FLUID AND ELECTROLYTE MANAGEMENT

Rationale
Prerequisites
Competencies

Rationale
All human beings need an uninterrupted supply of water, electrolytes, and energy. Excessive or diminished fluid intake or losses may lead to severe physiologic derangements, with significant morbidity and even mortality.

Prerequisites
Knowledge of the following:

• Water and electrolyte distribution in body compartments.
• The relationship between basal metabolic rate and daily water requirements.
• Daily glucose requirements.
• The role of the adrenal gland and antidiuretic hormone (ADH) in maintaining serum sodium and body water balance.
• Pathophysiology of hypernatremic and hyponatremic dehydration.

Competencies

Knowledge:

1. Describe the conditions in which fluid administration may need to be restricted (such as the syndrome of inappropriate ADH secretion, congestive heart failure, or renal failure) or increased (e.g. fever). (U)
2. Describe the physical findings in hypovolemic shock and the approach to restoration of circulating fluid volume (i.e. "rescue" fluid infusion) (U)
3. Describe the causes and consequences of fluid imbalances and electrolyte disturbances leading to dehydration and such conditions as hypernatremia, hyponatremia, hyperkalemia, hypokalemia, and severe acidosis. (U)

Skills:

1. Obtain historical and physical finding information necessary to assess the hydration status of a child. (CP)
2. Calculate and write orders for intravenous maintenance fluids for a child considering daily water and electrolyte requirements. (CP)
3. Calculate and write orders for the fluid therapy for a child with severe dehydration caused by gastroenteritis to include "rescue" fluid to replenish circulating volume, deficit fluid, and ongoing maintenance. (CP)
4. Explain to parents how to use oral rehydration therapy for mild to moderate dehydration. (CP)

Click here to link to the Clinical Case Scenarios.