Clinical gems Emergency On the Wards Paediatrics

Paediatric Fluids – not as difficult as you thought

This post is courtesy of review by Dr Mohan Swaminathan and Dr Dyanne Wilson. Dr Swaminathan is a Paediatrician and Neonatologist, and Dr Wilson is a Paediatrician and Paediatric Endocrinologist, both working in Tropical North Queensland.

The most recent IV fluid guide lines were published by the Lady Cilento Children’s Hospital at the end of 2015. Due to ongoing concerns that children in some centres may be being administered excessive amounts of hypotonic intravenous fluids, these guidelines have been circulated state wide. We include a link to the entire guideline here.  Intravenous Fluid Guidelines – Paediatric and Neonatal.

The important take home points are very simple, so don’t let the complexity of the guidelines bamboozle you.

You need to know:

Resuscitation of children is performed with normal saline. Initial bolus is 10 to 20ml/kg. Always notify your senior staff if you are going to do this.

Maintenance of children is performed with normal saline with 5% glucose.

Hypotonic fluids such as 4% glucose 1/5 NS, 3% glucose 1/3 NS, and 5% glucose should only be charted under the direction of a consultant.

There are separate guidelines for children with DKA. Resuscitation of children with DKA will always be done in consultation with a paediatrician. The fluid guideline document links to the statewide DKA guidelines.

Always attempt to place an intravenous cannula as peripherally as possible – try to avoid the cubital fossa if you can.

Consider whether fluids can be replaced orally or via a nasogastric tube to avoid having to place a cannula.

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