Simple method to calculate IV FLUIDS in children

How to give intravenous fluids to a child in shock without severe malnutrition   

1. Check that the child is not severely malnourished, as the fl uid volume and rate are different. (Shock with severe malnutrition,)  
2. Insert an IV line (and draw blood for emergency laboratory investigations).  
3. Attach Ringer’s lactate or normal saline; make sure the infusion is running well.  
4. Infuse 20 ml/kg as rapidly as possible.

Age (weight) and  Volume of Ringer’s lactate or normal saline solution (20 ml/kg)

• 2 months (< 4 kg) 50 ml 
•  2–< 4 months (4–< 6 kg) 100 ml
• 4–< 12 months (6–< 10 kg) 150 ml 
• 1–< 3 years (10–< 14 kg) 250 ml 
• 3–< 5 years (14–19 kg) 350 ml

Reassess the child after the appropriate volume has run in. 
Reassess after fi rst infusion: 
• If no improvement, repeat 10–20 ml/kg as rapidly as possible. • If bleeding, give blood at 20 ml/kg over 30 min, and observe closely.

Reassess after second infusion: 
• If no improvement with signs of dehydration (as in profuse diarrhoea or cholera), repeat 20 ml/kg of Ringer’s lactate or normal saline. 
• If no improvement, with suspected septic shock, repeat 20 ml/kg and consider adrenaline or dopamine if available. 
• If no improvement, see disease-specific treatment guidelines. You should have established a provisional diagnosis by now. 

After improvement at any stage (pulse volume increases, heart rate slows, blood pressure increases by 10% or normalizes, faster capillary refi ll < 2 s)