Use replacement fluids with appropriate electrolyte concentrations to replacethe fluids being lost
Use replacement fluids with appropriate electrolyte concentrations to replacethe fluids being lost: Excerpt from Avoiding Common Pediatric Errors
Author:
Michael S. Potter and Anthony Slonim, MD
What to Do - Make a Decision
Pediatric patients may experience fluid loss and dehydration in a number
of ways. The gastrointestinal tract represents one of the most significant
sources of water and electrolyte losses that can result in dehydration and
electrolyte imbalance. Accompanying these fluid and electrolyte losses are
resulting acid–base disturbances that occur through bicarbonate loss in the
stool or acid losses through vomiting.
There are several sources of electrolyte imbalance that occur through
the loss of body fluids. Table 146.1 provides the electrolyte concentrations
for common gastrointestinal secretions. Being mindful of these electrolyte
concentrations can assist providers in appropriately selecting replacement
fluids and replenishing deficits.
To correct electrolyte imbalances caused by sodium, potassium, and
chloride losses in stool and urine, maintenance fluids are frequently selected
to augment the body's homeostatic mechanisms and compensate for the
electrolyteimbalance.Thegeneralmaintenancerequirementsforsodiumare
2to3mEq/kg/24hourandtherequirementforpotassiumis1to2mEq/kg/
24 hour. As long as at least half of these elements are bound as a chloride salt,
the chloride requirements will automatically be satisfied due when disassociation of the ions occurs. Most commercially available intravenous solutions
are adequate for replacement and are much less expensive and error-prone
than customized solutions. Table 146.2 provides the electrolyte profiles for
commonly available intravenous solutions.
Suggested Readings
Greenbaum LA. Pathophysiology of body fluids and fluid therapy. In: Behrman RE, Kliegman
RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 17th ed. Philadelphia: Saunders; 2004.
Schiller LR, Sellin JH. Diarrhea. In: Feldman M, Friedman LS, Brandt L. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 8th ed.
Philadelphia: Saunders; 2006.
Wait RB, Seymour NE. Fluids, electrolytes, and acid-base balance, Chapter 45. In: Mulholland
MW, Maier RV, Lillemoe KD, et al. Greenfield's Surgery: Scientific Principles and Practice.
4th ed. Philadelphia: Lippincott Williams & Williams; 2006:224;191–242.
Pictures
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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