儿科不同疾病的补液原则（Principles of fluid replacement in pediatric diseases）

儿科不同疾病的补液原则（Principles of fluid replacement in pediatric diseases） 儿科不同疾病的补液原则(Principles of fluid replacement in pediatric diseases) The principle of fluid replacement in pediatric diseases;.Txt once owned should not be forgotten; those who cannot get more should cherish; those who belong to themselves should not give up; what has been lost must be kept in memory. The fifth section is different from pediatrics The principle of fluid replacement in diseases Matters needing attention Liquid therapy for diarrhea Liquid therapy for children with diarrhea is the most common in pediatrics A typical rehydration therapy, basic and the aforementioned methods Same. 2 fluid replacement for infant malnutrition Malnutrition occurs in infants who suffer from dehydration The metabolism of body fluid has the following characteristics: 1 The volume of extracellular fluid increased relatively, and most of them were hypotonic The loss of subcutaneous fat; malnutrition in children Less fat, skin, poor plumpness, water loss estimation The degree is easy to be high. Produce ketone body increase, again With poor kidney regulation, resulting in less urine and Acid metabolites accumulate, so they are prone to acid Poisoning is more likely to cause potassium deficiency, calcium deficiency and lack of potassium Sodium; at the same time there is edema at the time of dehydration And polyuria, unlike ordinary children when they lose water The appearance of skin and Ru membrane drying and oliguria Like, should be treated with caution; the heart function Poor or excessive infusion, easy to appear heart power Failure and pulmonary edema due to the long-term heat; In short supply, resulting in the decrease of liver glycogen storage, Therefore, children prone to hypoglycemia, fluid infusion is not Can only use salt water. Rehydration therapy is usually the same as above, but We should pay attention to the following characteristics: (1) the amount of fluid infusion: according to The actual weight, fluid replacement, total amount of fluid should be more than general Fluid loss in children reduced by 1/4 1/3. 2 Rehydration components: as children suffer from dehydration, mostly hypotonic The sodium content of the tonic solution should be properly raised The ratio of electrolytes to non electrolytes increases To 2:1 (2/3 Zhang fluid), among them Zhang Hanna It is better to use sodium bicarbonate to correct the acid Poison. Infusion rate: should be slightly slower, press 3 one SmL/ (H) speed input, total liquid volume In 24h, at a uniform speed, no cut Can be eager to correct the loss of water in the short term. But - Severe dehydration with poor circulation were still around The volume of blood must be expanded first, usually according to the actual body Give weight 20mL/kg, at 3Omin, LH Intravenous drip. Supplying potassium should be supplied as soon as possible, If enough urine, begin with potassium solution. When necessary, increase the glucose concentration to 15%. Potassium deficiency was supplemented by intravenous drip of potassium chloride The concentration of <0.3%, at 6 sh, can be even Use 7d until you can stop eating. Reinforcing Alkali: sodium bicarbonate solution should be used Before). Severe dehydration, acidosis, and shock, Give first 2:1 sodic solution (2 physiological Salt water with 1 portions of 1.4% sodium bicarbonate) or isotonic 20mL/ rose fast intravenous sodium bicarbonate solution Note. The calcium and magnesium should also be added: early, special Not for children with Lou Lou disease. All in acids After correction or continuous infusion of Zd or more, 10% calcium gluconate 5 should be given at the same time 10mL add liquid into the drip or sub mouth Clothing. Children with convulsions were treated with calcium When treatment fails, 25% Magnesium Sulfate can be given 0.2 0.4mL/ (kg / HR) deep intramuscular injection Shoot, 1 /lZh, use 1, one 3D. The heat Dosage and protein supplement: plasma, whole blood or albumin may be given as appropriate to correct low eggs White blood, prevent and eliminate oedema, increase immunity Pestilence helps to correct dehydration. If dehydration is difficult To correct, except for blood transfusion, can be given to the kidneys Adrenocortical hormone. Fasting time should be short, as soon as possible Fed with high protein, fat free yogurt, when necessary, stomach Tube feeding; increased supply of heat; should be noted Intended to provide multivitamins and, if necessary, to the vein Infusion of amino acids and fat emulsions. 3 infants with pneumonia rehydration The majority of children with pneumonia did not show significant body Fluid disorder, but severe pneumonia, especially severe cases Viral pneumonia has a long course and many different courses Disturbance of water and electrolyte metabolism. 3., the characteristics of water loss in infants with pneumonia are heavy In children with pneumonia are water shortage, fever And increase respiration rate, resulting in insensible dehydration The volume of fluid is decreased, and the loss of water is higher than hypertonic See more. Metabolic acidosis and respiration Acidosis and respiratory alkalosis, but mostly Mixed acidosis. It can also cause water and sodium storage Stay. Blood potassium is generally not low. But the course of disease is longer, Malnutrition, vomiting, or diarrhea, on the kidneys In the case of corticosteroids and diuretics, blood potassium Can reduce. 3.2 principles of fluid replacement No fluid, so as not to increase the burden on the heart, induced Heart failure and pulmonary edema. Pairs can not eat Can be given intravenous infusion, the total volume of 60 80mL/ (kg. D). Infants may be biased in quantity Larger, larger children should be relatively small. High fever, Severe children with dyspnea or microcirculation dysfunction The total fluid volume can be biased due to non dominant dehydration High. The dropping liquid can be 1/3 1/2 Liquid. Sodium boiling occurs easily, so the amount of sodium is not appropriate Overmuch. Routine intravenous potassium supplementation is not necessary. The velocity of intravenous drip should be Zommol/LO Except for the treatment of primary diseases, liquid therapy Is indispensable. The main points of fluid infusion are as follows: blood sodium <120mmof/L. Whatever it is, it should be improved Blood sodium. With 3% sodium chloride, 12mL/kg can be lifted High blood sodium, 10mmol/L, or as measured by formula Calculate: should fill mmol (130) two Get blood sodium) (mmol/L) X weight (kg) Xo.6. Converted to the required 3% sodium chloride (19 NaCl, two 17mmol Na), in 4H Supplementary calculation of the amount of 1/3, 1/2, margin Continue to supply according to the illness, raise blood sodium commonly To the safe range of 130mmol/L. The blood sodium is 120, 130mmol/L. A. low The blood volume of hyponatremia, according to hypotonic dehydration rehydration (see above). B. normal blood volume, low sodium The main limiting factor for blood pressure is the amount of water Overt dehydration + previous day urine volume. Serious may First with lmg/kg intravenous injection of furosemide at, however Hypertonic hypertonic saline solution. C. high blood volume is low Hyponatremia requires both restriction of water and restriction of water Sodium salt can be used diuretics to expel excess in the body Water and sodium. Severe cases can be treated with dialysis. Hyponatremia, especially chronic hyponatremia Treatment. The rate of blood sodium improvement should not be too fast, General (0.smmol/ (L. H). Tachycardia Increase the blood sodium and make the extracellular fluid permeate rapidly Elevated and lowered as originally adapted to hyponatremia Osmotic pressure (potassium) in a cell (including brain cells) The release of ions and organic solutes is not in time So that the brain cells are relatively low The occurrence of cell dehydration may cause a serious disease Central pontine lesion of central pontine The clinical manifestations of sheath disease include unconsciousness and somnolence, Pseudobulbar palsy, paralysis, convulsions, very To death. Hyponatremia should be reviewed in time Blood sodium level is beneficial to judge the therapeutic effect, Make treatment more targeted. (full text)