![]() Physiologically the amount of fluid filtering outward from the arterial ends of the capillaries equals almost exactly the fluid returned to the circulation by absorption. The Starling hypothesis says that the fluid movement due to filtration across the capillary wall is dependent on the balance between the hydrostatic and the oncotic pressure gradient across the capillary wall. At equilibrium the product of molar concentration of diffusible ions on either side of membrane will equal, maintaining the electrical neutrality. By definition Donnan effect states that when a semipermeable membrane separates a solution of non-diffusible ions from another solution of diffusible ions, equilibrium is attained with unequal distribution of diffusible ions across the semipermeable membrane due to presence of proteins. The distribution of content (fluid and ions) in ECF and ICF compartment is controlled by the Donnan effect and Starling forces. Interstitial fluid has lower proteins but otherwise has a composition equivalent to ICF. Intracellular compartment predominantly consists of potassium (K), magnesium (Mg), proteins, and phosphates. Sodium (Na +) is the primary cation and chloride (Cl -) the major anion in plasma which is part of extracellular compartment. The Intracellular fluid accounts for two-thirds of body water and around 24 weeks gestation, close 80% of total body weight of the fetus is made up of water, which reduces to around 60% at the age of one year of age and in adults it is between 50% and 60%. We performed a PUBMED search for articles using keywords including ‘children’, ‘intravenous fluid therapy’, ‘crystalloids’, ‘colloids’, ‘fluid homeostasis’, ‘blood loss’, ‘estimation of blood loss’, ‘blood loss management’, ‘perioperative fluid ‘ to get our source articles.ĭistribution of Body water in a 30 kg child ![]() This review is an attempt to provide a historical perspective and current evidence-based approach to peri-operative pediatric fluid management. Recently, there has been a lot of debate about this concept, especially as there are serious concerns regarding the development of complications like hyponatremia and hyperglycemia, both of which can result in neurological damage or even mortality in a sick child. Anesthetists have always followed pediatric maintenance fluid calculations based on Holiday and Segar formula based on studies conducted on healthy children more than 70 years ago. In perioperative setup, the fluid is administered to meet fluid deficits (fasting, and other daily based losses), blood losses and third space losses. Pediatric population is heterogeneous so one formula may not suffice and hence both the quantitative and qualitative perspective of fluid management should be based on physiology and pathology of the child along with their perioperative needs. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.Appropriate fluid management is vital for adequate tissue perfusion and balancing the internal milieu especially in perioperative settings and critically ill children. ![]() CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.Īccordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. ![]() The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. Use of this site is subject to the Terms of Use. ©2023 by Children's Hospital of Philadelphia, all rights reserved. If you have questions about any of the clinical pathways or about the process of creating a clinical pathway please contact us. ![]()
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