Fluid Management in Dehydrated Children
Overview
Fluid therapy in children must be weight‑based and guided by clinical assessment of dehydration and the severity/etiology of illness. Priorities, in order, are: resuscitate shock, replace fluid deficit, then provide ongoing maintenance and replace ongoing losses.
Safe practice requires the appropriate fluid type, correct volumes/rates, and active monitoring. National UK guidance (NICE NG29 for IV fluids; NICE CG84 for gastroenteritis/ORS) and paediatric life‑support recommendations should inform local protocols.
Assessment and the role of weight
- Record current weight (kg) on drug and fluid charts and, if available, pre‑illness weight.
- Use weight as the most reliable objective measure of fluid change over time.
- If pre‑illness weight is unavailable, estimate dehydration severity from general appearance, capillary refill, heart rate, skin turgor, mucous membranes, urine output and conscious level.
- Always calculate fluid prescriptions from the child’s current weight and document the basis for any deficit estimate.
Estimating dehydration and calculating deficit
- Use clinically estimated percentage dehydration to plan initial replacement when pre‑illness weight is unknown.
- Approximate conversions:
- ≈5% dehydration → deficit ≈ 50 ml/kg.
- ≈10% dehydration → deficit ≈ 100 ml/kg.
- These are approximations for initial planning; adjust totals according to ongoing assessment and monitoring.