Malnutrition And Fluids

MALNUTRITION http://crisbertcualteros.page.tl

COMPUTATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Interpretation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],HFA (stunting) C >95 N 90-94 Mild 85-90 Mod <85 Severe

EXAMPLE ,[object Object],[object Object],[object Object],[object Object]

WATERLOW CLASSIFICATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object]

COMPUTATION FOR TOTAL CALORIC REQUIREMENT (TCR) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],EXAMPLE: 1 yr old baby weighing 10kg

A. Solve for TOTAL CALORIC REQUIREMENT (TCR) ,[object Object],[object Object],[object Object]

B. Determine TCR CHON in grams, then convert to calories ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

C. Subtract TCR CHON from TCR total then get fraction of CHO & fats (usual ratio 60:40) ,[object Object],[object Object],[object Object]

D. Convert back to grams ,[object Object],[object Object],[object Object]

E. Write final prescription ,[object Object],[object Object],[object Object]

Catch-up Calories ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

COMPUTATION FOR TOTAL CALORIC REQUIREMENT (TCR) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],EXAMPLE: 13yo, girl, BW=29kg

Generalities ,[object Object],[object Object],[object Object],[object Object]

Maintenance fluid ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Components of Maintenance water 05% Stool 35% Insensible (skin and lungs) 60% Urine

[object Object],[object Object],[object Object],Maintenance fluid

Body Weight Method for calculating Maintenance Fluid Volume ,[object Object],The maximum total fluid per day is normally 2,400 ml Eg. 25kg child (1000+500+100) = 1600ml/day 100ml/kg/day, plus 50ml/kg/day, plus 20ml/kg/day 1st 10kg BW 2nd 10kg BW BW > 20kg Total Fluid Requirement BW (kg)

Maintenance fluid to gtts/min ,[object Object],[object Object],[object Object]

Maintenance Fluids ,[object Object],Eg. 25kg child: 25kg x 60ml/kg/d = 1500ml/day 75 100 75 60 50 0-3 3-10 10-20 20-30 >30 Volume of Fluid in 24h (ml/kg/d) Weight (kg)

Maintenance Fluids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Eg. 8y.o. girl, 25kg, 125cm BSA = 0.931 TFR = 1488ml/day

Comparison ,[object Object],[object Object],[object Object],[object Object]

Maintenance Electrolytes 1-2 meq /kg / 24 hour Potassium 2-3 meq /kg / 24 hour Sodium

Composition of Intravenous solutions 28 3 4 109 130 Ringer lactate 38.5 38.5 ¼ Normal Saline (0.225% NaCl) 77 77 ½ Normail Saline (0.45% NaCl) 154 154 Normal saline (0.9%NaCl) Lactate- Ca++ K+ Cl+ Na+ Fluid

Adjustments in maintenance Water Hypothyroidism ,[object Object],[object Object],Miscellaneous Oliguria / anuria Polyuria Renal ,[object Object],[object Object],[object Object],Gastrointestinal Tract Humidified ventilator Tachypnea Lungs mist tent ,[object Object],[object Object],[object Object],[object Object],Skin Causes of Decreased water needs Causes of Increased Water needs Source

Replacement Fluid ,[object Object],[object Object],[object Object]

Replacement Fluid ,[object Object],[object Object]

Adjusting Fluid therapy in Diarrhea ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Adjusting Fluid Therapy for Emesis or Nasogastric losses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fluid Management of Specific Fluid & Electrolytes Disturbance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management of Specific Fluid & Electrolytes Disturbance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Assessment of State of Hydration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Assessment of State of Hydration

Classify Dehydration ,[object Object],[object Object],[object Object],[object Object]

Additional Clinical Parameters of Dehydration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Additional Clinical Parameters of Dehydration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Additional Clinical Parameters of Dehydration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Classify Dehydration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Classify Dehydration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Deficit Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment Plan A: Treat Diarrhea at Home ,[object Object],[object Object]

Treatment Plan B: Treat Some Dehydration with ORS ,[object Object],[object Object],900-1400 700-900 400-700 200-400 In ml 2 yrs-5 yrs 10-<12 kg 6-<10 kg < 5kg Weight 2 yrs-5 yrs 12 mos – 2 yrs 4 mos – 12 mos Up to 4 mos Age

Treatment Plan B: Treat Some Dehydration with ORS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment Plan B: Treat Some Dehydration with ORS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment Plan C: Treat severe Dehydration Quickly ,[object Object],* Repeat once if radial is still very weak or not detectable 2 ½ hours 30 minutes* Children (12 mos-5 yrs) 5 hours 1 hour* Infants (under 12 mos) Then give 70 ml / kg in: First give 30 ml / kg in: Age

Treatment Plan C: Treat severe Dehydration Quickly ,[object Object],[object Object],[object Object]

FOOD GUIDES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Malnutrition And Fluids

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Malnutrition And Fluids