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*The professional part involved in this article is only for medical professionals to read for reference.
This is the most reasonable supplement.
Diarrhea is the most common type of disease in children's gastroenterology.
In severe cases, it can cause dehydration and electrolyte disorders.
If not treated in time, it can endanger the life of the child.
.
How to refill children with diarrhea and dehydration in clinical practice is a test of the basic skills of pediatricians.
Especially in primary hospitals, there are many children with diarrhea, and they must be mastered.
Here, the author, based on my clinical experience and relevant guidelines, will learn with everyone the rehydration treatment for children with dehydrated diarrhea.
▌The first step: First, a child with diarrhea and dehydration comes to see a doctor.
We need to determine the degree of dehydration in order to guide us in the next step of rehydration therapy.
1.
Clinically, the degree of dehydration is divided into mild, moderate and severe.
The specific clinical manifestations of different degrees are as follows: 2.
According to the permeability, it is divided into hypotonic dehydration, isotonic dehydration and hypertonic dehydration, as follows: ▌ Step 2: After completing the first step, then we need to understand how to refill, including how much, what, and the speed of replenishment, which is what we usually call the three settings: quantitative, qualitative, and fixed rate.
1.
The total amount of fluid replacement: consists of three parts, cumulative damage + continued loss + physiological requirements.
Mild dehydration: 90~120ml/kg·d Moderate dehydration: 120~150ml/kg·d Severe dehydration: 150~180ml/kg·d2.
The tension of rehydration: After the total amount of rehydration is determined, you should know how many sheets you need to give The liquid is used for rehydration (the preparation of liquid tension is described in detail in the pediatric textbook, so I will not repeat it here).
① Cumulative loss: Determined according to the nature of dehydration (Note: If the clinical results of serum sodium are unknown and it is difficult to judge the nature of dehydration, it can be treated as isotonic dehydration first).
Hypotonic dehydration: 2/3 sheets Isotonic dehydration: 1/2 sheets Hypertonic dehydration: 1/3 sheets ②Continuous loss: 1/2~1/3 sheets ③Physiological requirement: 1/4~1 /5 sheets 3.
The rate of rehydration: the first 1/2 of the total amount of rehydration is input within 8-12 hours, the fluid rate is 8-10ml/kg·h, and the remaining 1/2 is input within 12-16 hours.
Speed 5ml/kg·h.
▌Step 3: Start rehydration 1.
Oral rehydration: It is suitable for preventing dehydration and treating mild and moderate dehydration.
It is recommended to choose hypotonic ORS.
①Prevent dehydration: From the beginning of diarrhea, children should be given enough oral fluids to prevent dehydration, ORS and other cleansing water should be given, and a certain amount of fluid should be added after each loose stool until the diarrhea stops.
(Note: Use ORS with caution in neonates) ②Treat mild and moderate dehydration: ORS dosage (ml) = weight (kg) × (50~75), take it within 4 hours.
Evaluate dehydration after 4 hours, and then choose an appropriate plan.
2.
Intravenous fluids: suitable for ① moderate and severe dehydration; ② severe vomiting, diarrhea or abdominal distension.
Note: If the child is severely dehydrated with peripheral circulatory disturbances, the volume must be expanded first.
(1) Fluid supplementation on the first day: The process is as follows (see Figure 1) ① Use 2:1 isotonic sodium-containing solution 20ml/kg, intravenous bolus or rapid instillation within 30-60 minutes to rapidly increase blood volume and improve circulation Re-evaluate dehydration after volume expansion.
If you are still in shock, you can reuse isotonic sodium-containing solution for 1 to 2 times.
(Only used for severe dehydration with peripheral circulatory disturbances) ②Mainly to replenish the accumulated loss: if there is no circulatory disturbance, rehydration starts at this stage.
If there is an expansion, the expansion capacity needs to be subtracted.
Replenishment cumulative loss = total fluid replacement ÷ 2-(capacity expansion), drip in 8~12 hours, liquid rate 8~10ml/kg·h.
