Calculation of infusion in children. Infusion therapy

Infusion therapy.

Infusion therapy- this is a drip or infusion intravenously or subcutaneously of drugs and biological fluids in order to normalize the water-electrolyte, acid-base balance of the body, as well as for forced diuresis (in combination with diuretics).

Indications to infusion therapy: all types of shock, blood loss, hypovolemia, loss of fluid, electrolytes and proteins as a result of uncontrollable vomiting, intense diarrhea, refusal to take fluids, burns, kidney disease; disturbances in the content of basic ions (sodium, potassium, chlorine, etc.), acidosis, alkalosis and poisoning.

Contraindications to infusion therapy are acute cardiovascular failure, pulmonary edema and anuria.

Principles of infusion therapy

The degree of risk of infusion, as well as preparation for it, should be lower than the expected positive result from infusion therapy.

The infusion should always be aimed at positive results. As a last resort, it should not aggravate the patient's condition.

Constant monitoring of the condition of both the patient and all indicators of the body’s functioning is required during the infusion.

Prevention of complications from the infusion procedure itself: thrombophlebitis, disseminated intravascular coagulation, sepsis, hypothermia.

Goals of infusion therapy: restoration of blood volume, elimination of hypovolemia, ensuring adequate cardiac output, maintaining and restoring normal plasma osmolarity, ensuring adequate microcirculation, preventing aggregation shaped elements blood, normalization of the oxygen transport function of the blood.

There are basic and corrective I. t. The purpose of basic I. t. is to provide the body with physiological needs for water or electrolytes. Corrective I. is aimed at correcting changes in water, electrolyte, protein balance and blood by replenishing missing volume components (extracellular and cellular fluid), normalizing the disturbed composition and osmolarity of water spaces, hemoglobin levels and plasma colloid osmotic pressure.

Infusion solutions are divided into crystalloid and colloid. TO crystalloid include solutions of sugars (glucose, fructose) and electrolytes. They can be isotonic, hypotonic and hypertonic in relation to the value of normal plasma osmolarity. Sugar solutions are the main source of free (electrolyte-free) water, and therefore they are used for maintenance hydration therapy and to correct free water deficiency. The minimum physiological need for water is 1200 ml/day Electrolyte solutions (physiological, Ringer's, Ringer-Locke, lactasol, etc.) are used to compensate for electrolyte losses. The ionic composition of physiological solution, Ringer's, Ringer-Locke solutions does not correspond to the ionic composition of plasma, since the main ions in them are sodium and chlorine ions, and the concentration of the latter significantly exceeds its concentration in plasma. Electrolyte solutions are indicated in cases of acute loss of extracellular fluid, consisting predominantly of these ions. The average daily sodium requirement is 85 mEq/m 2 and can be fully provided with electrolyte solutions. Daily potassium requirement (51 mEq/m 2 ) replenish polarizing potassium mixtures with glucose solutions and insulin. Use 0.89% sodium chloride solution, Ringer and Ringer-Locke solutions, 5% sodium chloride solution, 5-40% glucose solutions and other solutions. They are administered intravenously and subcutaneously, in a stream (in case of severe dehydration) and drip, in a volume of 10–50 or more ml/kg. These solutions do not cause complications, except for overdose.

Solution (0.89%) sodium chloride is isotonic with human blood plasma and therefore quickly cleared from the vascular bed, only temporarily increasing the volume of circulating fluid, so its effectiveness in cases of blood loss and shock is insufficient. Hypertonic solutions (3-5-10%) are used intravenously and externally. When applied externally, they promote the secretion of pus, exhibit antimicrobial activity, and when administered intravenously, they increase diuresis and replenish the deficiency of sodium and chlorine ions.

Ringer's solution- multicomponent physiological solution. A solution in distilled water of several inorganic salts with precisely maintained concentrations, such as sodium chloride, potassium chloride, calcium chloride, as well as sodium bicarbonate to stabilize the acidity of the solution pH as a buffer component. Administered intravenously in a dose of 500 to 1000 ml/day. The total daily dose is up to 2-6% of body weight.

Glucose solutions. Isotonic solution (5%) - subcutaneously, 300–500 ml; IV (drip) - 300–2000 ml/day. Hypertonic solutions (10% and 20%) - intravenously, once - 10–50 ml or drip up to 300 ml/day.

Ascorbic acid solution for injection. IV - 1 ml of 10% or 1–3 ml of 5% solution. Highest dose: single - not higher than 200 mg, daily - 500 mg.

To compensate for the loss of isotonic fluid (for burns, peritonitis, intestinal obstruction, septic and hypovolemic shock), solutions with an electrolyte composition close to plasma (lactasol, ringer-lactate solution) are used. With a sharp decrease in plasma osmolarity (below 250 mOsm/l) hypertonic (3%) sodium chloride solutions are used. When plasma sodium concentration increases to 130 mmol/l the administration of hypertonic solutions of sodium chloride is stopped and isotonic solutions are prescribed (lactasol, ringer lactate and saline s). When plasma osmolarity increases due to hypernatremia, solutions are used that reduce plasma osmolarity: first 2.5% and 5% glucose solutions, then hypotonic and isotonic solutions of electrolytes with glucose solutions in a 1:1 ratio.

