Fluids electrolytes pediatrics

1. DEHYDRATION-
PLAN A/B/C
By :Darayus P.Gazder (DPG)
Roll Number: 18
GROUP: C

2. DEHYDRATION
Dehydration is the loss of water and salts that are
essential for normal body function.
 Assess the degree of dehydration
The degree of dehydration dictates the urgency of the situation
and the volume of fluid needed for rehydration

3. Infants are more susceptible to dehydration because
of:
Dependence on adults to replace fluids
Rapid breathing
Losses of water through skin and lungs due to larger
surface area
Immature renal function, therefore decreased
conservation of water (There is a ‘Decreased Urinary
concentration capacity’)
-Dehydration is not a disease rather a symptom of
another process

4. Classification
1. Clinical (% Loss of body weight)
MILD Weight loss < 5%
MODERATE Weight loss between 5-10%
SEVERE Weight loss >10%

5. An infant with
Mild dehydration (3% to 5% of body weight dehydrated):
Thirsty/ ↓ Urine Output/ History of decreased intake and
increased fluid losses
Moderate dehydration (7–10%):
Intravascular space depletion is evident by an increased heart
rate and reduced urine output. Clear physical signs and
symptoms.
Severe dehydration (10–15%):
Is gravely ill/ The decrease in blood pressure indicates that vital
organs may be receiving inadequate perfusion (shock)

7. 2. Biochemical
Isotonic
Serum sodium level between 130-150mmol/L (Lost equal
amounts of electrolytes and fluids)
Hypotonic
Serum sodium level < 130mmol/L(Lost more electrolytes
than fluids)
Hypertonic
Serum sodium level > 150mmol/L(Lost more fluids than
electrolytes)

8. 3. WHO (Assessment of dehydration)
No dehydration Some dehydration Severe dehydration
Condition Well alert
Restless and
irritable
Lethargic or
unconscious
Anterior
Fontanelle
Normal Depressed Very Depressed
Eyes* Normal Sunken Sunken and dry
Tears Present Absent Absent
Mouth and
tongue
Moist Sticky Dry
Thirst Drinks normally Drinks eagerly
Drinks poorly or not
at all
Skin turgor*
Goes back
quickly
Goes back slowly
Goes back very
slowly
Plan A Plan B Plan C

10. MANAGEMENT
 Plan A : NO DEHYDRATION
 Plan B: SOME DEHYDRATION
 Plan C: SEVERE DEHYDRATION

11. PLAN A
Treat for Diarrhea at Home

13. Counsel the mother on the 4 Rules of Home Treatment:
1.Give Extra Fluid
2. Continue Feeding
3. When to Return[Advice to mother]
4. Give oral Zinc for 10 days.
PLAN A :Treat Diarrhea at Home

14. 1) Give Extra fluids (as much as the child will take)
Tell the mother:
Breastfeed frequently and for longer at each feed
If the child is exclusively breastfed, give ORS or clean
water in addition to breast milk
If the child is not exclusively breastfed, give one or
more of the following:
Food-based fluids:
Soup, Rice water and yoghurt or clean water.
“ KYB DIET”

15.  It is important to give ORS at home when:
1. The child has been treated with Plan B or Plan C during this
visit
2. The child cannot return to a clinic if diarrhea gets worse
 Teach the mother how to mix and give ORS. Give the mother 2
packets of ORS (1000 ml ) to use at home.
 Show the mother how much fluid to give in addition to the usual
fluid intake:
Up to 2 years: 50–100 ml after each loose stool
2 years or more: 100–200 ml after each loose stool
 Tell the mother to:
 Give frequent small sips from a cup.
 If the child vomits, wait 10 minutes then continue - but more
slowly
 Continue giving extra fluid until the diarrhea stops.

16. Composition of ORS
MAKING
ORS
AT
HOME

17. 2. Continue feeding:
•Continue to breast feed frequently
•If child is not Breast Fed, give cows milk or formula milk half diluted
for 2 days
•If the child is 6months or older or already taking solid food. After
rehydration give freshly prepared foods like cereal with pulses,
vegetables, meat or fish. (4-6times a day)
•Give fresh juice or mashed banana to provide potassium
3. When to return for follow up visit:
After 5 days for follow up
4. When to return immediately, when the child is:
•Not able to drink or breastfeed
•Becomes sicker
•Develops a fever
•Blood in stools

18. 5. GIVE ZINC SUPPLEMENTS (Anti-diarrheal)
10 mg/day for infants below 6yrs, 20mg/day of zinc for 10-14 days(>6y)
TELL THE MOTHER HOW MUCH ZINC TO GIVE:
Up to 6 months 1/2 tablet per day for 14 days
6 months or more 1 tablet per day for 14 days
SHOW THE MOTHER HOW TO GIVE ZINC SUPPLEMENTS
1.For Infants dissolve the tablet in a small amount of expressed breast milk,
ORS or clean water, in a small cup or spoon
2.Older children tablets can be chewed or dissolved in a small amount of
clean water in a cup or spoon
REMIND THE MOTHER TO GIVE THE ZINC SUPPLEMENTS
FOR THE FULL 14 DAYS

