II. Definition

III. Example Case

  1. Weight: 35 kg Child
  2. Dehydration: 10%
  3. Serum Sodium: 158

IV. Calculate Replacement and Replace Phase 1 Fluids

  1. Approach as per Pediatric Dehydration Management
  2. Deficit: 3500 cc - 700 cc (Replaced Phase 1)
  3. Replacement
    1. Replacement given over 48-72 hours
    2. Total = 2800cc + 75 cc/h x 48 hours = 6400cc/48 hours
    3. Hourly rate = 133 cc/hour for 48 hours

V. Choose Saline Solution

  1. Start with D5 1/2 Normal Saline
  2. Monitor Serum Sodium every 2-4 hours
    1. Decrease Serum Sodium 1/2 meq/L/hour (10 meq/L/day)
    2. Do not lower Serum Sodium by >15 meq/L/day
  3. Serum Sodium not correcting
    1. Switch to D5 1/4 Normal Saline
  4. Serum Sodium still not correcting
    1. Calculate Total Body Water Deficit (TBWD)
      1. TBWD = 4 cc/kg x (weight kg) x (Serum Sodium - 145)
      2. TBWD = (4 cc/kg x 35 kg) x (158 - 145) = 1820 cc
    2. Replace Total Body Water Deficit (TBWD)
      1. Replace TBWD with D5W over 48 hours
      2. Total: 1820 cc/48 hours
      3. Hourly: 38 cc/hour D5W
    3. Replace remainder with maintenance fluids
      1. Balance: 133 cc/hour - 38 cc/hour
      2. Hourly: 95 cc/hour D5 1/2 Normal Saline

VI. Summary: 35 kg Child, hypertonic severe dehydration

  1. Start: D5 1/2NS with 20 KCl at 133 cc/hour for 48 hours
  2. No Serum Sodium change:
    1. Switch: D5 1/4NS with 20 KCl at 133 cc/h for 48 hours
  3. Still no Serum Sodium change
    1. TBWD Replacement: D5W at 38 cc/h for 48 hours
    2. Maintenance: D5 1/2NS with 20 KCl at 95 cc/h for 48h

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