Pediatric Fluid Requirements – Dehydrated Child

From FMTS talk by Dr Karee Byram:

1. Determine severity of dehydration:

  • Older kid:  3% (30mL/kg), 6% (60mL/kg), 9% (90mL/kg)
  • Infant:  5% (50mL/kg), 10% (100mL/kg), 15% (150mL/kg)
  • Example:  9 mo old kid, weighs 10kg, 5% dehydrated clinically = 500mL deficit.

2.  Give the bolus:

  • 20mL/kg
  • Example:  10kg child x 20mL = 200mL bolus.

3.  Calculate remaining deficit after bolus:

  • Example:  After 200mL bolus – 500mL – 200mL = 300mL remaining deficit

4.  Calculate maintenance rate:  the 4/2/1 rule (Holliday-Segar Method)

  • Example:  10kg = 40mL/hr OR 1000mL/day

5.  Determine total fluid rate:

  • Example:  1000mL [maintenance for one day] + 300mL [remaining deficit from 3 above] = 1300 mL over 24 hours
  • Give half in first 8 hours (650 mL in this example) and half over second 16 hours (650 mL in this example).
  • Example:  So, 650/8 = 81.2 mL/h over first 8 hours, then 650/16 = 40.6 mL/h over second 16 hours.

REMEMBER:  Do NOT give fluids at rate > 2x maintenance rate!

Image result for harriet lane pediatric clinical signs of dehydration

 

 

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