BP: blood pressure; D10LR: lactated Ringer's with 10% dextrose; D5LR: lactated Ringer's with 5% dextrose; IV: intravenous; LR: lactated Ringer's; ORT: oral rehydration solution; RBC: red blood cells; ReSoMal: rehydration solution for malnutrition.
* Closely monitor for signs of fluid overload (eg, every 5 to 15 minutes) during fluid therapy including:¶ Signs of clinical improvement include improved mental status, perfusion (decreased capillary refill time), and vital signs (ie, reduction in tachycardia or, for patients with hypotension, increased BP).
Δ If LR or other balanced crystalloid solution is unavailable for rapid fluid infusion, use normal saline. If D5LR or D10LR are unavailable for maintenance fluids, use D5NS or D10NS.
◊ Fluid volume and rate varies based on presence or absence of severe acute malnutrition. Refer to UpToDate content on shock in children managed in resource-limited settings and fluid management in children in resource-limited settings with severe dehydration (the WHO plan C).
§ The IV should be placed in the largest peripheral vein possible. Epinephrine (adrenaline) for continuous infusion should be diluted to a standard concentration, eg, 10 to 40 mcg/mL (not exceeding 64 mcg/mL) and administered using an IV pump. The starting dose of epinephrine is 0.02 to 0.05 mcg/kg per minute. Titrate up to 1 mcg/kg per minute as needed. If epinephrine is unavailable, norepinephrine is an acceptable alternative.
¥ For calculation of maintenance and replacement fluids, refer to UpToDate content on maintenance fluids in children and approach to the child with diarrhea in resource-limited settings.
‡ For details of oral rehydration, refer to separate UpToDate topics on oral rehydration therapy and management of diarrhea in resource-limited settings.Do you want to add Medilib to your home screen?