Colloidal solutions- These are solutions of high molecular weight substances. They help retain fluid in the vascular bed. These include dextrans, gelatin, starch, as well as albumin, protein, and plasma. They use hemodez, polyglucin, reopoliglucin, reogluman. Colloids have a higher molecular weight than crystalloids, which ensures their longer stay in the vascular bed. Colloidal solutions restore plasma volume faster than crystalloid ones, which is why they are called plasma substitutes. In terms of their hemodynamic effect, solutions of dextran and starch are significantly superior to crystalloid solutions. To obtain an antishock effect, a significantly smaller amount of these media is required compared to solutions of glucose or electrolytes. With loss of fluid volume, especially with blood and plasma loss, these solutions quickly increase venous flow to the heart, filling of the heart cavities, cardiac output and stabilize blood pressure. However, colloid solutions can cause circulatory overload more quickly than crystalloid solutions. Routes of administration: intravenous, less often subcutaneous and drip. The total daily dose of zadextrans should not exceed 1.5-2 g/kg due to the risk of bleeding that may occur as a result of blood coagulation disorders. Renal dysfunction (dextran kidney) and anaphylactic reactions are sometimes observed. They have detoxifying properties. They are used as a source of parenteral nutrition in cases of prolonged refusal to eat or inability to feed by mouth. Blood and casein hydrolysins are used (Alvesin-Neo, polyamine, lipofundin, etc.). They contain amino acids, lipids and glucose.

In cases of acute hypovolemia and shock, colloidal solutions are used as media that quickly restore intravascular volume. In hemorrhagic shock initial stage treatment to quickly restore circulating blood volume (CBV) use polyglucin or any other dextran with a molecular weight of 60,000-70,000, which are transfused very quickly in a volume of up to 1 l. The rest of the lost blood volume is replaced with solutions of gelatin, plasma and blood. Part of the lost blood volume is compensated by administering isotonic electrolyte solutions, preferably a balanced composition in proportion to the lost volume as 3:1 or 4:1. In case of shock associated with loss of fluid volume, it is necessary not only to restore bcc, but also to fully satisfy the body's needs for water and electrolytes. Albumin is used to correct plasma protein levels.

The main thing in the treatment of fluid deficiency in the absence of blood loss or osmolarity disorders is the replacement of this volume with balanced salt solutions. For moderate fluid deficiency, isotonic electrolyte solutions are prescribed (2.5-3.5 l/day). With severe fluid loss, the volume of infusions should be significantly larger.

Volume of infused liquid. Exists simple formula, proposed by L. Denis (1962):

with 1st degree dehydration (up to 5%) - 130-170 ml/kg/24h;

2nd degree (5-10%) - 170-200 ml/kg/24 hours;

3rd degree (> 10%) - 200-220 ml/kg/24 hours.

The total volume of infusate per day is calculated in the following way: to the age-related physiological requirement, an amount of fluid is added equal to the decrease in weight (water deficiency). Additionally, 30-60 ml is added for each kg of body weight to cover current losses. With hyperthermia and high temperature environment add 10 ml of infusate for each degree of body temperature exceeding 37°. 75-80% of the total volume of the calculated fluid is administered intravenously, the rest is given in the form of drink.

Calculation of the volume of daily infusion therapy: Universal method:(For all types of dehydration).

Volume = daily requirement + pathological losses + deficiency.

Daily requirement - 20-30 ml/kg; at ambient temperature more than 20 degrees

For each degree +1 ml/kg.

Pathological losses:

Vomiting - approximately 20-30 ml/kg (it is better to measure the volume of losses);

Diarrhea - 20-40 ml/kg (it is better to measure the volume of losses);

Intestinal paresis - 20-40 ml/kg;

Temperature - +1 degree = +10ml/kg;

RR more than 20 per minute - + 1 breath = +1ml/kg ;

Volume of discharge from drainage, probe, etc.;

Polyuria - diuresis exceeds the individual daily requirement.

Dehydration: 1. Skin elasticity or turgor; 2. Content Bladder; 3. Body weight.

Physiological examination: skin elasticity or turgor is an approximate measure of dehydration:< 5% ВТ - не определяется;

5-6% - skin turgor is slightly reduced;

6-8% - skin turgor is noticeably reduced;

10-12% - skin fold stays in place;

Metrogyl solution. Ingredients: metronidazole, sodium chloride, lemon acid(monohydrate), sodium hydrogen phosphate anhydrous, water d/i. Antiprotozoal and antimicrobial drug, a 5-nitroimidazole derivative. IV administration of the drug is indicated for severe infections, as well as in the absence of the possibility of taking the drug orally.

Adults and children over 12 years old - at an initial dose of 0.5-1 g intravenously (duration of infusions - 30-40 minutes), and then every 8 hours, 500 mg at a rate of 5 ml/min. If well tolerated, after the first 2-3 infusions they switch to jet administration. The course of treatment is 7 days. If necessary, intravenous administration is continued for a longer time. The maximum daily dose is 4 g. According to indications, switch to maintenance oral administration at a dose of 400 mg 3 times a day.

To hemostatic drugs include cryoprecipitate, prothrombin complex, fibrinogen. The cryoprecipitate contains large amounts of antihemophilic globulin (blood coagulation factor VIII) and von Willebrand factor, as well as fibrinogen, fibrin-stabilizing factor XIII and impurities of other proteins. The drugs are released in plastic bags or bottles in frozen or dried form. Fibrinogen has limited use: It is indicated for bleeding caused by fibrinogen deficiency.

