兒童液體療法英文課件

InfantileLiquidTherapyObjectiveSummaryCharacteristicofInfantileBodyFluidBalanceFluid,Electrolyte,&Acid-baseDisordersCommonSolution

of

LiquidTherapyInfantileDiarrheaLiquidTherapyInfantileLiquidTherapyObjec1ObjectiveCharacteristicofInfantileBodyFluidBalance

——RealizedPathophysiologyofInfantileFluid,Electrolyte&Acid-baseImbalance

——BefamiliarwithClinicalmenifestationsofInfantileFluid,Electrolyte&Acid-baseDisorders——MasteredCommonSolutionComponentofLiquidTherapy

——BefamiliarwithLiquidTherapyofInfantileDiarrhea

——MasteredObjectiveCharacteristicofInf2Summary

Bodyfluidisimportantcomponentofhumanbodyandthephysiologicalequilibriumofbodyfluidisanimportantfactorforhumanliving.Thedynamicequilibriumoffluid,electrolyte,acid-base,osmoticpressuredependsonnormalregulatingfunctionofnerve,incretion,lungandkidney.Becauseoftheinfantilephysiologicpeculiarity,Thesesystematicfunctionsareeasilyaffectedbydiseasesand/orenvironmentandaremaladjusted.Therefore,thedisorderofwater,electrolyteandacid-baseiscommoninpediatricclinic.Summary Bodyfluidisim3Characteristic

ofInfantileBodyFluidBalanceA.

Totalbodywater&itsdistributionBodywatercompartmentsrelatedtoage(totalbodymass%)

Age

TBWECF

ICFPlasmaISFNewborninfant78637351year70525402～14years6652040Adult55～66510～1540～45TBW:

totalbodywaterECF:extracellularfluidICF:intracellularfluidISF:interestitialfluidCharacteristicofInfantileBo4Characteristic

of

Infantile

Body

Fluid

BalanceB.ElectrolytecompositionofbodyfluidECF: Na+、

Cl-，HCO3-ICF: K+、Mg2+、HPO42-、ProteinC.Watermetabolism

a.Largewaterrequirements,swiftwaterexchange,unobvious

waterloss(doubleadult’samount).Infant’swaterexchangeamountis1/2ofECF,theadult’sisjust1/7.b.Immaturebodyliquidregulatingfunction,immatureconcentrationanddilutionfunctionofinfantile.CharacteristicofInfantileBo5Fluid,Electrolyte&Acid-baseDisordersA.DegreeofdehydrationDehydrationMildModerateSevereDecreaseinbodyweight5％(50ml/kg)5～10％(50～100ml/kg)>10％(100～120ml/kg)PsycheDepressed,hyperirritableDepressed,hyperirritableLethargic,comaOrbit,FontanelSunken±SunkenSeverelysunkenSkinturgorNormal±DecreaseMarkedlydecreaseMucousmembranesDry±DrySeverelydryTearsDecrease±DecreaseAbsentUrineMildoliguriaoliguriaAnuriaBloodpressureNormalNormalLowFluid,Electrolyte&Acid-base6TypeofdehydrationPathogenySerumsodiumPathophysiology&clinicalcharacteristicIsosmoticAcutegastrointestinalfluidlose130～150mmol/LECF:decrease,Osmoticpressure(intracellular=extracellular)DehydrantvolumeaccordwithdehydrantphysicalsignHypotonicChronicgastrointestinalfluidlose<130mmol/LECF:severelydecrease,

Easilyshock，SevererdehydrantsignthantheothertwokindsHyperosmoticHighgradefever,Infection>150mmol/LICF:severelydecrease,

MilderdehydrantsignthantheothertwokindsFluid,Electrolyte&Acid-baseDisordersB.PropertyofdehydrationTypeofdehydrationPathogenySe7C.MetabolicacidosisPathogeny