③Continue the rehydration stage: replenish the remaining 1/2 amount, drip in 12 to 16 hours at a liquid rate of 5ml/kg·h.
Figure 1: Flow chart of intravenous rehydration (quoted from Pediatrics 8th Edition) (2) Day 2 rehydration: After the first day of rehydration, dehydration and electrolyte disturbances are basically corrected, and the second day mainly supplements the physiological requirements and continued loss ORS can generally be taken orally.
If diarrhea is still frequent or those who cannot take it, intravenous rehydration.
The physiological requirement is 60~80ml/kg, and the amount of continued loss is replenished according to how much is lost.
The rehydration tension is 1/3 sheets.
Example: A child, 2 years old, weighing 12 kg, was admitted to the hospital for "vomiting and loose stools for 2 days".
Since the onset, frequent vomiting, loose watery stools, stool frequency about 10 times a day, irritability, poor appetite, and a significant decrease in urine output.
Physical examination: mental irritability.
The skin and mucous membrane all over the body are dry and have poor elasticity.
Sunken eye sockets on both sides.
Dry lips.
Auxiliary examination: renal function suggests serum Na: 135mmol/L.
Diagnosis: 1.
Acute gastroenteritis; 2.
Moderate isotonic dehydration.
The intravenous rehydration process on the first day is as follows: 1.
First calculate the total amount of rehydration: the child is moderately dehydrated, the total amount of rehydration is 120~150ml/kg, here we take 150ml/kg, that is, the total amount of rehydration is 12×150= 1800ml.
2.
Supplement the cumulative loss: cumulative loss=1800÷2=900ml, because the child is isotonic dehydration, so we choose 1/2 Zhang solution, that is, 2:3:1 sodium-containing solution (2 parts 0.
9% NaCl +3 copies of 5%GS+1 copies of 1.
4%NaHCO3).
The amount of each serving is 900÷6=150ml0.
9%NaCl: 150×2=300ml5%GS:150×3=450ml1.
4%NaHCO3=150×1=150ml3, the stage of continued rehydration: supplement the continued loss and physiological needs The amount of rehydration is 1/2 of the remaining, that is, 900ml.
Choose 1/3 of the solution, that is, 1:2 sodium-containing solution (1 part of 0.
9% NaCl + 2 parts of 5% GS). The amount per serving is 900÷3=300ml 0.
9% NaCl: 300×1=300ml 5%GS: 300×2=600ml Of course, in addition to rehydration treatment for children with diarrhea and dehydration, it also includes potassium, calcium, and magnesium supplements , Zinc supplements, microecological preparations, intestinal mucosal protective agents, diet and other treatments, sensitive antibiotics should be used for bacterial infections.
After mastering the rehydration treatment for children with diarrhea and dehydration, it is necessary for pediatricians to practice more clinically, apply theoretical knowledge in clinical practice, and be able to make the most reasonable rehydration strategy based on the child’s condition.
The health of children with diarrhea is escorted.
References: 1.
Hu Yamei, et al.
Zhu Futang Practical Pediatrics.
8th edition [M].
People's Medical Publishing House.
2.
Wang Weiping, et al.
Pediatrics.
8th edition [M].
People's Medical Publishing House.
3 .
Gastroenterology Group of Pediatrics Branch of Chinese Medical Association, Editorial Board of Chinese Journal of Pediatrics.
Clinical Practice Guidelines for Acute Infectious Diarrhea in Children in China[J].
Chinese Journal of Pediatrics, 2016, 54(7):483-488.
4.
Fan Juan , Li Maojun, Wu Qing, et al.
Diagnosis and management of infectious diarrhea in children——Introduction to the 2017 American Academy of Infectious Diseases Clinical Practice Guidelines for the Diagnosis and Treatment of Infectious Diarrhea[J].
Chinese Journal of Practical Pediatrics, 2019, 34(15 ): 1121-1126.
