Pediatric Fluid and Electrolyte

A child can lose a clinically important fraction of circulating volume before the absolute volume loss appears large. Diarrhea, vomiting, fever, tachypnea, poor intake, burns, renal losses, and third spacing may produce dehydration, while excessive hypotonic fluid, impaired water excretion, or inappropriate antidiuretic hormone release may produce dilutional hyponatremia. The nurse’s first task is to determine whether the child has impaired perfusion, a dangerous sodium disturbance, or both. Fluid therapy is not a single prescription. The correct fluid, rate, and monitoring plan change with the child’s weight, age, diagnosis, serum sodium, renal function, ongoing losses, and response to treatment. A maintenance order for a stable child must not be applied automatically to a child with shock, diabetic ketoacidosis, renal dysfunction, severe burns, or neurologic disease.