Pediatric Fluid and Electrolyte

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Acute II Exam I

Urine Output Pediatrics

Infants and toddlers > 2-3ml/kg/hr
Preschool&young >1-2 ml/kg/hr
School age&adolescent >0.5-1 ml/kg/hr

Maintenance Fluid Pediatrics

Up to 10 Kg 100ml/kg/24hr
11-20kg 1000ml+(50ml/kg/24hr)
>20 kg 1500ml+(20ml/kg/24hr)

Total Body Weight of Water

90% in premies 60-65% in Children
75-80% in infants 50% in Adults

% of Extracellular Space

40% in infants (More rapid fluid shifts, cn lose entire ECF in 2-3 days <3)
20% in adults

Body Surface Area

Children have a proportionally greater body surface area, higher insensible losses than adults.

Urine Acidity Ped's

Decreased ability to acidify urine in infants more difficulty compensating for acidosis.

Metabolic Rate Ped's

Increased metabolic rate leads to increased insensible losses.

Other Fluid and Electrolyte Ped's

Preverbal kids can't convey thirst, immature renal function

Isonatremic (135-145 mEq/L)

Most common type of dehydration. Equal losses of Na+ and H20 caused by vomiting, diarrhea, insensible fluid loss and excess exercise.

Hyponatremic (<130 mEq/L)

Decreased Na+ due to dilutional effect of too much H20; caused by renal losses from diuretics, ingestion of too much water (over-diluted formula) or too much loss from gastric drainage.

Mild Dehydration

Mild tachycardia, lose 5% of body weight, skin turgor slightly decreased, mucous membranes dry (mostly normal assessment findings)

Moderate Dehydration

10 % body weight loss, skin turgor decreased more, fontanel's depressed, mucous membranes very dry, cool extremities, pale skin, mod. tachycardia, periph pulses diminished, irritable and lethargic, mild oliguria.

Severe Dehydration

15 % body weight loss, skin turgor severely decreased, fontanel's depressed, mucous membranes parched, cold extremities, mottled and gray skin, extreme tachycardia, reduced BP, no periph. pulses, unresponsive, marked oliguria/anuria.

Risk Factors for Dehydration

Aptic Fibrosis Prior Hx of Heart
Diabetes disease
Obesity Long exercise period
Mental Retardation Recent change of Env.

Interventions Dehydration

Oral Rehydration (1-2 sips per minute pedialyte)
IV fluids containing Na+

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