Journal List > J Korean Med Assoc > v.49(10) > 1080704

Kim: Intravenous and Oral Fluid Therapy in Dehydrated Children

Abstract

The administration of adequate fluid to the severely dehydrated patients takes precedence over all other treatment regardless of the underlying disease. Although the understanding of pathogenesis and the appropriate management of water, electrolytes, and acid-base disturbance are emphasized in medical education, many physicians are not very confident in treating the patients with those disturbances. The first thing that should be remembered in fluid therapy is how much of water and sodium is required to the patients-in other words, how much water with what concentration of sodium should be given to the patients. Water deficit can be estimated by assessing the severity of dehydration, while the sodium deficit from the types of dehydration, that is, the plasma sodium concentration of the patients. This review will summarize the principles of how to choose and give the adequate fluid according to the severity and the types of dehydration.

Figures and Tables

Table 1
Composition of Intravenous solutions
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Table 2
Metabolism and Maintenance Fluid
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Table 3
Daily Caloric Expenditure & Water Requirement
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Table 4
Clinical manifestations of dehydration according to the severity of dehydration
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Table 5
Compositon of Oral Solutions
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References

1. Greenbaum LA. Behrman RE, Kliegman RM, Jenson HB, editors. Pathophysiology of body fluids and fluid therapy. Nelson Textbook of Pediatrics. 2003. 17th ed. Philadelphia: WB Saunders;191–252.
2. Holiday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957. 19:823–832.
crossref
3. Moritz ML, Ayus JC. Prevention of hospital acquired hyponatremia; a case for using isotonic saline in maintenance therapy. Pediatrics. 2003. 111:227–230.
crossref
4. Kaneko K, Shimojima T, Kaneko K. Risk of exacerbation of hyponatremia with standard maintenance fluid regimens. Ped Nephrol. 2004. 19:1185–1186.
crossref
5. Holliday MA, Friedman AL, Wassner SJ. Extracellular fluid restoration in dehydration: a critique of rapid versus slow. Pediatr Nephrol. 1999. 13:292–297.
crossref
6. AAP Provisional Committee on Quality Improvement, Subcommittee on Acute Gastroenteritis. Practice parameter: the management of acute gastroenteritis in young children. Pediatrics. 1996. 97:424–435.
7. Arieff AI, Ayus JC, Fraser CL. Hyponatremia and death or permanent brain damage in healthy children. BMJ. 1992. 304:1218–1222.
crossref
8. Laureno R, Karp BI. Myelinolysis after correction of hyponatremia. Ann Intern Med. 1997. 126:57–62.
crossref
9. Lein YH, Shapiro JI, Chan L. Effects of hypernatremia on organic brain osmoles. J Clin Invest. 1990. 85:1427–1435.
crossref
10. Thaper N, Sanderson IR. Diarrhea in children; an interface between developing and developed children. Lancet. 2004. 363:641–653.
11. International Study Group on Reduced-Osmolarity ORS solutions. Multicentre evaluation of reduced-osmolarity oral rehydration salts solution. Lancet. 1995. 345:282–285.
12. Thillanagayam AV, Hunt JB, Farthing MJ. Enhancing clinical efficacy of oral rehydration therapy; is low osmolality the key? Gastroenterol. 1998. 114:197–210.
crossref
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