Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For a patient with Staphylococcal Scalded Skin Syndrome (SSSS) presenting with extensive skin involvement, managing fluid and electrolyte balance requires careful assessment, appropriate intravenous fluid therapy if indicated, and continuous monitoring.
1. Assessment for Dehydration and Shock
- Initially, assess for clinical dehydration and hypovolaemic shock using clinical features such as altered responsiveness, sunken eyes, dry mucous membranes, tachycardia, tachypnoea, prolonged capillary refill time, reduced skin turgor, hypotension, pale or mottled skin, and cold extremities NICE NG29,NICE CG84.
- It is important to recognise that children younger than 1 year, particularly those younger than 6 months, are at an increased risk of dehydration NICE CG84.
2. Laboratory Investigations
- Measure plasma electrolyte concentrations (sodium, potassium, urea, creatinine) and blood glucose when starting intravenous (IV) fluids NICE NG29,NICE CG84.
- These measurements should be repeated at least every 24 hours, or more frequently if there are electrolyte disturbances or a risk of hypoglycaemia NICE NG29.
- If shock is suspected or confirmed, measure venous blood acid-base status and chloride concentration NICE CG84.
- Consider point-of-care testing for measuring plasma electrolyte concentrations and blood glucose in time-critical situations when IV fluids are needed NICE NG29.
3. Intravenous Fluid Therapy (if indicated)
- For fluid resuscitation in newborn babies under 28 days, use glucose-free crystalloids containing sodium in the range of 130 to 154 mmol/litre, with a bolus of 10 to 20 ml/kg over less than 10 minutes NICE NG51.
- For patients up to 16 years, use glucose-free crystalloids containing sodium in the range of 130 to 154 mmol/litre, with a bolus of 10 ml/kg over less than 10 minutes NICE NG51. When administering fluids, take into account pre-existing conditions (for example, cardiac disease or kidney disease), as smaller fluid volumes may be needed NICE NG51.
- For patients aged 18 years and over, use crystalloids containing sodium in the range of 130 to 154 mmol/litre, with a bolus of 500 ml over less than 15 minutes NICE NG51.
- Do not use starch-based solutions or hydroxyethyl starches for fluid resuscitation NICE NG51.
- Human albumin solution 4 to 5% should only be considered for fluid resuscitation in patients with sepsis and shock NICE NG51.
- For children under 12 years, use a pump, or a syringe if no pump is available, to deliver intravenous fluids for resuscitation in bolus form NICE NG51.
4. Ongoing Monitoring and Reassessment
- Record the types and volumes of fluid input and output (urine, gastric, and other) hourly, maintaining running totals NICE NG29.
- Maintain 12-hourly fluid balance subtotals and 24-hourly fluid balance totals NICE NG29.
- Reassess the fluid prescription, current hydration status, and whether oral fluids can be started every 12 hours NICE NG29.