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Pediatric Isotonic Dehydration

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Pediatric Isotonic Dehydration, Isotonic Dehydration Management in Children

  • Definition
  • Protocol
  • Example Case
  1. Weight: 35 kg Child
  2. Dehydration: 10%
  3. Serum Sodium: 140 (Normal)
  • Protocol
  • Calculate Maintenance Fluid Requirements
  1. See Pediatric Dehydration Management
  2. Hourly = 75 cc/hour for 35 kg child
    1. First 10 kg: (4 cc/kg/hour x 10 kg)
    2. Next 10 kg: (2 cc/kg/hour x 10 kg)
    3. Remaining 15 kg: (1 cc/kg/hour x 15 kg)
  3. Daily: 1800 cc/day
  • Protocol
  • Calculate Remaining Deficit to be replaced
  1. See Pediatric Dehydration Management
  2. Estimate level of dehydration
    1. Mild Dehydration (3%) = 30 ml/kg
    2. Severe Dehydration (12%) = 120 ml/kg
  3. Subtract Phase 1 Resuscitation already replaced
  4. Calculation
    1. Phase 1: 20 cc/kg/bolus x 35 kg x 1 bolus = 700 cc
    2. Deficit (10%): 100 ml/kg x 35 kg = 3500 cc
    3. Remaining Deficit: 3500 cc - 700 cc = 2800 cc
  • Protocol
  • Divide 2800 cc Remaining Deficit over 24 hours
  1. First 8 hours: 75 cc/h + 1400cc/8h = 250 cc/hour
  2. Next 16 hours: 75 cc/h + 1400cc/16h = 163 cc/hour
  • Protocol
  • Saline guide (Rough)
  1. Precautions
    1. Exercise caution with hypotonic solutions (Hyponatremia)
    2. Consider D5 NS as maintenance fluid instead of D5 1/2NS
    3. McNab (2015) Lancet [PubMed]
  2. Weight <28 kg: D5 1/2NS (prior recommendation D5 1/4NS)
  3. Weight >28 kg: D5 1/2NS (77 meq/L)
  • Summary
  • 35 kg Child with isotonic dehydration
  1. First 8 hours: D5 1/2NS with 20 KCl at 250 cc/hour
  2. Next 16 hours: D5 1/2NS with 20 KCl at 163 cc/hour