Hgugehd hv if.

1. Pediatrics
Islamic Emirate of Afghanistan
Malalay Institute of Higher Education
Medical Faculty
Dr Fazal Mohammad Panezai
MD,Pediatricion

2. water
• Water is the major component of body mass.
• Fetus body contains about 90% water.
• Infants body contains about 60% water.
• Preterm baby contain more water than term baby.
• Total body water is distributed in two major compartments
• The kidneys are the major regulators of water output with nearly 2/3 of
daily water losses being urine.
1. Intra Cellular Fluids(2/3)
2. Extra Cellular Fluids(1/3)

3. Hyponatremia
• When serum sodium level less than 130 mEq/dl
Hyponatremia causes
Hypovolemic hyponatremia Emessis,diarhhea,burns,peritonitis,sepsis
Euvolemic hyponatremia SIADH,hypothyroidism,waterintoxication
,diluted formula
Hypervolemic hyponatremia CHF,cirrhosis,Nephrotic syndrom

4. Clinical findings:
• Brainstem herniation
• Apnea
• Seizures
• Nausea
• vomiting
Diagnosis:
• History
• S electrolytes
• Urine exam
Management:
• 3% (if Na <120)/hypovolemic natramia
• Fluid restriction(hyper/euvolemic)+diuretics+vasopressin antagonist

5. Hypernatremia
• When serum sodium levels are more than 145 mEq/l
Causes:
• Reduced water
intake
• Diarrhea,sweating,
fever
Clinical findings:
• Dehydration
• Irritable
• Dry mucous membrane
diagnosis:
• History
• S Electrolytes
management:
• N/3+D5%
• N/4+D5%
• Fluid rate 1.5 times maintenace

6. Hypokalemia
When serum potassium level are less than 3.5 mEq/l
Causes:
• Less intake
• Diarrhea
• Vomiting
• Insulin
• Loop diuretics
Clinical findings:
• Weakness
• Paresthesias
• Polyuria
• Paralysis
• Arrhythmias
Diagnosis:
• S Electrolytes
• ECG
Management:
• 2-4 mEq/kg/day (oral)
• 0.5-1.0 mEq/kg/ over 1 hour

7. Hyperkalemia
When serum pottasium level are greater than 5.5 mEq/l
Causes:
• Acidosis
• Renal failure
• injury
Clinical findings:
• Weakness
• Confusion
• paralysis
Diagnosis:
• S Electrolytes
• ECG
Management:
• Ca gluconate 2ml/kg
• Sodium bicarbonate
• Insulin
• dialysis

8. Blood pH
Acidemia
(↓pH)
Alkalemia
(↑pH)
↑pCO2 ↓HCO3 ↑HCO3
↓pCO2
Respiratory
acidosis
metabolic
acidosis
Respiratory
alkalosis
Metabolic
alkalosis
↑HCO3 ↓pCO2 ↑pCO2
↓HCO3
Respiratory acidosis
with compensatory
metabolic alkalosis
Metabolic acidosis
with compensatory
Respiratory alkalosis
Respiratory Alkalosis
with compensatory
metabolic acidosis
Metabolic alkalosis
with compensatory
Respiratory acidosis

9. Anion gap
• The difference between the serum of the measured cations (Na,K) and
anions(Cl,HCO3).
• Normal Anion gap is 8-12.

10. 1)Increased anion gap
• Hypokalemia
• Hypocalcemia
• Hypomagnesemia
• Renal failure
2)Normal anion gap
• Renal tubular acedosis
• Hypernatremic
dehydration
3)Decreased anion gap
• Hyperkalemia
• Hypercalcemia
• hypermagnesemia
Causes of metabolic acidosis:
Management of metabolic acidosis:
• Cause
• Sodium bicarbonate
• complication
Metabolic acidosis

11. Metabolic alkalosis
Causes:
• Vomiting
• Diuretics
Clinical findings:
• Underlying disease
Management:
• Underlying cause
• Volume expansion

12. Respiratory acidosis
Respiratory acidosis occurs when:
• Alveolar ventilation falls
• Carbon di oxide production is increased
• Low blood Ph
Causes:
• Depressed central respiratory drive
• Acute paralysis of the respiratory muscle
• Extensive burn injury
• fever

13. Clinical features:
• Air hunger with retractions and use of accessory muscles
• Anxiety
• Confusion
• Coma
• Tachycardia
• hypotension
Treatment:
• Cause
• Assisted ventilation

14. Respiratory alkalosis
Respiratory alkalosis occurs when:
• Decrease in Pco2
• Hyperventilation
Causes:
• Hypoxia
• Hypoxemia
• Pulmonary edema
• Pneumonia
Clinical features:
• Depends on the underlying
cause
Managemant:
• Treat the underlying cause

15. Thanks