Paediatric Fluid Management
As PassingTheFinal pointed out, one of the questions done badly in the April 2008 paper was one of the questions the college felt was answered badly. The question was:
A 4 year old (20 kg) is admitted with acute appendicitis and is scheduled for urgent surgery. She has
been vomiting for 2 days, is pyrexial, has a tachycardia of 170 bpm and prolonged capillary refill.
a) Describe the perioperative fluid management of this case using intravenous crystalloids. (60%)
b) Outline the complications that can occur with inappropriate intravenous crystalloid therapy. (30%)
There were several publications last year which prompted that particular question, we suspect. The first of these was the National Patient Safety Agency report into use of intravenous fluids in paediatric practice, specifically it was Reducing the risk of hyponatraemia when administering intravenous infusions to children.
Their advice essentially boils down to NOT using 0.18% NaCl with 4% glucose except in specialist areas, using 0.9% NaCl for resuscitation, and maintenance with 0.45% NaCl + 5% glucose or 0.45% NaCl + 2.5% glucose, bearing in mind these are hypotonic solutions. Hypotonic solutions should definitely not be used in children at risk of developing hyponatraemia. More info in the link above!
Another publication that will have prompted this is the Association of Paediatric Anaesthetists of Great Britatin and Ireland’s Consensus Guideline on Perioperative Fluid Management in Children from September last year. These are worth reading, if only to realise that consensus is not always easy to reach, and for some of the insights it offers!
Anaesthesia journal published an editorial in Volume 62 Issue 4 , Pages 322 - 324 (April 2007) about the guidelines.
An older article can be found in the CEACCP from the British Journal of Anaesthesia: Cunliffe M. Fluid and Electrolyte Management in Children. 2003; 3:1-4. (You will need a password for this, which you can arrange through the Royal College if you don’t already have one. To do this, email your college reference number and your name to subs@rcoa.ac.uk with a request to get access to CEACCP and BJA online.)
Hope that is useful….
Recently
Leave a Reply