Monday, March 2, 2015

Fluid resuscitation in paediatric

Fluids are given intravenously for the following reasons:

  • Circulatory support in resuscitating vascular collapse.
  • Replacement of previous fluid and electrolyte deficit.
  • Maintenance of daily fluid requirement.
  • Replacement of ongoing losses.
  • Severe dehydration with failed nasogastric tube fluid replacement
  • (e.g. on-going profuse losses, diarrhoea or abdominal pain).
  • Certain co-morbidities, particularly GIT conditions (e.g. short gut or
  • previous gut surgery)


Dosing: 

  • Fluid deficit sufficient cause impaired tissue oxygenation (i.e. clinical shock)
  • Should be corrected with a fluid bolus of 10-20mls/kg
  • Fluid boluses of 10mls/kg in selected situations - e.g. diabetic ketoacidosis, intracranial pathology or trauma.
  • Always reassess circulation - give repeat boluses as necessary.
Other factors/ monitoring:

  • Always reassess circulation - give repeat boluses as necessary
  • Look for the cause of circulatory collapse - blood loss, sepsis, etc. This helps decide on the appropriate alternative resuscitation fluid.
  • Avoid low sodium-containing (hypotonic) solutions for resuscitation as this may cause hyponatremia
  • Check blood glucose: treat hypoglycemia with 2mls/kg of 10% Dextrose solution
  • Measure Na, K and glucose at the outset and at least 24hourly from then on. More frequent testing is indicated in ill patients or those with co-morbidities. Rapid results of electrolytes can be done with blood gases measurements.
  • Consider septic work-up or surgical consult in severely unwell patients with abdominal symptoms (i.e. gastroenteritis).


            (i) Shock WITHOUT severe Malnutrtion





                (ii) Shock WITH severe Malnutrition

                 Reference:

                1. Malaysian Paediatric Protocol 3rd edition
                2. Pocket Book of Hospital Care for Children. WHO 2013



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