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FLUID & ELECTROLYTES � (infants & children)�

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Shabnam

Demonstrator INS-KMU

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Distribution of Body Water

Intravascular

Interstitial

Intracellular

ICF

ECF

Na+

K+

Cl-

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Fluid composition varies at different ages

75%water

ECF=45%,ICF=30%

65% water, ECF= 25%, ICF = 40%

Adult female

50% water, ECF=10-15%, ICF=40%

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Electrolytes in body fluid �Compartments

INTRACELLULAR

EXTRACELLULAR

potassium

sodium

magnesium

chloride

phosphorous

bicarbonate

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Electrolyte Concentrations

Component

ECF

ICF

Na+

High

Low

K+

Low

High

Ca++

Low

Low (higher than ECF)

Proteins

High

High

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Water Balance in Infants

  • Infants & young children
    • Greater need for water
    • More vulnerable to alterations
    • Infants have greater & more rapid water loss
  • Water & electrolyte disturbances occur more frequently & more rapidly
    • Children adjust less promptly to these alterations

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Cont…..

  • Metabolic Rate
    • Higher in infancy
    • Greater production of metabolic wastes
  • Kidney Function
    • Immature at birth
    • Inability to concentrate or dilute urine
    • More likely to become dehydrated or over hydrated

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Fluid Losses in Infants

LUNGS

URINE, FECES

SKIN

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                                                                                              �Infant wearing knit cap.�Copyright © 1999, Mosby, Inc.

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Maintenance Requirements

Weight

Requirement

0-10 kg

100cc/kg/24hr

11-20 kg

1000 + 50cc/kg/24hr

>20 kg

1500 +

20cc/kg/hr

Example: 8 kg child

800cc/24hr

33 cc/hr

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Dehydration = Total Out > Total In

  • Types:
  • Isotonic
    • Electrolyte = Water
  • Hypotonic
    • Electrolyte < Water
  • Hypertonic
    • Water < Electrolyte

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Degrees of Dehydration

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Mild

Moderate

Severe

Fluid Vol loss

<50ml/kg

50-90ml/kg

>100 ml/kg

Skin Color

Pale

Gray

Mottled

Skin Elasticity

Decreased

Poor

Very Poor

M.M.

Dry

Very Dry

Parched

U.O.

Decreased

Oliguria

Marked Oliguria

BP

Normal

Normal or lowered

Lowered

Pulse

Normal or Increased

Increased

Rapid, thready

Cap R. T.

<2 sec

2-3 sec

>3 sec

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Assessment

  • Vital signs
  • Behavior—changed—Response to stimuli
  • Skin changes
  • General Body assessment—sunken eyes, no tears, sunken fontanel
  • Weight
  • U.O

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Earliest Detectable Signs

  • Tachycardia
  • Dry skin and mucous membranes
  • Sunken fontanels
  • Circulatory Failure (coolness, mottling of extremities)
  • Loss of skin elasticity
  • Delayed cap refill

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Loss of Skin Elasticity due to dehydration

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Manifestations of ECF Deficit (Dehydration)

  • S & S
    • Weight loss
    • Blood pressure drop
    • Delayed capillary refill
    • Oliguria
    • Sunken fontanel
    • Decreased skin turgor
  • Physiologic Basis
    • Decreased fluid vol.
    • Inadequate circ. Blood
    • Decreased vascular volume
    • Inadequate kidney circ.
    • Decreased fluid volume
    • Decreased interstitial fluid

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Management of Mild to Moderate Dehydration

  • Oral Rehydration
    • Pedialyte
    • Infalyte
    • Rehydralate

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    • Rules regarding rehydration
      • 50-100ml/kg within 4 hours

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Home Management?

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Oral Rehydration

  • ORS (Oral Rehydrating Solution)
    • First 4-6 hours
      • Na + glucose (Pedialyte, RS)
    • Then, if tolerated, give 30-60 cc/kg X 24 hours
      • Glucose + Na (Pedialyte, L,Resol,Infalyte)

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Moderate to Severe Dehydration Management

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Goals of IV Therapy

  • Expand ECF volume and improve circulatory and renal function (Isotonic solution .9%NS,LR, D5W)
  • K+ after kidney function is assessed
  • Begin oral feedings

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When to resume normal diet?

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Conditions causing Fluid Imbalances

  • Phototherapy
  • Increased RR
  • Fever
  • Vomiting
  • Diarrhea *(Gastroenteritis)*
  • Drainage tubes, blood loss
  • Burns

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Phototherapy

                                                                                              �Infant under phototherapy. Note that the eyes are shielded and a diaper is used to contain the diarrheal stools.�Copyright © 1999, Mosby, Inc.

*Wallaby

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Tachypnea

  • Respiratory Alkalosis
  • Increase in rate and depth of breathing
  • Loss of CO2

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Causes of hyperventilation (tachypnea): Fear, pain, fever, CHF, anemia

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Fever

  • Each degree of fever increases basal metabolic rate (BMR) 10%, with a corresponding fluid requirement

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Vomiting

  • Metabolic Alkalosis
  • Loss of acid from stomach
  • pH
  • HCO3
  • H+
  • Treatment: Prevent further losses and replace lost electrolytes

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Example: Pyloric Stenosis

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Diarrhea

  • Metabolic Acidosis
  • loss of HCO3 from G.I Tract
  • pH
  • HCO3

Treatment:

  • Correct base deficit, replace losses of with NaHCO3

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Drainage Tubes/�Blood loss

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Burns

  • Fluid loss is 5-10 X greater than from damaged skin
  • Abnormal exchange of electrolytes between cells and interstitial fluid

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SUMMARY

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Reasons why infants & children are at > risk for developing fluid & electrolyte imbalance?

  • Increased % of body weight is H2O
  • Large volume of ECF
  • Increased BSA (insensible loss)
  • Increased Metabolic rate
  • Immature Kidneys

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Why is it necessary to use a pump or other volume control when infusing Ivs into children?

  • Avoid overload
  • Specifically monitor input

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How would you measure U.O. for a child who is not toilet trained?

  • Weigh diaper
  • 1 gram = 1 cc

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What is considered oliguria in an infant or child?

  • <1ml/kg/hr

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How will you assess for hydration in a 6 month old?

  • Mucous Membranes
  • Skin
          • Eyes
  • Perfusion
          • Blood Pressure
  • Heart Rate

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What lab tests provide useful information when the concern is dehydration?

  • Serum osmolality test.
  • Blood serum electrolyte test (sodium,potassium,urea,and glucose could be used to screen for dehydration)

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What are your nursing responsibilities when caring for a child with Fluid and Electrolyte imbalance?

  • I & O
  • Weight
  • Initiate IV and maintain
    • Accurate infusion, type and rate
    • Protect IV site
  • Assess hydration status
  • Parental support

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Thank you