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Discussion

Ped's Question

I start my Ped's rotation on Sunday and we have a worksheet to fill out...I just want to see if you all think I am going in the right direction..

Baby admitted with dehydration...give normal saline maintence fluids until pt voids more than 250cc..then switch to D5 1/4 with 10KCL/L/. Now the question is why do you change the fluid after the child starts to void??

My thoughts on this is that you know that the kidneys are perfusing and making urnie the way they should be, so now that we know that we are going to start to add some electrolytes back in to correct any imbalances...am I going the right way with this??

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Yes, and if the child is not voiding, you don't want to put extra K+ in the blood stream as this can build to toxic levels very quickly, as the kidneys are not filtering out and excreting the excess amounts. Hyperkalemia is the most lethal of the electrolyte imbalances - too high K+ will cause cardiac arrest.

You give isotonic saline FIRST for dehydration. Isotonic solutions stay in the extracellular space, which is the interstitial spaces and the intravascular space (blood stream). Infants have proportionally more fluid in the extracellular space than older children and adults. They can dehydrate very quickly. When the child begins to void sufficiently, this shows that dehydration is beginning to resolve. Then you can add some dextrose (for energy) and change the solution from isotonic to a hypotonic solution, which will also perfuse the cells and the kidneys.

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Thanks!! It is nice to know that I was not completely off base! I appreciate the additional info...it is great!! Thanks again

You're very welcome :)

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