Dehydration in children and toxicosis with exsicosis at an early age

Toxicosis with early-stage exciticosis (intestinal toxicosis) is a syndrome complex characterized by dehydration, CNS damage and hemodynamic disorders. Toxicosis with exsicosis (TE) is the most frequent variant of toxicosis. Dehydration in a child can develop at any age and with various diseases, but more often it occurs and is more difficult for infants, especially young children.

According to some reports, more than half of all cases of FC occur during the first year of life. In the first hours of the disease, the severity of the condition depends on the presence of toxicosis and its severity, and not on the nosological form of the disease.

[1]

What causes dehydration in a child?

The rapid development of dehydration in a child "especially early in life" is promoted by the features of water-salt metabolism of a growing organism. The infant has a higher percentage of water in the body compared to the adult, but the volume of H2O is much smaller, so the loss is more noticeable. For example, in an adult for the appearance of signs of the disease, the frequency of vomiting should be no less than 10-20 times, and the baby - only 3-5 times.

The reserves of H2O in a baby are mainly represented by extracellular fluid, which includes intravascular - the most constant value that determines the circulating blood volume (BCC), and the interstitial fluid is a more labile indicator. The infant has a higher level of perspiration, which is caused by a high respiration rate and a larger lung surface area per kilogram of body weight (compared to an adult). In addition, the baby has more H2O loss through the gastrointestinal tract, which is associated with a greater frequency of defecation, and through the kidneys (a relatively low concentration of kidneys leads to excessive loss of water and salts).

Dehydration in a child develops with significant loss of water and electrolytes, which occur mainly in vomiting and diarrhea. However, it can also occur with increasing "imperceptible" losses (loss of moisture through the respiratory tract with pronounced dyspnea, through the skin during hyperthermia, etc.).

Most toxicosis with exsicosis develops against the background of infectious diseases, primarily intestinal infections caused by bacteria, viruses, protozoa. Dehydration in children can develop with pneumonia (due to respiratory failure) and meningitis (due to indomitable vomiting). For the development of TE, the etiology of the underlying disease is not critical.

The cause of dehydration in the child can also be poisoning, violation of the gastrointestinal tract (including congenital anomaly, for example congenital pyloric stenosis), severe metabolic disorders (adrenogenital syndrome, diabetes mellitus).

Dehydration in a child can also have iatrogenic character: with excessive prescription of diuretics, hypertensive pores and protein preparations (in the form of infusions), the use of concentrated infant formula.

In addition, it is necessary to emphasize that the most common cause of dehydration syndrome is intestinal infection.

Pathogenesis

The release of water from the vessels leads to irritation of the baroreceptors and the mobilization of H2O from the interstitium, and then from the cells. Loss of fluid increases the viscosity of blood and reduces the rate of blood flow. In these conditions, the body responds by increasing the tone of the sympathetic nervous system and releasing hormones: adrenaline, norepinephrine and acetylcholine. There is a spasm of precapillary arterioles with simultaneous arteriovenous shunting in the tissues. This process is compensatory and leads to centralization of blood circulation.

The centralization of blood circulation, in turn, is aimed at maintaining adequate blood supply to vital organs, primarily the brain and heart. In this case, peripheral organs and tissues suffer. So, the blood flow in the kidneys, adrenal glands, muscles, abdominal organs, skin becomes much lower than necessary for their normal functioning. As a result, hypoxia appears on the periphery, hypoxia develops, acidosis develops, vascular permeability increases, detoxification processes are disrupted, and energy deficits increase. Against the backdrop of increasing hypoxia of the adrenal glands, the release of catecholamines increases, which normally lead to a spasm of precapillary arterioles and centralization of blood circulation, and in a acidosis a paradoxical reaction develops: arterioles expand (spasm is replaced by precapillary paresis with persistent spasm of postcapillaries). There comes the decentralization of blood circulation and pathological deposition ("sequestration") of blood. A significant part of the blood is separated from the main blood flow, which leads to a sharp disruption of blood supply to vital organs. In these conditions, the phenomenon of myocardial ischemia increases in the infant and cardiac insufficiency develops; in the liver, there is a violation of all types of metabolism (processes of glycolysis and glycogenesis, reamination, etc. Are violated). As a result of venous congestion, the volume of pulmonary ventilation decreases, the diffusion of oxygen and carbon dioxide is disturbed; decreased renal filtration. All these processes can lead to hypovolemic shock (shock due to loss of H2O).

