THE ART OF REHYDRATION

Fitri Musdalifa

Infant

Child

Adult

Fat

16%

23%

30%

Total body water(TBW)

Extracellular Fluid (ECF)
Intracellular Fluid (ICF)

75%
40%
35%

70%
30%
40%

55-60%
20%
40%

Extracellular chemical elements

Sodium(meq/L)
Potassium(meq/L)
Chloride(meq/L)
Bicarbonate(meq/L)
Phosphate(meq/L)
Protein(g/100ml)
Osmotic
Pressure(mOsm/L)

Newborn

Adults

140
5-6,5
107
21-24
5-8
5
310

140
3,8-6
103
22-27
2,5-4,5
7
310

Severity of dehydration
Percent of body
weight lost

Amount of body fluid

lost,ml/kg ( % )
Infants

Older children
and adults

Mild

50 ( 5 % )

30 ( 3 % )

Moderate

100 ( 10 % )

60 ( 6 % )

Severe

150 ( 15 % )

90 ( 9 % )

Severity dehydration
Percent of body
weight lost

Sign and symptoms

Mild
1% - 5%

Dry mouth
Skin turgor
Decreased urination
Blood Pressure normal

Moderate
6% - 10%

Sunken eyes
Depressed fontanelles
Oliguria
Blood Pressure normal

Severe
9% - 15%

Cardiovascular instability : hypotension ,

Tachycardia
Anuria

Treat Severe dehydration quickly

Can you give iv

fluid
Immediately ?

Yes

Age

First give
30ml/kg

Then give
70 ml / kg

Infants
< 12 months

1 hour

5 hour

Children
< 5 years

30 minute 2 hours

No
Yes
Nasogastric tube
For rehydration

Give 20 ml/kg/h for 6 hours

Reassess the child every 1-2h

INTRAVENOUS FLUIDS RAPIDLY FOR SHOCK

20ml / kg BB Isotonic fluid
(Ringers Lactate / Normal Saline)

If no improvement , repeat x2

Improvement
(Stable )

No Improvement
Colloid / Blood

Replacement of fluid losses

and
Maintenance

No Improvement
Re-evaluate
Use of inotropic agent

Management of shock
Airway
Ensure airway is patent
May require intubation

Breathing
Ensure adequate ventilation ( spontaneous or controlled)
Ensure that chest movement is adequate

Management of shock

Circulation
Intravenous
Intraosseous

Fluid resuscitation
Fluid choice : normal saline or Ringers Lactate

Peripheral Veins

Scalps Veins

External jugular vein

-15-30 degree head down position

-Head turned to one side away from
the puncture

Femoral Vein

-Supine with buttocks 5cm elevated

-Introduce the needle at 10-20
degrees
1-2cm distal to the inguinal ligament
0,5-1cm medial to the femoral artery

Intraosseous

Anteromedial surface tibia

1-2cm below the tibial tuberosity
Distal femur(2 cm above the lat
condyle

Needle # 18 biasa
Fluid :RL, RA, NaCl, D5
Drug : Adrenalin, Atropin, Lidocain

Monitor
Respiratory rate
Oxygen saturation

Management of shock

Management of shock
Monitor

Management of shock
Monitor

Management of shock
Monitor
Urine Output ( > 0,5 ml / kg / h )
Central Venous Pressure