Nov 12, 2018 infants and children who present to the ed with mild to moderate dehydration may respond to fluid boluses and may be discharged home with close followup with their primary care provider. Treatment is with oral or iv replacement of fluid and electrolytes. Diarrhoea 6 your recording form look at your imci recording form for the sick child. Pediatric airway equipment maintenance fluid requirements 421 rule. Rehydration is the cornerstone of treatment for cholera. Hypotonic dehydration is also seen in adrenal insufficiency. Ivfs are required if sufficient fluids cannot be provided by using enteral administration for reasons such as gastrointestinal illness, respiratory compromise, neurologic impairment, a perioperative state, or being moribund from an acute or chronic illness. As an estimate for the amount of fluid to replace, the goal should be to drink 10 mlkg body weight for each watery stool and estimate volume of. Describe common methods of treatment for dehydration and diarrhea in young children, including oral rehydration solutions, medications and intravenous fluid replacement. The american academy of pediatrics and the who both recommend oral replacement. Recognize how to avoid as well as treat complications of. The physical exam will help determine clinical evidence of dehydration as evidenced by sunken eyes, decreased. Fluids in context of associated comorbidities like malnutrition, sepsis and acute kidney injury also need further exploration.
A similar calculation is made for potassium deficit, but it is assumed that 40% of the total water deficit has been lost from the intracellular fluid space icf and that the mean concentration of. Another way to assess the degree of dehydration in children with acute dehydration is change in body weight. Replacement fluid therapy for reptiles should be based on the animals hydration status and condition and available products. Monitoring fluid and electrolyte therapy is an important role of the pediatric pharmacist. Oral rehydration therapy protocol in pediatric dehydration. After completing this article, readers should be able to. Perioperative fluid replacement for children and infants is a complex and somewhat controversial topic. You can access the worksheet and quiz any time to see how much knowledge you have about fluid replacement in pediatrics. Evidence with respect to fluid type, volume, and rate of therapy is still evolving. Dehydration occurs when fluid output is greater than fluid input. Evidence to improve patient care in emergency medicine brought to you exclusively by the publisher of. Spandorfer, in comprehensive pediatric hospital medicine, 2007. See maintenance fluid requirements in children hollidaysegar formula. Care should be taken in determining fluid replacement rates, particularly in prolonged exercise lasting greater than 3 h.
Maintenance intravenous fluids ivfs are used to provide critical supportive care for children who are acutely ill. Who initial treatment of dehydration for severe acute. How does fluid replacement for dehydration work in a medical. Dehydration remains a major cause of morbidity and mortality in infants and young children worldwide. If you dont replace lost fluids, you will get dehydrated. Feb 07, 2016 the best seminar in pediatric fluid therapy on slideshare. Oral rehydration therapy protocol in pediatric dehydration, dehydration management in children with oral replacement, pediatric diarrhea fluid replacement. In children, the most common abnormality requiring fluid therapy is hypovolemia or dehydration, often related to vomiting and diarrhea from gastroenteritis. Children with mild to moderate dehydration should have their estimated fluid deficit rapidly replaced.
In people with severe acute malnutrition, mild and moderate dehydration caused specifically by cholera, should be immediately treated with oral rehydration salts ors 4. If a child is prescribed a hypotonic fluid, change to an isotonic fluid for example, 0. May 30, 2019 if there are signs of significant dehydration, like elevated resting heart rate and low blood pressure, doctors will give you fluids intravenously. However, this method depends on knowing a precise, recent preillness weight. This refers to dehydration, water loss alone without change in sodium.
