This document discusses fluid and electrolyte therapy. It covers the components of body water, body fluid composition, electrolyte balance, water content at different ages, regulation of body water and electrolytes, dehydration, and oral and intravenous fluid therapy.
Some key points include:
- Body water is divided into extracellular fluid (ECF) and intracellular fluid (ICF)
- Electrolytes like sodium, potassium, and chloride are important for fluid balance and cell function
- Dehydration occurs when fluid losses exceed intake and can be classified as mild, moderate, or severe
- Oral rehydration therapy (ORT) using oral rehydration salts (ORS) is the main treatment for dehydr
This lecture is based on National guidelines(Sri Lanka) and guidelines by NHS UK. all the materials used to prepare the lecture are trusted and high in quality. also the books referred are internationally recognized. both hyper and hypokalemia management included in the lecture. lecture is free and you can even download. i kept no copy rights. i appreciate your support, comments and suggestions. also i would be grateful if you can make these lectures popular. wishing your success.
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)
This lecture is based on National guidelines(Sri Lanka) and guidelines by NHS UK. all the materials used to prepare the lecture are trusted and high in quality. also the books referred are internationally recognized. both hyper and hypokalemia management included in the lecture. lecture is free and you can even download. i kept no copy rights. i appreciate your support, comments and suggestions. also i would be grateful if you can make these lectures popular. wishing your success.
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)
fluid and electrolyte imbalance
normal physiology of fluid regulation
FLUID IMBALANCES- fluid volume excess, fluid volume deficit, third spacing,
ELECTROLYTE IMBALANCES- hypo and hypernatremia, hypo and hyperkalemia, hypo and hypercalcemia
Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin.
When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are chemicals that the body creates when it breaks down fat to use for energy. The body does this when it doesn’t have enough insulin to use glucose, the body’s normal source of energy. When ketones build up in the blood, they make it more acidic.
fluid and electrolyte imbalance
normal physiology of fluid regulation
FLUID IMBALANCES- fluid volume excess, fluid volume deficit, third spacing,
ELECTROLYTE IMBALANCES- hypo and hypernatremia, hypo and hyperkalemia, hypo and hypercalcemia
Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin.
When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are chemicals that the body creates when it breaks down fat to use for energy. The body does this when it doesn’t have enough insulin to use glucose, the body’s normal source of energy. When ketones build up in the blood, they make it more acidic.
This PPT gives an idea to MBBS students about the Type of fluids, Calculating the daily requirements as well as the drop rate to be used in day today clinical practice.
Fluid therapy in pediatrics/ oral dehydration solution/Dehydration.Haneen Hassan
Introduction.
Oral rehydration solution.
How to prepare ORS.
How to administer ORS.
How to give ORS.
Limitation of ORS.
Definition of Dehydration.
Degree of dehydration.
- *FCPS1 One Month CRASH Course for May Attempt By Dr. Nusrat*
*[ONLY 3 SPOTS remaining]*
Course Highlights:
1. Students will be given Live Lectures on Zoom, recordings will be available, alternative day Mock tests. There will be theory discussion, RAFII, SK and mcqs group.
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3. Video access will be unlimited
4. Students will be taught EXTENSIVELY covering all systems, anatomy, neuro and minors
5. This is limited offer.
6. Registration must be done *before 15th April*
7. No one will be accepted after the 15th.
8. Contact for registration
9. *Registration Form:* https://docs.google.com/forms/d/1lKm_9XrFW1pqtXLhgSxqIP_Oolv81Zh3pBJqEax3wII/edit?usp=drivesdk
10. You will be added into the group as soon as you register.
11. Contact 03164500454 for any further queries.
12. Course Price: Rs. 4000 (Eid Discount till 12th April, after which it will be 4500)
13. *THIS IS LIFESAVER, GAME CHANGER AND HOPE* for students who have failed before, job waale and mothers and married women who can't give enough time for self study.
14. Dr. Nusrat aap pe mehnat karain gii, Yaad karwayain gii, and insha'Allah insha'Allah you'll ace it!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
2. Components of
Body Water
ECF
Intravascular fluid: within blood vessels (5%)
Interstitial fluid: between cells - blood vessels (15%)
Transcellular fluid: cerebrospinal, pericardial,
synovial
ICF
Inside cell
Most of body fluid here - 40% weight
Decreased in elderly
3.
4. Body Fluid Composition
Electrolyte :
…is a substance capable of conducting
electric current in solution.
They exist in ions
> Cations : Na+
, K+
, Ca++
etc.
> Anions : Cl-
, HCO3
-
Conc. of electrolytes – expressed in mEq/L
Equivalent weight: wt. of the substance in grams that can combine with or
displace 1 gram of hydrogen.
