fluids & electrolytes basics

7/29/2019 Fluids & Electrolytes Basics

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Rhishikesh ThakreDM (Neonatology)

MD, DCH, DNB, FCPS.


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Total body water in 2body compartments

Intracellular fluid (ICF)

Extracellular fluid (ECF

- Interstitial space

- Intravascular space

1st week ECF volume

decreases


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!

!


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92%

86%

77%72%

66%62%

60%

45%

30% 28%26%26%

32%

42%38%

36%

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.80.9

1

0 3 6 9//0 3 6 9

TBW

ECF

ICF

B

odyWaterContent(%)

FETUS NEWBORN

Age (months)

100

90

80

70

60

50

40

30

20

10

0

%


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++ -- ++ --++ --

100

Cations

Na 140 143 010

K 004 004 160Anions

Cl 104 114 002

HCO3 025 029 008

Na HCO3

Cl

Na HCO3

Cl

K

Mg

Na

HCO3

Pr

PO4

200

Plasma ISF ICF

o

KP

o

K

P


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GOAL :

Prevent dehydration & hypoglycemia

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36822202550Isolyte P

Ped. Maint.

347343450D5 0.2%NaCl

381575750D5 0.33%NaCl

415777750D5 NS

585154154505% DNSDextrose,electrolyte

solution

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278505%Electrolyte

freesolution

1547777 NS isotonic

2702291115131RL308154154NSIsotonic

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mOsm/L

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ClKNaDextr.


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~ For hypoglycemia correction~ For increasing glucose conc

25 % D

~ IV Maintainence for > 1000g forfirst 24 48 h

~ For hypoglycemia correction

10 % D

~ IV Maintainence for < 1000 gfirst 24 - 48 h

~ Vehicle for ACT, Aminophyline,

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~ Maintenance IV fluid ( > 48 h)Isolyte P

~ Correction of symptomatichyponatremia

3 % NS~ Replacement of ileostomy loses NS

~ Volume expander in shockRL

~ Volume expander in shock~ Vehicle for phenytoin, Sodabicarb,Aminophyline

~ Replacement of gastric aspirate~ Correction of hyponatremia

NS

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Physical signs Urine output

Daily weight Blood urea Hematocrit

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Restrict fluids during the acute phase Watch for diuresis : Increase fluid rapidly

Avoid hypervolumia during entire therapy

No weight loss or static weight in first 72 hrs

Isolated diastolic shock is an early marker ofopening of PDA in RDS during recovery


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(

Symptomatic : restrict fluids Presence of isolated diastolic low blood

pressure is an earliest marker of opening

of ductus Weight gain : development of CCF

Ensure normokalemia before digitalizing

If no response to CCF in 24 hrs, checkelectrolytes


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U/O not a reliable indicator for ARF Presence of oliguria, unexplained weight

gain warrants renal chemistry

Check electrolytes :

Low Na = fluid retention

High Na = renal tubular pathology


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D153,

Dehydration +

in shock

Normal ECS

( partially treated )Hypervolumia

Fluid boluses (NS)

Restore volume+ Deficit ( 10%)

Replace

free water + maint.In > 48 hours DiuresisDialysis


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