Pediatrics Book

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Pediatric Hypertonic Dehydration

Aka: Pediatric Hypertonic Dehydration, Hypertonic Dehydration Management in Children
  1. See Also
    1. Pediatric Dehydration Management
  2. Definition
    1. Pediatric Dehydration
    2. Serum Sodium > 150
  3. Example Case
    1. Weight: 35 kg Child
    2. Dehydration: 10%
    3. Serum Sodium: 158
  4. 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
  5. 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
  6. 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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