MD Luthfy Lubis

:Learning Outcomes

Participants know the components of fluid

compartments
Participants learn the fluid and electrolytes
requirements of infants and children
Participants become competent in calculating daily
needs of fluid and electrolytes in paediatrics
Participants may fluently order indicated fluid and
electrolytes therapy in paediatrics
Participants should be able to mention the
indications and contraindications of most
frequently used parenteral and rehydration fluids

The Basics
Body as a Compartment

Total body water, intracellular fluid, and extracellular

fluid as a percentage of body weight and a function of
age. (From Winters RW: Water and electrolyte
regulation. In Winters RW, editor: The body fluids in
pediatrics, Boston, 1973, Little, Brown.)

The Basics
Body as a Compartment

The concentrations of the major cations and anions in

the intracellular space and the plasma, expressed in
mEq/L.

Why electrolytes important?

Osmolality.

Beware of hyperglycemia!

The Basics
Body as a Compartment

Regulation of
plasma osmolality
(PO)
Independent systems

for water balance and

sodium balance
Maintained at 285295 mOsm/kg
Regulated by:
osmoreceptors, ADH,

Regulation of
volume
Regulated by: RAA

system, effective GFR

Fluids and Electrolytes

Requirements

Maintenance requirements
i.e. water and electrolytes lost during

normal basal metabolism.

Deficit repletion
i.e. water and electrolytes lost before the

patient is hospitalized

Ongoing losses
i.e. water and electrolytes lost due to

ongoing medical condition

Maintenance Requirements

Basal calorie
method
Useful for all ages
Based on EER
Complicated!
For 100 calories/24 hr

100-120 ml H2O,
2-4 mEq Na, 2-3 mEq
K

Holliday-Segar
method

Maintenance Requirements

Deficit Repletion
Water Deficit

A.

Calculated
assessment

Clinical assessment

Deficit Repletion
Solute Deficit Based on Solute Fluid
Deficit (Isonatremic Dehydration)

B.

ECF 20% BW (3/4 EV, 1/4 IV)

Dehydration ECF & ICF loss vary
< 3 days illness: 80% ECF deficit, 20% ICF
deficit
> 3 days illness: 60% ECF deficit, 40% ICF
deficit

Deficit Repletion

Deficit Repletion
C.

Excess Electrolyte Deficits

(Hyponatremic Dehydration)

Deficit Repletion
D.

Free Water Deficit (Hypernatremic

dehydration)
Additional Na or K deficit calculated based
on serum laboratory findings
Estimates 4 ml/kg to lose serum Na by 1
mEq/L

Deficit Repletion
Solute Fluid Deficit (Hypernatremic
Dehydration)

E.

The amount of additional volume loss

beyond free water deficit

Deficit Repletion
Solute Fluid Deficit (Hypernatremic
Dehydration)

E.

The amount of additional volume loss

beyond free water deficit

Deficit Replacement
Strategy

Phase I
Rapid fluid resuscitation with isotonic fluid
Be careful on this phase for patient with

hyperosmolarity!
Do not forget to substract resuscitated fluids
from the total deficits.

Phase II
Deficit repletion, maintenance, ongoing

losses (24-48 hours)

Deficit Replacement
Strategy
Hypernatremic dehydration avoid
rapid correction CPM (rate of Na
correction should not > 0.5-1 mEq/L)
Hypernatremic dehydration excess
free water loss do not reduce Na
serum > 15 mEq/24 hr due to risk of
cerebral edema

Deficit Replacement
Strategy

Example 1
Determine an adequate
fluid schedule for a 7-kg
(pre-illness weight)
infant who has been ill
for 3 days and clinically
appears 10%
dehydrated. Current
weight is 6.3 kg. Serum
Na+ = 137 mEq/L.
An intravenous (IV) line
has just been placed,
but no IV fluid has been
administered.

Example 2
Determine an adequate
fluid schedule for a 7-kg
(pre-illness weight)
infant who has been ill
for 3 days and clinically
appears 10%
dehydrated. Current
weight is 6.3 kg. Serum
Na+ = 115 mEq/L.
An intravenous (IV) line
has just been placed,
but no IV fluid has been
administered.

Example 3

Determine an
adequate fluid
schedule for a 7-kg
(pre-illness weight)
infant who has been ill
for 3 days and
clinically appears
between 10% and
15% dehydrated.
Current weight is 6.1
kg.
Serum Na+ = 160
mEq/L.

Parenteral Fluids
What to choose?

Parenteral Fluids
What to choose?