WHY THIS BORING TOPIC. q Intake of Sick Newborn – at the mercy of neonatologist. q Small amount of fluid can make a big difference. q Fluid Overload - may lead to NEC, PDA, CLD. HOW WET ARE THE NEWBORN. q TBW - 0.7 L/kg in Newborn 0.6 L/kg at 1yr. Age q ECF 40% - Newborn
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q Intake of Sick Newborn – at the mercy of neonatologist.
q Small amount of fluid can make a big difference.
q Fluid Overload - may lead to NEC, PDA, CLD.
q TBW -0.7 L/kg in Newborn
0.6 L/kg at 1yr. Age
q ECF40% - Newborn
20% - Older Children
qInfant < 30 wks. & <1250 gm.
qSick Term Newborns
- Severe birth asphyxia
<1 kg 1-1.5 kg. >1.5 kg.
1st day 100 ml/kg. 80 ml/kg. 60 ml/kg.
7th day 190/ml/kg 170 ml/kg 150 ml/kg.
q increase 15 ml/kg/day upto 6th day
q Add 20 ml/kg/day for Phototherapy & Warmer.
qAll calculation done on birth wt. till body wt. exceeds birth wt.
q Fluid if prematures nursed in Plastic heat Sheild
1st 48 hrs. <1 kg - 5% Dextrose
1-1.5 kg. - 10% Dextrose
>1.5 kg. - 10% Dextrose
After that ISO – P Na+ - 20 mEq / lit
K+ - 20 mEq / lit
Cl - 25 mEq / lit
D - 5%
25ml 25% D+ 75ml
ISO – P Na+ - 22.7 mEq / lit
K+ - 18 mEq / lit
Cl - 22 mEq / lit
D - 10%
2/3 of Maintenance
q NEC & other condition with loss in 3rd space
q ELBW / VLBW neonates – Due to high IWL.
Term – 1% Per day
qAllow a wt. Loss
Preterm – 2% Per day
q 1st 48 hrs – no electrolyte required
q Replace Gastric fluid loss ½ NS + KCL
Other body fluids NS + KCL
q Give fluid direction 8-12 hrly in sick neonates
q 10% Dextrose
q 80 ml / day
q 20 ml 6 hourly
q 10% Dextrose 3.5ml / hr = 3 drops / min
warmer & phototherapy, calculate fluid requirement
q ISO – P
q 315 ml + 60 ml + 60 ml = 435 ml
q 108 ml / 6 hrs.
q 18 ml / hr. = 18 drops / min.
C.CALCIUM :q Give to IDM
q Add from day 1.
q 36-72 mEq / kg / day
4- 8 ml / kg / day of 10% Cal. gluconate
qOptimum requirement 4-6 mg / kg / min
q Conc. Used - 5%, 10%, 12.5% (max)
q Glucose infuse – (mg / kg / min) = % Gx rate (ml / hr.)
x 0.167 x wt.
q Thumb rule – 3 ml / kg / hr of 10% D = 5mg / kg / min
q Remain careful about glucose in – LBW
q Urine output 1 – 3 ml/kg/hr.
q Allow a weight loss 1 – 2% / day in 1st wk.
(weigh the splint before putting i/v line)
q Absence of Edema / Dehydration / Hepatomegaly
q Urine Sp. gravity 1005 - 1015
q Euglycaemia - 75 – 100 mg / dl
q Normonatremia - 135 - 145 mEq / lit
q Normokalemia - 4 – 5 mEq / lit
Check Daily - Definitely
q Wt. - loss > 3% - dehydration
<1% over dehydration
q Urine output <1 ml / kg / hr – dehydration or SIADH
(Hourly) >4 ml / kg / hr. – overhydration / dieresis
Napkin weight technique
Collect in syringe from cotton
q Urine specific gravity >1015 fluid deficit
(each sample if possible) <1005 fluid overload
q Blood Glucose
q Clinical Signs
Check Daily --- if possible
q Serum Na+
q Serum K+
q Blood Urea
q Serum Creatinine
Urine Sp gr. 1040.