For the syndrome of TE is characterized by a dyshydria - extracellular dehydration in combination with edema of brain cells.

Symptoms of dehydration in a child

Clinical symptoms of dehydration in a child develop due to pathological water losses (vomiting, diarrhea, prolonged hyperthermia, polyuria, increased perspiration, etc.) and is characterized by disorders of the nervous system and clinical signs.

At the forefront are changes from the nervous system: the baby becomes restless, capricious, he has increased excitability (I degree). In addition, they note thirst, sometimes even an increased appetite (the baby tries to compensate for the loss of fluids). Clinical signs of dehydration in the child are expressed moderately: a slight decrease in the turgor of tissues, a slight dryness of the skin and mucous membranes, slightly sunk a large fontanel. There may be a small tachycardia, blood pressure, usually within the age limit. Observe a moderate thickening of the blood (hematocrit at the upper limit of the norm or slightly higher than it). In the study of the acid-base blood state (CBS), compensated metabolic acidosis (pH in physiological limits) is revealed. These changes are typical for the initial stage of dehydration, corresponding to the I degree of FC.

If losses of water and electrolytes with vomiting and / or diarrhea continue, and body weight deficiency exceeds 5% (grade II), the baby's anxiety is replaced by lethargy and inhibition, and the clinical signs of dehydration in the child become more pronounced. He refuses to drink (as this increases vomiting), dryness of the skin and mucous membranes arises, the turgor of tissues decreases sharply (if you put the skin in a fold, then it straightens slowly), the facial features are sharpened (the chin is clearly outlined, the eyes "fallen in"), sits a large fontanel. In addition, the pulse rate increases and the frequency of breathing increases, blood pressure is in most cases reduced, heart sounds are muffled, oliguria develops. The parameters of hematocrit significantly exceed the norm (by 10-20%), the content of red blood cells and hemoglobin in the peripheral blood is increased by no less than 10%, subcompensated metabolic acidosis (pH 7.34-7.25) develops.

The most severe clinical signs of dehydration in the child, as well as the unfavorable outcome of FC, are observed at grade III, when the water deficit exceeds 10%. The depression of the central nervous system continues as a result of swelling and swelling of the brain cells: the baby is indifferent to the surrounding, adynamic, it is possible the development of seizures. The symptoms of dehydration in the child are sharply expressed: the skin is dry, pale with pronounced cyanosis as a result of venous stasis; sometimes reveal a sclera (skin covers with a sclera cold, waxy color, pasty), the turgor of tissues is sharply reduced, the skin fold is almost not straightened; The tongue is covered with a white coating and viscous viscous slime. In addition, deafness of cardiac tones is characteristic, bradycardia often develops. In the lungs they listen to damp (stagnant) wheezing, the rhythm of breathing is disturbed (from tachypnea to the rhythm of Chain-Stokes and Kussmaul). Peristalsis of the intestine is reduced, up to the paresis as a result of severe electrolyte disturbances. Atony and paresis of the bladder, anuria develop. Body temperature, as a rule, is lowered, systolic blood pressure is significantly lower than the age norm. Prognostically unfavorable signs: dry cornea (no tear and eyelids do not close), soft eyeballs. The parameters of hematocrit and hemoglobin are significantly deviated from the norm. Observed decompensated metabolic acidosis (pH <7.25).

Define dehydration in a child in most cases can be by clinical signs. This takes into account the nature of the disease (begins acutely or gradually), the prevailing mechanism of water loss (vomiting or diarrhea), respiratory rate and the severity of the temperature response.

