FLUIDS AND

ELECTROLYTES
FLUID RESUSCITATION
AND HYDRATION
 LUDAN’S/MODIFIED LUDAN’S

<2 yrs/<10 Kg > 2 yrs/10 kg

(cc/kg) (cc/kg)
Mild 50 30

Moderate 100 60
(D5LRS/PLRS)
Severe 150 90
(PLRS or PNSS)
 Weight x TFR / 8 hours
MILD = 9kg X 50 cc
HYDRATION =450/8hrs
WEIGHT: 9 KG =56-57 ugttsmin
FLUIDS:

D5 NSS IVF: D50.3 NSS 450 cc to run

TFR: at 56-57 ugtts/min for 8 hrs
then for reassessment
50cc/kg
 Weight x TFR / 8 hours
= 20kg X 30 cc
MILD
=600/8hrs
HYDRATION
=75 ugtts/min or
WEIGHT: 20 KG
18-19 gtts/min
FLUIDS:

D5LRS
TFR:
IVF: D5LRS 1L to run at
18-19 gtts/min for 8 hrs
30cc/kg then for reassessment
MAINTENANCE
 TOTAL FLUID MODIFIED DARROW
REQUIREMENTS WEIGHT FLUID
REQ’MENT (CC/KG/DAY)
MAINTENANCE:
< 3 KG 75
<15 KG=D5IMB 3-10KG 100
>15 KG=D5NM 11-20 75
21-30 60
31-40 50
>40 40
 HOLIDAY-SEGAR METHOD

Wt (kg)
3-10 100cc/kg
11-20 1000 + 50ml for each kg> 10
>20 1500 + 20ml for each kg>20
 1. Weight x TFR / 24 hours
= 10 X 100 cc
EXAMPLES =1000cc/24
MICROSET: 60 microdrops
=41-42 ugtts/min or
(ugtts)/minute
Weight: 10 kg If >60ugtts/min:
10-11gtts/min
Divide it by 4 to convert to
Fluids: drops (gtts)/minute for
D5IMB MACROSET

TFR:
IVF: D5IMB 1000 cc to run at
41-42 ugtts/min x 24 hours
100 cc/kg/day
 2. Weight x TFR/ 24
= 25 X 60 cc
EXAMPLE
=1500cc/24
Weight: 25 kg =62-63 ugtts/min or 15-16
gtts/min
Fluids:
D5NM
IVF: D5NM 1 Liter to run at
TFR: 15-16 gtts/min
60 cc/kg/day
• PNSS- (-) urine output in 6 hrs
• PLRS- (+) urine output in 6 hrs
 RENAL/CARDIAC PATIENTS
BSA= square root of Wt (kg) X Ht (cm)
divided by 3600
Weight: 25kg • If feeding:
Height: 120cm • Heplock
If NPO: • Limit OFI
Day 1 – BSA X 500 cc/Day • BSA x 500cc
=0.9 X 500 • 450cc / 3 (shifts)

=450 cc / 24 hrs
= 18-19 ugtts/min
Day 2 – BSA X 500 + ½ of urine output

E.g.: urine out =600 cc

0.9 X 500 + 300
=750 cc to run at 31-32 ugtts/min
 TFR for NEONATES
(cc/kg/day)

Day Term Preterm SGA

1 70 60 60
2 85 80 90
3 100 100 120
4 110 120 150
5 130 140 180
6 140 160 210
7 160 180 240
8 160 200 240
 Fluids for Neonates

• 1st day of life: use D10 Water

• 2nd day onwards: use D10IMB
• if px is feeding with good HGT, may use D5 IMB
 Fluids for Neonates

EXAMPLES
3kgs, term infant, Day 1 of Life
Day 1: 3 kg X 70 cc
=210 cc / 2
=105 cc/ 12 hours

IVF: D10 Water 500cc to release 105 cc per soluset 12 hrs to run
at 8-9 ugtts/min for 2 doses
 1.2 kgs x 80 = 96 cc
FLUIDS FOR IVF = D10 IMB
NEONATES
D5IMB 85.5 cc
D2 of life D5050 10.5 cc
Preterm ------------
Weight: 1.2 kgs
96 cc/soluset to
TFR: run at 4 ugtts/min for 24
hours
80 cc/kg/day
COMPUTATION OF
MEDICATIONS
 Ampicillin

Therapeutic Dose:
- Pneumonia/Sepsis: 100 MKD
- Meningitic: 200 MKD
• < 7 days = q 12 hrs
• > 7 days = q 6 hrs
 Ampicillin

3 kgs, 3 days term 7kg, 5 months old, PCAP

wt x TD/2 • Wt x TD / 4
= 3x 100 /2
= 7 x 100 / 4
= 150 mg q 12 hours
=175 mg q6 hours
Start ampicillin 150
mg q 12 hours
 Pen G Na

To check the therapeutic dose:

