This document compares fluid therapy approaches for two types of shock: gastroenteritis (GE) shock and dengue shock syndrome (DSS). For GE shock, caused by secretory diarrhea leading to extracellular fluid loss, the treatment is fluid loading followed by oral rehydration over 24 hours. For DSS, caused by plasma leakage and third spacing of fluid, loading fluids is followed by careful replacement of fluid losses at specific hourly rates to avoid overloading while still reversing shock. Making the critical decision between overload and bleeding is important, as it can save the patient's life. Both conditions require narrow therapeutic indices and appropriate type, rate, duration and volume of fluid administration.

1. Fluid Therapy
in
GE Shock Vs. DSS
Dr. Aung Kyi Wynn
Senior Paediatrician

2. Hypovolemic shock
Different pathology
Different management

3. 5 years old child
Body weight 15 kg

4. GE SHOCK OR
CHOLERA SHOCK

5. Secretory diarrhoea
External fluid loss
From extravascular space
10% of body weight loss S/S of
shock

6. Fluid loading dose
R/L or N/S or D/S
25% glucose or 5% D/S (for
hypoglycemia)

7. 20 ml/kg within 15 min
Second Loading dose if not improved

8. RMO/ 24 hour
Rehydration, Maintenance, Ongoing
loss
Pre-illness = measured + 10% of BW
BW BW
( 15 kg = 13.5 kg + 10% of BW)

10. Rehydration
10% loss – 100 ml/kg
100 ml * 15 kg = 1500 ml
30 ml/kg in first ½ hr (450 ml)
70 ml/kg in 2 ½ hr (1050 ml)
Without loading dose

11. Maintenance
Holliday-Segar Method (15kg = 10 + 5
)
1st 10 kg 100ml/kg
1000ml
2nd 10 - 20 kg 50ml/kg
250ml
Over 20 kg 20ml/kg _
1250

12. Ongoing loss
From intake-output chart
10ml/kg (150 ml) for 1 time of loose
motion

13. Total RMO
Rehydration 1500 ml
Maintenance 1250 ml
2750 ml
Ongoing loss ?

14. Total 6 bottles of drip / 24 hr
Wide therapeutic index
Low risk for overloading

15. DSS

16. Immune reaction
Increase vascular permeability
Plasma leakage (from vascular space)
Third space loss (serous cavity)

17. Loss in 4-6% of body weight – S/S of
shock
If coagulation defect +
GI bleeding
External loss

18. Only overload and bleeding
Death

19. Loading dose (20ml/kg)
R/L or N/S
Colloid gelofusin or Plasma 10ml/kg/hr

20. Replacement
4% loss 5% loss 6 % loss
40 ml/kg 50 ml/kg 60 ml/kg
600 ml 750 ml 900 ml
Rate 10 or 6 or 3 or 1- 2 ml/kg/hr

21. Maintenance
Same 1250ml

22. Ongoing loss
1. Plasma leakage
2. Bleeding fresh blood 10ml/kg

23. 1. Replacement 4% loss 5% loss 6% loss
Crystalloid (or) 600 ml 750 ml 900 ml
Colloid
2. Maintenance
Crystalloid 1250 ml 1250 ml 1250 ml
3. Ongoing loss
Crystalloid (or) ? ? ?
Fresh whole blood ? ? ?
1850 ml 2000 ml 2150 ml

24. 1 ½ of maintenance
1250 * 1 ½ = 1875

25. Shock not revived when close to 24 hr
or 1850ml
Decrease PCV 20% suddenly
Fresh whole blood

26. Raised Hb G% = FWB ml/kg /6 = 10/6 =1.6
If raised PCV >5% wrong
decision

27. CRITICAL POINT DECISION
(OVERLOAD or BLEEDING)
CAN SAVE LIFE

28. Narrow therapeutic index
Type of fluid, rate, duration,
appropriate volume, timely

29. Fluid Therapy in Cholera shock Vs.
DSS

30. References
Handbook for clinical management of
dengue –WHO 2012
The Harriet Lane Handbook – the Johns
Hopkins Hospital 2000
Paediatric Management Guideline –
Myanmar Paediatric Society – 2nd edition
- 2011
Paediatric Protocols for Malaysian
hospitals – Malaysian Paediatric
Association – 2nd edition – 2010