Recent literature has emerged in which researchers describe the contextdependent use of ivfs, which should be prescribed, ordered, dosed, and delivered like any other drug. The total body water tbw comprises 45% to 80% of total body mass in the human body, varying with sex, age, and fat content. Intravenous fluid therapy background and principles. Perioperative fluid therapy is aimed at providing maintenance fluid requirements, at correcting fluid deficit and at providing the volume of fluid needed to. Nov 12, 2019 in conclusion, fluid therapy is the mainstay in the management of dka. Op ghai essential of pediatrics textbook pdf download.
Without treatment, cpv can be life threatening due to sepsis, severe fluid losses and electrolyte derangements secondary to anorexia, vomiting, and diarrhea. Pdf managing fluids and electrolytes in children is an important skill for pharmacists, who can play an important role in monitoring therapy. The second phase of fluid therapy is to provide maintenance plus deficit replacement. The resuscitative phase is the acute presentation window, when ivfs are needed to restore adequate tissue. What would be the fluid deficit of this child in cc.
However, accumulating evidence shows that using hypotonic fluids may lead to an. By means of the following formulae, the caloric expenditure of hospitalized patients can be determined from weight alone. Practical guidelines on fluid therapy by dr sanjay pandya 2nd edition pdf for free. Managing fluids and electrolytes in children is an important skill for pharmacists, who can play an important role in monitoring therapy. Optimal fluid therapy for traumatic hemorrhagic shock ronald chang, mda, john b. Practical guidelines on fluid therapy by dr sanjay pandya 2nd. Apr 05, 2014 fluid therapy in paediatrics prepared by. Ban slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
Intravenous fluid therapy childrens hospital colorado. S44s51 3 any recent edition of the harriet lane handbook maintenance fluid and electrolytes. Parenteral fluid therapy is a basic component of the care of hospitalized infants and children. One should replace the other 50% of the deficit plus deliver the required maintenance solution over the next 16 hours. A free powerpoint ppt presentation displayed as a flash slide show on id. It is generally agreed that the maintenance requirements for water of individuals is determined by their caloric expenditure. Supplemental reading 1 segar we, parenteral fluid therapy, curr probs peds, vol 3, 1973 2 santosham m and greenbough wb, oral rehydration therapy. Fluid and electrolyte therapy in low birth weight infants. Perioperative intravenous fluid therapy in children.
However, this method depends on knowing a precise, recent preillness weight. Op ghai pediatrics textbook pdf download the free book has over 768 pages and is the 8th edition of the series. A similar calculation is made for potassium deficit, but it is assumed that 40% of the total water deficit has been lost from the intracellular fluid space icf and that the mean concentration of. Nov 30, 2018 concerns about iatrogenic hyponatremia have led to growing use of isotonic solutions instead. This website provides free medical books this website provides over 0 free medical books and more for all students and doctors this website the best choice for medical students during and after learning medicine. Another way to assess the degree of dehydration in children with acute dehydration is change in body weight. Perioperative fluid therapy in pediatrics murat 2008. Perioperative fluid therapy should be considered as a medical prescription of which both the volume and the composition should be adapted to the patient status, the type of operation and the expected events in the postoperative period. Fluid bolus therapy fbt is a standard of care in the management of the septic, hypotensive, tachycardic andor oliguric patient. Mar 18, 2008 fluid therapy in the neonatal period will not be considered in the present lecture.
How to improve maintenance intravenous fluid prescribing. Fluid resuscitation therapy for paediatric sepsis request pdf. Intravenous maintenance fluid therapy consists of water and electrolytes to replace daily losses in ill children in whom enteral fluids are insufficient. Organizing fluid needs into maintenance, deficit, and replacement therapy can provide a systematic, understandable approach to determining fluid therapy. Sep 01, 2018 investigators from multiple institutions conducted a randomized controlled trial to assess the effects of rate of administration of iv fluids and sodium chloride nacl content on neurologic outcomes in children presenting with diabetic ketoacidosis dka. The dose of fluid during these 4 phases of fluid therapy needs to be adjusted on the basis of the unique physiologic needs of each patient, and a specific protocoled dose is not able to be applied to all patients. Errors in prescribing or administration can increase morbidity, with inadequate provision causing hypovolaemia and poor organ perfusion, and excessive fluids leading to overload and cardiac failure. Two days ago the patient was seen for the same symptoms weight at that time was 5500 grams. Fluid therapy for pediatric patients with diabetic. Clinicians who care for inpatients must be able to assess the need for parenteral fluid therapy and to specify the composition of fluid and rate of administration. Fluid and electrolyte problems can be challenging but generally can be tamed by an organized approach, application of a few principles.
