Abstract
Fasting is minimized in children to reduce anxiety and irritability as well as physiologic and metabolic derangements. Fasting times have been shortened in children to 6 h for solids, 4 h for formula milk, and 1 h for clear fluids. Fasting from breast milk for 3 h is acceptable, although this may vary between centers. Neonates have low glucose stores and are at risk of hypoglycemia during fasting. It can be difficult to quantify the degree of dehydration in children, and emphasis has instead shifted to detecting ‘red flags’ warning of serious dehydration or shock. Hyponatremia is a risk of hypotonic, glucose-containing intravenous fluids, and now isotonic fluids are standard for children. Fluid therapy for neonates continues with high-glucose, low-sodium fluids because of their predisposition to hypoglycemia and poor renal concentrating ability. Blood transfusion is uncommon in children, but many recent changes in the management of critical bleeding in adults have been adapted to children.
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Fasting
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IV Fluids
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Blood Transfusion
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Review Question
Review Question
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1.
An 8 month old baby is diagnosed with intussusception and scheduled for laparotomy. The heart rate is 160 bpm and blood pressure is 75/45 mmHg. His serum electrolytes are:
Na+ 132 mmol/L (normal 135–145)
K+ 3.0 mmol/L (normal 3.5–5.5)
Cl− 102 mmol/L (normal 95–110)
Creatinine 90 μmol/L (normal 60–110)
Lactate 3 mmol/L (normal 1–1.8)
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(a)
How severely dehydrated is this baby?
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(b)
Describe your fluid management before and after surgery
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(a)
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Bergesio, R., Johnson, M. (2020). Fluid Management in Children Undergoing Surgery and Anesthesia. In: Sims, C., Weber, D., Johnson, C. (eds) A Guide to Pediatric Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-030-19246-4_5
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DOI: https://doi.org/10.1007/978-3-030-19246-4_5
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