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fluid of choice in neonate with septic shock


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Guest ajaymenon

Dear Vj,

Maintenance in the 1st few days ,typically is with 10% D alone ,without any electrolytes in a well child .however ,in your case,with hypotension presumed sepsis. The reason for hypotension might involve either a single cause or more likely , a combination of fluid loss, bleeding ,hormonal(ANP,BNP,ADH,renin angiotensin aldosterone mech:),and symp:nervous system interactions .The guide to fluids and electrolytes will depend on fluid Input /out put, hematocrit /platelets and urea/electrolytes.hope this helps !!

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I agree with @ajaymenon, choices of fluids would depend on the etiology of shock and how clinical markers/lab parameters develop.

I would use normal saline and/or blood products for hemodynamic volume support.

When it comes to inotropes, I would probably start with dopamine and add dobutamine if needed. Vasopressor support with higher dose dopamin and possibly epinephrin.

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Agree with the above, but you explicitly described your shock situation as caused by a sepsis and in that case you probably would have to consider that clotting is going to be deranged. So FFP and PLT might be necessary but as mentioned, maintenance as usual G5-10%.

One other thing is the choice of inotropes. Most established inotropes are Dopamine, Dobutamine and Adrenalin and most of the time in this order. Unfortunately the main reason for initiating these drugs is still low blood pressure which , as we all know, is a very poor predictor for organ perfusion.

I would like to bring to your mind that Milrinone can be of great benefit in patients with so called “cold shock”, patients with poor peripheral perfusion and impaired diastolic function. The myocardium is suffering from sepsis as well, and just constricting the periphery in order to have a better blood pressure does not make thing easier for the heart.

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  • 1 month later...

Besides assessment of lab results, diuresis, BP, capilary refill time, we use echocardiofraphy for assesment of contractility function and refiling of the heart. The heart sounds and peripheral pulsation are also important, like the heart action. And we use 0.9% NaCl 10 ml/kg /10-20 min as bolus. The most infants react better, and slowly your heart action. Well, we evaluate the kidney function (lab res and diuresis) , the all signs of low perfusion and low function of the heart and than we dised - ususally we give bolus fluids, than dopa, dobuta etc. Unfortunately,we dont have Milrinon.

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