HYPOVOLAEMIC SHOCK IN CHILDREN

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)