This ppt contains fluid and electrolyte imbalances such as hypernatremia,hyponatremia,hypokalemia,hyperkalemia,metabolic acidosis,metabolic alkalosis,respirator acidosis,respiratory alkalosis.

1. Fluids,Electrolytes and acid-
base disturbances
Presented By Shalini Rana(Nursing Tutor)
Child Health Nursing
1 Presentation 4 - 19 June 2023

2. Dehydration
• it is de
f
ined as excessive loss of body water.
• it is a clinical state results from decrease in total quantity of
electrolytes.
• dehydration is more common in infant and children.
• most common types of dehydration is isotonic.
Q1.De
f
ine dehydration .
2 Presentation 4 - 19 June 2023

3. Assessment of dehydration
• 1)Clinical history
• 2)physical examination
• 3)detail history includes amount of urine output,vomitus& diarrheal
losses.
• 4)assessment of skin turgor and capillary re
f
illing time
• 5)pulse,resp & B.P should be checked.
Q.Explain assessment of dehydration.
3 Presentation 4 - 19 June 2023

4. • 6)laboratory investigations(if required)
• 7)Serum electrolytes,blood urea & creatinine,acid base status,plasma
osmolality,hematocrit values & urine speci
f
ic gravity.
4 Presentation 4 - 19 June 2023

5. Management of dehydration
• management should be started after assessment of hydration
status.
• vitals signs monitoring.
• intravenous infusion of isotonic solution (RL or normal saline as
per the required ml per lg weight of baby.
• or plasma to achieve normal urine output,correction of potassium
de
f
iciet and acidosis.
Q.How will you manage a patient with diarrhoea?
5 Presentation 4 - 19 June 2023

6. • Intravenous
f
luid or oral rehydration therapy(ORT)
• ORS should be given along with tinc tablet.
• mother should be involved during rehydration therapy,especially in ORT.
• hydration should be re assessed at regular interval .
• intake and output record is vital responsibility of nursing personnel
during rehydration therapy.
6 Presentation 4 - 19 June 2023

7. Overhydration
• it occurs due to inattentive or unintentional excessive infusion
of salt free or poor salt glucose solution or due to plain water
enema.
• Child may present with distended neck veins,pulmonary
crepitations or wheeze and dependent edema.
• the child may have convulsions and shock due to cerebral
edema
• cerebral edema resulting from sudden water overload and ECF
dilution.
Q.Explain over hydration or water intoxication.
7 Presentation 4 - 19 June 2023

8. • management of dehydration:-
• 1)water restriction
• give diuretics(furosemide)
• in severe cases,peritoneal dialysis with hypertonic
glucose should be given.
contd.....
8 Presentation 4 - 19 June 2023

9. • it is de
f
ined as when serum sodium level is less than 130mEq/L
• it is due to water retention,sodium loss or both.
• Mostly occurs in cases of acute
diarrhea,pneumonia,meningitis,sepsis,heart failure,hepatic
failure and renal diseases.
• Causes-renal sodium loss in prematurity,chronic diuretic therapy
etc
Q.Explain hyponatremia.
9 Presentation 4 - 19 June 2023

10. • extrarenal sodium losses due to vomiting,diarrhea,nasogastric
drainage,burn,cystic
f
ibrosis and excessive sweating.
• nutritional de
f
icit,paracentesis
• abnormal retention of sodium & water in nephrotic syndrome
• cirrhosis of liver,CCF,renal failure.
continued.....
10 Presentation 4 - 19 June 2023

11. • clinical manifestations are:-
• restlessness
• confusion
• convulsions
• hypotension
• heart failure
• unconsciousness
• patient may be asymptomatic.
Q.What are the clinical manifestation and management of
hyponatremia?
11 Presentation 4 - 19 June 2023

12. • management of hyponatremia:-
• administer 3% solution of aodium chloride(saline),10ml/kg body
weight for symptomatic hyponatremia.
• furosemide may be given along with 3 percent saline
•
f
luid should not be restricted if there is any sign of
hypoproteinemia.
continued,...
12 Presentation 4 - 19 June 2023

13. Hypernatremia
• it is de
f
ined as the term when seeim sodium is more than
150mlEq/L.
• It occurs due to water loss in diarrhea,vomiting,diuresis
and burns or excessive sodium intake.
• Causes-faulty preparation of ORS,high sodium content in
breast milk and salt poisoning.
• Clinical manifestations-
irritability,confusion,twitching,seizures,tough
skin,metabolic acidosis etc.
Q.Explain hypernatremia and its management.
13 Presentation 4 - 19 June 2023

14. • management:-
• give infusion of ringer lactate or saline to correct hypovolemia.
• control GI
f
luid loss and fever.
• guve ORS or plain water if child is conscious.
• Child's condition should be monitor frequently.
• CNS symptoms like convulsions should be corrected by giving
anti convulsive and mannitol therapy.
continued...
14 Presentation 4 - 19 June 2023

15. • when potassium level is less than 3.5mEq/L.
• common causes are septicemia,diuretic therapy etc.
• causes-PEM,diabetic ketoacidosis,decrease in muscle mass ,cushing
syndrome etc.
• clinical manifestations-weakness of skeletal muscle,hypotonia,diminished
re
f
lexes,abdominal distention,ECG changes,cardiac arrest etc.
•
Q.Explain hypokalemia and its management in detail.
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25. Thanks & Regards
"Don't forget to drink water everyday and
eat healthy diet"
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