Electrolyte correction Wednesday, 1 April, 2020 4:55 PM Sodium 1. Maintenance keep 2-3mmol/kg/day 2. Deficit 135-Na Eg baby weight 1.5kg, sodium 128, asymptomatic on ivd 1/5NS D10% 1. 135-127: 7mmol deficit 2. +3mmol maintenance daily 3. Equal to 10mmol needed 4. 0.154 mmol/ml (constant of NS) +5 (bcoz 1/5ns) x 24hours x drip rate Eg : 0.154+5x24x3.4 = 2.5133 (not enough) If change to half saline 0.154+2x24x3.4 = 6.2832 (not enough) G HYPONATREMIA * DEFINED AS NA < 135 MMOUL * HYPONATREMIC ENCEPHALOPATHY, CORRECTION BY 4MUKG OF 3% SALINE (RAISE NA BY 3 MMOUL) * NA CORRECTION MUST NOT > 0.5 MMOL/H TO PREVENT OSMOTIC DEMYELINATION SYNDROME ° + I HYPONATREMIA WITH NORMAL OR RAISED VOLUME, SHOULD MANAGEDWITH | FLUID RESTRICTION aw) ws HYPONATREMIA * CONTENT OF SODIUM IN DIFFERENT SOLUTION 0.45% SALINE -77MMOUL 0.9% SALINE - 154 MMOL/L 3% SALINE - 513 MMOL/L ORAL MIXT SODIUM 20% —- 3.4 MMOL/ML ORAL MIXT SODIUM 10% = - 1.7 MOUND) HYPONATREMIA CALCULATION OF SODIUM CORRECTION Sodium. Deficit (ml saline) = Wt(kg) x 4 x (140 - [Na]) /% saline. To incr serum Na by 0.5mmol/L/hr (max safe rate), infusn rate (ml/hr) = 2 x Wt(kg) / (% saline infused); hours of infusion = 2 x (140 - serum Na). 4mi/kg of X% saline raises serum Na by Xmmol/L. Need 2-6 mmol/kg/day. NaC! MW = 58.45, 1g NaCl = 17.1mmol Na, NaCl 20% = 3.4mmol/ml. a 7 ae Cs 8) Be yt ot aa ae moat = Lt ita => GS) Dy el - = mor Be ache tg = ho” sor omet 2 << geo ls Jos ae: sgn bey. = Ww Lomls a oe ¥ Urls Severe hyponatremia Fast correct 2cc/kg % 0.6 x weight(ke) The calculated requirements can then be given from the following available solutions dependent on the availability and hydration status: 0.9% sodium chloride contains 154 mmol/I of Sodium 3% sodium chloride contains 513mmol/I of Sodium + In acute symptomatic hyponatraemia in term neonates and children, review the fluid status, seek immediate expert advice (for example, from the paediatric intensive care team) and consider taking action as follows: ‘© A2 mi/kg bolus (max 100 mi) of 3% Sodium Chloride over 10-15 mins. ‘+ Afurther 2 ml/kg bolus (max 100 ml) of 3% Sodium Chloride over the ext 10-15 mins if symptoms are stil present after the initial bolus. ‘If symptoms are still present after the 2” bolus, check plasma sodium level and consider a third 2mi/kg bolus (max 100 mi) of 3% Sodium Chloride over 10-15 mins. ‘+ Measure the plasma sodium concentration at least hourly. ‘+ As symptoms resolve, decrease the frequency of plasma sodium ‘measurements based on the response to treatment. PotassiumPotassium Safe rate k 0.3-0.5mmol 13.3xg kclx(drip rate/(500+bw) Deficit : (4-k )x0.4xwt Maintainance 1-2mmol/kg/Day 1g KCL = 10mls mist Kcl = 13.3mmol m e al Gegensy, Ben 7, hows ef wo. (- Bae v famine 10: Ooh s YD aug | rata HEN v NS & aS 5 ‘ VY Ne iN orev é Fast correction potassium 13.3/total dilution (100) x ?g x rate drip per hour/wt =0.4 mmol/kg/h + to use in k less than 2.5 or symptomatic How to calculate safe rate and concentration in potassium off Day 14 of life, ivd 6cc/hour, added 0.5g kl in 500cc NS Boks) \ mand leg / day 1. 144cc ivd total per day + 500 NS x 0.5g KCL = 0.144g / day 2. 0.144g x 13.3mmol + weight 2kg : 0.9mmol/kg/day (Safe rate) 3. 0.9mmol/kg/d + 24hours = 0.04mmol/kg/h (concentration) Phosphate - normal 1.1- 1.8 IV Potassium dihydrogenphosphate 0.06mmol/kg/hr for 6h 1mmol/ml Max: 0.2mmol/kg/hr (7Ommol/day) For sodium dihydrogenphosphate : LAXATIVES > OSMOTIC LAXATIVES I Phosphate @ INDICATIONS AND DOSE Hypophosphataemia | Hypophosphataemic rickets | Osteomalacia > BY MOUTH USING EFFERVESCENT TABLETS » Neonate: 1 mmol/kg daily in 1-2 divided doses, dose can be taken as a supplement in breast milk—caution advised as solubility in breast milk is limited to 1.2 mmol in 100 mL if calcium also added, contact pharmacy department for details. Child 1 month-4 years: 2-3 mmol/kg daily in 2-4 divided doses, dose to be adjusted as necessary, dose can be taken as a supplement in breast milk—caution advised as solubility in breast milk is limited to 1.2 mmol in 100 mL if calcium also added, contact pharmacy department for details; maximum 48 mmol per day Child 5-17 years: 2-3 mmol/kg daily in 2-4 divided doses, dose to be adjusted as necessary; maximum 97 mmol per day BY INTRAVENOUS INFUSION » Neonate: 1 mmol/kg daily, dose to be adjusted as necessary. ’ ’ Child 1 month-1 year: 0.7 mmol/kg daily, dose to be adjusted as necessary Child 2-17 years: 0.4 mmol/kg daily, dose to be adjusted as necessary IMPORTANT SAFETY INFORMATION Some phosphate injection preparations also contain potassium. For peripheral intravenous administration the concentration of potassium should not usually exceed 40 mmol/litre. The infusion solution should be thoroughly mixed. Local policies on avoiding inadvertent use of potassium concentrate should be followed. The potassium content of some phosphate preparations may also limit the rate at which they may be administered. @ CAUTIONS GENERAL CAUTIONS Cardiac disease - dehydration - diabetes mellitus - sodium and potassium concentrations of preparations Ref. Jannah. BNF BRITISH NATIONAL FORMULARY Calcium 2-2.7 Calcium gluconate 10% solution: 0.5ml/kg slow iv 0.23mmol/ml Max 20ml Magnesium Normal 0.7-1.0 mmol/L Correction 0.2ml/kg over 20 mins rows Magnesium sulphate 50% (2mmol/ml). Low Mg: 0.2mi/kg iy IV, then 0.16mi/m*/hr. Asthma, digoxin tachycardia, South. prem labour, pul ht: 0.1mi/kg (50 mg/kg) IV over 20min, then 0.06 mi/kg/hr (30mg/kg/hr); keep serum Mg 1.5- 2.5mmol/L (pul ht 3-4mmol/L). Myoc infarct (NOT/kg): 2.5 mi/hr (Smmol/hr) IV for 6hr, then 0.5 mi/hr (1mmol/hr) for 24- 48hr. VF: 0.05-0.1ml/kg (0.1-0.2 mmol/kg) IV. Incompatible