兒童液體療法英文

InfantileLiquidTherapyObjectiveSummaryCharacteristicofInfantileBodyFluidBalanceFluid,Electrolyte,&Acid-baseDisordersCommonSolutionofLiquidTherapyInfantileDiarrheaLiquidTherapyObjectiveCharacteristicofInfantileBodyFluidBalance———RealizedPathophysiologyofInfantileFluid,Electrolyte&Acid-baseImbalance——BefamiliarwithClinicalmenifestationsofInfantileFluid,Electrolyte&Acid-baseDisorders——MasteredCommonSolutionComponentofLiquidTherapy——BefamiliarwithLiquidTherapyofInfantileDiarrhea——MasteredSummaryBodyfluidisimportantcomponentofhumanbodyandthephysiologicalequilibriumofbodyfluidisanimportantfactorforhumanliving.Thedynamicequilibriumoffluid,electrolyte,acid-base,osmoticpressuredependsonnormalregulatingfunctionofnerve,incretion,lungandkidney.Becauseoftheinfantilephysiologicpeculiarity,Thesesystematicfunctionsareeasilyaffectedbydiseasesand/orenvironmentandaremaladjusted.Therefore,thedisorderofwater,electrolyteandacid-baseiscommoninpediatricclinic.CharacteristicofInfantileBodyFluidBalanceA.Totalbodywater&itsdistributionBodywatercompartmentsrelatedtoage(totalbodymass%)Age

TBWECF

ICFPlasmaISFNewborninfant78637351year70525402～14years6652040Adult55～66510～1540～45TBW:totalbodywaterECF:extracellularfluidICF:intracellularfluidISF:interestitialfluidCharacteristicofInfantileBodyFluidBalanceB.ElectrolytecompositionofbodyfluidECF:Na+、Cl-，HCO3-ICF:K+、Mg2+、HPO42-、ProteinC.Watermetabolisma.Largewaterrequirements,swiftwaterexchange,unobviouswaterloss(doubleadult’’samount).Infant’swaterexchangeamountis1/2ofECF,theadult’sisjust1/7.b.Immaturebodyliquidregulatingfunction,immatureconcentrationanddilutionfunctionofinfantile.Fluid,Electrolyte&Acid-baseDisordersA.DegreeofdehydrationDehydrationMildModerateSevereDecreaseinbodyweight5％(50ml/kg)5～10％(50～100ml/kg)>10％(100～120ml/kg)PsycheDepressed,hyperirritableDepressed,hyperirritableLethargic,comaOrbit,FontanelSunken±SunkenSeverelysunkenSkinturgorNormal±DecreaseMarkedlydecreaseMucousmembranesDry±DrySeverelydryTearsDecrease±DecreaseAbsentUrineMildoliguriaoliguriaAnuriaBloodpressureNormalNormalLowTypeofdehydrationPathogenySerumsodiumPathophysiology&clinicalcharacteristicIsosmoticAcutegastrointestinalfluidlose130～150mmol/LECF:decrease,Osmoticpressure(intracellular=extracellular)DehydrantvolumeaccordwithdehydrantphysicalsignHypotonicChronicgastrointestinalfluidlose<130mmol/LECF:severelydecrease,

Easilyshock，SevererdehydrantsignthantheothertwokindsHyperosmoticHighgradefever,Infection>150mmol/LICF:severelydecrease,

MilderdehydrantsignthantheothertwokindsFluid,Electrolyte&Acid-baseDisordersB.PropertyofdehydrationC.MetabolicacidosisPathogeny1.Theloseoflargeamountofbasicsubstances（gastrointestinaltract,kidneys）2.ToomuchAcidmetabolite（hungriness,diabetes,renalfailure,hypoxia）3.Toomuchacidsubstanceintake（longtimetotakecalciumchloride,ammoniumchloride,aminoacidetc.）DegreeMildHCO3-18~13mmol/LModerateHCO3-13~9mmol/LSevereHCO3-<9mmol/LFluid,Electrolyte&Acid-baseDisordersD.HypokalemiaPathogeny1.Lackofintake2.Lossofkaliumfromkidneysorgastrointestinaltract3.Burn,dialysisetc.4.Abnormalkaliumdistributioninsideoroutsidecells（alkalosis,insulintherapy、periodicanesthesia）Fluid,Electrolyte&Acid-baseDisordersClinicalmenifetation1.Nervoussystem——depressed2.Muscle——inertiaoflimbs，musculartensiondown，severelyretardantparalysis，respiratorymuscleparalysis3.Heart——heartrateincreasing,arrhythmia,Adams－Stokessyndrome,heartratedecreasing，atrioventricularblock,heartsoundlowering,cardiogram:Uwaveappearing，U≥T，flattenedTwave4.Kidney——concentratingfunctionlowering,urinevolumeincreasingFluid,Electrolyte&Acid-baseDisordersCommonSolutionofLiquidTherapyA.Nonelectrolytesolution5％、10％glucoseB.Electrolytesolution0.9％NaCl、1.4％％、5％NaHCO3、10％KClC.MixedsolutionsrefertothefollowingtableCommonmixedsolution0.9%NaCl1.4%NaHCO35~10%G.S2:121－3:2:12134:3:24236:2:1216CommonSolutionofLiquidTherapyInfantileDiarrheaLiquidTherapyA.VolumeDegreeTotalvolumeCumulatedlosingvolumeKeeptransfusingperiod（physiologicalneed,losingcontinuing）Mild90～120ml/kg45～60ml/kg45～60ml/kgModerate120～150ml/kg60～75ml/kg60～75ml/kgSevere150～180ml/kg75～90ml/kg75～90ml/kgB.QualityDehydrantcategoryCumulatedlosingvolumeKeeptransfusingperiod（physiologicalneed,losingcontinuing）Hypotonicdehydration4:3:21/3～1/4SodicsolutionIsosmoticdehydration3:2:11/3～1/4SodicsolutionHyperosmoticdehydration1/3Sodicsolution1/3～1/4SodicsolutionInfantileDiarrheaLiquidTherapyC.SpeedTotalvolumeCumulatedlosingvolumeKeeptransfusingperiod（physiologicalneed,losingcontinuing）24h8～12h12～16

h－8～10ml/kg/h5ml/kg/hInfantileDiarrheaLiquidTherapyD.ShockvolumeexpansionVolumeSolutionSpeed20ml/kg2:1or1.4％NaHCO330～60minInfantileDiarrheaLiquidTherapyTotalvolume≤300mlE.TreatmentofmetabolicacidosisMildormoderatemetabolicacidosismetabolicacidosis:NospecialtreatmentSeveremetabolicacidosis：1.4%NaHCO33ml/kg，[HCO3-]levelcanincreaseabout1mmol.F.TreatmentofhypokalemiaSupplykaliumafterurination(urination6hoursofpreadmission,bladderpercussing－dullnote)Kaliumsupplementconcentration:0.2～～0.3％(≯0.3％)VenoclysisperiodoftotalKaliumsupplementperday≮≮8hours.InfantileDiarrheaLiquidTherapyCaseanaly