In order to ensure the best outcome, treatment should be aimed toward symptomatic supportive care, aggressive fluid therapy, antiemetics, antibiotic therapy, and nutritional support. In the first 8 hours one should give of the normal maintenance plus replacement of. Dehydration in children msd manual professional edition. Moritz, md, faap,o subcommittee on fluid and electrolyte therapy maintenance intravenous fluids ivfs are used to provide critical supportive care for children who are acutely ill. Complications of iv therapy pain extravasation hematoma complications of iv therapy infiltration local infection pyrogenic reaction complications of iv. Feb 07, 2016 the best seminar in pediatric fluid therapy on slideshare. This will in turn facilitate tissue oxygen delivery without causing harm.
Fluid therapy is divided into maintenance, deficit, and. Fluid therapy in diabetic ketoacidosis american academy of. For generations, the hollidaysegar method published in 1957 and based on studies of the caloric expenditure of previously healthy hospitalized infants has been the standard for the composition and rate of ivf in pediatric patients of all ages despite the authors disclaimers. Oral rehydration therapy the american academy of pediatrics recommends oral. Achieving optimal iv fluid therapy should improve perioperative outcomes and is a key component. For weights ranging from 0 to 10 kg, the caloric expenditure is 100 calkgday. Optimal fluid therapy for traumatic hemorrhagic shock. Fluid and electrolyte therapy in the very lowbirthweight. Maintenance fluid therapy represents the fluid and electrolytes requirements needed by the average individual with a normal intracellular icf and extracellular ecf fluid volumes over a 24. Evidence with respect to fluid type, volume, and rate of therapy is still evolving. Ppt intravenous fluid therapy powerpoint presentation. Fluids in context of associated comorbidities like malnutrition, sepsis and acute kidney injury also need further exploration. If you continue browsing the site, you agree to the use of cookies on this website.
Hala alnahrain universitycollege of medicine iraqbaghdad. Holcomb, mdb introduction hemorrhage is a top cause of death after injury and is the leading cause of potentially preventable trauma deaths. Fluid management and dehydration texas tech university. Diagnosis and management of dehydration in children. If you need op ghai pediatrics 7th or 9th edition, check the page updates.
Affiliated with the department of pediatrics, women and infants hospital of rhode island, providence, and the brown university program in medicine, providence infants with respiratory distress syndrome rds often require parenteral fluid therapy during the course of acute respiratory illness due to difficulty giving oral feedings. Maintenance therapy replaces the ongoing daily losses of water and electrolytes occurring via physiologic processes urine, sweat, respiration, and stool, which normally preserve homeostasis. The first 30 pages discuss principles of water, electrolyte and acidbase balance including basic differences in fluid compartment. The goal of iv fluid administration is to restore and maintain tissue fluid and electrolyte homeostasis and central euvolemia, while avoiding salt and water excess. The recent national institute for health care excellence guideline on intravenous fluid therapy in children and young people in the hospital recommends isotonic maintenance fluids.
The goal of fluid therapy is to preserve the normal body water volume and its electrolyte composition. In the past decade, the standard approach to pediatric maintenance intravenous fluid ivf therapy has shifted. However, contemporary evidence for fbt improving patientcentred. This book successfully combines basic physiology of water and electrolyte metabolism with applicable schedules of fluid therapy. These facets open doors for more multicentric research. By paying close attention to the fluid needs of pediatric patients and monitoring response to fluid therapy, the pediatric pharmacist can have a positive influence on the health of the child. Assess fluid and electrolyte needs following algorithm1. Intravenous fluid therapy in children and young people in. The prescription of intravenous fluids requires an understanding of fluid homeostasis and should be tailored to the individual, the disease and the intended therapeutic goal. Based on the hollidaysegar formula, hypotonic fluids have been widely used in pediatrics for several decades. Mar 01, 2008 fluid and electrolyte adaptation in most very lowbirthweight newborns generally occurs in three phases, and awareness of the changes associated with each phase can aid clinicians in determining appropriate adjustments in fluid and electrolyte therapy. Holcomb, mdb introduction hemorrhage is a top cause of death after injury and is the leading cause of potentially. Biochemical abnormalities occur frequently in patients receiving iv fluid therapy and reflect the response to the fluid administered.
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