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Fluid Therapy in Dehydration: DR Ngugi
Fluid Therapy in Dehydration: DR Ngugi
Dr Ngugi
Cold Hands plus, weak / absent pulse, and one of: Capillary refill > 3 secs Not alert, AVPU < A
Shock
Shock
Pulse easy to feel, but unable to drink or AVPU < A plus: Sunken Eyes Skin pinch 2 secs
Severe Dehydration
Shock
Severe Dehydration
Some Dehydration
Shock
Severe Dehydration
K+ 4.0 0 5.4
Plasma
Existing fluid
Low sodium concentration fluids that should not be used to correct shock or severe dehydration unless there is severe malnutrition
All concentrations are in mmol/l
Na+
Half Strength Darrows (& 5% Dextrose)
K+
17
61
Low sodium concentration fluids that should not be used to correct shock or severe dehydration in any situation.
All concentrations are in mmol/l
Na+
Dextrose (4%) / Saline (0.18%) 5% Dextrose
K+ 0 0
31 0
Age 12 months to 5 years 30 mls / kg over 30 mins 70 mls / kg over 2.5 hours
Phase 1 Phase 2
Then re-assess child if still signs of severe dehydration repeat step. If signs improving treat for some dehydration
This is equivalent to correcting 10% dehydration in 3 6 hours
Re-assessment
Cold Hands - Weak (absent) pulse Prolonged capillary refill? Reduced level of consciousness? Sunken Eyes / Slow skin pinch Pulse OK but unable to drink plus Sunken Eyes Skin pinch 2 secs? Able to drink plus 2 or more of: Sunken Eyes and / or Skin pinch 1 - 2 secs Restlessness / Irritability
Shock
Severe Dehydration
Prescribing ORS
75 mls / kg of ORS over 4 hours. After 4 hours reassess and reclassify;
Severe, Some or no dehydration?
Counseling the mother / caretaker? What do you tell the mother of an 8kg child?
ORS in practice.
300 mls
200 mls
Prescribing ORS
75 mls / kg for an 8kg child?
600 mls in 4 hours 2 large cups / 2 soda bottles in 4 hours 3 small cups in 4 hours.
Questions?
Summary
A small number of signs are most useful in classifying the severity of dehydration. Shock & severe dehydration must be treated using fluids with physiological sodium concentrations. Classify severity, treat by specifying fluid, the volume needed and the time to give it in. Then reassess.