Laboratory investigations: Do not routinely perform blood biochemistry. Measure plasma sodium, potassium, urea, creatinine and glucose concentrations if: –intravenous fluid therapy is required or –there are symptoms or signs suggesting hypernatraemia. Measure venous blood acid–base status and chloride concentration if shock is suspected or confirmed. Urine specific gravity Other tests may be done to determine the cause of the dehydration (for example, blood sugar level to check for diabetes).diabetes
Questions? 1.Which method of rehydration? 2.How much fluid should patient receive? 3.With what speed should the fluids be given? 4.What type of solution?
Basic fluid need + Fluid lost + Extra fluid deficit
Basic fluid need: Depends on the weight (/24 hours): 1-10kg –100 mL / kg kg –50 mL / each kg > 10 kg kg –20 mL / each kg > 20 kg Over mL /24 hours
How much fluid did the patient loose? Patients’ weight Assess according to the table: up to 5% 6-10% >10%
Extra fluid deficit Vomitting Diarrhoea Fever Tachypnoe for each episode of vomitting/ loose stool/ degree of fever≥ 38°C add additional 10ml/kg/24 hours
If intravenous fluid therapy is required for rehydration (and is not hypernatraemic at presentation): use an isotonic solution such as 0.9% sodium chloride, or 0.9% sodium chloride with 5% glucose, for fluid deficit replacement and maintenance speed of rehydration: 50% within the first 8 hours(bolus included) 50% within the remaining 16 hours
Suspect hypernatraemicdehydration if there are any of the following: jittery movements increased muscle tone hyperreflexia convulsions drowsiness or coma.
If intravenous fluid therapy is required in hypernatraemic dehydration: obtain urgent expert advice on fluid manageme replace the fluid deficit slowly - typically over 48 hours monitor the plasma sodium frequently, aiming to reduce it at a rate of less than 0.5 mmol/l per hour.
Treat suspected or confirmed shock with a rapid intravenous infusion of 20 ml/kg of 0.9% sodium chloride solution.