19. Plan B
Treat for Some Dehydration
with ORS

21. Plan B
Treat for Some Dehydration with ORS
In the clinic,
 Give recommended amount of ORS over 4-hour
period
 DETERMINE AMOUNT OF ORS TO GIVE
DURING FIRST 4 HOURS

22. AGE Up to 4
months
4 months
up to 12
months
12 months
up to
2 years
2 years
up
to 5
years
WEIGHT < 6 kg 6–< 10 kg 10–<12
kg
12–19kg
Amount of
fluid(ml) over
4 hours
200–400 400–700 700–900 900–1400

23. Use the child’s age only when you do not know the weight.
The approximate amount of ORS required (in ml) can also be
calculated by multiplying the child’s weight in kg times 75.
If the child wants more ORS than shown, give more
For infants below 6 months who are not breastfed, also give
100–200ml clean water during this period
Show the mother how to give ORS solution:
Give frequent small sips from a cup
If the child vomits, wait 10 minutes then continue - but more
slowly
Continue breast feeding whenever the child wants

24. After 4 hours:
Reassess the child and classify the child for dehydration
1) Select the appropriate plan to continue treatment
2) Begin feeding the child in clinic
If the mother must leave before completing treatment:
a) Show her how to prepare ORS solution at home
b) Show her how much ORS to give to finish 4-hour
treatment at home
c) Give her enough ORS packets to complete rehydration.
d) Also give her 2 packets as recommended in plan A.
Explain 4 rules of Home Treatment:
1. Give Extra Fluid
2. Continue Feeding
3. When to Return
4. Oral Zinc

25. Plan C
Treat severe Dehydration Quickly

26. SEVERE DEHYDRATION
2 or more of the following:
 Abnormally sleepy/difficult to wake
 Sunken eyes
 Not able to feed/drinking poorly
 Skin pinchgoes back very slowly
Classify for dehydration
Plan C

27. Plan C
Can you give
intravenous (IV)
fluid
immediately?
YES
Start IV fluid immediately. If the child can
drink, give ORS by mouth while the drip is set
up. Give 100 ml/kg Ringer's Lactate
Solution (or, if not available, normal saline),
divided as follows
* Repeat once if radial pulse is still very weak
or not detectable.
•Reassess the child every 1-2 hours. If
hydration status is not improving, give the IV
drip more rapidly.
•Also give ORS (about 5 ml/kg/hour) as soon
as the child can drink: usually after 3-4 hours
(infants) or 1-2 hours (children).
•Reassess an infant after 6 hours and a child
after 3 hours.
•Classify dehydration. Then choose the
appropriate plan (A, B, or C) to continue
treatment.
AGE 30ml/kg 70ml/kg
<1yr (Infant) 1hr* 5hrs
>1yr (Children) 30mins 2 ½ hrs
NO

28. Is IV treatment
available nearby
(within
30 minutes)?
YES
•Refer URGENTLY to hospital for IV
treatment.
•If the child can drink, provide the mother
with ORS solution and
show her how to give frequent sips during
the trip.
NO

29. Are you trained to use
a naso-gastric (NG)
tube for rehydration?
Can the child drink?
YES
YES
NO
NO
•Start rehydration by tube (or mouth)
with ORS solution:
give 20 ml/kg/hour for 6 hours (total
of 120 ml/kg).
•Reassess the child every 1-2 hours while
waiting for transfer:
If there is repeated vomiting or
increasing abdominal distension, give
the fluid more slowly.
If hydration status is not improving
after 3 hours, send the child for IV
therapy.
After 6 hours, reassess the child.
Classify dehydration. Then choose the
appropriate plan (A, B or C) to
continue treatment.

30.  Refer URGENTLY to hospital for IV or NG
treatment
NOTE:
 If the child is not referred to hospital, observe the
child at least 6 hours after rehydration to be sure the
mother can maintain hydration giving the child ORS
solution by mouth.

31. Thank you!!

36. Complications of
Dehydration
 Shock
 Metabolic acidosis
 Paralytic ileus
 Convulsions and Coma
 Malnutrition
 Acute renal shutdown
 Opportunistic infections
 DIC
 Death

37. DEFICIT
 if the child is 1yr or less than 1yr old
then:
30ml/kg 1 hr
70ml/kg 5 hrs
 IF the child is more than 1 yr old
then:
30ml/kg 30mins
70ml/kg 2½ hrs

38. INVESTIGATIONS
 Blood count
 Stool examination
 Serum electrolytes and bicarbonates
 Urine examination and culture
 Blood culture
 X-Ray chest

39. Maintenance
 1-10kgs 100ml/kg
 10-20kgs 1000ml + 50ml/kg
 20-30kgs 1500ml + 20ml/kg