Memilih dan Menghitung Jenis dan Jumlah Cairan Intravena Pasien Anak

Summary

This video explains the calculation and administration of intravenous fluids for children in different scenarios: maintenance, replacement, and resuscitation. It covers essential formulas like the Holiday-Segar formula for determining daily fluid needs based on a child's weight and age, and how to adjust for dehydration and fluid loss due to illness. The video also highlights the selection of appropriate fluids such as isotonic crystalloid solutions and potassium supplements, depending on the child’s condition, and the use of resuscitation fluids in cases of shock. Clear instructions are provided for fluid calculation in various clinical situations.

Takeaways

• 😀 Fluid management for children involves three main goals: maintenance fluid, replacement fluid, and resuscitation fluid.
• 😀 Maintenance fluid is the minimum fluid requirement for children who cannot take oral fluids, and it is calculated using the Holiday-Segar formula.
• 😀 The Holiday-Segar formula calculates fluid requirements based on a child's weight: 100 ml/kg for the first 10 kg, 50 ml/kg for the next 10 kg, and 20 ml/kg for any weight above 20 kg.
• 😀 For neonates (under 28 days old), the fluid requirement formula is different, with higher glucose percentages depending on the presence of serious diseases.
• 😀 Replacement fluid is used when there is fluid loss due to factors such as vomiting, diarrhea, or fever, and may include electrolyte supplements like potassium.
• 😀 Potassium-supplemented fluids (such as KN3B) may be given to children experiencing fluid loss with high potassium levels from conditions like vomiting or diarrhea.
• 😀 For patients with dengue fever, it is recommended to avoid lactated Ringer's solution and use a different fluid such as Ringer's acetate to avoid additional liver burden.
• 😀 The fluid deficit is calculated by determining the percentage of dehydration based on weight loss, which helps in correcting the fluid imbalance.
• 😀 Dehydration percentage can be assessed both clinically (e.g., signs of dry mouth, sunken eyes) and through weight measurements before and after illness.
• 😀 Resuscitation fluid is provided to children in shock, with a recommended initial bolus of 10 ml/kg of normal saline (NS 0.9%) within 10 minutes for rapid restoration of circulation.

Q & A

What is the purpose of fluid maintenance for children?

Fluid maintenance is the minimum fluid requirement for children who cannot intake fluids orally, ensuring they receive adequate hydration to maintain normal bodily functions.

What formula is used to calculate fluid maintenance for children over 28 days old?

The Holiday-Segar formula is used: 100 ml/kg/day for the first 10 kg, 50 ml/kg/day for the next 10 kg, and 20 ml/kg/day for the remaining weight.

How do you calculate the fluid maintenance for a 40 kg child using the Holiday-Segar formula?

For a 40 kg child, the calculation would be: 10 kg × 100 ml = 1000 ml, 10 kg × 50 ml = 500 ml, 20 kg × 20 ml = 400 ml. The total is 1000 ml + 500 ml + 400 ml = 1900 ml/day, which is 79.17 ml/hour.

What is the recommended fluid choice for children older than 28 days requiring fluid maintenance?

For children older than 28 days, the recommended fluid choice is crystalloid isotonic solutions with 5% glucose, such as D5NS (5% glucose with normal saline) or D5RL.

What is fluid replacement, and when is it necessary?

Fluid replacement is required for patients who experience fluid loss due to conditions like vomiting, diarrhea, fever, or dehydration. It helps replenish lost fluids and maintain proper hydration.

What fluid should be used for children experiencing vomiting or diarrhea?

Children with vomiting or diarrhea, which causes loss of potassium, may need fluids with added potassium, such as KN3B, which has higher potassium levels than sodium.

Why is Ringer's Lactate avoided in patients with Dengue Hemorrhagic Fever (DHF)?

Ringer's Lactate is avoided in DHF because its lactate is metabolized in the liver, and patients with DHF often have liver dysfunction. Instead, Ringer's Acetate is used because it is metabolized in muscle tissue.

How do you calculate fluid deficit in a dehydrated child?

Fluid deficit is calculated by multiplying the percentage of dehydration by the child’s weight and then multiplying by 10 ml. For example, a 40 kg child with 5% dehydration would have a deficit of 40 kg × 5% × 10 ml = 2000 ml.

What is the purpose of fluid resuscitation in children?

Fluid resuscitation is given to children in shock to stabilize their condition quickly. It involves administering a bolus of fluids, typically Normal Saline 0.9%, at a dose of 10 ml/kg within 10 minutes.

What fluid should be used for children in shock, and what is the typical dose?

In cases of shock, the recommended fluid is Normal Saline 0.9%. The typical dose is 10 ml/kg, administered over less than 10 minutes. The dose may be adjusted for neonates or patients with specific conditions.