•Length  115 cm

•BSA          0.5 M2

•BP 96/55

•

•John is admitted to Surgery.  The procedure will require about 45 min of anesthesia time.

•

•He was instructed to be 'NPO' after midnight the night before.  His case was scheduled for 0800 and he arrived at the registration desk at 0630.

•

•Surgery was performed without apparent complication; the case began at 0845 and concluded at 0930.  John went to Recovery for post-operative observation.  He was taken to his room on the floor by 1100. 

•

•Parenteral fluids were offered during the procedure, in Recovery, and after his arrival to the floor.  The family was told that he would be allowed to ingest 'clears', indicating transparent beverages.  The IV fluid could be discontinued once he was tolerating oral feedings well.

•

•He underwent general anesthesia during his surgery.  Analgesia was provided by one dose of morphine sulfate given in Recovery and by subsequent doses of acetaminophen.

Case: Community Acquired Pneumonia

•

John Doe DOB 2/3/1995

•50 kg

•John has had nasal congestion for 7 days.  He began to have fever 3 days ago.  He ate little solid food for 2 days, but has been offered sips of fluids. He has a persistent cough.  He has been offered antipyretics and antitussive Rx.  He has vomited twice the morning of admission.

•Chest X-ray reveals a consolidation in the RLL and RML

•Examination reveals tachypnea, tubular breath sounds on the R chest, cool dry hands and feet, and slightly dusky nailbeds. 

•Oral mucosae are dry and sticky.  Elasticity is decreased with transient tenting over the abdomen.  Turgor is decreased with Cap Refill of 4-6 sec at the fingertip.

•

•Maintenance Water Rate

•

•0–10 kg 4 mL/kg/hr

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•10–20 kg 40 mL/hr + 2 mL/kg/hr × (wt-10 kg)

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•>20 kg 60 mL/hr + 1 mL/kg/hr × (wt-20 kg) *

•---------------------------------------------------

•*The maximum fluid rate is normally 100 mL/hr

•

•

•Body Surface Area Method  Maintenance Water Rate = 1500* mL / M2 / 24 hr

•

•Maintenance Electrolytes

•Sodium 2–3 mEq/kg/24 hr

•

•Potassium 1–2 mEq/kg/24 hr

•

•

•Body Weight Method for Calculating Maintenance Fluid Volume

•Body Weight Fluid per Day

•0–10 kg 100 mL/kg

•

•11–20 kg 1,000 mL + 50 mL/kg for each kg > 10 kg

•

•> 20 kg 1,500 mL + 20 mL/kg for each kg > 10 kg * 

•-------------------------------------------* The maximum total fluid per day is normally 2,400 mL.

•

•Components of Maintenance Water

•Urine 60%

•Insensible losses 35% (skin and lungs)

•Stool 5%