Infantile Liquid Therapy Objective Summary Characteristic of Infantile

Infantile Liquid Therapy Objective Summary Characteristic of Infantile Body Fluid Balance Fluid, Electrolyte, & Acid-base Disorders Common Solution of Liquid Therapy Infantile Diarrhea Liquid Therapy

Objective • • • Characteristic of Infantile Body Fluid Balance ——Realized Pathophysiology of Infantile Fluid, Electrolyte & Acidbase Imbalance ——Be familiar with Clinical menifestations of Infantile Fluid , Electrolyte & Acid-base Disorders ——Mastered Common Solution Component of Liquid Therapy ——Be familiar with Liquid Therapy of Infantile Diarrhea ——Mastered

Summary Body fluid is important component of human body and the physiological equilibrium of body fluid is an important factor for human living. The dynamic equilibrium of fluid, electrolyte, acid-base, osmotic pressure depends on normal regulating function of nerve, incretion, lung and kidney. Because of the infantile physiologic peculiarity, These systematic functions are easily affected by diseases and/or environment and are maladjusted. Therefore, the disorder of water, electrolyte and acid-base is common in pediatric clinic.

Characteristic of Infantile Body Fluid Balance A. Total body water & its distribution Body water compartments related to age (total body mass%) Age TBW Newborn infant ECF ICF Plasma ISF 78 6 37 35 1 year 70 5 25 40 2～ 14 years 66 5 20 40 Adult 55～ 66 5 10～ 15 40～ 45 TBW: total body water ECF: extracellular fluid ICF: intracellular fluid ISF: interestitial fluid

Characteristic of Infantile Body Fluid Balance B. Electrolyte composition of body fluid ECF: + Na 、 Cl ，HCO 3 - ICF: K + 、Mg 2+ 、HPO 4 2 、Protein C. Water metabolism a. Large water requirements, swift water exchange, unobvious water loss (double adult’s amount ). Infant’s water exchange amount is 1 / 2 of ECF , the adult’s is just 1 / 7. b. Immature body liquid regulating function , immature concentration and dilution function of infantile.

Fluid, Electrolyte & Acid-base Disorders A. Degree of dehydration Dehydration Mild Moderate Severe Decrease in body weight 5％ 5～ 10％ >10％ (50 ml / kg) (50～ 100 ml / kg) (100～ 120 ml / kg) Psyche Depressed, hyperirritable Lethargic, coma Orbit, Fontanel Sunken ± Sunken Severely sunken Skin turgor Mucous membranes Normal ± Decrease Markedly decrease Dry ± Dry Severely dry Tears Decrease ± Decrease Absent Urine Mild oliguria Anuria Blood pressure Normal Low

Fluid, Electrolyte & Acid-base Disorders B. Property of dehydration Type of dehydration Pathogeny Serum sodium Isosmotic Acute gastrointestinal fluid lose 130～ 150 mmol / L Hypotonic Hyperosmotic Pathophysiology & clinical characteristic ECF: decrease, Osmotic pressure (intracellular = extracellular) Dehydrant volume accord with dehydrant physical sign Chronic gastrointestinal fluid lose <130 mmol / L ECF: severely decrease, Easily shock ， Severer dehydrant sign than the other two kinds High grade fever, Infection >150 mmol / L ICF: severely decrease, Milder dehydrant sign than the other two kinds

Fluid, Electrolyte & Acid-base Disorders C. Metabolic acidosis Pathogeny 1. The lose of large amount of basic substances（gastrointestinal tract, kidneys） 2. Too much Acid metabolite （hungriness, diabetes, renal failure, hypoxia） 3. Too much acid substance intake （long time to take calcium chloride, ammonium chloride, amino acid etc. ） Degree Mild Moderate Severe HCO 3 HCO 3 - 18~13 mmol / L 13~9 mmol / L <9 mmol / L

