In this section
Guideline on Neonatal Fluid Requirements
Guideline on intravenous fluid requirements
Checklist of commonly used fluids
Maintenance Fluid Calculator
Dehydration can occur with many childhood illnesses. When assessing dehydration it is important to consider:
Degree of dehydration (deficit)
Maintenance fluid requirements
NOTE: If a child is haemodynamically unstable (ie shock)
the shock needs to be corrected
Give boluses of 10-20ml/kg of normal (0.9%) saline, which may be repeated.
Do not include this fluid volume in any subsequent calculations of hydration
RED FLAGS: Children with the
following require Senior Medical Assessment
ASSESSMENT: DEGREE OF DEHYDRATION
Assess on clinical signs and documented recent loss of weight (NB: Bare weight on same scales is most accurate). Weigh bare child and compare with any recent (within 2 weeks) weight recordings. Precise calculation of water deficit due to dehydration using
clinical signs is usually inaccurate. The best method relies on the difference between the current body weight and the immediate pre-morbid weight. Unfortunately this is often not available.
Clinical signs of dehydration give only an approximation of the deficit.
Patients with mild (
<4%) dehydration have no clinical signs. They may have increased thirst.
Other 'signs of dehydration' (such as sunken eyes, lethargy & dry mucous membranes) may be considered in the assessment of dehydration, although their significance has not been validated in studies, and they are less reliable than the signs
Unless an accurate & recent loss of weight is available as a guide, calculating percentage weight loss by clinical signs is only an estimation.
DeficitA child's water deficit in mls can be calculated following an estimation of the degree of dehydration expressed as % of body weight. (e.g. a 10kg child who is 5% dehydrated has a water deficit of 500mls). The deficit is replaced over a time period that varies
according to the child's condition. Precise calculations (eg 4.5%) are not necessary. The rate of rehydration should be adjusted with ongoing assessment of the child.
Replacement of Deficit
Replacement may be rapid in most cases of
gastroenteritis (best achieved by oral or nasogastric fluids), but should be slower in diabetic ketoacidosis and
meningitis, and much slower in states of
hypernatraemia (aim to rehydrate over 48 hours, the serum sodium should not fall by >1mmol/litre/hour).
Ongoing losses (eg from drains, ileostomy, profuse
diarrhoea)These are best measured and replaced - calculations may be based on each previous hour, or each 4 hour period depending on the situation. (eg. 200ml loss over previous 4 hours becomes replacement of 50ml/hr for the next 4 hours.)
Replacement of Ongoing lossesNormal (0.9%) saline may be sufficient, or 5% albumin may be used if sufficient protein is being lost to lower the serum albumin. See
Burns guideline for additional losses from burns.