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脱水症治療のアルゴリズム

低張液輸液による医原性低Na血症には常に留意する必要がある。初期輸液・維持輸液ともに等張液を使用すべきとの意見があるが、等張液を使用する場合は、低血糖の予防のため2.5~5%程度のブドウ糖を添加するか、糖分の添加された製剤(ヴィーンDやラクテックDなど)を使用する必要がある。血清Naの補正は基本的に12 mEq/L/日以内を目標とする。
中等度までの脱水症においては、経口補液療法は経静脈輸液と同等の脱水是正効果がある。
中枢神経症状を伴う重篤な低Na血症では最初の数時間で血清Naを5~6 mEq/L程度上昇させることを目標とする。
血清Naの補正は12 mEq/L/日を超えないようにする。
低張液輸液には医原性低Na血症の危険性がある。
医原性低Na血症の予防のためには低張液ではなく等張液を使用すべきである。
出典
img
1: 著者提供

WHOガイドラインによる重症脱水の乳幼児に対する経静脈輸液

WHOのガイドラインでは、重症脱水に対して表の通り推奨を行っている。
表の投与速度による100 ml/kgの乳酸リンゲル液(なければ生理食塩液)経静脈投与する。経口摂取が可能であれば輸液準備の間にORTを行う。
出典
imgimg
1: Guideline: Updates on Paediatric Emergency Triage, Assessment and Treatment: Care of Critically-Ill Children
著者: .
Abstract/Text: Children admitted to hospital often die within 24 hours of admission. Many of these deaths could be prevented if very sick children are identified soon after their arrival in the health facility, and treatment is started immediately. This can be facilitated by rapid triage for all children presenting to hospital to identify those needing immediate emergency care. The Emergency Triage Assessment and Treatment (ETAT) guidelines provide guidance on the most common emergency conditions in children presenting at the health facility. These include but are not limited to airway obstruction and other breathing problems; circulatory impairment or shock; severely altered CNS function (coma or convulsive seizures); and severe dehydration which require urgent appropriate care to prevent death. The recommendations in this publication complement or update guidance in published WHO ETAT training materials published in 2005 and the 2nd edition Pocket book for hospital care for children published in 2013. This guideline however, does not cover all WHO recommendations on paediatric ETAT. It covers only those identified and prioritized by the WHO guideline development group for update in 2013. Other ETAT recommendations not covered in the current publication will be addressed in future ETAT guideline updates. This updated guideline was prepared by a panel of international experts and informed by systematic reviews of evidence as up to 2015 and makes recommendations on three main areas: when to start and stop oxygen therapy; oxygen flow rates and humidification in severely ill children with emergency signs; which intravenous fluids, at what rate and for how long, should be used in the management of infants and children presenting with impaired circulation or shock; and anticonvulsant medicines for children with acute seizures when intravenous (IV) access is and is not available; second-line anticonvulsant medicines for children with established status epilepticus; pharmacological interventions as prophylaxis to prevent recurrence of febrile seizures in children; and diagnostic tests that should be performed on infants and children presenting with seizures with altered consciousness. This guideline is intended for use in low-resource settings where infants and children are likely to be managed by non-specialists. Their aim is to provide clinical guidance to these health workers on managing infants and children presenting with signs of severe illness.

脱水の重症度分類

出典
img
1: 著者提供

脱水症治療のアルゴリズム

低張液輸液による医原性低Na血症には常に留意する必要がある。初期輸液・維持輸液ともに等張液を使用すべきとの意見があるが、等張液を使用する場合は、低血糖の予防のため2.5~5%程度のブドウ糖を添加するか、糖分の添加された製剤(ヴィーンDやラクテックDなど)を使用する必要がある。血清Naの補正は基本的に12 mEq/L/日以内を目標とする。
中等度までの脱水症においては、経口補液療法は経静脈輸液と同等の脱水是正効果がある。
中枢神経症状を伴う重篤な低Na血症では最初の数時間で血清Naを5~6 mEq/L程度上昇させることを目標とする。
血清Naの補正は12 mEq/L/日を超えないようにする。
低張液輸液には医原性低Na血症の危険性がある。
医原性低Na血症の予防のためには低張液ではなく等張液を使用すべきである。
出典
img
1: 著者提供

WHOガイドラインによる重症脱水の乳幼児に対する経静脈輸液

WHOのガイドラインでは、重症脱水に対して表の通り推奨を行っている。
表の投与速度による100 ml/kgの乳酸リンゲル液(なければ生理食塩液)経静脈投与する。経口摂取が可能であれば輸液準備の間にORTを行う。
出典
imgimg
1: Guideline: Updates on Paediatric Emergency Triage, Assessment and Treatment: Care of Critically-Ill Children
著者: .
Abstract/Text: Children admitted to hospital often die within 24 hours of admission. Many of these deaths could be prevented if very sick children are identified soon after their arrival in the health facility, and treatment is started immediately. This can be facilitated by rapid triage for all children presenting to hospital to identify those needing immediate emergency care. The Emergency Triage Assessment and Treatment (ETAT) guidelines provide guidance on the most common emergency conditions in children presenting at the health facility. These include but are not limited to airway obstruction and other breathing problems; circulatory impairment or shock; severely altered CNS function (coma or convulsive seizures); and severe dehydration which require urgent appropriate care to prevent death. The recommendations in this publication complement or update guidance in published WHO ETAT training materials published in 2005 and the 2nd edition Pocket book for hospital care for children published in 2013. This guideline however, does not cover all WHO recommendations on paediatric ETAT. It covers only those identified and prioritized by the WHO guideline development group for update in 2013. Other ETAT recommendations not covered in the current publication will be addressed in future ETAT guideline updates. This updated guideline was prepared by a panel of international experts and informed by systematic reviews of evidence as up to 2015 and makes recommendations on three main areas: when to start and stop oxygen therapy; oxygen flow rates and humidification in severely ill children with emergency signs; which intravenous fluids, at what rate and for how long, should be used in the management of infants and children presenting with impaired circulation or shock; and anticonvulsant medicines for children with acute seizures when intravenous (IV) access is and is not available; second-line anticonvulsant medicines for children with established status epilepticus; pharmacological interventions as prophylaxis to prevent recurrence of febrile seizures in children; and diagnostic tests that should be performed on infants and children presenting with seizures with altered consciousness. This guideline is intended for use in low-resource settings where infants and children are likely to be managed by non-specialists. Their aim is to provide clinical guidance to these health workers on managing infants and children presenting with signs of severe illness.