Infusion therapy is the parenteral infusion of fluids to maintain and restore their volumes and quality compositions in the cellular, extracellular and vascular spaces of the body. This method of therapy is used only when the enteral route of absorption of electrolytes and fluid is limited or impossible, as well as in cases of significant blood loss requiring immediate intervention.

Story

Back in the thirties of the nineteenth century, it was first used infusion therapy. Then T. Latta published an article in a medical journal about a method of treating cholera by parenteral administration soda solution into the body. This method is still used in modern medicine and is considered quite effective. In 1881, Landerer injected the patient with a solution of table salt, and the experiment was successful.

The first blood substitute, which was based on gelatin, was put into practice in 1915 by physician Hogan. And in 1944, Ingelman and Gronwell developed blood substitutes based on dextran. The first clinical uses of hydroxyethyl starch solutions began in 1962. A few years later, the first publications appeared on perfluorocarbons as possible artificial carriers of oxygen throughout the human body.

In 1979, the world's first blood substitute based on perfluorocarbon was created and then clinically tested. It is gratifying that it was invented in the Soviet Union. In 1992, again, Soviet scientists introduced a blood substitute based on polyethylene glycol into clinical practice. 1998 was marked by obtaining permission to medical use polymerized human hemoglobin, created a year earlier at the St. Petersburg Research Institute of Hemoglobin.

Indications and contraindications

Infusion therapy is indicated for:

any types of shock;
hypovolemia;
blood loss;
loss of proteins, electrolytes and fluids due to intense diarrhea, uncontrollable vomiting, kidney disease, burns, refusal to take fluids;
poisoning;
violations of the content of basic ions (potassium, sodium, chlorine, etc.);
alkalosis;
acidosis.

Contraindications to such procedures are pathologies such as pulmonary edema, cardiovascular failure, and anuria.

Goals, objectives, directions

Infusion transfusion therapy can be used for different purposes: both for psychological impact on the patient, and for solving resuscitation and intensive care problems. Depending on this, doctors determine the main directions of this treatment method. Modern medicine uses the capabilities of infusion therapy for:

Program

Infusion therapy is carried out in accordance with a specific program. It is compiled for each patient after recalculation general content free water and electrolytes in solutions and identifying contraindications to the prescription of certain components of treatment. Basis for liquid balanced therapy is created as follows: first, basic infusion solutions are selected, and then electrolyte concentrates are added to them. Often, adjustments are required during program implementation. If pathological losses continue, they must be actively compensated. In this case, it is necessary to accurately measure the volume and determine the composition of the lost liquids. When this is not possible, it is necessary to focus on ionogram data and, in accordance with them, select suitable solutions for infusion therapy.

The main conditions for the correct implementation of this method of treatment are the composition of the administered fluids, dosage and rate of infusion. We must not forget that an overdose in most cases is much more dangerous than a certain deficiency of solutions. As a rule, infusion therapy is carried out against the background of disturbances in the regulatory system water balance, and therefore quick correction is often dangerous or even impossible. Long-term treatment over many days is usually required to correct severe fluid distribution problems.

Particular care should be taken when selecting infusion treatment methods for patients suffering from pulmonary or renal failure, as well as for elderly and old age. They definitely need to monitor the functions of their kidneys, brain, lungs and heart. The more severe the patient’s condition, the more often it is necessary to examine laboratory data and measure various clinical indicators.

System for transfusion of infusion solutions

These days, almost none serious pathology cannot do without parenteral fluid infusions. Modern medicine is simply impossible without infusion therapy. This is due to the high clinical effectiveness this method of treatment and the versatility, simplicity and reliability of operation of the devices necessary for its implementation. System for transfusion of infusion solutions among all medical products is in high demand. Its design includes:

A semi-rigid dropper equipped with a plastic needle, a protective cap and a liquid filter.
Air metal needle.
Main tube.
Injection unit.
Liquid flow regulator.
Infusion pump.
Connector.
Injection needle.
Roller clamp.

Thanks to the transparency of the main tube, doctors are able to fully control the process of intravenous infusion. There are systems with dispensers, the use of which eliminates the need to use a complex and expensive infusion pump.

Since the elements of such devices come into direct contact with the internal physiological environment of patients, high demands are placed on the properties and quality of the starting materials. The infusion system must be absolutely sterile to exclude toxic, viral, allergenic, radiological or any other negative impact on the sick. To do this, structures are sterilized with ethylene oxide, a drug that completely frees them from potentially dangerous microorganisms and contaminants. The outcome of the treatment depends on how hygienic and harmless the infusion system used is. Therefore, hospitals are recommended to purchase products made by manufacturers that have proven themselves in the medical goods market.

Calculation of infusion therapy

To calculate the volume of injections and current pathological losses liquid, actual losses should be measured accurately. This is done by collecting faeces, urine, vomit, etc. over a specified number of hours. Thanks to such data, it is possible to calculate infusion therapy for the upcoming period of time.

