49. Higher metabolic rates Increased body surface area to mass index Higher body water contents (water comprises approximately 70% of body weight in infants, 65% in children, 60% in adults) Young pediatric patients tend to be more susceptible to fluid losses a quick turnover of fluids and solute
50. Normal routes of fluid excretion in infants and children. Lungs Skin Urine & feces insensible water losses
55. Degrees According to the severity of the symptoms and signs The key point to distinguish severe cases from mild and moderate ones is poor peripheral circulation and even shock. Dehydration
57. Types of dehydration Hypertonic Isotonic Hypotonic The type is defined according to the change of serum osmolality (serum Na+ concentration) Dehydration
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60. Hypertonic dehydration Loss of more water than sodium with high serum Na concentration (>150mmol/L) 1. Less obvious signs of dehydration 2. Particularly dangerous : Water is drawn out of the brain and cerebral shrinkage within a rigid skull may lead to multiple, small cerebral haemorrhages and convulsions. A shift of water from ICF to ECF The least common, usually results from high insensible water losses or from profuse, low-sodium diarrhea Types of dehydration Definition:
79. Treatment Fasting severe vomiting Regulating and limiting the diet Antibiotic : bacterial infection Microecological drug : lactobacilli GI tract mucosa protector : smecta Drug therapy Fluid therapy Mainstay of treatment Dietary therapy
88. Oral fluid therapy Mild or moderate dehydration. No severe vomiting or abdominal distention Indications ORS may be used with unlimited water intake. The fluid is best given in small amounts frequently . Fluid therapy
89. Ingredient amount (grams) NaCl 3.5 NaHCO 3 2.5 KCl 1.5 Glucose 20 Water 1000ml Oral rehydration salt (ORS) It has been advocated by the WHO Formula of rehydration salt: 2/3 tonicity and the potassium concentration is 0.15%
90. 40℃ warm water or cooled boiled water Oral rehydration salt (ORS)
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96. The amount of fluid 60-80 ml/kg /day Maintenance requirements 10-30ml/kg/day Ongoing abnormal losses 100-120 50-100 50 Preexisting losses (ml/kg) 150-180 120-150 90-120 Total amount (ml/kg) Severe Moderate Mild Degrees of dehydration
99. Speed 5ml / kg / h 8 ～ 10ml / kg / h 12 ～ 16h 8 ～ 12h 24h Keep transfusing period （ physiological need, losing continuing ） Cumulated losing volume Total volume
108. Etiology of infantile diarrhea To evaluate the severity of dehydration caused by infantile diarrhea, you should pay attention to some signs For fluid therapy, the commonly used non-electrolyte solution and the electrolyte solutions 2:1 isotonic solution ,2:3:1 solution component and usage key points about K + replacement the main distinction between severe and mild infantile diarrhea Key Points
