Adjusting Fluid Therapy: Diarrhea

AVERAGE COMPOSITION OF DIARRHEA
Sodium: 55 mEq/L
Potassium: 25 mEq/L
Bicarbonate: 15 mEq/L 
APPROACH TO REPLACEMENT OF ONGOING DIARRHEA LOSSES
Solution: D5 1/4 NS + 15 mEq/L bicarbonate + 25 mEq/L KCl
Replace stool mL/mL every 1–6 hr

Adjusting Fluid Therapy for Altered Renal Output    

OLIGURIA/ANURIA
Place the patient on insensible fluids (1/3 maintenance)
Replace urine output mL/mL with 1/2 NS 
POLYURIA
Place the patient on insensible fluids (1/3 maintenance)

Measure urine electrolytes

Replace urine output mL/mL with a solution that is based on the measured urine electrolytes

Adjusting Fluid Therapy for Emesis or Nasogastric Losses

    AVERAGE COMPOSITION OF GASTRIC FLUID
Sodium: 60mEq/L

Potassium: 10mEq/L

Chloride: 90mEq/L 
APPROACH TO REPLACEMENT OF ONGOING LOSSES
Solution: D5 1/2 NS + 10mEq/L KCl

Replace output mL/mL every 1–6 hr

Calculation of Deficit Water and Electrolytes

WATER DEFICIT
Percent dehydration × weight 
SODIUM DEFICIT
Water deficit × 80 mEq/L 
POTASSIUM DEFICIT
Water deficit × 30 mEq/L

References: History

Now and then: the history of parenteral fluid administration

References: Basic Fluid Therapy

Pediatric hydration therapy: Historical review and a new approach

Fluid therapy for children

Parenteral fluid therapy for infants and children

Development of a clinical dehydration scale for use in children between 1 and 36 months of age

References: Isotonic vs Hypotonic Maintenance Fluids

Intravenous fluids for seriously ill children-time to reconsider

Intravenous fluids for seriously ill children-Reply

Hypotonic vs isotonic saline in hospitalized children-a systematic review

Hospital-Acquired Hyponatremia Is Associated With Excessive Administration of Intravenous Maintenance Fluid

High antidiuretic hormone levels and hyponatremia in children with gastroenteritis

Acute hyponatremia related to intravenous fluid administration in hospitalized children- an observational study

ACUTE HOSPITAL-INDUCED HYPONATREMIA IN CHILDREN-a physiologic approach