Pediatrics Book

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Pediatric Dehydration Management

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  1. See Also
    1. Pediatric Dehydration
  2. Replace Phase 1 Acute Resuscitation
    1. Give LR OR NS at 10-20 ml/kg IV over 30-60 minutes
    2. May repeat bolus until circulation stable
  3. Calculate 24 hour maintenance requirements
    1. Formula
      1. First 10 kg: 4 cc/kg/hour (100 cc/kg/24 hours)
      2. Second 10 kg: 2 cc/kg/hour (50 cc/kg/24 hours)
      3. Remainder: 1 cc/kg/hour (20 cc/kg/24 hours)
    2. Example: 35 Kilogram Child
      1. Hourly: 40 cc/h + 20 cc/h + 15 cc/h = 75 cc/hour
      2. Daily: 1000 cc + 500 cc + 300 cc = 1800 cc/day
  4. Calculate Deficit (See Pediatric Dehydration)
    1. Mild Dehydration: 4% deficit (40 ml/kg)
    2. Moderate Dehydration: 8% deficit (80 ml/kg)
    3. Severe Dehydration: 12% deficit (120 ml/kg)
  5. Calculate remaining deficit
    1. Subtract fluid resucitation given in Phase 1
  6. Calculate Replacement over 24 hours
    1. First 8 hours: 50% Deficit + Maintenance
    2. Next 16 hours: 50% Deficit + Maintenance
  7. Determine Serum Sodium Concentration
    1. Pediatric Hypertonic Dehydration (Serum Sodium > 150)
    2. Pediatric Isotonic Dehydration
    3. Pediatric Hypotonic Dehydration (Serum Sodium < 130)
  8. Add Potassium to Intravenous Fluids after patient voids
    1. Potassium source
      1. Potassium Chloride
      2. Potassium Acetate for Metabolic Acidosis
    2. Potassium dosing
      1. Weight <10 kilograms: 10 meq/liter KCl
      2. Weight >10 Kilograms: 20 meq/liter KCl

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