Keterangan
Fluid therapy and electrolyte management are critical aspects of pediatric intensive care unit (PICU) management, aiming to restore and maintain fluid balance and electrolyte homeostasis in critically ill children. Clinical conditions necessitating PICU admission often lead to fluid shifts and electrolyte disturbances, including dehydration, hyponatremia, hypernatremia, hypokalemia, and hyperkalemia. Initial assessment involves evaluating hydration status, electrolyte levels, and monitoring vital signs and urine output. Fluid resuscitation strategies vary based on the underlying condition and may involve isotonic crystalloid solutions, colloids, or blood products. Careful monitoring is essential to prevent complications such as fluid overload or electrolyte imbalances. Electrolyte replacement is tailored to correct specific deficits or excesses while considering renal function and ongoing losses. Regular assessment and adjustment of fluid and electrolyte therapy based on clinical response and laboratory findings optimize outcomes and reduce the risk of adverse events in critically ill children in the PICU.
Ringkasan
- Body fluid composition changes significantly with age. Fetuses are nearly 90% water, decreasing to 70-80% at birth, and further as age increases. Total body water is divided into intracellular and extracellular fluid. The extracellular fluid dominates in fetuses, while intracellular fluid becomes more prominent with age. In adolescents, approximately 2/3 of the body fluid is intracellular, and 1/3 is extracellular.
- Electrolyte concentration varies across body fluid compartments. Sodium is the predominant ion in the extracellular compartment, maintaining a concentration of approximately 135-145 mEq/L. Conversely, potassium is the major intracellular ion, with concentrations ranging from 120-150 mEq/L.
- Osmolarity, the number of osmotically active particles in one liter of water, is normally between 285 and 295. It can be calculated using the formula: 2 * Sodium + Glucose/18 + BUN/2.8. Sodium is the primary determinant of osmolarity, while glucose and BUN have minimal impact. Tonicity, or effective osmolarity, dictates water movement between intracellular and extracellular compartments, and is also largely determined by sodium levels.
- Intravenous fluids are categorized as resuscitation, deficit, maintenance, and replacement fluids. Resuscitation fluids, typically isotonic saline, are administered in emergencies to ensure immediate organ perfusion. Deficit fluids address pre-hospital fluid losses, while maintenance fluids sustain normal daily functions, guided by the Holiday-Segar formula. Replacement fluids compensate for ongoing losses during hospitalization.
- Hyponatremia requires assessing osmolarity, hydration status, and urine sodium concentration. Hypovolemic hyponatremia treatment involves shock correction and addressing fluid and sodium deficits. The rate of correction should not exceed 0.5 mEq/L per hour or 10-12 mEq/L per day. Hypernatremia management involves calculating fluid deficits and free water losses.
- Hyperkalemia is initially treated with calcium gluconate, nebulized albuterol, and insulin/dextrose. Hypokalemia, defined as potassium levels below 3.5 mEq/L, can be mild, moderate, or severe. Oral potassium supplementation is favored for mild to moderate cases, with intravenous therapy reserved for severe depletion or inability to take oral medications.
- Oral rehydration therapy is generally preferred for mild to moderate dehydration. Slow correction rates for both hyponatremia and hypernatremia are essential, alongside frequent monitoring and adjustments. Hypotonic fluids should be avoided during resuscitation.
Contoh Sertifikat
Tentang Pembicara
Komentar
Komentar
Anda harus login untuk meninggalkan komentar.