Paediatric Acute care Guidelines PMH Emergency Department

Medication

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Resuscitation Fluid

Reason Fluid Volume /Rate

To restore circulatory volume, if shocked:

Tachycardia
Capillary refill > 2 secs (centrally)
Hypotension

Crystalline (1st line):
0.9% saline

Colloid: 
Haemaccel or 4% Albumin

Packed red blood cells

20mL/kg boluses (< 3 mths 10mL/kg)

Reassess and repeat until no longer shocked

In blood loss, aim to start giving boluses of packed RBC after 40mL/kg of crystalloid

To be administered as fast as possible

 

Maintenance Fluids

Reason Fluid Volume / Rate

Maintain hydration by replacing:

Normal losses (kidneys, GIT)
Insensible lossses (lungs, skin)

Choice according to age:

Neonate = 10% dextrose 

Child = 0.9% NaCl + 5% dextrose

Only add potassium (KCl) when passed urine:
2-6mmols/kg/24 hrs

Max dose: 0.5mmols/kg/hr

Never bolus fluids containing KCl (add to maintenance fluid bag)

(2mmol/kg/24 hours is equivalent to 10 mmol KCl in 500ml running at maintenance rate)

The volume is weight related:

< 10kg = 100mL/kg/24hrs

10-20kg = 1000mL + (50mL for each kg over 10kg) per 24hrs

> 20kg = 1500mL + (20mL for each kg over 20kg) per 24hrs

 

Deficit Replacement Fluids

Reason Fluid Volume Rate

Restore hydration by replacing fluids already lost

e.g. gastroenteritis, burns

Depends on clinical condition:

Vomiting/diarrhoea – 0.9% saline + 5% dextrose

Burns:  see ED Guideline 
Burns – Fluids

Pyloric Stenosis:  see ED Guideline Pyloric Stenosis

Deficit = Weight x % dehydrated x 10

To calculate the percentage dehydrated see ED Fluid Calculator

If normonatraemic rehydrate over 24 hours

If hypernatraemic or hyperosmolar rehydrate over 48 hours

Calculate the total fluid amount for 24 hrs  =  Maintenance fluid + Deficit fluid 
Hourly rate = total amount / 24 (ml/hr)

Also see the ED Fluid Calculator where you can enter the child’s weight and estimated percentage dehydration and print out all the appropriate calculations.

For fluids in Diabetic Ketoacidosis, see ED DKA Fluid Calculator.

Special

Any decision to stop IV therapy, (e.g. when transferring a patient to a ward area or undergoing a procedure such as X-ray etc) must be authorised by a Senior Nurse or Doctor.

If a patient is receiving IV hydration for a period greater than 24 hours, monitoring of electrolytes is recommended.

 

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References

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