This is the most reasonable supplement.
Diarrhea is the most common type of disease in children's gastroenterology.
In severe cases, it can cause dehydration and electrolyte disorders.
If not treated in time, it can endanger the life of the child.
.
How to refill children with diarrhea and dehydration in clinical practice is a test of the basic skills of pediatricians.
Especially in primary hospitals, there are many children with diarrhea, and they must be mastered.
Here, the author, based on my clinical experience and relevant guidelines, will learn with everyone the rehydration treatment for children with dehydrated diarrhea.
▌The first step: First, a child with diarrhea and dehydration comes to see a doctor.
We need to determine the degree of dehydration in order to guide us in the next step of rehydration therapy.
1.
Clinically, the degree of dehydration is divided into mild, moderate and severe.
The specific clinical manifestations of different degrees are as follows: 2.
According to the permeability, it is divided into hypotonic dehydration, isotonic dehydration and hypertonic dehydration, as follows: ▌ Step 2: After completing the first step, then we need to understand how to refill, including how much, what, and the speed of replenishment, which is what we usually call the three settings: quantitative, qualitative, and fixed rate.
1.
The total amount of fluid replacement: consists of three parts, cumulative damage + continued loss + physiological requirements.
Mild dehydration: 90~120ml/kg·d Moderate dehydration: 120~150ml/kg·d Severe dehydration: 150~180ml/kg·d2.
The tension of rehydration: After the total amount of rehydration is determined, you should know how many sheets you need to give The liquid is used for rehydration (the preparation of liquid tension is described in detail in the pediatric textbook, so I will not repeat it here).
① Cumulative loss: Determined according to the nature of dehydration (Note: If the clinical results of serum sodium are unknown and it is difficult to judge the nature of dehydration, it can be treated as isotonic dehydration first).
Hypotonic dehydration: 2/3 sheets Isotonic dehydration: 1/2 sheets Hypertonic dehydration: 1/3 sheets ②Continuous loss: 1/2~1/3 sheets ③Physiological requirement: 1/4~1 /5 sheets 3.
The rate of rehydration: the first 1/2 of the total amount of rehydration is input within 8-12 hours, the fluid rate is 8-10ml/kg·h, and the remaining 1/2 is input within 12-16 hours.
Speed 5ml/kg·h.
▌Step 3: Start rehydration 1.
Oral rehydration: It is suitable for preventing dehydration and treating mild and moderate dehydration.
It is recommended to choose hypotonic ORS.
①Prevent dehydration: From the beginning of diarrhea, children should be given enough oral fluids to prevent dehydration, ORS and other cleansing water should be given, and a certain amount of fluid should be added after each loose stool until the diarrhea stops.
(Note: Use ORS with caution in neonates) ②Treat mild and moderate dehydration: ORS dosage (ml) = weight (kg) × (50~75), take it within 4 hours.
Evaluate dehydration after 4 hours, and then choose an appropriate plan.
2.
Intravenous fluids: suitable for ① moderate and severe dehydration; ② severe vomiting, diarrhea or abdominal distension.
Note: If the child is severely dehydrated with peripheral circulatory disturbances, the volume must be expanded first.
(1) Fluid supplementation on the first day: The process is as follows (see Figure 1) ① Use 2:1 isotonic sodium-containing solution 20ml/kg, intravenous bolus or rapid instillation within 30-60 minutes to rapidly increase blood volume and improve circulation Re-evaluate dehydration after volume expansion.
If you are still in shock, you can reuse isotonic sodium-containing solution for 1 to 2 times.
(Only used for severe dehydration with peripheral circulatory disturbances) ②Mainly to replenish the accumulated loss: if there is no circulatory disturbance, rehydration starts at this stage.
If there is an expansion, the expansion capacity needs to be subtracted.
Replenishment cumulative loss = total fluid replacement ÷ 2-(capacity expansion), drip in 8~12 hours, liquid rate 8~10ml/kg·h.
