1. 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

2. Objective ——Realized Characteristic of Infantile Body Fluid Balance
Pathophysiology of Infantile Fluid, Electrolyte & Acid-base Imbalance ——Be familiar with
Clinical menifestations of Infantile Fluid , Electrolyte & Acid-base Disorders ——Mastered
Common Solution Component of Liquid Therapy
——Be familiar with
Liquid Therapy of Infantile Diarrhea
——Mastered

3. 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.

4. Body water compartments related to age (total body mass%)
Characteristic of Infantile Body Fluid Balance
A. Total body water & its distribution
Body water compartments related to age (total body mass%)
Age
TBW
ECF
ICF
Plasma
ISF
Newborn infant 78 6 37 35
1 year 70 5 25 40
2～14 years 66 20
Adult
55～66
10～15
40～45
TBW: total body water ECF: extracellular fluid
ICF: intracellular fluid ISF: interestitial fluid

5. Characteristic of Infantile Body Fluid Balance
B. Electrolyte composition of body fluid
ECF: Na+ 、 Cl-，HCO3 -
ICF: K + 、Mg 2+ 、HPO4 2-、Protein
C. Water metabolism
a. Large water requirements, swift water exchange, unobvious water loss (double adult’s amount ). Infant’s water exchange amount is 1 / 2 of ECF , the adult’s is just 1 / 7.
b. Immature body liquid regulating function , immature concentration and dilution function of infantile.

6. Depressed, hyperirritable
Fluid, Electrolyte & Acid-base Disorders
A. Degree of dehydration
Dehydration
Mild
Moderate
Severe
Decrease in
body weight 5％
(50ml / kg)
5～10％
(50～100ml / kg)
>10％
(100～120ml / kg)
Psyche
Depressed,
hyperirritable
Depressed, hyperirritable
Lethargic,
coma
Orbit, Fontanel
Sunken ±
Sunken
Severely sunken
Skin turgor
Normal ±
Decrease
Markedly decrease
Mucous membranes
Dry ±
Dry
Severely dry
Tears
Decrease ±
Absent
Urine
Mild oliguria
oliguria
Anuria
Blood pressure
Normal
Low

7. Fluid, Electrolyte & Acid-base Disorders
B. Property of dehydration
Type of dehydration
Pathogeny
Serum sodium
Pathophysiology &
clinical characteristic
Isosmotic
Acute gastrointestinal fluid lose
130～150
mmol / L
ECF: decrease,
Osmotic pressure
(intracellular = extracellular)
Dehydrant volume accord with dehydrant physical sign
Hypotonic
Chronic gastrointestinal fluid lose
<130
ECF: severely decrease,
Easily shock ，
Severer dehydrant sign than the other two kinds
Hyperosmotic
High grade fever, Infection
>150
ICF: severely decrease,
Milder dehydrant sign than the other two kinds

8. Fluid, Electrolyte & Acid-base Disorders
C. Metabolic acidosis
Pathogeny
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.）
Degree
Mild HCO ~13 mmol / L
Moderate HCO ~9 mmol / L
Severe HCO < mmol / L

9. 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）

10. Fluid, Electrolyte & Acid-base Disorders
Clinical menifetation
1. Nervous system ——depressed
2. Muscle——inertia of limbs，muscular tension down，severely
retardant paralysis，respiratory muscle paralysis
3. Heart —— heart rate increasing, arrhythmia, Adams－Stokes
syndrome, heart rate decreasing，atrioventricular block,
heart sound lowering,
cardiogram: U wave appearing，U≥T， flattened T
wave
4. Kidney—— concentrating function lowering, urine volume increasing

11. Common Solution of Liquid Therapy
A. Nonelectrolyte solution
5％、10％ glucose
B. Electrolyte solution
0.9％ NaCl、1.4％、5％ NaHCO3、10％ KCl
C. Mixed solutions
refer to the following table

12. Common Solution of Liquid Therapy
Common mixed solution
0.9% NaCl
1.4% NaHCO3
5~10%G.S
2:1 2 1 －
3:2:1 3
4:3:2 4
6:2:1 6

13. Infantile Diarrhea Liquid Therapy
A. Volume
Degree
Total volume
Cumulated losing volume
Keep transfusing period
（physiological need, losing continuing）
Mild
90～120ml/kg
45～60ml/kg
Moderate
120～150ml/kg
60～75ml/kg
Severe
150～180ml/kg
75～90ml/kg

14. Infantile Diarrhea Liquid Therapy
B. Quality
Dehydrant category
Cumulated losing volume
Keep transfusing period
（physiological need, losing continuing）
Hypotonic dehydration
4:3:2
1/3～1/4
Sodic solution
Isosmotic dehydration
3:2:1
Hyperosmotic
dehydration
1/3

15. Infantile Diarrhea Liquid Therapy
C. Speed
Total volume
Cumulated losing volume
Keep transfusing period
（physiological need, losing continuing）
24 h
8～12 h
12～16 h －
8～10ml / kg /h
5ml / kg /h

16. Infantile Diarrhea Liquid Therapy
D. Shock volume expansion
Volume
Solution
Speed
20ml/kg
2:1 or 1.4％NaHCO3
30～60min
Total volume ≤ 300ml

17. Infantile Diarrhea Liquid Therapy
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 hypokalemia
Supply kalium after urination (urination 6 hours of preadmission,
bladder percussing－dull note)
Kalium supplement concentration: 0.2～0.3％(≯0.3％)
Venoclysis period of total Kalium supplement per day ≮8 hours.

18. Infantile Diarrhea Liquid Therapy
Case analysis
Infant, male, 9 months, diarrhea 2 days, admission date
After eating un-boiled bean curd 2 days ago, yellow waterish stools, bulky, no blood, no tenesmus, defecation 10～15/day; one stool 6 hours of preadmission, a little, yellow urine. Physical examination：T38ºC, R32/min, P120/min, dyspyoria, Fontanel 1.5×1.5cm2, sunken, orbit sunken, decreased Skin turgor, dry lip, dry periglottis, pharynx (－), heart rate 120/min, no arrhythmia, mild dull heart sounds, lungs(－), mild abdomen swelling, soft abdomen, liver 1.5cm below ribs, bowel sounds 10～12/min, no high notes，two lower limbs patellar reflex (negative)