1、Infantile Liquid Therapy ObjectiveSummaryCharacteristic of Infantile Body Fluid BalanceFluid, Electrolyte, & Acid-base DisordersCommon Solution of Liquid TherapyInfantile Diarrhea Liquid TherapyObjectiveCharacteristic of Infantile Body Fluid Balance RealizedPathophysiology of Infantile Fluid, Electr
2、olyte & Acid-base Imbalance Be familiar withClinical menifestations of Infantile Fluid , Electrolyte & Acid-base Disorders MasteredCommon Solution Component of Liquid Therapy Be familiar withLiquid Therapy of Infantile Diarrhea MasteredSummary Body fluid is important component of human body and the
3、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 systematic f
4、unctions 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 BalanceA. Total body water & its distributionBody water compartments related to age (total
5、 body mass%) AgeAge TBWTBWECFECF ICFICFPlasmaISFISFNewborn infant78637351 year7052540214 years6652040Adult5566510154045TBW: total body water ECF: extracellular fluid ICF: intracellular fluid ISF: interestitial fluidCharacteristic of Infantile Body Fluid BalanceB. Electrolyte composition of body flui
6、dECF: Na+ 、 Cl-，HCO3 -ICF:K + 、Mg 2+ 、HPO4 2-、ProteinC. Water metabolism a. Large water 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 co
7、ncentration and dilution function of infantile. Fluid, Electrolyte & Acid-base DisordersA. Degree of dehydration DehydrationMildModerateSevereDecrease in body weight5(50ml / kg)510(50100ml / kg)10(100120ml / kg)PsycheDepressed, hyperirritableDepressed, hyperirritableLethargic,comaOrbit, FontanelSunk
8、en Sunken Severely sunkenSkin turgorNormal Decrease Markedly decreaseMucous membranesDry Dry Severely dryTearsDecrease DecreaseAbsentUrineMild oliguria oliguriaAnuriaBlood pressureNormalNormalLow Type of dehydrationPathogenySerum sodiumPathophysiology & clinical characteristicIsosmoticAcute gastroin
9、testinal fluid lose130150mmol / LECF: decrease, Osmotic pressure (intracellular = extracellular)Dehydrant volume accord with dehydrant physical signHypotonicChronic gastrointestinal fluid lose150mmol / LICF: severely decrease, Milder dehydrant sign than the other two kindsFluid, Electrolyte & Acid-b
10、ase DisordersB. Property of dehydrationC. Metabolic acidosisPathogeny 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 acid substance intake （long time to take calcium chloride, amm
11、onium chloride, amino acid etc.）DegreeMild HCO3- 1813 mmol / LModerate HCO3- 139 mmol / LSevere HCO3- 9 mmol / LFluid, Electrolyte & Acid-base DisordersD. Hypokalemia Pathogeny 1. Lack of intake 2. Loss of kalium from kidneys or gastrointestinal tract 3. Burn, dialysis etc. 4. Abnormal kalium distri
12、bution inside or outside cells （alkalosis, insulin therapy、periodic anesthesia）Fluid, Electrolyte & Acid-base DisordersClinical menifetation 1. Nervous system depressed 2. Muscleinertia of limbs，muscular tension down，severely retardant paralysis，respiratory muscle paralysis 3. Heart heart rate incre
13、asing, 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 increasingFluid, Electrolyte & Acid-base DisordersCommon Solution of Liquid TherapyA.
14、 Nonelectrolyte solution5、10 glucoseB. Electrolyte solution 0.9 NaCl、1.4、5 NaHCO3、10 KClC. Mixed solutions refer to the following tableCommon mixed solution0.9% NaCl1.4% NaHCO3510%G.S2:1213:2:12134:3:24236:2:1216Common Solution of Liquid TherapyInfantile Diarrhea Liquid TherapyA. VolumeDegree Total
15、volumeCumulated losing volumeKeep transfusing period（physiological need, losing continuing）Mild90120ml/kg4560ml/kg4560ml/kgModerate120150ml/kg 6075ml/kg6075ml/kgSevere150180ml/kg7590ml/kg7590ml/kgB. QualityDehydrant categoryCumulated losing volumeKeep transfusing period（physiological need, losing co
16、ntinuing）Hypotonic dehydration4:3:21/31/4 Sodic solutionIsosmotic dehydration3:2:11/31/4Sodic solutionHyperosmoticdehydration1/3 Sodic solution1/31/4Sodic solutionInfantile Diarrhea Liquid TherapyC. SpeedTotal volumeCumulated losing volumeKeep transfusing period（physiological need, losing continuing
17、）24 h 812 h1216 h810ml / kg /h5ml / kg /hInfantile Diarrhea Liquid TherapyD. Shock volume expansionVolume Solution Speed20ml/kg2:1 or 1.4NaHCO33060minInfantile Diarrhea Liquid TherapyTotal volume 300mlE. Treatment of metabolic acidosis Mild or moderate metabolic acidosis metabolic acidosis: No speci
18、al treatment Severe metabolic acidosis：1.4%NaHCO3 3ml/kg， HCO3- level can increase about 1 mmol.F. Treatment of hypokalemiaSupply kalium after urination (urination 6 hours of preadmission, bladder percussingdull note) Kalium supplement concentration: 0.20.3( 0.3) Venoclysis period of total Kalium su
19、pplement per day 8 hours.Infantile Diarrhea Liquid TherapyCase analysis Infant, male, 9 months, diarrhea 2 days, admission date1998-08-10. 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 litt
20、le, yellow urine. Physical examination：T38C, 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