Features of clinical signs of dehydration in a child

Criteria	Isotonic	Hypotonic	Hypertensive
Nature of the onset of the disease	Can be sharp	Gradual	Acute
The predominant mechanism of fluid loss	Moderate vomiting and diarrhea or massive diarrhea and increased perspiration	Severe vomiting, massive diarrhea	Diarrhea, increased perspiration, hyperthermia, vomiting
Weight loss	Moderate (about 5%)	More than 10%	Less than 10%
Thirst	Moderate	Not expressed	Expressed
Temperature	Subfebrile	Normal or subnormal	High
Leather	Dry	Relatively humid and cold with a "marble pattern", acrocyanosis	Dry and warm, hyperemic
Mucous membranes	Dry	Can be covered with viscous mucus	Very dry ("the tongue sticks to the palate")
Blood pressure	Normal or reduced	Low	Normal or increased
Diuresis	Oliguria	Oliguria, anuria	Long remains in norm, then - oliguria
The digestive tract	-	Paresis of the intestine	-
Eye Symptoms	Not expressed	Eyeballs sunken, soft	Eyeballs are reduced in size, soft, crying without tears
The state of the big fontanel	Moderately sinks	Wants	Does not sink
Convulsions	Not typical	Tonic (no meningeal symptoms)	Clonic-tonic (there is rigidity of the occipital muscles)
Concentration of total protein	Increased	Decreased	Increased
Hematocrit	Enhanced	Significantly increased	Slightly elevated
Concentration of sodium	Norm	Decreased	Increased
Concentration of potassium	Norm	Decreased	Increased
Osmolarity	Norm	Decreased	Increased
Behavior	Lethargy	Lethargy, inhibition, adynamic	Significant concern

Isotonic dehydration in a child is observed more often and is considered to be the easiest type of exsicosis, in which an equivalent amount of water and salts is lost, moderate metabolic disturbances occur. However, cases of severe course of this type of pathology with disorders of consciousness and other severe disorders are described.

External signs of dehydration in the child are sharply expressed in the hypertonic variant and moderately in hypotonic, despite the fact that the loss of body weight with hypotonic TE is greatest. It should also be noted the inconsistency of the pronounced dryness of the skin and mucous membranes and the condition of the large fontanel in patients with hypertonic dehydration. In severe cases, an increase in the osmotic concentration of cerebrospinal fluid can lead to the development of convulsions and coma.

With acute water loss (in which not only the volume of water lost, but also the rate of FC) is important, in the conditions of rapidly increasing circulatory insufficiency, hypovolemic shock develops. This type of shock is more often observed in patients with hypotonic and isotonic TE and significantly less often in hypertensive patients. The main symptoms of hypotonic shock are: lowering of blood pressure, hypothermia, tachycardia and cyanosis. If you do not provide timely assistance, the patient dies.

In addition to water and sodium ions, in vomiting and diarrhea, vital ions of potassium and calcium are lost in infants.

Hypokalemia can develop as a result of inadequate intake of potassium from food, because of toxicosis with exsicause with indomitable vomiting, diarrhea, with diuretics, and also due to other causes (prolonged use of glucocorticoids, overdose of cardiac glycosides, etc.). Symptoms of hypokalemia:

• oppression of the central nervous system;
• muscular hypotension;
• hyporeflexion;
• paresis and paralysis (can develop in severe cases);
• impaired breathing;
• tachycardia;
• paresis of the intestine;
• violation of renal concentration function.

With a critical decrease in potassium concentration, cardiac arrest may occur (in the systole phase).

Hyperkalemia is observed with rapidly developing dehydration of the hypertonic type, oliguria and anuria, acidosis, overdose of potassium preparations, etc. Signs of hyperkalemia:

• increased excitability, possible convulsions;
• brad and cardia;
• increased intestinal peristalsis.

With hyperkalemia, cardiac arrest may also occur (in the diastole phase).

Hypocalcemia develops in infants with significant fluid loss, as well as with rickets, hypothyroidism of parathyroid glands, kidney failure, etc. Manifestations of hypocalcemia:

• convulsive alertness, convulsions;
• bradycardia;
• paresis of the intestine;
• renal failure (violation of renal nitrogen function).

Hypercalcemia in toxicosis with exsicosis is extremely rare.

