pediatric

1. Fluid and Electrolyte
imbalance in pediatric
Yosra Raziani
Lecturer at nursing department
Komar university of science and technology
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2. Distribution of body fluids
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3. WATER BALANCE
• MECHANISM OF FLUID Movement
• Maintaining water balance
• Changes in fluid volume related to growth
• Water balance in infants
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4. • INFANT AND YOUNG CHILDREN are at high risk for fluid and
electrolyte imbalance . which of the following factors contribute to
this vulnerability:
• decreased body surface area
• Lower metabolic rate
• Mature kidney function
• Increased ECF volume
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5. Water balance in infants
• Body surface area
• Metabolic rate
• Kidney function
• Fluid requirement
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8. DISTRIBUTION OF FLUID AND ELECTROLYTE BALANCE
• Disturbances of fluid and their solute concentration are closely
interrelated.
• Alterations in fluid volume affect the electrolyte component and
change in electrolyte concentration influence fluid movment
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9. DEHYTRATION
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10. DEHYTRATION
• Dehydration is a common body fluid disturbance encountered in the
nursing care of infants and children
• It occurs whenever the total output of fluid exceeds the total intake
regardless of the underlying cause.
• Although dehydration can result from lack of oral intake (especially in
elevated environmental temperature )more often it is a result of
abnormal losses such as those that occur in vomiting or dehydration.
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12. TYPE OF DEHEYDRATION
• Isotonic (electrolyte loss=water loss)
• Hypotonic(electrolyte loss>water loss)
• Hypertonic(electrolyte loss<water loss)
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13. DEGREE OF DEHYDRATION
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14. DIAGNOSIS EVALUTION
• To initiate a therapeutic plan several factors must be determined:
• The degree of dehydration based on physical assessment
• The type of dehydration
• Initial plasma sodium concentrations
• Serum bicarbonate concentration
• Any associated electrolyte
• Asid-baseimbalances
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15. THERAPEUTIC MANAGMENT
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Mildly dehydration:
50ml/kg
Moderate dehydration:
100ml/kg
Fluid losses from diarrhea:
10ml/kg

16. Parenteral fluid therapy
A. Initial therapy is used to expand ECF volume quickly and to improve
circulatory and renal function
B. Subsequent therapy is used to replace deficit
C. The final phase of therapy allows the patient to return to normal
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19. NURSING RESPONSIBILITIES
IN FLUID AND ELECTROLYTE DITURBANCES
• ASSESMENT
• HISTORY
• CLINICAL OBSERVATION
• INTAKE AND OUTPUTE MEASUMENT
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20. CONDITIONS THAT PRODUCE FLUID AND ELECTROLYTE IMBALANCE
•DIARRHEA
•VOMITING
•SHOCK
•BURNS
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21. DIARRHEA
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Diarrhea is a symptom that result from disorders
involving digestive ,absorptive , and secretory function
Diarrhea is caused by abnormal intestinal
water and electrolyte transport
In the U.S approximately 200000children younger than age 5 are
hospitalized and approximately 200 children younger than 5
years die of diarrhea and dehydration each year

22. TYPES OF DIARRHEA
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Acute diarrhea :
Is defined as a sudden increase in frequency and a
change in consistency of stool ,often caused by an
infectious agent in the GI tract.
Usually self –limited<14 days duration
Chronic diarrhea:
Is an increase in stool frequency and increase water
content with a duration of more than 14 days.
It in often caused by chronic condition such as
malabsorption syndrome ,IBD.FOOD ALLERGY, OR
a result of inadequate management of acute diarrhea

23. Etiology OF DIARRHEA
• Most pathogens that cause diarrhea are spread by the fecal-oral route
through contaminated food or water or are spread from person to
person where there is close contact .
• Lack of clean water ,crowding ,poor hygiene , nutritional deficiency
and poor sanitation are major risk factors , especially for bacterial or
parasitic pathogens.
• The most common causes of acute GI are infectious agents ,viruses
bacteria , and parasites.
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24. Etiology OF DIARRHEA
• Rotavirus disease is most severe in children 3 to 24 months of age.
• Children younger than 3 months of age have some protection from
the diseases because of maternally acquired antibodies.
• Salmonella infection has the highest occurrence in infants .
• Antibiotic administration is frequently associated with diarrhea
because antibitics alter the normal intestinal flora.
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25. Therapeutic management
• The major goals in the management of acute diarrhea Include:
1. Assessment of fluid and electrolyte imbalance
2. Rehydration
3. Maintenance fluid therapy
4. Reintroduction of an adequate diet
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26. Nutrition & propulsion education
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30. Nursing care in vomiting
• Direct the management of vomiting toward detection and treatment
of the cause of the vomiting and prevention of complications such as
dehydration and malnutrition .
• Antiemetic drug may be indicated when the vomiting can be
anticipated ,is of limit duration ,and has a known cause.
• The cause of the vomiting determines the nursing care.
• Position the infant or childe to prevent aspiration.
• Emphasize the need for the child to brush the teeth.
• Monitor fluid and electrolytestatus
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32. shock
Circulatory system failure to supply oxygen and nutrients to meet cellular
metabolic demands
• Hypovolemic shock
• Septic shock
• Toxic shock syndrome
• Anaphylaxis
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33. Nursing care in shock
• Ventilatory support
• Establishing iv line
• Fluid administration
• Improvement of the pumping action of heart
• Hemodynamic monitoring
• The best position is flat with the leg elevated
• Medical therapy
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34. Burns
❑Mortality from burns and scalds is low but morbidity (pain and scarring) is high.
❑Rates of injury are highest in the 12 to 24 month age group (44/100000/year)
❑Around half of these are scalds, almost all of which occur in the home.
❑Hot drinks, water on stoves, kettles and hot tap water are most commonly involved.
❑The severity of the burn is closely related to temperature of the liquid. Liquid at 60°C will burn
children in less than 5 seconds, compared with 10 minutes if the liquid is at 49°C.
❑Hot object burns also typically occur in the home and typically involve heaters, irons and
ovens.
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35. Epidemiology
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36. Nursing assessment
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Assessment
❑ History
❑ Size of burn
❑ Depth of injury
❑ Age
❑ Location of burn
❑ Trauma
❑ Diagnostic evaluation

