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IV. FLUID - ٠٦٤٩٢٧
IV. FLUID - ٠٦٤٩٢٧
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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