Matt O’Meara: Fluids and Kids: FEAST or Famine
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Transcript of Matt O’Meara: Fluids and Kids: FEAST or Famine
FEAST or Famine
Matthew O’MearaDirector Emergency
Sydney Children’s Hospital Randwick
FEAST
Fever + impaired perfusion
No bolusAlbumin20mL/kg
Saline20mL/kg
Saline40mL/kg
Albumin40mL/kg
Severe Hypotension
48 hour mortality 28 day mortality
Sick?
• Fever +
• Decreased level of consciousness• 62% can’t sit, 15%
unresponsive
• and/or
• respiratory distress (83%)
Poor perfusion
Shocked?
• FEAST
• cap refill 3 sec, or
• leg temp gradient, or
• weak radial pulse volume, or
• tachycardia
• CRT or 3 seconds or more, or a lower limb temperature gradient, or a weak radial pulse volume (21%) or severe tachycardia, based on age – over 180 for infants, over 160 for 1-5 years and over 140 for children over 5 years of age. (i
WHO
Cold hands and feet and
cap refill 4 sec and
fast weak pulse
Inclusion Benefit?
So FEAST hasn’t changed my practice,
tell me something new
• Hyponatraemia and death or permanent brain damage in healthy children. Arieff BMJ 1992
• Fatal Hyponatraemic brain oedema... Sjoblom ICM 1997
• Fatal Iatrogenic Hyponatraemia. Playfor ADC 2003
• Acute Hyponatraemia in children admitted to hospital. Halberthal BMJ 2001
• Prevention of Hospital acquired hyponatraemia. Moritz Pediatrics 2003
“From three to 120 inpatient hours after hypotonic fuid administration patients developed progressive lethargy, headache, nausea and emesis with explosive onset of respiratory arrest”.
Moritz Pediatrics 2003
Too much fuidor
Not enough salt?
The fuid type, not the rate, determines the
risk of hyponatraemia
Hyponatraemia is less likely when isotonic
saline is used
Relationship between IV fuid type and development of hyponatraemia.
Is saline the best fuid?
How much Sugar?
What’s being done?
What should you do differently?
• Resuscitate with saline/colloid/blood
• Maintenance with more salt and enough glucose at usual rate
• Check your patient