Stead Family Department of Pediatrics

  • Fluid and Electrolyte Management

    Rationale

    An uninterrupted supply of water, electrolytes and an energy source is particularly important in infants and young children because of their high total body water, basal metabolic rate and daily turn-over of water. Inadequate intake or excessive loss may result in dehydration and electrolyte imbalance. Left untreated this can lead to an altered level of consciousness, vascular collapse, renal failure and death. Young infants with gastroenteritis are particularly vulnerable to dehydration and electrolyte imbalance.

    Objectives

    • Demonstrate knowledge of the following, including basic pathophysiology where appropriate:
      • Daily water and electrolyte requirements and the calculation of "maintenance" fluid need.
      • Factors which increase daily fluid requirements.
      • Causes of excessive fluid loss leading to dehydration.
      • Clinical complications of dehydration, including hypernatremia, hyponatremia, hyperkalemia and acidosis.
      • Effect of pH on serum potassium levels.
      • Conditions in which fluid administration may need to be restricted.
    • Know the basic composition and the appropriate use of
      • Oral electrolyte solutions.
      • Standard intravenous solutions (e.g. D5W, "Peds solution," Ringers Lactate, "Normal" saline.)
    • Identify dehydration by history, physical examination and laboratory studies.
      • Describe the physical findings in mild, moderate and severe dehydration.
      • Discuss the relationship of weight loss to dehydration.
      • List the appropriate laboratory studies and their interpretation.
    • Write orders for a dehydrated patient and demonstrate knowledge of their rationale:
      • Vascular resuscitation (expansion)
      • Deficit fluids
      • Maintenance fluids
      • Ongoing losses
      • Adjustments for fever, activity etc.