FLUID AND ELECTROLYTES BALANCE IN CHILDREN

FLUID REPLACEMENT

• Replacing the fluid deficit, maintenance requirements and replacement of losses.

• Vital in infants and young children because of their high total body water, basal metabolic rate, and daily turn-over of water.

• Should children experience excessive fluid losses, they may become dehydrated. And if left untreated may altered level of consciousness, vascular collapse, renal failure and death.

DISTRIBUTION OF TOTAL BODY FLUIDAdult • 60% of adult body weight is fluid.• Intracellular fluid (ICF), within the cells = 40% of body

weight.• Extracellular fluid (ECF) = 20% of body weight.

Developmental Differences (Children)Infants and young children4 areas of immature functioningIncreased fluid I/O relative to size (Total body fluid in

children is 20% more than adult)Greater surface area relative to size - > water loss through

skinIncrease metabolic rate up to 2 yearsImmature kidney function – requires more fluid to excrete

wastes

Causes of fluid loss Excessive vomiting or diarrhea Hemorrhage Some medications – diuretics Surgery Fasting over night prior to surgery

Signs and SymptomsThirsty Dry mouthLethargy and irritable to touchSunken fontanel Decrease blood volume (Hypotension, tachycardia,

oliguria)Decrease tissues perfusion - cyanosis (check

capillary refill time)Tissue dehydration (loss of skin turgor)

Management

Divided into 3 phases:- Deficit therapy Maintenance therapy Replacement therapy

Deficit therapy – refers to the management of fluid and electrolytes losses that occur prior to presentation for surgery and itself has 3 components:

a.) estimation of dehydration severity (from history and clinical evaluation

b.) determination of fluid deficit type (due to overnight fasting)

c.) deficit repair

Maintenance fluid therapyOn going fluid and electrolytes requirement

therapy during the course of surgeryReplace the losses from insensible losses

(evaporative loss) and urinary loss.

Replacement therapyReplace ongoing abnormal fluid and

electrolytes losses [from third space loss, blood loss]

Obtain history from parents to assess the state of hydration

Recognize the physical findings Information giving of – importance of initial

fluid replacement and maintenance to parents and child accordingly

Explain the consequences of electrolytes imbalance

Explain the used of oral rehydration therapy [GE]

I/O updates regularly