Why is fluid balance important in children

Hypotonic Fluids containing a sodium concentration less than plasma are NOT recommended for routine use in children. An infant with severe gastroenteritis requires fluid rehydration and is not tolerating enteral fluids. A decision is made to proceed with IV fluid treatment The infant weighed 10 kg prior to this illness but her current weight is 9 kg. Next you calculate the infant's maintenance fluid requirement and check it using the calculator :.

A re-assessment of the child's fluid status, including any ongoing losses, should be completed within 6 hours. Sodium chloride 0. The Royal Children's Hospital Melbourne. Intravenous fluids. IV fluids - for children beyond the newborn period See also Resuscitation: Care of the seriously unwell child Dehydration Maintenance Fluids Calculator Follow specialised fluid guidance for: Neonates Trauma , including burns Severe electrolyte disturbances, including hypernatraemia , hyponatraemia , diabetic ketoacidosis and pyloric stenosis Cardiac, liver and renal impairment Inborn errors of metabolism known or suspected Oncology hyperhydration Key points Whenever possible, the enteral route should be used In most situations, the preferred fluid type is sodium chloride 0.

Effect of fluid administration on the development of symptomatic patent ductus arteriosus and congestive heart failure in premature infants. N Engl J Med. Hydration during the first days of life and the risk of bronchopulmonary dysplasia in low birth weight infants. J Pediatr. Risk factors for chronic lung disease in the surfactant era: a North Carolina population-based study of very low birth weight infants. N C Neonatol Assoc Pediatr.

Segar JL. A physiological approach to fluid and electrolyte management of the preterm infant: review. J Neonatal Perinatal Med. Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. Randomized controlled trial of restrictive fluid management in transient tachypnea of the newborn.

Is there a benefit to postoperative fluid restriction following infant surgery? Congenit Heart Dis. Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Med. Reliability of the fluid balance in neonates. Acta Paediatr.

Assessment of renal functional maturation and injury in preterm neonates during the first month of life. Am J Physiol Renal Physiol.

The role of fluid overload in the prediction of outcome in acute kidney injury. Pediatr Nephrol. Bronchopulmonary dysplasia: possible relationship to pulmonary edema. Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants.

J Perinatol. Fluid overload in infants following congenital heart surgery. Acute kidney injury and fluid overload in neonates following surgery for congenital heart disease. Fluid overload is associated with late poor outcomes in neonates following cardiac surgery.

Fluid overload independent of acute kidney injury predicts poor outcomes in neonates following congenital heart surgery. Multivariate assessment of traditional risk factors for chronic lung disease in very low birth weight neonates.

Newborn Lung Project J Pediatr. Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants.

Association between early postnatal weight loss and death or BPD in small and appropriate for gestational age extremely low-birth-weight infants. Early fluid overload is associated with mortality and prolonged mechanical ventilation in extremely low birth weight infants. Eur J Pediatr. Pediatr Res. The impact of fluid overload on outcomes in children treated with extracorporeal membrane oxygenation: a multicenter retrospective cohort study.

Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy. Crit Care Med. Lee ST, Cho H.

Fluid overload and outcomes in neonates receiving continuous renal replacement therapy. Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy: a multicenter retrospective cohort study. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry.

Am J Kidney Dis. Fluid overload associates with major adverse kidney events in critically ill patients with acute kidney injury requiring continuous renal replacement therapy. Heart failure in children: part II: diagnosis, treatment, and future directions. Circ Heart Fail. Effect of early furosemide administration in neonates with respiratory distress syndrome. Pediatr Pulmonol.

Diuretics for respiratory distress syndrome in preterm infants. Guignard JP, Iacobelli S. Use of diuretics in the neonatal period. Incidence and outcomes of neonatal acute kidney injury AWAKEN : a multicentre, multinational, observational cohort study.

Lancet Child Adolesc Health. Peritoneal dialysis vs. Ann Thorac Surg. Kidney support in children using an ultrafiltration device: a multicenter, retrospective study. Clin J Am Soc Nephrol. Continuous kidney replacement therapy in critically ill neonates and infants: a retrospective analysis of clinical results with a dedicated device.

Stevenson JG. All patients should have fluid balance charts to assess fluid input, ongoing losses and urine output. Oral rehydration solution should be given in small volumes at frequent intervals. Regular reassessment will be required to determine its effectiveness. This is given orally, along with maintenance fluids , over 4 hours as oral rehydration solution.

For example, a child who weighs 10kg will require mL AND maintenance fluid over 4 hours. In a child who is not in shock, yet requires IV fluids, deficit correction should be achieved as follows note: there are varied methods for calculating fluid deficit and so this information should serve as a guide for learning. Use up to date national guidance in your area or hospital for patient management. In a patient with hypernatraemic dehydration , call for senior paediatric help.

Fluid will need to be replaced slowly over 48 hours in order to avoid cerebral oedema. These include:. In a patient who is nil by mouth for a surgical procedure or not tolerating enteral fluids but not yet dehydrated, maintenance fluids should be prescribed as follows over a 24 hour period using 0.

Remember to monitor electrolytes to determine if anything such as potassium should be added to the fluids. Note: Over 24 hours, males rarely need more than mL and females rarely need more than mL 5. Once you've finished editing, click 'Submit for Review', and your changes will be reviewed by our team before publishing on the site.

We use cookies to improve your experience on our site and to show you relevant advertising. To find out more, read our privacy policy. Introduction Dehydration occurs when fluid output is greater than fluid input. Aetiology It is useful to think of the causes of dehydration as falling under one of two categories.

Inadequate intake of fluid Excessive loss of fluid Causes of inadequate fluid intake include: Structural malformation — e. These will most likely be picked up and managed during the neonatal period. Discomfort — e. Respiratory distress — In order to feed and drink, it must be possible to temporarily stop breathing.

This is very difficult if already short of breath. Neglect — Though uncommon and rarely deliberate, poor fluid intake may result from inadequate feeding in neonates and infants and poor education or supervision in children. Can present in a variety of common paediatric conditions such as gastritis, gastroenteritis , pyloric stenosis , mesenteric adenitis, acute appendicitis and diabetic ketoacidosis.

Excessive sweating — e. Polyuria — Diabetes mellitus most commonly type 1 in paediatrics , diabetes insipidus Burns. Clinical Features History A good history will provide information as to whether or not an infant or child may be dehydrated, as well as the underlying cause. It is important to consider: Recent or ongoing fluid losses Vomiting, diarrhoea, excessive sweating, polyuria Quantity of fluid loss In a patient who has vomited; how many episodes of vomiting over how long and how much fluid is in each vomitus Is the patient still eating and drinking?

If so how much? Along with asking about fluid losses, this will give a rough estimate of the current fluid status of the patient.