I.

V fluid
Types of dehydration:
1- no or minimal dehydration
Percentage of wt. Loss in infants <5%
Percentage of wt. loss in children < 3%
2- mild to moderate (some) dehydration:
Percentage of wt. Loss in infants 5_10%
Percentage of wt. Loss in children 3_6%
3-Severe dehydration
Percentage of wt. Loss in infants >15%
Percentage of wt. Loss in children>9%
Calculation of fluid
Deficit
In infants:
 Mild dehydration 50ml/kg
 Moderate dehydration 60_100ml/kg
 Severe dehydration 110_150 ml/kg
In Children:
 Mild dehydration 30ml/kg
 Moderate dehydration 60ml/kg
 Severe dehydration 90ml/kg
Maintenance:
 1st 10kg x 100ml
 2nd 10 kg x 50 ml
 More than 20kg x 20ml
‫‪Shock therapy: given in severe dehydration : 20 ml/kg NS 0.9% in 20 min.‬‬
‫‪( maximum 1 hour ) If no response repeat shock therapy, if also no response‬‬
‫)‪give: albumin + fresh frozen plasma (if hypoalbuminemia or coagulopathy‬‬
‫‪Or blood if anemia give 10ml/kg over 1 h‬‬
‫‪Types of fluid :‬‬
‫‪Deficit:‬‬
‫)‪give D1/2 NS ( if isonatremic : Na ( 135_145‬‬
‫‪Maintenance:‬‬
‫‪ give D1/4 NS: if < 10kg‬‬
‫‪ give D1/2 NS : if >10kg‬‬
‫‪ If hyponatremic Na < 135‬‬
‫‪ If < 120 : give hypertonic NS (0,3%): 3ml/kg in 30 min‬‬
‫‪ When Na reaches 125 :start NS (0,9%) first choice or DNS Or D 1/2 NS‬‬
‫‪ NS‬بذيذ يكىٌ يعدل ازحفاع انصىديىو‬ ‫يعخًد االخخياز عهً َسبت انصىديىو ديذ َبدأ‬
‫(‪ )12mEq/24h‬إذا كاٌ طهىع انصىديىو بًعدل أسسع يٍ َصف يهي ‪َ ،‬ذىل نـ ‪ DNS‬وإذا ضم‬
‫طهىعه سسيع َذىل نـ ‪D1/2NS‬‬
‫عُد وصىل ‪ Na‬إنً (‪ )130-135‬يفضم حذىيم ‪ fluid‬إنً ‪ D1/2NS‬وَسخًس عهيه إنً آخس شيء((أو‬
‫‪ D1/4NS‬إذا كاٌ ‪))infant‬‬
‫))‪ Hypertonic :- ((Na > 145‬‬
‫َعطي ‪ D1/2NS‬بذيذ يكىٌ َزول ‪َ Na‬صف يهي بانساعت وإذا كاٌ انُزول بطيء َذىل ‪ DNS‬وإذا‬
‫ضم َزونه بطيء َذىل ‪NS 0,9%‬‬
‫وإذا كاَج َسبت انصىديىو ‪َ 531 – 523‬صذخ َسبت انصىديىو خالل يىو وادد وإذا كاَج ‪:‬‬
‫‪ 511 – 531‬خالل يىييٍ‬
‫‪ 511 -515‬خالل ‪ 1‬أياو‬
‫‪ 594 -512‬خالل ‪ 2‬أياو‬
‫مالحظة ‪ :‬خالل فخسة انخصذيخ نهصىديىو سىي كاَج يىو أو يىييٍ أو رالرت أياو أو‪ ،...‬يذسب ‪Deficit‬‬
‫يسة واددة فقظ ويٍ رى َقسًه عهً عدد أياو انخصذيخ ‪ ،‬نكٍ ‪ maintenance‬يضم رابج نكم يىو ‪.‬‬
‫يزالً ‪ :‬كاَج َسبت انصىديىو ‪َ ، 513‬ذسب ‪deficit‬وَقسًه عهً ‪ ( 1‬ألٌ ‪ 513‬يخى انخصذيخ خالل ‪1‬‬
‫أياو) رى َضيف انُاحج إنً ‪ maintenance‬خالل يىو وادد وَكسز انكًيت يدة ‪ 1‬أياو‬
Eg: Na=175
Deficit=600
Maintenance=1000
011 = 1 ً‫ عه‬411 ‫َقسى‬
5011 = )5111 ‫ (ياني هى‬maintenance ‫ يع‬011 ‫َجًع‬
‫ في انيىو انزاَي ويزهها في انيىو انزانذ‬5011‫ في انيىو األول و‬5011 ‫يعُي َعطيه‬
Notes:
 Hypertonic diarrhea lead to brain hemorrhage
 Hypotonic diarrhea lead to brain edema
 In diarrhea and vomiting : 1ml of stool or vomit is replaced by 1ml of fluid
