Infantile Liquid Therapy
Objective
Summary
Characteristic of Infantile Body Fluid Balance
Fluid,Electrolyte,& Acid-base Disorders
Common Solution of Liquid Therapy
Infantile Diarrhea Liquid Therapy
Objective
? Characteristic of Infantile Body Fluid Balance
—— Realized
? Pathophysiology of Infantile Fluid,Electrolyte &
Acid-base Imbalance —— Be familiar with
? Clinical menifestations of Infantile Fluid,Electrolyte
& Acid-base Disorders —— Mastered
? Common Solution Component of Liquid Therapy
—— Be familiar with ?
Liquid Therapy of Infantile Diarrhea
—— Mastered
Summary
Body fluid is important component of human
body and the physiological 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 easily 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 Balance
A,Total body water & its distribution
Body water compartments related to age (total body mass%)
Age TBW ECF ICF Plasma ISF
Newborn infant 78 6 37 35
1 year 70 5 25 40
2～ 14 years 66 5 20 40
Adult 55～ 66 5 10～ 15 40～ 45
TBW,total body water ECF,extracellular fluid
ICF,intracellular fluid ISF,interestitial fluid
Characteristic of Infantile Body Fluid Balance
B,Electrolyte composition of body fluid
ECF,Na+, Cl-,HCO3 -
ICF,K +, Mg 2+, HPO4 2-,Protein
C,Water metabolism
a,Large water requirements,swift water exchange,
unobvious water loss (double adult’s amount ),Infant’s
water exchange amount is 1 / 2 of ECF,the adult’s is
just 1 / 7,
b,Immature body liquid regulating function,immature
concentration and dilution function of infantile,
Fluid,Electrolyte & Acid-base Disorders
A,Degree of dehydration
Dehydration Mild Moderate Severe
Decrease in
body weight
5％
(50ml / kg)
5～ 10％
(50～ 100ml / kg)
>10％
(100～ 120ml / kg)
Psyche Depressed,hyperirritable Depressed,hyperirritable Lethargic,coma
Orbit,Fontanel Sunken ± Sunken Severely sunken
Skin turgor Normal ± Decrease Markedly decrease
Mucous
membranes Dry ± Dry Severely dry
Tears Decrease ± Decrease Absent
Urine Mild oliguria oliguria Anuria
Blood pressure Normal Normal Low
Type of
dehydration Pathogeny
Serum
sodium
Pathophysiology &
clinical characteristic
Isosmotic
Acute
gastrointestinal
fluid lose
130～ 150
mmol / L
ECF,decrease,
Osmotic pressure
(intracellular = extracellular)
Dehydrant volume accord with dehydrant physical sign
Hypotonic
Chronic
gastrointestinal
fluid lose
<130
mmol / L
ECF,severely decrease,
Easily shock,
Severer dehydrant sign than the other
two kinds
Hyperosmotic High grade fever,Infection >150 mmol / L
ICF,severely decrease,
Milder dehydrant sign than the other
two kinds
Fluid,Electrolyte & Acid-base Disorders
B,Property of dehydration
C,Metabolic acidosis
Pathogeny
1,The lose of large 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.）
Degree
Mild HCO3- 18~13 mmol / L
Moderate HCO3- 13~9 mmol / L
Severe HCO3- <9 mmol / L
Fluid,Electrolyte & Acid-base Disorders
D,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 Disorders
Clinical menifetation
1,Nervous system —— depressed
2,Muscle—— inertia of limbs,muscular tension down,severely
retardant paralysis,respiratory muscle paralysis
3,Heart —— heart rate increasing,arrhythmia,Adams－ Stokes
syndrome,heart rate decreasing,atrioventricular block,
heart sound lowering,
cardiogram,U wave appearing,U≥T,flattened T
wave
4,Kidney—— concentrating function lowering,urine volume increasing
Fluid,Electrolyte & Acid-base Disorders
Common Solution of Liquid Therapy
A,Nonelectrolyte solution
5％,10％ glucose
B,Electrolyte solution
0.9％ NaCl,1.4％,5％ NaHCO3,10％ KCl
C,Mixed solutions
refer to the following table
Common mixed
solution 0.9% NaCl 1.4% NaHCO3 5~10%G.S
2:1 2 1 －
3:2:1 2 1 3
4:3:2 4 2 3
6:2:1 2 1 6
Common Solution of Liquid Therapy
Infantile Diarrhea Liquid Therapy
A,Volume
Degree Total volume Cumulated losing volume
Keep transfusing period
（ physiological need,
losing continuing）
Mild 90～ 120ml/kg 45～ 60ml/kg 45～ 60ml/kg
Moderate 120～ 150ml/kg 60～ 75ml/kg 60～ 75ml/kg
Severe 150～ 180ml/kg 75～ 90ml/kg 75～ 90ml/kg
B,Quality
Dehydrant category Cumulated losing volume
Keep transfusing period
（ physiological need,
losing continuing）
Hypotonic dehydration 4:3:2 1/3～ 1/4
Sodic solution
Isosmotic dehydration 3:2:1 1/3～ 1/4
Sodic solution
Hyperosmotic
dehydration
1/3
Sodic solution
1/3～ 1/4
Sodic solution
Infantile Diarrhea Liquid Therapy
C,Speed
Total volume Cumulated losing volume
Keep transfusing period
（ physiological need,
losing continuing）
24 h 8～ 12 h 12～ 16 h
－ 8～ 10ml / kg /h 5ml / kg /h
Infantile Diarrhea Liquid Therapy
D,Shock volume expansion
Volume Solution Speed
20ml/kg 2:1 or 1.4％ NaHCO3 30～ 60min
Infantile Diarrhea Liquid Therapy
Total volume ≤ 300ml
E,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 hypokalemia
Supply kalium after urination (urination 6 hours of preadmission,
bladder percussing－ dull note)
Kalium supplement concentration,0.2～ 0.3％ (≯ 0.3％ )
Venoclysis period of total Kalium supplement per day ≮ 8 hours,
Infantile Diarrhea Liquid Therapy
Case analysis
Infant,male,9 months,diarrhea 2 days,admission date
1998-08-10,After eating un-boiled bean curd 2 days ago,yellow
waterish stools,bulky,no blood,no tenesmus,defecation 10～
15/day; one stool 6 hours of preadmission,a little,yellow urine,
Physical examination,T38oC,R32/min,P120/min,dyspyoria,
Fontanel 1.5× 1.5cm2,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
10～ 12/min,no high notes,two lower limbs patellar reflex
(negative)
Infantile Diarrhea Liquid Therapy
Objective
Summary
Characteristic of Infantile Body Fluid Balance
Fluid,Electrolyte,& Acid-base Disorders
Common Solution of Liquid Therapy
Infantile Diarrhea Liquid Therapy
Objective
? Characteristic of Infantile Body Fluid Balance
—— Realized
? Pathophysiology of Infantile Fluid,Electrolyte &
Acid-base Imbalance —— Be familiar with
? Clinical menifestations of Infantile Fluid,Electrolyte
& Acid-base Disorders —— Mastered
? Common Solution Component of Liquid Therapy
—— Be familiar with ?
Liquid Therapy of Infantile Diarrhea
—— Mastered
Summary
Body fluid is important component of human
body and the physiological 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 easily 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 Balance
A,Total body water & its distribution
Body water compartments related to age (total body mass%)
Age TBW ECF ICF Plasma ISF
Newborn infant 78 6 37 35
1 year 70 5 25 40
2～ 14 years 66 5 20 40
Adult 55～ 66 5 10～ 15 40～ 45
TBW,total body water ECF,extracellular fluid
ICF,intracellular fluid ISF,interestitial fluid
Characteristic of Infantile Body Fluid Balance
B,Electrolyte composition of body fluid
ECF,Na+, Cl-,HCO3 -
ICF,K +, Mg 2+, HPO4 2-,Protein
C,Water metabolism
a,Large water requirements,swift water exchange,
unobvious water loss (double adult’s amount ),Infant’s
water exchange amount is 1 / 2 of ECF,the adult’s is
just 1 / 7,
b,Immature body liquid regulating function,immature
concentration and dilution function of infantile,
Fluid,Electrolyte & Acid-base Disorders
A,Degree of dehydration
Dehydration Mild Moderate Severe
Decrease in
body weight
5％
(50ml / kg)
5～ 10％
(50～ 100ml / kg)
>10％
(100～ 120ml / kg)
Psyche Depressed,hyperirritable Depressed,hyperirritable Lethargic,coma
Orbit,Fontanel Sunken ± Sunken Severely sunken