= atomic weight / valance
For monovalent ions, 1 equivalent = 1 mole
For divalent ions, 1 Eq = 0.5 mol
For trivalent ions, 1 Eq = 0.333 mol
5. Body Fluid Composition
Osmolality :
…is a count of the total number of osmotically
active particles in a solution and is equal to the
sum of the molalities of all the solutes present
in that solution.
Normal = 290 mOsm/Kg
Molarity is the number of particles of a particular
substance in a volume of fluid (mmol / L)
&
Molality is the number of particles disolved in a mass
weight of fluid (mmol / kg)
6. ELECTROLYTE BALANCE
The exchange of interstitial and
intracellular fluid is controlled mainly by the
presence of the electrolytes sodium and
potassium
NaNa++
KK++
NaNa++
KK++
NaNa++
KK++
NaNa++
KK++
8. ELECTROLYTE BALANCE
Potassium is the chief intracellular cation
and sodium the chief extracellular cation
Because the osmotic pressure of the
interstitial space and the ICF are generally
equal, water typically does not enter or
leave the cell
KK++
NaNa++
9. Water is …
At Birth
75% of body wt.
By 2 years
60 % of body wt.
40% ICF
20% ECF
5% Intravascular (plasma)
15% Interstitial
Adult
55% - Males
51% - Females
10. Regulation of Body Water & Electrolytes
For every 100 Cal metabolized, body ..
Loses Gains
65 ml water in urine
40 ml by sweating
15 ml from lungs
5 ml in feces
15 ml from metabolism
Net loss of water = 110 ml per 100 Cal metabolized
11. Fluid Loss
Absolute deficit of ECF
Diarrhoea
Vomiting
Polyuria
Decreased intake
Decrease in effective circulation
Nephrotic syndrome
Cirrhosis of liver
Portal hypertension
14. ELECTROLYTE BALANCE
A change in the concentration of either
electrolyte will cause water to move into or
out of the cell via osmosis
A drop in potassium will cause fluid to
leave the cell whilst a drop in sodium will
cause fluid to enter the cell
KK++
H2O
H2O
H2O
H2O
H2O
H2O
H2O H2O
KK++
KK++
KK++
NaNa++
NaNa++
NaNa++
NaNa++
15. Why Infants are more vulnerable to water loss
Physiological inability of
their renal tubules to
concentrate
Higher metabolic rate
Larger body surface
area
Poorly developed thirst
mechanism
Larger turnover water
exchange
(50% of ECF every day)
16. Dehydration
Water isn’t replaced in body
Fluid shifts from cells to EC space
Cells lose water
Happens in confused, comatose, bedridden
persons along with infants & elderly
19. Signs of Dehydration
Tachycardia
Oliguria
Irritable / lethargic
Sunken eyes and fontanel
Decreased tears
Dry mucus membranes
Mile tenting of skin
Delay in CFT
Cool & pale
Moderate:
20. Signs of Dehydration
Rapid & weak pulse
Decreased BP
No urine output
Very sunken eyes &
fontanel
No tears
Tenting of skin
CFT – very delayed
Cold & mottled skin
Parched mucus
membranes
Severe:
21. Degrees of Dehydration
From treatment point of view, dehydration is
usually classified as :
No dehydration,
Some dehydration and
Severe dehydration.
Some Dehydration
When symptoms and/or signs of dehydration are present.
Severe Dehydration
In the presence of shock and lethargy it is referred to as severe
IMNCI System
23. Oral Rehydration Therapy
ORT is the cheap, simple and effective way to treat
dehydration caused by diarrhoea.
Many of the millions of children who die every year
in developing countries from diarrhoea could be
saved if they were given ORT promptly.
This includes giving extra fluids at home such as
tea, soups, rice water and fruit juices to prevent
dehydration, and the use of Oral Rehydration salts
(ORS) solutions to treat dehydration
24. Physiologic Basis For ORS
Sodium passes into these outermost cells by
co-transport facilitated diffusion via the SGLT1
protein.
The co-transport of sodium into the epithelial
cells via the SGLT1 protein requires glucose.
Two sodium ions and one molecule of
glucose/galactose are transported together
across the cell membrane through the SGLT1
protein.
26. Advantages of Low Osmolar ORS
• Reduces stool output by about 25% when
compared to the standard WHO ORS.
• Reduces vomiting by almost 30%
• Reduces the need for IV therapy by > 30%.
