Fluid Therapy

in

GE Shock Vs. DSS

Dr. Aung Kyi Wynn

Senior Paediatrician

Hypovolemic shock

Different pathology

Different management

5 years old child

Body weight 15 kg

GE SHOCK OR CHOLERA SHOCK

Secretory diarrhoea

External fluid loss

From extravascular space

10% of body weight loss S/S of

shock

Fluid loading dose

R/L or N/S or D/S

25% glucose or 5% D/S (for

hypoglycemia)

20 ml/kg within 15 min

Second Loading dose if not improved

RMO/ 24 hour

Rehydration, Maintenance, Ongoing

loss

Pre-illness = measured + 10% of BW

BW BW

( 15 kg = 13.5 kg + 10% of BW)

Rehydration

10% loss – 100 ml/kg

100 ml * 15 kg = 1500 ml

30 ml/kg in first ½ hr (450 ml)

70 ml/kg in 2 ½ hr (1050 ml)

Without loading dose

Maintenance

Holliday-Segar Method (15kg = 10 + 5

)

1st 10 kg 100ml/kg

1000ml

2nd 10 - 20 kg 50ml/kg

250ml

Over 20 kg 20ml/kg _

1250

ml

Ongoing loss

From intake-output chart

10ml/kg (150 ml) for 1 time of loose

motion

Total RMO

Rehydration 1500 ml

Maintenance 1250 ml

2750 ml

Ongoing loss ?

Total 6 bottles of drip / 24 hr

Wide therapeutic index

Low risk for overloading

DSS

Immune reaction

Increase vascular permeability

Plasma leakage (from vascular space)

Third space loss (serous cavity)

Loss in 4-6% of body weight – S/S of

shock

If coagulation defect +

GI bleeding

External loss

Only overload and bleeding

Death

Loading dose (20ml/kg)

R/L or N/S

Colloid gelofusin or Plasma 10ml/kg/hr

Replacement

4% loss 5% loss 6 % loss

40 ml/kg 50 ml/kg 60 ml/kg

600 ml 750 ml 900 ml

Rate 10 or 6 or 3 or 1- 2 ml/kg/hr

Maintenance

Same 1250ml

Ongoing loss

1. Plasma leakage

2. Bleeding fresh blood 10ml/kg

1. Replacement 4% loss 5% loss 6% loss

Crystalloid (or) 600 ml 750 ml 900 ml

Colloid

2. Maintenance

Crystalloid 1250 ml 1250 ml 1250 ml

3. Ongoing loss

Crystalloid (or) ? ? ?

Fresh whole blood ? ? ?

1850 ml 2000 ml 2150 ml

1 ½ of maintenance

1250 * 1 ½ = 1875

Shock not revived when close to 24 hr

or 1850ml

Decrease PCV 20% suddenly

Fresh whole blood

Raised Hb G% = FWB ml/kg /6 = 10/6 =1.6

If raised PCV >5% wrong

decision

CRITICAL POINT DECISION

(OVERLOAD or BLEEDING)

CAN SAVE LIFE

Narrow therapeutic index

Type of fluid, rate, duration,

appropriate volume, timely

Fluid Therapy in Cholera shock Vs.

DSS

References

Handbook for clinical management of dengue –WHO 2012

The Harriet Lane Handbook – the Johns Hopkins Hospital 2000

Paediatric Management Guideline –Myanmar Paediatric Society – 2nd edition - 2011

Paediatric Protocols for Malaysian hospitals – Malaysian Paediatric Association – 2nd edition – 2010