Doctorese Babble -- Fluids and Electrolytes

Fluids and Electrolytes

1.     Heat loss – insensible water loss – 50%

2.     Solute loss – urine (Na, K, Cl) – 50%

100kcal --> 100mL fluid

Neonates have highest BMR – require more fluids

1.     Weight – Holiday Seey

Weight	Day	Hour
First 10kg	100mL/kg	4mL/kg/hr
Next 10kg	50mL/kg	2mL/kg/hr
Every subsequent kg	20mL/kg	1mL/kg/hr

2.     Body Surface area – more accurate but takes much longer to calculate

3.     Calculations

a.     Maintenance

                                               i.     100kcal -- 100mL H20, 3-4 meq Na, 2 meq K

                                             ii.     <3 months -- D5% + ¼ NS + 20meq K

                                            iii.     > 3 months -- D5% + ½ NS + 20meq K

                                            iv.     Bolus fluids

1.     Normal Saline

2.     Ringer’s Lactate

3.     Blood

4.     Albumin

5.     **Gatorade or Pedialite are closest to NS

6.     Do not withhold feeding

7.     20mL/kg – then reassess and repeat if needed up to 3-4 times unless edema increases (adults are 0.5-1.0L)

                                             v.     blah

b.     Deficit

	Mild 5% in neonates 3% in toddler and adults	Moderate 10% in neonates 6%	Severe 15% in neonates 9%
Tears/eyes	Sunken eyes	Sunken eyes	Sunken eyes
Membrane perf.
Skin turgor		Decreased turgor with tenting	Decreased turgoor with tenting
Fontanelle
Cap refill	<2s	<3s	> 3 s
Oral Mucosa
Urine output and spec gravity (1.010)		Decreased output and increased gravity	No output
HR	+	+	+
BP		Decreased	Decreased

c.     Ongoing losses – 10mL/kg extra fliud per loose stool

4.     I’s/O’s

a.     Urine (2:1) or specific gravity

b.     Blood à Hb, creatinine, BUN

c.     Urine osmolarity – 280-320

5.     Hypernatremic dehydration – give more fluids