Fluids with too much sugar (ex, fruit juice) can lead to greater osmotic load in the intestinal lumen, producing more diarrhea.Use an acceptable Oral Rehydration Solution to help maintain hydration.For every episode of diarrhea, replete 10ml/kg.For every episode of emesis, replete 2ml/kg.While, it is difficult to truly measure the amount of emesis or diarrhea, most recommend the following:.Fox and others have told us and parents can help to prevent dehydration by starting oral fluid rehydration as soon as the pediatric patent starts vomitting ( Diarrhea and Dehydration): Managing children that are either not dehydrated or clinically shocked is (mathematically!) less complex.Īnd remember that any child in compensated or uncompensated shock requires an immediate finger stick blood sugar as does any pediatric patient who just looks “mildly unwell.”īut remember that a child can be mildly dehydrated with a normal physical exam as Dr. In summary, NICE’s guidelines for the dehydrated child can easily be followed by offering these specified volumes of fluid every 10 minutes during the first 4-hour period, without the need to resort to complex calculations.
Clinically shocked children require rapid intravenous fluid resuscitation (20ml/kg of 0.9% Sodium Chloride) and urgent hospital transfer. (Appendix 1 details worked calculations). These figures (combining both replacement fluid and maintenance fluid calculations in a single figure) could be used to give parents specific, practical rehydration advice, with the aim of encouraging successful oral rehydration and decreasing paediatric inpatient admissions.
In making these calculations, the clinician requires not only a knowledge of the child’s weight but also an appreciation of the formulas used in paediatric practice to calculate a child’s daily maintenance fluid requirements.
Maintenance fluid calculator peds plus#
NICE recommend giving 50 ml/kg of oral rehydration salt solutions (ORS) over 4 hours to replace their fluid losses plus an additional volume of ORS to provide the maintenance fluids required by that child during that 4-hour period of time. For clinically dehydrated children, additional fluids are required to not just maintain their normal body water but also to replace their fluid losses. Returning now to the “NICE Solution” article (Resource below): Patients with mild ( <4%) dehydration have no clinical signs.
Pediatric Dehydration Guideline (Resource below) reminds us that:Ĭlinical signs of dehydration give only an approximation of the deficit. For those children that are not clinically dehydrated, NICE actively encourage oral drinks. This process can however be greatly simplified by the application of a simple, clinical observation described below for the management of the dehydrated child… Reviewing the fluid strategies for each of these three groups (summarised below), it is clear that calculating the fluid volumes required to rehydrate the dehydrated child is the most complex and as a result, these calculations may prove less accessible in routine clinical practice. those that are clinically shocked (1),(2). those that are not clinically dehydrated, The recently published NICE guideline for the management of gastroenteritis identifies three distinct clinical groups of children: The “NICE solution” article (above) is a wonderful practical review of oral rehydration therapy for pediatric dehydration (and because these posts are just my study notes – I have included most of the brief article): Here is a link to the excellent article A “NICE solution” to orally rehydrate the dehydrated child aged under 5-years by Dr.
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