• Results in reduced hospitalization
27. Super ORS
… are the special types of ORS which instead of mono-sugars
contain more complex sugars. They may be Food- based ( as
rice-based ) or otherwise be starch-free (Glycine / alanine based
or Glucose polymer based
Advantages of Super-ORS
Provides rehydration.
Helps in reducing the stool output, frequency of stools and
duration of diarrhea.
Furnishes increased amount of calories (180 kcal/ litre)
Contributes to weight gain, as it provides additional nutrition (thus
is especially useful for those who are malnourished).
With gradual release of glucose, prevents secondary disaccharide
intolerance.
Disadvantages
Short shelf-life (not exceeding 10 hours)
28. Resomal
An oral rehydration salt (ORS) adapted to the needs of
the severely malnourished patients.
Ingredient Amount
Water (boiled & cooled) 2 litres
WHO-ORS One 1 litre-packet
Sugar 50 g
Electrolyte/mineral solution 40 ml
(K, Mg and Zn)
ReSoMal contains approximately 45 mmol Na, 40 mmol K
and 3 mmol Mg/litre
ReSoMal solution must only be given orally in small sips / by NG tube.
29.
30. Management of Diarrhoea
Plan A: Treat Diarrhoea at Home
Plan B: Treat Some Dehydration with ORS
Plan C: Treat Severe Dehydration Quickly
31. ORT to prevent Dehydration – Plan A
Counsel the mother 4 rules of Home Treatment
1. Give Extra fluid (as much as the child takes)
2. Give Zinc supplements
3. Continue Feeding
4. When to Return
32. ORT to prevent Dehydration – Plan A
1. Give Extra fluid (as much as the child takes)
1. Tell mother to breast feed, give ORS, food based fluids
(soup, rice water, yoghurt drinks), or clean water
2. Teach mother how to mix and give ORS
3. Show how much extra fluid to give in addition to usual
fluid intake
1. Upto 2 yrs : 50 – 100 ml after each loose stool
2. 2 yrs or more : 100 – 200 ml
33. ORT to prevent Dehydration – Plan A
2. Give Zinc Supplements
1. Tell mother how much zinc to give
1. Up to 6 mo : ½ tab per day for 14 days
2. 6 mo and > : 1 tab per day for 14 days
2. Show mother how to give zinc supplements
3. Remind mother to give zinc for full 14 days
34. ORT to prevent Dehydration – Plan A
3. Continue Feeding
4. When to Return
1. Immediately :
1. Child is not able to drink or breastfeed
2. Child becomes sicker
3. if blood per stool or
4. drinking poorly
2. After 5 days : if diarrhoea persists
35. Prevention of dehydration – Plan A
Age Amt of ORS after
each stool
< 24mo 50 - 100ml
2yr -10yr 100 - 200ml
> 10yrs As much as wanted
How much ORS ?
36. ORT to prevent Dehydration – Plan B
for Patients with physical signs of Dehydration
a) Correction of existing water and electrolyte
deficit as indicated by the presence of signs of
dehydration
b) Replacement of ongoing losses due to
continuing diarrhoea to prevent recurrence of
dehydration
c) Provision of normal daily fluid requirement
37. Weight Wt 6 kg 6 – 10 kg 10 – 12 lg 12 – 19 kg
Use child’s age only when you do not know the weight.
Approx amt of ORS required (ml) = Child’s Wt. in Kg. X 75
38. SOME DEHYDRATION: PLAN B
ORS: 75ml/kg plus
for ongoing losses
(50ml/stool)
one liter of potable
water + one full
sachet of ORS to be
dissolved & kept in a
container with lid.
39. When is ORT ineffective ?
High stool purge rate ( > 5 ml/kg/hr)
Persistent vomitings ( > 3 / hr)
Incorrect preparation of ORS
Abdominal distension
Glucose malabsorption
40. Children with Severe Dehydration – Plan C
Start IV fluids immediately
While drip is being set up give ORS
of child can drink
42. Principles Of Rehydration
1. Step I
• Restore intravascular volume
• Normal saline (20ml/kg) over 20 minutes
(Repeat until intravascular volume restored)
2. Step II
• Calculate 24 hour water needs (maintenance &
deficit)
• Calculate 24 hour electrolyte needs
• Both maintenance & Deficit sodium and potassium
• Subtract the fluid volume/ electrolyte concentration
used in resuscitation phase.
