Question

Discuss the management of electrolyte and fluid and its

Answer 1

Answer:

Fluid Requirements:-

The body composition of the ELBW infant is 85 to 90% water of which one-third is intracellular water (ICW) and two-thirds is extracellular water (ECW).The management of the fluid in the extracellular space becomes important in both the immediate management of the infants volume status as well as how the management will affect the onset of postnatal diuresis and potential subsequent morbidities [intraventricular hemorrhage (IVH), patent ductus arteriosus (PDA), and bronchopulmonary dysplasia (BPD)] related to a delay in diuresis.During transition there is a redistribution of body water from the interstitial space to the extracellular space as well as reabsorbed lung fluid, resulting in an expansion of extracellular water volume and an increase in its sodium content.A serum sodium measured at this time before the establishment of postnatal diuresis may be low (130-134 mEq/L), reflecting an expanded extracellular fluid (ECF) volume. Adding sodium at this stage can prevent the postnatal diuresis and further expand the ECF and contribute to edema formation in the periphery as well as the lung.Infants cannot excrete a sodium load as well as an adult even when the fractional excretion of sodium (FENa) is maximized. The physiologic attempt to conserve sodium may be a developmental one in that the preterm infant needs sodium for growth and development.An adaptive response of the kidney is to elicit an antinaturietic renal tubular response, resulting in an attempt to conserve sodium by the kidneys.The FENa is higher in the preterm infant compared with the term newborn and adult (FENa = 1%). The FENa can be as high as 12.4% during the postnatal diuresis.The high FENa begins to fall as the postnatal diuresis abates followed by weeks of renal sodium conservation.A positive sodium balance is a requirement for growth.Exogenous sodium should not be added to intravenous fluids in the first days of life until the postnatal diuresis has been established, which occurs when the urine output drops and the specific gravity is >1.012.

Explanation: