Chapter 129: Fluid and Electrolyte Therapy in Infants and Children

INTRODUCTION

This chapter provides a basic a guide to parenteral rehydration, maintenance fluids, and management of common electrolyte abnormalities in children.

The most common cause of fluid and electrolyte abnormalities in children is dehydration.¹ Dehydration results from a negative fluid balance due to decreased intake, increased output (renal, GI, or insensible losses from the skin or respiratory tract), or disease states such as burns, sepsis, or diabetes. Negative fluid balance can occur in the intracellular fluid or extracellular fluid compartments and may be accompanied by derangements in electrolytes. Table 129-1 lists some of the common causes of dehydration. Common signs of dehydration are listed in Table 129-2, and a validated clinical scoring system predicting the need for parenteral rehydration is provided in Table 129-7 of chapter 128, "Vomiting, Diarrhea, and Dehydration in Infants and Children."

PATHOPHYSIOLOGY

Infants and children are particularly susceptible to dehydration for a number of developmental and physiologic reasons. They are dependent on caretakers to provide oral fluids and therefore cannot regulate their intake. In addition, young children ...