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                                    Fluids and Electrolyte Therapy in the Paediatric Surgical Patient  29
          Calcium Balance                                        Table 5.7: Evidence-based research.
           • Normal serum values: 2.5 mmol/l.                      Title      The maintenance need for water in parenteral fluid therapy.
                                                                   Authors    Holliday MA, Segar WE
           • Hypocalcaemia may present with: seizures, jitters, and ECG chang-
            es of long Q-T interval.                               Institution  Department of Pediatrics, University of California, San
                                                                              Francisco, California, USA
           • Treatment includes: calcium supplement orally or calcium gluco-  Reference  Pediatrics 1957; 19:823–832
            nate infusion.
                                                                   Problem    Fluid and electrolytes in children.
                      Evidence-Based Research                      Historical   Classic paper describing the use of intravenous fluids in the
          Table 5.7 comments on a paper on the maintenance need for water in   significance/   paediatric population involving the perioperative setting to
                                                                              some degree.
          parenteral fluid therapy.                                comments


                                                    Key Summary Points

             1.  Fluid management in the paediatric surgical population can   4.  Bowel obstruction in the paediatric patient commonly presents
                be a real challenge, especially in the preterm infant with an   with metabolic acidosis due to delayed presentation.
                immature physiological state.                    5.  A surgeon preparing the paediatric patient for surgery must
             2.  With the small circulating blood volume in the paediatric   determine whether sodium or potassium levels are abnormal
                patient, fluid management is a critical aspect of each patient   and attempt correction prior to surgical management because
                who presents for surgery, and vigilance is critical.  these abnormalities are much more common than in the adult
                                                                   population.
             3.  Many paediatric patients who present for surgery in Africa have
                a delayed presentation and need a normal saline (NS) fluid   6.  Fluid overload in the paediatric surgical patient is not
                bolus with glucose measurement prior to the onset of surgery.  uncommon, and strict observation of maintenance and third
                                                                   space fluids are essential to avoid this problem.




                                                         References

             1.   Gregory GA, ed. Pediatric Anesthesia, 2nd ed. Churchill   4.   Cote C, Lerman J, Todres I, eds. A Practice of Anesthesia for
                 Livingstone, 1989.                                 Infants and Children, 4th ed. Saunders, 2008.
             2.   Darmstadt GL. Determination of extended-interval gentamicin   5.   Graef J. Manual of Pediatric Therapeutics, 6th ed. Lippincott-
                 dosing for neonatal patients in developing countries. Pediatr Infect   Raven, 1997.
                 Disease J, 2007; 26(6):502–507.
             3.   Stavroudis TA, Miller MR, Lehmann CU. Medication errors in
                 neonates. Clinics in Perinatology 2008; 35(1):141–161.
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