Abstract
There is a high frequency of diarrhea and vomiting in childhood. As a consequence the focus of the present review is to recognize the different body fluid compartments, to clinically assess the degree of dehydration, to know how the equilibrium between extracellular fluid and intracellular fluid is maintained, to calculate the effective blood osmolality and discuss both parenteral fluid maintenance and replacement.
Highlights
The first part of this review, published some months ago, outlined the physiology of the body fluid compartments, dehydration and extracellular fluid volume depletion [1]
In hypovolemic hyponatremia vasopressin release is triggered by the low effective arterial blood volume
Assessing the cause of hyponatremia may be straightforward if an obvious cause is present or in the presence of a clinical evident extracellular fluid volume depletion
Summary
Hypernatremia reflects a net water loss or a hypertonic sodium gain, with inevitable hypertonicity [3,5]. The prescription for intravenous maintenance fluids was originally described by Holliday more than 50 years ago [19], who rationalized a daily H20 requirement of 1700-1800 ml/m2 body surface area and the addition of 3 and 2 mmol/kg body weight of Na+ and K+ respectively (as it approximates the electrolyte requirements and urinary excretion in healthy infants) This is the basis for the traditional recommendation that hypotonic intravenous maintenance solutions are ideal for children [19]. Children with hypernatremic dehydration are hydrated parenterally with isotonic crystalloid solutions until diagnosis of the dyselectrolytemia, followed by slightly hypotonic solutions (e.g.: half-saline) in order to slowly correct circulating sodium level (abruptly correcting hypernatremia using a sodium free glucose solution creates an increased risk for the development of brain edema; Figure 3). This regimen, which may be effective because it causes simultaneously water diuresis and renal sodium retention, is well tolerated, and has been used chronically in ambulatory pediatric patients [8,26]
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