《临床医学》课程教学资源（PPT课件讲稿）Infantile Liquid Therapy

Infantile liquid Therapy Objective Summary Characteristic of Infantile body Fluid balance Fluid, Electrolyte, Acid-base Disorders Common Solution of liquid Therapy Infantile Diarrhea Liquid Therapy

Infantile Liquid Therapy Objective Summary Characteristic of Infantile Body Fluid Balance Fluid, Electrolyte, & Acid-base Disorders Common Solution of Liquid Therapy Infantile Diarrhea Liquid Therapy

Obiective Characteristic of Infantile body Fluid balance Realized Pathophysiology of Infantile Fluid, Electrolyte acid base Imbalance Be familiar with Clinical menifestations of Infantile Fluid. Electrolyte Acid-base disorders -Mastered Common Solution Component of Liquid Therapy -Be familiar with Liquid Therapy of Infantile Diarrhea Mastered

Objective • Characteristic of Infantile Body Fluid Balance ——Realized • Pathophysiology of Infantile Fluid, Electrolyte & Acid￾base Imbalance ——Be familiar with • Clinical menifestations of Infantile Fluid , Electrolyte & Acid-base Disorders ——Mastered • Common Solution Component of Liquid Therapy ——Be familiar with • Liquid Therapy of Infantile Diarrhea ——Mastered

Summary Body fluid is important component of human body and the physiological equilibrium of body fluid is an important factor for human living. The dynamic equilibrium of fluid, electrolyte, acid-base osmotic pressure depends on normal regulating function of nerve, incretion, lung and kidney. Because of the infantile physiologic peculiarity, These systematic functions are easily affected by diseases and/or environment and are maladjusted Therefore, the disorder of water, electrolyte and acid-base is common in pediatric clinic

Summary Body fluid is important component of human body and the physiological equilibrium of body fluid is an important factor for human living. The dynamic equilibrium of fluid, electrolyte, acid-base, osmotic pressure depends on normal regulating function of nerve, incretion, lung and kidney. Because of the infantile physiologic peculiarity, These systematic functions are easily affected by diseases and/or environment and are maladjusted. Therefore, the disorder of water, electrolyte and acid-base is common in pediatric clinic

Characteristic of Infantile Body Fluid Balance A. Total body water its distribution Body water compartments related to age(total body mass % ECF ge TBW ICF Plasma ISF Newborn Intant 78 37 35 I year 70 25 40 2-14 years 66 6555 20 40 Adult 55~66 10~1540~45 TBW: total body water ECF extracellular fluid ICF intracellular fluid ISF: interstitial fluid

Characteristic of Infantile Body Fluid Balance A. Total body water & its distribution Body water compartments related to age (total body mass%) Age TBW ECF ICF Plasma ISF Newborn infant 78 6 37 35 1 year 70 5 25 40 2～14 years 66 5 20 40 Adult 55～66 5 10～15 40～45 TBW: total body water ECF: extracellular fluid ICF: intracellular fluid ISF: interestitial fluid

Characteristic of Infantile Body Fluid balance B. Electrolyte composition of body fluid ECF:Na、cr,Hco3 ICF:K+、Mg2+、HPO42、 Protein C. Water metabolism a. Large water requirements, swift water exchange unobvious water loss(double adults amount ). Infants water exchange amount is 1/2 of ecf, the adult's is Just 1/7 b. Immature body liquid regulating function, immature concentration and dilution function of infantile

Characteristic of Infantile Body Fluid Balance B. Electrolyte composition of body fluid ECF: Na+ 、 Cl-，HCO3 - ICF: K + 、Mg 2+ 、HPO4 2-、Protein C. Water metabolism a. Large water requirements, swift water exchange, unobvious water loss (double adult’s amount ). Infant’s water exchange amount is 1 / 2 of ECF , the adult’s is just 1 / 7. b. Immature body liquid regulating function , immature concentration and dilution function of infantile

Fluid, Electrolyte Acid-base Disorders A. Degree of dehydration Dehydration Mild Moderate Severe Decrease in 5% 5~10% >10% body weight 50ml /kg) (50~100ml/kg) (100~120ml/kg) pi Depressed Lethargic hyperirritable hyperirritable coma Orbit. Fontanel Sunken土 Sunken Severely sunken Skin turgor Normal± Decrease Markedly decrease Mucous membranes Dry t everely dry T ears Decrease± Decrease Absent UI rIne Mild oliguria oliguria Anuria Blood pressure Normal Normal