If the dynamics of injections for past period, then taking into account excess or deficiency of water in the body will not be difficult. The volume of therapy for the current day is calculated using the following formulas:

if maintaining water balance is required, the volume of infused liquid should be equal to the physiological need for water;
in case of dehydration, to calculate infusion therapy, it is necessary to add the indicator of extracellular water volume deficiency to the indicator of current pathological fluid losses;
during detoxification, the volume of fluid required for infusion is calculated by adding the physiological need for water and the volume of daily diuresis.

Volume correction

To restore an adequate circulating blood volume (CBV) during blood loss, infusion solutions with different volumetric effects are used. In combination with dehydration, it is preferable to use isosmotic and isotonic electrolyte solutions that simulate the composition of the extracellular fluid. They produce a small volumetric effect.

Among colloidal blood substitutes, solutions of hydroxyethyl starch, such as “Stabizol”, “Infukol”, “KHAES-steril”, “Refortan”, are now becoming increasingly popular. They are characterized long period half-life and high volumetric effect with relatively limited adverse reactions.

Volume correctors based on dextran (preparations "Reogluman", "Neorondex", "Poliglyukin", "Longasteril", "Reopoliglyukin", "Reomacrodex"), as well as gelatins (preparations "Gelofusin", "Modezhel", " Gelatinol").

If we talk about the most modern methods of treatment, now more and more attention is being drawn to the new solution “Polyoxidin”, created on the basis of polyethylene glycol. Blood products are used in intensive care to restore adequate circulating blood volume.

Now more and more publications are appearing on the topic of the benefits of shock therapy and acute shortage BCC by low-volume hyperosmotic volume correction, which consists of successive intravenous infusions hypertonic electrolyte solution followed by the introduction of a colloidal blood substitute.

Rehydration

With such infusion therapy, isosmotic or hypoosmotic electrolyte solutions of Ringer, sodium chloride, drugs “Lactosol”, “Acesol” and others are used. Rehydration can be achieved through different options introducing fluid into the body:

The vascular method can be implemented intravenously, provided that the lungs and heart are functionally intact, and intra-aortically in case of acute pulmonary injury and heart overload.
The subcutaneous method is convenient when it is not possible to transport the victim or there is no vascular access. This option is most effective if you combine the infusion of fluids with taking hyaluronidase drugs.
The intestinal method is advisable when it is not possible to use a sterile set for infusion therapy, for example, in field conditions. In this case, fluid is administered through an intestinal tube. It is advisable to carry out the infusion while taking gastrokinetics, such as the medications Motilium, Cerucal, Coordinax. This option can be used not only for rehydration, but also for volume correction, since the rate of fluid intake is quite high.

Hemororrheocorrection

Such infusion therapy is carried out along with the correction of blood volume during blood loss or separately. Hemororrheocorrection is performed by infusing solutions of hydroxyethyl starch (previously, dextrans, especially low molecular weight ones, were used for these purposes). The use of an oxygen-carrying blood substitute based on fluorinated carbons perfluoran brought significant results For clinical use. The hemororrheocorrective effect of such a blood substitute is determined not only by the property of hemodilution and the effect of increasing between blood cells electrical expansion, but also by restoration of microcirculation in edematous tissues and changes in blood viscosity.

Normalization of acid-base balance and electrolyte balance

To quickly relieve intracellular electrolyte disorders, special infusion solutions have been created - “Ionosteril”, “Potassium and magnesium aspartate”, Hartmann’s solution. Correction of uncompensated metabolic disorders acid-base balance in case of acidosis is carried out with solutions of sodium bicarbonate, the drugs “Trometamop”, “Trisaminol”. For alkalosis, a glucose solution is used in combination with an HCI solution.

Exchange corrective infusion

This is the name given to the direct effect on tissue metabolism through active ingredients blood substitute. We can say that this is borderline drug treatment direction of infusion therapy. Among the exchange-correcting media, the first is the so-called polarizing mixture, which is a solution of glucose with insulin and magnesium and potassium salts added to it. This composition helps prevent the occurrence of myocardial micronecrosis during hypercatecholaminemia.

Exchange-corrective infusions also include polyionic media that contain substrate antihypoxants: succinate (the drug “Reamberin”) and fumarate (the drugs “Polyoxyfumarin”, “Mafusol”); infusion of oxygen-carrying blood substitutes based on modified hemoglobin, which, by increasing the delivery of oxygen to tissues and organs, optimize energy metabolism in them.

Impaired metabolism is corrected through the use of infusion hepatoprotectors, which not only normalize metabolism in damaged hepatocytes, but also bind markers of lethal synthesis in hepatocellular failure.

To some extent, exchange-corrective infusions include artificial parenteral nutrition. Infusion of special nutrient media nutritional support of the patient and relief of persistent protein-energy deficiency are achieved.

Infusions in children

One of the main components of intensive care in young patients in various critical conditions is parenteral fluid infusion. Sometimes difficulties arise as to which drugs should be used during such treatment. Often critical conditions are accompanied by severe hypovolemia, therefore infusion therapy in children is carried out using colloidal saline solutions (Stabizol, Refortan, Infucol) and crystalloid saline solutions (Trisol, Disol, Ringer's solution, 0.9 - percent sodium chloride solution). Such means allow you to normalize the volume of circulating blood in the shortest possible time.

Very often, emergency and emergency pediatricians medical care are faced with such a common problem as dehydration of the child’s body. Often pathological loss of fluid from the lower and upper sections gastrointestinal tract are a consequence infectious diseases. In addition, infants and children under three years of age often suffer from a lack of fluid intake during various periods. pathological processes. The situation can be further aggravated if the child has insufficient concentrating ability of the kidneys. High fluid requirements may be further increased by fever.

