Fluid Management

Includes:

• Maintenance fluids
• Calculating how fast the IVI should drip
• How to make up fluids containing 5% or 10% Dextrose
• Glucose and electrolyte content of IV fluids

Does not include:

• Treatment of Shock
  • Well nourished/severely malnourished child Shock protocol
• Management of Dehydration
  • Well-nourished child Acute gastroenteritis protocol
  • Severely malnourished child Malnutrition protocol
  • Hypernatraemic dehydration Electrolyte protocol
• Maintenance fluids for neonates Neonatology protocol

Maintenance Fluids

Calculating fluid requirement for 24 hours:
Assuming no dehydration and no extra losses (e.g. from a surgical drain or from an NGT) a child will require over 24 hours:

• 100mls x 10kg for his first 10kg = 1000mls
• + 50mls x 4kg for his next 4kg = 200mls
• Total = 1200ml over 24hours
• Which is 50mls per hour (1200mls/ 24hours) (with the second formula it would have been 40mls + 8 mls resulting in 48mls/h)

• 100mls/kg for her first 10kg=1000mls
• + 50mls/kg for her next 10kg=500mls
• + 20mls/kg for her last 15kg=300mls
• Total = 1800ml over 24hours
• Which is 75mls per hour (1800mls/ 24hours) (with the second formula it would have been 40mls + 20mls + 15mls = 75mls/h)

If there are other ongoing losses (e.g. from and NGT or from a drain) these should be added to the total daily fluid requirements

These fluid requirements are the same whether the child takes the fluid orally, by NGT or IV drip.

Calculating oral fluids requirements per feed:

Example 3
A 7 kg baby who is too breathless to breast feed, but is able to drink expressed milk from a spoon or cup will require:

• 100mls x 7kg = 700mls per 24 hours
• If the mother is feeding the child every 3 hours, then there will be a total of 8 feeds per day
• Therefore the baby will require 700mls/ 8 feeds every feed
• Which is approx 90mls of milk per feed

Feeds (EBM) can also be given 3 hourly via NG tube. Show the mother how many syringes or cups to be given at each feed.

Calculating How Fast The IVI Should 'Drip'

1. What type of giving set do you have?
   There are three types of giving sets available at QECH
   • Standard paediatric - 60 drops in 1 ml
   • Standard adult - 20 drops in 1ml
   • Other adult - 15 drops in 1ml
   • Every time you set up an IVI you should check on the giving set package to determine what type you are using
   • What rate do you want the fluids to run at - in mls/hr

You can now work out how many "drops per minute" the IVI should drip:

This can be simplified for each of the giving sets:

Example 1

• His maintenance fluid requirements are 7.2kg x 100mls = 720mls per 24 hours
• This is 30mls per hour
• (ml/hr = drops per min for 60 drops per 1ml giving set)
• 30mls per hour means that the IVI should be 'dripping' at 30 drops per minute
• This is 1 drop every 2 seconds

Example 2

• Her maintenance fluid requirements are
• (10kg x 100mls) + (10kg x 50mls) + (13kg x 20mls) = 1760mls per 24 hours
• This is 73.3mls per hour
• (Desired rate ml/hr ÷ 3 = no. of drops per min for 20 drops per 1ml giving set)
• 73 ÷ 3 means that the IVI should be 'dripping' at 24 drops per minute
• This is 4 drops every 10 seconds.

How to make up fluids containing 5% or 10% Dextrose

If you want to give a child IV fluids containing 5% dextrose or 10% dextrose and there is no suitable fluid available you will have to make it up by mixing 50% Dextrose or 25% Dextrose depending on what is available and another IV fluid. NEVER use 5% Dextrose solutions.

• If there is a burette available use a burette.
• If no burette available make sure you empty out some of the bag of Ringers Lactate/Normal Saline before adding dextrose. This will ensure that:
  • Less 50% dextrose is needed
  • If the IV fluids are accidentally left to run through the child will receive less fluid to overload them.

• The total volume in the bag should not exceed 500mls, but should usually be less - particularly in infants.

To make up 100 mls of R/L with 10% dextrose in a burette:

• Put 80ml of fluid (Normal Saline/Ringers Lactate) in burette.
• Draw up 20ml of 50% Dextrose and add to burette. (80 ÷ 4 = 20 ml)
• This makes 100ml of Normal Saline/Ringer's Lactate with 5% Dextrose.
• Label the burette using white tape, writing the type of fluid, time of commencement and rate to be given at.

To make up 400 ml of R/L with 5% dextrose without a burette.

• Take a 1L bag of Ringers Lactate and drain it until 360 ml remain.
• Draw up 40ml of 50% dextrose and add it to the bag. (360 ÷ 9 = 40 ml)
• This makes 400 ml of Ringers Lactate with 5 % Dextrose.
• Label the bag using white tape, writing the type of fluid, time of commencement and rate to be given at.

Glucose and Electrolyte content of IV fluids (contents per litre)