Classification

There is no generally accepted classification of toxicosis with exsicosis. Nevertheless, there are 3 degrees (in severity of clinical manifestations) and 3 types (by the ratio of the amount of water and salts in the body).

Degree of severity of dehydration in a child is determined by the deficiency of body weight (as a percentage of its original value), which developed as a result of loss of fluid.

1. I (light, compensated) develops with a body weight deficit of 3 to 5%. Manifestations of dehydration in a child are insignificant and reversible. There are no hemodynamic disturbances or they are also insignificant.
2. II (medium, subcompensated) - body mass deficiency is from 5 to 10%. Observe moderate manifestations of exsicosis. Hemodynamic disorders are compensated.
3. III (severe, decompensated) - deficiency of body weight exceeds 10%. With an acute loss of water and, as a consequence, a body mass deficit of more than 15%, a fatal outcome occurs. At this degree, clinical signs and decompensations of hemodynamics are expressed. Patients in need of emergency medical care in intensive care and intensive care units.

It should be remembered that the above percentages of body mass deficit at different degrees are used only in infants of young age (up to 5 years), and older than 5 years, these indicators change in the direction of decrease.

Loss of water at different degrees of dehydration in infants,% of body weight

Age	Degree of dehydration
	I	II	III
Up to 5 years	3-5	5-10	> 10
Older than 5 years	<3	3-5	> 6

Types of dehydration in children

View	Concentration of Naa + in serum
Isotonic (iso-osmolar, mixed, extracellular)	Within normal limits
Hypotonic (hypo-osmolar, salt-deficient, extracellular)	Below norm
Hypertonic (hyperosmolar, water-deficient, intracellular)	Above the norm

Concentration of electrolytes in serum is normal

Electrolytes	Concentration, mmol / l
Sodium	130-156
Potassium	3.4-5.3
Calcium total	2.3-2.75
Calcium ionized	1.05-1.3
Phosphorus	1.0-2.0
Magnesium	0.7-1.2
Chlorine	96-109

Isotonic dehydration in a child develops with relatively equal losses of water and electrolytes. The concentration of sodium in the blood plasma at this form is within normal limits.

Hypotonic occurs with loss of predominantly electrolytes. With this type of dehydration, the osmolality of the plasma decreases (Na + below the norm) and water moves from the vascular bed to the cells.

Hypertension is characterized by a relatively greater loss of water, exceeding the loss of electrolytes. Total losses, as a rule, do not exceed 10%, however, because of the increase in osmotic plasma concentration (Na above the norm), cells lose water and intracellular water loss develops.

It should be noted that some authors distinguish 3 periods of FC: prodromal, the period of height and the period of reverse development. Other authors, in addition to the degrees and types of dehydration, also suggest the allocation of 2 options - with hypovolemic shock or without it.

[2], [3], [4],

Diagnosis of dehydration in a child

Diagnosis of toxicosis with exsicosis is based on clinical signs of dehydration in the child: thirst, dry skin and mucous membranes (mucous membranes of the mouth and conjunctiva), the westernization of the large fontanel and eyeballs, a decrease in turgor and elasticity of the subcutaneous tissue, reduced diuresis, changes in the central nervous system (anxiety or lethargy, somnolence, convulsions), lowering blood pressure, hemodynamic disorders (pallor and cyanosis of the skin, cold extremities), acute loss of body weight for several hours or days.

Degree and type of dehydration in children, the severity of electrolyte disorders help to clarify laboratory studies (it should be noted that it is not always known how much the body weight has decreased). The following laboratory parameters are determined:

• hematocrit and hemoglobin concentration (total blood test);
• concentration of total protein and electrolytes - sodium, potassium, calcium (biochemical blood test);
• COC blood.

At the I degree, the hematocrit value, most often, is at the upper limit of the norm and is 0.35-0.42, at grade II - 0.45-0.50, and at grade III it can exceed 0.55 (however, if dehydration develops the baby with anemia, then the hematocrit will be much lower).

In addition, as the TE increases, the concentration of hemoglobin and protein increases.

