II. Definition

III. Example Case

  1. Weight: 35 kg Child
  2. Dehydration: 10%
  3. Serum Sodium: 120

IV. 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)

V. 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

VI. 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)

VII. 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

VIII. Monitoring

  1. Monitor Serum Sodium every 2-4 hours
  2. Raise Serum Sodium <= 2 meq/L/hours

IX. 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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