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:
- 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!