1.Theloseoflargeamountofbasicsubstances（gastrointestinaltract,kidneys）2.ToomuchAcidmetabolite（hungriness,diabetes,renalfailure,hypoxia）3.Toomuchacidsubstanceintake（longtimetotakecalciumchloride,ammoniumchloride,

aminoacid

etc.）DegreeMild

HCO3-

18~13mmol/LModerate

HCO3-

13~9mmol/LSevere

HCO3-

<9mmol/LFluid,Electrolyte&Acid-baseDisordersC.MetabolicacidosisFluid,8D.Hypokalemia

Pathogeny

1.Lackofintake2.Lossofkaliumfromkidneysorgastrointestinaltract3.Burn,dialysisetc.4.Abnormalkaliumdistributioninsideoroutsidecells

（alkalosis,insulintherapy、periodicanesthesia）Fluid,Electrolyte&Acid-baseDisordersD.HypokalemiaFluid,Electrol9Clinicalmenifetation1.Nervoussystem——depressed2.Muscle——inertiaoflimbs，musculartensiondown，severelyretardantparalysis，respiratorymuscleparalysis3.Heart——heartrateincreasing,arrhythmia,Adams－Stokessyndrome,

heartratedecreasing，atrioventricularblock,heartsoundlowering,cardiogram:Uwaveappearing，U≥T，flattenedTwave4.Kidney——concentratingfunctionlowering,urinevolumeincreasingFluid,Electrolyte&Acid-baseDisordersClinicalmenifetationFluid,E10CommonSolutionofLiquidTherapyA.Nonelectrolyte

solution

5％、10％glucoseB.

Electrolyte

solution

0.9％NaCl、1.4％、5％NaHCO3、10％KClC.Mixedsolutions

refertothefollowingtableCommonSolutionofLiquidTher11Commonmixedsolution0.9%NaCl1.4%NaHCO35~10%G.S2:121－3:2:12134:3:24236:2:1216CommonSolutionofLiquidTherapyCommonmixedsolution0.9%NaCl12InfantileDiarrheaLiquidTherapyA.VolumeDegreeTotalvolumeCumulatedlosingvolumeKeeptransfusingperiod（physiologicalneed,losingcontinuing）Mild90～120ml/kg45～60ml/kg45～60ml/kgModerate120～150ml/kg60～75ml/kg60～75ml/kgSevere150～180ml/kg75～90ml/kg75～90ml/kgInfantileDiarrheaLiquidThe13B.QualityDehydrantcategoryCumulatedlosingvolumeKeeptransfusingperiod（physiologicalneed,losingcontinuing）Hypotonicdehydration4:3:21/3～1/4SodicsolutionIsosmoticdehydration3:2:11/3～1/4SodicsolutionHyperosmoticdehydration1/3Sodicsolution1/3～1/4SodicsolutionInfantileDiarrheaLiquidTherapyB.QualityDehydrantcategory14C.SpeedTotalvolumeCumulatedlosingvolumeKeeptransfusingperiod（physiologicalneed,losingcontinuing）24h8～12h12～16

h－8～10ml/kg/h5ml/kg/hInfantileDiarrheaLiquidTherapyC.SpeedTotalvolumeCumulat15D.ShockvolumeexpansionVolumeSolutionSpeed20ml/kg2:1or1.4％NaHCO330～60minInfantileDiarrheaLiquidTherapyTotalvolume

≤

300mlVolumeSolutionSpeed20ml/kg2:16E.Treatmentofmetabolicacidosis

Mildormoderatemetabolicacidosismetabolicacidosis:NospecialtreatmentSeveremetabolicacidosis：1.4%NaHCO33ml/kg，[HCO3-]levelcanincreaseabout1mmol.F.Treatmentofhypokalemia

Supplykaliumafterurination(urination6hoursofpreadmission,bladderpercussing－dullnote)Kaliumsupplementconcentration:0.2～0.3％(≯0.3％)VenoclysisperiodoftotalKaliumsupplementperday≮8hours.Infant