This document discusses fluid management in neonates. It covers neonatal fluid physiology, insensible water loss, factors affecting it, ways to minimize it, fluid assessment, laboratory parameters to assess fluid status, maintenance fluid requirements, and special considerations for conditions like respiratory distress syndrome, birth asphyxia, and patent ductus arteriosus. The key goals of fluid therapy in newborns are to maintain appropriate extracellular fluid volume and composition, electrolyte concentrations, and pH balance.
The purpose of this presentation is to provide an overview of fluid and electrolyte maintenance related handicaps and physiological changes in early neonatal period and its management in brief.
The purpose of this presentation is to provide an overview of fluid and electrolyte maintenance related handicaps and physiological changes in early neonatal period and its management in brief.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Iv fluid therapy (types, indications, doses calculation)kholeif
All what you need to know intravenous fluids, types, indications, contraindications, how to calculate fluid rate and drug dosages.
Embed code (http://www.slideshare.net/slideshow/embed_code/16138690)
Dehydration in Children and Fluid Management (with discussion on Unani Manage...Dr. Nazia
This Presentation discusses pediatric daily fluid requirements, body water balance, dehydration and its management.
Additionally, it gives an insight to Unani management of dehydration.
Medical Students/Healthcare Professionals belonging to either Modern System of Medicine (allopathy) or Indian System of Medicine may find this presentation helpful.
Content credit to rightful owner (wherever applicable).
Slides belong to this Author.
Children and adults differ physically and mentally.
As a nurses it is necessary to learn the differences to deliver the care accordingly.
CLASSIFICATION:
Anatomical differences
Physiological differences
Psychological differences
Children are more prone to dehydration than adults. At the same time, exposure to many chemical agents and some biological agents leads to vomiting and diarrhea.
As a result, children may be more symptomatic and show symptoms earlier than adults.
Children have a higher proportion of rapidly growing tissues than adults, and some agents, including ionizing radiation and mustard gas, significantly affect rapidly growing tissues.
As a result, children are more prone to ionizing radiation and other agents that affect rapidly growing tissue than adults.
Children have relatively small airways compared with adults. The smaller the caliber of the airway, the greater the reduction in airflow as a result of increased pulmonary secretions that occur following exposure to chemicals or edema from inhalation of hot gases
As a result, children suffer more pulmonary pathology than adults at the same level of exposure.
Hello Guys,
This presentation talks about diagnosis and management of Antenatally detected hydronephrosis. We have discussed evidence based fetal hydronephrosis management including - antenatal followup schedule, fetal interventions, postnatal screening and follow up proforma, MCU, Functional renal scans, prophylactic antibiotics and available surgical management options.
This presentation is an overview of congenital cyanotic heart diseases, with a special discussion on Tetralogy of Fallot. We discuss the pathophysiology, clinical manifestations as well as the most updated management options for treating this condition. The topic ends with a few important complications seen in TOF patients. Hope you find it useful.
You can follow us on: Facebook page 'Neonatohub' (online academic platform) OR visit our YouTube channel 'Neonatohub' for more paediatric and neonatology presentations.
Hi Guys,
This presentation talks about Tuberculosis diagnosed in mother in the antenatal period, its treatment, implications on mother and fetus, the various protocols available currently regarding the neonatal management . Special focus being in major issues like breastmilk feeding, BCG, AKT prophylaxis, mother-child isolation.
Hope you find it useful.
P.S. - Please checkout my youtube channel - 'NEONATOHUB' & Facebook page 'Neonatohub' for lectures on neonatology.
Hello Guys,
This presentation consists of the updated guidelines under National tuberculosis elimination programme of India (MOHFW). The presentation includes case definitions and diagnostic algorithms for Pulmonary, Extrapulmonary and Drug resistant TB(MDR/ XDR TB) and the tratment protocols in pediatric cases.
Hope you find it useful.
This presentation is a simplified version of the various types of cardiac arrythmias seen in pediatric age groups. We have discussed supraventricular tachycarsias and prolonged QT syndrome in details here. Hope everyone finds it useful.
Hello guys,
Todays presentation aims at discussing the most common syndromic causes of short stature - Turners syndrome and Downs syndrome. We have discussed the Genetics, Phenotype and co-morbidities with their individual management strategies. I hope you find it uselful too.
This presentation discusses cranial hemorrhage in a newborn baby. We have included extracranial and intracranial bleed discussion in neonates. Intraventricular hemorrhage (IVH) is further discussed in details in terms of pathophysiology, management strategies and clinical studies related to it.
Hope this presentation is helpful for the knowledge and practice of medical students, pediatricians and neonatologists and helps in practical management of your NICU babies as well.
