Principles of management are similar to the ones in adults
BUT:
- Recognising this may be more difficult than in adults
- Vital signs may change little, even when up to 25% of blood volume is lost (class 1 and 2 hypovolaemia)
- Tachycardia is often the first response to hypovolaemia but may also be caused by fear or pain
Classification of hypovolaemia in children
| INDICATOR | CLASS 1 MILD |
CLASS 2 PROGRESSING |
CLASS 3 SEVERE |
CLASS 4 END STAGE |
|---|---|---|---|---|
| % of total blood volume loss |
<15 | 15-25 | 25-40 | >40 |
| Pulse rate | Normal | >150 | >150 | >150 |
| Pulse pressure |
Normal | N | decreased | Absent |
| Systolic BP | Normal | N | low | Absent |
| Capillary refill |
Normal | high | very high | Absent |
| Respiratory rate |
Normal | N/ or high | very high | increased Slow sighing |
| Mental state |
Normal | Irritable | Lethargic | Comatose |
| Urine output (ml/kg/ hour) |
<1 | <1 | <1 | <1 |
Normal ranges for vital signs in children
| AGE (YEARS) |
PULSE (RATE/MIN) |
SYSTOLIC BP (MMHG) |
RESPIRATION (RATE/MIN) |
BLOOD VOL (ML/KG) |
|---|---|---|---|---|
| <1 | 120–160 | 70–90 | 30–40 | 85–90 |
| 1–5 | 100–120 | 80–90 | 25–30 | 80 |
| 6–12 | 80–100 | 90–110 | 20–25 | 80 |
| >12 | 60–100 | 100–120 | 15–20 | 70 |
Management
- Initial fluid challenge should represent 25% of blood volume as signs of hypovolaemia may only show after this amount is lost
- If there are signs of class 2 hypovolaemia or greater, give 20-30 ml/kg of Normal Saline 0.9% (or Ringer’s lactate) over 60 minutes
- Start rapidly
- Monitor BP
- Reduce rate depending on BP response
- Depending on response, repeat up to 3 times if necessary i.e. up to max 60 ml/kg
If no response:
- Give further IV fluids and blood transfusion
- Initially transfuse 20 ml/kg of whole blood or 10 ml/kg of packed cells (only in severe anaemia)