Infants have less urine concentrating ability than adults and maximum concentrating ability is not reached until approximately 18 months. IV fluid administration is not a completely benign intervention, but selection of maintenance IV fluid rate and composition that is tailored more precisely to specific patients / disease states can improve safety and reduce IV fluid-related adverse effects including iatrogenic hyponatremia Otherwise healthy euvolemic pediatric patients in ED setting awaiting admissionĮxclusion criteria ( note: guidelines may apply but fluids must be carefully managed)Įndocrine disorders causing electrolyte abnormalitiesīack to Top PART I: Background / rationale This guideline was developed through local consensus based on published evidence and expert opinion as part of the UCSF Northern California Pediatric Hospital Medicine Consortium.īack to Top Consensus Clinical Guidelines Inclusion criteriaĮuvolemic general pediatric (surgical and non-surgical) patients in inpatient setting requiring IV fluids Monitor strict intake and output, weight, blood pressure, and signs of fluid overload daily in patients receiving maintenance IV fluidsĭiscontinue maintenance IV fluids as soon as patients can take adequate enteral fluids Use caution and select fluids on a case-by-case basis for patients with the following conditions: Renal disease/renal dysfunction, endocrine disorders causing electrolyte abnormalities, neurosurgery or brain injury, severe cardiac disease, ICU Level of Care (PICU or NICU), severe malnutrition, known metabolic disease, sickle cell patients, liver failure/hepatic dysfunction, high extrarenal water lossĭo not use ¼ NS for maintenance fluids outside the neonatal periodĪdd 5% dextrose to maintenance fluids for patients with limited or no oral nutritional intakeĪdd potassium to maintenance fluids unless contraindicatedĬheck serum electrolytes (with attention to sodium, chloride, bicarbonate) at 24 hours after initiation of maintenance IV fluids for patients receiving >75% of maintenance needs via IV re-check serum electrolytes as indicated In patients older than 28 days who do not meet exclusion criteria, use isotonic fluids Maintenance IV fluids are appropriate for euvolemic patients who cannot take adequate enteral fluidsĬalculate hourly maintenance fluid rates using standard weight-based formula (4-2-1 rule)ĭo not use maintenance IV fluids at rates above calculated maintenance, and calculate replacement for ongoing fluid losses separately from maintenance Use best available evidence to guide selection and monitoring of appropriate maintenance IV fluids with consideration for patient-specific factors Reduce utilization of maintenance IV fluids Standardize care of pediatric patients who require maintenance IV fluids in the hospital
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |