Fluid and Electrolyte Balance

and Fluid Therapy

Xiaoli Zhang
The third affiliated hospital of
zhengzhou university
 Characteristics of
Fluid and Electrolyte Balance

in Children
Body fluid volume and distribution
 The percentage of fluid in the body
varies with age. The younger children
have more body fluid than older
children.
 The plasma portion of ECF remains
relatively constant.
 The major difference is in interstitial
fluid .
 Body fluid distribution for infants and children at various age is
listed in table.
Total body water & its distribution

Body water compartments related to age (total body mass%)

Age TBW ECF ICF

Plasma ISF
Newborn 80 5 40 35
infant
1 year 70 5 25 40
2 ～ 14 65 5 20 40
years
Adult 55 ～ 60 5 10 ～ 15 40 ～ 45

TBW: total body water ECF: extracellular fluid

ICF: intracellular fluid ISF: interstitial fluid
Regulation of fluids and
electrolytes
 Despite wide variations in the dietary intake
,volume and composition of body fluids are
maintained in an extremely narrow range as
excretion is adjusted to match intake.

 1 skin and lung regulation

 2 gastrointestinal regulation
 3 renal regulation
(Ⅰ) dehydration
 It is defined as decrease of gross
body fluid or extracellular fluid
especially.

 Dehydration contains losses of

sodium, potassium and other
electrolyte in addition to water loss.
A. Degree of dehydration
Dehydration Mild Moderate Severe

weigh loss(%) 3~5 ％ 5 ～ 10 ％ >10 ％

General Alert, restless Lethargic, irritable comatose

appearance

Anterior Flat Slight sunken Sunken

fontanelles

Skin elasticity Decreased Moderately Markedly decrease

decreased

Tears Present reduced Absent

 Thirst Slight Moderate Severe

Mucous Dry Very dry Severely dry

membranes

Urine output Decresed oliguria severe oliguria

Blood pressure Normal Normal or lowered Lowered

pulse Normal or increased increased Rapid, thready

Estimated fluid 30~50 50-100 100-120

deficit(ml/kg)
B. Type of dehydration

 Isotonicdehydration
 hypotonic dehydration

 hypertonic dehydration
 ①Isotonic dehydration
 electrolyte and water are lost in the
same proportion
 serum sodium concentration
① remains
normal, between 130 to 150mmol/l
 the major loss is from the ECF
 clinical manifestations include sunken
eyes, lack of tears, dry mucosa, loss of
elasticity and decreased urine output
②hypotonic dehydration
 The electrolyte deficit exceeds the
water deficit.
 Plasma sodium concentration is less
than 130mmol/l.
 Water transfers from the ECF to the
ICF to establish osmotic equilibrium.
 This movement further increases the
ECF volume loss . Easily shock
③hypertonic dehydration
 Water loss in excess of electrolyte loss.
 Plasma sodium concentration is greater
than 150mmol/l.
 Fluid shifts from the ICF to the ECF.
 Shock is less apparent. However,
neurologic disturbances ,such as
seizures, are more likely to occur
 because rapid dehydration may cause significant
fluid shift and brain cells to dehydrate.
 Type of dehydration
Type of Pathogeny Serum Pathophysiology &
dehydration sodium clinical characteristic

Isotonic Acute 130 ～ 150 ECF: decrease,

gastrointe- mmol / L (intracellular = extracellular)
stinal fluid Dehydrant volume accord with
lose dehydrant physical sign

Hypotonic Chronic <130 ECF: severely decrease,

gastrointe- mmol / L Easily shock ，
stinal fluid
Severer dehydrant sign than
lose
the other two kinds
Hypertonic High grade >150 ICF: severely decrease,
fever, mmol / L Milder dehydrant sign than
Infection the other two kinds
(Ⅱ) Hypokalemia (<3.5mmol/l)

Pathogeny
1. Lack of intake ( poor food intake over an
extended period or administration of IV fluids without
added K )

2. Excessive loss from kidneys or

gastrointestinal tract ( vomiting,diarrhea )

3. A shift from extracellular to the

intracellular spaces ( occurs with
alkalosis,insulin administration and periodic paralysis)
Clinical manifestation


Nervous and Muscles——drowsiness , musle
weakness, hyporeflexia, abdominal distention

 Heart—— heart rate increasing, arrhythmia,

heart sound lowering
ECG(electrocardiograph) : amplitude or
inversion of T wave, ST segment depression,
prolonged QT interval, and increased height
of U wave
Therapeutic managment

 Determine and treat cause

 Supply potassium

 Renew normal diet as soon as

possible
noticed
 Daily dosage of supplemental potassium is
3~4mmol/kg(200~300mg/kg)
 Concentration less than 0.3% by IV
 Transfusion duration more than 8 hours daily
 Avoiding IV push
 Supplement lasting 4 to 6 days
 Normal renal function (Supply kalium after urination 6
hours of preadmission)
Disturbances of acid-base banlance
 The pH value is determined by taking the
negative logarithm of the H+ concentration.
 PH concentration is maintained between
7.35-7.45 by the kidneys, the lungs, a variety of chemical
buffers, and some metabolic processes.