For hypovolemic shock that has developed against the background of dehydration, crystalloid solutions are used in a dosage of 15-20 milliliters per kilogram per hour. If so intensive therapy turns out to be ineffective, a 0.9 percent sodium chloride solution or the drug “Ionosteril” is administered in the same dosage.

100 - (3 x age in years).

This formula is approximate and is suitable for calculating the volume of infusion therapy for children over one year of age. At the same time, convenience and simplicity make this calculation option indispensable in medical practice doctors.

Complications

When performing infusion therapy, there is a risk of developing all kinds of complications, which is due to many factors. Among them are:

Violation of infusion technique, incorrect sequence of administration of solutions, combination of incompatible drugs, which leads to fatty and air embolism, thromboembolism, phlebothrombosis, thrombophlebitis.
Violation of technique during catheterization of a vessel or puncture, which leads to injury to adjacent anatomical formations and organs. When an infusion solution is introduced into the paravasal tissue, tissue necrosis, aseptic inflammation, and dysfunction of systems and organs occur. If fragments of the catheter migrate through the vessels, they perforate the myocardium, which leads to cardiac tamponade.
Violations in the rate of infusion of solutions, which causes overload of the heart, damage to the integrity of the vascular endothelium, hydration (edema of the brain and lungs).
Transfusion donated blood for a short period (up to 24 hours) in an amount that exceeds 40-50 percent of the circulating blood, which provokes massive blood transfusion syndrome, and it, in turn, is manifested by increased hemolysis, pathological redistribution of blood, decreased ability of the myocardium to contract, and gross disturbances in system of hemostasis and microcirculation, the development of intravascular disseminated coagulation, disruption of the kidneys, lungs, and liver.

In addition, infusion therapy can lead to anaphylactic shock, anaphylactoid reactions, and when using non-sterile materials - to infection infectious diseases, such as serum hepatitis, syphilis, acquired immunodeficiency syndrome and others. Possible post-transfusion reactions during transfusion incompatible blood, which are due developing shock and hemolysis of red blood cells, which is manifested by hyperkalemia and severe metabolic acidosis. Subsequently, disturbances in the functioning of the kidneys occur, and free hemoglobin and protein are found in the urine. Ultimately, acute renal failure develops.

Finally

After reading this article, you probably noticed how far medicine has come in relation to the systematic use of infusion therapy in clinical practice. It is expected that in the near future new infusion preparations will be created, including multicomponent solutions, which will make it possible to solve several therapeutic problems in a complex.

The human body is 75-80% water; this has long been a proven fact.

The proper functioning of all organs depends on the quantitative and qualitative composition of this fluid. It affects metabolic processes, transports various nutrients and dissolved gases to the body's cells.

Infusion therapy (IT) is modern method treatment, which consists of providing the body with the missing water, electrolytes, nutrients and medications.

The use of liquids with different physical and chemical characteristics for IT allows you to quickly relieve symptoms of pathological conditions and restore a normal liquid internal environment.

Infusion therapy is a necessary, and sometimes the only effective, procedure for resuscitation of patients in critical condition.

Depending on the goals pursued by IT, doctors make decisions on the quantitative and qualitative composition of solutions introduced into the human body. The following factors are taken into account:

cause and degree of hypovolemia;
patient's age;
accompanying illnesses.

To determine the composition and volume of infusion media, the following indicators are taken into account:

degree of hemodilution;
distribution of aqueous media in the body;
plasma molarity.

Types of infusion therapy according to the method of administering solutions:

intravenous (most common use);
intra-arterial (used if it is necessary to deliver medication to the site of inflammation);
intraosseous (rarely used due to the complexity and danger of the method).

Infusion therapy allows you to solve the following problems:

normalizes the composition of circulating blood;
restores blood volume during blood loss;
supports normal macro- and microcirculation;
promotes excretion toxic substances;
normalizes acid-base, electrolyte balance;
normalizes the rheological and homeostatic properties of blood;
with the help of active components it affects tissue metabolism;
provides parenteral nutrition;
allows long-term and even injection medications;
normalizes immunity.

Indications for use of IT:

any type of shock;
kidney diseases;
dehydration and loss of proteins due to vomiting or intense diarrhea;
severe burns;
refusal to take fluids;
violation of the content of basic ions;
alkalosis and other poisonings;
acidosis;
blood loss;
hypovolemia;

Contraindications to IT:

pulmonary edema;
anuria;
cardiovascular failure.

