Matt O'Meara reads the fine print on fluid management in paeds and straight talks on best practice.

1. FEAST or Famine
Matthew O’Meara
Director Emergency
Sydney Children’s Hospital Randwick

4. FEAST

5. Fever + impaired perfusion
No bolus
Albumin
20mL/kg
Saline
20mL/kg
Saline
40mL/kg
Albumin
40mL/kg
Severe Hypotension

6. 48 hour mortality 28 day mortality

7. Sick?
• Fever +
• Decreased level of
consciousness
• 62% can’t sit, 15%
unresponsive
• and/or
• respiratory distress
(83%)

8. Poor perfusion

9. Shocked?
• FEAST
• cap refill 3 sec, or
• leg temp gradient, or
• weak radial pulse
volume, or
• tachycardia
• CRT or 3 seconds or more, or a lower limb temperature
gradient, or a weak radial pulse volume (21%) or severe
tachycardia, based on age – over 180 for infants, over 160
for 1-5 years and over 140 for children over 5 years of age.
(i
WHO
Cold hands and feet and
cap refill 4 sec and
fast weak pulse

12. Inclusion Benefit?

13. So FEAST hasn’t
changed my practice,
tell me something new

14. • Hyponatraemia and death or permanent
brain damage in healthy children. Arieff BMJ 1992
• Fatal Hyponatraemic brain oedema... Sjoblom
ICM 1997
• Fatal Iatrogenic Hyponatraemia. Playfor ADC 2003
• Acute Hyponatraemia in children admitted
to hospital. Halberthal BMJ 2001
• Prevention of Hospital acquired
hyponatraemia. Moritz Pediatrics 2003

15. “From three to 120 inpatient hours after hypotonic fuid administration patients developed
progressive lethargy, headache, nausea and emesis with explosive onset of respiratory arrest”.
Moritz Pediatrics 2003

18. Too much fuid
or
Not enough salt?

19. The fuid type, not the
rate, determines the
risk of hyponatraemia

20. Hyponatraemia is less
likely when isotonic
saline is used

21. Relationship between IV fuid type and development of
hyponatraemia.

23. Is saline the best fuid?

24. How much Sugar?

25. What’s being done?

28. What should you do
differently?
• Resuscitate with saline/colloid/blood
• Maintenance with more salt and enough
glucose at usual rate
• Check your patient