exam 3 fluid balance

Some Practice Problems

¨1. Your patient weighs 15 pounds. The PNP orders D5NS to run at maintenance rate. What would this rate be? ¨2. The Pediatric Resident order 0.9 NSS at twice maintenance rate for your 36 pound patient who is hypovolemic. What do you calculate this rate to be? ¨3. Your 28 kg post operative patient is ordered D5W at half maintenance rate. The P.A. orders the infusion to run at 75 mL/ hour. Is this a correct rate for this child?

IV Fluid Administration **Review pges. 1275 - 1276

¨Administering IV fluids to an infant or child requires close attention to the child's fluid status. ¨Typically, the amount of fluid to be administered in a day (24 hours) is determined by the child's weight (in kilograms) using the following formula: ¤100 mL per kg of body weight for the first 10 kg ¤50 mL per kg of body weight for the next 10 kg ¤20 mL per kg of body weight for the remainder of body weight in kilograms ¨Table 35.4 gives examples of calculating a child's fluid requirements using body weight. ¨Once the 24-hour total fluid requirement is determined, this amount is divided by 24 hours to arrive at the correct hourly rate of infusion. ¨100 - 50 -20 Formula. Generally used for children up to 50 kg. ¨Child must be monitored closely for hyper- or hypovolemia!

FLUID BOLUS

¨Expected urine output infant & child 0.5 - 2 mL/ kg/hour ¨Bolus IV fluid is 20 mL/ kg. May be repeated up for a total of 3 boluses. (Please review isotonic, hypotonic & hypertonic IV solutions!) vPerfusion, urine output, specific gravity are monitored and patient evaluated for further boluses. ¨Practice: ¨Your patient has been ordered a fluid bolus of normal saline to run over 3- hours. Your patient weighs 61.6 pounds. At what rate should the IV pump be programmed?

Formula for Fluid maintenance

•100 mL/kg for first 10 kg •50 mL/kg for next 10 kg •20 mL/kg for remaining kg •Add together for total mL needed per 24-hour period. •Divide by 24 for mL/hr fluid requirement. •Thus, for a 23-kg child: •100 × 10 = 1,000 •50 × 10 = 500 •20 × 3 = 60 •1,000 + 500 + 60 = 1,5601,560/24 = 65 mL/hr

INTRAVENOUS MAINTENANCE FLUID CALCULATIONS BY BODY WEIGHT

•<10 kg in weight •100 mL per kg of weight = # mL for 24 hours üExample: A child weighs 7.4 kg ü7.4 × 100 = 740 mL (daily requirement) ü740/24 = 30.8 or 31 mL/hour •11-20 kg in weight •100 mL per kg of weight for the first 10 kg + 50 mL/kg for the next 10 kg = # mL for 24 hours üExample: A child weighs 16 kg ü(10 × 100 = 1,000) plus (6 × 50 = 300) üTotal = 1,300 mL (daily requirement) ü1,300/24 = 54 mL/hour •>20 kg in weight •100 mL/kg for the first 10 kg + 50 mL/kg for the next 10 kg + 20 mL/kg for each kg > 20 kg = # mL for 24 hours üExample: A child weighs 30 kg ü(10 × 100 = 1,000) plus (10 × 50 = 500) plus (10 × 20 = 200) üTotal = 1700 mL (daily requirement) ü1,700/24 = 70.8 or 71 mL/hour