INTRAVENOUS FLUIDS IN CHILDREN

Fluid management in children

  • Total daily maintenance fluid requirement is100 ml/kg for the first 10 kg plus50 ml/kg for the next 10 kg plus25 ml/kg for each subsequent kg
  • Give more than above if child is dehydrated or in fluid loss or fever (10% more for each 1°C of fever)
  • Monitor IV fluids very carefully because of risk of overload
  • Fluids which can be used for maintenance:
    • Half normal saline plus 5% or 10% dextrose
    • Ringer’s lactate with 5% dextrose
    • Normal saline with 5% dextrose
    • Do not use Dextrose 5% alone

Fluid management in neonates

  • Encourage mother to breastfeed or if child unable, give expressed breast milk via NGT
  • Withhold oral feeding in case of bowel obstruction, necrotizing enterocolitis, or if feeding is not tolerated (abdominal distension, vomiting everything)
  • Withhold oral feeding in acute phase of severe sickness, in infants who are lethargic, unconscious or having frequent convulsions

Total amount of fluids (oral and/or IV)

Day 1: 60 ml/kg/day of Dextrose 10%

Day 2: 90 ml/kg/day of Dextrose 10%

Day 3: 120 ml/kg/day of half normal saline and dextrose 5%

Day 4 onwards: 150 ml/kg/day

  • If only IV fluids are given, do not exceed 100 ml/kg/day unless child is dehydrated, under a radiant heater or phototherapy
  • If facial swelling develops, reduce rate of infusion
  • When oral feeding is well established, raise the total amount to 180 ml/kg/day

Shock in non-malnourished child

  • Use Ringer’s lactate or normal saline
  • Infuse 20 ml/kg as rapidly as possible

If no improvement

  • Repeat 10-20 ml/kg of IV fluids
  • If bleeding, give blood at 20 ml/kg

If still no improvement

  • Give another 20 ml/kg of IV fluids

If no improvement further still

  • Suspect septic shock
  • Repeat 20 ml/kg IV fluids and consider adrenaline or dopamine

If improvement noted at any stage (reducing heart rate, increase in blood pressure and pulse volume, capillary refill <2 seconds)

  • Give 70 ml/kg of Ringer’s lactate (or Normal saline if Ringer’s not available) over 5 hours (if infant <12 months) or 2.5 hours (if child >12
    months)

Note

  • In children with suspected malaria or anaemia with shock, IV fluids should be administered cautiously and blood should be used in severe anaemia

Shock in malnourished child

  • In malnourished children, give 15 ml/kg over 1 hour, use one of the following:
  • Ringer’s lactate with 5% glucose
  • Half strength darrow’s solution with 5% glucose
  • 0.45% Sodium chloride plus 5% glucose
  • Repeat once

If signs of improvement

  • Switch to oral or NGT ReSoMal at 10 ml/kg/hour for up to 10 hours

If no improvement

  • Give maintenance IV fluids 4 ml/kg/hour
  • Transfuse 10 ml/kg slowly (over 3 hours)
  • Start refeeding
  • Start IV antibiotics

Commonly used IV fluids and indication

Normal saline or Ringer’s lactate with 5% dextrose3 (to be prepared)Na 154/130 K 0/5.4 Glucose 25 g in 500 ml

  • Maintenance fluid in children
NAME COMPOSITION INDICATIONS
Sodium
Chloride 0.9%
(normal saline)		 Na 154 mmol/L
Cl 154 mmol/L		 Shock, dehydration
in adults (and
children)
Maintenance fluid in
adults
Dextrose
(Glucose) 5%		 Glucose 25 g in
500 ml		 Maintenance fluid in
adults
Dextrose
(Glucose) 10%
(to be prepared)		 Glucose 50 g in
500 ml		 Hypoglycaemia in
children and adults
Maintenance fluids
in newborns day 1
and 2
Dextrose 50% Glucose 50 g in
100 ml		 Hypoglycaemia in
adults
Ringer’s lactate
(Sodium lactate
compound,
Harmann’s
solution)		 Na 130 mmol/L
K 5.4 mmol/L
Ca 1.8 mmol/L		 Shock, dehydration
in children (and
adults)
Maintenance fluid in
adults
½ strenghth
Darrow’s
solution in 5%
glucose5		 Na 61 mmol/L
K 17 mmol/L
Glucose 25 g in
500 ml		 Shock and
dehydration in
malnourished
children
Half normal
saline (Nacl
0.45%) dextrose
5%2
(to be prepared)		 Na 77 mmol/L
Cl 77 mmol/L
Glucose 25 g in
500 ml		 Maintenance fluid in
children
Shock and
dehydration in
malnourished
children

Note

  1. Prepare from Dextrose 5% and 50%:
    • Remove 50 ml from Dextrose 5% 500 ml bottle and
      discard
    • Replace with 50 ml of Dextrose 50%. Shake
    • Follow normal aseptic techniques
    • Use immediately, DO NOT STORE
  2. Prepare from Normal saline 500 ml bottle and dextrose
    5% and 50%

 

  • Replace 250 ml of Normal saline with 225 ml of
    Dextrose 5% and 25 ml of Dextrose 50%
  • Prepare by replacing 50 ml of normal saline or Ringer’s
    500 ml bottle with 50 ml of Dextrose 50%