1. First 24 hours of life - D10W (D5W in infants <1000 gm).
2. Addition of electrolytes may be considered after 24-48 hours and there is adequate urine output (50% intake):
- If serum Na+ >145 mEq/liter, maintain on Na+ free solution.
- If serum K+ <3.8 mEq/liter, add K+ to solution (2-3 mEq/kg/day).
- If serum Na+ drops <135 mEq/liter, consider addition of Na+ (3-4 mEq/kg/day).
3. Usual maintenance solution for infants with normal hydration and electrolyte balance at 48-72 hours of age is: 1/4N.S. + 20mEq KCl/liter
4. Serum electrolytes should be monitored at least daily in infants whose IV fluid intake exceeds 40% of total intake.
5. Do not add Ca gluconate routinely to UAC and UVC infusions until TPN started.
HEPARIN IN IV FLUIDS
- Heparin is added to all maintenance IV fluids unless "Without heparin" is specifically ordered.
- Concentration of heparin in IV fluids is as follows: IV <2cc/hr: 0.25U/cc
FLUID CALCULATION
For mechanically ventilated infants, use the birth weight for the first 4-7 days of life until weight loss has stabilized; then use daily weight. Indicate on the order sheet what weight is being used to calculate fluids and medications. During rounds and sign-outs, it should be made clear what weight is being used for calculations.
FLUID GUIDELINES
|
Day 1 |
60-70 cc/kg IV |
Maximum 75 cc/kg IV + PO |
| Day 2 |
RDS 60-70 cc/kg IV |
Maximum 80 cc/kg IV + PO |
| Day 3 |
RDS 80 cc/kg IV |
Maximum 90 cc/kg IV + PO |
| Day 4 |
RDS 80-100 cc/kg IV |
Maximum 100 cc/kg IV + PO |
| Day 5 |
RDS 100 cc/kg IV |
Maximum 120 cc/kg IV + PO |
| Day 6-7 |
RDS 120 cc/kg IV |
Maximum 120 cc/kg IV + PO |
EXCEPTIONS
- Note: For extreme prematurity daily fluid volumes are much higher due to insensible losses
- >7 days - advancement is individualized
- Birth asphyxia and/or suspected cerebral edema - insensible H2O loss 40-50 cc/kg/d.
- Phototherapy - evaluate hydration status q8-12h by weight and/or BUN, and serum electrolytes. May increase fluids by 10%, or more as needed.
- Ventilator - evaluate hydration status q8-12h. May increase or decrease fluid intake to accommodate for fluctuations in fluid balance.
- Chronic lung disease (BPD) - no greater than 150 cc/kg if O2 dependent + diuretics.
- Note: cc/kg/day may not reflect an infant's fluid intake or requirements. Serum Na, BUN, weight, and total intake and output may be more useful in adjusting fluid requirements than calculated cc/kg/day.
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