Fluid, Electrolyte & Acid-base Disorders D. Hypokalemia Pathogeny 1. Lack of intake 2. Loss of kalium from kidneys or gastrointestinal tract 3. Burn, dialysis etc. 4. Abnormal kalium distribution inside or outside cells （alkalosis, insulin therapy、periodic anesthesia）

Fluid, Electrolyte & Acid-base Disorders Clinical menifetation 1. Nervous system ——depressed 2. Muscle——inertia of limbs，muscular tension down，severely retardant paralysis，respiratory muscle paralysis 3. Heart —— heart rate increasing, arrhythmia, Adams－Stokes syndrome, heart rate decreasing，atrioventricular block, heart sound lowering, cardiogram: U wave appearing，U≥T， flattened T wave 4. Kidney—— concentrating function lowering, urine volume increasing

Common Solution of Liquid Therapy A. Nonelectrolyte solution 5％、10％ glucose B. Electrolyte solution 0. 9％ Na. Cl、1. 4％、5％ Na. HCO 3、10％ KCl C. Mixed solutions refer to the following table

Common Solution of Liquid Therapy Common mixed solution 0. 9% Na. Cl 1. 4% Na. HCO 3 5~10%G. S 2: 1 2 1 － 3: 2: 1 2 1 3 4: 3: 2 4 2 3 6: 2: 1 2 1 6

Infantile Diarrhea Liquid Therapy A. Volume Degree Total volume Cumulated losing volume Keep transfusing period （physiological need, losing continuing） Mild 90～ 120 ml/kg 45～ 60 ml/kg Moderate 120～ 150 ml/kg 60～ 75 ml/kg Severe 150～ 180 ml/kg 75～ 90 ml/kg

Infantile Diarrhea Liquid Therapy B. Quality Dehydrant category Cumulated losing volume Keep transfusing period （physiological need, losing continuing） Hypotonic dehydration 4: 3: 2 1/3～ 1/4 Isosmotic dehydration 3: 2: 1 Hyperosmotic dehydration 1/3 Sodic solution 1/3～ 1/4 Sodic solution

Infantile Diarrhea Liquid Therapy C. Speed Total volume Cumulated losing volume Keep transfusing period （physiological need, losing continuing） 24 h 8～ 12 h 12～ 16 h － 8～ 10 ml / kg /h 5 ml / kg /h

Infantile Diarrhea Liquid Therapy D. Shock volume expansion Volume Solution Speed 20 ml/kg 2: 1 or 1. 4％Na. HCO 3 30～ 60 min Total volume ≤ 300 ml

Infantile Diarrhea Liquid Therapy E. Treatment of metabolic acidosis Mild or moderate metabolic acidosis: No special treatment Severe metabolic acidosis： 1. 4%Na. HCO 3 3 ml/kg， [HCO 3 -] level can increase about 1 mmol. F. Treatment of hypokalemia Supply kalium after urination (urination 6 hours of preadmission, bladder percussing－dull note) Kalium supplement concentration: 0. 2～ 0. 3％(≯ 0. 3％) Venoclysis period of total Kalium supplement per day ≮ 8 hours.

Infantile Diarrhea Liquid Therapy Case analysis Infant, male, 9 months, diarrhea 2 days, admission date 1998 -08 -10. After eating un-boiled bean curd 2 days ago, yellow waterish stools, bulky, no blood, no tenesmus, defecation 10～ 15/day; one stool 6 hours of preadmission, a little, yellow urine. Physical examination：T 38ºC, R 32/min, P 120/min, dyspyoria, Fontanel 1. 5× 1. 5 cm 2, sunken, orbit sunken, decreased Skin turgor, dry lip, dry periglottis, pharynx (－), heart rate 120/min, no arrhythmia, mild dull heart sounds, lungs(－), mild abdomen swelling, soft abdomen, liver 1. 5 cm below ribs, bowel sounds 10 ～ 12/min, no high notes，two lower limbs patellar reflex (negative)