Children fluid requirements

Even if a medication is available in multiple formulations and dosage forms, the prescriber must consider the absorption and distribution differences between adult and pediatric patients. Blood supply at injection or infusion site, available blood supply for unit muscle mass, and skeletal muscle mass relative to body mass vary with patient age and size, causing drug absorption to vary, as well. A rapid intravenous bolus in a pediatric patient might result in acute toxicity a slow intravenous infusion, often required in neonates, can cause erratic, unreliable drug delivery in an older child. In addition, the volume of fluid tolerated for intravenous delivery varies significantly with the age and size of the patient. The blood supply and blood flow to and from the injection site are of prime importance since a gradual decrease in blood supply per unit muscle mass is seen with maturation. In addition, the skeletal muscle mass relative to... 

The child s subsequent course was one of gradual hepatic deterioration.At age 3 years, he was noted to have ascites (intra-abdominal fluid accumulation). This progressed slowly until the age of 6 years, when severe ascites and peripheral edema necessitated the initiation of spironolactone (a potassium-sparing diuretic). Several admissions to the hospital were required over the next 6 years for ascites with scrotal edema. Serum albumin values were persistently low, less than 2.0 g/dL. During this time, the patient also had two episodes of primary peritonitis (intraperitoneal infection) and one episode of a-streptococcal sepsis. 

There are multiple formulas that can he used to fluid-resuscitate a burn patient. The Parkland formula is well established and commonly used. Before calculation can be done, it is necessary to determine the patient s weight (in kilograms) and correctly estimate the percentage TBSA burned. A good estimation tool for use in the field is the Rule of Nines (Figure 12.1). Because of their disproportionately large heads, children under 30 kg require an adjusted approximation of percentage TBSA. A child s entire head represents 18 % of the TBSA, and each lower extremity represents 14% of the TBSA. 

All pediatric intravenons infusions require safety measures to make sure the child is not fluid overloaded. Using a pump is a method of ensuring that the rate of infusion is maintained and that too much fluid is not infused at one time. Most hospitals also require... 

Methodology includes a well-hydrated child prior to the injection of tracer, which is accomplished by offering fluids freely before the injection. Anesthetic cream should be applied to relieve the discomfort of the injection this requires a 60-min wait for the cream to have its effect and so provides an opportune time for ensuring good hydration. The maximum recommended doses are Tc-99m MAGS, 80 MBq Tc-99m DTPA, 200 MBq. The minimum doses are ... 

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