In most cases, metabolic acidosis develops in the FC, the severity of which is assessed by the blood COS: pH, which is normally 7.35-7.45 (for newborns, shifting to the acid side up to 7.25); excess / deficiency of bases BE ± 3 mmol / l (in newborns and infants up to +5 mmol / l); HCO3- 20-25 mmol / l; the total concentration of buffer bases is 40-60 mmol / l.

If it is not possible to take a blood sample (for technical reasons), for electrochemical studies, electrolyte disturbances (and their severity) can be assessed by ECG changes.

With hypokalemia, the following signs appear on the ECG:

• decrease in the ST segment below the isoline;
• a smoothed, negative or two-phase T wave;
• increase in the amplitude of the tooth P;
• increase in the duration of the QT interval.

Hyperkalemia is accompanied by the following changes:

• high pointed T;
• shortening of the QT interval;
• an extension of the interval PQ.

For hypocalcemia is typical:

• prolongation of the QT interval;
• reduction of the amplitude of the T wave;
• shortening of the PQ interval.

Hypercalcemia is rare. With an excess of calcium, observe:

• truncation of the QT interval;
• change in the amplitude of the T wave;
• increase in the interval PQ.

[5], [6], [7]

Treatment of dehydration in a child

For the successful treatment of dehydration in the child, the early onset of etiotropic therapy is important. Since one of the main causes of toxicosis with eksikozom - intestinal infections, then in severe bacterial forms of the disease are shown antibiotics, which have activity against gram-negative microflora. In most cases, aminoglycosides (gentamicin, amikacin), protected penicillins (amoxicillin + clavulanic acid) and cephalosporins of the third generation (ceftriaxone, cefotaxime) are used in the dose doses, the route of administration is parenteral. With an average and light course of the disease, preference should be given to such drugs as probiotics (bifidobacteria bifidum), drugs of the nitrofuran series (furazolidone), specific bacteriophages (salmonella, coliprotein, etc.).

The next important component of toxicosis therapy with exsicosis is the elimination of diarrhea and vomiting. Children are rinsed stomach (using Ringer's formula from the calculation of 100 ml for 1 month of life to 1 year and 1.5-2 l from 1 year to 3 years), appoint an unloading diet. The composition and quantity of food, as well as the frequency of its reception, depend on the age and severity of its condition. A general rule for infants is the "rejuvenation" of a diet, when the lure of a baby is excluded from feeding, breast milk, liquid fermented milk products ("Agusha 1", "Agusha 2", baby kefir, etc.) and adapted fermented milk mixtures (" NAN "," Nutrilon ", etc.). The increase in the volume of food and the expansion of diet are carried out gradually as the condition of the baby improves and the symptoms disappear. In addition, metoclopramide (cerucal *) and others are used to normalize peristalsis.

The basis for treating dehydration in a child is rehydration, the main purpose of which is to restore the normal amount and composition of body fluids. For the correct conduct of rehydration, it is necessary to determine the volume of water, its composition and mode of administration. In pediatrics, two methods of administering the liquid are used, inward and parenterally.

The method of rehydration, in which drugs (r-ro electrolytes) are administered orally, are used, as a rule, in infants with I degree of exsicosis and in some cases at grade II. Preference is given to the introduction of liquid inside, since this method is practically safe for the patient, it can be performed in outpatient settings (the effectiveness will largely depend on how early the rehydration therapy is started). There are special rehydration solutions for oral administration (rehydron, glucosolan, etc.). For the treatment of acute diarrhea recommend r-ry (for ingestion) with reduced osmolarity, as a decrease in osmolarity of solutions leads to a decrease in stool volume and frequency of vomiting; In addition, there is less need to switch to infusion therapy (IT).

In pediatric practice for oral rehydration, also use the "Carrot-rice decoction ORS 200" produced by Hipp on the basis of an improved electrolyte solution with optimal osmolarity.

