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Fluid and Electrolytes: Clinical Aspects

Stanley Hellerstein MD1
 1 Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Chief, Section of Pediatric Nephrology, The Children's Mercy Hospital, Kansas City, MO.

Dr Daniel C. Darrow, a clinician and one of the investigators whose contributions helped lay the foundation of modern fluid therapy, made the following observation in his book, A Guide to Learning Fluid Therapy: "Fluid therapy inevitably is carried out by rules which achieve results without requiring continual resort to complicated scientific reasoning. The chief difficulty is that no simple rules based on body weight or surface area meet the varying physiological requirements by infants, children, and adults. Nevertheless, by recognizing that body size has two dimensions, the same general rules apply at all ages to patients of different weights."

The dimensions of body size pertinent to fluid therapy are caloric production and weight. The usual ongoing fluid expenditures—maintenance fluids—are related to energy production, while restoration of normal body composition in patients with water and electrolyte deficits on excesses are related to changes in body weight. It should be added that when fluids for a patient are prescribed based on "convenient rules," the physician must be aware of the assumptions that renal function is not significantly impaired and that the homeostatic mechanisms for conservation and excretion of water and solute are intact. If this is not the case, the provision of water and electrolytes must be based on assessment of ongoing fluid expenditures.




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B. H. Brouhard
Fluid and Electrolyte Therapy
Clinical Pediatrics, July 1, 1997; 36(7): 401 - 402.
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