account for losses. Environmental losses are higher in radiant warmers
compared to a humidified incubator. Infants with phototherapy should have a
50ml/kg/day increase in fluids while on phototherapy. Patients with gastroschisis,
ruptured omphalocele, and bladder extrophy have greater evaporative losses
requiring a bolus of 20 ml/kg of isotonic fluid at birth and an increase of the
maintenance infusion by 20-25% until coverage of the exposed viscera is
accomplished. Surgical patients often have gastrointestinal fluid losses that
should be replaced with consideration of both the volume and electrolyte
concentration of these losses. Gastric fluids are typically replaced with D5 0.45
% NS with 20 mEq/liter of KCL, whereas biliary and intestinal losses are replaced
with Lactated Ringers solution. Urine output should be monitored to ensure
adequate perfusion.
Gastrointestinal Fluid Losses
Electrolyte
Composition
(mEq/L):
Na+ K+ CI- HCO3
Gastric 60 - 80 5 - 20 100 - 150 0
Biliary 120 - 140 5 - 15 80 - 120 30
Pancreatic 120 - 140 5 30 - 50 80 - 100
Small bowel 100 - 140 5 - 15 90 - 130 30
Diarrhea 10 - 90 10 - 80 10 - 110 10 - 75iii. Electrolytes