FLUID THERAPY Nurul Sazwani

DEHYDRATION Definition : a state of negative fluid

balance decreased intake increased output fluid shift

SIGNS & SYMPTOMS appears unwell altered responsiveness, for example is

irritable or lethargic decreased urine output pale or mottled skin cold extremities Headache, dizziness, fainting Orthostatic hypotension Thirst Loss of appetite, nausea paresthesia

SUSPECTED DEHYDRATION?

Fast! Capillary refill -normal< 2s

Poor skin turgor Hypotension Tachycardia Shock

SUBJECTIVE TESTLaboratory investigations: Do not routinely perform blood biochemistry. Measure plasma sodium, potassium, urea,

creatinine and glucose concentrations if: –intravenous fluid therapy is required or –there are symptoms or signs suggesting

hypernatraemia. Measure venous blood acid–base status and

chloride concentration if shock is suspected or confirmed.

Urine specific gravity Other tests may be done to determine the cause of

the dehydration (for example, blood sugar level to check for diabetes).

REHYDRATION!Questions? 1.Which method of rehydration?

2.How much fluid should patient receive?

3.With what speed should the fluids be given?

4.What type of solution?

HOW MUCH FLUID?

Basic fluid need + Fluid lost + Extra fluid deficit

HOW MUCH FLUID? Basic fluid need:Depends on the weight (/24 hours):1-10kg –100 mL / kg11-20 kg –50 mL / each kg > 10 kg20-70 kg –20 mL / each kg > 20 kgOver 70 -2500-3000mL /24 hours

HOW MUCH FLUID?How much fluid did the patient loose? Patients’ weight Assess according to the table: up to 5% 6-10% >10%

HOW MUCH FLUID?Extra fluid deficit •Vomitting •Diarrhoea •Fever •Tachypnoe

for each episode of vomitting/ loose stool/ degree of fever≥ 38°C add additional 10ml/kg/24 hours

TYPE OF SOLUTION ORS – Oral rehydration solution

Milk? Fruit juice? Sodas? Carbonated beverages? Caffeinated drinks? Sports drinks?

SPEED & TYPE OF FLUID GIVEN

If intravenous fluid therapy is required for rehydration (and is not hypernatraemic at presentation):

use an isotonic solution such as 0.9% sodium chloride, or 0.9% sodium chloride with 5% glucose, for fluid deficit replacement and maintenance

speed of rehydration:50% within the first 8 hours(bolus

included)50% within the remaining 16 hours

!!! HYPERNATRAEMIC DEHYDRATION!!!!

Suspect hypernatraemicdehydration if there are any of the following:

jittery movements increased muscle tone hyperreflexia convulsions drowsiness or coma.

!!! HYPERNATRAEMIC DEHYDRATION!!!!

If intravenous fluid therapy is required in hypernatraemic dehydration:

obtain urgent expert advice on fluid manageme

replace the fluid deficit slowly - typically over 48 hours monitor the plasma sodium frequently, aiming to reduce it at a rate of less than 0.5 mmol/l per hour.

SHOCK!!! Treat suspected or confirmed shock with

a rapid intravenous infusion of 20 ml/kg of 0.9% sodium chloride solution.

THE END