IT principles:

Anti-shock measures. Conducted over a period of 2 - 4 hours. At the first stage, solutions of sodium bicarbonate, albumin or plasma substitutes are introduced. Next - saline solutions. Objectives: restoration of satisfactory indicators of central geodynamics. After its restoration, electrolyte-free solutions (glucose) are introduced.
Compensation for additional services. Continues for 24 hours, with severe dehydration up to 3 days. Solutions of glucose, potassium chloride, calcium and magnesium are used. Potassium is administered in small quantities and slowly. If there is a deficiency, IT is carried out from several days to a week or more.
VEO support. Lasts for 2 - 4 days or more. IT is carried out evenly throughout the day. Injected solutions: saline and colloidal. If IT does not promote sufficient detoxification, then the method of extracorporeal blood purification is included in the complex of therapy.
In the treatment of hyperhydration they use following methods:
- limit the introduction of salt and water;
- use diuretics;
- using plasma substitutes, the volume of circulating blood is restored;
- hemodialysis is performed.
When carrying out IT, errors are possible, consisting of an incorrectly designed program, estimation of the volume of liquids, speed of administration, and so on. Therefore, during infusion therapy, its effect is continuously assessed.
Enteral therapeutic nutrition for the required period.
Observations on the progress of IT:
- measure fluid loss during vomiting and diarrhea;
- Body temperature and blood pressure are measured 3-4 times a day;
- assess the patient’s condition: skin color, lips, behavior;
- adjust the volume and high-quality composition infusions depending on the patient’s condition;
- stop IT if it worsens.

IT calculation:

The volume of infusion therapy is determined by calculating the amount of fluids daily requirement, pathological losses and deficits.

At an ambient temperature of 20 degrees Celsius, the daily requirement is 20 - 30 ml/kg. When the air temperature rises, 1 ml/kg is added per 1 degree.
Pathological losses are measured by the following indicators:
- elevated temperature bodies;
- vomiting;
- diarrhea;
- breathing rate;
- volume of fluid separated through drainage, probe, etc.
Dehydration (fluid deficiency) is determined by the elasticity (turgor) of the skin and the contents of the bladder; body weight.

Indications for use and calculation of infusion therapy in children

Infusion therapy is indicated for children with the development of dehydration against the background of the following pathologies:

One of the frequently used procedures when a child is in critical condition is parenteral fluid infusion. Due to the fact that when the child is in in serious condition, hypovolemia often occurs, infusion therapy in such situations is carried out using the following components:

colloidal solutions: infukol, stabizol; refortan;
crystalloid solutions: disol, trisol, ringer.

Calculation of infusion therapy in children is carried out using the Vallaci formula. From 100 conventional units the product of the number 3 and the child’s age is subtracted. The resulting value in ml/kg is the daily fluid requirement for children.

Volume of infusion therapy equal to the sum 1.7 daily requirement and pathological losses. In this case, one should take into account the body’s daily need (taking into account age) for basic electrolytes: potassium, sodium, magnesium, calcium.

When conducting infusion therapy in children, the child’s condition is especially carefully monitored;
heart rate;
blood pressure;
state of consciousness;
skin color and temperature.

Solutions for infusion therapy: crystalloid, colloid, blood products

Infusion therapy allows high-quality and short time fight the most complex pathologies. AND modern medicine can't do without this effective method treatment that is easy to carry out using easy-to-use devices.

The infusion therapy set is equipped with the following elements:

a dropper with a liquid filter, a plastic needle and a cap;
roller clamp;
connector;
injection needle;
injection unit;
air metal needle;
main tube;
liquid flow regulator.

To avoid infectious infection The patient's infusion therapy set must be sterilized with ethylene oxide. This drug completely eliminates the presence of any types of microorganisms on the structural elements.

The following solutions are used for IT:

colloidal;
crystalloid;
blood products.

Colloidal solutions for infusion therapy, action.

due to the presence of particles with a large molecular weight, they almost do not penetrate into the intercellular space;
quickly replenish blood volume;
stimulate blood circulation in all areas of the vascular bed.

Compound:

plasma, stabizol, albumin (large molecules);
refortan, perftoran; hemohes (medium molecules).

Crystalloid solutions for infusion therapy, action:

capable of penetrating any liquid inside a person;
easily enter the intercellular space and balance it;
they are accessible in treatment, as they are not expensive;
can be used both to replenish fluid volume in the body and to support its functions;
saline solutions for infusion therapy have the disadvantage of rapid elimination from the body.

Compound:

glucose;
reamberin, trisol, disol, acesol (all preparations based on chlorine and sodium).

If in a salt solution for IT low content salts, then such a solution is called hypotonic, and with high - hypertonic.

Based on physiological solutions, preparations for IT are prepared with organic acids: succinic, acetic and others.

Blood products, action:

detoxification of the body;
replenish the deficiency of platelets and red blood cells;
adjust the fluidity and volume of circulating blood;
at big losses blood best replenish its deficiency;
disadvantage - can cause allergies and rejection.

Compound:

plasma;
platelet mass;
leukocyte mass;
red blood cell mass;
albumins.

What are the complications of infusion therapy?

In case of inaccurate diagnosis of disorders of water-electrolyte homeostasis, incorrect preparation of the IT algorithm, violation of the procedure technique and as a result of some other factors possible the following complications infusion therapy:

Principles of infusion rehydration therapy

General rules drawing up an infusion therapy program

1. Colloidal solutions contain sodium salts and belong to saline solutions and their volume must be taken into account in the total volume of saline solutions.

2. In total, colloidal solutions should not exceed 1/3 of the total daily volume of fluid for infusion therapy.

3. In children younger age the ratio of glucose and salt solutions is 2:1 or 1:1; in older age, the amount of saline solutions increases (1:1 or 1:2).

3.1. The type of dehydration affects the ratio of glucose-saline solutions in the composition of infusion media.

4. All solutions must be divided into portions (“droppers”), the volume of which for glucose usually does not exceed 10-15 ml/kg and 7-10 ml for colloidal and saline solutions. The container for one drip should not contain more than ¼ of the daily volume of liquid. More than 3 drips it is unrealistic to spend a day on a child.

