Use replacement fluids with appropriate electrolyte concentrations to replacethe fluids being lost

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.

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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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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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