Paediatric fluid management
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This document discusses guidelines for intravenous fluid management for shock in pediatric patients from Dr. Udai Bhan Yadav of the General Hospital in Alwar, Rajasthan. It provides recommendations on administering IV fluids like Ringer's Lactate or normal saline for shock at doses of 20ml/kg. For severe malnutrition, IV fluids should be given at 15ml/kg over 1 hour. Guidelines are also given for IV glucose administration depending on age and weight to treat low blood sugar. Charts provide volumes of IV fluids and glucose solutions to administer based on patient age and weight.
Paediatric fluid management
- 1. Dr Udai Bhan Yadav MBBS.DMCH Senior Medical Officer General Hospital Alwar Rajasthan. Dr Udai Bhan Yadav General Hospital Alwar rajasthan1 PAEDIATRICS. FLUID MANAGEMENT
- 2. Iv fluid for shock Dr Udai Bhan Yadav General Hospital Alwar rajasthan2 If child is not severely malnourished Insert an intravenous line Draw blood for emergency laloratory investigations Attach ringers lactate or normal saline Make sure the infusion is running well. Infuse 20ml /kg as rapidly as possible. Reassess child after appropriate volume has run in.if no improvement seen.up to third infusion can be given of each 20mg/kg as rapid as possible. Reassess after third infusion if no improvement ,give blood 20mg/kg over 30 minutes. Reassess after fourth infusion if no improvement see treatment guide lines.After improvement at any stage pulse slows faster capillary refill.
- 3. Iv fluid for shock chart Dr Udai Bhan Yadav General Hospital Alwar rajasthan3 Age weight Volume of RL/NS 20ML/KG 2 MONTHS <4 KG 75 ml 2 <4 MONTHS 4-<6kg 100ml 4 <12 MONTHS 6-<10kg 150ml 1 ,<3 YEARS 10-<14kg 250ml 3 <5 YEARS 14-<19kg 350ml
- 4. Iv fluid for shock in a child with severe malnutrition. Dr Udai Bhan Yadav General Hospital Alwar rajasthan4 Insert an iv line ,draw blood for emergency laboratory investigations. Weight the child or estimate the weight to calculate the volume of fluid to be given Give iv fluid 15 ml/kg over 1 hour.use RL with 5% glucose, or half normal saline with5%glucse,or half strength Darrow”s sol with 5%glucose or if these are unavailable Ringer”s lactate. Measure the pulse and breathing rate at start and every 5-10 minutes if there is sign of improvement pulse and breathing rate falls then Give repeate iv 15ml/kg over 1 hours. Switch to oral or nasogastric rehydration with 10ml/kg/hour.initiate re feeding with starter F-75 If child fail to improve after first15ml/kg iv,assume child has septic shock.Give maintenance iv fluid 4ml/kg/hr.with waiting for blood.transfuse fresh whole blood at 10ml/kg slowly over 3hours.use packed cells if cardiac failure.Initiate refeeding with starterF75. If child deteriorates during rehydration breathing increase by5breath/min.or pulse 25beat/min stop infusion.it worsen the condition.
- 5. Iv fluid for shock in a child with severe malnutrition. chart Dr Udai Bhan Yadav General Hospital Alwar rajasthan5 Weight Volume iv fluid Weight Volume iv fluid Give over 1 hour 15 ml/kg Give over 1 hour 15 ml/kg 4kg 60ml 12kg 180ml 6kg 90ml 14kg 210ml 8kg 120ml 16kg 240ml 10kg 150ml 18kg 270ml
- 6. Iv glucose Dr Udai Bhan Yadav General Hospital Alwar rajasthan6 Insert iv line and draw blood for emergency laboratory investigations. Check blood glucose if low <2.5mmol/litre(45mg/dl) in a well nourished or <3mmol/litre (55mg/dlin aseverly malnourished child. Give 5ml/kg of 10%glucose sol rapidly by iv injection.rechek blood glucose in30 minutes.if it is low repeate 5ml/kg of 10%glucose solution. Feed child as soon as concious. If not able to feed without danger of aspiration give iv containing 5-10%glucose or milk or sugar sol via nasogastric tube ,to make sugar sol dissolve 4 level tsf of sugar(20gm) in 200ml of clean water
- 7. Iv glucose chart Dr Udai Bhan Yadav General Hospital Alwar rajasthan7 Age Weight Volume of 10% glucose solution to give as bolus 5ml/kg Less than 2 months <4kg 15ml 2-<4 months 4<6 kg 25ml 4-<12months 6<10kg 40ml 1-<3years 10<14kg 60ml 3-<5 years 14<19kg 80ml
- 8. Iv fluid in severe dehydration Dr Udai Bhan Yadav General Hospital Alwar rajasthan8 Give 70ml/kg of Ringers lactate sol.or if not available normal saline over 5 hours in infants age,12 months and over2-30 hours in children age 12months to 5 years Reassess child every 1-2hr .if the hydration status is not improving ,give iv drip more rapidly. Also give ORS sol about 5ml/kg/hr as soon as child can drink. This is usually after 3-4hr in infants or 1-2hr in childrens. Reassess after 6hr to infants and after 3hrs to childrens,classify dehydration.then choose appropriate diarrhoea treatment plan A,B or C. If possible observe child for at least 6hr after rehydration to be sure that mother can maintain hydration by giving child ORS sol by mouth.
- 9. Dr Udai Bhan Yadav General Hospital Alwar rajasthan9 Weight AGE <12MONTHS GIVE OVER 5 HOURS AGE 12 MONTHS TO5 YEARS GIVE OVER 2HOUR AND 30 MINUTES <4kg 200ML(40ML/HR) 4<6kg 350ML(70ML/HR) 6<10kg 550ML(110ML/HR) 550ML(220ML/HR) 10<14KG 850ML(170ML/HR) 850ML(340ML/HR) 14<19KG 1200ML(240ML/HR) 1200ML(480ML/HR)
- 10. Dose of ORS powder Dr Udai Bhan Yadav General Hospital Alwar rajasthan10 WEIGHT VOLUME ORS SOLUTION PER HOURS <4kg 15ml 4<6kg 25ml 6<10kg 40ml 10<14kg 60ml 14<19kg 80ml
- 11. Thank you Dr Udai Bhan Yadav General Hospital Alwar rajasthan11