Pathology fluid balance

1. FLUID BALANCE

38. Dehydration:-
It mean volume depletion and
occurs when fluid loss from the
extracellular space at a rate that
exceeds intake.

40. Body fluid distribution
• The body contains 2 major fluid compartments: the intracellular
fluid (ICF) and the extracellular fluid (ECF). The ICF comprises of two
thirds of the total body water (TBW), while the ECF accounts for the
remaining third. The ECF is further divided into the interstitial fluid
(75%) and plasma (25%). The TBW comprises approximately 70% of
body weight in infants, 65% in children, and 60% in adults.
• Infants' and children’s higher body water content, along with their
higher metabolic rates and increased body surface area to mass
index, contribute to their higher turnover of fluids and solute.
Therefore, infants and children require proportionally greater
volumes of water than adults to maintain their fluid equilibrium and
are more susceptible to volume depletion. Significant fluid losses
may occur rapidly, leading to depletion of the intravascular volume.
•

41. Causes of dehydration in
children
1. Dehydration is most often caused by a viral infection that causes
fever, diarrhoea, vomiting and a decreased ability to drink or
eat.Common viral infections causing vomiting and diarrhoea
include rotavirus.
2. Sometimes sores in a child's mouth caused by a virus make it
painful to eat or drink, helping to cause or worsen dehydration.
3. More serious bacterial infections can make a child less likely to eat
and may cause vomiting and diarrhoea. Common bacterial
infections include Salmonella, E coli, CampylobacterandC.difficile.
4. Parasitic infections such as Giardia lamblia cause the condition
known as giardiasis.
5. Increased sweating from a very hot environment can cause
dehydration.
6. Excessive urination caused by unrecognised or poorly
treated diabetes (not taking insulin) and Diabetes insipidus.

42. 7Third-space extravasation of
intravascular fluid (eg,
pancreatitis, peritonitis, sepsis,
heart failure)
8Hemorrh
age 9-
burn

43. Signs &Symptoms of dehydration in
children
You should be concerned if your child has an excessive loss of fluid
from vomiting or diarrhoea, or if the child refuses to eat or drink.
Signs of dehydration:
1. Sunken eyes
2. Decreased frequency of urination or dry nappies
3. Sunken soft spot on the top of the head in babies (called the
fontanelle)
4. No tears when the child cries
5. Dry or sticky mucous membranes (the lining of the mouth
or tongue)
6. Lethargy (less activity than normal)
7. Irritability (more crying, fussiness)
8. Abnormal capillary refill time
9. Abnormal skin turgor
10 .Abnormal respiratory pattern

46. investigation
• A full blood count may identify seriousness or type of
infection.
• Blood cultures may identify the type of bacterial
infection.
• Blood chemistry may identify
any electrolyte abnormality caused by vomiting and
diarrhoea, and may identify serious imbalances in body
chemistry caused by illness.
• Urinalysis may identify bladder infection, give evidence
of severity of dehydration and may identify sugar and
ketones in urine (evidence of uncontrolled diabetes).
• Stool examination

47. Evaluation the degree of
dehydration

48. CALCULATION OF THE DEFICIT:-
Determining the fluid deficit necessitates clinically determining the
percent dehydration and multiplying this percentage by the
patient's weight; a child who weighs 10 kg and is 10% dehydrated
has a fluid deficit of 1 L.
10kg x 10/100= 1L. .
CALCULATION OF MAINTENANCE:-
100 ml/kg for the first 10 kg body wt.
50 ml/kg for the second 10 kg body wt.
25 ml/kg for the third 10 kg body wt.
= 1000 ml.
= 500 ml.
= 250 ml.
TOTAL FLUID REQUIRMENT:- equal to
Fluid deficit + maintenance within 24 hrs.