In this section
This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network
Guideline on Neonatal Fluid RequirementsChecklist of commonly used fluidsDehydrationHyponatraemia GuidelineHypernatraemia Guideline
BackgroundUnwell children (+/- abnormal hydration)MonitoringSpecial fluidsNotify Paediatric Team when:Consider transfer when:Information specific to RCH patientsCalculating Maintenance FluidsNotes
How much Fluid?
If required, administer an initial bolus(es) of fluid to correct intravascular depletion then:
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
Maintenance plusDeficit (dehydration guidelines), plusOngoing losses (dehydration guidelines)
Remember that the maintenance fluid volume will need to be adjusted in ALL unwell children.
In non-dehydrated children, consider using 2/3 maintenance in unwell children, especially those with pneumonia or meningitis. For fluid options in the dehydrated child see dehydration guidelines.
REMEMBER to consider deficit and ongoing losses - especially in severe gastroenteritis, if there are drain losses, ileostomies etc.
Which Fluid?DO NOT use 0.18% NaCl with 4% glucose with KCl 20mmol/L (or 4% and 1/5 NS, or 5% and ¼ NS) in unwell children.
Three good fluid solutions for sick children include:
Premade solutions with potassium chloride 20mmol/L are available and should be used unless the serum potassium is elevated, there is anuria or renal failure.
*The most appropriate NaCl concentration is currently subject to research at RCH in the PIMS study.
Outside the newborn period, do not use these fluids apart from exceptional circumstances and check the serum sodium regularly
10% DextroseUsed in neonates (sometimes with additional NaCl). Used in ICU for patients under 12 months (with 0.45% saline). Sometimes used by infusion in neonates and children with metabolic disorders. Check blood glucose regularly.
15-20% DextroseVery occasionally used by infusion in children with metabolic disorders. Check blood glucose regularly.
25% and 50% DextroseRarely required in children, misuse can cause severe adverse events. Only used in discussion with senior staff as bolus or low volume infusions (1-2 ml/hr) to correct refractory hypoglycaemia.
- Unsure of which fluid/how much fluid to use- Electrolyte abnormalities- Using a non-standard 'special' fluid
- Children requiring care above the level of comfort of the local hospital.- Severe electrolyte or glucose abnormalities
For advice and inter-hospital (including ICU level) transfers ring the Sick Child Hotline: (03) 9345 7007
Information Specific to RCHChildren on intravenous fluids need daily electrolyte monitoring.
MOST UNWELL CHILDREN SHOULD NOT BE GIVEN UNADJUSTED MAINTENANCE - BUT IT IS THE BASIS FROM WHICH OUR CALCULATIONS ARE MADE.
100mls/hour (2400mls/day) is the normal maximum amount.
There is often confusion about the difference between oral and IV fluid requirements for young infants. The water requirement is identical for both routes of administration. The relatively low energy density of milk means that infants need 150-200mls/kg/day to obtain adequate nutrition. That is why they pass more dilute urine than older children.