Paediatric Fluid Resuscitation

Question 1

What fluid would you use to resuscitate a sick/hypovolaemic child? How much?

Answer 1

• Normal saline
• 10mL/kg boluses

Question 2

What are the maintenance fluid guidelines for children?

Answer 2

• Remember that sick children need less fluid than well ones as they are secreting ADH
• RCH guidelines recommend P148 fluid stratified by weight. Check these
• Traditional
  
  • 4/2/1 rule
    
    • 4 ml/kg/hr for 0-10kg
    • 2 ml/kg/hr for 10-20kg
    • 1 ml/kg/hr for 20+ kg
    • Max of 100mL/hr

Question 3

What is the most common problem with fluid resuscitation in children?

Answer 3

• Hyponatraemia
  
  • Can result from ADH release due to stress response and fluid retention
  • Can result from natriuresis due to volume loading and ANP release
• Encephalopathy
  
  • Can occur at Na below 120 mmol/L

Question 4

What is the best way to clinically assess dehydration in a child? What signs might you use?

Answer 4

• Best - weight comparison within 2/52
• Mild (< 4%): may have no signs but increased thirst
• Moderate (4-6%): CRT > 2 secs, tachypnoea, mild decreased tissue turgor
• Severe (> 6%): CRT > 3 secs or mottling, other signs of shock, deep acidotic breathing, decreased tissue turgor