Patients who are severely volume depleted or who are unable to tolerate oral fluids must be admitted, with a pediatric consultation. An athlete should drink early and often, and be allowed unrestricted fluid replacement. Sarah kiguli and colleagues call for who to think again rpberto schmidtafpgetty images the world health organization recommendations on management of common childhood illnesses affect the lives of. By paying close attention to the fluid needs of pediatric patients and monitoring response to fluid therapy, the pediatric pharmacist can have a positive influence on the health of the child. The american academy of pediatrics recommends oral rehydration. Dehydration in children explore from the msd manuals medical professional version. Pediatric emergency medicine practice clinical pathways. Dehydration is a general state in which there is a totalbody fluid deficit. Clinical signs of dehydration should be taken into consideration first, as they can. Algorithms for iv fluid therapy in children and young people. Fluid management and dehydration texas tech university. Infants and children are at greater risk of developing dehydration than adults due to higher metabolic rates, inability to communicate thirst or selfhydrate effectively and greater water requirements per unit of weight 1,2. Hala alnahrain universitycollege of medicine iraqbaghdad.
Risk for injury related to decreased level of consciousness the child will not. Under normal physiologic conditions, water constitutes 70% of lean body mass. For children oct 07, 2015 know how to manage hypernatremic dehydration. Most of the volume loss in dehydration is extracellular fluid. Cerebral oedema is the predominant cause of this mortality. Pdf managing fluids and electrolytes in children is an important skill for.
Traditionally, the first step in determining the hourly fluid requirements for a child described by holliday and segar and coined as the 421 rule. The 20 world health organization guidelines continue to recommend rapid fluid resuscitation for children with shock despite evidence that this can be harmful. Dehydration hyponatraemia hypernatraemia neonatal intravenous fluid. Diagnosis and management of dehydration in children american. Although these children lack distinct signs of dehydration, they should be given more fluid than usual to prevent dehydration from developing. See oral rehydration therapy protocol in pediatric dehydration mild to moderate dehydration. Understand which patients are candidates for oral rehydration. Infants and small children are more likely to become dehydrated than adolescents and adults because they can lose fluid quickly. Replacement and redistribution adjust the iv fluid prescription to account for existing fluid andor electrolyte deficits or excesses, ongoing losses or abnormal distribution.
The safe use of iv fluid therapy in children requires accurate prescribing of fluid and careful monitoring. Fluid therapy for pediatric patients with diabetic. Nursing care plan the child with severe dehydration 318. The most common causes of dehydration in children are vomiting and. Fluid therapy is divided into maintenance, deficit, and replacement requirements.
Use this nursing diagnosis guide to develop your fluid volume deficit care plan. The second phase of fluid replacement therapy lasts for 8 hours. Assess diarrhoea and dehydration in sick child assess dehydration in sick young infant. Paediatric fluid management tutorial for medical s duration. Mcnab 2015 lancet pubmed weight dehydration in children amy canavan, md, virginia commonwealth university school of medicine, falls church, virginia billy s.
The goal of fluid therapy is to preserve the normal body water volume and its electrolyte composition. Nursing care plan the child with severe dehydration goal intervention rationale expected outcome 1. Fluid management and dehydration national pediatric nighttime curriculum written by dr. There is also a very limited role for antiemetic agents. Module organization this module follows the major steps of the imci process.
Anyone may become dehydrated, but the condition is especially dangerous for young children and older adults. Unfortunately, relying on the bodys thirst mechanism cannot prevent dehydration, so thirst should not be relied upon to determine fluid intake. For severe dehydration, the child may need iv fluids in the hospital. Sep 19, 2019 dehydration occurs when you use or lose more fluid than you take in, and your body doesnt have enough water and other fluids to carry out its normal functions. Table 1 shows the classification of diarrhea without dehydration or blood in stools, according to the imci strategy. Not only is fluid lost to the outside of the body but there is also a shift of fluid from the ecf to the icf. Children become dehydrated more easily as their body surface area. Pdf pediatric fluid and electrolyte therapy researchgate.
