Infant surgery

Infant electrolytes

Pyloric stenosis

Older children

Specific losses

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Neonates with medical/respiratory problems often require primarily glucose and calcium and no electrolytes in the first two days of life. Their initial fluids are:

D10W with 100mEq Ca Gluconate/liter @ indicated rate.

Electrolytes are then added in after 2-3 days and typical daily requirements are:

Sodium 3 mEq/kg/day

Potassium 2 mEq/kg/day

Calcium 20mg/kg/day (elemental)

Typically, this translates into D5 or D10 0.25 NS with 10mEq KCl/L and 100mEq Ca-Gluconate/L and this is the foundation for maintenance for surgical infants as well. The reason we don’t see this fluid much is that our infants get resuscitated with saline and usually get an equivalent of 0.45 NS with KCl postoperatively, then get switched to TPN until they commence feeding.

Some guidelines as to the replacement of fluid losses:  Identify the source of fluid loss. Gastric losses are best replaced with 0.45 or 0.9 NS with 20mEqKcl/L; Intestinal losses from an obstruction beyond the ampulla will contain HCO3 and can   be most easily repleted with LR. Transudative losses into the abdominal or pleural cavity approach serum electrolyte contents and 0.9 NS is usually used to replete the infant; ongoing losses are addressed by adjusting the maintenance fluid rate.

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