During infusion rehydration therapy, there are 4 stages: 1. anti-shock measures (1-3 hours); 2. Compensation for extracellular fluid deficiency (1-2-3 days); 3. maintaining water and electrolyte balance in conditions of ongoing pathological losses (2-4 days or more); parenteral nutrition (total or partial) or therapeutic enteral nutrition.

To maintain a state of homeostasis, it is necessary to ensure a balance between the fluid introduced into the body and the fluid that the body removes in the form of urine, sweat, feces, and exhaled air. The amount and nature of losses varies depending on the nature of the disease.

The amount of fluid required to compensate for the physiological losses of the body in children of different ages, not the same.

Table 1. 69.Age-specific fluid and electrolyte requirements for children

Physiological need for sodium in children early age is 3-5 mmol/kg; in older children, 2-3 mmol/kg;

The potassium requirement is 1-3 mmol/kg;

The requirement for magnesium is on average 0.1 mmol/kg.

The fluid and electrolyte requirements needed to replace physiological losses can be calculated using several methods.

Daily maintenance fluid (fluid requirement) can be calculated in several ways: 1) based on body surface area (there is a correlation between these indicators); 2) energy method (there is a relationship between energy needs and body weight). The minimum water requirement is 100-150 ml/100 kcal; 3) according to the Aberdeen nomogram (or tables made on its basis - table 1.69).

For some pathological conditions losses of water and/or electrolytes may increase or decrease significantly.

Table 1.70.Current pathological losses. Conditions that change fluid requirements

State

Fluid requirement

Fever Hypothermia Uncontrollable vomiting Diarrhea Heart failure Pulmonary edema Increased sweating Hyperventilation Increased air humidity Renal failure Intestinal paresis Phototherapy High ambient temperature Increased metabolism Mechanical ventilation of newborns (with good hydration)

Increase by 10 ml/kg for each degree of increase in temperature Decrease by 10 ml/kg for each degree of decrease in temperature Increase in requirement by 20-30 ml/kg/day Increase by 25-50 ml/kg/day Reduction in requirement by 25-50% depending on the degree of deficiency Reducing the need to 20-30 ml/kg/day Increasing the need by 10-25 ml/100 kcal Increasing the need to 50-60 ml/100 kcal Reducing the need by 0-15 ml/100 kcal Reducing the need to 15 -30 ml/kg/day Increase in need by 25-50 ml/kg/day Increase in need by 15-30% Increase in need by 50-100% Increase in need by 25-75% Reduction in need by 20-30 ml/kg of the daily requirement needs

To cover the fluid requirement, it is necessary to take into account the physiological fluid requirement (1500-1800 ml/m2) or calculated from the tables (Table 1.69), or energy method and add to them the fluid losses identified in the patient.

General principles calculating the required fluid:

SZh = SZhP+ ZhVO+ZhVTPP, Where SJ– calculated daily fluid, SZhP– daily maintenance fluid, ZHVO– fluid to compensate for dehydration, ZhVCCI- liquid to compensate for current pathological losses.

The need for water in a healthy or sick body is determined by the total amount of water excreted from the body through urine, through the skin, from the surface of the lungs, and with feces. For adults, the need for water is 40 ml/kg per day (V. A. Negovsky, A. M. Gurvich, E. S. Zolotokrylina, 1987), the daily need for sodium is 1.5 mmol/kg, for calcium - approximately 9 mmol (10 ml of 10% solution of gluconate or calcium chloride), and the daily requirement for magnesium is 0.33 mmol/kg. The amount of 25% magnesium sulfate can be determined by the formula:

Total daily requirement (MgSO4) in mmol: 2 = ml/day.

It is advisable to administer potassium chloride in a solution of glucose with insulin, but its concentration should not exceed 0.75% and the rate of administration 0.5 mmol/(kg hour). The total potassium load should not exceed 2-3 mmol/(kg day).

The physiological need for fluid is compensated with saline solutions and 5-10% glucose solution in a ratio of 1:2 or 1:1.

The next stage of implementation infusion program is to compensate for the deficiency of fluid and ions and current pathological losses in the patient’s body. It should be noted that this problem must be solved first, since this is where the success of treatment lies largely.

There are physiological and pathological losses. Thus, perspiration in adults is 0.5 ml/kg per hour. Loss through diuresis is normally 1 ml/kg per hour.

Knowledge of physiological losses is especially important and necessary when conducting infusion therapy in patients with renal failure, since the given figures for daily fluid requirements already include physiological losses. It is equally important to take into account pathological losses, which can reach significant values. Thus, with hyperthermia (more than 37°) and an increase in body temperature by 1°, water loss increases by an average of 500 ml per day. Water excreted through sweat contains 20-25 mOsmol/L Na+ and 15-35 mOsmol/L SG. Losses may increase with fever, thyrotoxic crises, treatment with some medicines(pilocarpine), high ambient temperatures.

Water loss in feces in an adult is normally about 200 ml/day. Digestion is accompanied by the release of about 8-10 liters of water with ions dissolved in it into the lumen of the stomach and intestines. IN healthy intestines almost all of this volume is reabsorbed.

