In this section
Hypernatraemia Neonatal Intravenous Fluid
How much Fluid?
If required, administer an initial bolus(es) of fluid to correct intravascular depletion then:
Give boluses of 10-20ml/kg of 0.9% sodium chloride (normal saline), which may be repeated.
Do not include this fluid volume in any subsequent calculations
Maintenance plusDeficit (dehydration guidelines), plus
Ongoing losses (dehydration guidelines)
This guideline should be used as a starting point and will need to be adjusted in ALL unwell children.
Generally 2/3 of maintenance rate should be used in unwell children unless they are dehydrated. This is because they are likely to be secreting anti-diuretic hormone (ADH), so will need less fluid. Children with meningitis or other acute CNS conditions will likely require additional fluid restriction – seek senior
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.
Some good fluid solutions for sick children include:
Plasma-Lyte148 and 5% Glucose
Replacement of deficit
Replacement of losses
Plasma-Lyte148 and 5% Glucose with 20mmol/L potassium
(15mmol/L of KCl will need to be added to a standard bag to bring the concentration to 20mmol/L)
Maintenance hydration - should only be used for children
Replacement of losses
Consider whether potassium is
required in the fluid. This should be
avoided, if possible, unless premade fluid bags containing potassium are
available. Adding potassium to bags of
fluid on the ward is a safety risk.
Hypotonic fluid (containing a sodium concentration less than plasma) is no longer recommended in children. These fluids have been associated with morbidity/mortality secondary to hyponatraemia. Fluids that should NOT be given include:
0.18% NaCl with 4% glucose +/- KCl 20mmol/L (or 4% and 1/5 NS) should NOT be given
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.
Children with severe electrolyte or glucose abnormalities.
Children requiring care above the level of comfort of the local hospital.For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.
Information Specific to RCH
0.45% sodium chloride and 5% glucose +/- KCl (or 5% and ½ NS) should NOT be given.
Children on intravenous fluids need daily electrolyte monitoring.
20-50% dextrose should not be given outside the ICU or NNU setting without discussion with a consultant.
100mls/hour (2400mls/day) is the normal maximum amount.
Note: 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.