This presentation aims at helping the pediatric trainees and practitioners to brush up their knowledge in Immunization. The schedule is based on the Universal Immunisation Programme. I have tried to cover as much as possible in terms of individual vaccines and hope it is beneficial to the reader.
This presentation aims at helping the pediatric trainees and practitioners to brush up their knowledge in Immunization. The schedule is based on the Universal Immunisation Programme. I have tried to cover as much as possible in terms of individual vaccines and hope it is beneficial to the reader.
This presentation is a part 2/4 of series of presentation on Paediatric immunization.This presentation aims at helping the pediatric trainees and practitioners to brush up their knowledge in Immunization. The schedule is based on the Universal Immunisation Programme. I have tried to cover as much as possible in terms of individual vaccines and hope it is beneficial to the reader.
This presentation aims at helping the pediatric trainees and practitioners to brush up their knowledge in Immunization. The schedule is based on the Universal Immunisation Programme. I have tried to cover as much as possible in terms of individual vaccines and hope it is beneficial to the reader.
This presentation is aimed at giving the basic information of a neonate classification on basis of gestational age and the birth weight. Prematurity has been discussed in details. I have also included the growth charts that can be used for growth monitoring in term as well as preterm babies.
** This presentation is available in a video lecture format at my youtube channel - NeonatoHub. Do watch it for further understanding of the topic & subscribe to the channel.
This presentation aims at discussion of the pathophysiology , clinical presentation and management of the different types of intracranial bleeds in a neonate. Special emphasis has been laid on intraventricular hemorrhage. The germinal matrix bleed in a preterm is discussed in depth along with the various evidence based management protocols available. Radiological diagnosis of IVH in a preterm / term baby will be discussed in the upcoming presentations.
Hello guys, bringing to you the concept of golden hour of neonatology. As in trauma, the first hour of neonatal life is most precious and this ppt is an attempt to highlight a few key aspects of this resuscitative strategy in premature infants.
Thsi presentation is a sincere attempt to demonstrate the aseptic techniques needed to collect blood culture, urine culture, diagnostic lumbar puncture. Disscussion about the use of there modalities in neonatology practice and the ways to increase their sensitivity and specificity is done.
this presentation is also available in a video lecture format at my Youtube channel - "NeonatoHub". Hope you enjoy it more in that format.
https://www.youtube.com/watch?v=vZ71vymGVC8
This presentation deals with the basic physics of human ventillation. I have made an effort to clarify most of the venti lingo , so as to make way for further discussions on ventilator use. Hope it turns out to be helpful for you. Thank you.
Respiratory physiology & Respiratory Distress syndrome in a newborn.Sonali Paradhi Mhatre
Hi guys, This ppt shows the pathophysiology of pulmonary surfactant in newborn and respiratory distress syndrome. Main focus is towards management of RDS esp. exogenous surfactant administration. Your comments are welcome. Thank you.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. Page 2
WHY FLUID MANAGEMENT ??....
• Neonatal body fluid physiology is very different from
older children & adults.
• Fluid and electrolyte requirement in a newborn varies as
per weight and gestation age as well as the Postnatal age
of the same child.
• Term and Preterm babies vary in their fluid and electrolyte
quantity requirement & compositions.
• Improper fluid and electrolyte management in newborn,
by itself, can result in serious morbidity and mortality in
the baby.
4. Page 4
Intrauterine Physiology
Early gestation : High Total body water content & large
extracellular compartment
Advancing gestation : Rapid cellular growth, Increased body
solids, fat deposition.
Reductions in Total body water, reduction in ECF volume and
Increase in ICF volume
Therefore, Premature infants have excess Total body fluids
& ECF volume expansion.
8. Page 8
Postnatal physiology - Late
Early days – Interstitial fluid absorbtion
in the intravascular compartment
Rise in circulating blood volume
Atrial Natriuretic Peptide released from
heart which enhances Sodium and
water excretion.
Abrupt decrease in Total Body water
and resultant weight loss in baby.
9. Page 9
Goals of Fluid therapy in newborns:
• 1. Maintain appropriate ECF volume.
• 2. Maintain ECF and ICF osmolality.
• 3.Maintain Ionic concentrations and
pH.
10. Page 10
Steps :
• 1. Estimating existing deficits or
excess.
• 2. Ongoing maintainance needs
calculations.
• 3. Supplying additional needs &
Ongoing losses.
Sensible fluid loss Insensible fluid loss
supply
FLUID
IV
ORAL
12. Page 12
Insensible water loss
• Known as "insensible water loss" as it is a process over
which organisms have little physiological control.
• Includes transepidermal water loss and fluid loss through
respiratory tract.
• IWL PRETERM>TERM
Reasons : Immaturity of Skin Barrier
Respiratory Distress
Larger body water content
More surface area for fluid loss.
13. Page 13
Insensible water loss (cont…..)
