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## Pediatric Hypotonic Dehydration

Aka: Pediatric Hypotonic Dehydration, Hypotonic Dehydration Management in Children
1. Pediatric Dehydration Management
2. Definition
3. Example Case
1. Weight: 35 kg Child
2. Dehydration: 10%
3. Serum Sodium: 120
4. Calculate Replacement and Replace Phase 1 Fluids
1. Approach as per Pediatric Dehydration Management
2. Deficit: 3500 - 700cc (Replaced Phase 1)
3. Replacement
1. First 8 hours
1. Total: 1400 + (75 cc/hour for 8 hours)
2. Hourly: 250 cc/hour for 8 hours (2 Liters over 8h)
2. Next 16 hours
1. Total: 1400 + (75 cc/hour for 16 hours)
2. Hourly: 163 cc/hour for 16 hours (2.6L over 16h)
5. Calculate Sodium Deficit and Sodium Requirement
1. Calculate Deficit
1. Formula: 0.6 x (weight kg) x (135 - Serum Sodium)
2. Example: (0.6 x 35 kilograms) x (135-120) = 315 meq
1. Formula: 3 meq/kg/day x (weight kg)
2. Example: 35 kg x 3 meq = 105 meq Sodium/24 hours
3. Subtract Replacement given Phase 1
1. Phase 1 Fluid bolus
1. Formula: 1000 cc contains 150 meq Sodium
2. Example: 700 cc contains 105 meq Sodium
2. Remaining Sodium Required: 315 - 105 = 210 meq
6. Choose Appropriate solution to replace sodium deficit
1. Available solutions
1. 1/4 Normal Saline contains 38 meq/L Sodium
2. 1/3 Normal Saline contains 51 meq/L Sodium
3. 1/2 Normal Saline contains 77 meq/L Sodium
4. Normal Saline contains 154 meq/L Sodium
2. Example
1. First 8 hours: Replace half sodium deficit
1. Sodium 157 meq in 2 Liters (78 meq/L)
2. Fluid: 1/2 Normal Saline (77 meq/L)
2. Next 16 hours: Replace half sodium deficit
1. Sodium 157 meq in 2.6 Liters (60 meq/L)
2. Fluid: 1/2 Normal Saline (77 meq/L)
7. Example Summary: 35 kg Child with hypotonic dehydration
1. First 8 hours: D5 1/2NS with 20 KCl at 250 cc/hours
2. Next 16 hours: D5 1/2NS with 20 KCl at 163 cc/hours
8. Monitoring
1. Monitor Serum Sodium every 2-4 hours
2. Raise Serum Sodium <= 2 meq/L/hours
9. Special Circumstance: Hyponatremic Seizure
1. Background
1. Serum Sodium raised 5 meq/L with 6 ml/kg of 3% NaCl
2. Protocol
1. Give 3% NaCl (0.5 meq NaCl/ml) IV over 1 hour
2. Give 3% NaCl at 6 ml/kg/hour until Seizure stops