Iv fluids when administering iv fluids, the type and amount of fluid may influence patient outcomes. If children and young people need iv fluids for routine maintenance, initially use isotonic crystalloids g that contain sodium in the range 1154 mmollitre. The american academy of pediatrics recommends that patients 28 days to 18 years. Medical and surgical patients aged 28 days to 18 years on critical care and general inpatient services. Pediatric guidelines for iv medication administration note. Perioperative fluid therapy in pediatrics murat 2008. Infants are particularly susceptible to the ill effects of dehydration because of their greater baseline fluid requirements due to a higher metabolic rate, higher evaporative losses due to a higher ratio of surface. Guideline summary iv fluids in children ncbi bookshelf.
Make sure to understand the differences between fluid products and their effects. Indications for prescribing iv fluids in pediatric patients 1. Past, current, and future hydration status should always be considered when prescribing maintenance fluids, as underdosing will lead to dehydration and. Maintenance fluids are frequently given through an intravenous line, but can also be given orally if the patient is able to tolerate oral therapy. Intravenous fluids can be especially dangerous in children, and oral rehydration solution orally or via. Managing fluids and electrolytes in children is an important skill for pharmacists, who can play an important role in monitoring therapy. Administer half of calculated volume over the first 8 hours. Consensus guidelines for iv fluid management ucsf benioff. Ivfs are required if sufficient fluids cannot be provided by using enteral administration for reasons such as gastrointestinal illness, respiratory compromise, neurologic impairment, a perioperative state, or being moribund from an acute or chronic illness. Isotonic versus hypotonic maintenance iv fluids in hospitalized children. Fluid resuscitationtreatment of dehydration for dehydration,shock,blood lossisotonic normal saline or lactated ringers give 20mlkg as bolus. Intravenous fluid therapy is a high risk activity in the paediatric population. In a collapsed patient iv fluids are given initially rapidly at a rate of 100 mlmin to avoid hypovolemia and irreversible shock. As indicated level of evidence for output, for infection upon.
The key changes in the second edition of the standards regarding the content of iv fluids for children and neonates include. Pre existing condition for example, cardiac or kidney disease. Preexisting condition for example, cardiac or kidney disease. Fluid management and dehydration texas tech university. Sensible losses, which include urine output and fecal water, make up the majority of ongoing losses, with additional contributions. Crystalloids crystalloid solutions contain small molecules that flow easily across semipermeable membranes, from the bloodstream into the cells and body tissues. Dehydration remains a major cause of morbidity and mortality in infants and young children worldwide. Lowbirthweight and premature infants have decreased energy stores and increased metabolic needs compared with those of fullterm and averageweight newborns. Maintenance intravenous fluids ivfs are used to provide critical supportive care for children who are acutely ill. Pediatric guidelines for iv medication administration. Capillary refill fluid prescribing practices and a lack of guidelines for fluid composition administration and electrolyte monitoring.
Maintenance fluids are given to compensate for ongoing losses and are required for all patients. Fluid therapy is divided into maintenance, deficit, and. Iv fluids remember the first step in the hyperkalemic patient is to remove k from iv fluids. Northern california pediatric hospital medicine consortium. Initial rehydration with fluid of choice level of evidence. Finally, the convalescent phase reflects the period when exogenous fluid administration is stopped, and the patient returns to intrinsic fluid regulation. Hemolysis and tissue trauma release vast amounts of potassium into the ecf. Concerns have been raised that this approach results in a high incidence of hyponatremia and that isotonic ivfs could prevent the development of hyponatremia. Guidelines for prescribing intravenous fluids for paediatrics. Weightbased dosing of fluids is important given the fact that a patients total body water and blood volume are based on their weight. Nsw health second edition summary the standards address the appropriate choice of iv fluids and measures related to their procurement, storage and safe administration.
Pediatric burn resuscitation january 2018 guidelines for. Introduction perioperative and postoperative fluid management in pediatric cardiac surgery vary according to operation type, fluid needs and the condition of each patient adaptation. Intravenous fluid ther enous fluid therapy in children and y in. Trusted answers from the american academy of pediatrics. Later on the fluid therapy is adjusted according loss in stools and sweat. Supplying fluids and food for patients who are unable to maintain oral intake. Iv fluids prescribed to replace losses from the gi tract and other extracellular fluid ecf compartments should be of the same electrolyte composition as the fluid that is being lost. Maintenance intravenous fluids in acutely ill patients. Objectives physiology of fluid distribution different types of iv fluids distribution of iv fluids in body compartments maintenance fluid calculation calculation of deficits phases of resuscitation special circumstances. The administration of hypotonic ivfs has been the standard in pediatrics. Bicarbonate 12 meqkg iv to be guided by blood gas analysis calcium chloride 1020 mgkg iv 0. Pdf pediatric fluid and electrolyte therapy researchgate. Dehydration is a symptom or sign of another disorder, most commonly diarrhea.
Early, rapid iv administration of isotonic fluids is widely accepted as a cornerstone of therapy for septic shock. Maintenance intravenous fluids in children american academy of. Incorrect prescription or administration of intravenous fluids has caused harm and deaths in children. Use of intravenous fluid with a sodium concentration of 140mmoll has a lower risk of hyponatraemia than fluids containing less than 140mmoll sodium. Gastroenteritis and dehydration active learning template. The aap strongly recommends the use of isotonic maintenance intravenous fluids for most pediatric patients. Maintenance intravenous fluids ivfs are used to provide critical supportive care for children. Algorithms for iv fluid therapy in children and young people. The pediatric and geriatric population principles of iv therapy bsn470 pediatric iv therapy neonate. Perioperative and postoperative fluid management in. Physiological studies normal saline, half normal saline, or similar. Perioperative and postoperative fluid management in pediatric cardiac surgery. Standardize care of pediatric patients who require maintenance iv fluids in the hospital.
Pdf managing fluids and electrolytes in children is an important skill for pharmacists, who can play an. Intravenous fluid therapy in children and young people in hospital ng29. Intravenous fluids in pediatrics linkedin slideshare. Do not use maintenance iv fluids at rates above calculated maintenance, and calculate replacement. Maintenance iv fluid until patient taking adequate oral intake. Measure plasma electrolyte concentrations and blood glucose when starting iv fluids for routine maintenance except before most elective surgery, and at least every 24 hours.
Recently, a large randomized controlled trial of fluid resuscitation conducted in children with severe febrile illnesses in a resourcelimited setting found worse outcomes to be associated with iv fluid boluses. These have a lower osmolarity than body fluids, causing fluids to shift back into cells. Adjust maintenance fluids in acute illness see over. All paediatric patients on intravenous fluids will have minimum daily electrolyte monitoring. Term neonate, child or young person requires iv fluid resuscitation. Iv fluids the three types of intravenous fluids are. Hypertonic solutions any solution that has a higher osmotic pressure than another solution that is, has a higher concentration of solutes than another solution, which means it draws fluid out of the cell and into the extracellular space. Fluid and electrolyte administration in children sickkids. American academy of pediatrics aap target population. Give 20 mlkg normal saline or lactated ringers over 1015 minutes. Intravenous fluid guidelines paediatric and neonatal. Sickle cell pain crisis guidlines virginia premier. Intravenous fluids can be especially dangerous in children, and oral rehydration solution orally or via nasogastric route should be used wherever possible.