Pediatrics Book

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Pediatric Hypotonic Dehydration

Aka: Pediatric Hypotonic Dehydration, Hypotonic Dehydration Management in Children
  1. See Also
    1. Pediatric Dehydration Management
  2. Definition
    1. Pediatric Dehydration
    2. Serum Sodium < 130
  3. Example Case
    1. Weight: 35 kg Child
    2. Dehydration: 10%
    3. Serum Sodium: 120
  4. 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)
  5. 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
  6. 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)
  7. 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
  8. Monitoring
    1. Monitor Serum Sodium every 2-4 hours
    2. Raise Serum Sodium <= 2 meq/L/hours
  9. 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

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