The composition of standard rehydration solutions with the usual (regidron, glkozolan) and with reduced osmolarity (gastrolit)

Components of solutions	Regidron	Glucosolan	Tours
Sodium	3.5 (chloride) + 2.9 (citrate)	3.5 (chloride) + 2.5 (bicarbonate)	1.75 (chloride) + 2.5 (bicarbonate)
Potassium chloride	2.5	1.5	1.5
Glucose	10	20	14.5

The baby can also be soldered with 5% glucose solution, decoction of dried fruits, tea, mineral and boiled water (often the baby prefers this or that drink, which is due to the type of dehydration). Use for rehydration of standard p-ra (for ingestion) should be combined with the introduction of salt-free solutions, when using p-ditch with reduced osmolarity, this need not be. The liquid should be at room temperature (not to provoke vomiting), it should be given fractional (from a spoon or pipette every 5-10 minutes).

Indication for the implementation of infusion therapy is a severe degree of TE with marked electrolyte and metabolic disorders. For its implementation, colloidal and crystalloid solutions are used. The action of colloidal blood substitutes is based on increasing the colloid-osmotic pressure of the intravascular fluid and thus keeping part of the water in the vascular bed. More often, albumin 5 and 10% concentration and reopolyglucin * are used. A single dose of 5% albumin and rheopolyglucin usually does not exceed 10 mg / kg (maximum daily dose of 20 mg / kg), for a 10% solution of albumin 5 mg / kg and 10 mg / kg. However, in most cases, these volumes are not enough, so the rest of the fluid replenishes 5 or 10% of glucose and saline solutions (ringer Ringer *, trisol *, etc.). Thus, rehydration therapy is carried out using several p-rots, and in different quantitative proportions. The choice of starting solution and the ratio of the number of solutions depend on the type of dehydration and the severity of the condition.

For hypertensive dehydration in a child and a satisfactory state of hemodynamics, therapy should be started with 5% glucose solution, which immediately, practically without lingering in the vascular channel, enters the interstitium and then into the cells (which is what is required for this type of exsicosis). The use of colloids as a starting agent at this type of TE is contraindicated in connection with the danger of enhancing intracellular dehydration against the background of increased oncotic pressure.

The choice of solutions for rehydration therapy: the ratio of the volume of glucose and sodium-containing solution (colloid or crystalloid) for infants of different ages

Type of dehydration in the baby and the starter solution	Newborns	1-6 months	Older than 6 months
Isotonic (10% solution of glucose)	3: 1	2: 1	1: 1
Hypertensive (5% rp glucose)	4: 1	4: 1	3: 1
Hypotonic (5% of r-r albumin)	3: 1	2: 1	1: 1

In isotonic dehydration, glucose is also used as the starting solution, but at a higher concentration (10%). In this case, the hyperosmolarity of the solution allows some time to maintain the BCC, as well as replenish the intracellular deficiency after the r-p leaves the vascular bed.

When hypotonic form with hemodynamic disorders treatment should be started with a colloidal or crystalloid solution. In most cases, 5% of albumin is used, and less often other plasma substitutes. However, the use of rheopolyglucin (hyperoncotic drug) can enhance dehydration due to the transition of the interstitial fluid to the vascular bed.

The ratio of the number of solutions of glucose and sodium-containing p-rods depends both on the type of TE and on age. In newborns (due to physiological hypernatremia) and in infants of early age (due to their tendency to hypernatremia), fewer sodium-containing pits are administered. Excessive administration of saline r-ditch is dangerous because of the threat of development of hyperosmolar conditions.

The amount of fluid required for rehydration therapy can be calculated in several ways. When calculating one of the methods take into account: the need for water (according to age), the amount of water deficit (the difference in body weight before the disease and at the time of examination) and the volume of pathological losses.

Physiological need for water in infants of different ages

Age	Water requirement, ml / (kgхс)
2-4 weeks	130-160
3 months	140-160
6 months	130-155
9 months	125-145
12 months	120-135
2 years	115-125
4 years	100-110
6 years	90-100

The volume of pathological losses is calculated as follows: 10 ml / (kghsut) for each degree of body temperature increase above 37 ° C, 10-20 ml / (kghsut) with continuing vomiting and the same for diarrhea (depending on the severity of the symptoms). Another method, the most convenient for practical use, is the calculation of the daily volume of liquid according to the Denis table, which takes into account the degree of dehydration in the child and his age. The smaller the age, the greater the amount of fluid per kilogram of body weight required for the same degree of ex and goat.

