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Discussion in 'Clinical Rotations' started by mmmcdowe, Jul 24, 2011.
What is the rule of thumb on when you switch from quarter to half normal. Is it at 10 or 20kg?
10 kg, but I was taught that this was really old dogma and that any kid a week old could handle the real stuff
There are so many kids that get hypotonic fluids for no reason. If they aren't a neonate and they don't have huge free water losses (like infectious diarrhea) then give them d5 NS and avoid the slow downward crawl of your sodium that no one seems to notice.
I just do D5 1/2NS for under a year honestly. But then I rarely need to start that stuff in the ER, I just tend to bolus it.
You mean you bolus NS...right?
For everyone's education - the basis for doing 1/4 or 1/3NS is due to the estimated range of Na being 2-4 mEq/kg/day. On the lower end of things, at 20kg, you're closer to 1/4NS, while at the upper end of the range, you're at 1/2 NS. As far as I know, there are no studies showing a benefit to using hypotonic solutions. The Peds Nephrologists will still discuss the appropriateness of using hypotonic fluids, but practically...it's a moot point. In the NICU, the babies are going to be on TPN within 24 hours with precisely controlled levels of sodium, and if you've made it home and then come into the ED sick, you're going to get resuscitated with NS, and on the floor, likely going to get D5 1/2NS...
I did bolus D5,1/2 one time off the maintenance drip, having one IV and running the baby up to the PICU myself 5 minutes into the bolus, but that is the exception. NS for boluses. D5 1/2 for Maintenance type drips.
(the bolus in that case was for catch-up purposes, not for resuscitation.)
To my understanding you always bolus at full NS... and then rehydrate at 1/4 or 1/2 NS depending on the weight (split half and half over 8, then 16 hours) and then maintenance can ALWAYS be on 1/4 NS if you like.
Please do correct me if I'm wrong.
I would disagree that you can ALWAYS use 1/4NS for maintenance fluids. In fact, I would argue that most cases, you will not use 1/4 NS more likely D5 1/2 NS or 1/2NS for maintenance IVFs. Barring your renal kids and sick neonates, most kids should be able to handle 1/2 NS. Plus 1/4NS as maintenance fluids runs the risk of putting your patient hyponatremic. And yes, you bolus with NS.