Fluid Maintenance in Pediatric Patients

C. Hammond RN, MN

Finding Balance
Too Much Just Right

Too Little

Volume is Important

Needed for all metabolic processes Imbalance results in negative health consequences
Delicate requirements of pediatric patients

Delicate Balance in Pediatrics

Greater proportion of body fluids, higher metabolisms, more fluid output, small size Need relatively more fluids to maintain balance

Assessing Fluid Balance

Vital signs Monitor I & O Daily weights Mucous membranes Skin turgor Capillary Refill Fontanels Lungs Level of consciousness

Signs of Over-hydration
Edema

Shortness
Crackles Cough Increased

of breath

weight Increased BP Bulging fontanels Altered urine output

Conditions that may limit fluid requirements

CHF

Increased
SIADH Post

ICP

op Renal failure

Signs of Dehydration (vary with severity)

Tachycardia Fever Thirst Decreased cap refill Sunken eyes No tears Dry skin and membranes Decreased weight Decreased urine output Late signs= dizziness, lethargy, altered mental status, low BP

Conditions requiring Increased Fluids

Fever

Vomiting
Diarrhea Burns Diabetes

insepidus Tachypnea Shock Renal failure

So what is the right amount?

Maintenance

fluid: The amount of fluid the body needs in order to replace normal losses WEIGHT, WEIGHT, WEIGHT!!!

The 4-2-1 Rule

4
2 1

ml/kg/hr for the first 10 kg ml/kg/hr for the second 10 kg

ml/kg/hr for the remaining weight

Lets Practice!
1)

7 year old Jane is 23 kg. What is the minimum amount of fluid she should drink? 4 day old Ben has an IV. If he is 3.2 kg, what is the hourly rate the IV should be infusing at to maintain his fluid requirements?

2)

Jack is 17 kg.
1.

Calculate the hourly fluid maintenance requirement. Convert this into his requirements for a 24hr period.

2.

Management of Pediatric Dehydration

Normal

Saline bolus of 20ml/kg (can be repeated twice if needed) Replace deficit and ongoing losses
Provide

maintenance fluids

What goes in must come out!

Urine

output in the pediatric population:

Infants- 2ml/kg/hr Children- 1ml/kg/hr Adolescents- 0.5ml/kg/hr

Oliguria= <0.5ml/kg/hr Anuria= 0 Polyuria= >3ml/kg/hr

Calculating urine output

Urine output divided by patient weight divided by # hours since previous output 1) 10kg Joe was last changed at 1400. It is now 1800 and his wet diaper weighs 84mg (dry diaper weight has already been subtracted). Is this an adequate output?

To summarize
Our

bodies rely on maintaining adequate fluid volume patients are more sensitive to changes in volume can use the 4-2-1 Rule to calculate basic fluid maintenance requirements in pediatric patients

Pediatric

We