Daily volume of fluid for rehydration therapy, depending on age and degree of dehydration (according to Denis), ml / kg

Degree of Dehydration	Up to 1 year	1-5 years	5-10 years
I	130-170	100-125	75-100
II	175-200	130-170	110
III	220	175	130

The ratio of the amount of the fluid administered orally and the amount administered parenterally may increase or decrease (if the fluid is insufficiently received by ingestion, it is necessary to increase the amount administered parenterally, and if the condition improves and the fluid intake increases, the amount injected parenterally can be reduced).

With rehydration therapy, which must be performed from the first hours of development of toxicosis with exsicosis, the effectiveness of treatment depends largely on the rate of fluid administration to the patient. If the patient has no signs of hypovolemic shock, then in the first 6-8 hours, the volume of fluid for stopping hypovolemia is replenished, and in the subsequent 16-18 hours - the final elimination of toxicosis with exsicosis. From the second day of treatment, the volume of fluid depends primarily on the current loss.

If the patient is diagnosed with hypovolemic shock, then the treatment is started with colloidal solutions: 5% albumin or rheopolyglucin. Within 1-2 hours, colloidal solutions are administered at a dose of 15-20 ml / kg under the control of blood pressure. Then after it is increased, infusion therapy is carried out, guided by general principles.

In addition to replenishment of water loss, at FC it is necessary to correct electrolyte disturbances.

Deficiency of sodium (mmol) is determined by the formula:

D (Na +) = (Na + normal - Na + b.) X MT x K,

Where: D (Na +) - deficiency (mmol); Na + norms. - normal concentration of sodium (usually a normal concentration of 140 mmol / l); Na + b. - the sodium content in the patient's plasma (mmol / L); MT - body weight (kg); K - coefficient of extracellular fluid (0.5 - for newborns, 0.3 - for infants, 0.2 - for adults). (1 ml of a 10% solution of sodium chloride contains 1.7 mmol of sodium.)

Hyponatremia often does not require additional administration and it can be eliminated by applying a glucose-insulin-potassium mixture, especially in infants.

The daily physiological requirement for potassium is 1.5-2.0 mmol / kg (with a body weight of up to 15 kg - 2.0 mmol / kg, with a body weight of more than 15 kg - 1.5 mmol / kg), with development of hypokalemia, calculation deficiency of potassium is carried out according to the formula:

DK + = (K + norm-K + b.) X MT x K,

Where DK + - potassium deficiency, mmol; K + norms. - usually a normal indicator is considered to be the level of potassium 5 mmol / l; K + b. - the content of potassium in the patient's plasma, mmol / l; MT - body weight, kg; K - coefficient of extracellular fluid. (1 ml of 7.5% potassium chloride solution contains 1 mM potassium.)

To eliminate the potassium deficiency in the body use solutions of potassium chloride (4, 7, 5 and 10%). Potassium chloride potassium chloride is diluted in a glucose solution to a concentration of 0.5% (the maximum permissible concentration of potassium chloride in glucose is 1%). Enter potassium chloride potassium only drip, at a rate not exceeding 0.4 ml / min. With the introduction of potassium, you need to monitor diuresis.

Correction of metabolic acidosis is usually carried out during the treatment of the underlying disease (IT with replenishment of bcc, correction of electrolyte disturbances). The use of sodium hydrogencarbonate is advisable only if acidosis (decompensated) is expressed, and CBS parameters reach critical values (pH <7.25, BE <10 mmol / L, HCO3 <18 mmol / l). When used in other cases, there is a risk of developing alkalosis.

The effectiveness of the therapy is assessed by decreasing and eliminating the clinical manifestations of dehydration, improving the overall condition of the baby, gaining weight at least 1-2% per day from the baseline data, positive dynamics of laboratory parameters (hematocrit, hemoglobin, protein and electrolytes, blood CBC).

What prognosis does dehydration have in a child?

The prognosis depends on the degree of TE, the age of the baby, the time spent looking for a doctor, the nosological form of the disease, against which dehydration developed.