Pediatric fluid management

Keyword

Pediatric fluid management

Intravenous fluid management

• 4-2-1 rule : “0~10kg” 4mL/kg + “10kg ~ 20kg” 2mL/kg + “20kg~” 1mL/kg

< Ex. if, 25kg child : (10 × 4) + (10 × 2) + (5 × 1) = 65 mL >

• Third space loss

1 mL/kg/hr for a minor surgical procedure 부터 15 mL/kg/hr for major abdominal procedures

• If, significant cardiac or renal dysfunction

20 - 40 mL/kg of a balanced salt solution during anesthesia

• Postoperative fluid management : 2-1- 0.5 rule, 공복 12시간 이상 시 standard hypotonic solution (D5 0.45% saline) 4-2-1 rule (avoid hypernatremia)

Hyperglycemia vs hypoglycemia

• Child - glycogen 합성능력 떨어져 hypoglycemia 잘 빠지나 true incidence는 불명확

(hypoglycemia 가능성 있으면 5% dextrose in 0.45% normal saline or

Transition to 10% glucose infusion rate by 33% to 40%)

• High blood glucose level - hypoxic brain damage , routine use of glucose-containing solution 비권장 “For most children, lactated Ringer solution is the only fluid required”

(mitochondrial disease 있는 환아는 use of 10% glucose)

Infant & Neonate

체표면적 크고 피부 미성숙해 metabolic demand 증가, phototherapy, radiant warmer 사용 시 water loss 증가하나 체온유지가 장기적으론 수분유지에 유리함

• Neonate : kidney 미성숙 - reduce fluid requirement

Term newborn 70 mL/kg day 1, 80 mL/kg on day 3, 90 mL/kg on day 5, and 120 mL/kg on day 7.

(Preterm은 slightly higher)

• Newborns are generally started on 10% glucose to prevent hypoglycemia
• Infants unable to tolerate oral feeding may continue to receive 10% glucose solutions

Reference