Due to the predominant loss of extracellular fluid in hypotonic dehydration, vascular collapse is seen more often and. Pediatric hypertonic dehydration serum sodium 150 pediatric hypotonic dehydration serum sodium pediatric isotonic dehydration. Emergency medicine practice pediatric emergency medicine practice em practice guidelines update the lifelong learning and selfassessment study guide em critical care ed overcrowding. Treating hypernatremic dehydration american academy of. A physical exam and thorough history are essential before developing a fluid replacement plan. Exercise caution with hypotonic solutions hyponatremia consider d5 ns as maintenance fluid instead of d5 12ns. Fluid resuscitationtreatment of dehydration for dehydration,shock,blood lossisotonic normal saline or lactated ringers give 20mlkg as bolus. For children 10% start rehydration with oral replacement solution. Intravenous fluid therapy in children and young people in. Dehydration can be caused by not drinking enough fluids, vomiting, or diarrhea. Organizing fluid needs into maintenance, deficit, and replacement therapy can provide a systematic, understandable approach to determining fluid therapy.
Algorithms for iv fluid therapy in children and young people in hospital consider isotonic crystalloids that contain sodium in the solution algorithm 4. Diagnosis and management of dehydration in children amy canavan, md, virginia commonwealth university school of medicine, falls church, virginia billy s. These facets open doors for more multicentric research. These guidelines only apply to children who cannot receive enteral fluids. Pediatric critical care, golisano childrens hospital, university of rochester school of medicine, rochester, ny. Restrict maintenance iv fluids in children and young people who are hypervolaemic or. Dehydration means that the body has lost too much fluid.
Maintenance fluid therapy does not replace deficits or ongoing additional losses and does not provide nutritional support. Understand that the signs and symptoms of dehydration are related. Fluid management in diabetic ketoacidosis archives of. The most important part of managing diarrhea is the replacement of lost fluids. Mar 20, 2019 the nursing diagnosis fluid volume deficit also known as deficient fluid volume is defined as decreased intravascular, interstitial, andor intracellular fluid. Maintenance therapy replaces the ongoing daily losses of water and electrolytes occurring via physiologic processes urine, sweat, respiration, and stool, which normally preserve homeostasis. Fluids and electrolytes m3 dehydration pediatrics, part 1 dr. Due to the predominant loss of extracellular fluid in hypotonic dehydration, vascular collapse is seen more often and earlier than in the other types of dehydration. It does not replace the need for the application of. Ors is a fluid that contains salt, sugar, potassium chloride and citrate to replenish the lost fluids and electrolytes that led to dehydration 6. Clinicians need to recognize the signs and symptoms of dehydration to safely restore fluid and electrolytes. Fluid volume deficit related to excess losses and inadequate intake the child will return to normal hydration status and will not develop hypovolemic shock.
Nov 12, 2019 in conclusion, fluid therapy is the mainstay in the management of dka. Pediatric saskatchewan registered nurses association. Fluid therapy maintains the normal volume and composition of body fluids and, if needed, corrects any existing abnormalities. Pdf managing fluids and electrolytes in children is an important skill for pharmacists, who can play an important role in monitoring therapy. Fluid therapy was described in the literature as early as 1918 in pediatric patients with dehydration bailey 2010. These updated recommendations include administering 50100 ml of orskg body weight during 24 hours to replace the estimated fluid deficit, with additional ors administered to replace ongoing losses. Dehydration and oral rehydration acid base, electrolytes. Oral rehydration salts and, when necessary, intravenous fluids and electrolytes, if administered in a timely manner and in adequate volumes, will reduce fatalities to well under 1% of all patients. Fluid therapy is divided into maintenance, deficit, and replacement. Pediatric clinical practice guidelines for nurses in primary care. The longer the exercise duration the greater the cumulative effects of slight mismatches between fluid needs and replacement, which can excessive dehydration or dilutional hyponatremia. Start the oral rehydration protocol see above calculate 24 hour maintenance requirements.
568 305 1420 1062 274 845 1533 876 673 347 179 1227 484 1085 271 752 540 864 721 71 482 349 856 783 134 1418 971 1146 163 1081 649 450 720 840