Fluid therapy in paediatric surgical emergencies a simplified scheme and its clinical application

A scheme is presented for fluid and electrolyte therapy in paediatric surgical patients. It was applied on 31 infants and children undergoing various surgical procedures. During application of the scheme frequent clinical assessment as well as laboratory estimation of serum electrolytes were undertaken. The clinical response was satisfactory in the majority of cases. The scheme could be applied safely to children and infants requiring emergency operation without the help of laboratory estimation except in few complicated cases. The response to intravenous fluid therapy in 31 newly born infants and children undergoing major surgery has been studied. The plan of treatment was designed to provide for correlation of dehydration if present and for maintenance of normal fluid and electrolyte levels. Solutions of glucose and of sodium chloride in varying concentrations were used to relief the dehydration, resume urinary flow and restore tissue fluids. Potassium salts were added to these solutions at the proper time. The scheme included an initial phase of 40-80 ml/kgm body weight, a maintenance quantity of 100-150 ml/kgm body weight and a replacement therapy for losses of 20 ml or more per kgm body weight. Cases with marked distension and low sodium levels and those with low potassium serum levels were given special attention. Laboratory estimations of sodium and potassium serum levels were undertaken on admission, and on the first and second post-operative days. Clinical progress in response to intravenous fluid therapy was satisfactory in the majority of cases. Since confidence in the present plan of treatment has increased, it can now be applied to children and infants requiring emergency operation without the help of laboratory estimation except in some complicated cases