"""Raw"" Formula for Calculating Maintenance Fluid Volumes in Low Birth-Weight and Premature Babies"

BACKGROUND.Fluid management of low birth weight and preterm babies can be challenging; as the determination of maintenance fluid volumes have to be calculated to suit the demands of this delicate neonates in order to avoid fluid over-load or dehydration. It is on this background that this study to derive an easy to use formula for calculating maintenance fluid volumes in this category of babies was embarked upon; utilizing existing Tables.METHOD.One of the most developed Tables on this subject matter; the 'Paediatric Surgical Unit Guidelines; Sheffield Children's Hospital' was selected; re-ordered; subjected to analysis; factorization and simplification; in order to derive the formula. To validate its accuracy the Table was re-constructed using the derived Formula. The derived Table was then compared with the original table. The paired sample T- test; using variation in days and in weights; did not show any statistically significant (p0.05) difference between the two Tables RESULTS.From the Table the formula; 20{(R+A)-W}; ml kg~ 1 day~ 1 was derived. This translates to 20(R+A-W) ml kg~ 1 day 1or 0.8(R+A-W) ml kg ~ 1Hr~ K Where: R - Rehydration factor (ranging mostly from 3 to 5); A

New thoughts on Acute Volume Therapy

Modern fluid therapy requires an understanding of the underlying physiological abnormalities induced by acute illness; the nature of the fluids to be administered; the differences between the various intravenous fluid preparations and concepts regarding appropriate amounts of volume to be given. Crystalloid solutions expand the extracellular fluid (ECF) space and are redistributed between the intravascular and extracellular compartments in a ratio of 1:4 in proportion to the normal distribution of fluid between these two spaces. The most widely used crystalloids; 0.9saline and balanced salt solutions such as Ringer's lactate; fall well short of the desired composition. 'Normal' saline is significantly hypertonic (osmolality 308 mOsm/l) and has a very high chloride content (154 mmol/l; normal plasma range 95 - 105 mmol/l). Infusions of as little as 2 litre 0.9saline during surgical procedures will produce a significant; metabolic acidosis owing to the chloride load. Ringer's lactate (or acetate); like 0.9saline; is not an ideal solution. The Cl- content is substantially higher than plasma chloride (111mmol/l); the Na+ content lower (131 mmol/l) and the osmolarity of the solution is 274 mOsm/l. Colloids are suspensions of particles of various sizes that aim to maintain plasma volume by maintaining the colloid osmotic pressure in plasma; thus retaining the administered volume within the circulation. Recently the 'third space' concept has been questioned and attention has focused on the potential adverse effects of excess administration of crystalloid solutions. Intravenous fluid loading is often used as first-line therapy for patients with hypotension or circulatory failure; but in only half of patients does cardiac output respond positively after fluid challenge. For the remainder of patients fluid loading may be associated with adverse consequences. Mechanically ventilated patients have a higher mean CVP; more indicative of mean intrathoracic pressure than of cardiac filling or intravascular fluid status. The patient who demonstrates a positive response to passive leg raising has been reliably shown to benefit from the administration of intravenous fluid. It has recently been established that not only systolic pressure variation but also several analogous derivatives provide valuable clinical information on a continuous basis. The predictive value of systolic pressure variation is well attested to in ventilated patients. Patients breathing spontaneously demonstrate the same phenomenon; but critical assessment is more difficult

Bien utiliser les sels de rehydratation orale

N.A.

Les diarrhees chez les enfants; vive la rehydratation !

Le Burkina Faso traverse un contexte epidemiologique difficile. Les diarrhees infantiles sont endemiques; avec des pics pendant la saison hivernale. La mortalite imputable a ces diarrhees est importante. Pourtant; des moyens simples et efficaces existent pour reduire fortement cette mortalite.

Clinical trial of pap-salt solution in the treatment of dehydrated children

In a randomised clinical trial; the efficacy of pap-salt solution (PSS) was compared with the WHO oral rehydration salt (ORS) solution in 212 children; aged between six months and five years. All the children who received PSS were successfully treated and there was no difference (p0.05) in the pre- and post-treatment values of the serum electrolytes in the two groups of children. Pap-salt solution was acceptable to the patients; readily available and much cheaper than the ORS solution. PSS is; therefore; recommended for the rehydration of children with mild and some degree of dehydration in situations where ORS solution is not available

Incidence et traitement de la diarrhee chez les enfants de moins de 5 ans en zones rurale et urbaine au Cameroun

