儿童液体疗法件

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 RealizedPathophysiology of Infantile Fluid, Electrolyte & 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 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 distributionBody water compartments related to age (total body mass%),TBW: total body water ECF: extracellular fluid ICF: intracellular fluid ISF: interestitial fluid,Characteristic of Infantile Body Fluid Balance,B. Electrolyte composition of body fluidECF:Na+ 、 Cl-，HCO3 -ICF:K + 、Mg 2+ 、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, Electrolyte & Acid-base Disorders,A. Degree of dehydration,Fluid, Electrolyte & Acid-base Disorders,B. Property of dehydration,C. 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 calcium chloride, ammonium chloride, amino acid etc.）DegreeMild HCO3- 1813 mmol / LModerate HCO3- 139 mmol / LSevere 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. 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 appearing，UT， flattened T wave 4. Kidney concentrating function lowering, urine volume increasing,Fluid, Electrolyte & Acid-base Disorders,Common Solution of Liquid Therapy,A. Nonelectrolyte solution5、10 glucoseB. Electrolyte solution 0.9 NaCl、1.4、5 NaHCO3、10 KClC. Mixed solutions refer to the following table,Common Solution of Liquid Therapy,Infantile Diarrhea Liquid Therapy,A. Volume,B. Quality,Infantile Diarrhea Liquid Therapy,C. Speed,Infantile Diarrhea Liquid Therapy,D. Shock volume expansion,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 hypokalemiaSupply kalium after urination (urination 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 Therapy,Case analysis Infant, male, 9 months, diarrhea 2 days, admission date1998-08-10. After eating un-boiled bean curd 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/m