Intravenous fluids in children

Seek expert advice.

Is the preferred method of treatment in severe dehydration.

• children who can drink, even poorly, should be given ORS solution by mouth until the IV drip is running.

Use intravenous fluid therapy for clinical dehydration if:

• shock is suspected or confirmed
• a child with red flag symptoms or signs shows clinical evidence of deterioration despite oral rehydration therapy
• a child persistently vomits the ORS solution, given orally or via a nasogastric tube.

Suspected or confirmed shock should be treated with a rapid intravenous infusion of 20 ml/kg of 0.9% sodium chloride solution.

• if the child is still in shock
  • immediately give another rapid intravenous infusion of 20 ml/kg of 0.9% sodium chloride solution and
  • consider possible causes of shock other than dehydration
  • consider consulting a paediatric intensive care specialist if a child remains shocked after the second rapid intravenous infusion

Once symptoms and/or signs of shock resolve after rapid intravenous infusions, start rehydration with intravenous fluid therapy

• if the child is not hypernatraemic at presentation
  • use an isotonic solution such as 0.9% sodium chloride, or 0.9% sodium chloride with 5% glucose, for fluid deficit replacement and maintenance
  • for those who required initial rapid intravenous fluid boluses for suspected or confirmed shock, add 100 ml/kg for fluid deficit replacement to maintenance fluid requirements, and monitor the clinical response
  • for those who were not shocked at presentation, add 50 ml/kg for fluid deficit replacement to maintenance fluid requirements, and monitor the clinical response
  • measure plasma sodium, potassium, urea, creatinine and glucose at the outset, monitor regularly, and alter the fluid composition or rate of administration if necessary
  • consider providing intravenous potassium supplementation once the plasma potassium level is known
• if the child presents with hypernatraemic dehydration
  • obtain urgent expert advice on fluid management
  • use an isotonic solution such as 0.9% sodium chloride, or 0.9% sodium chloride with 5% glucose, for fluid deficit replacement and maintenance
  • replace the fluid deficit slowly – typically over 48 hours
  • monitor the plasma sodium frequently, aiming to reduce it at a rate of less than 0.5 mmol/l per hour

Switch from intravenous hydration to oral rehydration solution once hydration is improved and the patient can drink.

Reference:

• (1) National Institute for Health and Clinical Excellence (NICE) 2009. Diarrhoea and vomiting in children. Diarrhoea and vomiting caused by gastroenteritis: diagnosis, assessment and management in children younger than 5 years