Dr. Dafalla Ahmed Babiker Jazan University

Transcription

1 Dr. Dafalla Ahmed Babiker Jazan University

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4 objectives Overview Definition of dehydration Causes of dehydration Types of dehydration Diagnosis, signs and symptoms Management of dehydration Complications of dehydration

5 Fluid compartments ICF 40% of body wt ECF 20% of body wt In neonates body fluid is around 70-75%

6 Dehydration is a condition that can occur with excess loss of water and other body fluids. Dehydration results from decreased intake and/or increased output Renal Gastrointestinal Skin (burn)

7 Diarrhea Vomiting DKA Diabetes insipidus Congenital adrenal hyperplasia Poor oral intake e.g oral ulcers

8 When assessing a child with dehydration, we need to address : the degree of dehydration Acute loss of body weight reflects the loss of fluid, not lean body mass; so, a 1 kg weight loss should reflect the loss of one liter of fluid.

9 Mild dehydration (3 to 5 percent volume loss) A history of fluid losses may be the only finding, as clinical signs may be absent or minimal. Such patients may have a reduction in urine output, but this may not be noticed.

10 Moderate dehydration (6 to 9 percent volume loss) Signs and symptoms are now apparent and can include the following: Irritability Tachycardia Decreased skin turgor Sunken eyes Dry mucous membranes Eager to drink

11 Decreased peripheral perfusion with a delay in capillary refill between two and three seconds. There is a history of reduction in urine output Decreased tearing In infants, an open fontanelle will be sunken Orthostatic falls in blood pressure

12 Severe dehydration ( 10 percent volume loss) Such children typically have a near-shock presentation as manifested by lethargy hypotension, decreased peripheral perfusion with a capillary refill of greater than three seconds cool and mottled extremities deep respirations with an increase in rate decreased skin turgor (> 2 seconde) sunken eyes Unable to drink

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14 Investigation Urea and electrolytes Serum bicarbonate(< 17 in moderate, sever dehydration) Urine sodium Urine osmolality and specific gravity Investigation for underlying problem e.g stool analysis

15 According to serum sodium level the dehydration can be classified into Isonatremic A serum sodium between 130 and 150 meq/l. In this setting, solute is lost in proportion to water loss. As an example, in patients with secretory diarrhea (eg, Vibrio cholerae gastroenteritis), the solute concentration of the diarrheal fluid is similar to the plasma solute concentration, thus the serum sodium concentration is not affected.

16 Hypernatremic (serum sodium greater than 150 meq/l) reflects water loss in excess of solute loss. In children with viral gastroenteritis (eg, rotavirus), the solute concentration of the diarrheal fluid typically ranges between 40 and 100 meq/l. Loss of this relatively dilute fluid will tend to induce hypernatremia if there is no concomitant water intake. This entity is referred to as hypernatremic dehydration.

17 Hyponatremic (serum sodium less than 130 meq/l) reflects net solute loss in excess of water loss. This does not occur directly, as losses such as diarrhea are not hypertonic to plasma. Rather, solute and water are lost in proportion, and water is taken in and retained (because secretion of antidiuretic hormone induced by hypovolemia limits water excretion), lowering the serum sodium concentration.

18 Treatment Severe dehydration Rapid volume repletion is required in children with severe dehydration, 20 ml/kg of normal saline bolus can be repeated up to 60ml/kg

19 Then correct the fluid deficit according to the serum sodium level if within normal or hyponatremic over 24 hr if hypernatremic meq/l over 48hr meq/l over 72hr (Deficit according to degree of dehydration+ daily requirement + ongoing losses) D5 ½ NS In case symptomatic hyponatremia (seizures ) give hypertonic saline 3%

20 Moderate dehydration treat with ORS 75 ml /kg over 4-6 hr In certain situations we treat moderate dehydration with I.V fluids

21 Indications for intravenous therapy include: Inability of the child to take ORT (eg, alteration in mental status, ileus, or anatomic anomaly) Inability of the care taker to provide ORT Failure of ORT to provide adequate rehydration (eg, persistent vomiting)

22 Calculation of fluids in moderate dehydration 75 ml/kg +daily requirement half of this volume over 8 hrs. and the other half over 16 hr. + replacing ongoing losses D5 ½ NS Or the whole volume over 24 hrs. + replacing ongoing losses

23 Daily requirement : 1 st 10 kg 100 ml 2 nd 10 kg 50 ml More than that 20ml Ongoing loses 10ml/kg for one motion Do not forget to treat electrolyte imbalance (hypokalemia) In hyre/hyponatremic dehydration, decrease/increase sodium by not more than 0.5mEq/L/hr

24 Mild dehydration, treat with ORS

25 During treatment closely monitor the child for: Vital signs ( pulse and BP) Urine output Signs of dehydration or overload

26 Complications shock renal failure electrolytes imbalance seizures brain edema

27 Thank you