 [HCO3-] : [H2CO3] = 20:1

 Acid- base disturbances fall into four major
categories:
metabolic acidosis / alkalosis
respiratory acidosis / alkalosis
(Ⅲ) Metabolic acidosis
Pathogeny
1. The lose of large amount of basic
substances （ gastrointestinal tract, kidneys ）
2. Increased Acid production (including hungriness,
diabetes, renal failure, hypoxia ）
3. Too much acid substance intake （ such as salicylate
poisoning ）

The most common cause of metabolic acidosis

in children is diarrhea.
 Degree

Mild acidosis HCO3- 13~18 mmol / L

Moderate acidosis HCO3- 9~13 mmol / L

Severe acidosis HCO3- <9 mmol / L

 Clinical manifestation
 Deep and rapid respirations
 Decrease peripheral vascular resistance and
cardiac ventricular function, resulting in
tachycardia, arrhythmias, hypotension, and
tissue hypoxia
 Cherryred lips, anorexia, nausea, muscle
weakness, listlessness and even lethargy and
coma
 Therapeutic management
Correcting the primary cause
---- mild acidosis

Replacing the excessive losses of HCO3-

with sodium or potassium bicarbonate
----moderate and severe acidosis
5%NaHCO3(mmol)=(22- HCO3- mmol/l) Х 0.5 Х Weight (Kg)

5%NaHCO3(ml)=(22- HCO3- mmol/l) Х 0.5 Х Weight (Kg) / 0.6

=(-BE) Х 0.5 Х Weight (Kg)

# half amount
Common Solution of Liquid Therapy
5 ％ glucose
A. Nonelectrolytical solution
10 ％ glucose

B. Electrolytical solution
0.9 ％ NaCl 103 ％
1.4 ％ NaHCO KCl

3 ％ 、 10%NaCl 5 ％ NaHCO3
C. Mixed solutions
refer to the following table
Common 5/10% 0.9% 1.4% osmolality
mixed G.S NaCl NaHCO3
solution

2:1 － 2 1 isotonic

3:2:1 3 2 1 1/2

3:4:2 3 4 2 2/3

6:2:1 6 2 1 1/3
The therapy has three categories
• Deficit replacement

• Supplemental replacement of ongoing

losses

• Maintenance
A Deficit replacement
There are three essential components
of administering the therapy: volume,
Component and rapidity.

1)Volume
in principle ,the fluid supplements:
Mild dehydration 50ml/kg
Moderate dehydration 50~100ml/kg
Severe dehydration 100~120ml/kg
2)Component: determined by the types
of dehydration

Hypotonic Hyperosmolar solution

Isotonic isotosmolar solution

Hypertonic hyposmolar solution

3)rapidity
 In the first 8-12 hours of thansfusion

 Severe dehydration :
to restore circulatory status
20ml/kg of isotonic sodium solution
(<300ml totally)
30~60minutes
B Supplemental replacement of
ongoing losses
 estimate
 1/3~1/2 isotonic sodium solution

 Given equably within 24 hours

 (In the other 12~16 hours)
C Maintenance (physiological
need)

 About 60~80ml/kg daily

 1/5~1/4 isotonic sodium solution

 Given equably within 24 hours

In summary
 Total volume
 Mild 90~120 ml/kg
 Moderate 120~150 ml/kg
 Severe 150~180 ml/kg

 Components
 Hypotonic hypertonic (2/3 isotonic)
 Isotoic isotonic (1/2 isotonic)
 Hypertonic hypotonic (1/3 isotonic)
ORs(oral rehydration salts)
(The world health organization recommended)

 Composition:
 sodium chloride 3.5g
 Bicarbonate sodium 2.5g
 Potassium chloride 1.5g
 glucose 20.0g
 And water 1000ml to dissolve

 2/3 isotonic
 The concentration of potassium is 0.15%
HAPPY
PIG
YEAR