Causes of shock include

  • Bleeding
  • Severe infection (septic shock)
  • Severe dehydration
  • Cardiac disease
  • Trauma

Clinical Features

  • Cold hands
  • Capillary refill >3 seconds
  • Weak fast pulse
  • Children with these signs are in shock and need emergency treatment.


  1. For a child without severe malnutrition:
    • Infuse 20ml/kg of normal saline or Ringer’s lactate as rapidly as possible.
    • Reassess and give a second dose if there is no improvement. You may need 2 or 3 repeats to restore circulating blood volume
  2. For a child with severe malnutrition:
    • Give 15ml/kg of Ringer’s lactate with 5% dextrose or half normal saline with 5% dextrose and infuse over 1 hour.
    • After resuscitation: Admit and look for the cause if not already obvious and treat.


  • Hb, WBC, platelets
  • Blood sugar
  • Urea and electrolytes, creatinine
  • Blood sugar
  • C&S (blood and body fluids).
  • Coagulation screen if needed

Management – General

  • Resuscitate with normal saline or dextran 20ml/kg. Repeat if necessary – up to 80ml/kg may be required but watch for heart failure. A CVP line is useful.
  • Hourly pulse and BP
  • Catheterize and monitor urine output hourly: If less than 1–2ml/kg/hr after adequate fluid replacement give frusemide 1–2mg/kg IV STAT. If urine output does not increase assume renal failure and manage accordingly.
  • Oxygen via nasal prongs or catheter.
  • Definitive treatment of cause.

Management – Pharmacological

  • Start empirically on:
    • Crystalline penicillin + gentamicin + metronidazole IV. Oral metronidazole can be started as soon as patient is able to swallow.
    • Specific antibiotics depend on source of infection and C&S results.
  • Ensure that the facilities and skills for intensive care management are available.