This document discusses the management of shock in both non-malnourished and malnourished children. For non-malnourished children, the steps include resuscitating, giving oxygen, checking for hypoglycemia, administering IV fluids, blood transfusion if needed, and specific treatments depending on the type of shock. For malnourished children, the initial steps are the same but IV fluids are limited to a maximum of 30mL/kg total to avoid overhydration, and blood transfusion may be used if sepsis is suspected instead of dehydration. Close monitoring of vitals is important, and feeding should begin once the child is stabilized.

1. PAEDIATRICS AND CHILD HEALTH
• Paediatrics and Child Health
• Management of Shock In:
- No Malnutrition
- Malnutrition
Dr. Chongo Shapi (BSc.HB, MBChB, CUZ)
- Medical Doctor.
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2. SHOCK IN THE NON-MALNOURISHED
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3. Steps
1. Resuscitate: ABCs
2. Give Oxygen 2-3L/min by nasal tubes (remember
shock means reduced O2 delivery to meet the
metabolic demands of the body)
3. Check RBS and give bolus 5mL/Kg IV glucose of
10% dextrose if hypoglycaemic
4. Give IVFs: bolus of 20mL/kg of 0.9% NS over 30
min
- Reassess the patient’s vitals (BP/CRT, PR, RR, UO)
after the 30-60 min
5. If no response, repeat the 20mL/Kg bolus of NS
over 30-60 minutes and reassess after the 30-60 min
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4. Steps
5. If no response, again repeat the final 20mL/Kg bolus of NS over 30-60
minutes and reassess after the 30-60 minutes. You can ONLY repeat the IVF
bolus up to a maximum of 60 mL/Kg. Otherwise, you will overload the
patient
6. If no response with the IVFs, give hourly maintenance 0.9% NS (know
formula) while awaiting BT
• Commence BT at 20mL/Kg over 3 hours
- Monitor vitals (BP/CRT, PR, RR, UO)
- Check for any signs of BT reaction e.g. fever, itchy rash, dark red urine,
confusion, shock etc
- If reaction present, stop BT and give adrenaline to prevent anaphylactic
shock and give steroids to reduce the inflammation
7. Give:
a. Antibiotics if septic shock
b. Inotropes if cardiogenic shock
c. Vasopressors if distributive shock
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5. Vasopressors
Adrenergic Receptors:
α – subtype-1: vascular smooth muscle
 Increase SVR, afterload
β – Myocardium, bronchial smooth muscle
& vessels
 β -1: increase HR & contractility
 β -2: bronchodilation, peripheral vasodilation
Dopaminergic – renal, coronary, cerebral
beds
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6. Summary of inotropes
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7. Maintenance Fluid
Infusion rate = [total fluid volume/day]/24 hrs
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8. SHOCK IN THE MALNOURISHED
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Dr. Chongo Shapi, BSc.HB, MBChB, CUZ.
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9. SHOCK IN THE MALNOURISHED
• Shock from dehydration and sepsis are likely to
coexist in severely malnourished children
• They are difficult to differentiate on clinical signs
alone
• Children with dehydration will respond to IV fluids
• Those with septic shock and no dehydration will
not respond
• The amount of fluid given is determined by the
child’s response
• Overhydration must be avoided
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10. To Start Treatment
1. Resuscitate: ABCs
2. Give Oxygen 2-3L/min by nasal tubes
3. Check RBS and give bolus of 10% glucose (5 ml/kg) IV.
If you don’t have the glucose sticks, assume every
malnourished child has hypoglycaemia
4. Give infusion of IVFs at 15 ml/kg over 1 hour. Use:
a. ½ SD with 5% dextrose
b. ½ NS with 5% dextrose
c. RL with 5% dextrose
d. If these are unavailable, RL (without dextrose)
Monitor vitals (BP/CRT, PR, RR, UO) every 10 min
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11. 5. If no response, repeat IV 15 ml/kg over 1 hour. You can
ONLY give a maximum of 2 attempts in malnourished
children (total of 30mL/kg)
6. Give antibiotics (a must)
• If there are signs of improvement (e.g. fall of PR/RR),
it means that the patient had dehydration:
1. Then switch to oral or nasogastric rehydration with
ReSoMal WHEN PATIENT IS OUT OF SHOCK:
a. In the first 2 hours, give 5 ml/kg every 30 min
b. In the next 4-10 hours, give 5-10mL/Kg alternating
every hour with starter F-75
c. Enter patient in stabilization phase with starter F-75
2-3 hourly (including night time)
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12. • If the child fails to improve after giving 2 infusions of IVFs at
15 mL/Kg, assume that the child has septic shock
• In this case:
a. Give maintenance fluid at 4mL/kg/hr while waiting for
blood
b. When blood is available transfuse fresh whole blood at 10
mL/kg slowly over 3 hours
- Monitor vitals (BP/CRT, PR, RR, UO)
- Check for any signs of BT reaction e.g. fever, itchy rash, dark
red urine, confusion, shock etc
- If reaction present, stop BT and give adrenaline to prevent
anaphylactic shock and give steroids to reduce the
inflammation
c. Then begin feeding with starter F-75
d. Make sure antibiotics were given
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13. • If the child gets worse during treatment, stop
the infusion to prevent the child’s condition
worsening
a. RR increases by ≥ 5/min
b. PR increases by ≥ 25/min
c. Rise in JVP
d. Increasing oedema e.g. puffy eyelids
These indicate, child in CCF
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14. The End!
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