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