Pediatric Dehydration Management

1. See Also
   1. Pediatric Dehydration
   2. Oral Rehydration Therapy Protocol in Pediatric Dehydration
2. Indications
   1. Severe Pediatric Dehydration
3. Labs
   1. Serum electrolytes
      1. Obtain in all cases of severe dehydration
      2. Correct serious electrolyte abnormalities prior to starting phase 2 (maintenance replacement)
   2. Serum Glucose
      1. Monitor in infants and toddlers with Diarrhea
4. Management: Adjuncts
   1. Consider a single dose of Zofran to aid transition to Oral Rehydration Therapy
5. Management: Initial Replacement (Phase 1 Acute Resuscitation)
   1. Give 20 ml/kg normal saline or lactated ringers over 10-15 minutes
   2. May repeat bolus until circulation stable
      1. May require up to 60 ml/kg within the first hour
      2. Stabilization criteria include
         1. Normal Heart Rate
         2. Capillary Refill <2 seconds
         3. Intact mental status
         4. Adequate urine output
   3. After fluid boluses until circulation stable
      1. Administer 100 ml/kg of fluid
         1. Option 1: Oral Rehydration Solution
            1. See Oral Rehydration Therapy Protocol in Pediatric Dehydration
         2. Option 2: Intravenous normal saline or lactated ringers
      2. Initiate maintenance fluids
         1. Option 1: Oral Rehydration Solution
            1. See Oral Rehydration Therapy Protocol in Pediatric Dehydration
         2. Option 2: Continue intravenous hydration as below
6. Management: Maintenance Replacement with IV fluids (Phase 2 Resuscitation)
   1. See Oral Rehydration Therapy Protocol in Pediatric Dehydration (mild to moderate dehydration)
      1. Start the oral rehydration protocol at the
   2. Calculate 24 hour maintenance requirements
      1. See Maintenance Fluid Requirements in Children (Holliday-Segar Formula)
   3. 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)
   4. Calculate remaining deficit
      1. Subtract fluid resucitation given in Phase 1
   5. Calculate Replacement over 24 hours
      1. First 8 hours: 50% Deficit + Maintenance
      2. Next 16 hours: 50% Deficit + Maintenance
   6. Determine Serum Sodium Concentration
      1. Pediatric Hypertonic Dehydration (Serum Sodium > 150)
      2. Pediatric Hypotonic Dehydration (Serum Sodium < 130)
      3. Pediatric Isotonic Dehydration
         1. Weight <28 kg: D5 1/4NS
         2. Weight >28 kg: D5 1/2NS
   7. 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
   8. Correct for ongoing losses
      1. Reassess intakes and outputs every 4 hours
         1. Adjust fluids to maintain adequate urine output and vital signs
      2. Replace stool outputs
         1. Indicated if stool >30/ml/kg/day
         2. Replace equal volume of stool losses with 1/2NS with 20 kcl (in addition to maintenance volume)
      3. Replace ongoing fever-related losses
         1. Replace 1 ml/kg/hour per degree increase above normal (in celcius)