Skin turgor Normal ± Decrease Markedly decrease
Mucous
membranes Dry ± Dry Severely dry
Tears Decrease ± Decrease Absent
Urine Mild oliguria oliguria Anuria
Blood pressure Normal Normal Low
Type of
dehydration Pathogeny
Serum
sodium
Pathophysiology &
clinical characteristic
Isosmotic
Acute
gastrointestinal
fluid lose
130～ 150
mmol / L
ECF,decrease,
Osmotic pressure
(intracellular = extracellular)
Dehydrant volume accord with dehydrant physical sign
Hypotonic
Chronic
gastrointestinal
fluid lose
<130
mmol / L
ECF,severely decrease,
Easily shock,
Severer dehydrant sign than the other
two kinds
Hyperosmotic High grade fever,Infection >150 mmol / L
ICF,severely decrease,
Milder dehydrant sign than the other
two kinds
Fluid,Electrolyte & Acid-base Disorders
B,Property of dehydration
C,Metabolic acidosis
Pathogeny
1,The lose of large 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.）
Degree
Mild HCO3- 18~13 mmol / L
Moderate HCO3- 13~9 mmol / L
Severe HCO3- <9 mmol / L
Fluid,Electrolyte & Acid-base Disorders
D,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 Disorders
Clinical menifetation
1,Nervous system —— depressed
2,Muscle—— inertia of limbs,muscular tension down,severely
retardant paralysis,respiratory muscle paralysis
3,Heart —— heart rate increasing,arrhythmia,Adams－ Stokes
syndrome,heart rate decreasing,atrioventricular block,
heart sound lowering,
cardiogram,U wave appearing,U≥T,flattened T
wave
4,Kidney—— concentrating function lowering,urine volume increasing
Fluid,Electrolyte & Acid-base Disorders
Common Solution of Liquid Therapy
A,Nonelectrolyte solution
5％,10％ glucose
B,Electrolyte solution
0.9％ NaCl,1.4％,5％ NaHCO3,10％ KCl
C,Mixed solutions
refer to the following table
Common mixed
solution 0.9% NaCl 1.4% NaHCO3 5~10%G.S
2:1 2 1 －
3:2:1 2 1 3
4:3:2 4 2 3
6:2:1 2 1 6
Common Solution of Liquid Therapy
Infantile Diarrhea Liquid Therapy
A,Volume
Degree Total volume Cumulated losing volume
Keep transfusing period
（ physiological need,
losing continuing）
Mild 90～ 120ml/kg 45～ 60ml/kg 45～ 60ml/kg
Moderate 120～ 150ml/kg 60～ 75ml/kg 60～ 75ml/kg
Severe 150～ 180ml/kg 75～ 90ml/kg 75～ 90ml/kg
B,Quality
Dehydrant category Cumulated losing volume
Keep transfusing period
（ physiological need,
losing continuing）
Hypotonic dehydration 4:3:2 1/3～ 1/4
Sodic solution
Isosmotic dehydration 3:2:1 1/3～ 1/4
Sodic solution
Hyperosmotic
dehydration
1/3
Sodic solution
1/3～ 1/4
Sodic solution
Infantile Diarrhea Liquid Therapy
C,Speed
Total volume Cumulated losing volume
Keep transfusing period
（ physiological need,
losing continuing）
24 h 8～ 12 h 12～ 16 h
－ 8～ 10ml / kg /h 5ml / kg /h
Infantile Diarrhea Liquid Therapy
D,Shock volume expansion
Volume Solution Speed
20ml/kg 2:1 or 1.4％ NaHCO3 30～ 60min
Infantile Diarrhea Liquid Therapy
Total volume ≤ 300ml
E,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 hypokalemia
Supply kalium after urination (urination 6 hours of preadmission,
bladder percussing－ dull note)
Kalium supplement concentration,0.2～ 0.3％ (≯ 0.3％ )
Venoclysis period of total Kalium supplement per day ≮ 8 hours,
Infantile Diarrhea Liquid Therapy
Case analysis
Infant,male,9 months,diarrhea 2 days,admission date
1998-08-10,After eating un-boiled bean curd 2 days ago,yellow
waterish stools,bulky,no blood,no tenesmus,defecation 10～
15/day; one stool 6 hours of preadmission,a little,yellow urine,
Physical examination,T38oC,R32/min,P120/min,dyspyoria,
Fontanel 1.5× 1.5cm2,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
10～ 12/min,no high notes,two lower limbs patellar reflex
(negative)
Infantile Diarrhea Liquid Therapy
