HYDRATION -TEST 3 PEDS
infant to child void per hour
0.5- 2 ml /kg/hr
fluid maintenence ??????
10 kg in weight 100 mL per kg of weight = # mL for 24 hours -Example: A child weighs 7.4 kg -7.4 × 100 = 740 mL (daily requirement) -740/24 = 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 -Example: A child weighs 16 kg -(10 × 100 = 1,000) plus (6 × 50 = 300) -Total = 1,300 mL (daily requirement) -1,300/24 = 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 -Example: A child weighs 30 kg -(10 × 100 = 1,000) plus (10 × 50 = 500) plus (10 × 20 = 200) -Total = 1700 mL (daily requirement) -1,700/24 = 70.8 or 71 mL/hour
KNOW!!- dehydration tx
IVF! •Initially rapid bolus of 20 mL/kg of 0.9% NS or LR; then reassess. Can repeat 3X. •Once initial fluid balance restored, IVF @ maintenance rate or 1.5 X maintenance rate. •Maintenance fluid requirements refer to the amount needed under conditions of normal hydration •See box 42.2 (you must know this!)(attached to slide) DO NOT BOLUS DEXTROSE, ONLY BOLUS ISOTONIC SOLUTIONS LIKE LR OR NS
nursing assessment dehydration
•Assess hydration status: •HR, BP •Skin turgor •Fontanels •Oral mucosa •Eyes •Color/temp of extremities •Mental status •Urine output •Labs •Weight change •Explore current & PMH for risk factors: •Diarrhea •Vomiting •Decreased oral intake •Sustained high fever •DKA •Extensive burns
100 50 20 rule for fluid maintenaence MEMORIZE
BOX 42.2FORMULA 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
Labs: Normal v Dehydration
BUN Normal: 5-17 mg/dL Dehydration: >17 mg/dL Serum bicarbonate (total Co2) 18-28 mEq/L or mmol/L Dehydration: < 17 mEq/L or mmol/L Sodium Na+ 134-143 mmol/L Dehydration: < 134 mmol/L Urine specific gravity 1.001-1.030 Dehydration: >1.030 -Hypotonic/hyponatremic dehydration: electrolyte loss is greater than water loss, more common in children -Bicarb is lost in diarrhea
IV FLuid administration formula for pediatrics
¨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!