fluid maintenance- ppp.ppt

7/27/2019 Fluid Maintenance- PPP.ppt

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Fluid Maintenance in

Pediatric Patients

C. Hammond RN, MN



Finding Balance

Just RightToo Much

Too Little



Volume is Important

Needed for allmetabolic processes

Imbalance results innegative healthconsequences

Delicate requirementsof pediatric patients



Delicate Balance in Pediatrics

Greater proportion of

body fluids, higher

metabolisms, more

fluid output, small size

Need relatively more

fluids to maintain

balance

http://photohome.com/pictures/baby-pictures/baby-portrait-night-2a.jpg



Assessing Fluid Balance

Vital signs

Monitor I & O

Daily weights

Mucous membranes Skin turgor

Capillary Refill

Fontanels Lungs

Level of consciousness



Signs of Over-hydration

Edema

Shortness of breath

Crackles

Cough

Increased weight

Increased BP

Bulging fontanels

Altered urine output



Conditions that may limit fluid

requirements

CHF

Increased ICP

SIADH Post op

Renal failure



Signs of Dehydration

(vary with severity) Tachycardia

Fever

Thirst

Decreased cap refill

Sunken eyes

No tears

Dry skin and membranes

Decreased weight

Decreased urine output

Late signs= dizziness, lethargy, altered mental status,low BP



Conditions requiring Increased

Fluids

Fever

Vomiting

Diarrhea

Burns

Diabetes insepidus

Tachypnea

Shock

Renal failure



So what is the right amount?

Maintenance fluid: The amount of fluid the

body needs in order to replace normal

losses

WEIGHT, WEIGHT, WEIGHT!!!



The 4-2-1 Rule

4 ml/kg/hr for the first 10 kg

2 ml/kg/hr for the second 10 kg

1 ml/kg/hr for the remaining weight



Let’s Practice!

1) 7 year old Jane is 23 kg. What is the

minimum amount of fluid she should

drink?

2) 4 day old Ben has an IV. If he is 3.2 kg,

what is the hourly rate the IV should be

infusing at to maintain his fluid

requirements?



Jack is 17 kg.

1. Calculate the hourly fluid maintenancerequirement.

2. Convert this into his requirements for a24hr period.



Management of Pediatric

Dehydration

Normal Saline bolus of 20ml/kg (can be

repeated twice if needed)

Replace deficit and ongoing losses

Provide maintenance fluids



What goes in must come out!

Urine output in the pediatric population:

Infants- 2ml/kg/hr

Children- 1ml/kg/hr

Adolescents- 0.5ml/kg/hr

Oliguria= <0.5ml/kg/hr

Anuria= 0

Polyuria= >3ml/kg/hr



Calculating urine output

Urine output divided by patient weight

divided by # hours since previous output

1) 10kg Joe was last changed at 1400. It is

now 1800 and his wet diaper weighs

84mg (dry diaper weight has already

been subtracted). Is this an adequate

output?



To summarize…

Our bodies rely on maintaining adequatefluid volume

Pediatric patients are more sensitive tochanges in volume

We can use the 4-2-1 Rule to calculatebasic fluid maintenance requirements inpediatric patients

fluid maintenance- ppp.ppt

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