Daily Fluid Balance & Prescription Chart Page 2
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1
2Calculation guidance for intravenous therapy for children over 4 weeks & under 16 years
Clinical signs of dehydration
CHILD
based on Parenteral Fluid Therapy Wallchart for children and young people - May 2014
Degree of
Signs are ordered in
RESUSCITATION = B
Dehydration
each column by severity
Fluid bolus volume for shocked patients =
I
Given over less than 15 minutes.
Required bolus volume (ml) = body weight (kg) x 20
=
I
ml
Moderate,
5% Dry mucous membranes (be wary in the mouth breather)
but if the setting is trauma or DKA x 10
=
I
ml
Diminished skin turgor (pinch test 1-2 sec)
Record this bolus volume
I
(mI) in prescription box below and identify this fluid bolus volume with letter
B
Altered neurological status (drowsiness, irritability)
Use only sodium chloride 0.9% - repeat if necessary -
REASSESS
- call for senior help
Deep (acidotic) breathing
For DKA / neonates, use separate prescription protocols.
REPLACEMENT: REDISTRIBUTION
Severe,
8% Decreased peripheral perfusion
Fluid deficit calculations (maximum 8%)
= D
Cool/mottled/pale peripheries
Yesterday’s Date
% of dehydration
x bodyweight in kg
x 10
=
11
ml
Capillary refill time > 2 sec
Amount given as fluid bolus volume
=
I
ml
Grand total in
Grand total out
Balance
Circulatory collapse
Residual deficit
(11 minus 1
)
=
111
ml
Give residual deficit over 48 hours (
111 divided by 48
)
=
1V
ml/hr
Do not use more than 8% dehydration in calculations.
Prescribe the calculated Maintenance and Deficit fluids individually.
Additional ongoing losses volume (e.g. vomiting, diarrhoea, drainage)
= O
Recent Weight
kg
/
/
Calculate at least every 4 hours (unless otherwise instructed)
Weighed
Replace lost volume with an equal volume of fluid (usually 0.9% saline + /- KCL)
=
V
ml
Estimated
ROUTINE MAINTENANCE = M
Date
Time
Weight
Na
K
Urea
Creatinine
Glucose
Chloride
Bicarbonate
Maintenance Fluid - in females > 40kg max 2000 ml/day, in males > 60kg max 2500 ml/day (equivalent to 80 & 100 ml/hour respectively)
(kg)
(mmol/L)
(mmol/L)
(mmol/L)
(micromol/L)
(mmol/L)
(mmol/L)
(mmol/L)
First 10kg;
4ml/kg/hr
=
VI
ml/hr
Second 10kg;
2ml/kg/hr
=
VII
ml/hr
For each kg over 20kg;
1ml/kg/hr
=
VIII
ml/hr
Maintenance total (
V1 + V11 +
V111)
=
IX
ml/hr
Consider reducing maintenance volume to 2/3 if risk of hyponatraemia is high.
=
IX
ml/hr
Prescribe the calculated Maintenance and Deficit fluids individually.
Indications - all that apply: Fluid Bolus volume, Deficit, On-going loss volume, Maintenance, Drug Prescription
* Medicines must be recorded in Drug Kardex
** Model name, Serial number.
Date
Time
Volume
Infusion Fluid/Type
Additives *
Rate ml/hr
Prescriber’s
Administered
Checked
Batch/Lot No.
Pump
Start
Finish
Volume
Range
Signature
By
By
& Expiry Date
Details **
given
Time
Time
a
b
c
d
e
f
g
h
i
j
REASSESSMENT
Is patients hydration improving?
Special Instructions:
Date
Time
Is infusion prescription still suitable? Doctors Signature
Are oral fluids now appropriate?
Yes or No
12 hour
Is potassium needed?
Reassessment
Yes or No
What about Urine output?
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