小儿补液英文修学习教案

1、小儿小儿(xio r)补液英文修补液英文修第一页，共72页。Last lesson Emphasis Etiology(in/ex/no) Pathogenesis(4+ex/b/v/no) Clinical manifestationDiagnosis DifferentialDiagnosis(p/d/n)Treatment Predisposing(4)第1页/共72页第二页，共72页。 Diagnosis +Infectious OrNoninfectious Dehydration Degree and quality Electrolyte disturbancesAndDistu

2、rbance of acid-base balance第2页/共72页第三页，共72页。mildmoderatesevereWater lossBy weightSpirit SkinMocous Anterior fontanel and eye ballTearUrine outputPeripheral circulation50ml/kg 5%Slightly dispiritedslightly agitatedSlightly drySlightly drySlightlydepressedNormalSlightly reducednormal50100ml/kg5%10%Dis

3、piritedAgitatedDry, paleVery dry depressedReducedLittle or No Little cool100120ml/kg10%Extremely dispiritedapathy, hypnody, comaGray mottledParched depressed greatlyNoNo urine outputCool, weak pulse,shock Dehydration 第3页/共72页第四页，共72页。 Dehydration Same proportion lossP IFCPIFCElectrolyte lossmoreP hy

4、potonic,IF+C hypertonicCell expansionSevereEasy to shockP: plasma, IF: interstitial fluid, C: cellIsotonicPIFCWater lossmoreP hypertonicIF+C hypotonicCell hydrationMildThirsty Acute diarrheaafter vomiting greatlyHypotonic Hypertonic Na+ :130150mmol/LNa+: 150mmol/L第4页/共72页第五页，共72页。Electrolyte disturb

5、anceDiarrhea complicated hyponatremia & hypernatremia hypokalemia hypocalcemia hypomagnesemia第5页/共72页第六页，共72页。 Clinical manifestation: electrolyte disorder Hypokalemia第6页/共72页第七页，共72页。hypokalemia K+ (potassium)3.5mmol/L (normal: 3.55.5 mmol/L)Clinical manifestation: nerve and muscular excitabili

6、ty第7页/共72页第八页，共72页。 hypocalcemia & hypomagnesemia第8页/共72页第九页，共72页。Case example An 8 month boy had diarrhea and vomited for 3 days, urine stream reduced, irritability. PE: Pulse rate 150/min, weight loss was 10%, blood pressure 65/40mmHg, skin color showed grey and skin turgor looked like tents.

7、Mucous membranes were very dry; eye ball was sunken greatly, anterior fontanel depressed greatly. Abdomen distended, bowel sound diminished. Questions: 1.What is the diagnosis? 2.How to administer the fluid therapy?第9页/共72页第十页，共72页。第10页/共72页第十一页，共72页。第11页/共72页第十二页，共72页。 features of body fluid balanc

8、e in children The youngerThe larger proportion of body waterTotal body water(by body mass)-amount of body fluid第12页/共72页第十三页，共72页。 features of body fluid balance in childrenThe youngerThe larger proportion of extracellular waterIntracellular Body fluidExtracellular Interstitial fluidPlasmaLymph flui

9、dSecretory juice-distribution of body fluid第13页/共72页第十四页，共72页。P6%IF37%IC35%IF20%IF10%15%IF25%IC40%P5%P5%P5%IC40%IC40%45%Neonate 78% 1y 70%2y14y 65%Adult 55%60% features of body fluid balance in children P: plasmaIF: interstitial fluidIC: intracellular-distribution of body fluid in different ages (by

10、 BW)第14页/共72页第十五页，共72页。features of body fluid balance in children-water requirement Requiring more water Regulating function poorly Easy water metabolism disturbance第15页/共72页第十六页，共72页。-water requirement第16页/共72页第十七页，共72页。Similar with adultExtracellular:Na+, Cl-, Hco3-Intracellular:K+, Mg, Hpo4=, pro

11、teinFeatures of neonate (Several days after birth) :Composition of body fluidParticularly in preterm infantK+, Cl-, P, lactic acidNa+, Ca+, Hco3-Function of excluding H+Acidosis 第17页/共72页第十八页，共72页。 Acid-base balance and adjust-two conceptAcid-base balance Acidity and alkalinityAnion-cation balance A

12、nion and cation第18页/共72页第十九页，共72页。 Acid-base balance and adjust -body liquidn Buffer systemn lung ：exhale of store CO2 (respiratory)n kidney: exclude H+ and store Na+ (metabolic)NaHCO3/H2CO3Na2HPO4/NaH2PO4Buffer system of plasma proteinAdjust HCO3- NaHCO3/H2CO3=20:1第19页/共72页第二十页，共72页。Acid-base index

13、Blood gas analysis（normal ）第20页/共72页第二十一页，共72页。Acid-base balance disorder respiratory acidosis respiratory alkalosis metabolic acidosis metabolic alkalosis第21页/共72页第二十二页，共72页。 Metabolic acidosis-clinical manifestationMild: breath frequency slightlySevere: occur:第22页/共72页第二十三页，共72页。To cure water and

14、electrolyte disturbanceRecover and maintain blood volume , osmotic pressure , Acidity , alkalinity and electrolyteNormal physiological functionFluid therapy Purpose第23页/共72页第二十四页，共72页。oralintravenousFluid therapy Method prevention dehydration: Rice soup add salt solute（1/3）Mild dehydration: ORS。Mild

