1. The document discusses fluid therapy for various conditions including severe dehydration, congestive cardiac failure, intestinal obstruction, and acute renal failure. 2. For severe dehydration, IV fluid therapy with Hartmann's solution or normal saline is given to replace fluid deficit over 1-5 hours depending on age, along with oral rehydration salts once able to drink. 3. Fluid therapy must be closely monitored and can cause complications like congestive cardiac failure or electrolyte imbalances if not properly managed. Precise replacement of fluid and electrolyte deficits is important to treat each condition discussed.

1. FLUID
THERAPY
1. Severe Dehydration
2. C.C.F.
3. Intestinal Obstruction
4. A.R.F.
Presented By :
Aman Gupta
Saturday, 03
December 2016
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2. BASIC PHYSIOLOGY
 Total Body Water
Extracellular Fluid(1/3rd) Intracellular Fluid(2/3rd)
 The ECF contains a high concentration of sodium, bicarbonate and
chloride, with a low concentration of potassium, calcium and
magnesium.
 In contrast, the ICF has a high concentration of potassium and
magnesium and a low concentration of sodium and bicarbonate.
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December 2016
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3. Dehydration is defined as the excessive loss of body fluid with an
accompanying disruption of metabolic processes or a state of fluid deficit in
the body.
• Weight loss < 5%
• Thirst & low urine output present
Mild
(No signs of
dehydration)
• Weight loss 5-10%
• Thirsty & drinks eagerly
Moderate
(Some
dehydration)
• Weight loss > 10%
• Not able to drink.
Severe
(Severe
dehydration)

4. W.H.O. GUIDELINE FOR THE CLASSIFICATION
OF DEHYDRATION
Parameters No dehydration
Some
dehydration
Severe
dehydration
Appearance
Well, alert
Restless, irritable Lethargic, or
unconscious; floppy
Eyes Normal Sunken Very sunken
Thirst Drinks normally, not thirsty Thirsty, drinks eagerly Not able to drink
Skin pinch Goes back quickly Goes back slowly Goes back very
slowly
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December 2016
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5. DAILY FLUID REQUIREMENTS
Holliday-Segar Method Holliday-Segar Estimate
First 10 kg 100 mL/kg/day 4 mL/kg/hr
Second 10 kg 50 mL/kg/day 2 mL/kg/hr
Every kg thereafter 20 mL/kg/day 1 mL/kg/hr
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December 2016
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6. Fluid Therapy -SEVERE DEHYDRATION
 Nil Per Oral
 I.V. Fluid Therapy Is Given
 Fluid deficit (ml) = weight (kg) x % dehydrated x 10 (ideally the
pre-dehydration weight should be used).
 For Eg. – 14 kg child who is 10 % dehydrated has a fluid loss of :
14 x 10 x 10 = 1400 ml.
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December 2016
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7. Fluid Therapy - Severe Dehydration
 If the child’s level of consciousness is reduced, airway, breathing & circulation
should be assessed.
 100ml/Kg IV Hartmann solution (or Normal Saline) should be given as follows :
 Reassess the child every hour , Repeat again if the radial pulse is still very weak or
not detectable.
Age 30ml/Kg 70ml/kg
Infants (<12 months) 1 hour 5 hours
Older children( > 12
months)
½ hour 21/2 hours

