Intravenous fluid therapy

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full PCH Emergency Department disclaimer.

Aim

To guide staff in the use of intravenous fluid therapy in children.

Resuscitation Fluid

Reason Fluid Volume / rate

To restore circulatory volume, if shocked:

- Tachycardia
- Capillary refill >2 seconds (centrally)
- Hypotension

Crystalloid (1st line):0.9% saline

Packed red blood cells 
10-20mL/kg boluses repeat if required

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: Choice according to age:
  
The volume is weight related

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

Neonate = 10% dextrose
Child = 0.9% NaCl + 5% dextrose

Only add potassium (KCl) when passing urine: 2-6mmols/kg/24hrs
Max dose: 0.5mmols/kg/hr

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

(2mmol/kg/24hrs is equivalent to 10mmol KCl in 500mL running at maintenance rate)
<10kg = 100mL/kg/24 hours

10-20kg =1000mL +(50mL for each kg over 10kg)/ 24 hours

>20kg=1500mL+(20mL for each kg over 20kg)/ 24 hours

Deficit replacement fluids

Reason Fluid Volume / rate
Restore hydration by replacing fluids already lost:
Depends on clinical condition: Deficit = weight x % dehydrated x 10
e.g. gastroenteritis, burns

Vomiting/diarrhoea - 0.9% NaCl + 5% dextrose

Burns Fluids guideline

Pyloric Stenosis
Fluid calculator

If normonatraemic rehydrate over 24 hours

If hypernatraemic or hyperosmolar rehydrate over 48 hours

Calculate the total fluid amount for 24hrs = maintenance fluid + deficit fluid.

Hourly rate = total amount/24 (mL/hr).

You can enter the child’s weight and estimated percentage dehydration into the Fluid Calculator and print out all the appropriate calculations.

For fluids in diabetic ketoacidosisDKA 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.

Bibliography

  1. AMH Children’s Dosing Companion (2015) Australian Medicines Handbook Pty Ltd
  2. Textbook of Pediatric Emergency Medicine. 6th ed. Fleisher GR, Ludwig S. Philadelphia: Lippincott Williams & Wilkins, 2010.
  3. Textbook of Paediatric Emergency Medicine 2nd Edition Cameron Elesevier 2012
  4. Robert M. Kliegman, Bonita M.D. Stanton, Joseph St. Geme, Nina F Schor Nelson Textbook of Pediatrics: 20th Edition Publisher: Elsevier 

Endorsed by:  Director, Emergency Department   Date:  Mar 2018


 Review date:   Mar 2021


This document can be made available in alternative formats on request for a person with a disability.