Matt O’Meara: Fluids and Kids: FEAST or Famine

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Matt O'Meara reads the fine print on fluid management in paeds and straight talks on best practice.

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Matt O’Meara: Fluids and Kids: FEAST or Famine

  1. 1. FEAST or FamineMatthew O’MearaDirector EmergencySydney Children’s Hospital Randwick
  2. 2. FEAST
  3. 3. Fever + impaired perfusionNo bolusAlbumin20mL/kgSaline20mL/kgSaline40mL/kgAlbumin40mL/kgSevere Hypotension
  4. 4. 48 hour mortality 28 day mortality
  5. 5. Sick?• Fever +• Decreased level ofconsciousness• 62% can’t sit, 15%unresponsive• and/or• respiratory distress(83%)
  6. 6. Poor perfusion
  7. 7. Shocked?• FEAST• cap refill 3 sec, or• leg temp gradient, or• weak radial pulsevolume, or• tachycardia• CRT or 3 seconds or more, or a lower limb temperaturegradient, or a weak radial pulse volume (21%) or severetachycardia, based on age – over 180 for infants, over 160for 1-5 years and over 140 for children over 5 years of age.(iWHOCold hands and feet andcap refill 4 sec andfast weak pulse
  8. 8. Inclusion Benefit?
  9. 9. So FEAST hasn’tchanged my practice,tell me something new
  10. 10. • Hyponatraemia and death or permanentbrain damage in healthy children. Arieff BMJ 1992• Fatal Hyponatraemic brain oedema... SjoblomICM 1997• Fatal Iatrogenic Hyponatraemia. Playfor ADC 2003• Acute Hyponatraemia in children admittedto hospital. Halberthal BMJ 2001• Prevention of Hospital acquiredhyponatraemia. Moritz Pediatrics 2003
  11. 11. “From three to 120 inpatient hours after hypotonic fuid administration patients developedprogressive lethargy, headache, nausea and emesis with explosive onset of respiratory arrest”.Moritz Pediatrics 2003
  12. 12. Too much fuidorNot enough salt?
  13. 13. The fuid type, not therate, determines therisk of hyponatraemia
  14. 14. Hyponatraemia is lesslikely when isotonicsaline is used
  15. 15. Relationship between IV fuid type and development ofhyponatraemia.
  16. 16. Is saline the best fuid?
  17. 17. How much Sugar?
  18. 18. What’s being done?
  19. 19. What should you dodifferently?• Resuscitate with saline/colloid/blood• Maintenance with more salt and enoughglucose at usual rate• Check your patient

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