In pathological conditions (diarrhea, vomiting, fistulas, intestinal obstruction), the body loses significant amount water and ions. When absorption processes from the intestine are disrupted, transcellular pools are formed, sequestering a large number of water and electrolytes. For an approximate correction, it is recommended to increase the volume of fluid by 20 ml/(kg day) with the development of stage II intestinal paresis. III degree- by 40 ml/(kg day). Corrective solutions must contain sodium, potassium, chlorine, etc. ions.

Frequent vomiting causes a water deficiency of an average of 20 ml/(kg day), and correction is best done with solutions containing chlorides and potassium.

For moderate diarrhea, fluid replacement is recommended at the rate of 30-40 ml/(kg day), for severe diarrhea - 60-70 ml/(kg day), and for profuse diarrhea - up to 120-40 ml/(kg day) with solutions containing ions sodium, potassium, chlorine, magnesium.

For hyperventilation, it is advisable for every 20 breathing movements above the norm, administer 15 ml/(kg day) glucose solution. At performing mechanical ventilation without adequate humidification, up to 50 ml/hour is lost, i.e. ventilation with a RO-6 type apparatus during the day requires additional administration from 1.5 to 2 liters of liquid.

The most ideal and most competent way to correct pathological losses is to determine the composition of the lost media and their quantity. In this case, even using official solutions, existing violations can be corrected quite accurately.

When calculating and selecting various infusion media, some difficulties arise when converting the amount of a substance contained in a solution into mmol and vice versa. Therefore, below we present such ratios for the most commonly used substances.

So, 1 ml contains:

7.4% KCl solution - 1 mmol K+ and 1 mmol Cl‾

3.7% KCl solution - 0.5 mmol K+ and 0.5 mmol Cl‾

5,8% NaCl solution- 1 mmol Na+ and 1 mmol Cl‾

8.4% NaHCO3 solution - 1 mmol Na+ and 1 mmol HCO3‾

4.2% NaHCO3 solution - 0.5 mmol Na+ and 0.5 mmol HCO‾

10% CaCl2 solution - 0.9 mmol Ca++ and 1.8 mmol Cl‾

10% NaCl solution -1.7 mmol Na+ and 1.7 mmol Cl‾

25% MgSO4 solution - 2.1 mmol Mg++ and 2.1 mmol SO4 ²‾

1 mole is equal to:

For successful therapy It is important to determine the ratio of glucose to saline solutions. This ratio will depend on the predominance of water or electrolyte loss. With isotonic dehydration, it is advisable to maintain the ratio of salt-free solutions to salt solutions at 1:1, with water deficiency - 4:1, salt deficiency - 1:2.

The volume of colloids depends, firstly, on the severity of hemodynamic disorders and the state of volemia; secondly, from the need to administer blood substitutes for vital reasons (for example, in the presence of bleeding - administration of plasma, blood).

The choice of the so-called “starting solution” will also depend on the degree of dehydration and its form. Let's clarify this idea. The third degree of dehydration occurs with severe hemodynamic disturbances and should be considered as hypovolemic shock. In this regard, despite the form of dehydration, therapeutic measures you should start with drugs that create a volemic effect (albumin, rheopolyglucin, hemodez), after which you need to move on to the introduction of fluids, depending on the form of dehydration.

Thus, it is advisable to begin the treatment of extracellular dehydration (salt deficiency exicosis) with the administration of an isotonic solution of sodium chloride. Administration of 5% glucose is contraindicated, since its rapid movement into the intracellular sector can cause brain edema. On the contrary, for cellular dehydration, a 5% glucose solution is recommended as a starting solution. Causing some hypotonicity of the extracellular sector, it ensures the saturation of the intracellular space with water. In case of total (general) dehydration syndrome, it is recommended to begin therapy with an isotonic glucose solution, followed by a transition to the administration of isotonic saline solutions.

When performing infusion therapy during surgery caesarean section or during childbirth, it is necessary to remember that the administration of glucose solutions before the birth of the child is indicated only for women with initial low level Sahara. This is dictated by the fact that the supply of glucose to the fetus through the uteroplacental bloodstream causes hyperinsulinemia, which, after the fetus is removed and the supply of glucose from the mother is stopped, can cause hypoglycemia and deterioration of the condition of the newborn. After the baby is removed, glucose and saline are usually administered in a 1:1 ratio.

The total volume of fluid required to correct the deficiency and daily requirement depends on the degree of dehydration. An important criterion for its determination are clinical and laboratory data.

The next task that needs to be solved is determining the time during which it is planned to correct dehydration. It is advisable to adhere to the principle that the total volume of fluid administered (enterally and intravenously) should be within 5-9% of body weight and weight gain should not exceed these figures, because they indicate the limit of the compensatory capabilities of the cardiovascular and urinary systems.

According to V.M. Sidelnikov (1983), the deficit of water and salts should be compensated for in 24-36 hours, and 60% of the water deficit should be introduced within the first 12 hours. In patients with heart failure, this period can be increased to 3 - 5 days. Finberg (1980) recommends administering half of the daily requirement in 6-8 hours, and the rest, plus the volume of pathological losses, in the remaining hours before the end of the day.

Lysenkov S.P., Myasnikova V.V., Ponomarev V.V.

Emergency conditions and anesthesia in obstetrics. Clinical pathophysiology and pharmacotherapy