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
- 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
- Remove 50 ml from Dextrose 5% 500 ml bottle and
- 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%