logging in or signing up Fluid and Electrolyte Basics gbaustian Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 287 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: December 07, 2010 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Case 1 : Case 1 5 yr/o, admitted for Mx/Tx ENT asks you to write fluid orders Child is healthy, 21kg Will be NPO Choose the correct fluids D5W @ TKO D5 0.2 NS + 20Meq KCL/l @ 90 cc/hr D5 0.5 NS @ 50 cc/hr Case 2 : Case 2 2 yr/o presents to the ED with 3 dy Hx of V/D T=99.5, P=90, BP=100/50, 10 kg Thristy, irritable, eyes seem sunken Voided 12 hrs ago What is(are) the deficits? The lab’s backed-up 2-3 hrs, what fluids should you initially use Slide 5: FLUIDS AND ELECTROLYTES after WILLIAM SEGARS, M.D. BODY FLUIDS : BODY FLUIDS 1/3 ECF 2/3 ICF 1/4 PLASMA 3/4 IF TBW 60%of WT in Kg GOALS : GOALS MEET ONGOING PHYSIOLOGIC REQUIREMENTS REPLACE PRE-EXSISTING DEFICITS REPLACE ONGOING LOSSES THEORY : THEORY DAILY PHYSIOLOGIC LOSSES ARE PROPORTIONAL TO CALORIC EXPENDITURES FLUID REQUIREMENTS ARE ~ KCAL/ DAY ELECTROLYTE REQUIREMENTS : ELECTROLYTE REQUIREMENTS Fluids are not just water!! Don’t forget about the electrolytes!! COMMON SOLUTIONS : COMMON SOLUTIONS D5NS = 150 mEQ Na/liter (154.0) D5 2/3 NS = 100 mEQ Na/liter (102.6) D5 1/2 NS = 75 mEQ Na/liter (77.0) D5 1/3 NS = 50 mEQ Na/liter (51.3) D5 1/4 NS = 38 mEQ Na/liter (38.5) D5 0.2 NS = 30 mEQ Na/liter (30.8) D5W = 0 mEQ Na/liter WRITE IT RIGHT : WRITE IT RIGHT D5 0.2 NS 20 mEQ KCl/liter @ 100cc/Hr EXAMPLES : EXAMPLES 10 Kg child : 10 Kg child 10 Kg child : 10 Kg child 100cc x 10Kg = 1000cc 15 Kg child : 15 Kg child 15 Kg child : 15 Kg child =1000cc + (15Kg - 10) x 50cc =1000cc + 250cc =1250cc 25 Kg child : 25 Kg child 25 Kg child : 25 Kg child =1500cc + (25Kg - 20Kg) x 20cc =1500cc + 100cc =1600cc 70 Kg child : 70 Kg child =1500cc + (70Kg - 20Kg) x 20cc =1500cc + 1000cc =2500cc DEFICITS : DEFICITS REQUIREMENTS = MAINTENANCE + DEFICITS DEHYDRATION : DEHYDRATION HOW BAD HOW MUCH HOW QUICKLY WHERE FROM WHAT TYPE HOW BAD (SEVERITY) : HOW BAD (SEVERITY) MILD - 2-4% THIRSTY / DRY MEMBRANES / NO TEARS MODERATE - 5-7% SOFT EYES / SOFT FONTANELLE SEVERE - 10% HEART RATE / SKIN TENTING / OLIGURIC HOW MUCH : HOW MUCH 1% DEHYDRATION = 10cc/Kg HOW QUICKLY / WHERE FROM : HOW QUICKLY / WHERE FROM NORMAL LOSSES 3-5 days 60% EXTRACELLULAR/40% INTRACELLULAR RAPID LOSSES 80% EXTRACELLULAR/20% INTRACELLULAR SLOW LOSSES (> 5 days) 50% EXTRACELLULAR/50% INTRACELLULAR WHAT TYPE : WHAT TYPE HYPOTONIC - Na < 130 ISOTONIC - Na 130 - 155 HYPERTONIC - Na > 155 EXAMPLE : EXAMPLE 10 Kg 3-5 days of vomiting and diarrhea 5% dry Na 135 mEQ EXAMPLE : EXAMPLE 70Kg 10% dry 2-3 days Na 140 mEQ HYPOTONIC DEHYDRATION : HYPOTONIC DEHYDRATION DECREASE IN TOTAL BODY Na SECOND MOST COMMON Na CORRECTION CALCULATION : Na CORRECTION CALCULATION (135 - OBSERVED Na) x WEIGHT x 0.6 EXAMPLE : EXAMPLE 10Kg 3-5 days 5% dry Na 120 mEQ HYPERTONIC DEHYDRATION : HYPERTONIC DEHYDRATION WATCH OUT !!! ASSUME 10% (SEVERE) DEHYDRATION FREE WATER CALCULATION : FREE WATER CALCULATION REPLACE 1/3-1/2 OF DEFICIT AS “FREE” WATER EXAMPLE : EXAMPLE 10Kg 3-5 days Na 160 mEQ SUMMARY : SUMMARY MAINTENACE D5 0.2 NS + 20 mEQ KCl/liter @ 42cc/Hr ISOTONIC D5 1/3 NS + 33 mEQ KCl/liter @ 63cc/Hr HYPOTONIC D5 2/3 NS + 33 mEQ KCl/liter @ 63cc/Hr HYPERTONIC D5 1/4 NS + 25 mEQ KCl/liter @ 42cc/Hr POINTS TO REMEMBER : POINTS TO REMEMBER NORMAL/PHYSIOLOGIC REQUIREMENTS REPLACE DEFICITS POINTS TO REMEMBER : POINTS TO REMEMBER DEHYDRATION MILD-2-4% = THIRST, DRY MEMBRANES, NO TEARS MODERATE-5-7% = SUNKEN / HOLLOW EYES & FONTANELL SEVERE-10%= SKIN TENTING, OLIGURIA, TACHYCARDIA POINTS TO REMEMBER : POINTS TO REMEMBER TONICITY ISOTONIC Na 130-150 mEQ / dL HYPOTONIC Na < 130 mEQ / dL HYPERTONIC Na > 155 mEQ / dL BIBLIOGRAPHY : BIBLIOGRAPHY Segar, W. E. Current Problems in Pediatrics 1972, Dec 3(2) CREDITS : CREDITS PRESENTATION SOFTWARE: MICROSOFT POWERPOINT 2003 CLIPART: T / MAKER CLICKART You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Fluid and Electrolyte Basics gbaustian Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 287 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: December 07, 2010 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Case 1 : Case 1 5 yr/o, admitted for Mx/Tx ENT asks you to write fluid orders Child is healthy, 21kg Will be NPO Choose the correct fluids D5W @ TKO D5 0.2 NS + 20Meq KCL/l @ 90 cc/hr D5 0.5 NS @ 50 cc/hr Case 2 : Case 2 2 yr/o presents to the ED with 3 dy Hx of V/D T=99.5, P=90, BP=100/50, 10 kg Thristy, irritable, eyes seem sunken Voided 12 hrs ago What is(are) the deficits? The lab’s backed-up 2-3 hrs, what fluids should you initially use Slide 5: FLUIDS AND ELECTROLYTES after WILLIAM SEGARS, M.D. BODY FLUIDS : BODY FLUIDS 1/3 ECF 2/3 ICF 1/4 PLASMA 3/4 IF TBW 60%of WT in Kg GOALS : GOALS MEET ONGOING PHYSIOLOGIC REQUIREMENTS REPLACE PRE-EXSISTING DEFICITS REPLACE ONGOING LOSSES THEORY : THEORY DAILY PHYSIOLOGIC LOSSES ARE PROPORTIONAL TO CALORIC EXPENDITURES FLUID REQUIREMENTS ARE ~ KCAL/ DAY ELECTROLYTE REQUIREMENTS : ELECTROLYTE REQUIREMENTS Fluids are not just water!! Don’t forget about the electrolytes!! COMMON SOLUTIONS : COMMON SOLUTIONS D5NS = 150 mEQ Na/liter (154.0) D5 2/3 NS = 100 mEQ Na/liter (102.6) D5 1/2 NS = 75 mEQ Na/liter (77.0) D5 1/3 NS = 50 mEQ Na/liter (51.3) D5 1/4 NS = 38 mEQ Na/liter (38.5) D5 0.2 NS = 30 mEQ Na/liter (30.8) D5W = 0 mEQ Na/liter WRITE IT RIGHT : WRITE IT RIGHT D5 0.2 NS 20 mEQ KCl/liter @ 100cc/Hr EXAMPLES : EXAMPLES 10 Kg child : 10 Kg child 10 Kg child : 10 Kg child 100cc x 10Kg = 1000cc 15 Kg child : 15 Kg child 15 Kg child : 15 Kg child =1000cc + (15Kg - 10) x 50cc =1000cc + 250cc =1250cc 25 Kg child : 25 Kg child 25 Kg child : 25 Kg child =1500cc + (25Kg - 20Kg) x 20cc =1500cc + 100cc =1600cc 70 Kg child : 70 Kg child =1500cc + (70Kg - 20Kg) x 20cc =1500cc + 1000cc =2500cc DEFICITS : DEFICITS REQUIREMENTS = MAINTENANCE + DEFICITS DEHYDRATION : DEHYDRATION HOW BAD HOW MUCH HOW QUICKLY WHERE FROM WHAT TYPE HOW BAD (SEVERITY) : HOW BAD (SEVERITY) MILD - 2-4% THIRSTY / DRY MEMBRANES / NO TEARS MODERATE - 5-7% SOFT EYES / SOFT FONTANELLE SEVERE - 10% HEART RATE / SKIN TENTING / OLIGURIC HOW MUCH : HOW MUCH 1% DEHYDRATION = 10cc/Kg HOW QUICKLY / WHERE FROM : HOW QUICKLY / WHERE FROM NORMAL LOSSES 3-5 days 60% EXTRACELLULAR/40% INTRACELLULAR RAPID LOSSES 80% EXTRACELLULAR/20% INTRACELLULAR SLOW LOSSES (> 5 days) 50% EXTRACELLULAR/50% INTRACELLULAR WHAT TYPE : WHAT TYPE HYPOTONIC - Na < 130 ISOTONIC - Na 130 - 155 HYPERTONIC - Na > 155 EXAMPLE : EXAMPLE 10 Kg 3-5 days of vomiting and diarrhea 5% dry Na 135 mEQ EXAMPLE : EXAMPLE 70Kg 10% dry 2-3 days Na 140 mEQ HYPOTONIC DEHYDRATION : HYPOTONIC DEHYDRATION DECREASE IN TOTAL BODY Na SECOND MOST COMMON Na CORRECTION CALCULATION : Na CORRECTION CALCULATION (135 - OBSERVED Na) x WEIGHT x 0.6 EXAMPLE : EXAMPLE 10Kg 3-5 days 5% dry Na 120 mEQ HYPERTONIC DEHYDRATION : HYPERTONIC DEHYDRATION WATCH OUT !!! ASSUME 10% (SEVERE) DEHYDRATION FREE WATER CALCULATION : FREE WATER CALCULATION REPLACE 1/3-1/2 OF DEFICIT AS “FREE” WATER EXAMPLE : EXAMPLE 10Kg 3-5 days Na 160 mEQ SUMMARY : SUMMARY MAINTENACE D5 0.2 NS + 20 mEQ KCl/liter @ 42cc/Hr ISOTONIC D5 1/3 NS + 33 mEQ KCl/liter @ 63cc/Hr HYPOTONIC D5 2/3 NS + 33 mEQ KCl/liter @ 63cc/Hr HYPERTONIC D5 1/4 NS + 25 mEQ KCl/liter @ 42cc/Hr POINTS TO REMEMBER : POINTS TO REMEMBER NORMAL/PHYSIOLOGIC REQUIREMENTS REPLACE DEFICITS POINTS TO REMEMBER : POINTS TO REMEMBER DEHYDRATION MILD-2-4% = THIRST, DRY MEMBRANES, NO TEARS MODERATE-5-7% = SUNKEN / HOLLOW EYES & FONTANELL SEVERE-10%= SKIN TENTING, OLIGURIA, TACHYCARDIA POINTS TO REMEMBER : POINTS TO REMEMBER TONICITY ISOTONIC Na 130-150 mEQ / dL HYPOTONIC Na < 130 mEQ / dL HYPERTONIC Na > 155 mEQ / dL BIBLIOGRAPHY : BIBLIOGRAPHY Segar, W. E. Current Problems in Pediatrics 1972, Dec 3(2) CREDITS : CREDITS PRESENTATION SOFTWARE: MICROSOFT POWERPOINT 2003 CLIPART: T / MAKER CLICKART