10kg, AGN
- PenG Na 500,000 U IV q 6
Cardiac or renal: 100,000 10kg x 100,000/4
-
u/kg/day 20 kg px
= 250,000 units/IV q 6
Pulmonary: 200,000
TD=Dosage
u/kg/day hours / weight
x frequency
=500,000 X 4 / 20
Meningitic: 300,000
u/Kg/D TD = 100,000 UKD
 PARACETAMOL
(10-20 MKd)
Preparations:
100mg/ml drops
120 mg/5ml syrup
125 mg/5ml syrup
150 mg/5ml syrup
250 mg/5ml syrup
Dosage = wt x TD x denominator/numerator
Ex: 5 mos. 6kg
= 6 x 10x 1/100=0.6 ml

TD= ml given x numerator/denominator/weight

Ex: 7y/o, 7.5 ml, 25kg
= 7.5 x 250 /5/25 = 15mkd
 DIAZEPAM
(0.2-0.8 MKd)
Preparations: 10mg/2 ml amp, 10 mg/tab
Ex: 10kg
wt x TD
= 10 x 0.2 = 2 mg IV/IM
Rectal:
= 10 kg X 0.5 =5 mg
 Amoxicillin
(30-50mkD)

preparations:
100mg/ml drops
125mg/5ml syrup
250 mg/5ml syrup
 Amoxicillin
Ex: 10 KG
• Dosage = wt X TD X denominator/numerator/ frequency of
giving
e.g. 10kg X 50mg X 5ml/ 250mg/ 3=3.3 ml

- TD = ml given X frequency of giving X

numerator/denominator/wt
Ex: 15kg, 5 ml TID
= 5 X 3 X 250 mg/5 ml/15
= 50 mkD
 Cotrimoxazole (5-8MKD)

Preparations:
200mg/40mg/5 ml susp
400 mg/80mg/5ml susp
400 mg/80mg/tab
800 mg/160 mg/tab
 Cotrimoxazole

10 kgs • TD = ml given x 2
• dosage = wt X TD X (freq. of giving) x
5/40/ freq of giving 40/5/wt

=10 X 8 X5 /40/2 = 5 x 2 x 40 /5/10

= 5 ml BID = 8 mkD
 Therapeutic doses

1. Chloramphenicol 50 – 100mkD
2. Cloxacillin 30 – 50 mkD
3. Cefaclor 30 – 50 mkD
4. Clindamycin 15 – 40mkD
5. Diphenhydramine 1mkd
6. Ranitidine 1 mkd
7. Dexamethasone 1mkD
 Therapeutic doses
8. Phenobarbital 10-30mg LD, 5mkD
9. Phenytoin 10-30mg LD, 5mkD
10. Hydrocortisone 10 mg LD, 5mkd
11. Ceftazidime 100-150mkD
12. Amikacin 15mkD
13. Gentamycin 5mkD
14. Oxacillin 100-200mkD
15. Cefuroxime 100mkD
16. Ceftriaxone 100mkD
 Interpretation of Growth charts

A child is very tall

 Interpretation of Growth charts

A child whose weight

–for-age falls in this range
may have growth problem.
Better assessed using
BMI-for-age
Interpretation of Growth charts

Possible Risk
 Interpretation of Growth charts

It is possible for
stunted or severely
stunted to become
overweight
 Application
1. Dr. Ajila admitted 1 patient a case of a 3 y/o male from
Baggao, presented with tea colored urine, oliguria and
peri-orbital edema which usually subside in the evening.
The BP was 130/100 with a weight of 23 kg. The height is
112 cm.
Total urine output is 300 cc for 18 hours.
Compute for the following:
1. BSA
2. Desired SBP
3. urine output
4. Fluid requirement for 24 hours
 Blood Pressure

• Accepted systolic BP:

• Maximum: Age (years) x 2 + 90
• Minimum: Age (years) x 2 + 70

Ex: 9y/o, 120/80

5 y/o, 80/50
14 y/o, 100/60
 Urine Output

• Normal UO: 0.5cc-1cc/kg/hr

UO: Total Urine output/ no. of hours/ wt.

Ex: UO: 500cc for 24 hours, wt: 15kg

= 500cc/15kg/24hours
= 1.3 cc/kg/hr
• 2. Intern Cardama called to Dr. Laurado referring a 1
y/o male with a history of vomiting 8 x and loose
bowel movement for 7x just this morning. His PE
revealed a non sunken eyeballs, with dry lips but
moist oral mucosa, and adequate UO. So his
assessment is AGE with some signs of dehydration.
The weight of the patient is 8 kgs.
Compute for mild hydration.
What fluid are you going to use.
• 3. Dr. Rivera has a baby at MBS on d2 of life 2.9 kg
39 weeks by BS delivered in our institution. Patient
was referred by the NOD due to poor suck and
febrile episode at 39. She was then admitted as a case
of Sepsis neonatorum EO.
Compute for the fluid for this patient.