1. Nurul Sazwani

2.  Definition : a state of negative fluid balance  decreased intake  increased output  fluid shift

3.  appears unwell  altered responsiveness, for example is irritable or lethargic  decreased urine output  pale or mottled skin  cold extremities  Headache, dizziness, fainting  Orthostatic hypotension  Thirst  Loss of appetite, nausea  paresthesia

4.  Fast! Capillary refill -normal< 2s  Poor skin turgor  Hypotension  Tachycardia  Shock

5. 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

7. 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?

8.  Basic fluid need +  Fluid lost +  Extra fluid deficit

9.  Basic fluid need: Depends on the weight (/24 hours): 1-10kg –100 mL / kg 11-20 kg –50 mL / each kg > 10 kg 20-70 kg –20 mL / each kg > 20 kg Over 70 -2500-3000mL /24 hours

10. How much fluid did the patient loose?  Patients’ weight  Assess according to the table: up to 5% 6-10% >10%

11. 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

12.  ORS – Oral rehydration solution  Milk? Fruit juice? Sodas? Carbonated beverages? Caffeinated drinks? Sports drinks?

13. 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

14. Suspect hypernatraemicdehydration if there are any of the following:  jittery movements  increased muscle tone  hyperreflexia  convulsions  drowsiness or coma.

15. 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.

16.  Treat suspected or confirmed shock with a rapid intravenous infusion of 20 ml/kg of 0.9% sodium chloride solution.