儿童液体疗法课件

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%) Age TBWECF ICFPlasmaISFNewborn infant78637351 year7052540214 years6652040Adult5566510154045TBW: total body water ECF: extracellular fluid ICF: intracellular fluid ISF: interestitial fluidCharacteristic of Infantile Body Fluid BalanceB. Electrolyte composition of body fluidECF:Na+ 、 Cl-，

6、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 concentration and

7、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, FontanelSunken Sunken Severe

8、ly sunkenSkin turgorNormal Decrease Markedly decreaseMucous membranesDry Dry Severely dryTearsDecrease DecreaseAbsentUrineMild oliguria oliguriaAnuriaBlood pressureNormalNormalLow Type of dehydrationPathogenySerum sodiumPathophysiology & clinical characteristicIsosmoticAcute gastrointestinal fluid l

9、ose130150mmol / 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-base DisordersB.

10、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, ammonium chloride,

11、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 distribution inside or

12、 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 increasing, arrhythmi

13、a, 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. Nonelectrolyte

14、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 volumeCumulated

15、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 continuing）Hypoton

16、ic 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）24 h 812 h1216

17、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 special treatment Sev

18、ere 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 supplement per day 8 hours.Infantile Diarrhea Liquid TherapyCase analysis Infant, male, 9 months, diarrhea 2 da