AN OVERVIEW OF MANAGEMENT OF DEHYDRATION IN PAEDIATRIC AGE GROUP

Dehydration has to be assessed first: a) Mild b) Moderate c) Severe Losses can be broadly classified as: a) Fluids b) Sodium Fluid loss is further classified as: a) Maintenance b) Deficit c) Concurrent Maintenance Requirements Weight Fluids Up to 10 kg body weight 100 ml/kg 10 to 20 kg body weight 1000 ml + 50 ml/kg over 10 kg More than 20 kg body weight 1500 ml + 25 ml/kg over 20 kg Deficit Replenishment Type of dehydration Mild Moderate Severe

Sodium 2-3 mEq/kg 2-3 mEq/kg 2-3 mEq/kg

Fluids 50 ml/kg 100 ml/kg 150 ml/kg

Sodium 7 mEq/kg 14 mEq/kg 21 mEq/kg

General Principles 1. Give 100% of maintenance fluid requirement but deficit is corrected only 2/3rd of the calculated value to rule out the possibility of fluid overload. 2. Out of the fluid calculated for 24 hours, 50% is given over first 8 hours and rest 50% is given over next 16 hours. 3. A combination of Normal Saline and 5% is used to match the exact requirement of fluid and Sodium. 4. Rapid Rehydration can be done with either Ringer lactate or Normal saline, however the former is the fluid of choice, given 20ml/kg for first 2 hours of fluid therapy. 5. For every 100 ml of fluid given, 1 ml of Potassium chloride ie 2 mEq of Potassium has to be added to protect against hypokalemia.

Ringer lactate contains Normal saline contents

135 mEq of Sodium per litre 150 mEq of Sodium per litre

ml/hour = (drops/min) X 3 (approx)

EXAMPLE: A BABY WEIGHING 10 KG BROUGHT TO HOSP WITH MODERATE DEHYDRATION

Requirements Fluid Maintenance 2/3rd of the Deficit Total 1000 ml 666 ml 1666 ml 27 mEq 93 mEq 120 mEq Sodium

1. Rapid Rehydration with Ringer lactate: ie 200 ml of fluid and 27 mEq of Sodium 2. Balance : 1666 200 = 1466 ml fluid 120 27 = 93 mEq Sodium

3. Fluid to be given in first 8 hours is 50% ie Fluid Sodium = 733 ml = 46 mEq

For 150 mEq of Sodium, Normal saline required is: 1000 ml For 46 mEq of Sodium, Normal saline required would be: 286 ml 4. To match fluid and electrolyte requirement, fluid to be given would be: 286 ml Normal Saline + 447 ml 5% Glucose 5. Total fluid to be given after rapid rehydration 286 ml Normal Saline + 447 ml 5% Glucose over first 8 hours 286 ml Normal Saline + 447 ml 5% Glucose over next 16 hours

ml/hour = (drops/min) X 3 (approx)

SUMMARY OF MANAGEMENT OF DEHYDRATION IN PAEDIATRIC AGE GROUP

Capt JP Khatri Med Offr

A. Rapid Rehydration with Ringer Lactate; given over 2 Hours

Weight

5 kg 100 ml

10 kg 200 ml

15 kg 300 ml

20 kg 400ml

25 kg 500 ml

30 kg 600 ml

Fluid

B. Fluid for First 8 Hours after Rapid Rehydration

Wt Dehydration Mild 83 ml NS + 200 ml 5% D Moderate 155 ml NS + 213 ml 5% D Severe 230 ml NS + 220 ml 5% D 165 ml NS + 400 ml 5% D 286 ml NS + 447 ml 5% D 500 ml NS + 400 ml 5% D 250 ml NS + 475 ml 5% D 500 ml NS + 500 ml 5% D 700 ml NS + 525 ml 5% D 283 ml NS + 600 ml 5% D 600 ml NS + 615 ml 5% D 1050 ml NS + 500 ml 5% D 580 ml NS + 650 ml 5% D 850 ml NS + 500 ml 5% D 1170 ml NS + 630 ml 5% D 450 ml NS + 525 ml 5% D 875 ml NS + 700 ml 5% D 1400 ml NS + 675 ml 5% D

5 kg

10 kg

15 kg

20 kg

25 kg

30 kg

C. Baby is to be reassessed after above fluid therapy:I) If the baby does not improve, the same amount of fluid is repeated over next 16 hours. II) Where the baby improves, fluid therapy is revised as per the improved status of the hydration. ml/hour = (drops/min) X 3 (approx)