Cette etude fait etat de l'incidence de la diarrhee chez 1348 enfants d'Edea-Ville et chez 1377 enfants du Departement du Nkam selon la technique d'echantillonnage aleatoire portant sur 30 grappes. L'etude montre en effet une augmentation de la frequence des episodes diarrheiques ville par rapport a la compagne. Les conduites therapeutiques sont elles aussi differentes car si en ville les parents preferent acheter des medicaments dans les villages les parents cherchent un traitement traditionnel. Les sels de rehydratation par voie orale sont presque inconnus et le faible pour centage des parents qui savent les preparer les utilise tres rarement. L'etude discute les raisons de cette faible utilisation et propose quelques solutions pour en augmenter l'emploi

ORT management at Chintheche

This article gives a brief summary on Oral Rehydration Therapy [ORT] practices by mothers at Chintheche Rural Hospital in Nkhata Bay District on early home management of under five children dith diarrhoea

Oral rehydration therapy in Malawi: impact on the severity of disease and on hospital admissions; treatment practices; and recurrent costs

In the first 2 years following refresher training of paediatric staff in oral rehydration therapy (ORT) and the establishment of an oral rehydration unit at the Kamuzu Central Hospital; Lilongwe; Malawi; there was a 50 percent decrease in the number of children admitted to the paediatric ward with the diagnosis of diarrhoeal diseases; a 56 percent decrease in the use of intravenous fluid to rehydrate such children; a threefold increase in the use of oral rehydration salts (ORS) exclusively to rehydrate children with mild or moderate dehydration; and a 39 percent decrease in the number of paediatric deaths associated with diarrhoeal diseases. Over the same period; there was a 32 percent decrease in recurrent hospital costs attributable to paediatric diarrhoeal diseases. As use of ORT continues to increase in Malawi; where diarrhoeal diseases account for 9 percent of paediatric hospital admissions; there should be considerable decreases in mortality from such diseases and concomitant increases in cost savings attributable to them

The efficacy of maize porridge based ORS in the treatment of dehydration due to acute infantile and childhood diarrhoeas

The results indicate that maize porridge based ORS is superior to the standard WHO-ORS in reducing stool output and fluid requirement in children with dehydration due to acute diarrhoea. It however offers no advantage over WHO-ORS in terms of weight gain and duration of hospital stay. We conclude that maize-ORS can safely be used in the treatment of mild to moderate dehydration due to acute diarrhoea

Food and fluid intake and weight changes in children hospitalised for measles in Muhimbili Medical Centre; Dar es salaam; Tanzania

168 children; 80 percent below 36 months of age; were weighed daily from admission until discharge or death. Food and fluid consumed by the first 82 children was weighed and recorded daily. The body weight of the children at discharge was not significantly different from that at admission. The mean daily fluid; protein and caloric intake for all children were below the recommended allowance for their weight and age

Oral rehydration therapy at Kamuzu Central Hospital

A look at how ORT was introduced to nurses and guardians at the pediatric ward of Kamuzu Central Hospital as part of the management of diarrhoea

Establishment of a regional oral rehydration training centre in Malawi: a feasibility report

The report concludes that there is a need for training in Oral Rehydration Therapy [ORT] and the standardization of oral rehydration salts [ORS] solutions; therefore a Regional Oral Rehydration Training Centre is needed and the project is feasible

Supervisors' manual for priority disease practices

This series; supported by the HEALTHCOM project; was designed to improve the communication skills of health workers and supervisors in child survival. The manuals were written to accompany tapes

Health workers' manual for priority disease practices

This series; supported by the HEALTHCOM Project; was designed to improve the communication skills of health workers and supervisors in child survival. The manuals were written to accompany tapes

Malawi national control of diarrhoeal disease programme: five year implementation plan; 1985-1989

Activities of the CDD Programme during the years 1985-1989 will include the promotion and development of oral rehydration salts [ORS] solutions; the distribution of ORS packets and oral rehydration therapy [ORT] materials and the training and education of ORT

Oral rehydration therapy in Malawi: impact on hospital admissions; hospital treatment practices and severity of disease

After the first two years after refresher training of pediatric staff in oral rehydration therapy [ORT] and the establishment of an oral rehydration unit at Kamuzu Central Hospital [KCH]; Lilongwe; there was a 50 percent decrease in the number of children admitted to the pediatric ward with the diagnosis of diarrheal disease; a 56 percent decrease in the use of intravenous fluid for rehydration of children hospitalized with diarrheal disease and a 70 percent increase in the use of oral rehydration salts [ORS] exclusively to rehydrate children with mild or moderate dehydration