The Pediatric Patient
There are few special considerations relevant to pediatric fluid
management in addition to those for the adult (see Chapter
60
). The neonate has limited ability to dilute or concentrate urine and
has a high fluid requirement. Neonates should not be without fluid for more than
3 to 4 hours; otherwise, significant dehydration may result. Food should be offered
until 6 to 8 hours before anesthesia induction, and glucose-containing clear liquids
should be given about 4 hours before induction. Clear liquids are
TABLE 46-23 -- Fluid calculations for a simulated case
|
Time |
Compensatory (mL) |
Deficit (mL) |
Maintenance (mL) |
Blood Loss (mL)
*
|
Third Space (mL) |
This Hour (mL)
†
|
Cumulative
‡
|
|
P-I
§
|
350 |
220 |
110 |
0 |
0 |
680 |
680 |
|
I-S
‖
|
— |
220 |
110 |
0 |
0 |
330 |
1010 |
|
First hour
¶
|
|
220 |
110 |
300 |
350 |
980 |
1990 |
|
Second hour
¶
|
|
220 |
110 |
300 |
350 |
980 |
2970 |
|
Third hour
¶
|
|
220 |
110 |
150 |
350 |
830 |
3800 |
|
Fourth hour
¶
|
|
0 |
110 |
0 |
200 |
330 |
4130 |
*Reflects
fluid replacement for blood loss. Preinduction phase lasts 15 to 20 minutes.
†Total
fluid administered during the hour.
‡Grand
total since beginning the case.
§Preinduction
phase lasts 15 to 20 minutes.
‖Induction until
intra-abdominal surgical entry (assumed to be 1 hour).
¶Operative
time.
defined as transparent liquids that do not contain particulate material or protein,
which coagulate in the acid medium of the stomach. Using the same principles as
outlined for adults, the neonate requires maintenance fluids of 0.3% NaCl with potassium.
Dextrose administration should not exceed 5 mg/kg/min. This can generally be met
by using 2.5% dextrose-containing fluids. During extensive, prolonged procedures,
blood glucose should be monitored and the rate of dextrose administration modified
accordingly. Otherwise, the choice and volumes of fluid are as described for an
adult.
