What are the treatment options for severe volume depletion in pediatric dehydration?

Updated: Nov 12, 2018
  • Author: Alex Koyfman, MD; Chief Editor: Muhammad Waseem, MS, MBBS, FAAP, FACEP, FAHA  more...
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Answer

Patients with severe volume depletion should receive intravenous isotonic fluid boluses (20-60 mL/kg). [5] In children with difficult peripheral access, perform intraosseous or central access promptly. Fluid boluses should be repeated until vital signs, perfusion, and capillary refill have normalized.

If a patient reaches 60-80 mL/kg in isotonic crystalloid boluses and is not significantly improved, consider other causes of shock (eg, sepsis, hemorrhage, cardiac disease). In addition, consider administering vasopressors and instituting advanced monitoring, such as a bladder catheter, central venous pressure, and measuring mixed venous oxygen saturation.

Although physicians typically give normal saline for these initial boluses, it is important to remember to check a bedside glucose level for patients who appear lethargic or altered. Treat hypoglycemia promptly. The appropriate dose is 0.25 g/kg IV (2.5 mL/kg of 10% dextrose or 1 mL/kg of 25% dextrose) with reassessment of glucose level after administration of dextrose.


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