This document discusses guidelines for intravenous fluid management for shock in pediatric patients from Dr. Udai Bhan Yadav of the General Hospital in Alwar, Rajasthan. It provides recommendations on administering IV fluids like Ringer's Lactate or normal saline for shock at doses of 20ml/kg. For severe malnutrition, IV fluids should be given at 15ml/kg over 1 hour. Guidelines are also given for IV glucose administration depending on age and weight to treat low blood sugar. Charts provide volumes of IV fluids and glucose solutions to administer based on patient age and weight.

1. Dr Udai Bhan Yadav MBBS.DMCH
Senior Medical Officer
General Hospital Alwar Rajasthan.
Dr Udai Bhan Yadav General Hospital Alwar
rajasthan1
PAEDIATRICS.
FLUID MANAGEMENT

2. Iv fluid for shock
Dr Udai Bhan Yadav General Hospital Alwar
rajasthan2
 If child is not severely malnourished
 Insert an intravenous line
 Draw blood for emergency laloratory investigations
 Attach ringers lactate or normal saline
 Make sure the infusion is running well.
 Infuse 20ml /kg as rapidly as possible.
 Reassess child after appropriate volume has run in.if no
improvement seen.up to third infusion can be given of
each 20mg/kg as rapid as possible.
 Reassess after third infusion if no improvement ,give blood
20mg/kg over 30 minutes.
 Reassess after fourth infusion if no improvement see
treatment guide lines.After improvement at any stage pulse
slows faster capillary refill.

3. Iv fluid for shock chart
Dr Udai Bhan Yadav General Hospital Alwar
rajasthan3
Age weight Volume of RL/NS
20ML/KG
2 MONTHS <4 KG 75 ml
2 <4 MONTHS 4-<6kg 100ml
4 <12 MONTHS 6-<10kg 150ml
1 ,<3 YEARS 10-<14kg 250ml
3 <5 YEARS 14-<19kg 350ml

4. Iv fluid for shock in a child with
severe malnutrition.
Dr Udai Bhan Yadav General Hospital Alwar
rajasthan4
 Insert an iv line ,draw blood for emergency laboratory investigations.
 Weight the child or estimate the weight to calculate the volume of fluid to
be given
 Give iv fluid 15 ml/kg over 1 hour.use RL with 5% glucose, or half
normal saline with5%glucse,or half strength Darrow”s sol with
5%glucose or if these are unavailable Ringer”s lactate.
 Measure the pulse and breathing rate at start and every 5-10 minutes if
there is sign of improvement pulse and breathing rate falls then
 Give repeate iv 15ml/kg over 1 hours.
 Switch to oral or nasogastric rehydration with 10ml/kg/hour.initiate re
feeding with starter F-75
 If child fail to improve after first15ml/kg iv,assume child has septic
shock.Give maintenance iv fluid 4ml/kg/hr.with waiting for
blood.transfuse fresh whole blood at 10ml/kg slowly over 3hours.use
packed cells if cardiac failure.Initiate refeeding with starterF75.
 If child deteriorates during rehydration breathing increase
by5breath/min.or pulse 25beat/min stop infusion.it worsen the condition.

5. Iv fluid for shock in a child with
severe malnutrition. chart
Dr Udai Bhan Yadav General Hospital Alwar
rajasthan5
Weight Volume iv fluid Weight Volume iv fluid
Give over 1 hour
15 ml/kg
Give over 1 hour
15 ml/kg
4kg 60ml 12kg 180ml
6kg 90ml 14kg 210ml
8kg 120ml 16kg 240ml
10kg 150ml 18kg 270ml

6. Iv glucose
Dr Udai Bhan Yadav General Hospital Alwar
rajasthan6
 Insert iv line and draw blood for emergency laboratory
investigations.
 Check blood glucose if low <2.5mmol/litre(45mg/dl) in
a well nourished or <3mmol/litre (55mg/dlin aseverly
malnourished child.
 Give 5ml/kg of 10%glucose sol rapidly by iv
injection.rechek blood glucose in30 minutes.if it is low
repeate 5ml/kg of 10%glucose solution.
 Feed child as soon as concious.
 If not able to feed without danger of aspiration give iv
containing 5-10%glucose or milk or sugar sol via
nasogastric tube ,to make sugar sol dissolve 4 level
tsf of sugar(20gm) in 200ml of clean water

7. Iv glucose chart
Dr Udai Bhan Yadav General Hospital Alwar
rajasthan7
Age Weight Volume of 10%
glucose solution to
give as bolus 5ml/kg
Less than 2 months <4kg 15ml
2-<4 months 4<6 kg 25ml
4-<12months 6<10kg 40ml
1-<3years 10<14kg 60ml
3-<5 years 14<19kg 80ml

8. Iv fluid in severe dehydration
Dr Udai Bhan Yadav General Hospital Alwar
rajasthan8
 Give 70ml/kg of Ringers lactate sol.or if not available
normal saline over 5 hours in infants age,12 months and
over2-30 hours in children age 12months to 5 years
 Reassess child every 1-2hr .if the hydration status is not
improving ,give iv drip more rapidly.
 Also give ORS sol about 5ml/kg/hr as soon as child can
drink. This is usually after 3-4hr in infants or 1-2hr in
childrens.
 Reassess after 6hr to infants and after 3hrs to
childrens,classify dehydration.then choose appropriate
diarrhoea treatment plan A,B or C.
 If possible observe child for at least 6hr after rehydration to
be sure that mother can maintain hydration by giving child
ORS sol by mouth.

9. Dr Udai Bhan Yadav General Hospital Alwar
rajasthan9
Weight AGE <12MONTHS
GIVE OVER 5 HOURS
AGE 12 MONTHS TO5
YEARS GIVE OVER
2HOUR AND 30
MINUTES
<4kg 200ML(40ML/HR)
4<6kg 350ML(70ML/HR)
6<10kg 550ML(110ML/HR) 550ML(220ML/HR)
10<14KG 850ML(170ML/HR) 850ML(340ML/HR)
14<19KG 1200ML(240ML/HR) 1200ML(480ML/HR)

10. Dose of ORS powder
Dr Udai Bhan Yadav General Hospital Alwar
rajasthan10
WEIGHT VOLUME ORS SOLUTION PER
HOURS
<4kg 15ml
4<6kg 25ml
6<10kg 40ml
10<14kg 60ml
14<19kg 80ml

11. Thank you
Dr Udai Bhan Yadav General Hospital Alwar
rajasthan11