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Calculating Full Maintenance = 100ml x 1st 10kgs + 50ml x 2nd 10kgs + 20ml x >20kgs Full Maintenance = Sensible ( )+ Insensible losses (30ml/kg/24hr or maintenance) 

When patients should receive more than full maintenance: y Febrile child on maintenance requires an additional 10% of total maintenance for every 1° > 38°C.  When patients should receive less than full maintenance: y Anuric patient should only have insensible losses replaced (i.e. third maintenance, 30ml/kg/24hr). y CHF and SIADH (as can occur in post-meningitis increased ICP); patient should receive twothirds maintenance. Example I: 10 kg boy with renal failure, calculate his maintenance fluid dose.  Anuric patient should be put on a third maintenance: 30ml x 10kg = 300ml / 24hr = 12.5 ml/hr Example II: 27 kg boy, calculate maintenance dose of fluid.  100ml x 1st 10kg + 50ml x 2nd 10kg + 20ml x 7kg = 1640ml / 24hr = 68.5ml/hr Calculating Electrolyte Replacement: Na 3 mEq/kg/day Cl 5 mEq/kg/day K 2 mEq/kg/day

2 Potassium is not given unless kidney function is known (i.e. patient passes urine ruling out kidney impairment/failure). Replacement Therapy: y When using weight comparison, measurements before disease should < 2 months past. Calculation of Deficit (for isotonic dehydration): 1 kg wt = 1 000 ml fluid e.g. 10% dehydration (calculated by wt/CS) means for every 1 kg, we lose 10% water, i.e. we lost 10% of 1 000 ml = 100 ml loss e.g. 15% dehydration = 1 000 ml x 0.15 = 150 ml loss Example III: 10 kg girl has 10% dehydration, isotonic, calculate rehydration fluid.  Maintenance = 100 ml x 10 kg = 1 000 ml  Deficit = 10 kg x 1 000 ml (volume of body water) x 0.1 ( ° of dehydration) = 1 000 ml  Moderate to severe dehydration, we give a challenge test which is a bolus of 20ml/kg/1hr (Nelson s 20 min) for rapid replacement and to see if patient passes urine (subtracted from the deficit total).  Bolus = 20 ml x 10 kg = 200 ml/hr (subtracted from deficit, see next)  Total = Deficit + Maintenance Deficit = 1 000 ml 200 ml = 800 ml Total = 1 800 ml  For rapid perfusion, we give half total over 8 hr and the rest over the remaining 16 hr.  1 800/2 = 900 ml/8hr = 112 ml/hr for 8 hr, and 900ml/16hr = 56.25 ml/hr for next 16 hr. Hypernatremic Dehydration: same as above, but after bolus, we give half total over the first 24 hr (i.e. 900ml/24hr = 37.5 ml/hr) and give the second half over the second 24 hr (avoiding brain herniation).