37. Degree of burn
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• Paediatric BSA
chart
• Child’s hand
• (palm and
adducted fingers)
• is 1% BSA
In Infant
1 X 9 for each arm.
2 X 9 for head
14% each lower limb
4 X 9 for trunk
Take 1% off head & add to legs for
each year of life >1

39. Nursing care in burns
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Resuscitation
 Burn (%) x Weight (kg) x 4 ml per day
 Calculated from the time of the burn
 Half in first 8 hours
 Out put :1cc/kg/hr
Maintenance – as usual over 24 hours

40. ACIDE-BASIC IMBALANCE
• A disturbance of acid –base equilibrium in the direction of acidosis or
alkalosis may come about in a variety ways.
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41. Respiratory acidosis
• Respiratory acidosis result from diminished or inadequate pulmonary
ventilation that cause an elevation in plasma Pco2 and thus an
increased concentration of dissolved carbonic acid , wich leads to
elevated carbonic acid and hydrogen ion concentration.
• Metabolic compensation for this type usually performed by kidneys
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42. RESPIRATORY ALKALOSIS
• respiratory alkalosis is caused by primary increase in the rate and
depth of pulmonary ventilation , resulting in unusually large amount
of carbon dioxide being exhaled.
• This reduce the plasma Pco2 and raises the PH
• Metabolic compensation for this type usually performed by kidneys
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43. METABOLIC ACIDOSIS
• Metabolic acidosis is lowered plasma PH caused by any process that
reduces the bicarbonate concentration .
• Compensation of metabolic acidosis is respiratory ,with alveolar
hyperventilation occurring immediately as the decrease in PH is
sensed the respiratory center.
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44. METABOLIC ALKALOSIS
• Metabolic alkalosis is represented by an elevated plasma PH that
occurs when there is a reduction in hydrogen ion concentration and
an excess of bicarbonate .
• Compensation of metabolic alkalosis is respiratory
• In children the most common causes of hydrogen ion depletion is loss
of HCL incident to hypertrophic pyloric stenosis . the infant product
large amount of HCL which is vomited with repeated feeding .
• HCL is also lost in gastric tube drainage.
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46. Electrolyte imbalance
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47. Hyponatremia manifestations
▪Sodium concentration <130 mEq /L
▪Associated with water loss:
▪Nausea
▪Weak pulse
▪Decrease blood pressure
▪Abdominal cramp
▪Lethargy
▪dizziness
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48. Hyponatremia nursing care
▪Determine and treat cause of sodium deficit
▪Administer iv fluid appropriate saline concentration
▪Monitoring
▪Check I & O
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49. Hypernatremia MANIFESTATIONS
▪Sodium concentration >150 mEq /L
▪INTENSE thirst
▪dry ,sticky mucous membranes
▪hypertermia
▪Oliguria
▪Nausea and vomiting
▪Nuchal rigidity
▪High plasma volume
▪alkalosis 49

50. Hypernatremia nursing care
▪Determine and treat cause of sodium excess
▪Administer iv fluid appropriate saline concentration
▪Monitoring
▪Check I & O
▪Monitor laboratory data
▪Monitor neurologic statuse
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51. Hypokalemia manifestations
▪potassium concentration <3.5 mEq /L
▪Abnormal ECG ( pvc , notched T waves)
▪Fatigue
▪Tachycardia or bradycardia
▪Ileus
▪Hypotention
▪Hyporeflexia
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52. Hypokalemia nursing care
▪ Determine and treat cause of potassium deficit
▪ Monitor vital signs including ECG
▪ ADMINISTER supplemental potassium(assess for adequate renal output before
administer)
▪ For iv replacement ,administer potassium slowly .always monitor ECG
▪ EVALUATE acid-base statuse
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53. Hyperkalemia manifestations
▪potassium concentration >5/5 mEq /L
▪Hyperreflexia
▪Oliguria
▪bradycardia
▪VF AND cardiac arrest
▪Apnea –respiratory arrest
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54. Hyperkalemia nursing care
▪Determine and treat cause of potassium excess
▪Monitor vital signs including ECG
▪Monitor potassium level
▪EVALUATE acid-base statuse
▪Administer iv fluid
▪Adminsiter iv insulin to facilitate movement of potassium into cell
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55. Hypocalcemia manifestations
▪calcium concentration < 8.8 mEq /L
▪Tetany
▪Cardiac arrest
▪Hypotention
▪Increase serum protein level
▪Change in clotting
▪Laryngospasm
▪Tingling of nose ,ears,fingertip,toes
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56. Hypocalcemia nursing care
▪Determine and treat cause of calcium deficit
▪Administer calcium supplements
▪Monitor iv site
▪Monitor serum protein level
▪Avoid cow milk in infants younger than 12 month
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58. Hypercalcemia manifestations
▪calcium concentration > 10.8 mEq /L
▪Constipation
▪Weakness , fatigue
▪Nausea , vomiting
▪Anorexia
▪Dry mouth(thirst)
▪Muscle hypotonicity
▪Kidney stones
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59. Hypercalcemia nursing care
▪Determine and treat cause of calcium excess
▪Monitor ECG
▪Monitor serum calcium levels
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60. Refrence
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