Infantile Liquid Therapy Objective  Characteristic of Infantile Body Fluid Balance  ——Realized  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  *  * Objective  Summary Characteristic of Infantile Body Fluid Balance  Fluid, Electrolyte, & Acid-base Disorders Common Solution of Liquid Therapy  Infantile Diarrhea Liquid Therapy  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.  Characteristic of Infantile Body Fluid Balance  A. Total body water & its distribution  Body water compartments related to age (total body mass%) 40～45 10～15 5 55～66 Adult 40 20 5 66 2～14 years 40 25 5 70 1 year 35 37 6 78 Newborn infant ISF Plasma ICF ECF TBW Age TBW: total body water  ECF: extracellular fluid ICF: intracellular fluid ISF: interestitial fluid 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. Fluid, Electrolyte & Acid-base Disorders  A. Degree of dehydration Low Normal  Normal  Blood pressure Anuria  oliguria  Mild oliguria Urine  Absent Decrease  Decrease ± Tears  Severely dry  Dry Dry ± Mucous membranes  Markedly decrease  Decrease Normal ±  Skin turgor  Severely sunken  Sunken Sunken ± Orbit, Fontanel  Lethargic, coma  Depressed, hyperirritable  Depressed, hyperirritable Psyche >10％(100 ～120 ml / kg) 5～10％(50 ～100 ml / kg) 5％(50ml / kg)  Decrease in body weight  Severe  Moderate  Mild Dehydration  ICF: severely decrease, Milder dehydrant sign than the other two kinds >150 mmol / L  High grade fever, Infection  Hyperosmotic ECF: severely decrease,  Easily shock ，Severer dehydrant sign than the other two kinds <130 mmol / L  Chronic gastrointestinal fluid lose  Hypotonic  ECF: decrease, Osmotic pressure (intracellular = extracellular) Dehydrant volume accord with dehydrant physical sign 130～150 mmol / L Acute gastrointestinal fluid lose Isosmotic Pathophysiology & clinical characteristic  Serum sodium  Pathogeny  Type of dehydration Fluid, Electrolyte & Acid-base Disorders  B. Property of dehydration  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	 HCO3 -  18~13  mmol / L Moderate 	HCO3 -  13~9 mmol / L Severe	 HCO3 -  <9 mmol / L  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 ）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  Fluid, Electrolyte & Acid-base Disorders  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 3 2 4 4:3:2 6 1 2 6:2:1 3 1 2 3:2:1 －1 2 2:1 5~10% G.S 1.4% NaHCO3 0.9% NaCl Common mixed solution  Common Solution of Liquid Therapy  Infantile Diarrhea Liquid Therapy  A. Volume Total volume Severe  Moderate  Mild 75～90 ml / kg 75～90 ml / kg  150 ～180 ml / kg 60～75 ml / kg 60～75 ml / kg  120 ～150 ml / kg  45～60 ml / kg 45～60 ml / kg  90 ～120 ml / kg Keep transfusing period （physiological need, losing continuing ）Cumulated losing volume Degree B.  Quality  1 / 3～1 / 4 Sodic solution  1/3 Sodic solution  Hyperosmotic dehydration  1 / 3～1 / 4 Sodic solution 3:2:1 Isosmotic dehydration  1 / 3～1 / 4 Sodic solution 4:3:2 Hypotonic dehydration Keep transfusing period （physiological need, losing continuing ）Cumulated losing volume  Dehydrant category Infantile Diarrhea Liquid Therapy  C. Speed 5 ml / kg / h 8～10 ml / kg / h －12～16  h 8～12 h 24 h Keep transfusing period （physiological need, losing continuing ）Cumulated losing volume  Total volume Infantile Diarrhea Liquid Therapy D.  Shock volume expansion 30～60min 2:1 or 1.4 ％NaHCO3 20 ml / kg Speed Solution Volume Infantile Diarrhea Liquid Therapy  Total volume ≤300 ml * *  *