3. Step III
• Replace ongoing losses
43. Electrolyte Deficit
Rapid Dehydration (< 2 days)
Ratio of ECF to ICF deficit is 75 : 25 %
Moderately Rapid Dehydration (2-7 days)
Ratio of ECF / ICF is 60 : 40 %
Slow Dehydration (>7days)
Ratio of ECF / ICF is 50 : 50 %
44. Classification of Dehydration based on Tonicity
Isonatremic (Isotonic) Dehydration
Serum Na =135 to 145 mEq./L
Hyponatremic (Hypotonic) Dehydration
Serum Na < 130 mEq./L
Hypernatremic (Hypertonic) Dehydration
Serum Na >145 mEq./L
45. Concept of Maintenance Fluids
Principles of Therapy -2. MAINTENANCE
Calculation based on caloric expenditure
46. Concept of Maintenance Fluids
Calculation based on caloric expenditure
[ Holiday & Segar Formula ]
Wt. Calories Expended Maintenance waterWt. Calories Expended Maintenance water
Till 10 Kg 100 Cal / Kg 100 ml / Kg
10 – 20 Kg 1000 Cal + 50 Cal for 1000 ml + 50 ml for
Every Kg > 10 / Kg Every Kg >10 / Kg
20 Kg 1500 Cal + 20 Cal for 1500 ml + 20 ml for
every Kg above 20 Kg every Kg above 20 Kg
47. Concept of Maintenance Fluids
Route Water Na K
Evaporative
Lungs
Skin
15
40
0
0.1
0
0.2
Stool 5 0.1 0.2
Urine 65 3.0 2.0
TOTAL 125 3.2 2.4
Less Metabolic Water 10 – 15
110 - 115
Loss per 100 Cal. of metabolism per Day
48. Concept of Maintenance Fluids
Calculation based on caloric expenditure
[ Holiday & Segar Formula ]
Wt Water (ml /day) Water
ml / hr
Electrolytes
mEq / L of water
0 – 10 kg 100 ml / kg 4 / kg Na 30, K 20
10 – 20 kg 1000 + 50 ml /kg for
each kg above 10
40 + 2 / kg
for each kg
above 10
Na 30, K 20
> 20 kg 1500 + 20 ml /kg for
each kg above 20
60 + 1 / kg
for each kg
above 10
Na 30, K 20
Baseline estimates are affected by fever (increasing by 12% for each degree
> 37.8° C), hypothermia, and activity (eg, increased for hyperthyroidism or
status epilepticus, decreased for coma).
49. Concept of Maintenance Fluids
Example : 22 kg child
For the first 10 kg: 10 X 100 = 1000 ml
For the second 10 kg 10 X 50 = 500 ml
For every kg > 20 2 X 20 = 40 ml
TOTAL = 1540 ml / 24 hrs
i.e. = 64 ml / hr maintenance fluid
50. Concept of Maintenance Electrolytes
Insensible water losses contain no electrolytes
Na+
and K+
losses are those present in urine,
feces and sweat.
•3 mEq of Na in 100 ml of fluid
•2 mEq of K in 100 ml of fluid
51. Maintenance Fluid and Glucose
Maintenance fluid must contain glucose –
To prevent hypoglycemia
To prevent catabolism by providing calories
• If 20 % of caloric requirement is met, tissue catabolism
can be avoided
• 5 g of glucose (provide 20 Cal. Is added to 100 ml of
maintenance fluid)
52. Concept of Maintenance Fluids
Composition
Differs from solutions used to replace deficits
and ongoing losses.
Patients require
Na 3 mEq/100 kcal/24 h (3 mEq/100 mL/24 h)
and
K 2 mEq/100 kcal/24 h (2 mEq/100 mL/24 h).
This need is met by using 0.2% to 0.3%
saline with 20 mEq / L of K in a 5% dextrose
solution.
Other electrolytes (eg, Mg, Ca) are not
routinely added.
53. Maintenance Fluid and Glucose
Maintenance fluid Choice –
< 1 yr : 0.2% NaCl, 5% D/W plus 2 mEq KCl / 100 ml
> 1 yr : 0.33% NaCl, 5% D/W plus 2 mEq KCl / 100 ml
> 3 yr : 0.45% NaCl, 5% D/W plus 2 mEq KCl / 100 ml
Rate : at 64 ml / hr
54. Calculating Deficit, Maintenance and
Total Electrolytes
Moderately Rapid (2-7 days)
Therefore ECF / ICF Ration is 60 / 40 %
Deficit Water is 1000 ml
ECF Component is 60% (600 ml) and
ICF component is 40% (400 ml)
Principle electrolyte in ECF is Na which is 140 mEq/L
For 600 ml = 84 mEq.
Principle electrolyte in ICF is K which is 150 mEq/L
For 400 ml = 60 mEq.