8. SOLUTION Na mmol/L K mmol/L Cl mmol/L Lactate
mmol/L
A: Preferred
Ringer’s Lactate 130 4 109 28
B: Acceptable
Normal Saline[0.9%] 154 0 154
Half normal
saline[0.45%]
77 0 77 0
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December 2016
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9. RESOMAL
 After the fluid therapy as soon as the child is able to take orally RESOMAL
– an oral rehydration salt, should be started.
 It contains mixtures of Potassium, Magnesium, Zinc, Copper & Sodium.
 Supplied as powder in sachets , dissolved in 1L of boiled , cooled Water.
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December 2016
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10. Saturday, 03
December 2016
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11. MONITORING FLUID THERAPY
Proper regulation of the quantity of fluids
Examine the patient frequently
Weigh the child daily
Monitor Fluid Input and Output-including urine and other
outputs closely
Laboratory parameters-Electrolytes, Urea and creatinine,
Hb/PCV, Urinalysis Saturday, 03
December 2016
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12. COMPLICATIONS OF FLUID THERAPY
 Due to Volume overload – C.C.F. , PULMONARY EDEMA
 Due to the substances in the fluid - ANAPHYLAXIS to contents of the
fluid,
Electrolyte derangement [hypo and hypernatraemia and kalaemias]
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December 2016
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13. CONGESTIVE CARDIAC FAILURE
 Fluid therapy may be needed in the following complications :
 HYPOKALEMIA : Deficit is corrected over 24 hours.
Replace the deficit by giving Potassium Chloride 2-4 mEq/kg/day orally in 3-4
divided doses.
I.V. correction for severe hypokalemia or associated arrhythmias : < 2.5 mEq/l.
For rapid correction : 0.5 – 1.0 mEq/kg over 1 hr.
 HYPERKALEMIA : I.V. 10% Ca Gluconate/ CaCl at 0.5 ml/kg over 5-10 mts under cardiac
monitoring. Discontinue if bradycardia develops.
Regular Insulin and I.V. Glucose (0.3 U Insulin/g glucose over 2 hr) will enhance the cellular
uptake of Potassium.
Sodium polystyrene sulfonate (Kayxelate) Oral/per rectal : 1g/kg(max.15g/dose) oral or as rectal
enema in 20-30% Alcohol.
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14. HYPONATREMIA : Treat Hypotension first, regardless of serum
sodium(N.S.,R.L., 5% Albumin).
Correct the deficit over 48-72 hours for chr. Hyponatremia.
Recommended rate of increase is 0.5 mEq/l/hr. Correction in first 48 hours
shouldn’t exceed 15-20 mEq/l.
For Acute & Symptomatic cases : Immediate increase in serum sodium level by 5-6
mEq/l with 3% hypertonic saline at a dose of 3-5 ml/kg over 2 hr is recommended.
Stop Further Therapy when the patient becomes symptom free or there is acute rise in
Sodium of 10mEq/l is noted.
Diuretics : I.V. Furosemide 5-10 mg/hr is given to initiate diuresis.
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December 2016
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15. INTESTINAL
OBSTRUCTION The basic biochemical abnormality that occurs in Intestinal
Obstruction is SODIUM & WATER loss and therefore appropriate
replacement therapy is done in following manner :
1.Nill Per Oral
2. Nasogastric decompression of stomach & bowel proximal to the
obstruction.
3. For Correction of fluid & electrolyte disturbance : R.L. or Normal
Saline.
Volume requirement varies and it is determined by hematological and
biochemical criteria.
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December 2016
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16. ACUTE RENAL FAILURE
 PRERENAL ARF : Respond to fluid therapy with improved renal perfusion and increased
urine output.
Dehydration : 20ml/kg of N.S. or R.L. is given over 45-60 minutes.
Patients with renal hypoperfusion, in whom the only reason for oliguria is intravascular vol.
depletion, responds to fluid with increase in urine output(2-4ml/kg over 2-3 hr).
Despite correction of dehydration, no diuresis occurs : FRUSEMIDE 2-3 mg/kg IV.
If these measures fail, diagnosis of AKI is made.
 INTRINSIC RENAL FAILURE : Daily fluid requirement is restricted to insensible water
losses(300-400ml/m²),urinary output and extrarenal fluid losses.
Patients with AKI require increased metabolic needs and are usually catabolic.
Hence, diet containing 1-1.2 g/kg of protein with a minimum of 60-80 cal/kg is recommended.
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December 2016
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