newPedsFluidBloodTherapy

newPedsFluidBloodTherapy - Pediatric Fluid Management and...

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Pediatric Fluid Management and Blood Product Therapy Joy Loy, M.D. MetroHealth Medical Center April, 2004
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ASA Fasting Guidelines Clear liquids 2 hours Breast Milk 4 hours Infant Formula Neonates 4 hours Infants 6 hours Nonhuman Milk 6 hours Solids 8 hours
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water, juice without pulp, carbonated beverages, clear tea, black coffee should not contain alcohol type of liquid ingested important than volume infants < 5 mos 10 ml/kg children and adults 15 ml/kg Clear Liquids
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is NOT a clear liquid does contain milk solids Breast Milk cleared from the stomach more quickly than nonhuman milk
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ASA Fasting Guidelines pre-op fast does not guarantee an empty stomach timing of last fluid ingestion has little relation to volume of gastric contents at induction
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ASA Fasting Guidelines gastric fluid volume and pH are independent of duration fluid fast beyond 2 hours main determinant: endogenous gastric secretion
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ASA Fasting Guidelines reduces the risk of pulmonary aspiration offering clear liquids up to 2 hours before induction > reduces hunger and irritability > preserves hydration > risk of hypoglycemia
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BODY FLUID COMPOSITION Total Body Water (TBW) = Intracellular Fluid ( ICF ) + Extracellular Fluid ( ECF ) Compartments a) interstitial fluid ( ISF ) : no protein b) plasma volume ( PV ) : with protein * ISF and PV basically same electrolyte content
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Body Fluid Composition INFANT CHILD A DULT Total Body Water 75 % 70 % 55-60 % ECF 40 % 30 % 20 % ICF 35 % 40 % 40 % Fat 16 % 23 % 30 %
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PHYSIOLOGIC CONSIDERATIONS Developmental Factors CVS : incomplete myocardial development immature sympathetic innervation IMPLICATION: neonates and young infants are more
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PHYSIOLOGIC CONSIDERATIONS Developmental Factors RENAL : immature renal function at birth GFR 25% of adult level at term adult level at age of 2 years concentrating capacity of newborn kidney term infant : max. 600-700 mOsm/kg adult : max. 1200 mOsm/kg
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PHYSIOLOGIC CONSIDERATIONS Developmental Factors free H 2 O clearance : excrete markedly dilute urine up to 50 mOsm / kg vs. 70-100 Osm/kg in adults Na reabsorption HCO 3 /H exchange urinary losses of K+ and Cl -
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PHYSIOLOGIC CONSIDERATIONS Developmental Factors IMPLICATION: Newborn kidney has limited capacity to compensate for volume excess or volume depletion
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PHYSIOLOGIC CONSIDERATIONS Developmental Factors HEPATIC : • limited hepatic glycogen stores > risk of hypoglycemia > provide 5%-10% dextrose in fluid maintenance > supplemental insulin for sustained hyperglycemia from dextrose
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PHYSIOLOGIC CONSIDERATIONS Metabolic and Fluid Requirements metabolic rate O 2 consumption neonates: 6-9 ml/kg/min adults: 3 ml/kg/min growth 120 kcal/kg/day
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PHYSIOLOGIC CONSIDERATIONS Metabolic and Fluid Requirements fluid requirement > greater BSA to mass ratio in infants > other factors: radiant warmers fever illness injury thinner skin and lack of keratinization of stratum corneum in premature neonates
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Compensatory Mechanisms 1) Temporary mechanism 2) Definitive mechanism
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newPedsFluidBloodTherapy - Pediatric Fluid Management and...

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