4. Case example An 8 – month boy had diarrhea and vomited for 3 days, urine stream reduced, irritability. PE: Pulse rate 150/min, weight loss was 10%, blood pressure 65/40mmHg, skin color showed grey and skin turgor looked like tents. Mucous membranes were very dry; eye ball was sunken greatly, anterior fontanel depressed greatly. Abdomen distended, bowel sound diminished. Questions: 1.What is the diagnosis? 2.How to administer the fluid therapy?
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6. Neonate …………… ... 80% Older children ……… ..65% Adult ………………… ..60% features of body fluid balance in children The younger The larger proportion of body water Total body water (by body mass) ----amount of body fluid
7. features of body fluid balance in children The younger The larger proportion of extracellular water Intracellular Body fluid Extracellular Interstitial fluid Plasma Lymph fluid Secretory juice ----distribution of body fluid
8. P 6% IF 37% IC 35% IF 20% IF 10% ~ 15% IF 25% IC 40% P 5% P 5% P 5% IC 40% IC 40%~45% Neonate 78% ~1y 70% 2y~14y 65% Adult 55%~60% features of body fluid balance in children P: plasma IF: interstitial fluid IC: intracellular ----distribution of body fluid in different ages (by BW)
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17. Severity clinical signs of dehydration Dehydration mild moderate severe Water loss By weight Spirit Skin Mocous Anterior fontanel and eye ball Tear Urine output Peripheral circulation ＜ 50ml/kg ＜ 5% Slightly dispirited slightly agitated Slightly dry Slightly dry Slightly depressed Normal Slightly reduced normal 50 ～ 100ml/kg 5% ～ 10% Dispirited Agitated Dry, pale Very dry depressed Reduced Little or No Little cool 100 ～ 120ml/kg ＞ 10% Extremely dispirited apathy, hypnody, coma Gray mottled Parched depressed greatly No No urine output Cool, weak pulse,shock
18. Dehydration Same proportion loss P IF C P IF C Electrolyte loss more P hypotonic, IF+C hypertonic Cell expansion Severe Easy to shock P: plasma, IF: interstitial fluid, C: cell Isotonic P IF C Water loss more P hypertonic IF+C hypotonic Cell hydration Mild Thirsty Acute diarrhea after vomiting greatly Hypotonic Hypertonic Na+ : 130 ～ 150mmol/L Na+: < 130mmol/L Na+: > 150mmol/L
24. To cure water and electrolyte disturbance Recover and maintain blood volume , osmotic pressure , Acidity , alkalinity and electrolyte Normal physiological function Purpose
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35. Liquid solution commonly used 5%GS 10%GS 0.9%NaCl 10%NaCl Ringer 5% NaHCO3 11.2% NaL 10%KCl Mixture nonelectrolyte solution electrolyte solution glucose enter the body by oxidation change into water and CO2 for energy and water without tension
39. 溶 液 每 100ml 含 Na∶Cl 电解质 1∶1 含钠液 ① 50ml,②50ml 1∶1 1/2 张 1∶2 含钠液 ① 35ml,②65ml 1∶1 1/3 张 1∶4 含钠液 ① 20ml,②80ml 1∶1 1/5 张 2∶1 含钠液 ① 65ml,④35ml 3∶2 等张 2∶3∶1 含钠液 ① 33ml,②50ml ④ 17ml 3∶2 1/2 张 4∶3∶2 含钠液 ① 45ml,②33ml 3∶2 2/3 张 ④ 22ml 续 表
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44. Accumulation losses amount mild ： 50ml/kg moderate: 50 ~100ml/kg severe ： 100 ~120ml/kg Water supplement-1: accumulation losses Amount , composition and speed: --- according to the degree and quality of dehydration
45. composition isotonic ： 1/2 tonicity(1:1) hypotonic ： 2/3 tonicity(4:3:1) Hypertonic:1/3~1/5 tonicity ( 1/3 tonicity) speed Principle: fast slow severe ： bolus of isotonic fluid 2:1 tonicity : 20ml/kg (<300ml ) in 30’~1h(rapidly expand) others ： 8~12h ( 8 ～ 10ml/ （ kg·h ） iv Water supplement-1 : accumulation losses Accumulation losses Dehydration :
46. Severity clinical signs of dehydration Dehydration mild moderate severe Water loss By weight Spirit Skin Mocous Anterior fontanel and eye ball Tear Urine output Peripheral circulation ＜ 50ml/kg ＜ 5% Slightly dispirited slightly agitated Slightly dry Slightly dry Slightly depressed Normal Slightly reduced normal 50 ～ 100ml/kg 5% ～ 10% Dispirited Agitated Dry, pale Very dry depressed Reduced Little or No Little cool 100 ～ 120ml/kg ＞ 10% Extremely dispirited apathy, hypnody, coma Gray mottled Parched depressed greatly No No urine output Cool, weak pulse,shock
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55. Principles of Therapy first fast then slow first thick then thin supplement potassium when having urine adjust any time and monitor