55. Calculating Deficit, Maintenance and
Total Electrolytes
Maintenance / d 1000 30 20
ECF Water Deficit 600 84 -
ICF Water Deficit 400 - 60
Total 2000 114 80
H2O Na K
ml mEq mEq
56. Na+
K
+
Cl
-
Bicarb++ Ca
++
G/100 ml mOsml/L
D5-W 5 252
D10-W 10 505
Normal Saline (0.9%) 154 154 308
0.45% Na Chloride 77 77 154
0.45% Na Cl + 5% Dex 77 77 5 400
0.33% Na Cl + 5% Dex 56 56 5 350
D5-Normal Saline 154 154 560
D5-0 45% Na Chloride 77 77 406
D5-0.2% Na Chloride 34 34 321
D5-Ringer's Lactate 130 4 109 28 2.7 525
Ringer's Lactate 130 4 109 28 2.7 273
3% Na Chloride 513 513 1027
Ready Mixed Solutions (Electrolyte Content is meq per Liter)
57. Fluid Therapy
Phase 1 : (Shock Therapy)
Restoration of volume - 1 to 2 hrs
20 ml / Kg N.Saline or R.L. rapid IV
58. Fluid Therapy
Phase 2 :
Replacement of ½ the calculated fluid loss
(Deficit + Maintenance) in first 8 hrs.
59. Fluid Therapy
Phase 3 :
Replacement of ½ the calculated fluid loss
(Deficit + Maintenance) in next 16 hrs
Replacement of K+
(after voiding with a max. of 40mEq/L)
Half the potassium deficit is replaced in 1st
day
60. Calculating pre-illness weight:
Eg. Infant with moderate isonatremic dehydration –
weighing now 5.3 kg
Pre illness weight is say ‘X’
X / 5.3 = 100 / 90
X = 530 / 90 = 5.9 kg.
Deficit is (10 % Dehydration) = 600 ml.
Maintenance fluid = 600 ml (Holideay& Segar)
61. Eg. 10 Kg child
Phase 1 (1st
hr)
20 ml / Kg of NS
(200 ml of NS, 31 mEq. of Na)
Phase 2 (2-8 hrs)
Replace half the fluid loss in next 7 hrs
900 ml in 7 hrs That is 129 ml / hr
We like to add Na in a conc of 46 mEq. L
(which is roughly in 1/3rd
NS
We can use 1/3 NS in 5% D/W at 129 ml / hr.
Phase 3 (hrs. 9-24) [ patient voids ]
Replace remaining half of fluid loss and add K now
900 ml over 16 hrs of D5, 1/3 NS at 56ml/hr
(Pt has 25mEq/L of K loss. We are replacing 900 ml (roughly 1 L) of
fluid we may chose 25mEq./L of KCl
62. Treating Hypotonic Dehydration
(S. Na+ < 130 mEq/L)
First calculate the total fluids and electrolytes needed for
isonatremic dehydration plus maintenance fluids.
Then use the following formula to raise the serum sodium:
Wt (kg) x 0.6 x desired mEq increase in serum Na+
After correction of shock, prefer ½ N DNS rather than 1/3 N DNS
If child is convulsing : 3ml/Kg of 3% Nacl over 10-15 min
Raising the S.Na by 5 mEq/L is sufficient to control symptoms.
63. Treating Hypertonic Dehydration
(S. Na+ > 150 mEq/L)
This type of dehydration is usually the most serious and
correction should be done with caution. Rapid correction
May result in CNS problems.
Generally, elevated serum sodium should be lowered no faster
than 15 mEq/L in 24 hours.
One simple way is to calculate the total maintenance and deficit
fluid and electrolytes that would be used in isotonic dehydration
but keep sodium at maintenance levels.
Give deficit fluid over 48 hrs rater than 24 hrs
Hydrating fluid must contain Na +
64. Treating Potassium Deficits
Regardless of the deficit, the usual maximum
concentration of K+ is 4 mEq per 100 ml of IV
fluid (for peripheral infusion).
For most instances 2-3mEq per 100 ml will
suffice.
In cases of hypokalemia higher levels can be
used, but the heart should be monitored.
Before giving potassium be aware of the
possible existence of renal failure.
65. Replacement of ongoing losses
Average composition of diarrhoeal stools
Na+ 55 meq/l
K+ 25 meq/l
HCO3 15 meq/l
Fluid for replacement (ml/ml every 1-6
hourly)
D 5 with 1/4 NS + 15 meq /l bicarbonate +
25 meq/l of KCL.
66. Priniciples of Rehydration - Summary
Select an appropriate fluid (based on total
water and electrolyte needs)
Administer half the calculated fluid during
the first 8 hours
Administer the remainder over the next 16
hours
Don’t add KCL until the child voids urine.