that vital organs may be receiving inadequate
perfusion (shock).

8. Biochemical assessment of dehydration
• Laboratory testing often reveals normal electrolytes and acid base
balance in children with mild hypovolemia. As a result, measurement
of serum electrolytes is typically limited to children with moderate to
severe hypovolemia who require intravenous fluid repletion.

9. Biochemical assessment of dehydration
Serum sodium
Changes in the serum sodium concentration play an important role in deciding the
type and speed of fluid repletion therapy, especially in children with severe
hyponatremia or hypernatremia.
• Hyponatremia: Serum sodium less than 130 mEq/L reflects net solute loss in
excess of water loss. e.g. hypovolemia-induced secretion of antidiuretic hormone
[ADH] limits water excretion).
• Isonatremia: Solute is lost in proportion to water loss. In patients with secretory
diarrhea (e.g., Vibrio cholerae gastroenteritis).
• Hypernatremia: Water loss in excess of solute loss. In children with viral
gastroenteritis (e.g., rotavirus), the solute concentration of the diarrheal fluid
typically ranges between 40 and 100 mEq/L. Loss of this relatively dilute fluid will
tend to induce hypernatremia if there is no concomitant water intake. This entity
is referred to as hypernatremic dehydration.

10. Biochemical assessment of dehydration
• Serum potassium: Either hypokalemia (e.g. Gastroenteritis) or
hyperkalemia (e.g. Metabolic acidosis) can occur in hypovolemic
patients. Hypokalemia is more common.
• Serum bicarbonate: The most useful laboratory test to assess degree
of dehydration in children. A value below 17 mEq/L refer to a children
with moderate or severe hypovolemia.

11. Management
• Mild
• Moderate
• Severe

12. ORS
Mild Moderate
Unless IV rehydration therapy is indicated.
- Effective
- Can prevent dehydration if given early
- Cheap
- No chance of overhydration
Severe dehydration should be treated with IV fluid administration.

13. ORT

14. ORT
• Administration of ORT:
• Replace ongoing loss:
• Vomiting: 10 ml/ kg of ORS for each episode
• Diarrhea: 2 ml/kg of ORS for each episode
•Deficit replacement with ORS:
• Mild: 50 ml/kg over 4 hours.
• Moderate: 100 ml/kg over 4 hours.

15. Management
• Indications for IV re-hydration are:
• Circulatory instability or shock.
• Inability of the child to take ORS (eg, alteration in mental status, ileus,
or anatomic anomaly).
• Inability of the caretaker to provide ORS.
• Failure of ORS to provide adequate rehydration (eg, persistent
vomiting).
• Severe electrolyte problems in clinical setting where ORS cannot be
closely monitored or electrolytes frequently assessed.

16. Calculation of maintenance fluids based on
body weight (Wt.) in children and infants:
Each additional kg
20ml/kg/day for each additional kg body weight
Second 10kg
50ml/kg/day for the second 10kg body weight
First 10kg
100 ml/kg/day for the first 10kg body weight
Add 12% for every 1 Celsius increment of temperature.

17. Sodium and potassium requirement
•2-3 mEq/kg/day
•0.157 mEq in 1 cc of NS.Na+
•1-2 mEq/kg/day
•Give 1 mEq in 100 cc of fluidK+

18. Calculation of water deficit

19. IV push in emergency cases
• 20 cc/kg.
• within 30 mins.
• 3 trials only.
• NS or LR.
• If patient not improved try plasma expanders.

20. Hypo
• 50% 1st 8 hrs.
• 50% in next 16
hrs.
Iso
• 50% 1st 8 hrs.
• 50% in next 16
hrs.
Hyper
• 50% 1st 16 hrs.
• 50% in next 32
hrs.
check sodium for determination of infusion rate
Na

21. Calculation of glucose requirement
Concentration of glucose should not exceed 15% of fluid concentration.

22. Calculation of the rate
𝑀𝑎𝑐𝑟𝑜 𝑑𝑟𝑖𝑝 =
𝐼𝑉 𝑓𝑙𝑢𝑖𝑑 × 15
h × 60
𝑀𝑖𝑐𝑟𝑜 𝑑𝑟𝑖𝑝 =
𝐼𝑉 𝑓𝑙𝑢𝑖𝑑 × 60
h × 60

23. Thank you