Body Fluid Composition

Jain, Amrish

doi:10.1542/pir.36-4-141

Cited by 26 publications

(63 citation statements)

References 3 publications

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“…Effective circulating volume denotes the part of the intravascular compartment that is in the arterial system and which effectively perfuse the tissues. Effective circulating volume can be reduced because of volume depletion and/or dehydration ( 33 , 34 ).…”

Section: Terms Relevant To the Discussionmentioning

confidence: 99%

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Management of Diarrhoeal Dehydration in Childhood: A Review for Clinicians in Developing Countries

Anígilájé

2018

Front. Pediatr.

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The survival of a child with severe volume depletion at the emergency department depends on the competency of the first responder to recognize and promptly treat hypovolemic shock. Although the basic principles on fluid and electrolytes therapy have been investigated for decades, the topic remains a challenge, as consensus on clinical management protocol is difficult to reach, and more adverse events are reported from fluid administration than for any other drug. While the old principles proposed by Holliday and Segar, and Finberg have stood the test of time, recent systematic reviews and meta-analyses have highlighted the risk of hyponatraemia, and hyponatraemic encephalopathy in some children treated with hypotonic fluids. In the midst of conflicting literature on fluid and electrolytes therapy, it would appear that isotonic fluids are best suitable for the correction of hypotonic, isonatraemic, and hypernatraemic dehydration. Although oral rehydration therapy is adequate to correct mild to moderate isonatraemic dehydration, parenteral fluid therapy is safer for the child with severe dehydration and those with changes in serum sodium. The article reviews the pathophysiology of water and sodium metabolism and, it uses the clinical case examples to illustrate the bed-side approach to the management of three different types of dehydration using a pre-mixed isotonic fluid solution (with 20 or 40 mmol/L of potassium chloride added depending on the absence or presence of hypokalemia, respectively). When 3% sodium chloride is unavailable to treat hyponatraemic encephalopathy, 0.9% sodium chloride becomes inevitable, albeit, a closer monitoring of serum sodium is required. The importance of a keen and regular clinical and laboratory monitoring of a child being rehydrated is emphasized. The article would be valuable to clinicians in less-developed countries, who must use pre-mixed fluids, and who often cannot get some suitable rehydrating solutions.

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Section: Terms Relevant To the Discussionmentioning

confidence: 99%

“…Volume depletion refers to any condition in which the effective circulating volume is reduced ( 34 ).…”

Section: Terms Relevant To the Discussionmentioning

confidence: 99%

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Management of Diarrhoeal Dehydration in Childhood: A Review for Clinicians in Developing Countries

Anígilájé

2018

Front. Pediatr.

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“…TBW decreases with age—70% in term newborns and 60% by age of 1 year. TBW is distributed in two major departments, about two-thirds of TBW is within cells—intracellular fluid; the remaining one-third—extracellular volume—is outside cells and is further divided in the smaller compartments: plasma, interstitial fluid, and transcellular fluid ( 1 ). Hyponatremia, defined as a serum sodium <135 mmol/l, is the most common electrolyte disorder encountered in clinical practice ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

Pathophysiology of Hyponatremia in Children

Zieg

2017

Front. Pediatr.

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Hyponatremia is a common electrolyte disorder in children. It is generally defined as plasma sodium of less than 135 mmol/l. Sodium homeostasis is essential for maintaining intravascular volume and is tightly linked to water balance. Plasma water volume is regulated mainly by the secretion of an antidiuretic hormone (ADH) and by the thirst mechanism. ADH is synthesized in the hypothalamus and stored in the posterior hypophysis. It binds to V2 receptors in the distal nephron and induces translocation of aquaporin water channels in the plasma membrane to retain water. There are two main types of receptors involved in the control of the body water balance—osmoreceptors and baroreceptors. Osmoreceptors reside in hypothalamus and respond to changes of extracellular fluid (ECF) osmolality. Baroreceptors are mechanoreceptors that sense blood pressure in the vessel wall. Response reflexes from baroreceptors influence sympathetic outflow, vessel tonus, and cardiac output. An increase of 1% of plasma osmolality may cause an increase in ADH levels, while the threshold of volume receptors for ADH secretion is higher. However, significant hypotension is a more potent stimulus for ADH secretion than increased osmolality. The main cause of pediatric hyponatremia is an abundance of free water. This may occur in hypovolemic children with low ECF volume, normovolemic patients with inappropriately increased ADH secretion, and also in hypervolemic individuals with decreased effective circulating volume and appropriately increased ADH levels. Proper understanding of the pathophysiology of hyponatremic states is essential for establishing the correct diagnosis and appropriate therapy.

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“…The TBW is divided into two components throughout the body: intracellular fluid compartment (ICF), which constitutes 40% of TBW, and extracellular fluid (ECF), which forms the remaining 20%. The ECF comprises interstitial fluid (IF) (15% of the TBW), and the remaining 5% of the TBW comprises intravascular plasma (Figures 1 and 2) [2][3][4]. This distribution of body fluids can have an impact on the management of pediatric gastroenteritis, as most of the fluid loss in AGE comes from the ECF.…”

Section: Body Water Distributionmentioning

confidence: 99%

Dehydration

Toaimah¹,

Manthattil²

2020

Perspective of Recent Advances in Acute Diarrhea

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Dehydration is one of the common presentations to the general practice or emergency departments (EDs) in children having acute gastroenteritis (AGE). Assessing the severity of dehydration remains a challenge among physicians, and the dehydration scales currently available are inaccurate. The correct assessment of dehydration is the basis for proper management of acute diarrhea in children. Rapid oral rehydration therapy (ORT) over 3-4 hours remains the cornerstone treatment of AGE with dehydration. It is advisable to reserve intravenous (IV) rehydration therapy for patients with severe dehydration and for those who fail ORT. Rapid standardvolume (20 ml/kg/hour) IV bolus of isotonic solution for 1-4 hours followed by oral fluid intake or maintenance IV fluids seems to be adequate for most cases requiring IV rehydration. A minority of patients may be presented with complications due to diarrheal dehydration, such as dyselectrolytemia, which requires careful calculation of fluids and electrolytes with slow correction approach.

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Body Fluid Composition

Cited by 26 publications

References 3 publications

Management of Diarrhoeal Dehydration in Childhood: A Review for Clinicians in Developing Countries

Management of Diarrhoeal Dehydration in Childhood: A Review for Clinicians in Developing Countries

Pathophysiology of Hyponatremia in Children

Dehydration

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