Fluid, Electrolyte & Acid-base Disorders A. Degree of dehydration Dehydration Mild Moderate Severe Decrease in body weight 5％ (50ml / kg) 5～10％ (50～100ml / kg) >10％ (100～120ml / kg) Psyche Depressed, hyperirritable Depressed, hyperirritable Lethargic, coma Orbit, Fontanel Sunken ± Sunken Severely sunken Skin turgor Normal ± Decrease Markedly decrease Mucous membranes Dry ± Dry Severely dry Tears Decrease ± Decrease Absent Urine Mild oliguria oliguria Anuria Blood pressure Normal Normal Low

Fluid, Electrolyte Acid-base Disorders B. Property of dehydration Type of Serum Pathophysiology dehydration Pathogeny sodium clinical characteristic ECF: decrease Acute 130~150 Osmotic pressure Isosmotic gastrointestinal intracellular= extracellular) fluid lose mmol /L Dehydrant volume accord with dehydrant physical sign ECF: severely decrease, Chronic Hypotonic gastrointestinal <130 Easily shock fluid lose mmol/L Severer dehydrant sign than the other two kinds ICF: severely decrease, High grade 150 Hyperosmotic fever, Infection mmol /L Milder dehydrant sign than the other two kinds

Type of dehydration Pathogeny Serum sodium Pathophysiology & clinical characteristic Isosmotic Acute gastrointestinal fluid lose 130～150 mmol / L ECF: decrease, Osmotic pressure (intracellular = extracellular) Dehydrant volume accord with dehydrant physical sign Hypotonic Chronic gastrointestinal fluid lose 150 mmol / L ICF: severely decrease, Milder dehydrant sign than the other two kinds Fluid, Electrolyte & Acid-base Disorders B. Property of dehydration

Fluid, Electrolyte Acid-base Disorders C. Metabolic acidosis Pathogeny 1. The lose of large amount of basic substances (gastrointestinal tract kidnevs 2. Too much Acid metabolite (hungriness, diabetes, renal failure, hypoxia) 3. Too much acid substance intake (long time to take calcium chloride ammonium chloride, amino acid etc.) D egree Mild HCO2 18-13 mmol /L Moderate HCO 13-9 mmol /L Severe HCO3 <9 mmol/L

C. Metabolic acidosis Pathogeny 1. The lose of large amount of basic substances（gastrointestinal tract, kidneys） 2. Too much Acid metabolite （hungriness, diabetes, renal failure, hypoxia） 3. Too much acid substance intake （long time to take calcium chloride, ammonium chloride, amino acid etc.） Degree Mild HCO3 - 18~13 mmol / L Moderate HCO3 - 13~9 mmol / L Severe HCO3 - <9 mmol / L Fluid, Electrolyte & Acid-base Disorders

Fluid, Electrolyte Acid-base Disorders D Hypokalemia Pathogeny 1. Lack of intake 2. Loss of kalium from kidneys or gastrointestinal tract 3. Burn. dialysis etc 4 Abnormal kalium distribution inside or outside cells (alkalosis, insulin therapy, periodic anesthesia

D. Hypokalemia Pathogeny 1. Lack of intake 2. Loss of kalium from kidneys or gastrointestinal tract 3. Burn, dialysis etc. 4. Abnormal kalium distribution inside or outside cells （alkalosis, insulin therapy、periodic anesthesia） Fluid, Electrolyte & Acid-base Disorders

Fluid, Electrolyte Acid-base Disorders Clinical menifetation 1. Nervous system -depressed 2. Muscle--inertia of limbs, muscular tension down, severely retardant paralysis, respiratory muscle paralysis 3. Heart heart rate increasing, arrhythmia, Adams-Stokes syndrome, heart rate decreasing, atrioventricular block heart sound lowering cardiogram: U wave appearing, U>T, flattened T wave 4. Kidney- concentrating function lowering, urine volume increasing

Clinical menifetation 1. Nervous system ——depressed 2. Muscle——inertia of limbs，muscular tension down，severely retardant paralysis，respiratory muscle paralysis 3. Heart —— heart rate increasing, arrhythmia, Adams－Stokes syndrome, heart rate decreasing，atrioventricular block, heart sound lowering, cardiogram: U wave appearing，U≥T， flattened T wave 4. Kidney—— concentrating function lowering, urine volume increasing Fluid, Electrolyte & Acid-base Disorders