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Pediatric Hypertonic Dehydration

See Also
1. Pediatric Dehydration Management
Definition
1. Pediatric Dehydration
2. Serum Sodium > 150
Example Case
1. Weight: 35 kg Child
2. Dehydration: 10%
3. Serum Sodium: 158
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
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
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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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.