A 3yo child with severe diarrhea and vomiting, looks lethargic, has sunken eyes and a feeble cry.
What is the choice of fluids?
a. 0.9%NS
b. 0.9%NS + 5%Dextrose
c. 0.45%NS + 5%Dextrose
d. 0.45%NS
answer: A
resuscitate with 0.9% then later maintenance with 0.45NS/5%dextrose
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 flowing. 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.
For maintenance: Use 0.45% saline with 5% glucose
N.b Hypernatraemic dehydration: re-hydrate slowly with 0.9% or 0.45% NS
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