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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.