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7/29/2019 Fluids & Electrolytes Basics
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Rhishikesh ThakreDM (Neonatology)
MD, DCH, DNB, FCPS.
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Total body water in 2body compartments
Intracellular fluid (ICF)
Extracellular fluid (ECF
- Interstitial space
- Intravascular space
1st week ECF volume
decreases
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!
!
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92%
86%
77%72%
66%62%
60%
45%
30% 28%26%26%
32%
42%38%
36%
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.80.9
1
0 3 6 9//0 3 6 9
TBW
ECF
ICF
B
odyWaterContent(%)
FETUS NEWBORN
Age (months)
100
90
80
70
60
50
40
30
20
10
0
%
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++ -- ++ --++ --
100
Cations
Na 140 143 010
K 004 004 160Anions
Cl 104 114 002
HCO3 025 029 008
Na HCO3
Cl
Na HCO3
Cl
K
Mg
Na
HCO3
Pr
PO4
200
Plasma ISF ICF
o
KP
o
K
P
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"#
!"#$% &"#$ '
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$ -.
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#"
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8)'9:;,':>
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GOAL :
Prevent dehydration & hypoglycemia
&
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+
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(G?",$ (G?",$( !0 1234153)( 136 #56
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)
36822202550Isolyte P
Ped. Maint.
347343450D5 0.2%NaCl
381575750D5 0.33%NaCl
415777750D5 NS
585154154505% DNSDextrose,electrolyte
solution
55610010%
278505%Electrolyte
freesolution
1547777 NS isotonic
2702291115131RL308154154NSIsotonic
gm/L
mOsm/L
CaLactate
ClKNaDextr.
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~ For hypoglycemia correction~ For increasing glucose conc
25 % D
~ IV Maintainence for > 1000g forfirst 24 48 h
~ For hypoglycemia correction
10 % D
~ IV Maintainence for < 1000 gfirst 24 - 48 h
~ Vehicle for ACT, Aminophyline,
Calcium gluconate
5 % D
$')*
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~ Maintenance IV fluid ( > 48 h)Isolyte P
~ Correction of symptomatichyponatremia
3 % NS~ Replacement of ileostomy loses NS
~ Volume expander in shockRL
~ Volume expander in shock~ Vehicle for phenytoin, Sodabicarb,Aminophyline
~ Replacement of gastric aspirate~ Correction of hyponatremia
NS
$')/9*
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: 2FI !0570 &6 &!60(5 &005&/0&6 &66/0' &05J0 /0 /0 /0
( &05#0 &0 !6 0;8 605&6 46 0
! %!;,- 45 mg%
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=()'"
2-./-')160>3/-./-
'9?/-./-
'6+!L+$
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Physical signs Urine output
Daily weight Blood urea Hematocrit
#)'!*
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GCC:
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Restrict fluids during the acute phase Watch for diuresis : Increase fluid rapidly
Avoid hypervolumia during entire therapy
No weight loss or static weight in first 72 hrs
Isolated diastolic shock is an early marker ofopening of PDA in RDS during recovery
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(
Symptomatic : restrict fluids Presence of isolated diastolic low blood
pressure is an earliest marker of opening
of ductus Weight gain : development of CCF
Ensure normokalemia before digitalizing
If no response to CCF in 24 hrs, checkelectrolytes
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:(
GC
;
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:(
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(
U/O not a reliable indicator for ARF Presence of oliguria, unexplained weight
gain warrants renal chemistry
Check electrolytes :
Low Na = fluid retention
High Na = renal tubular pathology
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D153,
Dehydration +
in shock
Normal ECS
( partially treated )Hypervolumia
Fluid boluses (NS)
Restore volume+ Deficit ( 10%)
Replace
free water + maint.In > 48 hours DiuresisDialysis
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:E %
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ICF ECF
K+ 98% K+ 2%
Dynamic equilibrium
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