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Monday, November 15, 2010
Sunday, November 7, 2010
Re: Jason Chan
Dear Jason Chan,
In response to :"hi there, i saw some article explains that rehydration therapy is divded into phases: phase 1 - 20ml/kg bolus NS or HM for the 1st hr, phase 2 - 2nd-8th hr, give 1/2 of deficit and maintenance then phase 3 give the remaining 50% in the remaining 16 hrs. my question is how can we decide what type of fluid to be introduced into the patient in phase 2 and 3 and when is necessary to give additional KCl? thx"
Yes, well said Jason. The formula that you mentioned is ABSOLUTELY right and is used. However, I have so far seen Neonatologist use that formula more for neonates. I believe it is a very cautious formula and in general peadiatrics, it is a good rule to follow. So, YES. I would encourage you to use the formula.
As for the type, it depends on the purpose of the fluids being used for. To come to an accurate choice requires a good understanding of the contents of each fluids i.e. Normal saline and Hartmann's solution. (which is not explained further here unless requested...:))
Having said that, the use of which type of fluids also varies from hospital to hospital and doctor to doctor. It is personal. In your reading, research & working experience, you'll have to come to a choice of your own. However, generally Normal saline is used for administration of intravenous drugs & quick fluid resuscitation (but there are also doctors who use Hartmann's). Hartmann's is regarded as the solution that most resembles the human plasma electrolyte contents, therefore it is best used to replace any fluids lost i.e. maintenance fluids and (since it has a considerable amount of electrolyte) for raising/maintaining the blood pressure.
As for KCl, it is ultimately given as both the patients' requirements (too sick to eat, losing too much fluids, etc) and either fluids (NS or HM) aren't sufficient. However, it is always wise to take a renal profile to assess the potassium level (as patients with chronic renal failure would have high potassium levels) and proceed as necessary. (the formula to how much KCl to give is not discussed here unless requested. :) )
Does this answer your questions? I hope so. :)
In response to :"hi there, i saw some article explains that rehydration therapy is divded into phases: phase 1 - 20ml/kg bolus NS or HM for the 1st hr, phase 2 - 2nd-8th hr, give 1/2 of deficit and maintenance then phase 3 give the remaining 50% in the remaining 16 hrs. my question is how can we decide what type of fluid to be introduced into the patient in phase 2 and 3 and when is necessary to give additional KCl? thx"
Yes, well said Jason. The formula that you mentioned is ABSOLUTELY right and is used. However, I have so far seen Neonatologist use that formula more for neonates. I believe it is a very cautious formula and in general peadiatrics, it is a good rule to follow. So, YES. I would encourage you to use the formula.
As for the type, it depends on the purpose of the fluids being used for. To come to an accurate choice requires a good understanding of the contents of each fluids i.e. Normal saline and Hartmann's solution. (which is not explained further here unless requested...:))
Having said that, the use of which type of fluids also varies from hospital to hospital and doctor to doctor. It is personal. In your reading, research & working experience, you'll have to come to a choice of your own. However, generally Normal saline is used for administration of intravenous drugs & quick fluid resuscitation (but there are also doctors who use Hartmann's). Hartmann's is regarded as the solution that most resembles the human plasma electrolyte contents, therefore it is best used to replace any fluids lost i.e. maintenance fluids and (since it has a considerable amount of electrolyte) for raising/maintaining the blood pressure.
As for KCl, it is ultimately given as both the patients' requirements (too sick to eat, losing too much fluids, etc) and either fluids (NS or HM) aren't sufficient. However, it is always wise to take a renal profile to assess the potassium level (as patients with chronic renal failure would have high potassium levels) and proceed as necessary. (the formula to how much KCl to give is not discussed here unless requested. :) )
Does this answer your questions? I hope so. :)
Wednesday, November 3, 2010
Re: Mark Lee
Dear Mark Lee,
Basically, the fluid management for children (& elderly) is MORE tedious as compared to an adults'. Having said that, its' not wrong (in fact, it is better) to actually use the formula used for management of fluids in a child on an adult.
However, since adults have a better tolerance of fluids imbalance as compared to a child, they are able to take (slightly) more/less of fluids than the body needs if given by any physician.
Therefore:
1) The clinical manifestations of dehydration can still be used in an adult (the table in my previous pdf file.)
2) However, the initial resuscitation steps for an adult during the ABC need NOT use the 20ml/kg body weight formula. Just run a pint (500ml) of Hartmann's solution or Normal Saline and check for the patients' haemodynamic status after each pint. Repeat this until the patient is stable. (you don't need to count to the exact amount of fluids needed as compared to a child.)
[NB: For extreme ages (children & elderly), the imbalance of fluid tolerance levels are less. This means that for this age groups, it’ll be VERY wise to provide the amount of fluids that is loss or needed, no more or less. So, you'll have to calculate the fluids needed in this age group.]
3) The formula to estimate maintenance requirements still remain the same for an adult as for a child.
[NB: For young adults who you decide to be less accurate in the management of fluids, do LOOK OUT for signs & symptoms of fluid overload, most notably-pleural oedema.]
Basically, the fluid management for children (& elderly) is MORE tedious as compared to an adults'. Having said that, its' not wrong (in fact, it is better) to actually use the formula used for management of fluids in a child on an adult.
However, since adults have a better tolerance of fluids imbalance as compared to a child, they are able to take (slightly) more/less of fluids than the body needs if given by any physician.
Therefore:
1) The clinical manifestations of dehydration can still be used in an adult (the table in my previous pdf file.)
2) However, the initial resuscitation steps for an adult during the ABC need NOT use the 20ml/kg body weight formula. Just run a pint (500ml) of Hartmann's solution or Normal Saline and check for the patients' haemodynamic status after each pint. Repeat this until the patient is stable. (you don't need to count to the exact amount of fluids needed as compared to a child.)
[NB: For extreme ages (children & elderly), the imbalance of fluid tolerance levels are less. This means that for this age groups, it’ll be VERY wise to provide the amount of fluids that is loss or needed, no more or less. So, you'll have to calculate the fluids needed in this age group.]
3) The formula to estimate maintenance requirements still remain the same for an adult as for a child.
[NB: For young adults who you decide to be less accurate in the management of fluids, do LOOK OUT for signs & symptoms of fluid overload, most notably-pleural oedema.]
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