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children
Case
• Newborn, 10 days old
3. 90 ml/kg
4. 120 ml/kg
5. 150 ml/kg
6. Depends on the urine output
Fluid management children I
• Neonates
– 1st 5 days of life: start with 30 ml/kg/24 h and
increase with 30 ml/day: i.e.: 30 – 60 – 90 –
120 – 150 ml/kg/24 h
– Beyond day 5: 150-180 ml/kg/24 h
– 8 feedings
Question
A. Neonates need relatively more fluid than older children
because their urine output is relatively higher
• A is true
• B is true
• A and B are true
• A and B are false
Surface in relation to bodymass
• A is true
• B is true
• A and B are true
• A and B are false
Case
• Boy, 5 yr
• Admitted to clinic for elective surgery, 1st
24 h no oral intake
5. A is true
6. B is true
7. A and B are true
8. A and B are false
Fluid management children II
• Neonates
– 150-180 ml/kg/24 h
• BW= (2*5)+8= 18 kg
• Intake: (10*100)+(8*50)=1400 ml
Question
A. The experienced nurse is right (as is always
the case with experienced nurses)
• A is true
• B is true
• A and B are true
• A and B are false
Case, boy 3 yr
• History/
– previous healthy, no malnutrition
– Since 2 d diarrhea, 5 watery stools/day
– Decrease urine output, thirsty
• PE/
– BW 8 kg, PR 140/min, skin turgor↓ dry mucosa
• Diagnosis/
– 5-10% dehydration
• Treatment: ORS
Break
Question about ORS
A. The combination of salt and sugar enhances fluid absorption
because sodium and glucose transport in the small intestine are
coupled, and glucose promotes absorption of both sodium ions
and water
7. A is true
8. B is true
9. A and B are true
10. A and B are false
Question about ORS
A. The combination of salt and sugar enhances fluid absorption
because sodium and glucose transport in the small intestine are
coupled, and glucose promotes absorption of both sodium ions
and water
• A is true
• B is true
• A and B are true
• A and B are false
Case
• Girl, 6 year
• History
– Since 2 days: profound diarrhea due to shigella
dysentery
– Decreased urine output
• PE/
– Bodyweight: 21.5 kg
– Irritable, dry membranes, deep set eyes, decreased skin
turgor
Question
The total fluid this patient needs in the 1st 24 h is:
1. 3.5 liter
2. 4 liter
3. 4.5 liter
4. 6 liter
Rehydration schedule
3 pillars:
2. daily intake
3. estimated deficit
4. ongoing losses
• 3.5 liter
• 4 liter
• 4.5 liter
• 6 liter
Case, boy 3 yr
• History/
– Severe diarhoea, no malnutrition
• PE/
– Lethargic, BW 7.6 kg, PR 140/min, skin turgor ↓ ↓ dry
mucosa, no tears
• Diagnosis/
– 10% dehydration
5. A is true
6. B is true
7. A and B are true
8. A and B are false
Malnutrition and fluid
pathophysiological concepts
• Malnourished children may have cardiomyopathy
• Conclusion:
– The risk of overhydration and congestive heartfailure in malnourished
children may be overemphasized
– ReSoMal does not prevent overhydration
Question
A. In healthy children overhydration easily leads to
hypertension, whereas congestive heart failure is a
more prominent feature in adults
• A is true
• B is true
• A and B are true?
• A and B are false
QUESTIONS?