 In fever give 10-15ml/kg for each 1C
 Give 1ml KCL for each 100ml of fluid
 Examples :
1- 3years child with moderate dehydration , Na=140mEq, wt.=11
Deficit=60x11 =660
Maintenance = 10 x 100 =1000
1 x 50 = 50
Deficit + maintenance = 660+ 1050= 1710ml/24h
‫ ساعت‬02 ‫ خالل‬051/311/311/311 : ً‫َقسى انكًيت بانطسيقت انخي َسيدها يزال‬
‫ يم‬15.03 = 02 ‫يم قسًت‬5151 = ‫خالل ساعت واددة‬
‫ ساعاث؟؟؟‬1 ‫ يم زاح يخى اخرها خالل‬311‫يعُي ال‬
1 ‫يم زاح يعطيُا‬15.03 ‫ عهً انكًيت انخي يقسزة اخرها خالل ساعت وهي‬311 ‫يعُي قسًُا‬
KCL: 1ml/100ml, so 5ml for 500ml
Type of fluid D1/2 NS
 :‫َكخب نهخًسيض‬
 D1/2NS(500ml) , KCL 5ml each drip in 7 h
‫ يهي زاح َعطيه في‬051 ‫ ساعت وزاح حبقً يعُا‬05 ‫ يهي خالل‬5311 ‫اآلٌ اعطيُا‬
KCL ٍ‫ يهي ي‬0 ‫انزالد انساعاث انًخبقيت وَضيف نها‬
Rate of infusion in micro dropper =
amount of fluid/(hours for drip x 3)
2- 4 months male with severe dehydration Na=167mEq , wt.=5kg, T= 39c
Deficit =120 x 5 = 600 ml
Temperature is increase 2C above normal, so deficit = 2 x10 x5 = 100ml
Pt. is hypernatremic Na=167, so drive deficit into 2 parts
Deficit = 600+100= 700,,,each day give 350ml
Maintenance = 5x100=500
First day : 350 + 500= 850ml/24h
We can drive it as 500ml then 350ml
Amount of fluid in 1 hour = 850÷24=35ml
So, 500ml is given in 500÷35= 14,,,350÷35=10
D1/2 NS(500ml), KCL 5ml in drip per 14h after check of urine output.
Then D1/4NS(350ml) kcl 3.5ml in drip per 10h after check of urine
output.
3- 5 years female has sever dehydration with shock Na=120mEq/L,
wt.=15kg she losses about 450ml stool and 200ml vomit.
#Shock therapy= 20x15=300ml. NS 0.9% given in 20 min.
#Deficit = 90x15=1350
#Deficit from stool= 450ml , deficit from vomit=200ml
Maintenance = 10x100=1000
5x50 = 250
Deficit + maintenance = 1350+450+200+1250=3250ml
3250-shock therapy =3250-300ml=2950ml
Pt. has hyponatermia , so start with hypertonic NS(0.3%) 3x15=45ml/ 30min.
)3ml/kg in 30min( ‫ أو أقل‬021 Na ‫مثل ما يقول القانون في حالة‬
Then give NS 0.9% and monitor Na when reach 130mEq/L give D1/2NS , so
2905 is divided as 500,500,500,500,500,400
Amount of fluid in hour = 2905÷23=126ml
So 500ml is given in 500÷126= 4 h

Special cases:
In RF: in infants : give 40% of maintenance + amount of urine output.
In children: give 25% of maintenance + amount of urine output.
In polyurea as D. insepidus: give all maintenance +amount of urine output.
In HF,CNS infection , respiratory infection and septicemia : give only tow
thirds of maintenance why?? Due to increase ADH lead to water and salts
retention
maintenance ٍ‫ َعطي يسة وَصف ي‬SCA ‫في داالث‬

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