- A 30 yrs Woman P2+o taken to labour room
- In last 1 hr of labour woman drunk 3L water + received
5% D i/v
- Delivered male baby 3kg, apgar 18 59
- after 6 hrs. the baby dev. Seizure
q What is the most likely cause of seizure?
q How to prevent this?
qSerum Na+ <130 mEq / lit
q Neurological Signs or Na+ <120 mEq / lit
qWhat to give :
3% Nacl 0.5 mEq Na+ / ml
2 – 3 ml /kg initial dose
use 3% Nacl to raise Na+ upto 125 mEq / lit
q NaHco3 7.5% solution 0.9 mEq Na+ / ml
(if 3% Nacl not available)
qHow to calculate deficit
Na+ deficit (mEq) = (desired Na+ - obs Na+) x wt x 0.6
Add next 2 days daily requirement 2-3 mEq / kg / day
correct in 48 hrs.
q Thumb rule - correct 1/3rd 8hr
1/3rd 16 hr
1/3rd 24 - 48 hr.
How to correct the hyponatremia ?
q Deficit of Na+ = (135 – 122) x 1.5 x 0.6 = 11.7 mEq.
q Maintenance Na+ = 3 x 1.5 x 2 (correction made in 48 hrs.)
= 9 mEq.
q Total requirements = 11.7 +9 = 20.7 mEq. = 21 mEq.
q Fluid requirements for 48 hrs. = 1.5 x 150 x 2 = 450 ml.
q 21 mEq Na+ in 450 ml. fluid = 50 mEq. Na+ in 1 lit.
q Fluid required = 450 ml. N/3 Solution.
q Serum Na> 150 mEq / lit
q Excess free water loss than Na+
q Do not treat with Na+ free water
q Fluid therapy -- 2/3 maintenance with N2 / N5 sol. + 5% D.
-- correct Na+ over 24 – 48 hrs. Do not drop >10 mEq / lit / day.
-- May require 3% NaCl if over correction leads to CNS signs.
q Predisposing factors present
Feature q wt. Gain with out oedema
q hypotonic hyponatremia
q Urine output
q Urine osmolality > plasma osmolality
Treat q Water restriction – 2/3 maintenance x 24 hrs
q 3% Nacl if Na+ <120 mEq / lit or CNS sign
q Frusemide Urinary electrolyte free H2o excretion
A Newborn 3kgs on 2nd day developed abdominal distension, NG tube inserted, on 3rd day Serum K+ observed was 2.1 mEq / lit. How to correct.
K+ deficit = (Req K+ - obs K+) x body wt.
= (3.5 - 2.1) x 3
= 1.4 mEq
q Max K+ i/v without ECG - monitoring – 40 mEq / lit = 2ml 1.5ml KCL / 100ml of Fluid.
q Max K+ i/v with ECG – monitoring – 60 - 80 mEq / lit
q Signs of hypokalenia in newborn – ileus
QT / ST depression
q Serum K+ > 6 mEq / lit
q How to manage
1. Check Sampling error and Recheck Value
2. Remove all sources of K+
3. Upto 7mEq / lit Kayexelate 1gm / kg at 0.5gm / ml of NS given as enema (upto 1- 3 cm) minimum retention time = 30 min.
Serum Calcium <7.0 mg / dl Ionised Cal <4.0 mg / dl
Treatment of Hypocalcaemic Crisis apnoea
1 – 2ml Ca-glu. / kg + 5 - 10% D 10ml over 10 min.
No response in 10min REPEAT DOSE
Maintenance Cal 8ml / kg / day x 48 hrs.
Switch to oral therapy
Refactory hypocalcaemia think hypomagnesaemia 0.2ml of 50% mgso4 2 doses 12hr. Apart i/v or deep im
Caution in Ca++ therapy
q Rapid i/v infusion - dysrythmia / bradycardia
q Extravasation of Ca++ Solution S/C necrosis & Calcification