Pediatric IV Fluids: The Basics

Fluid deficit

-must be replaced *on top of* maintenance fluid -replaced over 24 hrs -fluid bolus *isotonic fluid (NS, LR)* *10-20 cc/kg in peds* *reassess after bolus* *max of 3-20 cc/kg bolus*

What is the maximum fluid rate

100mL/hr

Electrolyte requirements Holliday-Segar method -Na -K

-Na= 3 mEq/ 100 cc H20 -K= 2 mEq/100 cc H20

a 20 kg child is determined to be 10% dehydrated

0.10 x 20 kg= 2kg 2kg x 1000= 2000 cc of fluid deficit

What is 1/2 NS

0.45% NaCl -77 mEq/L *Na* -77 mEq/L *Cl*

What is normal solution

0.9% NaCl -154 mEq/L *Na* -154 mEq/L *Cl*

Fluid of choice

D5 1/4 NS + 20 mEq/L Kcl OR D5 1/2 NS +20 mEq/L Kcl

What would the daily rate for a 15 kg child be

(4 x 10= 40) + (2x5=10) 50 ml/hr 50x24= 1200 ml/day

Holliday-Segar 4-2-1 Rule

*1. <10 Kg* -hourly= 4mL/kg/hr -daily= 100 mL/kg/day *2. 10-20 Kg* -hourly= 40mL + 2 mL/kg -daily= 1000mL + 50mL/kg/day for every kg>10 *3. > 20 Kg* -hourly= 60mL + 1 mL/kg -daily= 1500mL + 20mL/kg/day for every kg>20

Name the 3 methods of maintenance fluid requirements

*1.* Caloric Expenditure method *2.* Holliday-Segar Method -estimates caloric & fluid needs form wt alone -most common *3.* Body surface area method

4 findings in dehydration

*1.* Capillary refill >2 sec *2.* dry mucous membranes *3.* absent tears *4.* abnormal general appearance

Volume of maintenance requirements

*1.* Insensible loss= 45 mL -skin=30 mL -lungs=15 mL *2.* Renal loss= 50 mL *3.* Sweat loss= 10 mL *4.* Stool loss= 5 mL

Calculate the maintenance IV fluid rate for an 8 kg infant

*32 cc/hr* 8x4= 32cc/hr or 8x100=800/24=32 cc/hr

What would the daily rate for a 5 kg infant be

4 x 5= 20 ml/hr 20x24= 480 ml/day

Calculate the daily fluid requirement for a 17 kg child

(10x4) + (7x2)=54 cc/hr 55x24= 1296 cc/day OR (10x100)+ (7x50)=1350 cc/day 1350/24=56 cc/hr

Calculate the hourly IV fluid rate for a normal 25 kg child

1600 cc/day 1600/24 hr= 67 cc/hr

What is the maximum total fluid/day

2400 mL

When do you give a max bolus

only reached in pts in severe shock -usually only seen in resuscitation situations

What is the gold standard for assessing degree of dehydration

Pre illness wt- post illness wt= kg -kg= mg x 1000 mg of wt lost= cc of fluid lost