How to give intravenous fluids to a child in shock with severe malnutrition
Give
this treatment only if the child has signs of shock (usually there will
also be a reduced level of consciousness, i.e. lethargy or loss of
consciousness):
- Insert an IV line (and draw blood for emergency laboratory investigations).
- Weigh the child (or estimate the weight) to calculate the volume of fluid to be given.
- Give IV fluid at 15 ml/kg over 1 h. Use one of the following solutions according to availability:
– Ringer’s lactate with 5% glucose (dextrose);
– Half-strength Darrow’s solution with 5% glucose (dextrose); – 0.45% NaCl plus 5% glucose (dextrose).
4 kg 60 ml
6 kg 90 ml
8 kg 120 ml
10 kg 150 ml
12 kg 180 ml
14 kg 210 ml
16 kg 240 ml
18 kg 270 ml
If there are signs of improvement (pulse rate falls, pulse volume increases or respiratory rate falls) and no evidence of pulmonary edema
– repeat IV infusion at 15 ml/kg over 1 h; then
– switch to oral or nasogastric re hydration with ReSoMal at 10 ml/kg/hour up to 10 h;
– initiate re-feeding with starter F-75 (see p. 209).
If the child fails to improve after two IV boluses of 15 ml/kg,
– give maintenance IV fluid (4 ml/kg per h) while waiting for blood;
– when blood is available, transfuse fresh whole blood at 10 ml/kg slowly over 3 h (use packed cells if the child is in cardiac failure); then
– initiate re-feeding with starter F-75 ;
– start IV antibiotic treatment.
If the child deteriorates during IV re hydration (breathing rate increases by 5/min and pulse rate increases by 15/min, liver enlarges, fine crackles throughout lung fields, jugular venous pressure increases, galloping heart rhythm develops), stop the infusion, because IV fluid can worsen the child’s condition by inducing pulmonary edema.
