ge shock vs dss
TRANSCRIPT
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Fluid Therapy
in
GE Shock Vs. DSS
Dr. Aung Kyi Wynn
Senior Paediatrician
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Hypovolemic shock
Different pathology
Different management
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5 years old child
Body weight 15 kg
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GE SHOCK OR CHOLERA SHOCK
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Secretory diarrhoea
External fluid loss
From extravascular space
10% of body weight loss S/S of
shock
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Fluid loading dose
R/L or N/S or D/S
25% glucose or 5% D/S (for
hypoglycemia)
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20 ml/kg within 15 min
Second Loading dose if not improved
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RMO/ 24 hour
Rehydration, Maintenance, Ongoing
loss
Pre-illness = measured + 10% of BW
BW BW
( 15 kg = 13.5 kg + 10% of BW)
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Rehydration
10% loss – 100 ml/kg
100 ml * 15 kg = 1500 ml
30 ml/kg in first ½ hr (450 ml)
70 ml/kg in 2 ½ hr (1050 ml)
Without loading dose
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Maintenance
Holliday-Segar Method (15kg = 10 + 5
)
1st 10 kg 100ml/kg
1000ml
2nd 10 - 20 kg 50ml/kg
250ml
Over 20 kg 20ml/kg _
1250
ml
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Ongoing loss
From intake-output chart
10ml/kg (150 ml) for 1 time of loose
motion
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Total RMO
Rehydration 1500 ml
Maintenance 1250 ml
2750 ml
Ongoing loss ?
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Total 6 bottles of drip / 24 hr
Wide therapeutic index
Low risk for overloading
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DSS
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Immune reaction
Increase vascular permeability
Plasma leakage (from vascular space)
Third space loss (serous cavity)
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Loss in 4-6% of body weight – S/S of
shock
If coagulation defect +
GI bleeding
External loss
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Only overload and bleeding
Death
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Loading dose (20ml/kg)
R/L or N/S
Colloid gelofusin or Plasma 10ml/kg/hr
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Replacement
4% loss 5% loss 6 % loss
40 ml/kg 50 ml/kg 60 ml/kg
600 ml 750 ml 900 ml
Rate 10 or 6 or 3 or 1- 2 ml/kg/hr
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Maintenance
Same 1250ml
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Ongoing loss
1. Plasma leakage
2. Bleeding fresh blood 10ml/kg
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1. Replacement 4% loss 5% loss 6% loss
Crystalloid (or) 600 ml 750 ml 900 ml
Colloid
2. Maintenance
Crystalloid 1250 ml 1250 ml 1250 ml
3. Ongoing loss
Crystalloid (or) ? ? ?
Fresh whole blood ? ? ?
1850 ml 2000 ml 2150 ml
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1 ½ of maintenance
1250 * 1 ½ = 1875
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Shock not revived when close to 24 hr
or 1850ml
Decrease PCV 20% suddenly
Fresh whole blood
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Raised Hb G% = FWB ml/kg /6 = 10/6 =1.6
If raised PCV >5% wrong
decision
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CRITICAL POINT DECISION
(OVERLOAD or BLEEDING)
CAN SAVE LIFE
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Narrow therapeutic index
Type of fluid, rate, duration,
appropriate volume, timely
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Fluid Therapy in Cholera shock Vs.
DSS
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References
Handbook for clinical management of dengue –WHO 2012
The Harriet Lane Handbook – the Johns Hopkins Hospital 2000
Paediatric Management Guideline –Myanmar Paediatric Society – 2nd edition - 2011
Paediatric Protocols for Malaysian hospitals – Malaysian Paediatric Association – 2nd edition – 2010
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