• Gestational age, postnatal age and environmental factors
determine amount of IWL.
• Ambient humidity is one of the greatest determinants of
IWL.
• Other environmental factors include activity, airflow,
elevated body, and environmental temperature, skin
breakdowns & mucosal defects like seen in
gastrochisis,etc.
• Respiratory IWL is mainly dependant on the temperature
and humidity of the inspired gas, respiratory rate and tidal
volume and dead space ventillation.
14. Page 14
Insensible water loss (cont…..)
* IWL values increased approximately upto 30% with
Phototherapy exposure.
* Radiant warmers increase IWL by approx 50%.
Age
(d)
Birth weight Range (kg)
0.50-0.75 0.75-1 1-1.25 1.25-1.50 1.5-1.75 1.75-2
0-7 100 65 55 40 20 15
7-14 80 60 50 40 30 20
15. Page 15
Factors affecting Insensible water loss
Factors Effects on IWL
Maturity Inversely proportional to
birth wt. and gestational
age.
Radiant warmer Increased – 50%
Phototherapy Increased – 30%
High humidity Decreased – 30%
Plastic heat shield Decreased – 30%
16. Page 16
Ways to Minimise IWL
• Incubator use (min 50 % humidity).
• Humidification of inspired gases in head box and
ventilators.
• Thermoneutral temperature.
• Increased ambient humidity
• Thin transparent plastic barrier.
• Local oil application to minimise evaporative losses.
• Minimal use of stickings on baby skin and proper newborn
skin care.
• Humidified ventillator gases.
17. Page 17
Assessment
• HISTORY.........
• Body weight daily recording and charting.
• Tachycardia – may indicate hypo/hypervolemia.
• Perfusion – capillary refill time.
• Edema
• Hepatomegaly
• Blood pressure
• Skin turgor, mucus membrane dryness, AF – non reliable.
• Decreased urine output.
• Systemic examination to look for RDS, CHD, BPD
changes fluid calculations
18. Page 18
Laboratory Parameters
• Serum electrolytes :
Serum Na+ and K+ on admission and day3.
Every alternate day estimation for ventillated /
unstable baby.
Twice a week for other babies on IV Fluids.
• BUN and Creat twice a week.
19. Page 19
Laboratory Parameters
.
• Glucose estimation twice a day for ventillated
or unstable babies. Rest – once daily.
• Plasma osmolarity . Normal : 280-300mosm/l
• Urine specific gravity : 1.008 – 1.012 and correlate
with plasma osmolarity for ventillated/ sick babies.
• Blood gas analysis, septic workup for dehydrated
baby.
20. Page 20
Maintainance fluids
Birth
weight
(kg)
Dextrose
(conc)
Fluid Rate (ml/kg/day)
< 24 hrs 24 – 48 hrs > 48 hrs
< 1.0 5 – 10 100 120 140
1.0 – 1.5 10 80 100 120
> 1.5 10 60 80 100
Add maintainance calcium from day1
Electrolytes to be added after 48 hours of life. During 1st wk,
requirement of Na+,K+, Cl is 1-2 mEq/kg/d and beyond first wk,
2-3mEq/kg/d.
21. Page 21
Appropriate fluid & electrolyte balance
.Normal urine output : 1- 3 ml/kg/hr
Urine specific gravity : 1008 – 1012
Weight loss of 5% in term and 15% in preterm babies.
A weight loss of 2 – 3% per day is expected in the first week
of life.
Normal serum electrolytes.
Normal weight graph on charts.
23. Page 23
Respiratory distress syndrome
Consists of 3 phases – prediuretic phase (stabilization phase), Diuretic
phase (Restriction maintainance phase), Post diuretic (liberalization
phase.)
WHAT TO DO ???
1. Fluid restriction to 2/3rd of maintainanceduring the initial phase. After
diuresis occurs, fluid rate can be cautiously increased.
2. Prevent hypoglycemia. Shock can be treated with normal saline ±
ionotropes.
3. Full maintainance fluids can be achieved at the end of first week once
initial diuresis is completed.
4. Special care to be taken for calculating the insensible fluid losses and
supplying it.
24. Page 24
Birth asphyxia
Oliguria or anuria may be seen in these babies secondary to
SIADH or renal injury.
WHAT TO DO ???
1. Fluid restriction to 2/3rd of maintainance during period of
anuria.
2. Restore fluid intake to normal when urine production is
normal.
3. Fluid push (20cc/kg Normal saline) can be given if pre
renal cause suspected.
25. Page 25
PDA (only if symptomatic)
Patent ductus arteriosus need fluid restriction only if signs of
failure are present – tachycardia, hepatomegaly, edema,
sudden weight gain.
WHAT TO DO ???
1. Supply 2/3rd of total maintainance fluid.
2. Iv frusemide may be given SOS.