Professional Documents
Culture Documents
Distribution of body fluids in infants & children. Why are children more vulnerable for fluid imbalance. Fluid requirements for all age groups. Assessment of state of hydration. Vascular access.
Why children are more prone for fluid imbalance and dehydration?
Large body surface area High extracellular fluid ratio. Difficult calculation of the accurate requirement. Prematurity of kidneys. Frequent feeding problems Difficult venous access. Relatively small total body fluids.
Body Fluids
Intracellular
Extracellular
Intravascular
Interstitial
Transcellular
Plasma
Tissue fluid
Peritoneal fluid
Intravascular fluid
Intracellular fluid
Interstitial fluid
Fluid distribution according to age (Hiu Lam 1998, Metheny and Snively 1983) Intracellular fluid Extracellular fluid
Newborn 12 months 24 months Adult male 47% 53% 60% 67% 53% 47% 40% 33%
Infants have a greater proportion of extracellular fluid than older children and adults. Because extracellular fluid is more easily lost from the body than intracellular fluid, infants are more at risk of developing dehydration than older children and adults (infants also have a larger surface area to body mass ratio).
90 ml/kg
80 ml/kg 80 ml/kg 65 ml/kg
Balanced adequate body fluid is very important in maintaining adequate and effective circulation. Adequate circulation in turns will maintain normal tissue perfusion, and hence, all body cells will get adequate nutrition, and get rid of waste products.
Dynamic movement of body fluid between the vascular spaces and the tissues.
1.
2. 3.
OUT
How can we maintain the fluid balance in sick babies and children?
1) Resuscitation
Given in case of initiating treatment for a dehydrated child, or with acute fluid loss. Rate of 10-20 ml/kg N saline. Child is to be reviewed / 15 min. Can be repeated.
0
1
40
60
2
3
80
100
4
5
120
150
2) Maintenance B - Children
Parenteral: 5-10 kg 4ml/kg/hr. >10 kg first 10 kg : 4 ml/kg/hr. Second 10 kg : 2 ml/kg/hr. third 10 kg and more: 1 ml/kg/hr.
3) Ongoing loss
The amount depends upon the calculated loss (NG, Drain, Stoma, etc..) Type of fluid: 0.9% N saline + KcL.
NB: For stoma loss, we may replace only the amount of stoma output that exceeds 15 ml/kg/day. UOP: Excess of 5 ml/kg/hr
Neonates: - Maintenance: 10% Dextrose 0.18 N Saline - Replacement: 0.9% N Saline Infants and children: - Maintenance: 5% Dextrose 0.45% N saline - Replacement: 0.9% N Saline
General status of the child. Activity. UOP. Skin & Mucus membrane. Capillary refilling time (CRT). Pulse, blood pressure. Respiration. Temperature. Body weight.
Venous access
Peripheral
PICC
Central
1. Peripheral lines
Types of catheters
Location
Start from distal veins first, then proximal Upper limb then lower limb Preserve ACF for PICC lines Scalp and neck veins last resort.
2. Central lines
Non-tunneled
Hickman line
Hickman lines
Hickman line
Tunneled central line Inserted in the SVC / R Atrium Can be used for IVC in difficult cases. Durable (up to years) Main complications: Sepsis, blockage, and migration. Needs GA for removal.
Port a cath
Port a cath
Port a cath
SVC / R atrium More durable More expensive No external tubes. Bigger scar Needs GA for removal.
PICC lines
PICC lines
Can be as durable as Hickman line May not need GA. Removal doesnt need GA Should be treated as a central line (Aseptic techniques).
Vas Cath
Femoral line
Intraosseous injection
IO route
Only in critical emergency, with absolutely no apparent venous access, and urgent need for transfusion. Needs expertise, proper needles Very painful, not durable. Limited to <7 years old children