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1、Infantile Liquid Therapy ObjectiveSummaryCharacteristicofInfantileBodyFluidBalanceFluid,Electrolyte,&Acid-baseDisordersCommonSolution of LiquidTherapyInfantileDiarrheaLiquidTherapyObjectiveCharacteristicofInfantileBodyFluidBalance RealizedPathophysiologyofInfantileFluid,Electrolyte&Acid-baseImbalanc
2、eBe familiar withClinicalmenifestationsofInfantileFluid,Electrolyte&Acid-baseDisordersMasteredCommonSolutionComponentofLiquidTherapy Be familiar withLiquidTherapyofInfantileDiarrheaMasteredSummary Bodyfluidisimportantcomponentofhumanbodyandthephysiologicalequilibriumofbodyfluidisanimportantfactorfor
3、humanliving.Thedynamicequilibriumoffluid,electrolyte,acid-base,osmoticpressuredependsonnormalregulatingfunctionofnerve,incretion,lungandkidney.Becauseoftheinfantilephysiologicpeculiarity,Thesesystematicfunctionsareeasilyaffectedbydiseasesand/orenvironmentandaremaladjusted.Therefore,thedisorderofwate
4、r,electrolyteandacid-baseiscommoninpediatricclinic.Characteristic ofInfantileBodyFluidBalanceA.Total body water&its distributionBody water compartments related to age(total body mass%)AgeAge TBWTBWECFECF ICFICFPlasmaISFISFNewborninfant78637351year7052540214years6652040Adult5566510154045TBW:totalbody
5、waterECF:extracellularfluidICF:intracellularfluidISF:interestitialfluidCharacteristic of Infantile Body Fluid BalanceB.Electrolyte composition of body fluidECF:Na+、Cl-，HCO3-ICF:K+、Mg 2+、HPO4 2-、ProteinC.Water metabolism a.Largewaterrequirements,swiftwaterexchange,unobvious waterloss(doubleadultsamou
6、nt).Infantswaterexchangeamountis1/2ofECF,theadultsisjust1/7.b.Immaturebodyliquidregulatingfunction,immatureconcentrationanddilutionfunctionofinfantile.Fluid,Electrolyte&Acid-baseDisordersA.Degree of dehydration DehydrationMildModerateSevereDecreaseinbodyweight5(50ml/kg)510(50100ml/kg)10(100120ml/kg)
7、PsycheDepressed,hyperirritableDepressed,hyperirritableLethargic,comaOrbit,FontanelSunkenSunkenSeverelysunkenSkinturgorNormalDecreaseMarkedlydecreaseMucousmembranesDryDrySeverelydryTearsDecreaseDecreaseAbsentUrineMildoliguriaoliguriaAnuriaBloodpressureNormalNormalLowTypeofdehydrationPathogenySerumsod
8、iumPathophysiology&clinicalcharacteristicIsosmoticAcutegastrointestinalfluidlose130150mmol/LECF:decrease,Osmoticpressure(intracellular=extracellular)DehydrantvolumeaccordwithdehydrantphysicalsignHypotonicChronicgastrointestinalfluidlose150mmol/LICF:severelydecrease,Milderdehydrantsignthantheothertwo
9、kindsFluid,Electrolyte&Acid-baseDisordersB.Property of dehydrationC.Metabolic acidosisPathogeny 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 calciu
10、m chloride,ammonium chloride,amino acid etc.）DegreeMild HCO3-1813 mmol/LModerate HCO3-139 mmol/LSevere HCO3-9 mmol/LFluid,Electrolyte&Acid-baseDisordersD.Hypokalemia Pathogeny 1.Lackofintake2.Lossofkaliumfromkidneysorgastrointestinaltract3.Burn,dialysisetc.4.Abnormalkaliumdistributioninsideoroutside
11、cells（alkalosis,insulintherapy、periodicanesthesia）Fluid,Electrolyte&Acid-baseDisordersClinical menifetation1.Nervoussystemdepressed2.Muscleinertiaoflimbs，musculartensiondown，severelyretardantparalysis，respiratorymuscleparalysis3.Heartheartrateincreasing,arrhythmia,AdamsStokessyndrome,heartratedecrea
12、sing，atrioventricularblock,heartsoundlowering,cardiogram:Uwaveappearing，UT，flattenedTwave4.Kidneyconcentratingfunctionlowering,urinevolumeincreasingFluid,Electrolyte&Acid-baseDisordersCommonSolutionofLiquidTherapyA.Nonelectrolyte solution5、10 glucoseB.Electrolyte solution 0.9 NaCl、1.4、5 NaHCO3、10 KC
13、lC.Mixed solutions refer to the following tableCommon mixed solution0.9%NaCl1.4%NaHCO3510%G.S2:1213:2:12134:3:24236:2:1216CommonSolutionofLiquidTherapyInfantileDiarrheaLiquidTherapyA.VolumeDegreeTotalvolumeCumulatedlosingvolumeKeeptransfusingperiod（physiologicalneed,losingcontinuing）Mild90120ml/kg45
14、60ml/kg4560ml/kgModerate120150ml/kg6075ml/kg6075ml/kgSevere150180ml/kg7590ml/kg7590ml/kgB.QualityDehydrantcategoryCumulatedlosingvolumeKeeptransfusingperiod（physiologicalneed,losingcontinuing）Hypotonicdehydration4:3:21/31/4 Sodic solutionIsosmoticdehydration3:2:11/31/4Sodic solutionHyperosmoticdehyd
15、ration1/3 Sodic solution1/31/4Sodic solutionInfantileDiarrheaLiquidTherapyC.SpeedTotalvolumeCumulatedlosingvolumeKeeptransfusingperiod（physiologicalneed,losingcontinuing）24h812h1216h810ml/kg/h5ml/kg/hInfantileDiarrheaLiquidTherapyD.Shock volume expansionVolume Solution Speed20ml/kg2:1 or 1.4NaHCO330
16、60minInfantileDiarrheaLiquidTherapyTotalvolume 300mlE.Treatment of metabolic acidosis Mildormoderatemetabolicacidosismetabolicacidosis:NospecialtreatmentSeveremetabolicacidosis：1.4%NaHCO3 3ml/kg，HCO3-level can increase about 1 mmol.F.Treatment of hypokalemiaSupplykaliumafterurination(urination6hours
17、ofpreadmission,bladderpercussingdullnote)Kaliumsupplementconcentration:0.20.3(0.3)VenoclysisperiodoftotalKaliumsupplementperday8hours.InfantileDiarrheaLiquidTherapyCase analysisInfant,male,9months,diarrhea2days,admissiondate1998-08-10.Aftereatingun-boiledbeancurd2daysago,yellowwaterishstools,bulky,n
18、oblood,notenesmus,defecation1015/day;onestool6hoursofpreadmission,alittle,yellowurine.Physicalexamination：T38C,R32/min,P120/min,dyspyoria,Fontanel1.51.5cm2,sunken,orbitsunken,decreasedSkinturgor,drylip,dryperiglottis,pharynx(),heartrate120/min,noarrhythmia,milddullheartsounds,lungs(),mildabdomenswelling,softabdomen,liver1.5cmbelowribs,bowelsounds1012/min,nohighnotes，twolowerlimbspatellarreflex(negative)InfantileDiarrheaLiquidTherapy