儿科学精品课件：儿童液体疗法.ppt

1、Infantile Liquid Therapy,Objective,Summary,Characteristic of Infantile Body Fluid Balance,Fluid, Electrolyte, & Acid-base Disorders,Common Solution of Liquid Therapy,Infantile Diarrhea Liquid Therapy,Objective,Characteristic of Infantile Body Fluid Balance Realized Pathophysiology of Infantile Fluid

2、, Electrolyte & Acid-base Imbalance Be familiar with Clinical menifestations of Infantile Fluid , Electrolyte & Acid-base Disorders Mastered Common Solution Component of Liquid Therapy Be familiar with Liquid Therapy of Infantile Diarrhea Mastered,Summary,Body fluid is important component of human b

3、ody and the physiological equilibrium of body fluid is an important factor for human living. The dynamic equilibrium of fluid, electrolyte, acid-base, osmotic pressure depends on normal regulating function of nerve, incretion, lung and kidney. Because of the infantile physiologic peculiarity, These

4、systematic functions are easily affected by diseases and/or environment and are maladjusted. Therefore, the disorder of water, electrolyte and acid-base is common in pediatric clinic.,Characteristic of Infantile Body Fluid Balance,A. Total body water & its distribution Body water compartments relate

5、d to age (total body mass%),TBW: total body water ECF: extracellular fluid ICF: intracellular fluid ISF: interestitial fluid,Characteristic of Infantile Body Fluid Balance,B. Electrolyte composition of body fluid ECF: Na+ 、 Cl-，HCO3 - ICF: K + 、Mg 2+ 、HPO4 2-、Protein C. Water metabolism a. Large wat

6、er requirements, swift water exchange, unobvious water loss (double adults amount ). Infants water exchange amount is 1 / 2 of ECF , the adults is just 1 / 7. b. Immature body liquid regulating function , immature concentration and dilution function of infantile.,Fluid, Electrolyte & Acid-base Disor

7、ders,A. Degree of dehydration,Fluid, Electrolyte & Acid-base Disorders,B. Property of dehydration,C. Metabolic acidosis Pathogeny 1. The lose of large amount of basic substances（gastrointestinal tract, kidneys） 2. Too much Acid metabolite （hungriness, diabetes, renal failure, hypoxia） 3. Too much ac

8、id substance intake （long time to take calcium chloride, ammonium chloride, amino acid etc.） Degree Mild HCO3- 1813 mmol / L Moderate HCO3- 139 mmol / L Severe HCO3- 9 mmol / L,Fluid, Electrolyte & Acid-base Disorders,D. Hypokalemia Pathogeny 1. Lack of intake 2. Loss of kalium from kidneys or gastr

9、ointestinal tract 3. Burn, dialysis etc. 4. Abnormal kalium distribution inside or outside cells （alkalosis, insulin therapy、periodic anesthesia）,Fluid, Electrolyte & Acid-base Disorders,Clinical menifetation 1. Nervous system depressed 2. Muscleinertia of limbs，muscular tension down，severely retard

10、ant paralysis，respiratory muscle paralysis 3. Heart heart rate increasing, arrhythmia, AdamsStokes syndrome, heart rate decreasing，atrioventricular block, heart sound lowering, cardiogram: U wave appearing，UT， flattened T wave 4. Kidney concentrating function lowering, urine volume increasing,Fluid,

11、 Electrolyte & Acid-base Disorders,Common Solution of Liquid Therapy,A. Nonelectrolyte solution 5、10 glucose B. Electrolyte solution 0.9 NaCl、1.4、5 NaHCO3、10 KCl C. Mixed solutions refer to the following table,Common Solution of Liquid Therapy,Infantile Diarrhea Liquid Therapy,A. Volume,B. Quality,I

12、nfantile Diarrhea Liquid Therapy,C. Speed,Infantile Diarrhea Liquid Therapy,D. Shock volume expansion,Infantile Diarrhea Liquid Therapy,Total volume 300ml,E. Treatment of metabolic acidosis Mild or moderate metabolic acidosis metabolic acidosis: No special treatment Severe metabolic acidosis：1.4%NaH

13、CO3 3ml/kg， HCO3- level can increase about 1 mmol. F. Treatment of hypokalemia Supply kalium after urination (urination 6 hours of preadmission, bladder percussingdull note) Kalium supplement concentration: 0.20.3(0.3) Venoclysis period of total Kalium supplement per day 8 hours.,Infantile Diarrhea

14、Liquid Therapy,Case analysis Infant, male, 9 months, diarrhea 2 days, admission date 1998-08-10. After eating un-boiled bean curd 2 days ago, yellow waterish stools, bulky, no blood, no tenesmus, defecation 1015/day; one stool 6 hours of preadmission, a little, yellow urine. Physical examination：T38

15、C, R32/min, P120/min, dyspyoria, Fontanel 1.51.5cm2, sunken, orbit sunken, decreased Skin turgor, dry lip, dry periglottis, pharynx (), heart rate 120/min, no arrhythmia, mild dull heart sounds, lungs(), mild abdomen swelling, soft abdomen, liver 1.5cm below ribs, bowel sounds 1012/min, no high notes，two lower limbs patellar reflex (negative),Infantile Diarrhea Liquid Therapy,