TOTAL DAILY FLUID REQUIREMENT

For infants 3.5 to 10 kg 100 ml/kg

Children 11 to 20 kg 1000 ml + 50 ml/kg (over 10 kg)

Children >20 kg 1500 ml + 20 ml/kg (over 20 kg)

Maximum of 2400 ml per day

ASSESSMENT FOR DEHYDRATION

Parameters Mild Dehydration Moderate Dehydration Severe Dehydration
General appearance Well, alert Restless, irritable Drowsy, lethargic
Eyes Normal Sunken Very sunken
Tears Present Absent Absent
Fontanelle Normal Depressed Very depressed
Lips & Oral mucosa Moist Sticky Dry
Skin turgor Slightly decreased Decreased (1-2 secs) Very decreased (>2 secs)
Thirst Normal Eager to drink Unable to drink
Pulse rate Slightly increased Weak, thready pulses Rapid, non-palpable
Blood pressure Normal Decreased May be non-recordable
Respiratory rate Slightly increased Increased Deep and rapid
Urine output Normal Reduced Markedly reduced
Treatment PLAN A PLAN B PLAN C
 FOR STABLE PATIENTS REQUIRING FLUIDS

LUDAN’S METHOD
Weight Mild Dehydration Moderate Dehydration Severe Dehydration

< 15 kg 50 ml/kg 100 ml/kg 150 ml/kg

> 15 kg 30 ml/kg 60 ml/kg 90 ml/kg

IV Fluids PLR 1/4 computed x 1 hr PLR 1/3 computed x 1 hr

D5 0.3 NaCl x 6 – 8 hours
& Rates D5LR 3/4 computed x 5 – 7 hrs D5 0.3 NaCl 2/3 computed x 5 – 7 hrs

FOR UNSTABLE PATIENTS (SHOCK)

20 ml/kg PNSS given IV BOLUS (not fast drip) up to 3 doses

Reminders:
ü DO NOT exceed the total daily fluid requirement
ü Re-assess every after bolus, check pulses first, then BP
ü If still in shock, consider Dopamine drip, then Epinephrine drip

ORS HYDRATION GUIDELINES

Volume of ORS to be given Volume of ORS to be
Age
after each loose stools provided at home
< 24 months 50 to 100 ml 500 ml per day
2 – 10 years 100 to 200 ml 1,000 ml per day
> 10 years Ad lib 2,000 ml per day


MAINTENANCE FLUID
HOLLIDAY-SEGAR METHOD
per day per hour
First 10 kg 100 ml/kg/24 hours 4 ml/kg/hour
Next 10 kg 50 ml/kg/24 hours 2 ml/kg/hour
More than 20 kg 20 ml/kg/24 hours 1 ml/kg/hour

Infants: D5 IMB 500 ml

Children: D5NM 500 ml or 1,000 ml

Conditions requiring increased water requirement

12% increase for each

Fever
degree >37.5oC
Sweating 10 – 25% increase
Sustained hyperventilation / Excessive muscular activity 25 – 50 % increase
Hypermetabolic states
25 – 50% increase
(eg. Severe thermal injury, thyrotoxicosis, salicylate toxicity, etc.)
Newborn and young infant on radiation therapy / phototherapy 20% increase

Conditions requiring reduced water requirement

Edematous and anti-diuretic states 30% reduction

Hypothermia 15% reduction
Sedated / Paralyzed patient 40% reduction
Infants and children nursed in high environmental humidity 25% reduction
Enclosed incubator 25 – 50% reduction

Patient Assessment During Rounds

F Fluids à Show computation of TFR, current IV fluids, fluid output
R Respiration à Respiratory rate, quality of breathing, new onset crackles
I Infection à Assess for presence of fever and possible source

C Cardiac à Heart rate, peripheral pulses, capillary refill time, murmurs

H Hematologic à Abnormal blood counts, comparison from previous
M Metabolic à Acid-base balance, electrolytes, renal function, etc.
O Output & Input à Normal is 1 – 2 cc/kg/day, always show computation
N Neurologic à Level of consciousness, GCS, orientation, reflexes, etc.
D Diet à Good or poor feeding, diet not tolerated, check tube placement