15、/moderate dehydration : ORS mild: ORS： 5080ml/kg moderate: ORS：80100ml/kgSevere dehydration or vomiting and diarrhea intravenous第24页/共72页第二十五页，共72页。oral rehydration salts （ORS）Na+ 90mmol，+20mmol，Cl80mmol，HCO3 30mmolAdd water to 1000ml 2 / 3 isotonic , Total osmotic pressure: 220mmolCan be diluted in

16、 Children第25页/共72页第二十六页，共72页。sodium citrate could instead by NaHCO3第26页/共72页第二十七页，共72页。Na+GScarrierenterocyteBrush borderintracellularintercellularbloodNa+GSNa+GStransportpromoteNa+、H2O absorb Na+(pump) intercellular space(Cl- )OP H2O into blood第27页/共72页第二十八页，共72页。 Characteristics of ORS -Advantages

17、 Osmotic pressure similar with plasma( Correct losses by proper concentration of Na+ 、K+ 、Cl- Children easily accept the tastes Correct metabolic acidosis by sodium citrate Promote Na+ and H2O absorption by 2% GS第28页/共72页第二十九页，共72页。 Characteristics of ORS -disadvantages Liquid tonicity higher (2 / 3

18、) Can not be used as the maintenance media Na+ concentration is relatively higher to neonates and infants (proper diluted) . 第29页/共72页第三十页，共72页。Simple preparation at home第30页/共72页第三十一页，共72页。第31页/共72页第三十二页，共72页。 Na+ 142 Cation: K+ 5(mmol) Ca+ 2.5 Mg+ 1.5 HCO3- 27 Anion: Cl- 103 (mmol) HPO4= 1 SO4= 0.

19、5 Organo-anion 19.5151 mmol/L151 mmol/LOPP range：280320mOsm/LConcentration of electrolyte and calculation第32页/共72页第三十三页，共72页。100ml water1mmol1mOsmConcentration of electrolyte and calculation第33页/共72页第三十四页，共72页。1mmolGS1mOsm2mOsm1mmolNacll To electrolyte 1mmolCacl23mOsmConcentration of electrolyte and

20、 calculation第34页/共72页第三十五页，共72页。Fluid isotonicIsotonic liquid: osmotic pressure similar with plasma Sodium isotonic:Isotonic: 150mmol sodium in 1000ml tonicity: 75mmol sodium in 1000ml2/3 tonicity: 100mmol sodium in 1000ml1/3 tonicity: 50mmol sodium in 1000ml第35页/共72页第三十六页，共72页。Liquid solution commo

21、nly used5%GS10%GS0.9%NaCl10%NaClRinger5% NaHCO3 11.2% NaL10%KClMixturenonelectrolyte solutionelectrolyte solutionglucose enter the body by oxidation change into water and CO2 for energy and water without tension 第36页/共72页第三十七页，共72页。mol/L= e.g. 0.9%NaCl=0.154mol/L Concentration of electrolyte and cal

22、culationPercentage concentration of solute（%） 10Molecular weight (atomic weight)0.91058.5=154mmol/L 第37页/共72页第三十八页，共72页。Calculation 第38页/共72页第三十九页，共72页。第39页/共72页第四十页，共72页。常用常用(chn(chn yn yn) )溶液成分溶液成分溶溶 液液 每每100ml100ml含含 NaCl NaCl 电解质渗电解质渗透压透压 血血 浆浆 （142142：103103）3 3 ：2 2 300mmol/L 300mmol/L 0.9%0.

23、9%氯化钠氯化钠 0.9g 11 0.9g 11 等张等张5%5%或或10%10%葡萄糖葡萄糖 5 5或或10g 10g 5%5%碳酸氢钠碳酸氢钠 5g 3.5 5g 3.5张张1.4%1.4%碳酸氢钠碳酸氢钠 1.4g 1.4g 等张等张10%10%氯化钾氯化钾 10g 8.9 10g 8.9张张第40页/共72页第四十一页，共72页。溶溶 液液 每每100ml100ml含含 NaClNaCl 电解质电解质1111含钠液含钠液 50ml,50ml,50ml 11 1/250ml 11 1/2张张1212含钠液含钠液 35ml,35ml,65ml 11 1/365ml 11 1/3张张1414

24、含钠液含钠液 20ml,20ml,80ml 11 1/580ml 11 1/5张张2121含钠液含钠液 65ml,65ml,35ml 32 35ml 32 等张等张231231含钠液含钠液 33ml,33ml,50ml50ml 17ml 32 1/217ml 32 1/2张张432432含钠液含钠液 45ml,45ml,33ml 32 2/333ml 32 2/3张张 22ml22ml续续 表表第41页/共72页第四十二页，共72页。Water supplement & correct acidosis Accumulative losses -losses from onset to

25、 pre-treatment ongoing losses -continuing losses during treatment daily requirement -to maintain basically physiological functionAmount , composition and time第42页/共72页第四十三页，共72页。The first day fluid infusion ：Accumulation: accumulation lossesOngoing: daily: 第43页/共72页第四十四页，共72页。mildmoderatesevereWater

26、 lossBy weightSpirit SkinMocous Anterior fontanel and eye ballTearUrine outputPeripheral circulation50ml/kg 5%Slightly dispiritedslightly agitatedSlightly drySlightly drySlightlydepressedNormalSlightly reducednormal50100ml/kg5%10%DispiritedAgitatedDry, paleVery dry depressedReducedLittle or No Little cool100120ml/kg10%Extremely dispiritedapathy, hypnody, comaGray mottledParched depressed greatlyNoNo urin