The Wayback Machine - https://web.archive.org/web/20160324021754/http://www.fpnotebook.com:80/peds/FEN/PdtrcHyptncDhydrtn.htm
Logo

Pediatric Hypotonic Dehydration

Aka: Pediatric Hypotonic Dehydration, Hypotonic Dehydration Management in Children

I. See Also

  1. Pediatric Dehydration Management

II. Definition

  1. Pediatric Dehydration
  2. Serum Sodium < 130

III. Example Case

  1. Weight: 35 kg Child
  2. Dehydration: 10%
  3. Serum Sodium: 120

IV. Calculate Replacement and Replace Phase 1 Fluids

  1. Approach as per Pediatric Dehydration Management
  2. Deficit: 3500 - 700cc (Replaced Phase 1)
  3. Replacement
    1. First 8 hours
      1. Total: 1400 + (75 cc/hour for 8 hours)
      2. Hourly: 250 cc/hour for 8 hours (2 Liters over 8h)
    2. Next 16 hours
      1. Total: 1400 + (75 cc/hour for 16 hours)
      2. Hourly: 163 cc/hour for 16 hours (2.6L over 16h)

V. Calculate Sodium Deficit and Sodium Requirement

  1. Calculate Deficit
    1. Formula: 0.6 x (weight kg) x (135 - Serum Sodium)
    2. Example: (0.6 x 35 kilograms) x (135-120) = 315 meq
  2. Add Maintenance
    1. Formula: 3 meq/kg/day x (weight kg)
    2. Example: 35 kg x 3 meq = 105 meq Sodium/24 hours
  3. Subtract Replacement given Phase 1
    1. Phase 1 Fluid bolus
      1. Formula: 1000 cc contains 150 meq Sodium
      2. Example: 700 cc contains 105 meq Sodium
    2. Remaining Sodium Required: 315 - 105 = 210 meq

VI. Choose Appropriate solution to replace Sodium deficit

  1. Available solutions
    1. 1/4 Normal Saline contains 38 meq/L Sodium
    2. 1/3 Normal Saline contains 51 meq/L Sodium
    3. 1/2 Normal Saline contains 77 meq/L Sodium
    4. Normal Saline contains 154 meq/L Sodium
  2. Example
    1. First 8 hours: Replace half Sodium deficit
      1. Sodium 157 meq in 2 Liters (78 meq/L)
      2. Fluid: 1/2 Normal Saline (77 meq/L)
    2. Next 16 hours: Replace half Sodium deficit
      1. Sodium 157 meq in 2.6 Liters (60 meq/L)
      2. Fluid: 1/2 Normal Saline (77 meq/L)

VII. Example Summary: 35 kg Child with hypotonic dehydration

  1. First 8 hours: D5 1/2NS with 20 KCl at 250 cc/hours
  2. Next 16 hours: D5 1/2NS with 20 KCl at 163 cc/hours

VIII. Monitoring

  1. Monitor Serum Sodium every 2-4 hours
  2. Raise Serum Sodium <= 2 meq/L/hours

IX. Special Circumstance: Hyponatremic Seizure

  1. Background
    1. Serum Sodium raised 5 meq/L with 6 ml/kg of 3% NaCl
  2. Protocol
    1. Give 3% NaCl (0.5 meq NaCl/ml) IV over 1 hour
    2. Give 3% NaCl at 6 ml/kg/hour until Seizure stops

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Pediatric Hypotonic Dehydration." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies (from Trip Database) Open in New Window

Related Topics in Fluids, Electrolytes, and Nutrition

2016 Family Practice Notebook, LLC. Terms | Privacy (UBM) | About | Site Map | Blog

Footer Site Logo
Morty Proxy This is a proxified and sanitized view of the page, visit original site.