Management of Fluid and Electrolyte problems in Children

Seen in hospitalized patients.

Picked up on routine electrolyte measurement.

When correcting you must recognise that adaptive responses will have taken place in order to maintain normal ICF volume:

• Initially pumping out of K⁺ and Cl^- from cells.
• During next few days, organic molecules such as myo-inositol, amino acids and alcohols exported from cells.

Therefore, if the sodium concentration rises too quickly in the ECF and time is not allowed for these intracellular osmoles to return, then cells will shrink. In the CNS this may result in osmotic demyelination syndrome (ODS), a symmetrical demyelination commonly involving the base of the pons.

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