儿童液体疗法课件.ppt

1、Infantile Liquid Therapy ObjectiveSummaryCharacteristic of Infantile Body Fluid BalanceFluid,Electrolyte,&Acid-base DisordersCommon Solution of Liquid TherapyInfantile Diarrhea Liquid TherapyObjectiveCharacteristic of Infantile Body Fluid Balance RealizedPathophysiology of Infantile Fluid,Electrolyt

2、e&Acid-base Imbalance Be familiar withClinical menifestations of Infantile Fluid,Electrolyte&Acid-base Disorders MasteredCommon Solution Component of Liquid Therapy Be familiar withLiquid Therapy of Infantile Diarrhea MasteredSummary Body fluid is important component of human body and the physiologi

3、cal equilibrium of body fluid is an important factor for human living.The dynamic equilibrium of fluid,electrolyte,acid-base,osmotic pressure depends on normal regulating function of nerve,incretion,lung and kidney.Because of the infantile physiologic peculiarity,These systematic functions are easil

4、y affected by diseases and/or environment and are maladjusted.Therefore,the disorder of water,electrolyte and acid-base is common in pediatric clinic.Characteristic of Infantile Body Fluid BalanceA.Total body water&its distributionBody water compartments related to age(total body mass%)AgeAge TBWTBW

5、ECFECF ICFICFPlasmaISFISFNewborn infant78637351 year7052540214 years6652040Adult5566510154045TBW:total body water ECF:extracellular fluid ICF:intracellular fluid ISF:interestitial fluidCharacteristic of Infantile Body Fluid BalanceB.Electrolyte composition of body fluidECF:Na+、Cl-，HCO3-ICF:K+、Mg 2+、

6、HPO4 2-、ProteinC.Water metabolism a.Large water requirements,swift water exchange,unobvious water loss(double adults amount).Infants water exchange amount is 1/2 of ECF,the adults is just 1/7.b.Immature body liquid regulating function,immature concentration and dilution function of infantile.Fluid,E

7、lectrolyte&Acid-base DisordersA.Degree of dehydration DehydrationMildModerateSevereDecrease in body weight5(50ml/kg)510(50100ml/kg)10(100120ml/kg)PsycheDepressed,hyperirritableDepressed,hyperirritableLethargic,comaOrbit,FontanelSunken Sunken Severely sunkenSkin turgorNormal Decrease Markedly decreas

8、eMucous membranesDry Dry Severely dryTearsDecrease DecreaseAbsentUrineMild oliguria oliguriaAnuriaBlood pressureNormalNormalLow Type of dehydrationPathogenySerum sodiumPathophysiology&clinical characteristicIsosmoticAcute gastrointestinal fluid lose130150mmol/LECF:decrease,Osmotic pressure(intracell

9、ular=extracellular)Dehydrant volume accord with dehydrant physical signHypotonicChronic gastrointestinal fluid lose150mmol/LICF:severely decrease,Milder dehydrant sign than the other two kindsFluid,Electrolyte&Acid-base DisordersB.Property of dehydrationC.Metabolic acidosisPathogeny 1.The lose of la

10、rge amount of basic substances（gastrointestinal tract,kidneys）2.Too much Acid metabolite（hungriness,diabetes,renal failure,hypoxia）3.Too much acid substance intake（long time to take calcium chloride,ammonium chloride,amino acid etc.）DegreeMild HCO3-1813 mmol/LModerate HCO3-139 mmol/LSevere HCO3-9 mm

11、ol/LFluid,Electrolyte&Acid-base DisordersD.Hypokalemia Pathogeny 1.Lack of intake 2.Loss of kalium from kidneys or gastrointestinal tract 3.Burn,dialysis etc.4.Abnormal kalium distribution inside or outside cells （alkalosis,insulin therapy、periodic anesthesia）Fluid,Electrolyte&Acid-base DisordersCli

12、nical menifetation 1.Nervous system depressed 2.Muscleinertia of limbs，muscular tension down，severely retardant paralysis，respiratory muscle paralysis 3.Heart heart rate increasing,arrhythmia,AdamsStokes syndrome,heart rate decreasing，atrioventricular block,heart sound lowering,cardiogram:U wave app

13、earing，UT，flattened T wave 4.Kidney concentrating function lowering,urine volume increasingFluid,Electrolyte&Acid-base DisordersCommon Solution of Liquid TherapyA.Nonelectrolyte solution5、10 glucoseB.Electrolyte solution 0.9 NaCl、1.4、5 NaHCO3、10 KClC.Mixed solutions refer to the following tableCommo

14、n mixed solution0.9%NaCl1.4%NaHCO3510%G.S2:1213:2:12134:3:24236:2:1216Common Solution of Liquid TherapyInfantile Diarrhea Liquid TherapyA.VolumeDegree Total volumeCumulated losing volumeKeep transfusing period（physiological need,losing continuing）Mild90120ml/kg4560ml/kg4560ml/kgModerate120150ml/kg 6

15、075ml/kg6075ml/kgSevere150180ml/kg7590ml/kg7590ml/kgB.QualityDehydrant categoryCumulated losing volumeKeep transfusing period（physiological need,losing continuing）Hypotonic dehydration4:3:21/31/4 Sodic solutionIsosmotic dehydration3:2:11/31/4Sodic solutionHyperosmoticdehydration1/3 Sodic solution1/3

16、1/4Sodic solutionInfantile Diarrhea Liquid TherapyC.SpeedTotal volumeCumulated losing volumeKeep transfusing period（physiological need,losing continuing）24 h 812 h1216 h810ml/kg/h5ml/kg/hInfantile Diarrhea Liquid TherapyD.Shock volume expansionVolume Solution Speed20ml/kg2:1 or 1.4NaHCO33060minInfan

17、tile Diarrhea Liquid TherapyTotal volume 300mlE.Treatment of metabolic acidosis Mild or moderate metabolic acidosis metabolic acidosis:No special treatment Severe metabolic acidosis：1.4%NaHCO3 3ml/kg，HCO3-level can increase about 1 mmol.F.Treatment of hypokalemiaSupply kalium after urination(urinati

18、on 6 hours of preadmission,bladder percussingdull note)Kalium supplement concentration:0.20.3(0.3)Venoclysis period of total Kalium supplement per day 8 hours.Infantile Diarrhea Liquid TherapyCase analysis Infant,male,9 months,diarrhea 2 days,admission date1998-08-10.After eating un-boiled bean curd

19、 2 days ago,yellow waterish stools,bulky,no blood,no tenesmus,defecation 1015/day;one stool 6 hours of preadmission,a little,yellow urine.Physical examination：T38C,R32/min,P120/min,dyspyoria,Fontanel 1.51.5cm2,sunken,orbit sunken,decreased Skin turgor,dry lip,dry periglottis,pharynx(),heart rate 120/min,no arrhythmia,mild dull heart sounds,lungs(),mild abdomen swelling,soft abdomen,liver 1.5cm below ribs,bowel sounds 1012/min,no high notes，two lower limbs patellar reflex(negative)Infantile Diarrhea Liquid Therapy