Pediatrics Book

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Pediatric Isotonic Dehydration

Aka: Pediatric Isotonic Dehydration, Isotonic Dehydration Management in Children
  1. See Also
    1. Pediatric Dehydration Management
  2. Definitions:
    1. Pediatric Isotonic Dehydration
      1. Serum Sodium: 130 - 150
  3. Protocol: Example Case
    1. Weight: 35 kg Child
    2. Dehydration: 10%
    3. Serum Sodium: 140 (Normal)
  4. Protocol: Stabilization with Bolus Fluids (Phase I)
    1. See Pediatric Dehydration Management
    2. Give 20 ml/kg Normal Saline or Lactated Ringers over 10-15 minutes
    3. May repeat bolus until circulation stable
      1. May require up to 60 ml/kg within the first 1-2 hours
  5. Protocol: Calculate Maintenance Fluid Requirements
    1. Approach as per Pediatric Dehydration Management
    2. See Maintenance Fluid Requirements in Children
    3. Hourly = 75 cc/hour for 35 kg child
      1. First 10 kg: (4 cc/kg/hour x 10 kg)
      2. Next 10 kg: (2 cc/kg/hour x 10 kg)
      3. Remaining 15 kg: (1 cc/kg/hour x 15 kg)
    4. Daily: 1800 cc/day
  6. Protocol: Calculate Remaining Deficit to be Replaced
    1. See Pediatric Dehydration Management
    2. Estimate level of dehydration
      1. Mild Dehydration (3%) = 30 ml/kg
      2. Severe Dehydration (12%) = 120 ml/kg
    3. Subtract Phase 1 Resuscitation already replaced
    4. Calculation
      1. Phase 1: 20 ml/kg/bolus x 35 kg x 1 bolus = 700 ml
      2. Deficit (10%): 100 ml/kg x 35 kg = 3500 ml
      3. Remaining Deficit: 3500 ml - 700 ml = 2800 ml
  7. Protocol: Divide 2800 cc Remaining Deficit over 24 hours
    1. First 8 hours: 75 ml/h + 1400 ml/8h = 250 ml/hour
    2. Next 16 hours: 75 ml/h + 1400 ml/16h = 163 ml/hour
  8. Protocol: Saline guide (Rough)
    1. Precautions
      1. Exercise caution with hypotonic solutions (Hyponatremia)
      2. Consider D5 NS as maintenance fluid instead of D5 1/2NS
      3. McNab (2015) Lancet [PubMed]
    2. Weight <28 kg: D5 1/2NS (prior recommendation D5 1/4NS)
    3. Weight >28 kg: D5 NS
  9. Protocol: Summary - 35 kg Child with isotonic dehydration
    1. Initial Bolus: 700 ml (20 ml/kg)
    2. First 8 hours: D5 NS with 20 KCl at 250 ml/hour
    3. Next 16 hours: D5 NS with 20 KCl at 163 ml/hour
  10. Resources
    1. Vega and Bhimji (2017) Pediatric Dehydration in Stat Pearls
      1. https://www.ncbi.nlm.nih.gov/books/NBK436022/
  11. References
    1. Walton (2020) Crit Dec Emerg Med 34(6): 3-9
    2. Canavan (2009) Am Fam Physician 80(7):692-6 [PubMed]

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