③Continue the rehydration stage: replenish the remaining 1/2 amount, drip in 12 to 16 hours at a liquid rate of 5ml/kg·h.
Figure 1: Flow chart of intravenous rehydration (quoted from Pediatrics 8th Edition) (2) Day 2 rehydration: After the first day of rehydration, dehydration and electrolyte disturbances are basically corrected, and the second day mainly supplements the physiological requirements and continued loss ORS can generally be taken orally.
If diarrhea is still frequent or those who cannot take it, intravenous rehydration.
The physiological requirement is 60~80ml/kg, and the amount of continued loss is replenished according to how much is lost.
The rehydration tension is 1/3 sheets.
Example: A child, 2 years old, weighing 12 kg, was admitted to the hospital for "vomiting and loose stools for 2 days".
Since the onset, frequent vomiting, loose watery stools, stool frequency about 10 times a day, irritability, poor appetite, and a significant decrease in urine output.
Physical examination: mental irritability.
The skin and mucous membrane all over the body are dry and have poor elasticity.
Sunken eye sockets on both sides.
Dry lips.
Auxiliary examination: renal function suggests serum Na: 135mmol/L.
Diagnosis: 1.
Acute gastroenteritis; 2.
Moderate isotonic dehydration.
The intravenous rehydration process on the first day is as follows: 1.
First calculate the total amount of rehydration: the child is moderately dehydrated, the total amount of rehydration is 120~150ml/kg, here we take 150ml/kg, that is, the total amount of rehydration is 12×150= 1800ml.
2.
Supplement the cumulative loss: cumulative loss=1800÷2=900ml, because the child is isotonic dehydration, so we choose 1/2 Zhang solution, that is, 2:3:1 sodium-containing solution (2 parts 0.
9% NaCl +3 copies of 5%GS+1 copies of 1.
4%NaHCO3).
The amount of each serving is 900÷6=150ml0.
9%NaCl: 150×2=300ml5%GS:150×3=450ml1.
4%NaHCO3=150×1=150ml3, the stage of continued rehydration: supplement the continued loss and physiological needs The amount of rehydration is 1/2 of the remaining, that is, 900ml.
Choose 1/3 of the solution, that is, 1:2 sodium-containing solution (1 part of 0.
9% NaCl + 2 parts of 5% GS). The amount per serving is 900÷3=300ml 0.
9% NaCl: 300×1=300ml 5%GS: 300×2=600ml Of course, in addition to rehydration treatment for children with diarrhea and dehydration, it also includes potassium, calcium, and magnesium supplements , Zinc supplements, microecological preparations, intestinal mucosal protective agents, diet and other treatments, sensitive antibiotics should be used for bacterial infections.
After mastering the rehydration treatment for children with diarrhea and dehydration, it is necessary for pediatricians to practice more clinically, apply theoretical knowledge in clinical practice, and be able to make the most reasonable rehydration strategy based on the child’s condition.
The health of children with diarrhea is escorted.
References: 1.
Hu Yamei, et al.
Zhu Futang Practical Pediatrics.
8th edition [M].
People's Medical Publishing House.
2.
Wang Weiping, et al.
Pediatrics.
8th edition [M].
People's Medical Publishing House.
3 .
Gastroenterology Group of Pediatrics Branch of Chinese Medical Association, Editorial Board of Chinese Journal of Pediatrics.
Clinical Practice Guidelines for Acute Infectious Diarrhea in Children in China[J].
Chinese Journal of Pediatrics, 2016, 54(7):483-488.
4.
Fan Juan , Li Maojun, Wu Qing, et al.
Diagnosis and management of infectious diarrhea in children——Introduction to the 2017 American Academy of Infectious Diseases Clinical Practice Guidelines for the Diagnosis and Treatment of Infectious Diarrhea[J].
Chinese Journal of Practical Pediatrics, 2019, 34(15 ): 1121-1126.
