Appropriate IV fluids for pediatrics

[zologista]

greetings,

[color=#48d1cc]it sounds as if you are all seasoned pediatric nurses. as for me, i recently moved. i was employed by a small rual hospital that serves pediatrics as well as geriatrics and everything in between. i floated between med/surg which includes pediatrics and er. i am currently in a similar situation. a small town hospital can be an advantage because generally our pt load is much smaller, however, one disadvantage is that we can not afford to specialize. we are jacks of all trades but masters of none.

[color=#48d1cc]i was wondering if there is a contraindication in giving pediatric pt and specifically children under 2 ns for extended periods of time. the last place that i worked generally ordered d51/4ns for the pediatric pt. the doctors at this hospital generally order ns. i went to school 14 almost 15 years ago and i seem to remember that pediatrics shouldn't have ns for extended periods due to renal function. does anyone have any information on this, or a trusted website with information?

[color=#48d1cc]thanks for your help

[color=#48d1cc]zologista

[NotReady4PrimeTime, RN]

About four years ago our standard of care changed for maintenance IV fluids. We used to use D5-1/2S for everyone, and then one of our intensivists presented some studies that demonstrated that D5-NS should be the IVF of choice for all children. The evidence suggests that isotonic, hyperosmolar IVF decreases the risk of cerebral edema in a wide variety of diagnoses. It has also been demonstrated that volume and electrolyte replacement for dehydration is more successful with a dextrose-NS fluid than with D5-1/2S. The instances where we've had symptomatic hypernatremia from the use of D5-NS are few, and there certainly are children for whom NS would not be appropriate.

[zologista]

thank you so much for your time. i appreciate the current information. my concern stemmed mainly from the fact that the child had 500ccns with 15meq of kcl running which i felt was extraordinally high for a child of 2 yrs old. i work night shift and it will be interesting to see how her labs looked this am.

thanks again for your time.

[NotReady4PrimeTime, RN]

15 mEq of potassium in 500 mL (30/L) isn't a lot for someone with normal kidneys. You can run up to 60 mEq per liter peripherally if it's going into a good sized vein. If the kiddie had gastro, her sodium and potassium would be depleted for the vomiting and diarrhea. I work in critical care and we often run potassium 1 mEq per mL centrally at 1 or 2 mL per hour in addition to 60 mEq per liter in their maintenance to correct a significant hypokalemia. I'm sure your little patient's labs were okay.

[zologista]

well thanks so much. as a matter of fact it was age-as they call it here. (acute gastroenteritis). and in fact when she came in they thought she was in dka because she was acidotic and her sugar was 305. however hbg a1c was normal and a dose of bicarb actually corrected her sugar without insulin being given and she was able to go home yesterday afternoon. her am lab did show an elevated potassium however and her fluids was changed in the early am.

thanks for all your concern and help.

zolo

[Pedi_needi]

The standard in our facility is D5 and 1/2 NS + 20 k...

Any thoughts on that?

[NotReady4PrimeTime, RN]

The standard in our facility is D5 and 1/2 NS + 20 k...

Any thoughts on that?

That would be the standard in most facilities. Just enough of everything to keep the patient on an even keel, so to speak. As I stated in my previous post, our standard changed about four years ago, but we nurses are rarely ever privy to the evidence behind such changes.

[Hooligan]

Children especially babies quickly use up there glucose stores and when sick can become hypoglycemic very rapidly which is also a reason for always having a D5.something running.