儿童液体疗法英文课件.ppt

Infantile Liquid Therapy ObjectiveSummaryCharacteristicofInfantileBodyFluidBalanceFluid,Electrolyte,&Acid-baseDisordersCommonSolution of LiquidTherapyInfantileDiarrheaLiquidTherapyObjectiveCharacteristicofInfantileBodyFluidBalance RealizedPathophysiologyofInfantileFluid,Electrolyte&Acid-baseImbalanceBe familiar withClinicalmenifestationsofInfantileFluid,Electrolyte&Acid-baseDisordersMasteredCommonSolutionComponentofLiquidTherapy Be familiar withLiquidTherapyofInfantileDiarrheaMasteredSummary Bodyfluidisimportantcomponentofhumanbodyandthephysiologicalequilibriumofbodyfluidisanimportantfactorforhumanliving.Thedynamicequilibriumoffluid,electrolyte,acid-base,osmoticpressuredependsonnormalregulatingfunctionofnerve,incretion,lungandkidney.Becauseoftheinfantilephysiologicpeculiarity,Thesesystematicfunctionsareeasilyaffectedbydiseasesand/orenvironmentandaremaladjusted.Therefore,thedisorderofwater,electrolyteandacid-baseiscommoninpediatricclinic.Characteristic ofInfantileBodyFluidBalanceA.Total body water&its distributionBody water compartments related to age(total body mass%)AgeAge TBWTBWECFECF ICFICFPlasmaISFISFNewborninfant78637351year7052540214years6652040Adult5566510154045TBW:totalbodywaterECF:extracellularfluidICF:intracellularfluidISF:interestitialfluidCharacteristic of Infantile Body Fluid BalanceB.Electrolyte composition of body fluidECF:Na+、Cl-，HCO3-ICF:K+、Mg 2+、HPO4 2-、ProteinC.Water metabolism a.Largewaterrequirements,swiftwaterexchange,unobvious waterloss(doubleadultsamount).Infantswaterexchangeamountis1/2ofECF,theadultsisjust1/7.b.Immaturebodyliquidregulatingfunction,immatureconcentrationanddilutionfunctionofinfantile.Fluid,Electrolyte&Acid-baseDisordersA.Degree of dehydration DehydrationMildModerateSevereDecreaseinbodyweight5(50ml/kg)510(50100ml/kg)10(100120ml/kg)PsycheDepressed,hyperirritableDepressed,hyperirritableLethargic,comaOrbit,FontanelSunkenSunkenSeverelysunkenSkinturgorNormalDecreaseMarkedlydecreaseMucousmembranesDryDrySeverelydryTearsDecreaseDecreaseAbsentUrineMildoliguriaoliguriaAnuriaBloodpressureNormalNormalLowTypeofdehydrationPathogenySerumsodiumPathophysiology&clinicalcharacteristicIsosmoticAcutegastrointestinalfluidlose130150mmol/LECF:decrease,Osmoticpressure(intracellular=extracellular)DehydrantvolumeaccordwithdehydrantphysicalsignHypotonicChronicgastrointestinalfluidlose150mmol/LICF:severelydecrease,MilderdehydrantsignthantheothertwokindsFluid,Electrolyte&Acid-baseDisordersB.Property of dehydrationC.Metabolic acidosisPathogeny 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.）DegreeMild HCO3-1813 mmol/LModerate HCO3-139 mmol/LSevere HCO3-9 mmol/LFluid,Electrolyte&Acid-baseDisordersD.Hypokalemia Pathogeny 1.Lackofintake2.Lossofkaliumfromkidneysorgastrointestinaltract3.Burn,dialysisetc.4.Abnormalkaliumdistributioninsideoroutsidecells（alkalosis,insulintherapy、periodicanesthesia）Fluid,Electrolyte&Acid-baseDisordersClinical menifetation1.Nervoussystemdepressed2.Muscleinertiaoflimbs，musculartensiondown，severelyretardantparalysis，respiratorymuscleparalysis3.Heartheartrateincreasing,arrhythmia,AdamsStokessyndrome,heartratedecreasing，atrioventricularblock,heartsoundlowering,cardiogram:Uwaveappearing，UT，flattenedTwave4.Kidneyconcentratingfunctionlowering,urinevolumeincreasingFluid,Electrolyte&Acid-baseDisordersCommonSolutionofLiquidTherapyA.Nonelectrolyte solution5、10 glucoseB.Electrolyte solution 0.9 NaCl、1.4、5 NaHCO3、10 KClC.Mixed solutions refer to the following tableCommon mixed solution0.9%NaCl1.4%NaHCO3510%G.S2:1213:2:12134:3:24236:2:1216CommonSolutionofLiquidTherapyInfantileDiarrheaLiquidTherapyA.VolumeDegreeTotalvolumeCumulatedlosingvolumeKeeptransfusingperiod（physiologicalneed,losingcontinuing）Mild90120ml/kg4560ml/kg4560ml/kgModerate120150ml/kg6075ml/kg6075ml/kgSevere150180ml/kg7590ml/kg7590ml/kgB.QualityDehydrantcategoryCumulatedlosingvolumeKeeptransfusingperiod（physiologicalneed,losingcontinuing）Hypotonicdehydration4:3:21/31/4 Sodic solutionIsosmoticdehydration3:2:11/31/4Sodic solutionHyperosmoticdehydration1/3 Sodic solution1/31/4Sodic solutionInfantileDiarrheaLiquidTherapyC.SpeedTotalvolumeCumulatedlosingvolumeKeeptransfusingperiod（physiologicalneed,losingcontinuing）24h812h1216h810ml/kg/h5ml/kg/hInfantileDiarrheaLiquidTherapyD.Shock volume expansionVolume Solution Speed20ml/kg2:1 or 1.4NaHCO33060minInfantileDiarrheaLiquidTherapyTotalvolume 300mlE.Treatment of metabolic acidosis Mildormoderatemetabolicacidosismetabolicacidosis:NospecialtreatmentSeveremetabolicacidosis：1.4%NaHCO3 3ml/kg，HCO3-level can increase about 1 mmol.F.Treatment of hypokalemiaSupplykaliumafterurination(urination6hoursofpreadmission,bladderpercussingdullnote)Kaliumsupplementconcentration:0.20.3(0.3)VenoclysisperiodoftotalKaliumsupplementperday8hours.InfantileDiarrheaLiquidTherapyCase analysisInfant,male,9months,diarrhea2days,admissiondate1998-08-10.Aftereatingun-boiledbeancurd2daysago,yellowwaterishstools,bulky,noblood,notenesmus,defecation1015/day;onestool6hoursofpreadmission,alittle,yellowurine.Physicalexamination：T38C,R32/min,P120/min,dyspyoria,Fontanel1.51.5cm2,sunken,orbitsunken,decreasedSkinturgor,drylip,dryperiglottis,pharynx(),heartrate120/min,noarrhythmia,milddullheartsounds,lungs(),mildabdomenswelling,softabdomen,liver1.5cmbelowribs,bowelsounds1012/min,nohighnotes，twolowerlimbspatellarreflex(negative)InfantileDiarrheaLiquidTherapy