Paediatric fluid resuscitation (343/1700)

A 6wk child is very sick-looking. Bloods: Na+=124, K+=2.8. Dehydrated. What would you choose
to resuscitate?

a. 0.18% NS + 4% dextrose + 20mmol KCl
b. 0.9% NS
c. 0.45% NS
d. 0.45% NS + 5% dextrose
e. 0.45% NS + 5% dextrose + 20 mmol KCl































Answer: B

IV fluid replacement in the first 24h in >10% dehydration NB: 
• 0.9% saline 20mL/kg IVI bolus, while calculations are performed. Continuously
monitor pulse, BP, ECG.
• Continue with boluses until the signs of shock ease.
• Then give the daily requirement + fluid deficit, making good continuing loss with 0.45% or 0.9% saline depending on type of dehydration.
• Measure plasma and urine creatinine and osmolality, and plasma bicarbonate. Metabolic acidosis usually corrects itself.
• Give potassium once you know that urine is fl owing. The ready-prepared fluid ‘0.45% Saline With 5% glucose With Potassium Chloride 20mmol/L’ is usually a good choice. Be guided by serum K+.

IV fluids for the first 24h in 5–10% dehydration 
Rapid rehydration involves 4 hours of 10mL/kg/h 0.9% NaCl then maintenance after if needed. Drop the fluid rate after 4h, and change to 0.45%/5% glucose.

N.b Hypernatraemic dehydration: re-hydrate slowly with 0.9% or 0.45% NS

For maintenance after rehydration: Use 0.45% saline with 5% glucose